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73–774 2013

REEVALUATING THE TRANSITION FROM 

SERVICEMEMBER TO VETERAN: HONORING A 

SHARED COMMITMENT TO CARE FOR THOSE 

WHO DEFEND OUR FREEDOM 

HEARING 

BEFORE THE

SUBCOMMITTEE ON DISABILITY ASSISTANCE 

AND MEMORIAL AFFAIRS 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

WEDNESDAY, MARCH 28, 2012 

Serial No. 112–53 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

CLIFF STEARNS, Florida 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

DAVID P. ROE, Tennessee 

MARLIN A. STUTZMAN, Indiana 

BILL FLORES, Texas 

BILL JOHNSON, Ohio 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

ANN MARIE BUERKLE, New York 

TIM HUELSKAMP, Kansas 

MARK E. AMODEI, Nevada 

ROBERT L. TURNER, New York 

BOB FILNER, California, Ranking 

CORRINE BROWN, Florida 

SILVESTRE REYES, Texas 

MICHAEL H. MICHAUD, Maine 

LINDA T. SA ́ NCHEZ, California 

BRUCE L. BRALEY, Iowa 

JERRY McNERNEY, California 

JOE DONNELLY, Indiana 

TIMOTHY J. WALZ, Minnesota 

JOHN BARROW, Georgia 

RUSS CARNAHAN, Missouri 

HELEN W. TOLAR, Staff Director and Chief Counsel 

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS 

JON RUNYAN, New Jersey, Chairman 

DOUG LAMBORN, Colorado 

ANN MARIE BUERKLE, New York 

MARLIN A. STUTZMAN, Indiana 

ROBERT L. TURNER, New York 

JERRY McNERNEY, California, Ranking 

JOHN BARROW, Georgia 

MICHAEL H. MICHAUD, Maine 

TIMOTHY J. WALZ, Minnesota 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 

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C O N T E N T S 

March 28, 2012 

Page 

Reevaluating The Transition From Servicmember To Veteran: Honoring A 

Shared Commitment To Care For Those Who Defend Our Freedom .............. 1 

OPENING STATEMENTS 

Chairman Jon Runyan ............................................................................................ 1 

Prepared Statement of Chairman Runyan ..................................................... 40 

Hon. Jerry McNerney, Ranking Democratic Member ........................................... 2 

Prepared Statement of Hon. Jerry McNerney ............................................... 40 

Hon. Russ Carnahan ............................................................................................... 4 

Prepared Statement of Hon. Russ Carnahan ................................................. 42 

WITNESSES 

John Medve, Office of VA-DoD Collaboration, U.S. Department of Veterans 

Affairs .................................................................................................................... 5 

Prepared Statement of John Medve ................................................................ 42 

Mr. Jim Neighbors, Director, Requirements and Strategic Integration, U.S. 

Department of Defense ........................................................................................ 6 

Prepared Statement of Jim Neighbors ........................................................... 44 

Executive Summary of Jim Neighbors ........................................................... 52 

Dr. Gail Wilensky, Senior Fellow, Project HOPE ................................................. 17 

Prepared Statement of Gail Wilensky ............................................................ 53 

Executive Summary of Gail Wilensky ............................................................ 56 

Mr. Ken Fisher, Chief Executive Officer, Fisher House Foundation, Inc. .......... 19 

Prepared Statement of Ken Fisher ................................................................. 56 

LTG James Terry Scott USA (Ret.), Chairman, Advisory Committee on Disability Compensation ........................................................................................... 21 

Prepared Statement of LTG James Terry Scott ............................................ 58 

Mr. John Wilson, Assistant Legislative Director, Disabled American Veterans 27 

Prepared Statement of John Wilson ............................................................... 60 

Mr. Phil Riley, Senior Benefits Liaison, Wounded Warrior Project .................... 29 

Prepared Statement of Phil Riley ................................................................... 64 

Overview of Wounded Warrior Project Testimony ......................................... 72 

Mr. Eric Greitens, Chief Executive Officer, The Mission Continues ................... 31 

Prepared Statement of Eric Greitens ............................................................. 72 

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REEVALUATING THE TRANSITION FROM 

SERVICEMEMBER TO VETERAN: HONORING 

A SHARED COMMITMENT TO CARE FOR 

THOSE WHO DEFEND OUR FREEDOM 

Wednesday, March 28, 2012 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON DISABILITY ASSISTANCE

AND MEMORIAL AFFAIRS, 

Washington, D.C. 

