SEAMLESS TRANSITION: IMPROVING VA/DOD 

COLLABORATION 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

( 

MAY 18, 2011 

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SEAMLESS TRANSITION: IMPROVING VA/DOD 

COLLABORATION 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

MAY 18, 2011 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

PATTY MURRAY, Washington, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

DANIEL K. AKAKA, Hawaii 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

RICHARD BURR, North Carolina, Ranking 

Member 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

SCOTT P. BROWN, Massachusetts 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

KIM LIPSKY, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

MAY 18, 2011 

SENATORS 

Page 

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

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 4 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 5 

Isakson, Hon. Johnny, U.S. Senator from Georgia ............................................... 6 

Johanns, Hon. Mike, U.S. Senator from Nebraska ............................................... 6 

Boozman, Hon. John, U.S. Senator from Arkansas .............................................. 7 

Brown, Hon. Scott P., U.S. Senator from Massachusetts ..................................... 377 

Begich, Hon. Mark, U.S. Senator from Alaska ..................................................... 379 

WITNESSES 

Gould, Hon. W. Scott, Deputy Secretary of U.S. Department of Veterans 

Affairs .................................................................................................................... 8 

Prepared statement .......................................................................................... 10 

Response to prehearing questions submitted by Hon. Patty Murray .......... 22 

Response to posthearing questions submitted by Hon. Patty Murray ......... 23 

Lynn, Hon. William J., III, Deputy Secretary, U.S. Department of Defense ..... 29 

Prepared statement .......................................................................................... 30 

Response to prehearing questions submitted by Hon. Patty Murray .......... 34 

Response to posthearing questions submitted by Hon. Patty Murray ......... 366 

(1) 

SEAMLESS TRANSITION: IMPROVING VA/DOD 

COLLABORATION 

WEDNESDAY, MAY 18, 2011 

U.S. SENATE, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 10:03 a.m., in room 

418, Russell Senate Office Building, Hon. Patty Murray, Chairman 

of the Committee, presiding. 

Present: Senators Murray, Tester, Begich, Burr, Isakson, 

Johanns, Brown of Massachusetts, and Boozman. 

OPENING STATEMENT OF HON. PATTY MURRAY, CHAIRMAN, 

U.S. SENATOR FROM WASHINGTON 

Chairman MURRAY. This hearing will come to order. Welcome to 

everyone who is here today. We are here today to examine the ongoing efforts of the Department of Defense and the Department of 

Veterans Affairs to provide a truly seamless transition for our servicemembers and our veterans. 

It has been more than 4 years since the world learned about the 

shameful conditions and bureaucratic red tape confronting our 

wounded, ill, and injured servicemembers that were recovering at 

the Walter Reed Army Medical Center. 

We have learned and done a lot in that time, and over the past 

decade that we have been at war. We have also learned much from 

what our new veterans have told us. Next week, we will hear from 

some of them about their experiences when we hold a followup to 

this hearing. 

Yet, despite all that has been learned and all that has been done 

to address these shortfalls over the last several years and despite 

the significant improvements in cooperation between Department 

of Defense and VA, substantial challenges remain. 

One of the primary areas that requires further improvements is 

the coordination of medical care for the injured. As you both know, 

prescribing narcotics is on the rise in the military. A military doctor stationed at Madigan Army Medical Center, in my homestate 

of Washington, recently cited an Army Surgeon General number 

that almost 14 percent of soldiers have been prescribed some form 

of opiate drug, with a full third of them being prescribed more than 

one opiate. 

It is imperative that those individuals receive a truly seamless 

handoff to VA medical care so a provider there can manage those 

medications after the individual has left the service. If that link is 

2 

not made, those new veterans become far more likely to abuse 

drugs, become homeless, or commit suicide. 

A key tool in this effort should be the post-deployment health assessment. However, I hear frequently from veterans that no one 

has followed up on the results of their screenings, they did not get 

referred to VA care nor did VA reach out to them, and there was 

no followup to ensure they received the care they needed. This 

process must be improved. 

Care for those who have been traumatically injured is another 

key priority. While the Department of Defense has outstanding 

prosthetic care, VA needs to do a lot better. I was shocked to hear 

of a veteran who, after receiving advanced prosthetics from the 

military, went to VA to have them adjusted and maintained. However, when the veteran got to the prosthetic clinic the VA employees were fascinated by his device, having never seen that model before, and were more interested, he said, in examining it than him. 

With the rates of injuries requiring amputation rising, we need 

to have the best possible care. As of early March 2011, 409 Operation Enduring Freedom servicemembers have needed limbs 

amputated. 

Not long ago, the idea that battlefield medicine could save the 

life of a quadruple amputee was unthinkable, but now it is the reality. VA is responsible for these veterans for the rest of their lives, 

and VA must be up to the task. 

After a decade of continuous conflict, I am concerned that the 

Nation is becoming desensitized to the physical and psychological 

wounds of war. While those watching on the nightly news may feel 

as though they have seen many such injuries, we can never forget 

how truly devastating some of these injuries are, and what an overwhelming impact they have on the servicemember or veteran’s life, 

as well as on their family. 

One tool to raise the quality of care in this area is the Center 

of Excellence on Amputations and Extremity Injuries, and establishing all of the centers of excellence that were required by law. 

Unfortunately, there has been very little progress in making 

these centers operational, with delays caused by what can only be 

characterized as bureaucratic infighting. I know that I speak for 

several Senators in saying we want these centers brought online, 

as the law requires, immediately. 

Mental health care is another area where we can improve collaboration. I note that the Departments have agreed on an integrated mental health strategy, and I look forward to the results of 

your continuing efforts to meet the guidelines of that strategy. This 

will be an important step toward making care more standardized 

and evidence-based, and will reduce duplication. 

Health care is not the only area that needs better collaboration. 

This Committee has previously looked at the Departments’ Joint 

Disability Evaluation System. While streamlining efforts where we 

can is important, the implementation of this joint program has not 

been without problems. Unfortunately, the numbers for this new 

process are trending in the wrong direction, and I would like to 

know what improvements DOD and VA hope to make in this 

regard. 

3 

This is particularly concerning because all too often this time 

spent waiting results in our men and women in uniform falling 

through the cracks of the system. You shared particularly troubling 

information about the number of wounded warriors who have 

taken their own lives or turned to drug abuse while waiting to complete the disability evaluation process. I look forward to actually 

asking you about this in the question and answer and comment period following your statement. 

Just last month this Committee held a hearing on employment 

and transition of new veterans. As a result of that hearing and numerous discussions with employers and veterans, I have introduced 

the Hiring Heroes Act, which will help streamline the hiring process for new veterans and equip them with the skills to successfully 

navigate the civilian employment market. 

That legislation will also require participation of all servicemembers in the Transition Assistance Program (TAP). I believe this will 

dramatically improve the experience of servicemembers who are 

transitioning out of the military and equip them with the skills 

needed to succeed in the civilian workforce. 

This will be especially true as VA, Labor, and the military services update and revise their portions of TAP. The revised program 

should be more relevant, user-friendly, and tailored to the needs of 

the individual servicemember. 

Underlying many of these issues are significant questions about 

IT solutions and how they affect health care and benefits. I am 

pleased to hear that Secretary Gates and Secretary Shinseki recently agreed to a plan that will deliver a common, integrated electronic health system. This level of communication and integration 

has the potential to revolutionize the way we deliver health care 

to servicemembers and veterans, and dramatically improve our current efforts. 

Deputy Secretary Lynn, I think you would call it a ‘‘force multiplier.’’ 

We all want to see this project accomplished correctly and on 

schedule, and we expect to see the same level of commitment to the 

development of a joint electronic health record under the leadership 

of the next Secretary of Defense as we have witnessed recently by 

Secretary Gates. 

As we assess the current state of DOD/VA collaboration, we must 

remember that the issues we confront today will not go away when 

the last troops leave Iraq and Afghanistan. Rather, they will be 

with us as a Nation for many years to come. When we send servicemembers into harm’s way, it is our non-negotiable duty to take 

care of them when they return home. Providing the best possible 

care and benefits to veterans is a cost of war. It is a cost that must 

be paid in full. 

So I want to thank both Deputy Secretaries for being here today. 

In your capacities as the co-chairmen of the Senior Oversight Committee, you are the individuals who can make these things happen, 

and we are counting on your leadership of your respective Departments. So, we look forward to hearing from both of you. 

I will now turn to Ranking Member Burr for his opening statement. 

4 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator BURR. Thank you, Madam Chairman, and to both Deputy Secretaries, welcome. I am pleased with the progress that is 

being made improving the lives of our Nation’s wounded warriors, 

their families, and as they transition from active duty to veterans’ 

status. I look forward to discussing how effectively the two Departments are working together and what more can be done. 

I want to apologize to both witnesses and to my colleagues. I just 

had an Honor Flight land about 40 minutes ago and shortly they 

are going to be at the World War II Memorial. Sometimes you do 

things out of a sense of urgency, so I will leave you and run down 

there to enjoy what may be their only viewing of the memorial 

built for their sacrifices. 

There has been a long history, going back to 1982, of DOD and 

VA sharing medical resources. However, only recently have the Departments attempted to collaborate on specific care programs for 

the Nation’s most severely wounded. 

Many of these programs began in response to recommendations 

from various commissions to address the 2007 media reports of 

poor conditions at Walter Reed. The idea for developing these 

‘‘joint’’ programs was to cut through the bureaucracy and create a 

better transition for both veterans and their families. 

It has been 4 years since the issues at Walter Reed came to light, 

and I cannot help but wonder if what we have done is to just create 

more bureaucracy. 

One area that was implemented at the suggestion of the DoleShalala Commission is the Federal Recovery Coordination Program. As this program was visualized, the government would hire 

Federal recovery coordinators to help veterans and their families 

navigate all of the benefits the servicemembers were entitled to 

throughout the entire Federal Government. 

Unfortunately, this is a perfect example of an idea that looked 

great on paper, but has yet to live up to expectations. A recent 

GAO report on the program shows that there are still problems 

with the two agencies working together. According to the report, 

there are problems coordinating the seven different services available through VA and DOD that support wounded servicemembers. 

For example, because both VA and DOD have care coordinators, 

there is a possibility for overlap in case management resulting in 

a duplication of efforts. 

Another problem is that one case file is not shared by both VA 

and DOD care coordinators. Because of this, GAO found a situation 

where a veteran with multiple amputations had one goal set by his 

FRC and the complete opposite goal set by his DOD recovery care 

coordinator. The FRC was instructing the veteran to transition out 

of the service and the RCC set a goal for that same veteran to remain on active duty. Surely, this is not the kind of service that 

Dole-Shalala envisioned. 

Another area that has been slow to move forward is integrating 

electronic health records. In April 2009, the President announced 

the development of an integrated electronic health record that will 

follow a veteran ‘‘from the day they first enlist until the day they 

are laid to rest.’’ However, 2 years later, the Departments only reVerDate Nov 24 2008 11:07 Oct 11, 2011 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 H:\ACTIVE\051811.TXT SVETS PsN: PAULIN
5 

cently identified a path forward which includes VA adopting DOD’s 

electronic health records system. While I am happy that this important venture is moving forward, I am disturbed it took 2 years 

to get to this point and wonder when, or if, this project will be 

completed. 

While the Departments have worked slowly on IT issues, they 

may have jumped the gun on the benefits side. Last year, DOD and 

VA started to roll out worldwide an integrated disability evaluation 

system or IDES. This was supposed to smooth the transition to civilian life by allowing injured servicemembers to find out what benefits they would get from each category before leaving the military. 

But there have been a range of challenges, including logistical 

issues, staffing shortages, inadequate IT solutions, and concerns 

about the quality-of-life for servicemembers going through the process. Also, goals set by VA and DOD for customer satisfaction are 

not being met and some facilities are struggling to meet timeliness 

goals. 

Nationwide, it is taking on average 394 days to complete the 

process, almost 100 days longer than the target; and at Camp 

Lejeune, it is taking on average 512 days. That is almost 11⁄2 years. 

These delays and the impact they are having on our wounded servicemembers are a serious concern. 

Overall, several years after instituting a coordinated effort to ensure we are taking care of our most severely wounded, ill, and injured servicemembers, issues still remain. All of this suggests that 

we need to take a serious look at whether these programs, as currently structured, are the best way to meet the needs of wounded 

servicemembers and their families. 

Madam Chairman, as we move forward, I certainly look forward 

to working with you to ensure that the two Departments work as 

a team to see that wounded our servicemembers get the care, the 

services, the benefits they earn and need without hassles and without delays. 

To our witnesses today, I commend you for the effort that both 

of you have made and encourage both the VA and the DOD to figure out what we need to move forward at a pace consistent with 

what I think we all share is in the best interest of these servicemen and women who we are here to serve. I thank the chair. 

Chairman MURRAY. Thank you very much, Senator Burr. 

I will turn it over to our Members for any opening statements 

if they wish to give them. We will begin with Senator Tester. 

STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

Senator TESTER. I will be very quick, Madam Chair. I appreciate 

your remarks and I appreciate your holding this hearing with the 

Ranking Member. 

I will just say thank you both for being here. This is critically 

important stuff. 

Whether you are talking about employment or medical records or 

mental health counseling—the list goes on and on—we have an obligation. And quite frankly, I have been on this Committee now 

starting my fifth year; and you have a Committee here that is willVerDate Nov 24 2008 11:07 Oct 11, 2011 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 H:\ACTIVE\051811.TXT SVETS PsN: PAULIN
6 

ing to work with both the Department of Defense and VA to make 

things better for our veterans. 

And, we have got a backlog, the VA has a huge backlog. I think 

the medical record issue is very, very important; and I think it falls 

on both the Department of Defense and VA to have a sense of urgency. Let us just put it that way. 

Then we are seeing the employment numbers or should I say unemployment numbers, coming out on our veterans which are catastrophic in my opinion. The people who serve this country come 

home, and they cannot get a job. 

So, the transition between DOD and VA needs some work, and 

I will just tell you both are quality individuals. I have worked with 

you before. You have some people around you who are very, very 

good. We have just got to get this fixed. I mean, we really do. 

Whatever we can do, and hopefully you have some suggestions on 

what maybe we can do as a Committee, what you need as individual agencies to move forward with the seamless transition in a 

way that makes sense in all areas because our veterans deserve no 

less. Thank you, Madam Chair. 

Chairman MURRAY. Thank you. 

Senator Isakson. 

STATEMENT OF HON. JOHNNY ISAKSON, 

U.S. SENATOR FROM GEORGIA 

Senator ISAKSON. Thank you, Madam Chairman. I will be brief 

too. In fact, I will apologize, first. I have to walk out for about a 

10-minute interview and I will be right back, because this is my 

number 1 issue on the Committee, as the Chairman knows. General Schumacher in Augustine, Georgia at Fort Gordon and the 

Charlie Norwood VA established the first seamless transition program for veterans leaving DOD and going into veterans health 

care. We have a lot of examples of the lives that were saved and 

the mental health improvement that soldiers have had from that, 

and I think we are going to hear some good news today on coordination and collaboration between DOD and Veterans Affairs. I appreciate both our Under Secretaries being willing to come and testify. If you all will pardon me, I will be back in 10 minutes to engage in questions and answers. 

Thank you, Madam Chairman. 

Chairman MURRAY. Thank you. 

Senator Johanns. 

STATEMENT OF HON. MIKE JOHANNS, 

U.S. SENATOR FROM NEBRASKA 

Senator JOHANNS. Madam Chair, thank you very much. 

Gentlemen, thank you so much for being here. 

The previous opening statements have really covered the bailiwick, if you will, so I do not have to say much. But there would 

be a couple of things that I would like to offer. 

One is, we all acknowledge that processing time is just dismal. 

You look at the number of days, and it is discouraging. It is for us; 

I know it must be for you. So, I look at that and I ask myself a 

couple of things. 

7 

One is as benchmarks are established to see if we are actually 

improving the system; how are we doing in meeting those benchmarks in a couple of areas? One area is just the mechanics of getting things done. Do we have the right IT system in place? How 

far along are we in deploying it? Is it working? Are people getting 

the training they need to deal with it? So, it is the platform sorts 

of issues. 

The second piece of it, though, is the human component. Are 

there offices that are just simply doing better and why are they 

doing better? If they have the same tools, the same resources, is 

it better leadership? Is it people that have received the training 

they need? Is it the fact that the positions that open up can be 

filled and so you do not have a problem there? 

For example, in the mental health area, I think part of the problem we are running into is we just do not have the evaluators to 

move the cases to get them done. I would like to hear your reaction 

to that statement as to whether you think that is an issue too. 

Again it just seems to me that if we could find some places where 

things are working—where cases are being processed, where the 

work is moving—and try to figure out what they are doing right 

there. It may unlock the door, if you will, to other areas of the 

country or other parts of the system that are not working as well. 

I agree with Senator Tester. You know, you are quality people 

with unbelievable backgrounds. You are here for a reason, and my 

attitude is as a Member of this Committee is I want to try to do 

everything I can to support your efforts to deal with this issue because at the end of the day if we can reduce the number of days 

for processing, we benefit people who have served. And that is 

huge. I mean, that is why all of us want to be on this Committee, 

to try to improve the lives of people who have served. 

With that I am anxious to hear your testimony and anxious to 

ask a few questions. Thank you. 

Chairman MURRAY. Thank you. 

Senator Boozman. 

STATEMENT OF HON. JOHN BOOZMAN, 

U.S. SENATOR FROM ARKANSAS 

Senator BOOZMAN. Thank you, Madam Chair. I appreciate your 

leadership and the Ranking Member’s in having the hearing. This 

is really very important. I too apologize. I am a Ranking Member 

on another Committee, and I am going to have to sneak out in a 

bit. 

But I do appreciate both of you. I know that you are working 

really hard to resolve this. Not only are you working hard, but I 

know that this is also important to Secretary Gates, and Secretary 

Shinseki, you know, who are working hard to get this resolved. 

We have got the problem not only of the problem with our 

wounded but also it makes it difficult for those in filling those slots 

when people are in limbo, and so that makes it difficult because we 

are running so lean and mean right now, you know, there are just 

lots of reasons that we need to get this done. 

So, we do appreciate your hard work. I know that I and the rest 

of the Committee are committed in a very bipartisan way to help 

you in any way that we can, whether we need additional legislation 

8 

or additional prodding or whatever in order to get this done. So, 

thank you very much. 

With that I yield back. 

Chairman MURRAY. Thank you. 

Today this Committee will hear from Deputy Secretary of Defense William Lynn, and from Deputy Secretary of Veterans Affairs, Scott Gould. Both deputy secretaries are co-chairman of the 

Senior Oversight Committee which is charged with supervising 

joint VA DOD initiatives. 

So, we appreciate both of you being here this morning and look 

forward to your testimony, and I will turn it over to you two to decide who will begin. 

STATEMENT OF THE HONORABLE W. SCOTT GOULD, DEPUTY 

SECRETARY OF U.S. DEPARTMENT OF VETERANS AFFAIRS 

Mr. GOULD. Chairman Murray, thank you, and good morning, 

Ranking Member Burr when he steps back in, and Members of this 

Senate Veterans’ Affairs Committee. 

I am honored to be here today with my partner Deputy Secretary 

Bill Lynn to discuss the issues that you mentioned, and frankly, 

the progress being made by VA and DOD to meet the needs of our 

returning and injured servicemembers, and to report on the wide 

range of collaborative efforts that are ongoing between our two Departments. 

I asked that my written statement be included in the record. 

Chairman MURRAY. Both of your statements will be included. 

Mr. GOULD. Thank you, ma’am. 

VA and DOD are committed to providing a comprehensive continuum of care and benefits that optimizes the health and well 

being of servicemembers, veterans, and their eligible beneficiaries. 

We have worked together closely for the past 2 years to ensure 

the smooth transition of servicemembers to veteran status. However, our Departments recognize that there is much more to do. 

I would like to thank Deputy Secretary Lynn and all the dedicated staff at the Department of Defense for their hard work and 

commitment to our team. 

The result of their work is a wide array of programs and initiatives aimed at improving this transition. The programs and initiatives address basically five areas of opportunity. 

Outreach efforts focused on informing and attracting more servicemembers to our benefits and services programs. Clients customer service initiatives designed to improve their experience in all 

facets of our health and benefits programs. Health care services designed to improve physical and mental health. Benefit services that 

assist with education, employment and/or compensation. Finally, 

the management infrastructure that supports the exchange of 

health and benefit information between the servicemember, the 

veteran, DOD, the VA, and frankly, the private sector. 

Collectively these initiatives are designed to make a complex 

array of benefits and services easier to access for the over 200,000 

servicemembers and demobilizing Guard and Reservists that transition from active duty each year. 

9 

Today I would like to highlight three VA/DOD collaborative initiatives that we are currently using to assist transitioning servicemembers. 

The first initiative is the DOD Yellow Ribbon program for mobilized members of the National Guard and Reserve. VA staff provides support at Yellow Ribbon events hosted by each of the services during the entire deployment cycle: beginning, middle, and 

end. 

In fiscal year 2010, there were over 2,000 of these events attended by over 600,000 servicemembers and their families. 

The second initiative changes the process through which wounded, ill, and injured servicemembers determine whether they will return to duty, medically retire, or leave the service with a VA disability. This new system is called the Integrated Disability Evaluation System or IDES. 

IDES is a better system for the servicemember and veteran than 

the legacy DES system. Medically separating servicemembers no 

longer experience a pay gap and now have only one medical exam 

with one proposed disability rating. 

IDES has also virtually eliminated the inconsistencies that often 

previously existed in disability ratings among the services and between the services and VA. A goal of IDES is to reduce the average 

processing time from 540 days, which it is today in the old system 

to 295 days while still respecting servicemember needs through the 

healing process. 

Unfortunately, IDES currently runs alongside the old DES system. There are approximately 14,000 servicemembers in the old 

system and only 13,000 in the new system. This means that two 

servicemembers with identical injuries may go through different 

processes with different levels of convenience and responsiveness. 