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

Room 334, Cannon House Office Building, Hon. Jon Runyan, 

[Chairman of the Subcommittee] presiding. 

Present: Representatives Runyan, Stutzman, McNerney, Walz, 

Carnahan. 

OPENING STATEMENT OF CHAIRMAN JON RUNYAN 

Mr. RUNYAN. Good morning and welcome, everybody. The Oversight Hearing of the Subcommittee on Disability Assistance and 

Memorial Affairs will now come to order. 

We are here today to examine the current framework in the ongoing efforts to streamline the transition process between active 

duty soldier to veteran. The streamlining of this process has been 

the implementation of the Integrated Disability Evaluation System, 

otherwise known as IDES. This program was created in December 

of 2007, following the recommendations of the Veterans Disability 

Benefits Commission and the President’s Commission on Care for 

American Returning Wounded Warriors, otherwise known as the 

Dole-Shalala Commission. 

The IDES goal was to improve the timeliness, effectiveness and 

transparency of the former legacy DES review process which has 

been in place for over 60 years. In October of 2010, the VA and the 

DoD worked in concert to begin the permanent shift to IDES 

around the country in 139 locations. 

The ultimate objective remains to fully close the gap which occurs between the separation from active duty service to the receipt 

of VA benefits and compensation. 

I am pleased to see the process being made to meet this objective 

under the new system, specifically helping to cut the transition 

time between active duty and veteran status. However, there are 

several issues and unforeseen problems which need to be addressed. First, issues with the processing times remain problematic; whereas some recovering warriors experience lengthy delays 

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in their attempt to navigate through the IDES system, others are 

rushed through without receiving the proper medical attention that 

they need. 

Secondly, many recovering warriors reported that they find the 

IDES process to be extremely confusing and difficult to understand. 

Further efforts must be made to work directly with our recovering 

warriors to ensure that they are making the right decision for 

themselves, their families and their futures. 

Finally, IDES is not as simple in practice as the various Commission reports were hoping it would be when it was first proposed. 

Now, nearly five years after its inception, it is important for both 

the VA and the DoD to continue evaluating the system and their 

efforts to achieve its goals of increasing transparency, improving 

consistency and eliminating duplicate processes. 

As a new generation of active duty servicemen and women return 

home from conflicts overseas, we must be prepared to meet our 

commitment to see that their transition to civilian and veteran life 

is as efficient and as simple as possible. This is our duty to see that 

their service is honored as best as our resources will permit. 

It is my hope that this Oversight Hearing will shed some light 

on some of the problems that we have encountered in the implementation of IDES so we may work together to find the best solution possible. 

I want to thank the VA, the DoD, and the present VSOs, Dr. 

Wilensky, Mr. Fisher and General Scott for their valuable input as 

we work together to find important solutions. 

We welcome today’s witnesses and we now call on the Ranking 

Member for his opening statement. 

[THE PREPARED STATEMENT OF CHAIRMAN JON RUNYAN APPEARS

IN THE APPENDIX]

OPENING STATEMENT OF HON. JERRY MCNERNEY, 

RANKING DEMOCRATIC MEMBER 

Mr. MCNERNEY. Thank you, Mr. Chairman. I would like to thank 

you for holding today’s hearing. 

The purpose of this hearing is to focus on the transition process 

of servicemembers to veterans, with a particular focus on the implementation of the Integrated Disability Evaluation System, also 

known as IDES, which is a joint VA/DoD examination and records 

integration effort initiated in 2007 as a result of the fallout from 

deplorable conditions and disjointed care found for our wounded 

warriors at the Walter Reed Army Hospital. 