We are committed to eliminating this inequity by implementing 

IDES nationwide by the end of this fiscal year. 

Although the Departments have worked through many challenges to improve the IDES process, we are not fully satisfied, and 

we are working aggressively to address improvements. Secretary 

Gates and Secretary Shinseki are also personally involved in making additional process improvements to IDES. 

Third, I would like to address the major strides we have made 

in sharing health and benefits data between our two Departments. 

Our objective is to ensure that appropriate health, administrative, 

and benefits information is visible, accessible, and understandable 

to all appropriate users through secure and interoperable information technology. 

For the past several years, we have shared increasing amounts 

of health information. Our clinicians can now electronically access 

health information for almost 4,000,000 servicemembers and veterans at a rate of 96,000 views per week. 

Chairman Murray, I would like to invite you and all of the Committee Members to Washington’s VA medical center for a demonstration of our VA’s electronic health record to see how it interfaces with DOD health data, and I think you all will be impressed. 

Even though we already exchange data between DOD and VA, 

and 100 percent of servicemembers and veterans already have an 

electronic medical record, the systems are in need of modernizaVerDate Nov 24 2008 11:07 Oct 11, 2011 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6633 H:\ACTIVE\051811.TXT SVETS PsN: PAULIN
10 

tion. Recently the Secretaries formally agreed that our two Departments would work cooperatively toward a single joint common electronic health record. We call this effort the Integrated Electronic 

Health Record or IEHR. 

We are currently developing detailed plans to achieve this complex goal. But once completed, the IEHR will be a national model 

for capturing, storing, and the sharing of electronic health information. 

Last, as a measure of our collaborative efforts and the concerted 

outreach efforts we have taken to inform and to attract servicemembers and veterans to use the services and benefits they have 

earned, I would like to share with you the following statistics. 

As of January 2011 over 50 percent of separated OIF, OEF, OND 

veterans have sought VA health care. And, as of May 1 of this 

year, 504,000 students were enrolled in college under the new G.I. 

Bill. 

We believe these new statistics are a validation of our outreach 

efforts. I can assure you VA will not rest until all veterans receive 

the benefits and services for which they are eligible. We look forward to working with Congress and with this Committee to achieve 

that goal. 

Chairman Murray, Ranking Member Burr, this concludes my 

statement. Deputy Secretary Lynn and I look forward to your questions. 

[The prepared statement of Mr. Gould follows:] 

PREPARED STATEMENT OF HON. W. SCOTT GOULD, DEPUTY SECRETARY, 

U.S. DEPARTMENT OF VETERANS AFFAIRS

Chairman Murray, Ranking Member Burr, Members of the Senate Veterans’ Affairs Committee, I am pleased to be here today to discuss the progress being made 

by the Department of Veterans Affairs (VA) and the Department of Defense (DOD) 

toward meeting the needs of returning and injured Servicemembers and to report 

on the wide range of VA and DOD collaboration that is ongoing between our two 

Departments. Secretary Lynn and I have worked together for the past 2 years to 

confront the major challenges before us. Our goal is to ensure the Servicemembers’ 

transition between VA and DOD is as smooth as possible and honors the enormous 

commitment they have made to the country and we have made to them as Veterans. 

Our Departments understand that we are responsible for the same men and women 

at different times of their lives and that together our Departments can help improve 

their transition experience as they move from one stage to the next. Since VA last 

testified before this Committee on VA/DOD collaboration efforts in 2008 we have 

made significant progress improving the transition process from military to civilian 

life, as well as enhancing the collaboration that exists between VA and DOD. 

MAJOR INITIATIVES AND IMPROVEMENTS

The two Departments continue to drive toward providing a comprehensive continuum of care to optimize the health and well being of Servicemembers, Veterans, 

and their eligible beneficiaries. Our joint efforts to provide a ‘‘single system’’ experience of life-time services are supported by three common goals: 1) efficiencies of operations; 2) health care; and 3) benefits. The goal of efficiencies of operations describes the Department’s efforts to reduce duplication and increase cost savings 

through joint planning and resource sharing. Our health care goal is a patient-centered health care system that consistently delivers excellent quality, access, and 

value across the Departments. We also strive to anticipate and address Servicemember, Veteran, and family needs through an integrated approach to delivering 

comprehensive benefits and services. I will describe the significant VA/DOD collaborative initiatives and programs to achieve these goals. In addition, I will also highlight outreach activities that complement these efforts. 

VA and DOD collaboration is governed by two oversight bodies co-chaired at our 

level called: the Senior Oversight Committee (SOC) and the Joint Executive Council 

11 

(JEC). As you know, the SOC was created in May 2007 in response to issues raised 

at the Walter Reed Army Medical Center. Since its inception, the SOC has served 

as the single point of contact for oversight, strategy, and integration of wounded, 

ill, and injured (WII) policies by DOD and VA. These efforts are coordinated to improve Servicemember and Veteran support throughout their recovery, rehabilitation, 

and reintegration to the Armed Forces and/or civilian life. As the co-chairs of the 

SOC, Deputy Secretary Lynn and I work together to keep the momentum going on 

this important work. While the SOC primarily focuses on WII issues, some objectives and initiatives overlap with broader DOD personnel and readiness issues and 

are, therefore, monitored by the VA/DOD JEC that I co-chair with Under Secretary 

of Defense for Personnel and Readiness, Dr. Clifford Stanley. 

The JEC provides senior leadership for the more expansive issues of collaboration 

and resource sharing between VA and DOD. The JEC directs appropriate resources 

and expertise to specific operational areas through its sub-councils, the Health Executive Council (HEC) and the Benefits Executive Council (BEC), and the Interagency 

Program Office (IPO) and several Independent Working Groups (IWGs). The JEC 

is also responsible for the preparation of the VA/DOD Annual Report and the VA/ 

DOD Joint Strategic Plan (JSP) that is submitted to this Committee. 

The JSP is the primary document through which the Secretaries of the Departments convey the coordination and sharing efforts between the two Departments. 

The JSP allows VA and DOD to guide and track the progress of interagency collaborative efforts to improve on the delivery of comprehensive benefits, provide patientcentered health care, and deliver effective and efficient delivery of benefits and services. While the JSP is managed by the JEC, it is a multifaceted document that encompasses a wide range of VA/DOD initiatives, some of which are also monitored 

and tracked in the SOC. Specific SOC initiatives documented in the JSP include the 

Federal Recovery Coordination Program (FRCP), Integrated Disability Evaluation 

System (IDES), Integrated Mental Health Strategy (IMHS), Centers of Excellence, 

and eBenefits. Whereas the SOC focuses on the WII population, the JEC serves as 

the permanent oversight body for the broad VA/DOD issues affecting all Servicemembers and Veterans. 

Many initiatives originating in the SOC are now institutionalized and tracked in 

the JEC. For example, the SOC aggressively pursued the development of the IMHS 

to immediately address the growing mental health needs of the WII and their families. After the strategy was approved by the SOC in October, 2010 we transferred 

it to the HEC under the JEC for permanent oversight and implementation. Similarly, the issue of credentialing and privileging of providers was initially examined 

in the SOC and transferred to the HEC for permanent oversight and management. 

EFFICIENCIES OF OPERATIONS

VA and DOD continue to leverage opportunities to create efficiencies by improving 

resource and information sharing and enhancing the coordination of business 

practices through joint planning. Some of these joint initiatives include: data sharing; the Integrated Disability Evaluation System (IDES); the VA/DOD Federal Recovery Care Program (FRCP); and the James A. Lovell Federal Health Care Center 

(JALFHCC). 

Data Sharing Between the Departments of Defense and Veterans Affairs 

In the last 2 years, we have made major strides in sharing health and benefits 

data between our two Departments, and made significant progress toward our longterm goal of seamless data sharing systems. Our objective is to ensure that appropriate health, administrative, and benefits information is visible, accessible, and understandable through secure and interoperable information technology to all appropriate users. For the past several years, we have shared increasing amounts of 

health information to support clinicians involved in providing day-to-day health care 

for Veterans and Servicemembers. Our clinicians can now access health information 

for almost four million Veterans and Servicemembers between our health information systems. Veterans and Servicemembers are able to access increasing amounts 

of personal health information from home or work sites through our ‘‘Blue Button’’ 

technology, using VA and DOD secure Web sites. 

For the last 2 years, we have worked together on a Virtual Lifetime Electronic 

Record (VLER). This project takes a phased approach to sharing health and benefits 

data to a broader audience, including private health clinicians involved in Veteran/ 

Servicemember care, benefits adjudicators, family members, care coordinators, and 

other caregivers. We are in the first phase of this project, with five operational 

‘‘pilot’’ sites where we are sharing health information between VA, DOD, and private sector health providers. 

12 

More recently, Secretary Gates and Secretary Shinseki formally agreed that our 

two Departments would work cooperatively toward a common electronic health 

record. We call this effort the ‘‘integrated Electronic Health Record,’’ or iEHR. As 

I speak to you today, our functional and technical experts are meeting to develop 

and draft detailed plans on executing an overall concept of operations that the two 

Secretaries will utilize to determine the best approach to achieving this complex 

goal. Once completed, the iEHR will be a national model for capturing, storing, and 

sharing electronic health information. 

James A. Lovell Federal Health Care Center 

The James A. Lovell Federal Health Care Center (JALFHCC) demonstration 

project is the culmination of over 5 years of collaboration between VA and DOD. The 

JALFHCC combines the missions of the Naval Health Clinic (NHC) Great Lakes 

and the North Chicago VA Medical Center. The JALFHCC is the first clinically and 

administratively integrated facility of its kind in the Nation, highlighted by a single 

governance structure covering personnel, IM/IT and financial integration. The facility serves both VA and DOD beneficiaries as an integrated entity. The JALFHCC 

demonstration project held a dedication ceremony on October 1, 2010. 

Integrated Disability Evaluation System 

In early 2007, VA partnered with DOD to make changes to the DOD’s existing 

Disability Evaluation System (DES). A modified process called the VA/DOD DES 

Pilot Model was launched in November 2007, and was intended to simplify and increase the transparency of the DES process for the Servicemember while reducing 

the processing time and improving the consistency of ratings for those who are ultimately medically separated. VA/DOD implemented the pilot in response to the 

issues raised at the Walter Reed Army Medical Center concerning the DOD Disability process in February, 2007, and the subsequent findings of many commissions, studies and reports. The pilot addressed recommendations that could be implemented without legislative change. Authorization for the pilot was included in 

the National Defense Authorization Act 2008 and further energized our efforts for 

improving DOD’s DES. 

From the outset, the Departments recognized that the VA/DOD DES Pilot Model 

was preceded by an outdated DOD legacy process that was, in some cases, cumbersome and redundant. The DES Pilot Model was launched originally as a joint 

VA/DOD process at three operational sites in the National Capital Region (NCR) 

and was recognized as a significant improvement over the legacy process. As a result, and to extend the benefits of the Pilot Model to more Servicemembers, VA and 

DOD expanded the Pilot. The DES Pilot Model started in the fall of 2007 with the 

original three pilot sites in the NCR and ended in March 2010, covering 27 sites and 

47 percent of the DES population. In July 2010, the co-chairs of the SOC agreed to 

adopt the pilot process as the standard business practice, expand the pilot, and rename it the Integrated Disability Evaluation System (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 Servicemembers. VA and DOD are now working together to complete the final 50 percent 

of the system. As a result, in October, 2010 we started the transition from the existing legacy DES to IDES using the DES Pilot Model process. Currently there are 78 

IDES sites operational nationwide (which includes the original 27 Pilot Model sites) 

representing 74 percent of the population. When fully implemented in October 2011, 

there will be a total of 139 IDES sites. 

Through the implementation of IDES, the Departments have created a more 

transparent, consistent, and expeditious disability evaluation process for Servicemembers being medically retired or separated from military service and provide a 

more effective transition as they move from DOD to VA. We believe that through 

the implementation of the DES Pilot Model we have largely achieved that goal. In 

contrast to the DES legacy process, IDES provides a single disability examination 

and a single-source disability rating that both Departments use in executing their 

respective responsibilities. This results in more consistent evaluations, faster decisions, and timely benefits delivery for those medically retired or separated. IDES 

has enhanced all non-clinical care, administrative activities, case management, and 

counseling requirements associated with disability case processing. As a result, VA 

can deliver benefits in the shortest period allowed by law following discharge, thus 

eliminating the ‘‘pay gap’’ that previously existed under the legacy process, i.e., the 

lag time between a Servicemember separating from DOD due to disability and receiving his or her first VA disability payment. 

IDES has also eliminated much of the sequential and duplicative processes found 

in the legacy system. Since the beginning of the pilot, over 5,800 Servicemembers 

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have completely transitioned from referral into IDES to Veteran status. As of 

April 30, 2011 there were 13,762 active cases in the IDES process. Prior to the roll 

out of IDES, it took an average of 540 days for the VA and DOD processes to be 

completed. Now under IDES the goal is to complete the process within 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 (the 

shortest period allowed by law). 

Despite the overall reduction in combined processing time achieved to date, there 

remains room for significant improvement in IDES execution. VA and DOD recognized that as we expanded outside of the NCR, we did not have robust business 

processes in place to certify each site’s preparedness before it became operational. 

Through our analysis of lessons learned, we have developed Initial Operating Capability (IOC) readiness criteria that ensure that future sites are operationally ready 

for IDES. For a site to be deemed ready it must: 1) provide adequate exam coverage 

through either the Veterans Health Administration (VHA), Veterans Benefits Administration (VBA) contracted services, or DOD; 2) have sufficient space and equipment for VA and DOD personnel; 3) meet VA information technology requirements; 

and 4) have local staff who have completed IDES training. If any of these criteria 

are not met, then the site is not considered certified to implement IDES. 

VA and DOD have hosted three joint training/planning conferences to set the 

stage for the roll-out of IDES sites. The conferences have resulted in improved communications between VA and DOD at each site, individual site assessment analyses 

and evaluations, and development of joint local plans to meet IOC requirements. 

As the Departments continue to move forward, we are aware of the concerns and 

recommendations of the Government Accountability Office (GAO) in its December 2010 report entitled ‘‘Military and Veterans Disability System: Pilot has 

Achieved Some Goals but Further Planning and Monitoring Needed.’’ VA and DOD 

agreed with the GAO recommendations and we are currently acting on those recommendations. 

VA and DOD are committed to supporting our Nation’s wounded, ill, and injured 

warriors and Veterans through an improved IDES. We recognize the requirement 

to continually evaluate and improve the process, and are constantly working toward 

that end. 

Federal Recovery Coordination Program (FRCP) 

In October 2007, the SOC established FRCP as a VA-administered program with 

joint oversight by VA and DOD. It is designed to coordinate access to Federal, state, 

and local programs, benefits, and services for severely wounded, ill, and injured Servicemembers, Veterans, and their families. The SOC maintains oversight of the 

FRCP. The program was specifically charged with providing seamless support from 

the time a Servicemember arrived at the initial Medical Treatment Facility in the 

United States through the duration of care and rehabilitation. Services are now provided through recovery, rehabilitation, and reintegration into the community. Federal Recovery Coordinators (FRC) are Masters-prepared nurses and clinical social 

workers who provide for all aspects of care coordination, both clinical and non-clinical. FRCs are located at both VA and DOD facilities. 

FRCs work together with other programs designed to serve the wounded, ill, and 

injured population including clinical case managers and non-clinical care coordinators. FRCs are unique in that they provide their clients a single point of contact 

regardless of where they are located, where they receive their care, and regardless 

of whether they remain on Active Duty or transition to Veteran status. 

FRCs assist clients in the development of a Federal Individual Recovery Plan and 

ensure that resources are available, as appropriate, to assist clients in achieving 

stated goals. More than 1,300 clients have participated in the FRC program since 

its inception in 2008. Currently, FRCP has more than 700 active clients in various 

stages of recovery. There are currently 22 FRCs with an average caseload of 33 clients. A satisfaction survey conducted in 2010 reported that 80 percent of FRCP clients were satisfied or very satisfied with the program. 

National Resource Directory 

Also established by the SOC, the National Resource Directory (NRD) is a comprehensive, Web-based portal that provides Wounded Warriors, Servicemembers, 

Veterans, and their families with access to thousands of resources to support recovery, rehabilitation, and reintegration. NRD is a collaborative effort between the U.S. 

Departments of Defense, Labor, and Veterans Affairs and has more than 13,000 

Federal, state and local resources which are searchable by topic or location. NRD’s 

success has resulted in more than 3,000 visitors per day to the Web site. NRD is 

continuously improving and implementing enhancements to the Web site that were 

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identified by recent usability testing. In April 2011, the NRD launched a mobile 

version of the Web site. 

HEALTH CARE

VA and DOD are committed to working together to improve the access, quality, 

effectiveness, and efficiency of health care for Servicemembers, Veterans and their 

beneficiaries. Some of our cooperative efforts include the Integrated Mental Health 

Strategy (IMHS), suicide prevention programs, Polytrauma and Traumatic Brain Injury (TBI) care, Centers of Excellence, Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) Care Management/Coordinators, VA’s liaisons for health care, and joint efforts to address toxic exposures/environmental hazards. 

Integrated Mental Health Strategy 

The development of the IMHS was a major focus of the SOC in FY 2010 and was 

finally approved in October 2010. Oversight of the program was then transferred to 

the Health Executive Council (HEC) under the JEC and the implementation of the 

strategy was approved at the November 8, 2010 HEC. The IMHS was developed in 

order to address the growing population of Servicemembers and Veterans with mental health needs. Mental health care provides unique challenges for the two organizations with separate missions in that they serve the same population, but at different times in their lives and careers. As such, the IMHS centers on a coordinated 

public health model to improve the access, quality, effectiveness, and efficiency of 

mental health services. Recipients of these services include Active Duty Servicemembers, National Guard and Reserve Component members, Veterans, and their 

families. 

The IMHS derives from joint efforts in 2009 and 2010 between VA and DOD subject matter experts, which included the DOD/VA Mental Health Summit. The Strategy is defined by 28 Strategic Actions which fall under the following four strategic 

goals: 1) Expand access to behavioral health care in DOD and VA; 2) Ensure quality 

and continuity of care across the Departments for Servicemembers, Veterans, and 

their families; 3) Advance care through community partnership and education and 

reduce stigma through successful public communication and use of innovative technological approaches; and 4) Promote resilience and build better behavioral health 

care systems for tomorrow. 

This collaboration is providing unique opportunities to coordinate our mental 

health efforts across the two Departments, for the benefit of all of our Servicemembers and Veterans. 

Suicide Prevention/ Veterans Crisis Line 

The VA Suicide Prevention Program is based on the concept of ready access to 

high quality Mental Health Care and other services. The Suicide Prevention network of Suicide Prevention Coordinators and Care Managers is based at every Medical Center and at very large Community Based Clinics across the country and provides a wide array of services, tracking, monitoring, and outreach activities. All Suicide Prevention Program elements are shared with the DOD and a conference is 

held annually to encourage use of all strategies across both Departments including 

products and educational materials. One of the main mechanisms to access this enhanced level of care provided to our high risk patients is through the Veterans Crisis Line. The Crisis Line is located in Canandaigua, New York, and partners with 

the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Suicide Prevention Lifeline. All calls from Veterans, Servicemembers, families, and friends calling about Veterans or Servicemembers are routed to the Veterans Crisis Line. The call center started in July 2007 and the Veterans Chat Service was started in July 2009. To date the call center has: 

• Received over 400,000 calls; 

• Initiated over 14,000 rescues; 

• Referred over 53,000 Veterans to local Suicide Prevention Coordinators for same 

day or next day services; 

• Answered calls from over 5,000 Active Duty Servicemembers; 

• Responded to over 15,000 chats; 

The call center is responsible for an average of 300 admissions a month to VA 

health care facilities and150 new enrollments a month for VA health care. 

VA/DOD Collaborations for Polytrauma/Traumatic Brain Injury (TBI) 

VA and DOD share a longstanding integrated collaboration in the area of TBI. 

Providing world-class medical and rehabilitation services for Veterans and Servicemembers with TBI and polytrauma is one of VA’s highest priorities. Since 1992, VA 

15 

and the Defense and Veterans Brain Injury Center (DVBIC) have been integrated 

at VA Polytrauma Rehabilitation Centers (PRC), formerly known as Lead TBI Centers, to collect and coordinate surveillance of long-term treatment outcomes for patients with TBI. From this collaboration, VA expanded services to establish the VA 

Polytrauma/TBI System of Care to provide specialty rehabilitation care for complex 

injuries and TBI. 

Today, this system of care spans more than 100 VA medical centers to create 

points of access along a continuum, and integrates comprehensive clinical rehabilitative services, including: treatment by interdisciplinary teams of rehabilitation specialists; specialty care management; patient and family education and training; psychosocial support; and advanced rehabilitation and prosthetic technologies. In addition to specialty services, Veterans and Servicemembers recovering from TBI receive 

comprehensive treatment from clinical programs involved in post-combat care including: Primary Care, Mental Health, Social Work and Care Coordination, Extended Care, Prosthetics, Telehealth, and others. 

VA’s provision of evidence-based medical and rehabilitation care is supported 

through a system-wide collaboration with the Commission on Accreditation of Rehabilitation Facilities to achieve and maintain national accreditation for VA rehabilitation programs. Collaboration with the National Institute on Disability and Rehabilitation Research TBI Model Systems Project enables VA to collect and benchmark 

VA rehabilitation and longitudinal outcomes with those from other national TBI 

Model Systems rehabilitation centers. With clinical and research outcomes that rival 

those of academic, private sector, and DOD facilities, VA leads the medical and scientific communities in the area of TBI and polytrauma rehabilitation. 

Since April 2007, VA has screened more than 500,000 Veterans from Operation 

Enduring Freedom (OEF)/Operation Iraqi Freedom/(OIF)/Operation New Dawn 

(OND) entering the VA health care system for possible TBI. Patients who screen 

positive are referred for comprehensive evaluation by a specialty team, and are referred for appropriate care and services. An individualized rehabilitation and community reintegration plan of care is developed for patients receiving ongoing rehabilitation treatment for TBI. Veterans who are screened and report current symptoms are evaluated, referred, and treated as appropriate. 