This hearing will allow us to not just to assess the effectiveness 

of the Integrated Disability Evaluation System, but other components of the Pre-Discharge Program established by the Departments of Defense and Veterans Affairs to streamline 

servicemembers’ transition from active duty to veterans’ status. 

Today’s discussion on IDES also follows up on our work implementing the Veterans’ Benefits Improvement Act of 2008, Public 

Law 110–389, which also paved the way for a number of initiatives 

targeting the VA claims backlog. 

In 2007, the Dole-Shalala Commission, set recommendations for 

the care of wounded warriors, and concluded that it is not nearly 

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enough to patch a system for transition to civilian life, as has been 

done in the past. The experiences of our men and women returning 

home complaining about lack of a clear outline of access to care, 

benefits, and services available to them highlighted the need for 

fundamental changes in the care management and disability systems. 

The Dole-Shalala findings marked the siren call for the creation 

of a joint effort between DoD and VA to move to a one-exam platform which today we know as the Integrated Disability Evaluation 

System or IDES. 

We must make every effort to focus our resources toward assisting transitioning servicemembers with the comprehensive, coordinated care and benefits that they deserve. This must occur at the 

very beginning of a servicemember’s reintegration. 

To this end, any member of the Armed Forces who has seen active duty, including those in the National Guard or Reserves, is eligible to apply for VA disability benefits prior to leaving military 

service through the Benefits Delivery at Discharge, Quick Start, or 

IDES pre-discharge programs. 

During the application process, servicemembers can get help in 

completing forms and preparing other required documentation from 

VA personnel located at their bases. Additionally, IDES combines 

the health exam required by the DoD upon exiting the military and 

the VA Disabilities Assessment Exam into a single process, albeit 

for different purposes. 

In the meantime, in an effort to provide even greater transition 

assistance, more elements and players, like the Federal Recovery 

Coordination Program, have been added to assist our wounded 

warriors. 

I know the intent of these programs are well meaning and have 

helped numerous veterans across our country, but I still hear from 

veterans in my district who have gone through these programs and 

continue to experience significant delays, confusion and other problems with effective reintegration. 

In fact, to that end, I would like to mention that Mr. Barrow, my 

colleague, has a helpful bill pending before the Health Subcommittee, H.R. 3016, that would improve reintegration efforts and 

require that the Federal Recovery Coordination Program operate 

jointly under the DoD and VA. 

Since its full implementation at the end of 2011, IDES has been 

expanded from 3 military bases to more than 139 sites globally and 

nationally. 

With the draw down of troops over the next few years, I am particularly concerned by the fact that the average processing time 

takes 400 days and that there are about 200,000 servicemembers 

already in the system. We don’t need another backlog and want to 

avoid that kind of outcome at all costs. 

I look forward to having an open dialogue with the panels here 

today, and with my colleagues, on ways to overcome challenges 

within the IDES system, and to accelerate processing without sacrificing quality. Separating servicemembers should not wait more 

than a year for assessments and benefits. 

It is my hope that through our examinations of the IDES and 

other pre-discharge programs today, coupled with the electronic inVACREP180 with DISTILLER

4 

tegration and other business reformation efforts accomplished over 

the last few years, we will continue to improve and transform today’s VA claims processing system and help our servicemembers 

successfully transition back into our communities, and not into another backlog. 

I look forward to hearing from our esteemed witnesses, and I 

thank you, Mr. Chairman. I yield back. 

[THE PREPARED STATEMENT OF HON. MCNERNEY APPEARS IN THE

APPENDIX]

Mr. RUNYAN. Thank you, Mr. McNerney. With that being said, 

in the order of business I would like to welcome our colleague, Mr. 

Carnahan, here. I ask unanimous consent that he participate in 

this hearing. 

Hearing no objection, so ordered. 

Do any other Member wish to make an opening statement? 

Mr. Carnahan is recognized. 