Additionally, 1,969 Veterans and Servicemembers with more severe TBI and extensive, multiple injuries were inpatients in one of the specialized VA Polytrauma 

Rehabilitation Centers between March 2003 and December 2010. VA and DOD collaborations in the area of TBI include: developing collaborative clinical research protocols; developing and implementing best clinical practices for TBI; developing materials for families and caregivers of Veterans with TBI; developing integrated education and training curriculum on TBI for joint training of VA and DOD heath care 

providers; and coordinating the development of the best strategies and policies regarding TBI for implementation by VA and DOD. 

Recent initiatives that have resulted from the ongoing collaboration between VA 

and DOD include: 

• Development and deployment of joint DOD/VA clinical practice guidelines for 

care of mild TBI; 

• A uniform training curriculum for family members in providing care and assistance to Servicemembers and Veterans with TBI (‘‘Traumatic Brain Injury: A Guide 

for Caregivers of Servicemembers and Veterans’’); 

• Implementing the Congressionally-mandated 5-year pilot program to assess the 

effectiveness of providing assisted living services to Veterans with TBI; 

• Integrated TBI education and training curriculum for VA and DOD health care 

providers (DVBIC); 

• Revisions to the International Classification of Diseases, Clinical Modification 

(ICD–9-CM) diagnostic codes for TBI, resulting in improvements in identification, 

classification, tracking, and reporting of TBI; 

• Collaborative clinical research protocols investigating the efficacy of various TBI 

treatments; and 

• Development of the protocol used by the Emerging Consciousness care path at 

the four PRCs to serve those Veterans with severe TBI who are slow to recover consciousness. 

VA Liaisons for Health Care 

VA has a system in place to transition severely ill and injured Servicemembers 

from DOD to VA’s system of care. Typically, a severely injured Servicemember returns from theater and is sent to a military treatment facility (MTF) where he/she 

is medically stabilized. A key component of transitioning these injured and ill Servicemembers and Veterans are the VA Liaisons for Health Care, who are either social workers or nurses strategically placed in MTFs with concentrations of recovVerDate Nov 24 2008 11:07 Oct 11, 2011 Jkt 000000 PO 00000 Frm 00021 Fmt 6633 Sfmt 6621 H:\ACTIVE\051811.TXT SVETS PsN: PAULIN
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ering Servicemembers returning from Iraq and Afghanistan. After initially having 

started with 1 VA Liaison at 2 MTFs, VA now has 33 VA Liaisons for Health Care 

stationed at 18 MTFs to transition ill and injured Servicemembers from DOD to the 

VA system of care. VA Liaisons facilitate the transfer of Servicemembers and Veterans from the MTF to the VA healthcare facility closest to their home or the most 

appropriate facility that specializes in services that their medical condition requires. 

VA Liaisons are co-located with DOD Case Managers at MTFs and provide onsite 

consultation and collaboration regarding VA resources and treatment options. VA 

Liaisons educate Servicemembers and their families about VA’s system of care, coordinate the Servicemember’s initial registration with VA, and secure outpatient appointments or inpatient transfer to a VA health care facility as appropriate. VA Liaisons make early connections with Servicemembers and families to begin building 

a positive relationship with VA. VA Liaisons coordinated 7,150 referrals for health 

care and provided over 26,825 professional consultations in fiscal year 2010. 

VHA OEF/OIF/OND Care Management 

As Servicemembers recover from their injuries and reintegrate into the community, VHA works closely with FRCs and DOD case managers and treatment teams 

to ensure the continuity of care. Each VA Medical Center has an OEF/OIF/OND 

Care Management team in place to coordinate patient care activities and ensure 

that Servicemembers and Veterans are receiving patient-centered, integrated care 

and benefits. Members of the OEF/OIF/OND Care Management team include: a Program Manager, Clinical Case Managers, and a Transition Patient Advocate (TPA). 

The Program Manager, who is either a nurse or social worker, has overall administrative and clinical responsibility for the team and ensures that all OEF/OIF/OND 

Veterans are screened for case management. Clinical Case Managers, who are either nurses or social workers, coordinate patient care activities and ensure that all 

clinicians providing care to the patient are doing so in a cohesive and integrated 

manner. The severely injured OEF/OIF/OND Veterans are automatically provided 

with a Clinical Case Manager while others may be assigned a Clinical Case Manager if determined necessary by a positive screening or upon request. The TPA helps 

the Veteran and family navigate the VA system by acting as a communicator, 

facilitator, and problem solver. VA Clinical Case Managers maintain regular contact 

with Veterans and their families to provide support and assistance to address any 

health care and psychosocial needs that arise. 

The OEF/OIF/OND Care Management program now serves over 54,000 Servicemembers and Veterans including over 6,300 who have been severely injured. The 

current caseload each OEF/OIF/OND case manager is managing on a regular basis 

is 54. In addition, they provide lifetime case management for another 70 Veterans 

by maintaining contact once or twice per year to assess their condition and needs. 

This is a practical caseload ratio based on the acuity and population at each VA 

health care facility. 

VA developed and implemented the Care Management Tracking and Reporting 

Application (CMTRA), a Web-based application designed to track all OEF/OIF/OND 

Servicemembers and Veterans receiving care management. This robust tracking system allows clinical case managers to specify a case management plan for each Veteran and to coordinate with specialty case managers such as Polytrauma Case Managers, Spinal Cord Injury Case Managers, and others. CMTRA management reports 

are critical in monitoring the quality of care management activities throughout 

VHA. 

OEF/OIF/OND Care Management team members actively support outreach events 

in the community, and also make presentations to community partners, Veterans 

Service Organizations, colleges, employment agencies, and others to collaborate in 

providing services and connecting with returning Servicemembers and Veterans. 

Caregiver Support 

Caregivers are a valuable resource providing physical, emotional, and other support to seriously injured Veterans and Servicemembers, making it possible for them 

to remain in their homes. Recognizing the importance of providing support and services to the caregivers of certain Veterans and Servicemembers who incurred or aggravated a serious injury in the line of duty on or after September 11, 2001, the new 

Caregivers and Veterans Omnibus Health Services Act of 2010, signed into law by 

President Obama on May 5, 2010, enhances existing services for caregivers of Veterans who are currently enrolled in VA care. It also provides unprecedented new 

benefits and services to family caregivers who care for certain eligible Veterans and 

Servicemembers undergoing medical discharge who have a serious injury that was 

incurred or aggravated in the line of duty on or after September 11, 2001 and who 

are in need of personal care services. These new benefits, which are being impleVerDate Nov 24 2008 11:07 Oct 11, 2011 Jkt 000000 PO 00000 Frm 00022 Fmt 6633 Sfmt 6621 H:\ACTIVE\051811.TXT SVETS PsN: PAULIN
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mented through an Interim Final Rule published earlier this month, include, for 

designated primary family caregivers of eligible Veterans and Servicemembers, a 

stipend, mental health services, and health care coverage if the primary family caregiver is not otherwise entitled to care or services under a health-plan contract. 

Starting in May 2011, we will begin to roll out these services and process applications to ensure delivery of benefits within the next few months. VA already offers 

a range of benefits and services that support Veterans and their family caregivers. 

These include such things as in-home care, specialized education and training, respite care, equipment and home and automobile modification, and financial assistance for eligible Veterans. VA is enhancing its current services and developing a 

comprehensive National Caregiver Support Program with a prevention and wellness 

focus that includes the use of evidence-based training and support services for caregivers. VA has designated Caregiver Support Coordinators at each VA Medical Center to serve as the clinical experts on caregiver issues; these Coordinators are most 

familiar with the VA and non-VA support resources that are available. VA has a 

Caregiver Support Web site (www.caregiver.va.gov) and Caregiver Support Line (1– 

855–260–3274) which provides a wealth of information and resources for Veterans, 

families, and the general public. 

Toxic Exposures 

VA and DOD are also working very closely together on toxic exposure issues. The 

DOD/VA Deployment Health Working Group (DHWG) under the JEC coordinates 

VA and DOD responses to toxic environmental exposures, such as exposures to burn 

pit smoke in Iraq and Afghanistan and to contaminated drinking water at Camp 

Lejeune. The DHWG facilitates interagency collaboration on surveillance of the potential health effects of environmental exposures, and coordinates communications 

to ensure consistency between DOD and VA. 

VA recognizes that the past methods of assessing specific hazardous exposures for 

links to adverse health outcomes has its limitations in that other important associations between deployment and adverse health outcomes may not be identified. As 

a result, VA is planning to expand upon current deployment-specific longitudinal cohort studies of Veterans who were deployed using non-deployed and non-Veteran 

comparison groups. The intent is to track, observe, compare, and analyze health outcomes in each group over time. This approach allows for examination of differences 

in health outcomes between those who were deployed to a combat theater of operations with those who were not deployed. An advantage of these studies is that they 

allow for a determination of the contribution of deployment to adverse health effects, as well as the examination of possible associations between potential environmental exposures and adverse health effects. 

In addition, VA recognizes the need to collaborate with DOD, to plan for future 

studies of deployed personnel from the time of deployment through the life span of 

all deployed Veterans. These studies would involve a cohort of deployed personnel, 

and non-deployed personnel and non-Veterans for purposes of comparison. This approach would allow for the examination of differences in all health outcomes and 

allow for the attribution of possible adverse health effects that may have resulted 

from a specific assignment or deployment. VA is currently evaluating opportunities 

for such studies. 

Camp Lejeune 

From the 1950s through the mid-1980s, persons residing or working at the U.S. 

Marine Corps Base Camp Lejeune, North Carolina, were potentially exposed to 

drinking water contaminated with volatile organic compounds (including industrial 

solvents and benzene from underground storage tanks). VA takes the health concerns of Veterans and their family members who were stationed at Camp Lejeune 

during this period very seriously. To provide fair and consistent decisions based on 

service during the period of potential exposure, VA has centralized Camp Lejeunerelated claims processing at its Louisville, Kentucky, Regional Office. 

The Agency for Toxic Substances and Disease Registry (ATSDR) is conducting ongoing research related to the potential exposures. Current ATSDR research is concentrating on refining hydrological modeling to determine the extent of benzene contamination. This information will then be used along with results from ongoing population studies to determine if the potentially exposed population at Camp Lejeune 

has experienced an increase in adverse health effects such as birth defects, cancers, 

and mortality. VA will closely monitor this research and will quickly consider the 

findings and take appropriate action. In addition, VA will support these studies by 

acting on ATSDR requests to confirm specific Veteran’s health issues. VA representatives regularly attend the quarterly Community Action Panel meetings hosted by 

18 

ATSDR. This fosters a close working relationship between ATSDR and VA and allows the Department to stay current with current research efforts. 

Burn Pits 

VA is very concerned about any potential adverse health effects among Veterans 

as a result of exposure to toxins possibly produced by burn pits. VA has asked the 

Institute of Medicine (IOM) to review the literature on the health effects of such 

exposures. While it is possible some Veterans could experience health problems related to exposures to toxins possibly produced by burn pits, the extent of the impact 

on health is unknown at this time. IOM’s examination of the scientific literature related to the burn pits in Iraq and Afghanistan also will determine what substances 

were burned in the pits and what byproducts were produced. We expect this study 

to be completed by early 2012. Other VA actions to address this issue include education of clinical providers and researchers. Experts from VA have provided several 

environmental exposure workshops to Compensation and Pension examiners, Environmental Health Coordinators, and primary care providers. These workshops address exposures to burn pits, oil fires, and sand and dust. VA researchers are collaborating with DOD and non-governmental experts in designing pulmonary research that will help answer questions in this important area. 

CENTERS OF EXCELLENCE

The Departments have established several collaborative Centers of Excellence. 

DOD Center of Excellence for Psychological Health and Traumatic Brain Injury 

(DCoE) 

In addition to the longstanding affiliation with DVBIC, VA collaborated to help 

DOD develop and establish the Defense Centers of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury. While DOD has lead Agency responsibility for this Center, with operational oversight assigned to the Assistant Secretary 

of Defense for Health Affairs ASD(HA), VA provides three staff members to DCoE: 

the Deputy Director for the DCoE, and two VA Senior Consultant/Liaison subject 

matter experts—one for TBI (from Office of Rehabilitation Services), and one for 

psychological health (from Office of Mental Health Services). VA staff members 

work closely within the DCoE, and their input is highly regarded for all policy recommendations related to TBI and Psychological Health, both within VA and DOD. 

DOD Vision Center of Excellence (VCE) 

DOD has lead Agency responsibility for this Center, and has assigned operational 

oversight to the Navy. In September 2010, a contract was awarded for the DOD/VA 

Vision Registry Pilot. The development of the registry pilot is currently in the test 

phase with linkages to the VA Data Store expected in the fourth quarter of FY 2011. 

Once proof of concept of the registry development is validated, the next phase will 

be to establish the registry as a program and system of record for full implementation. The Registry is being designed to interface with the electronic health records 

of VA and DOD, including iEHR, and other registries containing information about 

patient outcomes related to injuries that impact vision care and rehabilitation. The 

Vision Registry will be the first capability to combine VA and DOD clinical information into a single data repository for tracking patients and assessing longitudinal 

outcomes. 

Located in the National Capital Region, the VCE receives operational support 

from the Navy, and from the Office of Patient Care Services within VA. Currently, 

the VCE has a total of 13 permanent government employees (2 military, 6 DOD civilian, and 5 VA civilian employees). 

DOD Hearing Center of Excellence (HCE) 

The HCE continues to work toward achieving initial operating capability. DOD 

has lead Agency responsibility for this Center, and has assigned operational oversight to the Air Force. The primary focus of this Center is to implement a comprehensive plan and strategy for a registry for hearing loss and auditory injuries. 

VA will have access to the registry and the ability to add pertinent information regarding outcomes for Veterans who subsequently receive treatment through VA. The 

draft functional requirements for a Hearing Loss and Auditory System Injury Registry have been established to identify, capture, and longitudinally manage auditory 

injury data. Establishing and resourcing the Registry and clinical electronic network 

will help to prioritize joint collaborations for prevention and health care to improve 

outcomes for Servicemembers and Veterans with hearing loss and auditory disorders. 

An interim director for the HCE has been appointed and a working group of subject matter experts (SME) representing each Military Department and VA was esVerDate Nov 24 2008 11:07 Oct 11, 2011 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6621 H:\ACTIVE\051811.TXT SVETS PsN: PAULIN
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tablished. The HCE operational plan, facility planning and staffing documents, Registry implementation plan, and proposed budget are pending approval by DOD. 

DOD/VA Extremity and Amputation Center of Excellence (EACE) 

This DOD Center of Excellence was legislatively mandated to be ‘‘jointly’’ established by DOD and VA. The Deputy Secretary of Defense signed a Memorandum 

that established the Traumatic Extremity Injuries and Amputations Center of Excellence, and assigned operational oversight to the Army Surgeon General. A joint 

Memorandum of Understanding (MOU) for establishment of the Center was signed 

by the Assistant Secretary of Defense for Health Affairs (ASD (HA)) and Under Secretary of Health (VA) on August 18, 2010. A primary focus of this CoE will be to 

conduct research; there is no requirement for an associated Registry. VA and DOD 

have continued joint collaboration to meet the responsibility to perform basic, 

translational, and clinical research to develop scientific information. Continued focus 

will be on research efforts aimed at saving injured extremities, avoiding amputations, and preserving and restoring function of injured extremities. 

A working group comprised of representatives from the Services, VA, and Health 

Affairs has developed the concept of operations for the structure, mission and goals 

for the Center. Pending final approval by DOD, this plan will be sent to VHA for 

review and concurrence. Location of this CoE is yet to be determined. A small administrative staff and team of researchers are planned for this CoE; less than 25 

total staff, of which four to six are being requested from VA. 

Funding for the EACE in FY 2011 has been identified, and is being provided 

through the US Army Office of the Surgeon General. An interim director for the 

CoE has been appointed, and a working group of SMEs representing each Military 

Department and VA has been established. 

BENEFITS AND SERVICES

Benefits Delivery at Discharge (BDD) and Quick Start 

The BDD and Quick Start programs are elements of the Veterans Benefits Administration’s (VBA) strategy to provide transitional assistance to separating or retiring Servicemembers and engage Servicemembers in the claims process prior to 

discharge. A pre-discharge claim is any claim received from a Servicemember prior 

to release from active duty. VBA’s goal is to ensure that each and every Servicemember separating or retiring from active duty who wishes to file a claim with VA 

for service-connected disability benefits will receive assistance in doing so. 

Participation in the BDD program is open to Servicemembers who are within 60 

to 180 days of being released from active duty and who are able to report for a VA 

examination prior to discharge. BDD’s single cooperative examination process meets 

the requirements of a military separation examination and a VA disability rating 

examination. There are currently 96 BDD memoranda of understanding (MOU) covering the 131 military installations throughout the Continental United States, Germany, Italy, Portugal, the Azores, and Korea. The MOUs facilitate the collaboration 

between local VA Regional Offices (VARO) and local military installations by 

streamlining processing of pre-discharge claims. The BDD program goal is to provide disability compensation benefits within 60 days of discharge or retirement from 

active duty. The national average for processing is 92.3 days. 

VA introduced the ‘‘Quick Start’’ pre-discharge claims process in July 2008. This 

provides Servicemembers within 59 days of separation, or Servicemembers within 

60–180 days of separation who are unable to complete all required examinations 

prior to leaving the point of separation, to be assisted in filing their disability claim. 

Since 2010, the VAROs in San Diego and Winston-Salem process all Quick Start 

claims. In FY 2010, there were 54,733 claims received at MOU sites. VA and DOD 

are collaborating to improve the marketing and awareness strategies to increase 

participation in both programs. 

Military Service Coordinators (MSC) 

MSCs are located at key MTFs and VA medical facilities to meet with every injured OEF/OIF/OND Servicemember when medically appropriate. MSCs educate 

Servicemembers regarding VA benefits and services as well as additional benefits 

such as Social Security. MSCs assist Servicemembers and Veterans in completing 

benefits claims and gathering supporting evidence to facilitate expedited processing. 

VBA has approximately 120 MSCs providing benefits information and assistance in 

support of approximately 250 military installations. 

VBA OEF/OIF/OND Case Managers 

VBA places a high priority on ensuring the timely delivery of benefits to Servicemembers and Veterans seriously injured in OEF/OIF/OND. Each VARO has a dediVerDate Nov 24 2008 11:07 Oct 11, 2011 Jkt 000000 PO 00000 Frm 00025 Fmt 6633 Sfmt 6621 H:\ACTIVE\051811.TXT SVETS PsN: PAULIN
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cated OEF/OIF/OND case manager who is responsible for overseeing the OEF/OIF/ 

OND workload and outreach initiatives. The case manager’s responsibilities include 

working closely with National Guard and Reserve units to obtain medical records 

and coordinating with VHA case managers for expedited medical examinations. 

VBA OEF/OIF/OND case managers work with MTFs to ensure timely VA notification of new OEF/OIF/OND casualty arrivals and schedule inpatient visits by VA 

representatives. VARO and MTF staffs coordinate procedures at the local level. 

VARO employees contact Servicemembers as quickly as possible to provide claims 

assistance and complete information on all VA benefits. Some benefits, such as 

home and automobile adaptation grants and vocational rehabilitation benefits, may 

be used prior to a Servicemembers’ release from active duty. 

VA OUTREACH

Social Media (OPIA) 

VA has worked with DOD on a number of social media efforts including Facebook, 

Twitter, and a VA blog to post information relevant to newly separated Veterans. 

VA launched a Facebook page and Twitter feed aimed at returning Servicemembers 

that now has 110,000 subscribers and 16,000 followers, respectively. Since early 

2010, VA has made a deliberate and concerted effort to reach new Veterans in their 

own communities through dozens of active VA medical centers on Facebook and 

Twitter. Currently, 84 of 152 VA medical centers operate Facebook pages and 45 

operate Twitter feeds which keep Veterans informed and aware of events, changes, 

and tips for obtaining VA benefits. For example, VA uses both online resources to 

continually remind Veterans about the extension of retroactive stop-loss special pay. 

Additionally, VA recently shared information about the new Post Traumatic Stress 

Disorder (PTSD) application on its blog. The medical centers reach a combined audience of over 37,000 Veterans and their family members annually. eBenefits 

The eBenefits online Web-portal is a joint VA and DOD service that provides resources and self-service capabilities to Servicemembers and Veterans with a single 

sign-on. eBenefits is evolving as a ‘‘one-stop shop’’ for benefit applications, benefits 

information, and access to personal information. VA and DOD collaborate in quarterly releases to provide users with new self-service features. Servicemembers and 

Veterans can access official military personnel documents and generate civil service 

preference letters using the portal. Additional features allow users to apply for benefits, view the status of their disability compensation claims, update direct deposit 

information for certain benefits, and obtain a VA-guaranteed home loan Certificate 

of Eligibility. 

In June 2011, VA will enhance eBenefits to allow Servicemembers to participate 

in the Transition Assistance Program (TAP) online and integrate the VetSuccess 

portal, thus expanding the services Veterans can receive through a single sign-on. 

As of March 31, 2011, there were over 278,000 registered eBenefits users. Between 

July 1, 2010, and March 31, 2011, there were over 2 million unique visits to the 

eBenefits portal. 

Vet Centers 

Vet Centers are community-based counseling centers that provide outreach counseling and case management referrals for Veterans. Vet Centers also provide bereavement counseling for families of Servicemembers who died while on Active 

Duty. Through December 2010, Vet Centers have cumulatively provided face-to-face 

readjustment services to approximately 500,000 OEF/OIF/OND Veterans and their 

families. As outlined in Section 401 of Public Law 111–163, VA is currently drafting 

regulations to expand Vet Center eligibility to include members of the Active Duty 

Armed Forces who served in OEF/OIF/OND (includes Members of the National 

Guard and Reserve who are on Active Duty). 