OPENING STATEMENT OF HON. RUSS CARNAHAN 

Mr. CARNAHAN. Thank you, Mr. Chairman and Ranking Member 

McNerney. I am pleased to be sitting with the Subcommittee today 

and especially proud to have an organization from my district in 

St. Louis that has grown nationally. I had the pleasure of working 

with them. Testifying for them today will be their CEO, Eric 

Greitens of The Mission Continues. 

The Mission Continues is truly a remarkable organization that 

empowers veterans to transform their lives and the lives of others 

by participating in community service fellowships. The Mission 

Continues fellows serve six months as community nonprofit organization and afterwards either obtain full-time employment, pursue 

higher education or permanent roles in service. 

This is truly a remarkable program that not only gives veterans 

a much needed sense of purpose following military service, but also 

eases an often extremely difficult transition to civilian life and is 

an organization that is run by a Navy SEAL and many former 

members of the military. The Mission Continues has a keen understanding of the many challenges facing our servicemembers when 

they return home. 

As this organization continues to make this model more accessible and available to veterans across our country, my colleagues 

and I stand ready to continue to support them and their work in 

this life-changing mission for our veterans. 

With that, Mr. Chairman, again, I want to thank you for allowing me to join in the Subcommittee today. I look forward to hearing 

the testimony, not only of The Mission Continues but the other organizations who are here today to talk about these important 

issues. 

I yield back. 

[THE PREPARED STATEMENT OF HON. RUSS CARNAHAN APPEARS IN

THE APPENDIX]

Mr. RUNYAN. Thank you very much. I would like to welcome 

panel one, now. First, we will be hearing from Mr. John Medve 

with the Office of VA–DoD Collaboration and the Department of 

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5 

Veterans Affairs. And next we will hear from Mr. Jim Neighbors 

who is the Director of Requirements and Strategic Integration of 

Department of Defense. 

Your complete written statements will be entered into the hearing record. And Mr. Medve, you are now recognized for five minutes for your oral statement. 

STATEMENT OF JOHN MEDVE, OFFICE OF VA–DOD COLLABORATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; JIM 

NEIGHBORS, DIRECTOR, REQUIREMENTS AND STRATEGIC 

INTEGRATION, U.S. DEPARTMENT OF DEFENSE. 

STATEMENT OF JOHN MEDVE 

Mr. MEDVE. Thank you, Mr. Chairman. 

Good morning, Chairman Runyan, Ranking Member McNerney, 

and Members of the Subcommittee. My name is John Medve, Executive Director of the Department of Veterans Affairs Office of VA– 

DoD Collaboration within the VA’s Office of Policy and Planning. 

I am pleased to be joined by Mr. Jim Neighbors from the Department of Defense, as well as Mr. Michael McDonald from the Federal Recovery Care Coordination Program, Ms. Debbie Ender from 

the VHA, Mr. Tom Murphy from VBA. 

I ask that my complete statement be included in the record. 

The Subcommittee asked that I focus my testimony on the status 

of the transition process from DoD to VA, with an emphasis on the 

Integrated Disability System, IDES, and the Federal Recovery Coordination Program, FRCP, as well as VA’s Veterans Affairs Schedule for Ratings Disabilities, VASRD, modernization efforts. 

With respect to IDES, much has been accomplished to improve 

the DoD disability process in the wake of the issues identified in 

2007 at Walter Reed Army Medical Center. 

In early 2007, VA partnered with DoD to make changes to DoD’s 

legacy Disability Evaluation System, which resulted in the implementation of IDES. IDES is now the standard process for all 

servicemembers who are being medically transitioned out of their 

respective service. 

The goals of the joint process were to eliminate the benefits gap, 

increase transparency for servicemembers, reduce the processing 

time and improve the consistency of ratings for those who are ultimately medically separated. We have accomplished those goals. We 

are now focused on continuing improvement to that process. 

With respect to the Federal Recovery Coordination Program, 

FRCP, it was created in October 2007 in direct response to the 

Dole-Shalala Commission’s recommendation for improved care coordination for wounded, ill and injured servicemembers. Federal 

Recovery Coordinators, FRCs, are located in 12 facilities across the 

country, including four military treatment facilities, two VA Medical Centers, three VA poly-trauma centers, and three Wounded 

Warrior Program offices. 