In addition to the 300 Vet Centers that will be operational by the end of 2011, 

the Readjustment Counseling Service program also has 50 Mobile Vet Centers providing outreach to separating Servicemembers and Veterans in rural areas. The Mobile Vet Centers provide outreach and direct readjustment counseling at active military, Reserve, and National Guard demobilization activities. In response to the Ft. 

Hood shooting, VA deployed four Mobile Vet Centers that provided services to over 

8,200 Active Duty Services members, Veterans, and families in the Ft. Hood community. In addition, VA’s Secretary is adding licensed family counselors to over 200 Vet 

Center sites to better assist with military related family problems. 

Transition Assistance Program 

The Transition Assistance Program (TAP) is conducted under the auspices of a 

Memorandum of Understanding between the Departments of Labor, Defense, Homeland Security, and VA. The Departments work in conjunction with DOD in schedVerDate Nov 24 2008 11:07 Oct 11, 2011 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6621 H:\ACTIVE\051811.TXT SVETS PsN: PAULIN
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uling briefings and classes on installations to best serve Servicemembers. There is 

also a quarterly meeting between the Departments to discuss marketing and improvement of TAP. VA’s MSCs lead regularly scheduled TAP briefings at military 

installations throughout the country and at overseas locations. VA has streamlined 

and updated the VA portion of TAP, and in July 2011, an updated online version 

of the presentation will be available via eBenefits. In addition, VBA provides benefits transition briefings to Servicemembers retiring, separating, and residing overseas, as well as demobilizing Reserve and National Guard members (most demobilization briefings are conducted by VHA). In FY 2010, approximately 207,000 Active 

Duty, Reserve, and National Guard Servicemembers participated in over 5,000 transition briefings. For the period October 1, 2010, through March 2011, over 83,000 

Active Duty, Reserve, and National Guard Servicemembers participated in over 

2,000 transition briefings. 

Disabled Transition Assistance Program 

The Disabled Transition Assistance Program (DTAP) provides Servicemembers 

with information about VA’s Vocational Rehabilitation and Employment (VR&E) 

program. DTAP is the first step to ensuring professional and personal success after 

the military for eligible Veterans with disabilities. DTAP briefings are typically conducted in addition to the TAP briefings for Servicemembers with disabilities. During 

FY 2010, over 37,000 Servicemembers participated in 1,748 DTAP briefings around 

the world. Over 19,000 Servicemembers participated in 874 DTAP briefings during 

the period of October 1, 2010, through April 22, 2011. 

Yellow Ribbon Reintegration Program 

Through the DOD Yellow Ribbon Reintegration Program (YRRP), National Guard 

and Reserve units are partnering with VA to increase awareness and utilization of 

VA benefits, programs, and services. VHA has actively supported the DOD YRRP 

since the creation of the program in 2008. VHA personnel participate at Yellow Ribbon events across the country by providing: information; live briefings on VA benefits, programs, and services; personal assistance with VA form completion; and referrals to VA facilities for assistance. Representatives from VBA also participate in 

many Yellow Ribbon events providing information on VA disability compensation, 

education, loan guaranty, vocational rehabilitation and employment, and insurance. 

A growing number of military units are working closely with VA personnel to conduct 90-day post-deployment Yellow Ribbon events in VA medical centers (VAMC) 

in various states, resulting in cost savings and the strengthening of VA/DOD partnership at the local level. Conducting these events in VAMCs facilitates a smooth 

transition between DOD and VA by getting Servicemembers in the door of the 

VAMC and establishing a level of comfort with VA care. Servicemembers attending 

Yellow Ribbon events at a VAMC have opportunities for on-the-spot referrals for VA 

care, and, in some cases, same day care. 

In 2008, VHA’s Office of Interagency Health Affairs placed a full-time VA employee in the DOD YRRP at the Pentagon to assist in coordinating activities and 

policies. The role of the liaison is to serve as the full-time, on-site source of VA information for Yellow Ribbon specific issues and expedite the exchange of information 

between VA and the DOD YRRP Office. The liaison assists the YRRP Office with 

policy and procedure development by providing expertise and information on VA’s 

structure, benefits, and services. In addition, the liaison works collaboratively with 

VA staff members to assist with coordination of personnel and resources to support 

Yellow Ribbon events. 

Demobilization Initiative for Returning Veterans 

In coordination with National Guard and Reserve units, VAMC and Veterans Integrated Service Network (VISN) staff, along with Vet Center and VBA staff, provide briefings on VA services and benefits. These are conducted at 63 National 

Guard and Reserve demobilization sites nationwide. VHA staff also facilitate enrollment in VA health care by assisting National Guard and Reserve members with 

completing VA health care enrollment forms when they choose to enroll on site. The 

forms are then processed through VHA’s centralized Health Eligibility Center. The 

National Guard and Reserve members also receive outreach materials and a 

watermarked letter which serves as a type of temporary ID confirming enrollment 

in VA Health Care. 

The watermarked letter includes the name and phone number of the National 

Guard and Reserve member’s local OEF/OIF/OND Program Manager and lets 

VAMC staff know that he or she has enrolled in VA care, thus opening doors to immediate access within VA Health care services at their local VA Medical Center. 

During FY 2010, VHA supported 1,339 demobilization events, providing VHA staff 

22 

with face-to-face interactions for nearly 74,000 Servicemembers. As a result, 70,000 

have registered or enrolled in VHA Health care. 

Post-Deployment Health Reassessment (PDHRA) 

Since 2006, VHA has been focused on managing referrals from Reserve components for Servicemembers and Veterans who have completed the PDHRA. The 

PDHRA program requires these assessments to be completed at 90–180 days postdeployment. DOD uses a contractor to provide these screenings, either at a face-toface event or the member may elect to use the on-line assessment, which is followed 

up by a call with the contractor’s health care provider. When the PDHRA takes 

place at a face-to-face event, the local VAMC and Vet Center staff, when notified, 

will provide VA Outreach, education, enrollment, and as needed, referral for clinical 

services. Referred Veterans have a choice to receive their care at a local VAMC, Vet 

Center, or if they are a dual beneficiary may receive care for a non-service-connected 

condition via the TRICARE network. 

For Servicemembers who request a VHA appointment, the onsite VA staffs are 

able to schedule appointments for them at their local VAMC. During FY 2010, VHA 

supported 339 DOD PDHRA events with 44,443 Veterans and 1,319 family members 

attending. Of these Veterans, 38,059 were OEF/OIF/OND Veterans. 

CONCLUSION

VA and DOD continue to work together diligently to resolve transition issues 

while aggressively implementing improvements and expanding existing programs. 

These efforts continue to enhance the effectiveness of support for Servicemembers, 

Veterans, and their families. While we are pleased with the quality of effort and 

progress made to date, we fully understand our two Departments have a responsibility to continue these efforts. Through IDES, our goal is to create a less complex 

process which is more transparent to the Servicemember. We designed our case 

management programs to provide seamless support through the duration of care 

and rehabilitation and we are constantly improving those systems. We continue to 

explore ways to expand the availability of comprehensive benefits, online resources, 

and transition education programs to provide Servicemembers and Veterans direct 

access to the information and benefits they need. In addition, the two Departments 

are working toward a goal of a fully developed Virtual Lifetime Electronic Record 

that will provide health and benefits data to all authorized users in a safe, private, 

secure manner, regardless of the user’s location. Recently, Secretary Gates and Secretary Shinseki formally agreed that our two Departments would work cooperatively 

toward a common electronic health record. We are looking forward to delivering on 

this commitment. 

Thank you again for your support to our wounded, ill, and injured Servicemembers, Veterans, and their families and your interest in the ongoing collaboration and cooperation between our Departments. Chairman Murray, Ranking Member Burr, this concludes my testimony. I will be happy to respond to any questions 

that you or other Members of the Committee may have. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO HON. 

W. SCOTT GOULD, DEPUTY SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. In advance of the hearing, please provide the Committee with the following information for each location using the integrated Disability Evaluation System (IDES): 

e) The current staffing level for Military Services Coordinators. 

Response. Early in FY 2011, for the first 55 IDES sites, 68 Military Service 

Coordinators (MSCs) provide Servicemember counseling and support. As of 

April 30, 104 Military Service Coordinators (MSCs) were providing Servicemember counseling and support at 77 IDES sites. We expect to end FY 2011 

with a presence of 261 FTE, a mix of MSCs and Rating Veterans Service Representatives (RVSRs), across approximately 139 sites. RVSRs do the disability 

rating determinations and are located at the three Disability Rating Activity 

Sites (DRAS) where they complete the rating decisions used by both VA and 

DOD. The MSCs are located at the MTFs or other IDES locations and they assist the Servicemembers with gathering the medical evidence needed for the 

RVSRs to rate the case. 

f) The average time to complete all medical examinations. 

Response. As of March 31, 2011, the average number of days to complete all 

required exams, cumulative since the Initial Operating Capability, is 62 days. 

23 

t) The funding level for the IDES process, including funds that will be provided from any source. 

Response. VA’s IDES associated resources available for FY 2011 are estimated at $58 million. A detailed breakout by source and function is provided 

below. 

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

W. SCOTT GOULD, DEPUTY SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. IDES is to be fully implemented in October of this year. Have the remaining sites been certified to meet Initial Operating Capability readiness criteria 

in order to meet this target date? 

Response. The remaining IDES sites will be certified by September 30, 2011 prior 

to reaching their Initial Operating Capability (IOC). As sites are being brought on 

in stages, certification occurs in the final stage when the site has completed all program requirements and is determined to be operational. 

Question 2. The Virtual Lifetime Electronic Record (VLER) is in its first phase 

with five operational pilot sites where DOD and VA, as well as private sector health 

care providers, are sharing health information. Please comment on the progress 

being made at each of these sites, as well as any delays or collaboration issues that 

have occurred with respect to execution of those pilots. 

Response. VA is conducting an 11-region pilot of VLER Nation Wide Health Information Network Exchange. This pilot is currently active at five of the 11 planned 

locations, with the remaining six sites scheduled for activation in fall 2011. Information about the five locations currently sharing information is provided below as requested. To date, no major delays or collaboration issues have been identified. 

San Diego, CA Veterans Affairs Medical Center (VAMC)—private partners Kaiser 

Permanente (KP)/San Diego Beacon (UC San Diego) 

• Currently operational and sharing information with Kaiser Permanente and 

DOD 

– Shared patients with Kaiser Permanente: 491 


518VAq1t.eps
24 

– Shared patients with DOD: 10,539 

• San Diego Beacon exchange planned for FY12 

Hampton, VA VAMC—private partner MedVirginia 

• Currently operational and sharing information with MedVirginia and DOD 

– Shared patients with MedVirginia: 7,278 

– Shared patients with DOD: 5,283 

Spokane, WA VAMC—private partner Inland Northwest Health Services (INHS) 

• Currently operational and sharing information with INHS and DOD 

– Shared patients with INHS: 3,000 

– Shared patients with DOD: 479 

Richmond, VA VAMC—private partner MedVirginia 

• Currently operational and sharing information with MedVirginia 

– Shared patients with MedVirginia: 10,690 

Asheville, NC VAMC—private partner Western North Carolina Health Network 

(WNCHN) 

• Currently operational and sharing information WNCHN 

– Shared patients with WNCHN: 491 

Question 3. A strategic goal of the Integrated Mental Health Strategy is to reduce 

stigma through successful public communication and use of innovative technological 

approaches. How are both approaches directly addressing servicemembers’ concerns 

about avoiding detrimental effects on their career when seeking mental health care? 

Response. VA has established two national messaging campaigns, one for suicide 

prevention and one promoting the message that Veterans should seek mental health 

assistance when needed. We have employed the use of an experienced public relations firm to help us with these efforts. The firm understands the need to project 

these messages in a way that emphasizes the strengths of Veterans and does not 

stigmatize the situation more. Veteran groups have been consulted and messages 

crafted to demonstrate that seeking mental health care leads to improved functioning. Great care is taken to portray Veterans as being stable or fit. 

The VA National Suicide Hotline has re-branded itself as the Veterans Crisis Line 

and provides anonymous services to those who do not want to be identified. Veterans Chat (www.veteranscrisisline.net) is completely anonymous and provides a 

way to seek help without stigma attached. 

With regard to the use of innovative technological approaches, one example is the 

PTSD Coach smartphone application (app), which was jointly developed by VA and 

the Department of Defense (DOD) and launched in April 2011. Since its launch, the 

PTSD Coach has been downloaded by over 10,000 individuals in 37 countries. The 

app lets users track their PTSD symptoms, links them with public and personalized 

sources of support, provides accurate information about PTSD, and teaches helpful, 

evidence-based strategies for managing PTSD symptoms. The app is one of the first 

in a series of jointly designed resources by VA’s National Center for PTSD and 

DOD’s National Center for Telehealth and Technology to help Servicemembers and 

Veterans manage their readjustment challenges and receive anonymous assistance. 

A series of Web-based self-help programs is also being developed as part of the 

Integrated Mental Health Strategy. These programs are designed to be accessed 

anonymously, so that an individual can work on his or her own mental health or 

readjustment issues without experiencing detrimental career consequences. These 

programs will provide Veterans and Servicemembers with direct access to highly 

interactive, evidence-based self-help programs that may help them manage their 

symptoms and solve their problems without ever interacting with a mental health 

provider. Veterans and Servicemembers who so choose will also have the option of 

calling a toll free number to speak confidentially and anonymously with a coach who 

can help him/her through the program content. 

Furthermore, VA has disseminated and implemented telemental health services 

throughout Veterans Health Administration (VHA) to further promote access to 

mental health care. In fiscal year 2010, VHA provided telemental health services 

to approximately 50,000 Veterans. Significantly, many patients have expressed preference for telemental health services. VA is currently working to promote the delivery of evidence-based psychotherapies (EBPs) through telemental health modalities, 

which has been shown in initial research and clinical experiences to yield outcomes 

for many Veterans that are equivalent to traditional face-to-face EBP services. 

Question 4. VA researchers are collaborating with DOD and non-governmental experts in designing pulmonary research that will help answer questions about burn 

pit exposure. What protocols have been developed as a result of this effort? 

Response. There have been no clinical protocols developed to date as this issue 

is still being researched. Individual chemicals produced by burn pits can affect the 

25 

skin, respiratory system, internal organs, the nervous system, and the gastrointestinal tract. However, most toxic materials from burn pits are eliminated from 

the body in a matter of weeks. Several active VA efforts are under way to study 

the possible health effects of burn pits and to provide a scientific basis for the development of clinical protocols. For example: 

• VA asked the Institute of Medicine for an in-depth review of existing literature 

on burn pits and on the long-term health effects of exposure to burn pits in Iraq 

and Afghanistan. Their report is due in late 2011. 

• VA is leading the National Health Study for a New Generation of U.S. Veterans, which will reach out to 30,000 deployed and 30,000 non-deployed Veterans 

over 10 years. It covers a wide spectrum of health topics, including those that may 

be associated with burn pits. 

• VA is participating in the Millennium Cohort Study, a DOD project begun in 

2001 that has almost 150,000 participants. Data is being collected on respiratory 

health. 

• VA researchers are participants in a DOD sponsored Pulmonary Health 

WorkingGroup focused on potential lung diseases associated with deployment. This 

group has met several times and has formulated key research questions which include the following: 

1) What are the causes of the limited number of chronic lung disease cases identified to date? 

2) Are these cases an exacerbation of pre-existing lung disease? 

3) What are the short-term & long-term pulmonary effects in the deployed population? 

4) Can responsible agent(s) be identified? 

5) Do preventive measures during deployment need to be initiated? 

• VA is sponsoring additional studies by individual VA researchers and tracking 

other studies by non-VA researchers; and 

• Veterans can find out more about their health concerns related to potential exposures to burn pits by getting an exposure assessment offered by VA’s War Related 

Illness and Injury Study Center (WRIISC) program. The WRIISC provides clinical 

expertise for Veterans with deployment health concerns or difficult-to-diagnose illnesses. WRIISCs are in three locations: Washington, DC; East Orange, NJ; and Palo 

Alto, CA. For an appointment at a WRIISC, a VA primary care doctor must make 

a referral. 

Question 5. To what extent is the Department utilizing hyperbaric oxygen therapy 

to treat veterans? Additionally, what research protocols are currently active that 

deal with hyperbaric oxygen therapy? 

Response. Attached please find The VA Report to Congress on Hyperbaric Oxygen 

Treatment. This was submitted to Congress on April 2, 2010. 

VA has a long history of supporting research to improve wound healing. There 

are VA investigators exploring the use of Hyperbaric Oxygen Treatment (HBOT). 

For example, DOD is currently funding three coordinated research trials on the use 

of HBOT for persistent symptoms after mild TBI. A VA researcher at the Richmond 

VA Medical Center (VAMC) is participating in two of these trials. Two other VA investigators are also participating in other capacities with DOD on HBOT studies. 

HBOT is provided for Food and Drug Administration approved conditions at several 

VAMCs. VA will continue to support promising research in Complementary and Alternative Medicine and HBOT to ensure that Veterans have access to the best evidence-based health care. 

Question 6. VA has said, ‘‘We are committed to working with the Department of 

Defense, veteran service organizations and veterans to ensure that all those who 

may have been exposed at McMurdo Station receive the maximum amount of care 

and benefits they are entitled to under the law.’’ What is being done for those who 

are still suffering from cancers that the VA has yet to connect to McMurdo Station? 

Response. VA has not promulgated any presumptions of service connection based 

on exposure to radiation at McMurdo Station. Any Veteran exposed at McMurdo 

Station who has health concerns that they feel may be related to their exposure at 

McMurdo Station may file a claim for VA compensation and may be referred for a 

compensation and pension examination, if necessary, to decide the claim. 

Question 7. There are serious challenges in combatting the stigma associated with 

seeking mental health care. The Departments are still struggling to make it acceptable to ask for help. Additionally, commanders have an obligation to know how fit 

and ready those in their units are. In the meantime, providing confidentiality for 

servicemembers to seek treatment is very important. What is an acceptable balance 

of these concerns? 

26 

Response. It is widely recognized that patients’ personal information about mental 

health treatment has been the basis for stigmatization and that stigmatization discourages patients from seeking needed mental health treatment. Research indicates 

that privacy of health care information is one of Servicemembers’ major concerns in 

their decision not to seek mental health care. 

Under its mission, the DOD must ensure the medical readiness of its force. Thus 

DOD has an obligation to assess Servicemembers’ fitness for duty, and a right to 

require Servicemembers to provide the information DOD needs to conduct this assessment. In this respect, active duty Servicemembers have no right to confidentiality, vis a` vis, their employer, the DOD. In contrast, Veterans, non-active reservists, and National Guard members all have a legitimate expectation of confidentiality in VA because VA, as a civilian health care provider, has a professional obligation to protect the confidentiality of its patients. Just as lawyers and chaplains 

have a fiduciary obligation to protect the information of clients in order to maintain 

the trust relationship that is essential to their roles, VA providers must protect 

their patients’ information in order to maintain the trust required to fulfill their 

mission of service to Veterans. 

In VA, as in private-sector health care, breaching patient confidentiality by disclosing protected health information against the patient’s wishes requires special 

justification that meets clear and rigorous standards. Disclosures of protected health 

information by VA must comply with all applicable privacy statutes and regulations, 

such as the Privacy Act, the HIPAA Privacy Rule, 38 U.S.C. 7332, and 38 U.S.C. 

5701. Once VHA determines there is authority to release, a disclosure is ethically 

justifiable if all of the following conditions are met: 

1) There is a high probability of harm to the patient or others; 

2) The probable harm is very serious; 

3) The probable harm is imminent; 

4) There is a high probability that information disclosure will mitigate the harm; 

and 

5) No other reasonable means are available to mitigate the harm. 

For example, when a VHA provider determines that a soldier who carries a weapon poses a high risk of immediate harm to his unit, the provider has a duty to take 

action, which would include warning the patient’s DOD provider or command. When 

the conditions for a duty to warn are met, the duty is absolute. 

Meeting our obligation of confidentiality and ensuring patient choice regarding 

the sharing of that information are important for all patients, but especially important for Reservists and National Guard members who are subject to being recalled 

to active military service. Individuals in this cohort are often highly motivated to 

remain eligible to return to active military service in the future, and may fear that 

their eligibility could be adversely affected should their health information be disclosed to DOD. At a time when VA is actively reaching out to this cohort to encourage them to seek evaluation for Post Traumatic Stress Disorder, Traumatic Brain 

Injury, suicide risk, military sexual trauma, and other conditions potentially associated with military service, VA’s routine release of these patients’ health information 

to DOD could seriously undermine these patients’ willingness to provide VHA 

health care providers with thorough and accurate health information, their likelihood of seeking care in VHA, and their trust in the VHA health care system overall. 

As VA and DOD prepare to make significant investments to modernize their electronic health record systems, a variety of decisions must be made about how best 

to protect and promote the interests of patients. Such decisions must drive the design of IT systems. In particular, there is a need to ensure that the electronic health 

record ‘‘Way Ahead’’ is based on patient choice standards regarding access to health 

information. In this regard, a task force on VA/DOD Health Information Sharing is 

being convened to develop and recommend Consensus Standards on Health Information Sharing between VA and DOD to help guide policy and practice with regard 

to sharing of health information, including the design of future electronic health 

record systems, such as VLER. The intent is that these Consensus Standards will 

define an ethically appropriate balance of these concerns. 

Question 8. Do Federal Recovery Coordinators have sufficient access to patients 

and facilities and authority within both Departments to effectively case-manage 

their patients? 

Response. Federal Recovery Coordinators (FRC) provide care coordination for clients regardless of where they are located and without regard to active duty or Veteran status. FRCs work with care and case management officials within the Departments of Veterans Affairs and Defense to ensure that clients receive appropriate 

benefits and services in a timely manner. While there are often isolated issues of 

27 

access and authority, FRCs have not experienced systematic problems with respect 

to the clients who are referred to them. 