FRCs assist severely wounded, ill, and injured servicemembers, 

veterans and their families through each client’s recovery, rehabilitation, and reintegration. The FRC creates a Federal Individual Recovery Plan for each client based on the goals expressed by the cliVACREP180 with DISTILLER

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ent, with input from his or her family and/or caregiver and health 

care team. 

FRCP is unique to other programs in that once an FRC is assigned to a client, the FRC is the constant point of contact for that 

client throughout all transitions. 

With respect to the Veterans Affairs Schedule for Ratings Disabilities, the VASRD, it is a regulatory framework through which 

VA provides veterans with compensation for diseases and injuries 

they incur while serving our Nation. It is this rating schedule that 

guides the disability rating personnel of VA and DoD in making 

the correct determination of the compensation benefit level applicable for Veteran’s service-connected conditions. 

VA has partnered with DoD and the academic community to collaborate on revisions to the rating schedule. The collaboration involves public forums in which medical experts, members of the Advisory Committee on Disability Compensation, DoD officials, Veterans Service Organizations, and other stakeholders provide input 

and subsequently form working groups to substantively revise the 

rating schedule. 

The VA remains fully committed to meeting the needs of our Nation’s heroes and their families. VA and DoD are partners and will 

continue to work together diligently to resolve transition issues 

while aggressively implementing improvements and expanding existing programs. 

Thank you again for your support of our wounded, ill and injured 

servicemembers, veterans and their families. This concludes my 

testimony and I will be happy to respond to any questions. 

[THE PREPARED STATEMENT OF JOHN MEDVE APPEARS IN THE APPENDIX]

Mr. RUNYAN. Thank you, Mr. Medve. 

Mr. Neighbors, you are now recognized for your oral testimony. 

STATEMENT OF JIM NEIGHBORS 

Mr. NEIGHBORS. Good morning, Chairman Runyan, Ranking 

Member McNerney and Members of the Committee. My name is 

Jim Neighbors and I am the new Executive Director for DoD–VA 

Collaboration Office within the Office of Personnel and Readiness. 

It is my pleasure to be here with my friend, John Medve, to testify on the transition of our servicemember to veterans status. I 

would also like to take this opportunity to thank John publicly for 

helping to bring me up to speed on our very important work. 

Taking care of our servicemembers is the highest priority of the 

Department of Defense. Over the past five years, DoD and VA have 

worked together with assistance and guidance from Congress to reform the cumbersome and often confusing bureaucratic processes 

which provide care and benefits to our servicemembers when and 

where they need them. 

Working closely, deliberately and collaboratively, our departments have established governance at the highest levels to facilitate continuous improvements and to achieve our goal of seamless 

transition from servicemember to veteran. The duty of VA to an executive council co-chaired by the Deputy Secretary of Veterans Affairs and the Under Secretary of Defense for Personnel and ReadiVACREP180 with DISTILLER

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ness is the body created by Congress to formalize the collaboration 

between our departments ensuring interagency oversight to 

streamline, deconflict and expedite efforts to improve health care, 

disability processing and the seamless transition of servicemembers 

to veteran status. 

Additionally, the Secretary of Defense and the Secretary of Veterans Affairs meet on a quarterly basis to discuss high priority 

matters that span both departments such as the Integrated Disability Evaluation System and electronic health records. They will 

continue the dialogue toward resolving any issues and critical 

areas of collaboration between our departments. 

There are three areas I would like to particularly highlight on 

our work and focus on servicemembers. First, Recovery Care Coordination Program was established by Congress to provide recovery care coordinators or RCCs whose responsibilities include ensuring servicemembers’ non-medical needs are met during recovery, 

rehabilitation, reintegration and in addition to assisting with the 

development and implementation of individual comprehensive recovery plans. 

Currently, there are 171 RCCs and 198 Army advocates in 84 locations worldwide within the service Wounded Warrior Programs. 

More than 3,800 servicemembers and families have received the assistance of an RCC. 