The Federal Recovery Coordination Program (FRCP) is a referral program and 

participation is voluntary. Consequently, it is unclear whether all of the eligible ‘‘severely wounded, ill, and injured’’ Servicemembers and Veterans who could benefit 

from the FRCP are being enrolled in the program. The FRCP cannot readily identify 

these individuals because the ‘‘severely wounded, ill, and injured’’ classification is 

not captured in existing data sources. Additionally, the program’s broad eligibility 

criteria cannot be used systematically to identify potentially eligible Servicemembers and Veterans. Instead, the FRCP must rely on referrals from others to 

identify these individuals, although the program has also taken steps to identify potential enrollees through the FRCs’ efforts at medical facilities and through a ‘‘look 

back’’ initiative to identify eligible Veterans who were wounded prior to program implementation. 

Question 9. The joint electronic health record is the largest program ever developed between VA and DOD. The continuum of quality health care for millions of 

servicemembers and veterans is depending on the success of this project. What specifics can you provide on the time-line for delivery, project costs, and expectations? 

Response. The VA and DOD are working together to jointly develop an electronic 

health record that will provide information to both agencies about our Servicemembers and Veterans. Both agencies have agreed to consolidate data where applicable, use common services and develop a joint platform in order to realize economies of scale. We call this effort the ‘‘integrated Electronic Health Record,’’ or iEHR. 

Our functional and technical experts are currently developing a joint governance 

process, an overall concept of operations, and detailed plans to achieve this complex 

goal. The iEHR will be a national model for capturing, storing, and sharing electronic health information. 

Question 10. How would a joint electronic health record help the Department deal 

with exposure cases? 

Response. The integrated Electronic Health Record (iEHR) is a key strategic resource in improving the care of Servicemembers before, during, and after the transition from active duty to Veteran status. The implementation of common medical terminology will greatly enhance the ability to exchange computable, interoperable patient-centered data. A single record for each Servicemember and Veteran will add 

new capabilities for clinicians at both DOD and VA to quickly find needed information, improve operational efficiency, and reduce the need for redundant evaluations 

and testing. Jointly developed decision support resources and evaluation measures 

will help maintain a similar high standard of care and patient safety across both 

Departments, while improving the ability to both benchmark and identify patterns 

and trends over time. A common record for each Servicemember and Veteran will 

provide a foundation for improved communication across Departments in the form 

of electronic referrals, consultation requests, orders portability, and provider-provider messaging, thereby enhancing the continuity and timeliness of patient care. 

Transition for Servicemembers includes not only medical care, but evaluation for 

disability and benefits, which will also be enhanced as both Departments adopt 

matching terms and a common language to describe the care received by our beneficiaries. Our future electronic health record will contain not only resources for providers and clinical teams, but provide rich access to information for both Servicemembers and Veterans. Patient facing resources in the form of web portals, personal 

health records, eHealth and mobile applications which will remain consistent and 

familiar across the continuum from active duty to Veteran status, will highly increase the engagement of the Servicemember and Veteran in his or her care, and 

as a result, improve the patient care experience and improve health. 

Question 11. The Department recognizes the need to collaborate with DOD to plan 

for future studies on deployed personnel from the time of deployment through the 

life span of all deployed veterans. Today, where is the Department with this assessment? 

Response. Working together, VA’s Health Services Research and Development 

(HSR&D) and the DOD have recently released (February 2011) the VA/DOD Collaboration Guidebook for Healthcare Research to facilitate collaborative human subject healthcare research between VA and the DOD. The Guidebook provides suggestions and guidance for: 

• Identifying collaborators with common research interests/goals; 

• Summaries of administrative and funding mechanisms; and 

• Procedures and protocols needed for collaborative endeavors. 

In addition, the Guidebook offers: 

28 

• Suggestions for developing and submitting a proposal; 

• Examples of successful and unsuccessful research collaborations; 

• List of commonly used acronyms; and 

• Links to additional resources. 

This is now available at http://www.research.va.gov/va-dod/ and will assist researchers in both VA and DOD who are planning future studies on deployed personnel from time of deployment throughout the lifespan. This question is also related to questions #2, #9, and #10, with respect to data sharing between VA and 

DOD, that will be essential to such future research. 

Question 12. As members of the Guard and reserves transition in and out of active 

duty, they repeatedly switch between TRICARE, private insurance, and VA medical 

care. This creates a number of concerns regarding coordination of care, quality oversight, and the simple ability of the servicemember and family to manage those 

changes. How are these transitions being tracked by the Department and effectively 

managed? 

Response. VA’s Operation Enduring Freedom/Operation Iraqi Freedom/Operation 

New Dawn (OEF/OIF/OND) Care Management teams actively provide outreach to 

returning Guard and Reserve including annual Welcome Home events to welcome 

Servicemembers returning from deployment, and extended family members, to increase awareness of VA benefits and services. VA is partnering with National Guard 

and Reserve units to conduct 90-day post-deployment Yellow Ribbon events to increase awareness and utilization of VA benefits, programs and services. Military 

services demobilization events provide a setting for post-deployment National Guard 

and Reservist members to receive in-person briefings about VA services and benefits 

from locally-based VA Medical Center (VAMC), Veterans Benefits Administration 

and Vet Center staff. VHA staff facilitate enrollment on site for VA health care by 

assisting National Guard and Reserve members with completing VA health care enrollment forms, which are then processed by the VAMC where they live. The National Guard and Reserve members who register for VA Health Care receive a letter 

with the contact information of their local VAMC OEF/OIF/OND Program Manager. 

This letter serves as a temporary identification card for VA Health Care. VA coordinates referrals from Reserve components for National Guard and Reserve members 

and Veterans who have completed the Post Deployment Health Reassessment 

(PDHRA), a DOD program, which assesses returning Servicemembers for the need 

for health care services at 90–180 days post-deployment. When the PDHRA occurs 

at a face-to-face event, the local VAMC and Vet Center staff provide VA Outreach, 

education, enrollment, and as needed, referral for clinical services. Referred Veterans have a choice to receive their care at a local VAMC, Vet Center, or through 

the TRICARE system, which may be at a VAMC. For Servicemembers who request 

a VHA appointment, the onsite VA staff already has enrollment information in the 

Computerized Patient Record System and is able to schedule appointments immediately at their local VAMC. 

VA staff also works closely with the Transition Assistance Advisors (TAAs) who 

work in each state/territory and serve as the statewide point-of-contact to assist Servicemembers in accessing VA benefits and healthcare services. They coordinate with 

VA to assist the Servicemember/Veteran in the navigation processes from DOD, 

TRICARE, and VA. 

OEF/OIF/OND Care Management teams screen all returning combat Servicemembers and Veterans for the need for case management services at their initial 

VA appointment. Those who present with needs requiring case management support 

or who request a case manager, receive ongoing case management services according 

to their individualized care plan. All Veterans and Servicemembers receiving case 

management services, including Guard and Reserve, are tracked using a Web-based 

tracking system. VA case managers maintain regular contact with Servicemembers/ 

Veterans and their families/caregivers to provide support and assistance in addressing any health care and psychosocial needs and coordinate services among providers 

within VA, DOD, and the community. 

VA has specialized resources to support clinical teams coordinating care. These resources include VA’s Liaisons to the TRICARE Regional Office, who serve as intermediaries between VA facilities and the TRICARE regional contractors. They actively assist with authorizations and claims. Monthly calls with TRICARE contractors and VA’s Medical Sharing Office are held to review active duty Servicemembers 

who are receiving joint VA/DOD care. Education classes are held with the VA Medical Sharing Office to educate VA staff including OEF/OIF/OND care management 

teams and VA Liaisons for Healthcare as well as DOD and TRICARE staff, to ensure transition processes and procedures are consistent. The Health Eligibility Center serves as an overall resource for VA enrollment and eligibility questions. 

29 

Chairman MURRAY. Thank you very much. 

Secretary Lynn. 

STATEMENT OF HON. WILLIAM J. LYNN III, DEPUTY 

SECRETARY, U.S. DEPARTMENT OF DEFENSE 

Mr. LYNN. Thank you very much, Chairman Murray. I look forward to conversing with you, Ranking Member Burr, and the other 

Members of the Committee. 

Let me say at the outset I want to recognize and appreciate the 

partnership that DOD and VA has established under the leadership at VA of Scott Gould and General Shinseki. I think we have 

taken it to a new level. Both Departments I think are truly committed to making this a seamless transition for our servicemembers 

from the DOD system to the VA system, and I think the professionalism and the commitment of the staff in both Departments is 

helping making that a reality. 

We have reached a historic level of cooperation between the two 

Departments, but there are still, as Scott said, tasks to accomplish. 

But let me just orallu stress a couple of the items where I think 

we have started to make progress. 

I think the greater cooperation at a basic level means that the 

soldiers who separate from the services are greeted by more comprehensive mental and physical care, by greater opportunity for 

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

Especially when you compare the experience of our troops today 

to the generation of heroes who returned from Vietnam, I think the 

progress we have made toward a single system of lifetime care is 

significant. 

As you noted, Deputy Secretary Gould and I oversee the support 

system that is in place to treat our wounded, ill, and injured. What 

I would like to do is just highlight a couple of efforts that we have 

made to improve the transfer and care of our wounded warriors 

and our progress toward establishing an electronic health record. 

One of the central goals that Secretary Gould and I have had has 

been to modernize the disability evaluation system which had really remained in place unchanged for decades. 

Today the revised and improved integrated disability evaluation 

system serves about half of the 26,000 person population with a 

wider adoption a top priority. We are hoping to achieve that by the 

end of the year. 

Servicemembers using IDES receive a single set of physical disability examinations conducted according to VA examination protocols with simultaneous processing by both Departments. This has 

created a more consistent set of evaluations, a more orderly experience for servicemembers and their families, and during the transition those processed through IDES continue to receive full pay, allowances, compensation, medical-based support, care, and benefits. 

This largely eliminates the benefits gap that occurred under the 

legacy system. 

In short, IDES is fair, faster, and a significant improvement over 

the legacy system. By years’ end we hope to have completely fielded IDES at the 139 sites nationwide. 

30 

The average IDES processing time, as Scott mentioned, is currently about 400 days. That is down from the 540 days of the legacy system but it has not reached the goal that we have set up— 

under 300 days—and so we have a further distance to go but we 

do not plan actually to stop there. We have a Tiger team working 

on ideas of how we would set a goal beyond 300 days. 

Electronic health records is also a promising area of collaboration. Among the many current systems that exchange data to varying degrees, DOD and VA have created a service called the blue 

button: that will allow beneficiaries to safely and securely access 

personal health data at TRICARE online; to support our most severely wounded and injured at Walter Reed, Bethesda, and Brooke 

Army Medical Center; and to provide scanned records and radiology images for patients transferring to some of VA’s polytrauma 

rehabilitation centers. 

To create a truly integrated electronic health record, DOD and 

VA have agreed to implement a joint common platform that has 

compatible data and services, joint data centers, common interface 

standards, and a common presentation format. 

We are going to utilize commercially available components whenever possible. This is an ambitious program and it has great potential benefits. But we also need to recognize that developing a largescale IT system is difficult business, especially an interoperable 

system across two major Federal departments. So, we are closely 

absorbing lessons from other successful large joint IT systems. We 

plan to use those lessons to lead us to the best possible outcome. 

I cannot overstate how far DOD has come with our VA partners 

in the 4 years since our leaderships have made working jointly a 

standard operating procedure. 

Despite the significant achievements, however, we should not underestimate what remains to be done. Taking care of our wounded, 

ill, and injured servicemembers is one of the highest priorities for 

the Department, the service secretaries, and the service chiefs. Indeed, as Secretary Gates often remarks, other than the wars themselves we have no higher priority. 

So Madam Chairman, thank you again for your support of our 

wounded, ill, and injured servicemembers, veterans, and their families. I look forward to your questions. 

[The prepared statement of Mr. Lynn follows:] 

PREPARED STATEMENT OF WILLIAM J. LYNN III, DEPUTY SECRETARY, U.S. 

DEPARTMENT OF DEFENSE

Chairman Murray, Ranking Member Burr, and Members of this Committee, 

thank you for inviting us to testify before you today. We meet at a time of historic 

cooperation between the Department of Defense (DOD) and Department of Veterans 

Affairs (VA). Thanks to President Obama’s commitment to Veterans, and to delivering the care they have earned, we have established a programmatic cohesion between our Departments that is better than ever before. More so than at any time 

in our Nation’s history, soldiers who separate from the service are greeted by more 

comprehensive mental and physical care; by greater opportunity for education and 

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

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

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

lifetime care is significant. 

The accomplishments to date are the result of budget increases for the VA; the 

personal involvement of Secretary Gates and Secretary Shinseki, and of bureaucratic spadework at every level in both Departments. 

31 

Deputy Secretary Gould and I have the distinct honor of overseeing the support 

systems in place to treat our wounded, ill, and injured. We accomplish this work 

through the Senior Oversight Committee, which the Secretaries of Defense and Veterans Affairs established in May 2007. The Senior Oversight Committee is focused 

on the care of our wounded warriors as they transition from the Department of Defense to the Department of Veterans Affairs. Today I would like to update you on 

our efforts to improve the transfer and care of our wounded warriors, including significant advances in diagnosing and addressing Traumatic Brain Injury and mental 

health issues. I would also like to brief you on our progress toward establishing an 

electronic health record. 

The 2007 revelations regarding Walter Reed were a wakeup call for us all. In the 

four years since, our Departments have worked in tandem to improve policies, procedures, and legislation that impacts the care of our wounded warriors. As a result 

of efforts in both Departments and in Congress, we have reached important milestones in improving care for our wounded veterans. These milestones include a new 

disability evaluation system, improved case management, the sharing of electronic 

health care data, and the treatment of the signature wounds of our wars today, 

Traumatic Brain Injury and Post Traumatic Stress Disorder. 

DISABILITY EVALUATION SYSTEM

One of our main goals has been to modernize the Disability Evaluation System, 

which had remained relatively unchanged for decades. The revised and improved 

system developed by DOD and VA, known as the Integrated Disability Evaluation 

System (IDES), today serves over half of the approximately 26,000 people in the system. Its wide adoption is a priority of the VA and DOD leadership. 

Servicemembers using IDES receive a single set of physical disability examinations, conducted according to VA examination protocols, with simultaneous processing by both Departments. Designing the process in this way ensures the relationship between servicemembers and VA is established before they separate from the 

service, and delivers disability benefits at the earliest possible time. It also leads 

to more consistent evaluations and a more orderly experience for servicemembers 

and their families. Under IDES, duplicative requirements and misaligned timetables 

are reduced or eliminated. Servicemembers who are processed through IDES also 

continue to receive full pay, allowances, compensation, medical and base support 

care and benefits as they prepare to transition to civilian life and VA care. This is 

an improvement over the legacy system, which sometimes left outgoing servicemembers with a gap before their VA benefits began. 

In short, IDES is fairer, faster, and has eliminated the ‘‘benefits gap’’ between 

DOD and VA that plagued the legacy system. By the end of this year, IDES will 

be completely fielded and serving people at 139 sites nationwide. As a result, DOD 

and VA will be able to deliver benefits more expeditiously. Today’s average IDES 

processing time is approximately 400 days from referral to post-separation, down 

from 540 days. The goal of IDES is to bring processing time down under 300 days, 

and a tiger team is currently devising means to reduce this further. 

TRAUMATIC BRAIN INJURY (TBI)

In the Afghanistan and Iraq campaigns, we can be thankful that advances in protective equipment and battlefield medicine allow more of our warfighters to come 

home to their families and a grateful Nation. This also means more troops are surviving who would not have done so in past conflicts—brave men and women who 

will need care long after the conflicts are over. Because of the prevalence of IEDs 

on the battlefield, more of these warriors return not only with visible wounds, but 

with invisible wounds that cannot be seen and are hard to treat. 

We as a department have come a long way in recognizing this reality. In 2010, 

the Department established the National Intrepid Center of Excellence, which is 

dedicated to advancing our understanding of combat related psychological health 

and Traumatic Brain Injury conditions. Already, we have made significant advancements in diagnosing Traumatic Brain Injury during the past several years, including early detection and state-of-the-art treatment for those who sustain TBI. 

Today, we better understand blast dynamics, have improved the detection of biomarkers used in the diagnosis of concussion, and can make quicker and more accurate diagnoses. This in turn drives the development of new treatments. We are also 

helping increase awareness of the signs and symptoms of TBI and when and how 

to undergo an evaluation. Materials aimed at line commanders, providers, and servicemembers themselves as well as our Online Family Caregiver Curriculum are 

now widely available. 

32 

One of the emerging findings from the body of research on TBI is the importance 

of beginning treatment early. So we are aggressively working to improve the diagnosis and treatment of TBI in-theater. Steps we have taken include deploying a 

rapid field assessment of mild TBI and requiring, since 2010, the comprehensive 

evaluation of servicemembers who are exposed to potential concussive events. 

Overall, we have made great strides in finding TBI, tracking TBI, and treating 

TBI. We are now working to prevent TBI through developing better protective 

equipment and operational procedures. And in a sign of our recognition of TBI as 

the signature combat injury of our times, we accord those who suffer from it and 

mild TBI with the oldest commendation given by our military, the Purple Heart. 

MENTAL HEALTH

Despite our efforts to date, a tragic number of our servicemembers and veterans 

commit suicide. DOD and VA have developed a mental health strategy that ensures 

our suicide prevention efforts fully complement one another. We have consolidated 

reporting of suicide events and standardized the measure of risk and protective factors. A web-based clearinghouse now serves as a tool for research and analysis. We 

have also developed new clinical guidance for depression, substance abuse, mild 

TBI, and co-occurring psychological disorders. Clinical tools such as the VA/DOD 

Major Depressive Disorder Toolkit and the Co-occurring Conditions Toolkit help providers used evidence-based approaches to treating mental and physical illness. 

Because not every veteran or servicemember lives near a facility that can provide 

the needed level of care, we are exploring the use of telehealth services and establishing a network of practitioners to serve rural locations. We have developed Mobile 

Telehealth Units, a web- based assistance program, smart phone applications to aid 

in the management and treatment of PTSD, and the Virtual PTSD Experience, an 

immersive, interactive activity that educates users about combat-related stress. 

We have long known at the Defense Department that when you enlist a serviceperson, you effectively enlist a family. And when it comes to mental health, families 

are a crucial link. Our efforts to support families include a 24/7 phone line, online 

chat, and email; online self-help tools; and in Transition, a coaching and assistance 

program to bridge gaps in behavioral health support during transitional periods. 

Many of you have seen the Sesame Workshop programs that help children cope with 

deployments and injured parents or read one of the 190,000 copies of ‘‘A Handbook 

for Family and Friends of Servicemembers.’’ The mental and emotional health needs 

of military children are among the least attended to, but most important, aspects 

of our current tempo of operations. 

We are also seeking to break the cycle of silence around mental health issues. 

Public education initiatives, including the Real Warriors Campaign, encourages servicemembers and veterans grappling with psychological health concerns to seek 

treatment. The campaign’s public service announcements, which reach over 1.5 million servicemembers each week, feature servicemembers who have reached out, obtained care, and continue to lead productive military and civilian careers. 

ADVANCES IN CASE MANAGEMENT

We have also made significant progress in how the cases of individual veterans 

are managed. Thanks to legislative changes in FY 2008 National Defense Authorization Act and the December 2009 Department Instruction 1300.24, non-medical care 

provided to wounded, ill, and injured servicemembers has been standardized across 

military departments. 

Today, Recovery Care Coordinators develop a comprehensive recovery plan for 

each servicemember’s non-medical needs. This plan includes tracking actions and 

points of contact to meet the goals of the servicemember and his or her family. Recovery Care Coordinators then work with commanding officers and medical care providers to implement the plan. Servicemembers with injuries of a catastrophic nature 

are further assisted by a Federal Recovery Coordinator. These coordinators are also 

assigned to severely injured and ill servicemembers who are highly unlikely to return to duty and who will most likely be medically separated from the military. 

Within DOD there are currently 146 Recovery Care Coordinators in 67 locations 

placed within the Army, Navy, Marines, Air Force, United States Special Operations 

Command and Army Reserves. The Care Coordinators who work out of these centers are hired and jointly trained by the Department and the Services’ Wounded 

Warrior Programs. To ensure cases are managed so as to avoid duplication, we are 

striving to better coordinate their efforts. There also currently are 22 Federal Recovery Coordinators at 12 medical treatment facilities and VA medical centers around 

the country. 

33 

SHARING HEALTHCARE DATA ELECTRONICALLY

One of the most promising areas of collaboration between our Departments is 

electronic health records. To ensure the continuity of care, health care data must 

be shared. At present, a number of information systems share data. The Federal 

Health Information Exchange provides for the one-way electronic exchange of historic healthcare information from DOD to VA for separated servicemembers. The 

Bidirectional Health Information Exchange (BHIE) allows clinicians in both Departments to view health data on shared patients. The Clinical Data Repository/Health 

Data Repository (CHDR) enables bidirectional sharing of outpatient pharmacy and 

medication allergy data. The DOD and VA have created a service called the ‘‘Blue 

Button’’ that, once complete, will allow beneficiaries to safely and securely access 

personal health data at TRICARE Online, the Military Health System’s Internet 

point of entry. And to support our most severely wounded and injured servicemembers, Walter Reed Army Medical Center, National Naval Medical Center Bethesda, and Brooke Army Medical Center are providing scanned records and radiology images for patients transferring to VA Polytrauma Rehabilitation Centers in 

Tampa, Richmond, Palo Alto, and Minneapolis. 

To work toward a true integrated electronic health record (iEHR), DOD and VA 

have agreed to implement a joint common platform with compatible data and services, data centers, interface standards, and presentation formats. Our joint approach 

will utilize commercially available components whenever possible. It will be led by 

a Program Executive and Deputy Director selected by the Secretary of Defense and 

Secretary of Veterans Affairs and overseen by an advisory board co-chaired by the 

DOD Deputy Chief Management Officer and the VA Assistant Secretary for Information and Technology. 