Second, the Integrated Disability Evaluation System, streamlining the DES process with servicemembers receiving a single set 

of physical disability examinations conducted according to VA examination protocols, proposed disability ratings prepared by VA 

that both DoD and VA can use and processing by both departments 

to ensure the earliest possible delivery of disability benefits. 

The IDES is in use at 139 locations across all services. The Department is continuously monitoring statistics on IDES and exploring ways to improve the system and drive down processing time to 

reach our 295-day goal. As long as one servicemember is in the system longer than perceived helpful, we are obligated and committed 

to do all that we can to enhance the experience and make improvements. 

Finally, DoD and VA spearhead numerous interagency electronic 

health data-sharing activities and delivering IT solutions that significantly improve the secure sharing of appropriate electronic 

health information. Interagency health information exchange capabilities that levers the existing electronic health records of each department are in use today, and as both departments work to address the need to modernize our EHRs, we are working together to 

synchronize planning activities and identify a joint approach to 

modernization. 

To date, DoD has transmitted health data on more than 

5,800,000 retired or separated servicemembers to VA. Of those, approximately 2,300,000 have presented to VA for care, treatment or 

claims to termination. 

Mr. Chairman, I cannot overstate how far DoD has come in partnership with VA in recent years and we realize there is still more 

to do on these extremely important efforts. We will continue work 

with all of our partners to do anything and everything we can to 

provide our servicemembers with the absolute best care in treatVACREP180 with DISTILLER

8 

ment that they so rightfully deserve in return for their service to 

our Nation. 

Thank you again for the opportunity to be with you today. I look 

forward to your questions. 

[THE PREPARED STATEMENT OF JIM NEIGHBORS APPEARS IN THE

APPENDIX]

Mr. RUNYAN. Thank you very much. And with that, we will begin 

questioning in the order of arrival, which I think everybody here 

was at gavel call, or sitting in. 

First of all, Mr. Neighbors, according to the DoD Recovering 

Warrior Task Force 2011 Report, there is still work to be done 

identifying the recovery team and acknowledging the role VA has 

in the system. In previous hearings and testimony before this Committee, veterans seem to be confused on what part of the process 

is VA and what is DoD. Can you really explain why this is happening because I’m going to drill into many avenues of confusion? 

This is just the first one. 

Mr. NEIGHBORS. I understand. Mr. Chairman, I apologize. The 

Recovery Care Coordination Program that we have within DoD and 

then the FOC program that VA has, we consider them very complementary programs. We see different things that are involved 

with what DoD brings to this process and what the VA brings to 

the process. 

As I stated in my oral remarks, we look at non-clinical kinds of 

care things to help both the servicemember and the family. Now, 

if I could, I would like to kind of put a philosophy or a statement 

that we take very seriously and that is never alone known, as a 

servicemember who has come through a very, very traumatic happening obviously with some traumatic injury that has occurred to 

their body and even their mind, we take the efficacy very, very important to be very efficient, excuse me, very effective in what we 

are doing. And we realize that does, at times, appear to be— what 

is the word—redundant within our own selves and even across the 

boards but we are going to look at the things that we provide to 

a servicemember all along this continuum as that approach and 

philosophy ‘‘never alone,’’ so there may be some things there where 

we are making very good warm handoffs to the person, which I 

think is very true between not only the DoD entities and the VA, 

but there may be times when the person thinks they have four or 

five people, but we will err on the side of being very, very effective 

to that person 24 hours a day, seven days a week, always to have 

somebody that they can call on even if it is one or two or three levels deep within the points of contact that they have. 

And we also ensure that there is a warm handoff. And what I 

mean by that is there is notification through a number of channels 

that VA knows very directly every servicemember goes from a RCC 

to an FRC. Thank you, sir. 

Mr. RUNYAN. And just talking to the FRC and the RCC, I have 

experienced, through the veterans I have talked to, a lot of confusion on who is the go-to guy, where do I go when I have a problem 

if something is not working as I anticipated and/or the lack of the 

communication throughout that process. Can you touch on that beVACREP180 with DISTILLER

9 

cause that obviously, is going to come up in a later panel with some 

of the VSOs that have a lot more experience with it. 