We are also working with the private sector on the Nationwide Health Information Network and the Virtual Lifetime Electronic Record. These efforts will enable 

the Departments to view a beneficiary’s healthcare information not only from DOD 

and VA, but also from other participants in the network. To create a virtual 

healthcare record, data will be pulled from existing electronic healthcare records 

and exchanged using data sharing standards and standard document formats. A 

standard approach will not only improve the long-term viability of how information 

is shared between VA and DOD. It will also enable the meaningful exchange of information with other government and private sector providers. Both DOD and VA 

are currently executing pilots to demonstrate the value of this approach. 

These various systems, while incredibly important to patient care, do not yet constitute a fully electronic health record. Such a record will contain all relevant health 

information from accession through end of life for all servicemembers and veterans, 

improving patient outcomes while reducing cost. 

As we go about this ambitious program that has such potential benefit for our servicemembers, it is important to keep in mind the difficulty of what we are trying 

to accomplish. Developing large-scale IT systems is difficult for any organization, 

public or private. Jointly developing an interoperable system across two major Federal departments is more difficult still. Secretaries Gates and Shinseki appreciate 

this. They remain personally involved, and have directed us to approach this project 

bearing several lessons in mind. To the extent that other large joint IT systems 

have succeeded, they have based on a common data foundation, common service bus, 

and common service broker. We are closely observing these lessons and are confident they will lead to the best possible outcome. 

Finally, the James A. Lovell Federal Health Care Center in North Chicago, Illinois has combined the missions of the Naval Health Clinic Great Lakes and the 

North Chicago VA Medical Center into a single organizational structure. This 

unique DOD/VA effort operates under a single line of authority, integrating management of the full spectrum of health care services. Through this effort, we are demonstrating just how compatible our two Departments’ clinical processes and business 

rules are, which will help to enable the implementation of a joint, common electronic 

health record platform. In standing up this effort, the Departments developed reusable capabilities such as joint patient registration, medical single sign on with context management, and orders portability. These capabilities are in demand throughout our respective enterprises, and will be fully leveraged as we develop electronic 

health records. 

CONCLUSION

These measures, taken together, substantially and materially affect the experience of our men and women in uniform, and the families who support them. Our 

work to improve the care of wounded warriors, especially as they transition from 

DOD to VA, is the core of our efforts to provide those who have sacrificed so much 

34 

the care and benefits they are owed. I cannot overstate how far DOD has come with 

our VA partners in the four years since our leaderships have made working jointly 

a standard operating procedure. 

Despite the significant achievements I have highlighted in this testimony, we 

should not underestimate what remains to be done as we care for a new generation 

of veterans who have served under such difficult circumstances, for such sustained 

periods. We will continue to work with our colleagues at VA and throughout the 

government to do everything we can to provide our servicemembers with the absolute best care and treatment. Taking care of our wounded, ill and injured servicemembers is one of the highest priorities for the Department, the Service Secretaries, 

and the Service Chiefs. As the Secretary Gates often remarks, other than the wars 

themselves, we have no higher priority. 

Mrs. Chairman, thank you again for your support of our Wounded, Ill, and Injured Servicemembers, Veterans and their families. I look forward to your questions. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO

HON. WILLIAM J. LYNN III, DEPUTY SECRETARY, U.S. DEPARTMENT OF DEFENSE

Question 1. Please provide the Committee with the following information for each 

location which is using the Integrated Disability Evaluation System (IDES): 

Response. DOD answers, extracted from the Veterans Tracking Application, are 

provided in the attached spreadsheet, which lists each of the current 78 IDES locations and the requested data for items a–d and g–s. VA is responding to 1e, f, and 

t. Additional responses by the services to individual questions are included below. 

The responses to question 2 are also attached. 

a) The Initial Operating Capability (IOC) date. 

b) The number of servicemembers expected to enter the IDES process each 

year. 

c) The number of servicemembers currently enrolled in the IDES 

d) The current staffing level for Physical Evaluation Board Liaison Officers. 

e) The current staffing level for Military Services Coordinators. [See VA responses.] 

f) The average time to complete all medical examinations. [See VA responses.] 

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

IDES process. 

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

longer than 295 days. 

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

longer than 540 days. 

j) The average time it takes to complete the IDES process. 

k) The total number of individuals who have completed the IDES process. 

l) The number of individuals who have completed the IDES process and were 

placed on the permanent disability retirement list. 

m) The number of individuals who have completed the process and were 

placed on the temporary disability retirement list. 

n) The number of individuals who have completed the process and were separated with severance pay. 

o) The total number of individuals who have been removed from the IDES 

process. 

p) The number of individuals removed from the IDES process who received 

an Administrative Discharge after court martial. 

q) The number of individuals removed from the IDES process who received 

an Administrative Discharge excluding court martials. 

r) The number of individuals who have died during the IDES process and the 

causes of their deaths. 

s) The number of individuals in the IDES who were returned to duty. 

35 


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More on Item r. The number of individuals who have died during the IDES 

process and the causes of their deaths. 

Response. The VTA database indicates that 40 Service Members have died 

while enrolled in IDES. A spreadsheet is attached (only Army has responded 

as of 11:48 Monday, May 16, 2011). 


518VTA1.eps
45 

t) The funding level for the IDES process, including funds that will be provided from any source. [Additional responses from VA found in VA statements.] 

Military Departments and VA—Air Force Answer 

Physical Evaluation Board: 

Manpower Costs for IDES* (FY12 and out years) (Off, Enl, Civ) ......................................... $4.875M 

Operations and Maintenance Costs (FY12 and out years) ................................................... $159K 

Equipment .............................................................................................................................. $187K 

Space ...................................................................................................................................... $1.41M 

Training (Annual Conference) ................................................................................................ $1.50M 

Military Treatment Facilities: 

PEBLO (funded and identified unfunded requirements) ....................................................... $6.0M 

Equipment (High Speed Copies, Scanners) ........................................................................... $517K 

Operations and Maintenance ................................................................................................. $217K 

Patient Travel for Compensation & Pension exams .......................................................... $14K 

Psychiatrist (Hickam) ............................................................................................................. $225K 

* Manpower costs include extensive use of Reserve Component since FY07 and projected need to maintain that back-up for surge in 

workload. In FY11, Reserve Component man days used were 372 days for Enlisted and 993 man days were used for Officers. 

2. In advance of the hearing, please provide the Committee with copies of the following: 

a. All weekly or monthly IDES Reports for 2011 that have not previously 

been provided to the Committee 


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b. Any IDES Customer Satisfaction Quarterly Reports that have not previously been provided to the Committee 

Response. Office of Wounded Warrior Care and Transition Policy: The most recent 

published report for the period Oct-Dec 2010, is attached. 


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3. For each branch of the military, please provide a detailed plan for how the 

IDES process will be implemented at overseas locations. 

Response. This data was previously provided to SVAC on March 29, 2011, regarding the November 18, 2010, hearing. 

Navy: The Navy and Marine Corps have agreed in concept that the overseas 

(OCONUS) assigned personnel, requiring a referral into IDES, will receive permanent change of station orders to a continental United States (CONUS) location 

where sufficient resources exist to support the needs of the servicemember and family. The CONUS location will depend on the medical condition, the potential separation site, and the personal desires of the Sailor or Marine. However, the location 

must be near a Navy or Marine Corps activity for detailing and separation purposes 

and a Veterans Affairs (VA) medical facility to accomplish the compensation and 

pension evaluation. The VA has been active in the Navy OCONUS implementation 

meetings to date and has been informed that we project approximately 170 cases 

annually. The VA has not expressed any objections or concerns to the plan since 

caseload will be dispersed across the country. 

Air Force: Proposed Plan for Overseas IDES is to return Airmen either to TRAVIS 

AFB or ANDREWS AFB; those in PACAF would be sent on medical TDY Orders 

to Travis; those in USAFE would be sent on medical TDY orders to Andrews. Compensation and Pension exams will be scheduled in advance with the Military Services Coordinator and the PEBLO will coordinate timely TDY orders. The Airmen 

will return to their OCONUS duty station pending the decision of the Physical Evaluation Board. Air Force has finalized the overseas proposal and forwarded a copy 

of the memo to VA. Our intent is to meet with representatives from Veterans Affairs 

to identify requirements for Military Services Coordinators and Compensation and 

Pension Exams. 

Army: Based upon guidance received from The Surgeon General on March 25, 

2011, the Army intends to bring Soldiers that are assigned overseas and are referred into the disability evaluation system to a continental United States (CONUS) 

location for processing through IDES. The Soldier will receive permanent change of 

station (PCS) orders to an installation that has an active IDES program and that 

is near the Soldier’s home of record. When it is in the best interest of the Soldier 

and his or her family to remain at their overseas location, the Soldier, as an exception to policy and in lieu of PCS orders, will be provided medical temporary duty 

orders to travel to a CONUS location to complete those aspects of the disability 

process that are not available in the OCONUS location (e.g. the compensation and 

pension examination) and then return to their duty station. Given that the anticipated workload will be spread among all IDES sites, no significant increase in cases 

at any one location is expected. The Army will continue to develop this plan and 

thoroughly discuss it with the VA. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY SENATOR PATTY MURRAY TO

HON. WILLIAM J. LYNN III, DEPUTY SECRETARY, U.S. DEPARTMENT OF DEFENSE

Question 1. A strategic goal of the Integrated Mental Health Strategy is to reduce 

stigma through successful public communication and use of innovative technological 

approaches. How are both approaches directly addressing servicemembers’ concerns 

about avoiding detrimental effects on their career when seeking mental health care? 

Response. The Departments are coordinating public communications regarding 

mental health care availability and effectiveness to ensure that there are adequate 

and consistent sources of information that directly address Servicemembers’ concerns about seeking care. These concerns most often involve effect on career, effect 

on peer acceptance, effect on family acceptance and interference with presence on 

the job. Messaging from DOD leaders emphasize that seeking care is a sign of 

strength, and that seeking mental health care will not adversely affect one’s career. 

An example of the technological approach being utilized is the Department’s National Center for Telehealth and Technology (T2), which is engaged in multiple 

projects to help servicemembers access information and care while avoiding concern 

that accepting care in innovative ways. One such project is afterdeployment.org, a 

web-based application spanning18 topics: post-traumatic stress, depression, anger, 

drugs and alcohol, tobacco, physical injury, resilience, military sexual trauma, 

health and wellness, sleep, families and friendships, anxiety, Traumatic Brain Injury, life stress, stigma, families with kids, spirituality and work adjustment. Designed to provide an online and anonymous self-care solution, the Web site offers 

multiple access points to learn, immerse, and engage in behavior-change strategies. 

Features include topical libraries, self-assessments, video-based personal stories, 

interactive workshops, community forums, expert blogs and a provider training porVerDate Nov 24 2008 11:07 Oct 11, 2011 Jkt 000000 PO 00000 Frm 00372 Fmt 6633 Sfmt 6621 H:\ACTIVE\051811.TXT SVETS PsN: PAULIN
367 

tal. To date, evaluation of the Web site indicates it is effective and well-received and 

the site has approximately 5,000 monthly visitors. 

T2 has also developed the ‘‘T2 Virtual PTSD Experience’’ a Web-based 3D virtual 

world resource providing an interactive, immersive tool that informs users about 

PTSD causes, symptoms and resources for care. This tool, accessible 24/7 from a 

personal computer, allows servicemembers, veterans, and their families to access 

PTSD-related resources in a convenient, personal, and anonymous way. 

Question 2. The Department’s Extremity and Amputation Center of Excellence is 

a joint program established to conduct clinical research as well as develop scientific 

information aimed at saving injured extremities, avoiding amputation, and preserving and restoring function of injured extremities. The Department has already 

developed the concept of operations for the structure, mission and goals for the Center, so what is delaying final approval? 

Response. The Department is examining the implementation status of this and 

other Centers for Excellence. We would welcome the opportunity to brief you or your 

staff on their current status, and the targets and goals for meeting the objectives 

of each Center. 

Question 3. Today, the Vision Center of Excellence, the Hearing Center of Excellence, and the Limb Extremity Center of Excellence all face major challenges in 

meeting their mandated objectives due to insufficient resources, limited staffing, 

lack of organizational governance oversight, and inadequate funding. Please provide 

the Committee with a detailed time line, complete with targets and goals, for each 

Center. 

Response. The Department is examining the implementation status of these and 

other Centers for Excellence. We would welcome the opportunity to brief you or your 

staff on their current status, and the targets and goals for meeting the objectives 

of each Center. 

Question 4. There are serious challenges in combating the stigma associated with 

seeking mental health care. The Department is still struggling to make it acceptable 

to ask for help. In the meantime, providing confidentiality for servicemembers to 

seek treatment is very important. Additionally, commanders have an obligation to 

know how fit and ready those in their units are. What is an acceptable balance of 

these concerns? 

Response. There are no easy solutions to this problem. As you indicate, an acceptable balance includes measures to ensure confidentiality for routine matters and notification to commanders in more serious cases. 

Confidentiality for routine mental health evaluations must be present so that each 

individual servicemember can overcome the common reluctance to seek help early. 

In July 2009, the Department issued a directive type memorandum in order to help 

achieve this aim. In more serious cases, such as those involving threat of harm to 

self or others, or risk of endangering the military mission, commanders must be 

notified. 

Question 5. What is the Department doing to improve conditions in the Warrior 

Transition Units? Is there a way that VA can assist? 

Response. The Army and Marine Corps have taken significant steps to improve 

conditions in the Warrior Transition Units (WTUs) and Wounded Warrior Regiment 

(WWR). The Army created a systematic framework called the Comprehensive Transition Plan (CTP), a structured multidisciplinary process accomplished for every 

Warrior in Transition that includes an individual plan that the Warrior in Transition builds for him/herself with the support of the WTU cadre. This process allows 

Warriors in Transition to customize their recovery process, enabling them to set and 

reach their personal goals. 

There are also currently 56 Ombudsmen at 31 sites, usually co-located with a 

military treatment facility (MTF). These Ombudsmen advocate for Warriors in 

Transition and Families as they deal with various issues related to health care and 

transition, such as physical disability processing, reserve component medical retention, transition to the VA, and pay issues. In addition, Veterans Benefit Advisors 

and Veterans Health Advisors are available to help Warriors in Transition and their 

Families apply for VA benefits and to coordinate health care to ensure a smooth 

transition for those Soldiers who will be transitioning to Veteran status. 

The Department leadership and the Army continues to work with Congress to 

fund military construction projects, including the development of Warrior Transition 

complexes that will serve both Warriors in Transition and their Families. To date, 

more than $1.2 billion dollars has been spent or obligated to improve the accessibility and quality of Wounded Warrior barracks. Construction of complexes continues through FY 2012 at which time 20 state-of-the-art complexes will be in 

operation. 

368 

The Marine Corps WWR continues to enhance its capabilities to provide added 

care and support to wounded, ill, and injured (WII) Marines and their families in 

accordance with the Commandant’s Planning Guidance. The WWR has evolved from 

its initial focus, standing up programs and services to address the immediate needs 

of Marines and families as well as building capabilities and structure based on confirmed requirements and findings in warrior care. 

The WWR currently has 49 Recovery Care Coordinators (RCCs) located in the 

WWR headquarters and battalions, military treatment facilities, and VA Polytrauma Centers. The RCC program continually adopts improvements to help WII 

Marines and families through heightened coordination with all WII Marines’ advocates, which include Federal Recovery Coordinators. 

Marine Section Leaders have the ability to provide motivation and daily accountability to help Marines meet their established goals, and there is mandatory participation in the Warrior Athlete Reconditioning Program (WAR-P) for Marines in the 

WWR. As part of the Integrated Disability Evaluation System (IDES), Marines receive support from Regional Limited Duty Coordinators who assist Marines processing through the system, and Wounded Warrior Attorneys who provide advice. 

The Marine Corps has also evolved a practice of staying in contact with Marines 

post-transition via the Call Center or District Injured Support Coordinators, who 

are located throughout the country, to ensure identified transition needs have been 

satisfied. The Call Center also receives calls for assistance and serves as the WWR’s 

hub for social media outreach to include Facebook and Twitter, which helps ensure 

Marines and families stay up-to-date on warrior care. 

The Department has also focused considerable effort to improve and streamline 

the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) processes and reduce paperwork requirements to more efficiently move a servicemember’s disability package through the adjudication process. The collaboration between 

the Department of Defense (DOD) and the Department of Veterans Affairs (VA) ensures that Warriors in Transition have priority processing by the Veterans Health 

Administration (VHA) and Veterans Benefits Administration (VBA) 90 days prior to 

separating so they can receive their VA benefits and health care immediately upon 

discharge. 

Question 6. What is the Department doing at Joint Base Lewis-McChord to address the average wait time for a servicemember in the Integrated Disability Evaluation System (IDES) pilot program to get a medical examination, especially given 

that this program is being implemented worldwide? 

Response. At the time of the hearing, the VA completed disability examinations 

at Joint Base Lewis-McChord in an average of 46 days for Active Component (AC) 

soldiers and 49 days for Reserve Component (RC) soldiers. DOD is working with VA 

to improve IDES timeliness at all locations, including Joint Base Lewis-McChord. 

To address timeliness for our Servicemembers at Joint Base Lewis-McChord, DOD 

and VA monitor IDES performance, examine timelines, and identify VA staffing and 

resource requirements so that solutions can be effectively implemented to achieve 

timeliness goals. As a result, DOD has 14 IDES-related hiring actions pending at 

Joint Base Lewis-McChord and anticipates the additional staff will dramatically improve IDES timeliness for Servicemembers there. 

Question 7. In the Joint Base Lewis-McChord Integrated Disability Evaluation 

System (IDES) pilot program the ratio of servicemembers to DOD case managers 

is 130 soldiers to 1 case manager. This is well over the goal of 20 servicemembers 

for every 1 case manager. What is the Department doing to address this troubling 

ratio? 

Response. To address this ratio, the Department and the Services are working aggressively to hire additional Physical Evaluation Board Liaison Officers (PEBLOs) 

to reach the desired case manager ratio of 1:20. Providing better, expedited IDES 

processing is a priority for the Department and we are actively engaged at the individual installation level to accomplish this. 

Question 8. The joint electronic health record (EHR) is the largest program ever 

developed between VA and DOD. The continuum of quality health care for millions 

of servicemembers and veterans is depending on the success of this project. Please 

provide a time-line for delivery, project costs, and expectations. 

Response. The work continues on implementation plans and the refinement of initial cost and schedule estimates. Despite this ongoing work, the Department does 

not have a completed timeline for delivery or project costs at this time. The Secretaries of Defense and Veterans Affairs chair recurring meetings on the integrated 

EHR (iEHR) and agreed to the joint development/acquisition of a number of functional capabilities/applications for iEHR, using the following business rules: 

369 

• Purchase commercially available solutions for joint use whenever possible and 

cost effective; 

• Adopt applications developed by DOD, VA, or Federal agencies if a modular 

commercial solution is not available and currently exists inside government; and 

• Approve joint application development on a case by case basis, and only if a 

modular commercial or federally-developed solution is not available. 

Moving forward, the Departments will continue efforts to develop a joint EHR by 

taking the following steps: 

• Implement the EHR Governance Model 

• Name EHR Program Executive 

• Complete development of common data model, translation service and other 

building blocks of the ‘‘To Be’’ architecture 

• Finish negotiations for Data Center consolidation 

• Implement pilots of the EHR Graphic User Interface (GUI) 

• Finalize VA use of the DOD data model and acquisition of services 

• Purchase Enterprise Service Bus for both Departments 

• Establish Open Source Custodial Agent 

Question 9. How will the Department, along with VA, improve the reporting and 

tracking of potential cases of hazardous exposures? 

Response. DOD will improve reporting and tracking by creating individual longitudinal exposure records (ILERs), where multiple information management systems 

are mined for exposure related information and the results made available to the 

VA for diagnoses, treatment, and claims adjudication. The ILERs will, among other 

things, serve to take the burden of proof off our Veterans to prove Service-connected 

exposures. 

Question 10. As members of the Guard and reserves transition in and out of active 

duty, they repeatedly switch between TRICARE, private insurance, and VA medical 

care. This creates a number of concerns regarding coordination of care, quality oversight, and the ability of the servicemember and family to manage those changes. 

How are these transitions being tracked by the Department, and effectively 

managed? 

Response. Tracking the care of Guard and Reserve members transitioning in and 

out of active duty is far more difficult, in part because private insurance partners 

generally do not share enrollment data or health care documents with DOD. That 

said, there are provisions in Federal law that assist with these transitions, and the 

Department has undertaken a number of efforts to further assist Guard and 

Reservists. 

For example, the Uniformed Services Employment and Reemployment Rights Act 

(USERRA) provides that a person returning to a civilian job after military service 

is entitled to reinstatement of employer-provided health insurance coverage. Members of the Guard and Reserve may choose to enroll in TRICARE Reserve Select, 

which allows them to select TRICARE as their insurance provider while they are 

in a civilian status. Additionally, Guard/Reserve servicemembers and their families 

are eligible for TRICARE coverage up to 180 days pre-deployment, and 180 days 

post-deployment. If they are already a TRICARE Reserve Select member their premiums will be waived during this time period. 

Furthermore, the Virtual Lifetime Electronic Record (VLER), once completed, will 

aid servicemembers, both Active Duty and Guard and Reserve, as they transition 

to and from the Military Health System by ensuring their information can be exchanged between DOD, VA, other agencies, and the private sector. 

Chairman MURRAY. Thank you. Secretary Lynn, you said that 

you want to go beyond the 300 days. We are not there yet. When 

do we expect to reach the goal of 300 days? 

Mr. LYNN. The hope is to have the system which is now implemented in about half or for half the servicemembers, half of 26,000. 

We hope to have that system fully implemented by the end of this 

year, so that is this fiscal year, this fall. 

Chairman MURRAY. So the 15,000 that Secretary Gould talked 

about that are in the new system? 

Mr. LYNN. There is another 14 or so thousand that are in the old 

system. We want to transition those over the next six or so months 

into the new system. 