Mr. NEIGHBORS. I understand, sir, and I will obviously yield over 

to my VA counterpart to talk about the FRC piece of this since this 

is obviously within their daily work. 

I grant you and we have within the DoD continuous process improvements efforts that are always ongoing and looking at different 

things, not only within just the specific area, but with electronic 

records and everything else in transition that we are talking about. 

So I do recognize and agree that there are better ways to do things. 

We do take inputs and we work those regularly with VA. In fact, 

I think we have one coming up on Friday in which we are meeting 

again to discuss outputs from some of the things we have had in 

this area, so I agree, I guess, from my point of view as we are 

working these continuously and moving forward. 

Mr. MEDVE. Mr. Chairman, clearly if somebody is assigned a 

Federal Recovery Coordinator, that person should be the prime individual for the veteran or servicemember to go to and should be 

the one directing them across the whole set of issues that they are 

dealing with. 

The advantage of an FRC, clearly, is they handle both clinical 

and nonclinical issues. They are masters trained, nurses, social 

workers, and so part of the issue has been that the services want 

to ensure that they got kind of activity with that servicemember, 

and so the team of having an FRC and an RCC is complementary. 

In talking to the program directors in the field, this seems to be 

working better, that there is better coordination between the two, 

that the Federal Recovery individual recovery plan that is developed is now aligning better so there isn’t confusion for the 

servicemember on what the plan is since it is their plan. 

So there have been confusions in the past. We believe we are seeing improvement and we are working, obviously, to continually improve that. 

Mr. RUNYAN. And how are you actually educating them— obviously we are talking about servicemember and veteran in transition, how are you educating them to the process so they can understand it more when these problems do arise? 

Mr. MEDVE. If you don’t mind, Mr. Chairman, I would defer to 

Mr. McDonald who is here from the program to answer that question because he has got more hands-on experience than I do. 

Mr. RUNYAN. Okay. 

Mr. MCDONALD. Mr. Chairman, the purpose of the FRC to work 

with the individual is to let them know what responsibilities the 

FRC will handle. Being both clinical and non-clinical, they can 

work on both sides there. They can work on the DoD side and the 

VA side and what they try to do is to let the servicemember know, 

the servicemember and the family in some cases, know what they 

can do and what they can assist them with, and if they need that 

assistance, they can reach out and touch them. They will, at a minimum, stay in contact with their folks every 30 days and a lot of 

time when they are working on specific issues, that will be much 

more often obviously. Does that answer your question, sir? 

Mr. RUNYAN. Somewhat, but it goes back, just to make a point, 

with what Mr. Medve said, who the point of contact should be. I 

VACREP180 with DISTILLER

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think that part of the confusion is who is the go-to guy as we move 

through this process, and I think making that definition clear to 

everyone, because you said it three times in your answer to that 

question. 

Mr. MCDONALD. The problem, the reality is, sir, sometimes we 

will tell them we are available to reach out and they will sometimes call someone else. That’s the reality. What we try to inform 

them is, if they have an issue, let us know so we can be working 

on it with all the members of the team, which will include the 

RCC, the treatment team, the various case managers, such as that. 

One of the things that the FRC does is a continuous availability 

in terms of if they are assigned a client whether in the medical 

treatment facility, they will stay with that client using various 

transitions to other MPFs to PA poly-traumas, sometimes to private treatment centers, and the same MRCC stays with that person so that they are familiar, build a trust with the individual so 

that they know that that is the person to come back and advise us. 

In the first part, as with any relationship, is it is a developing 

thing and sometimes it is not clear. We can explain to please let 

us know what the issue is, but if they don’t come back to us, then 

that is difficult sometimes to manage that relationship. 

Mr. RUNYAN. Thank you. And I obviously, in dealing with it by 

speaking to veterans, know that clarity in the way we move forward in the process is essential—the process a lot of times is the 

issue. The process is unclear to a lot of people and obviously it falls 

on all of us not only to educate veterans, servicemembers and their 

families, but to have the system as a resource to where, we can access it and understand how we move through it, so thank you. 