370 

What we found, though, as we transition them in, what happens 

is that initially we actually get quite a lowering of the number of 

days as we work through the more routine cases on the faster system. 

But then what we find is that the time tends to come back up 

as we hit the harder backlog of cases. We need to work our way 

through that backlog which is what we are doing now with the existing cases, and so the data has actually gone up from where it 

was last fall. 

But we are working our way through that backlog. When we get 

our way through that backlog, we will then have a system where 

we are taking members who start in the new system and finished 

in the new system. At that point we should hit that 295 days. I 

cannot give you a date but I would say—— 

Chairman MURRAY. Are we talking months or years? 

Mr. LYNN. I would say 1 to 2 years. 

Chairman MURRAY. It still will take that long just to get 

people—— 

Mr. LYNN. I would hope to do it in a shorter period of time, but 

I do not want to overpromise. 

Chairman MURRAY. Is there anything this Committee can do to 

help expedite that, because these are individuals who are living in 

limbo. 

Mr. LYNN. Well, I think both Departments are committed to putting their resources toward working through the backlogs; and also 

when you go to a new system, you create transition difficulties. You 

need to surge resources to bases and facilities that are having 

problems. 

So, we have committed with our VA partners to do that. It is 

going to take over $700 million over several years. So, we are certainly looking. We will present that in our budget. We would certainly look for congressional support to spend those resources. 

Chairman MURRAY. This Committee needs to know honestly 

what the budget needs are because this is an obligation. We throw 

around 13,000, 300 days. These are individuals who are living 

through this, and I am very conscious of that. So we want to work 

with you, but we need honest budgets from both of you about what 

that will take. 

Mr. LYNN. Absolutely. 

Chairman MURRAY. I referenced something in my opening remarks that I want to ask about. The Department of Defense provided this Committee with information on those servicemembers 

who have died while they were enrolled in the joint disability program. Of the 34 deaths, 13 were suicides or drug overdoses. That 

is very troubling information. 

That means that the rate of suicide for those that are going 

through this program is more than double the rate of the Army and 

the Marine Corps. So, I wanted to ask both of you what your respective Departments are doing to address this troubling trend of 

suicides within the joint disability program? 

Mr. LYNN. Madam Chairman, the level of suicides is too high. 

Frankly, it is too high Department-wide. It is, as you know, higher 

with the people facing the challenges with disabilities. Certainly, 

371 

they have a more challenging life, and we need to do everything we 

can to ease those challenges. 

Part of it is what we just discussed. We need to make the disability evaluation system, that transition from DOD to VA, as expeditious and as congenial as possible. That is what we are about. 

We also need to support families and servicemembers with disabilities strongly in terms of the care coordinators, in terms of 

wounded warrior transition units. We need to inform families of 

the warning signs for suicides. 

Chairman MURRAY. You are saying we need to do that. Are we 

doing that? 

Mr. LYNN. Yes, we are. 

Chairman MURRAY. How is that being done? 

Mr. LYNN. Well, the system that is in place right now is we work 

with care coordinators to alert them to the signs. 

Chairman MURRAY. Actively, so everybody is involved in this? 

Mr. LYNN. Actively. Everybody is involved in this. The warrior 

transition units are particularly trained to look for signs and they 

are trained in how to deal with those. We have a broader suicide 

prevention system. We pay particular attention to the families of 

servicemembers because they are the most likely to be in a position 

to observe the early warning signs. 

Chairman MURRAY. Something is not working when we have this 

high number. Can you give me ideas or even a commitment to go 

back and take a look at these numbers and really look at our outreach? What are we doing to help support our families? Is it over 

use of drugs? And, come back to us because this is just unacceptable. 

Mr. LYNN. The numbers are too high, and I am happy to come 

back to you, Madam Chair. 

Chairman MURRAY. OK. Secretary Gould how about in the VA? 

Mr. GOULD. First of all, the numbers that you mentioned I just 

became aware of quite recently, and it is tragic to hear about the 

individual losses going down that list of individuals from DOD that 

have committed suicide. It is heart wrenching. 

As Secretary Lynn just said, we are very focused on making sure 

this transition goes well. The individuals who obviously are in that 

data are all on active duty and under the care of the DOD during 

that time. 

What we are trying to do is backstop in that process. VA is moving in parallel while those individuals are getting direct care. Bill 

has mentioned all of the various attributes of that. 

When transition time does come, VA is very focused on making 

sure that we are working to prevent suicides. We are conducting 

outreach and public education. We are amping up the resources 

that we bring to the fight on these issues. We are working to 

destigmatize it. We have a national crisis line that has served over 

400,000 people. Approximately 14,000 have been saved since 2007. 

We are working very, very hard and in a very focused fashion. 

Chairman MURRAY. Now, as result of the Joshua Omvig bill that 

we all worked to pass and support, I know that. 

I just want to say, Secretary Gould, I am very concerned about 

the high number of suicides, as I just said; but knowing that, we 

need to double our efforts with the soldiers who are coming out of 

372 

that program and leaving, because once they have left the program 

they are out there in the world, and we have to make sure that 

we are finding them. 

So, I am hoping that you take a look at those numbers and reflect on that given what we are doing with servicemembers who 

leave and go into the VA system. 

Mr. GOULD. Chairman Murray, we will. I would add and I think 

we all agree that the IDES systems is absolutely better than the 

legacy system. It is shorter. It eliminates the pay gap. The whole 

purpose here is not to put a veteran family in a situation where 

they do not have a paycheck. We want to make sure we are moving 

to that world. We do not want them to have to confront multiple 

medical examinations. The new system has one. 

So we think that on the whole the IDES system, despite the fact 

that it can and will be better, is a much better system than the 

one we are leaving behind. 

Chairman MURRAY. I think we all agree on that; but in the 

meantime, as you both just said, it is a while before we transition 

into that. 

So, I would like for the record for the both of you to provide the 

number of servicemembers and veterans who committed suicide or 

overdosed, who were in the warrior transition units and in the VA 

for the first time. 

So, if you could get back to me with those numbers I would appreciate it. 

Senator Isakson. 

Senator ISAKSON. Thank you, Madam Chairman. 

Secretary Lynn, I am told by Jim Lorraine at the Charlie Norwood VA and Laurie Ott, one of the big community supporters of 

that, that the Federal recovery program is essential to getting the 

seamless transition working, FRCs I think they call them. 

They commended the Department and the VA on establishing 

those. But there are only 22 Federal recovery coordinators in the 

United States and only two in Georgia where every ground troop 

from the U.S. Army goes through Georgia, either at Benning or 

Stewart, before they are deployed. 

It seems like 22 is a very small number of people to coordinate 

the transition of those wounded veterans from active duty to veterans care. 

What are you all doing to expand the Federal recovery program, 

the coordinator program, and how are you working to better get coordination between those coordinators working better? 

Mr. LYNN. Coordination is the key word there, Senator. The Federal recovery coordination program referred to is a VA program 

and I will turn to Secretary Gould. 

We have a parallel program called recovery care coordinator that 

complements that. We have actually 146 recovery care coordinators. That is a DOD program that handles people as they are in 

the DOD system that coordinates with their families, helps them 

navigate through that system. That is at 67 different installations. 

I do not know how many are in the installation you cited. We can 

get that for you. 

373 

They then coordinate with the Federal recovery coordination system which is a VA system. The objective is to make those two systems work seamlessly and in a complementary fashion. 

Let me ask Scott to talk about the FRC program. 

Mr. GOULD. Senator, just to get a sense of the numbers here, 

about the 1,300 clients in that system were served by individuals 

that you mentioned. About 80 percent customer satisfaction rating 

for that. 

I view this as a joint program. Our predecessor started this in 

2007 and recognized the following reality, that we had two agencies 

absolutely dedicated to taking care of their troops but what we 

wanted to focus on is making sure that the transition works more 

effectively. 

I think there is a very strong role. Bill and I have committed to 

a review of the Federal recovery coordinator program. We are going 

to hear a report next month in the Senior Oversight Committee, 

and the whole goal is to provide that person who has a view that 

extends between agencies and make sure that any last barrier can 

be knocked down, and any margin of additional service that we can 

provide to those most seriously wounded, ill, and injured warriors 

is provided. 

Senator ISAKSON. Well, if, as Secretary Lynn says, he has 163— 

is that right? 

Mr. LYNN. One hundred forty-six. 

Senator ISAKSON. If he has 146 coordinators at active duty and 

you have 22 in the FRC, that ratio itself begs the question: are we 

not understaffed, because the number is going to be about equal. 

Mr. GOULD. And, Senator, if that were the extent of the people 

who are focused to provide care coordination in VA, then I would 

conclude, as you have, that there is imbalance, but it is not. 

We have hundreds of people dedicated to care coordination roles 

within VA, and Mr. Lynn has just cited those individuals within 

DOD who provide that function. The Federal recovery coordinators 

are the layer on top of that which make sure that all of the individuals who are focused on providing care ordination, case management, team leaders, nurses on the ground, physicians, et cetera, at 

these facilities are working together across the boundary, and so 

the Federal recovery coordinators are really that top layer that ensures that the final measure of coordination is occurring between 

the two entities. 

But we have literally hundreds of people dedicated to that in the 

same way that the service does in our individual domains. What 

we want to do is function better across agencies. 

Senator ISAKSON. Well, you used a word that I hear very often 

that is problematic for me and that is layer. Sometimes there are 

too many layers and that is when people fall through the cracks. 

So, I think working on the coordination between those layers in 

the handoff is critical. And, my time is almost up, but I do want 

to mention one other thing. I have always taken great joy in the 

great logistics of our military and the great utilization they do and 

how they get so much done with so little. 

But I am really worried with Walter Reed closing and Bethesda 

taking over all of the work in this area, and the number of wounded warriors and their types of injuries from the wars we have been 

374 

in, and coming to Washington, I am wondering if Bethesda is going 

to be able to handle the weight of that. 

In Augusta, and I am not shilling for the home team here, but 

they are at 50 percent capacity at the VA hospital there. They 

could treat double the number of soldiers that they are treating 

right now. 

It would seem to me that with the numbers growing like you said 

in the testimony that I would like for you all to take a look at what 

facilities VA has around the country that are maybe underutilized 

in that rehabilitation so we can get better ratios for our soldiers. 

When we reach that level at Bethesda, we are sure we have the 

capacity to treat them. 

Mr. GOULD. Senator, I would be pleased to do that. We are constantly looking for opportunities to joint venture. In fact, we have 

nine locations across the country now that are under active consideration. 

Senator ISAKSON. Thank you. 

Chairman MURRAY. Senator Tester. 

Senator TESTER. Thank you, Madam Chair. It is not my home 

team so I can say this. 

I think it makes perfect sense to take a look at those facilities 

and figure out which ones. I mean, these are, well, I mean, it you 

do not want to overload one if the others are working. So, I appreciate Senator Isakson bringing that up. 

Deputy Secretary Lynn, you guys know the statistics for unemployment for our veterans as they come back in. It is atrocious. 

True, we are coming out of the worst recession since the 1930s. But 

the fact of the matter is where unemployment rates are for our veterans returning from combat are totally unacceptable. 

The chairman has a bill of which I am a co-sponsor of that she 

referenced in our opening remarks, and one of the things it does 

is it establishes a system for certifying the work and the skills 

gained the in the active military service. 

Can you clarify whether the DOD has the ability to establish 

such a system? And what it does is basically if you have a medic 

that is working in the medical field or if you have a truck driver, 

the list goes on and on. There are a lot of skills that are learned 

in the military. To be able to certify to the private sector once they 

get out of the DOD, be able to certify to the private sector that they 

have these skills. 

Does the DOD have the ability? 

Mr. LYNN. I will have to get back to you for the record. I am not 

aware of any program like that. 

Senator TESTER. If we were to set a program up like that, would 

you have the ability? Do you know that? If you do not, that is fine. 

You can get back to me on it. If we were to set a program up where 

the military, the Department of Defense, certifies that the work 

that these folks have done in the field establishes them at a level 

of expertise for the private sector, would the DOD have that 

ability? 

Mr. LYNN. Let me get back to you. 

Senator TESTER. I appreciate that. 

I think it is critically important. We heard from not 2 or 3 weeks 

ago a young gentleman by the name of Eric Smith in here who 

375 

could not get a job in the medical field because there was no recognition of the work he had done as a medic, which is pretty 

incredible. 

Deputy Secretary Gould, we have talked about electronic medical 

records for a long, long time. The GAO came out with a report or 

expressed concerns that the DOD and the VA lacked the mechanisms for identifying and implementing an efficient and effective IT 

solutions to create a joint system. I am sure you are aware of that. 

Can you speak to the measures you have taken to address that? 

Mr. GOULD. Senator, I would be happy to. If I might, just to add 

for Bill Lynn’s sake, at the VA we have been very focused on this 

issue. I think you are right. It is an opportunity for our veterans 

to translate the skills that they have, and so we actually have been 

working with DOD on this. 

VA has a system in place to help translate those skills that you 

are talking about. Someone who drives a truck in the military, who 

logs 100,000 miles under combat conditions, they ought to be safe 

for America’s roads. Can we find a way to do that a little bit more 

easily and efficiently? My sense is we can. 

Senator TESTER. Yes, and before I get—I will not ask this question again because you heard it but the fact is once they get to the 

VA end of things, once they get under your supervision, it is too 

late. This process has to be started when they are in the active 

military because it is important we certify what they have done. 

So, I appreciate that. 

Mr. GOULD. Sure. 

Senator TESTER. I appreciate, Deputy Secretary, I appreciate you 

being willing to get back to us and talk to us about how the Chairman’s bill will work, in fact, in the military because if it does not 

work we are going to have to address that then. 

How about the GAO concerns about the IT between DOD and 

VA? 

Mr. GOULD. Senator, I think the GAO concerns are legitimate, 

and as a result, the two secretaries got together and said we are 

going to fix it. That is the reason why we decided to implement a 

joint common electronic platform for our health records. 

But one thing if I could say quickly that should give this Committee confidence that we are heading down the right road despite 

Secretary Lynn’s concerns about the challenge of doing that is we 

have already delivered a prototype of the new interface. We will 

have in place by July of this year the new graphical user interface 

that will be the front-end of the system. 

Senator TESTER. Does that address the GAO concerns? 

Mr. GOULD. It does directly so it provides that common interface 

that both the DOD doctors and VA doctors have said would optimize their ability to treat patients in the system. We will have a 

single sign on in the North Chicago VA by the end of this year, and 

last, we will have significant functionality shared between the two 

agencies by June 2012. We are moving down the road quickly on 

incremental delivery of this new system. 

Senator TESTER. So, would it be fair to say the recent concerns 

that GAO put forth, you have addressed all the concerns? 

Mr. GOULD. I think that is fair to say that GAO has laid out an 

objective analysis of where we were, and in the last 60 to 90 days 

376 

we have taken enormous strides forward. Those recommendations 

and the direction that the Secretary has set have got us going to 

address these. We will do that. 

Senator TESTER. Are there any concerns that are not being 

addressed? 

Mr. GOULD. No. 

Senator TESTER. OK. I am out of time. 

Chairman MURRAY. Senator Johanns. 

Senator JOHANNS. Thank you, Madam Chair. 

Let me just offer for the record. I think, Senator Tester, you have 

a good idea here. When you think about our military today, it is 

vastly different than my generation, if you will, 30 years ago or 40 

years ago. 

These are true professionals. These are men and women who 

come and oftentimes make a career in the military. They are all 

volunteer. They are getting outstanding training. They are developing specialties in given areas that would translate to the private 

sector. I just wonder if we are not utilizing, fully utilizing that in 

terms of trying to employ them as they leave and return to the private sector. 

This is not well known but USDA actually has college where we 

grant degrees. Taxpayers do not pay for it so it is self-sustaining. 

But it is almost like that kind of concept, and I did not come prepared today to testify on that but you have turned a light bulb on 

in my head. I think it is a good idea and would be happy to work 

with you, Senator Tester, on that. 

Let me, if I might, start my questioning with a thought or two 

about mental health services. One of the things I mentioned in my 

opening statement is—just raise the question—are there enough 

evaluators as part of the backlog in terms of getting services? The 

fact that we have our evaluators just as busy as they possibly can 

be, doing as much as we possibly can, but we have positions open 

or we do not have enough. I would like to hear your thoughts on 

that, either one of you. It is actually a question for both of you. 

Mr. GOULD. So, Senator, let me start in. We have almost 20,000 

people in the VA focused on mental health care delivery, social 

service workers, clinicians, physicians, and the like. 

So, I believe that we have adequate resources in VA to be able 

to respond to any demand that DOD places on it. In fact, one of 

the things that Bill Lynn and I are working to do is to make sure 

that the process is as quick and efficient as it can be so that we 

do not create a logjam within the Armed Forces that would, as Senator Tester mentioned earlier, create a readiness issue for us. 

So, we are very focused on that. We believe we have the right 

capability. Deploying it at the moment in time where it is needed 

is a challenge. We need to get better advance data about where the 

demand will be and we have put in place contracting resources to 

be able to handle that surge capacity so that when we pick up the 

phone and call for additional services we can bring those into the 

challenge of processing individuals in IDES. 

Senator JOHANNS. Secretary Lynn, any thoughts? 

Mr. LYNN. Yes. The biggest challenge that we have in this area 

is bringing the resources to the right place at the right time. And, 

377 

by that I mean, we need to particularly focus on units that are deploying and then just returned from deployment. 

That tends to be a surge. Several thousand come to one location 

in a single point in time, and it overwhelms any reasonable number of mental health professionals they might have. They are just 

never going to have enough to deal with that surge in the confined 

period of time that you really want to. 

And, what you want to do is do an evaluation of people when 

they come home. You actually want to do baseline before they go. 

You want to do an evaluation when they come home, and then you 

want to do one 90 or 120 days later because oftentimes issues pop 

up that are delayed. 

What we have been trying to do in working with VA to tackle 

that is to make much greater use of virtual resources, not try and 

have a full complement of people on-site necessarily. That would be 

very difficult logistically to do. But to use virtual tools, to use 

Skype, use online materials. 

What this does is gives you an opportunity to have a personal 

consultation with each member rather than just say fill out a form 

which is the old method. In doing that, we have been particularly 

dependent on the resources that Scott just mentioned. 

We need to be able to take mental health professionals from 

around the country, point them to Fort Bragg or Fort Hood or 

Camp Lejeune, whatever the unit is returning to, so that we can 

bring that level of attention to the unit when they need that. 

The Army in particular has stepped out and has pioneered in 

this. The Marine Corps and the other services are going right behind them in doing it, and I think we can make significant 

progress in that area. 

Senator JOHANNS. OK. I am out of time. 

Chairman MURRAY. Thank you very much. 

Senator Brown. 

STATEMENT OF HON. SCOTT P. BROWN, 

U.S. SENATOR FROM MASSACHUSETTS 

Senator BROWN OF MASSACHUSETTS. Thank you, Madam Chair. 

Last December, GAO found that one of your pilot sites which, to 

be fair, was experiencing severe staffing shortages, spent an average of 140 days to complete just one exam. I know the desired 

timeline is 45 days. What is going on with that particular site? Are 

things getting better? Either one I guess. 

Mr. LYNN. Why do not I start. I mean, I think you have got the 

numbers right. I am not sure which site you are talking about. But 

there are challenges in making this transition. Overall, where we 

stand right now is that the old system, the average, the average 

not just for the evaluation but to get through the whole system is 

about 540 days. 

The average to get through the new system right now stands just 

under 400. We have a goal of getting it under 300. To get to that 

point what we have to do is deal exactly with the choke points that 

you are talking about, and our plan is to surge resources, in this 

case medical resources, to these choke points to get that backlog removed so that we hit the targeted number of days for each stage 

in the process, 45 as you said for the medical evaluation. 

378 

Senator BROWN OF MASSACHUSETTS. So is streamlining still to be 

at 400 days, 300 days, is that considered streamlining still? I mean, 

is that a realistic number? 

Mr. LYNN. Certainly, relative to 540. 

Senator BROWN OF MASSACHUSETTS. Yes. But when you are the 

servicemember trying to get on with your life, I mean, it is an 

eternity. 

Mr. LYNN. Fair enough. Go ahead. 

Mr. GOULD. Senator, I would just add that one of the challenges, 

I think one of the limitations of focusing on the time in the system 

is that there are actually two forces at work here. 

One is that we want to provide that servicemember with as much 

time as they and their families need to make that adjustment, and 

if that means a month or 2 months or 3 months and they are on 

military pay and they are getting military health care and their 

family is on TRICARE and we know where to find them and we 

know where to house them, that is a positive in my view. 

On the other hand, you do have individuals who say, look, I have 

come to terms with this. It has been life altering but my life is not 

over. I am ready for that transition. I think that is where you are 

pointing. That time needs to be shorter. 

What we are striving to create here is a system that allows the 

individual and the services the flexibility to get what each individual case requires. Our standard here is the veteran-centric approach which is what is good for them, what is right for them. We 

are also using other measures than length of time through the 

process. Customer satisfaction being one. Utilization being another. 

So, we are trying to find a balanced score card of how to measure 

people in this process and take care of them while we do. 

Senator BROWN OF MASSACHUSETTS. Are you concerned at all 

that, you know, when you are dealing with the contracting departments that they may be outpaced by innovative developments in IT 

and are you using things and are you adapting about using things 

like cloud data storage? Are you up on those things? 

Mr. GOULD. Senator, yes, I think this is one of the key components of the integrated electronic health record that secretaries 

Gates and Shinseki recently directed our two organizations to do. 

And, if I could just pick up a couple of key components there. 

One is we are adopting an open standard, common standard for 

data. We are building a new interface on a common basis. We are 

turning to the private sector to build the applications that will be 

part of this joint common electronic health platform. So we are 

leveraging to the maximum extent possible even so far as to use 

open source techniques to increase our rate of innovation and improve the rates of change that we have in our electronic health 

record systems. 

Senator BROWN OF MASSACHUSETTS. Just to stick with you for a 

second, sir, I cannot tell you how many hearings—I was just at 

hearing previously when we were talking about FEMA giving monies out inappropriately though no fraud, just through a mistake. 

I have had hearings with Senator Carper, and just monies that 

are going out under Medicare and Medicaid just through mistakes, 

76 billion a year, and, you know, it is just a mistake. OK great. 

379 

How sure will you be in the VA knowing that if Lieutenant Colonel Brown comes before you and you have everything that I am the 

right guy and that I am getting the benefits that I deserve? 

Mr. GOULD. That is a complex set of issues there. One is how effectively are we managing IT and making sure we do not have 

those high dollar mistakes. 

I think I am proud of our change in performance over the last 

2 years at VA. When we came on board there were over 300 separate IT projects. Today there are a little over 100. Only 20 percent 

of those projects were meeting their milestone goals, cost, schedule, 

and technical performance. Today over 80 percent are meeting 

those. 

Bill and I have committed to use that process called agile development in this joint development exercise that we are about to go 

through, and so we are bringing a sense of urgency and oversight 

and quality of management to this process that I think will avoid 

or lower substantially the risk that we might misspend money in 

this process. 

Senator BROWN OF MASSACHUSETTS. Thank you. 

Thank you, Madam Chair. 

Chairman MURRAY. Thank you. 

Senator Begich. 

STATEMENT OF HON. MARK BEGICH, 

U.S. SENATOR FROM ALASKA 

Senator BEGICH. Thank you, Madam Chair, and again thank 

both of you for being here again for the opportunity to have a few 

questions. 

We had a conversation, Secretary Gould, regarding Alaska and 

kind of how to deliver services and how to make sure they get the 

delivery. Can you give me some thoughts in regards especially 

around telemedicine? That is one of our biggest opportunities I 

think in rural health care not only for our State but I think for any 

State, Senator Tester’s, or others. 

So, could you give me some thoughts of how and what you see 

as an avenue and what the potential improvements are down the 

road in regard to telehealth and how you see that working especially in rural communities and then how connect up with existing 

services that may exist already in rural Alaska? 

Mr. GOULD. Senator, thank you for that question. 

This is an exciting area for VA and for the delivery of medical 

care. As you know, VA is one of the country’s leaders and innovators in telemedicine and telehealth. 

What makes it so sensible for VA to go out and go out hard, we 

are about a $165 million a year in investment in telemedicine and 

telehealth now, is that it essentially lowers the amount of time that 

a physician is in transit and puts him right out there in rural communities like your own and Senator Tester’s. There are communities where our biggest concern is delivering high quality care and 

creating and maximizing access. 

So, the use of telemedicine and telehealth allows someone in a 

remote, rural or very rural location to be able to tap into the expertise and specialty care that VA has throughout the system. 

380 

So, I see us using more of it. I see a strong business case for that 

to happen, and we are committed and engaged to rolling out telemedicine and telehealth nationwide. 

Senator BEGICH. Have you done, and when I say you I mean the 

VA, have they done a kind of strategic plan and kind of here is 

where we want to be with telehealth 5 years from now, 10 years 

from now? Is that something that has been developed because it 

will require resources, partnerships? Is that something that could 

be available to me or to the Committee if there is such a report 

done? 

Mr. GOULD. Certainly. There is a study and review, essentially 

the development of a business case with a clear vision, a net 

present value analysis that goes with that and the first wave of 

funds have obviously already been committed since we are a leader 

in this field. But we are putting additional money onto that this 

very year. I would be happy to share that with you. 

Senator BEGICH. Very good. I know we have introduced legislation about co-pays with regard to telemedicine. I do not know if you 

have had a chance to look at it. If you have not, we would be happy 

to share it with you because we think one is a cost saver for the 

VA. More people accessing it in certain ways will prevent higher 

costs in travel, higher cost in doctor visits and time consumption. 

So, if you have not looked at the legislation, we will share it with 

your office. I forgot to mention it to you when you came to see me 

that day. 

Mr. GOULD. Thank you, Senator. It sounds like an innovative approach to essentially finding more efficient ways for us to deliver 

care. 

Senator BEGICH. A little more incentive to get them on that. 

You may have answered this already during discussion earlier 

both of you but, Secretary Lynn, let me ask, and I know as a Member of the Armed Services Committee, DOD does their thing and 

then VA does their thing. Having you both here today is, I think, 

a great statement of kind of how these connections occur. 

Can you just from, and again you may have said it earlier. I 

want to just, I guess, hear it for myself. Do you think the Department of Defense, do you think they are stepping in the right direction aggressively enough in regards to recognizing that this transition that occurs to the VA, you do not just stop and say OK VA 

you deal with it? Do you think there is a culture change occurring 

enough that DOD recognizes their relationship with the soldier 

does not end when they are discharged? 

Mr. LYNN. Yes, I think there has been a culture change, Senator, 

and I think it is happening at multiple levels. At the top, Secretaries Shinseki and Gates have started from the very beginning 

meeting jointly to ensure that we have this seamless transition in 

the most recent set-up meetings. We talked about it today as really 

focused on implementing this integrated disability evaluation system and on gaining a joint electronic health record system. 

So, I think that top level focuses there but I think that has permeated the organizations. The Army and the Marine Corps, the 

other services tell me that the level of cooperation at the base level 

between base commanders and VA is unprecedented, that they deal 

with them now every day. 

381 

Part of it is with this disability evaluation system. But I think 

it is a broader relationship that is being built to accomplish just 

what you are talking about to make sure this transition that occurs 

is completely seamless. 

And, then finally in terms of the processes, the Integrated Disability Evaluation System which replaces the legacy DES which 

not only was not a system at all, it was actually a series of overlapping and inconsistent systems. Hence the integrated. 

It had several problems. As we talked about with Senator Brown, 

processing time was too long. The processes themselves were contradictory. You got two medical evaluations. The doctors had different opinions as they do. 

But maybe the biggest problem from the individual member is 

that it led often to a gap in pay and benefits. You would exit the 

DOD system and then it would take 6 or 9 months before you got 

fully into the VA system and actually got a check which is of course 

what it is. 

I think the new system, I do not want to say completely because 

you are going to find exceptions but it is designed to eliminate that 

gap, that we now keep them on the DOD payroll until they transition into the VA system, and that frankly creates a bill, but it is 

a bill well worth paying. So I think at that process level as well 

we have a cultural change in terms of how we view this. 

Senator BEGICH. I know my time is up. I know that is usually 

the biggest challenge for both the VA but DOD is kind of understanding that, and it sounds like you are making those good 

strides, that the soldier does not end the day they are discharged. 

They continue on, and there is this new integrated ability to ensure 

that, as you just described it, they do not have that gap of pay or 

benefits that are critical for that. Thank you. 

Obviously, the Committee Chairman who has put this meeting 

together today is really looking at this on an ongoing basis because 

I think that is where we hear, at least I hear the biggest complaints is that kind of once you are done with the DOD, then you 

are kind of out there in no man’s land, and VA is trying to look 

at the process. 

So I appreciate both of you being here today. 

Chairman MURRAY. Thank you very much. 

Secretary Gould, as you know, last week the Circuit Court of Appeals ruled that VA’s mental health services are inadequate and ordered the Department to work with the district court to revamp its 

entire mental health care system. 

I absolutely agree that more needs to be done to meet the mental 

health needs of veterans, but that ruling really was based on a 

number of points that I did not think were true and disagreed 

with. 

As all of us know, in the past several years Congress has made 

improvements to the VA’s mental health programs and made it a 

high priority. We passed the Joshua Omvig Suicide Prevention Act, 

the Justin Bailey Act, and we increased funding for mental health 

services that allowed us to hire more than 6,000 new mental health 

caseworkers since 2005. 

Those new professionals are seeing patients throughout the system including at many of our VA’s clinics. And, I know that VA is 

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currently revising the clinical standards that have transformed 

mental health care systems throughout the VA. 

There are absolutely things that the VA can do better especially 

reaching out to our veterans in rural America, and we know that 

VA and DOD have to work better together to make sure that mental health care needs are dealt with appropriately. 

I wanted to ask you today if you can discuss what the Department is going to do with respect to that Ninth Circuit ruling. 

Mr. GOULD. Chairman Murray, thank you, and I think you are 

quite right to summarize at a high level of both the active involvement of this Committee in oversight and the changes that have 

been driven by legislation, by vigorous oversight, and of course, the 

work that the VA has done as well to improve mental health care 

and adjudication of claims at VA. 

The decision was based on 2007 data, and we have traveled a 

long way in the 4 years since then. Our review will be to ask DOJ 

to honestly look at this. Meanwhile, we are working as hard as we 

can to comprehensively improve mental health care. 

Examples would be initiatives like our 24/7 crisis line, a 99 percent performance standard for 24-hour contact for anybody who is 

in crisis; 14 days or less, a 98 percent performance standard there. 

If somebody has an issue they can see somebody in 2 weeks’ time. 

We are vigorously pursuing outreach like suicide prevention. We 

have public service announcements, marketing campaigns, buses 

driving around cities with 800 numbers to call and coordinators in 

every local community dedicated to flushing this out and bringing 

people forward and destigmatizing the need to find help. 

And last, we are focused on research. We are figuring out how 

to prevent this, how to protect people from it, and we are even inquiring into brain changes that will occur when someone is in a situation like this. We are also modernizing our disability claims 

system. 

So we will ask DOJ to take a look at this very hard, and meanwhile we are focused on doing what we can do which is to improve 

the continuum of care between DOD and VA. 

Chairman MURRAY. OK. I appreciate that very much. 

I mentioned the in my opening remarks the issue of prosthetics, 

and I heard from a veteran recently who had received advanced 

prosthetics from the military, and I understand that when he went 

to the VA to get them adjusted, the VA employees had never seen 

the model that he was using before and, like I said, they were more 

interested in looking at that than they were in looking at him. 

Secretary Gould, I wanted to ask you what needs to happen to 

raise the quality of prosthetic care to the level that the military 

provides today? 

Mr. GOULD. Chairman Murray, first of all, for that individual, 

our deepest concerns and to focus on providing them the care that 

they need. 

Working with DOD on this is a little bit like working with 

DARPA. I mean, there is no question DOD has the primary responsibility for the advanced prosthetics. They have world-class facilities in three locations across the United States, the funding to do 

that, and they can focus those resources on the people who need 

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them and who need state-of-the-art bleeding-edge technology to be 

able to provide in this prosthetics world. 

We have 40,000 folks who have prosthetic devices in the VA, and 

by definition, we are restricted to providing technology that is commercially available. So, the DOD has got the lead stuff. We are providing commercially available. No question over time—— 

Chairman MURRAY. I thought the VA did research. 

Mr. GOULD. We do research as well, but not at the level and the 

sophistication and with the focus on so few individuals that DOD 

is able to employ in this instance. We do not have the same level 

of prosthetic leading-edge technology. We think we do it second to 

none for a broad base of individuals who have lost or had amputations due to vascular problems, not from combat. 

Chairman MURRAY. There has been a lot of progress in setting 

up the DOD/VA extremity and amputations center of excellence. 

When can we expect that to be fully operational? 

Mr. GOULD. Chairman Murray, as you pointed out earlier, I 

think that is a question of both DOD and VA collaboration and cooperation on that. I would turn to Secretary Lynn for that piece of 

the puzzle. 

This is the centers of excellence in DOD. 

Mr. LYNN. Yes. Congress has directed several centers of excellence, not just for prosthetics. 

Chairman MURRAY. Correct. 

Mr. LYNN. There is the vision center. What I think I owe you, 

Madam Chairman, is I think we need to take a close look at where 

we are because, frankly, in preparing for this hearing I did a comprehensive review of what was directed and where we stood, and 

I think we are not where we need to be. So, what I would rather 

do is come back to you after taking a quick, relatively quick look, 

come back to you with a plan for how we are going to implement 

this. 

Chairman MURRAY. I would very appreciate that because we 

have a lot of frustration with those centers, that is, in getting them 

up and established, and I am hearing a lot of complaints about how 

far behind it is. So, if you can get back to me directly with that, 

I would appreciate it. 

Senator Tester. 

Senator TESTER. Thank you, Madam Chair. 

For you Deputy Secretary Lynn, we have an Air Force Base in 

Great Falls called Malmstrom Air Force Base which we are particularly proud of in Montana and I think throughout the country. 

The issue of a medical records repository, which I do not know 

if you know anything about this, but the Air Force is looking to put 

a medical records repository, several of them around this country. 

Malmstrom Air Force Base is in the running. We have got Montana 

State University right next to that Air Force Base. It has a phenomenal amount of health technology system medical billing coding, medical transcription courses. It would be a perfect fit. There 

was a site survey recently completed on Malmstrom. 

Can you provide me or is it within your purview to be able to 

provide me with any details on the nature of the facilities being reviewed for suitability and discuss the current timetable for implementation of that? 

384 

Mr. LYNN. That particular one, no. But what I can tell you it is 

as part of the integrated electronic health record that Secretary 

Shinseki and Gates have directed at a foundational level what will 

make this successful is the use of common data is for the same 

record to go from DOD to VA with the servicemember. 

The initial piece and in many ways the most important is to go 

with common data. Part of that is we are going to rely on common 

data centers. We are going to utilize common data centers. Where 

we are in terms of actual site locations I cannot get into at this 

point. 

Senator TESTER. Can you get into it, can you go back and check? 

Mr. LYNN. I will certainly go back and check. 

Senator TESTER. And let me know who is being considered and 

where we are at in that process? 

Mr. LYNN. Yes. 

Senator TESTER. You are a gentleman and a scholar. Thank you. 

Deputy Secretary Gould, you and Joan Evans were in the other 

day in my office. I appreciate that visit. We talked about a pilot 

project around Vet Centers in, shall I say, frontier/rural areas of 

this country to really determine what kind of impacts there are because we have so many veterans living in rural areas, whether it 

is in Alaska, Montana, or other rural areas around this country. 

A pilot project in a highly rural area, I think, would be a great 

benefit. And, I just bring it up for the record today to make sure 

that it is on your radar screen and that we could work together potentially, work for that kind of a pilot. 

Mr. GOULD. Senator, thank you. It is, and we appreciate that 

suggestion. 

Senator TESTER. I appreciate your comment. 

Last, and I appreciate the Chairman going for any second round. 

American Indians serve in our Armed Forces at very, very high 

percentages, high greater numbers than any other ethnic group 

from a proportional standpoint. Health care for veterans on our Indian reservations is an ongoing struggle. Unemployment rates are 

through the roof. 

Are there any collaborative efforts that either of you know to specifically target the population in Indian country as they transition 

from the DOD to the VA? 

Mr. GOULD. We have recently appointed a senior executive to 

focus on native peoples, their veterans’ issues. We are focusing 

across the country on their needs, developing policies directly suited for them. We focus in our Yellow Ribbon and outreach efforts 

on making sure that every veteran is aware and enrolled in the 

system as early as possible. We are achieving about a 95-percent 

rate of penetration on that, and so, we are very focused on making 

sure that we have the people resources in place and the programs 

to be able to serve Native Americans. 

Senator TESTER. I appreciate that. In these programs and as you 

are gathering information, is there any opportunity or effort, either 

one, to talk to the folks on the ground in Indian country to find out 

how they feel they could be served in a way that makes sense both 

from an effective standpoint and a monetary standpoint? 

Mr. GOULD. Absolutely, Senator. In fact, we treat that as an 

intergovernmental issue with the tribal governments and extensive 

385 

travel and outreach, engagement both when the tribes’ representatives come here to Washington, extensive travel for Assistant Secretary Tammy Duckworth and her team is part of how we are trying to improve our outreach. 

Senator TESTER. I appreciate that very much. 

Thank you, Madam Chair, and I want to once again thank you 

both for being here today. I appreciate it. 

Chairman MURRAY. Thank you. Senator Begich. 

Senator BEGICH. Madam Chair, just a couple of quick questions. 

I want to follow up, Secretary Gould. You had said that, in response to the Chairman’s question, you do some research but you 

can use only commercially available prosthetics. Was that right? 

Mr. GOULD. Correct. We are restricted to use commercially available prosthetics. Among the reasons for that are the very large 

number of people that need to have prosthetics supported over time 

so they have to be maintained, and we also use that to create competitive pricing among all the possible vendors that are out there 

so that we can get, obviously, the best value and the highest quality product for the prosthetics devices that we do purchase from the 

private sector. 

Senator BEGICH. So it does not create a problem because if there 

is something that is not commercially available, how do you deal 

with that? 

Mr. GOULD. That is probably the challenge that Chairman 

Murray’s constituent had. They left the DOD care, had a state-ofthe-art system in place, but went for VA care, found that it was 

something so new that they were not able to make the repairs or 

make the adjustments. 

What we have done is embed our VHA personnel, prosthetics 

personnel, in the DOD system so we have folks who are there who 

can get a window into that. 

I imagine that, I hope that the conversation that unfolded was, 

look, we do not know how to figure that out but we will figure out 

how to get you care. And, I would be very interested to hear kind 

of what happened as the next step in that conversation. 

Senator BEGICH. If I can explore it just a second longer. If the 

mechanism was unable to be dealt with or repaired under VA, but 

DOD installed it, did they have the expertise? 

Mr. GOULD. Yes. 

Senator BEGICH. So why does not VA just contract with DOD and 

have it done? 

Mr. GOULD. I imagine that the next step was to have that person 

go and get the care and service that they needed. I would think the 

Chairman’s question and your follow-up to be about, are we doing 

as much as we can for those veterans who wear prostheses in our 

system, all 40,000 of them, many of them with diabetes and so on 

over time, I believe the answer is a wholehearted yes. We have a 

plan to further improve our system. We are working with our DOD 

colleagues on that. 

My earlier comments were just to show that there is an agency 

who is designated under law to be the primary lead for prosthetics 

and that is DOD; and as a consequence, the money, the people, the 

focus has resulted in world-class capabilities that would not be sensible to duplicate in the VA. But we still are able to avail ourselves 

386 

of their knowledge and we are learning from them. In fact, all industry then picks up the best inventions that they have and tries 

to make them commercially available. 

Senator BEGICH. I will leave it at that. I just want to echo, and 

we have talked about this also, what Senator Tester said about Indian country, especially in Alaska, how to deliver services in the 

very rural areas as we talked earlier about telemedicine but also 

just ensuring that they receive the benefits, the contact is there, 

and then how to use as we have talked to the VA for the last couple of years since I have been here on how we maximize, especially 

in Alaska because it is very different than the rest of the country, 

in how Indian health care is delivered. 

Indian health care is done by a consortium of tribes. It is managed throughout the whole State. It is not done by the Indian 

Health Services which is a different kind of model, actually we 

would argue the better model and actually is proving to be a much 

better delivery of services within the Indian Health Service. 

But because of that, and especially in rural areas, we have veterans who live in rural areas who are trying to get access but in 

order to do that it is very complicated to get to Anchorage or Fairbanks or some of the hubs. 

But yet we have clinics that are operated by the tribal consortium of Indian Health Services that are right next to their home, 

sitting right there. In one case, we are building one of two in the 

country in Nome, Alaska, $170 million state-of-the-art facility of 

the Indian Health Services to manage that whole area there, and 

there is no reason to replicate that from a veterans’ standpoint 

when the service is high quality there. 

So I know your office or the VA has been working with us aggressively trying to figure out how to do this and to deliver this. 

So again, I just want to put on the record that we are anxious to 

find what that magical opportunity is because we know when it is 

all done, it is just about hard cash and how to pay for the services, 

the Indian Health Services does, but the VA, veterans gone over 

there. 

But the reality is taxpayers are paying for both of these anyway. 

So it is to me more of an accounting issue. I just want to emphasize 

our point here that we want to continue to work with you to figure 

out what that right opportunity is even if it is a small demonstration project of areas of remoteness that are not connected by road 

and some very clear clarification so we are not privatizing the VA. 

We are not doing any of that. We are just trying to create access 

with another government agency that has great quality service 

equal to the VA. So I just want to put that forward. 

Mr. GOULD. Senator, thank you. Alaska has clearly been a big innovator here. One of our roles in VA is that we have to be flexible 

enough to work in partnership to create that community of care; 

and if there is a more efficient way, a better way for us to do it, 

we should certainly look into it. 

Senator BEGICH. Thank you. 

Thank you, Madam Chair. 

Chairman MURRAY. Thank you very much. 

I just wanted to mention to both of you, we have had a lot of discussion today about the joint disability evaluation system. At joint 

387 

base Lewis-McChord in my homestate of Washington, the average 

time that a soldier waits to get a medical examination today is 84 

days. That is well over the target of 45 days, and the ratio of servicemembers to DOD case managers is 130 soldiers to one case manager, well over the goal of 20 to 1. And, we know that soldier satisfaction is only 54 percent. 

So, we have heard from a lot of soldiers who put their lives on 

hold, their families on hold, that they are concerned about this 

process. I appreciate the comments you have made today, and I 

know the transition is difficult. But we have got to keep focusing 

on this because these are real families that are struggling. 

With that, I do want to thank Secretary Gould and Secretary 

Lynn for sharing with us their views today on what the VA and 

DOD can do together to better care for our servicemembers and 

veterans with both the visible and the invisible wounds of war. 

Next week, as I mentioned, this Committee is going to be hearing 

testimony from returning servicemembers and veterans who are 

going to speak about their experiences and talk about areas where 

the two Departments from their viewpoint can improve coordination to better meet their needs. 

I did want to say I was very encouraged this morning to hear 

that the VA has now assisted more than 625 severely wounded veterans in applying for the new services under the caregiver 

program. 

We have been following that very closely. It is very important to 

us, taking a long time to get to this point, but I am glad that those 

families can now begin to receive those very important benefits. It 

is going to make a big difference in their lives. 

With that, I look forward to working with both of you, the VA 

and the Department of Defense, in the months ahead as we continue to make sure that our transitioning servicemembers get the 

best care and services as quickly as possible. I appreciate both of 

you again being here today. 

This hearing is adjourned. 

[Whereupon, at 11:33 a.m., the Committee was adjourned.] 

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