And with that I will recognize the Ranking Member, Mr. 

McNerney for his questions. 

Mr. MCNERNEY. Thank you, Mr. Chairman. I think we made a 

little progress here in your questioning, so good work there. 

I think the goal is to make it seamless for the servicemember, 

obviously that is the goal. Are there technical issues, like communication between computers or any of that? Is that a problem at 

all? Can we just put that one to bed now, or do we need to talk 

about that for a little while? 

Mr. MEDVE. So, Congressman, thanks for the question. We are 

working on that. You know, I am sure you are familiar with that 

word, trying to develop or out on the boards developing an integrated electronic health record which once that comes into fruition, 

will, I think, be a great asset for us. In terms of the Integrative 

Disability Evaluation System and moving people through that process, we have one system called the Veterans Tracking Application 

that we use to manage where people are in the process so that we 

have the metrics and understand where they are at. 

We monitor those things every two weeks at the VA. The VA 

Chief of Staff holds a biweekly performance meeting with every 

senior executive that manages a part of that process down to the 

local level. As part of those discussions, if there are issues that we 

are having in terms of transmissions of data or anything like that, 

he immediately calls our Office of Information Technology to bore 

in on the problem and to fix it. 

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Mr. MCNERNEY. Well, that sounds good. Except, I want to get an 

idea of when these medical records are going to be standardized so 

that we can get this transition, that part of it, out of the way. So 

do you have an idea about when that can be expected to be finished? 

Mr. MEDVE. Sir, I know the two secretaries, as Mr. Neighbors alluded to, meet every quarter. At the last meeting at the end of February 27th, one of the marks on the wall is that we are putting the 

Integrated Electronic Health Record at the James A. Lovell Federal 

Health care Center. That’s the pilot site for it. They have required 

that there be two additional sites be in place by 2014 in order to 

build this, and so it is going to be a rolling development over the 

next several years. 

Mr. MCNERNEY. That is not good enough. That is just not even 

good enough. Yes, Mr. Neighbors. 

Mr. NEIGHBORS. Sir, if I could chime in and thank you for your 

question. DoD and VA are actually sharing more health information right now than any two organizations in the Nation. If I could 

just give you some statistics, please, on what that sharing is. 

Servicemembers’ data, again, that has been shared with VAs 

over a million times already, and what that turns into is for laboratory results. We have shared 23,000,000 of them to date, and these 

are in IT form. This is machine readable things that we push for, 

so they are not paper in this area— radiology, 3,600,000 million reports; pharmacy, 24,000,000 records. And patients have engaged on 

their medication, allergy information from what was about 27,000 

to now 1,200,000, which is a significantly improving patient safety. 

Those are just some areas. It is an entire IEHR. 

So between our organizations, we actually are doing some of the 

sharing already. And if I could, there are actually four locations 

pilot-wise which we are including private providers, such as a Kaiser Permanente or something, what we would bring to them into 

the fold here to. 

So between governmental entities, we have that actually going 

on right now. So you are right. We are not where we need to be. 

We are not completely there, absolutely, but there is stuff going on 

that is servicing our veterans. 

And the second thing I would like to say, sir, if I could, please, 

that is entity to entity. As far as giving a VA, excuse me, a veteran, 

or even a servicemember their health records, we can do that right 

now. We are working very closely with VA to enroll our 

servicemembers as they come in the door, into a platform, an IT 

platform called the E–Benefits Platform, that allows—we have got 

1,400,000 of them already signed up right now, but at any point 

in time after that from anywhere in the world, 24/7, they can actually download their medical records and hand them off to a private 

provider or anybody that they are involved with through that continuum right now, and that’s called the blue button capability. 

Maybe you have heard that or not. 

Mr. MCNERNEY. No, I haven’t heard that. One of the things that 

Mr. Medve was saying is that you can track an individual through 

the process, but is there an advocate for that individual or does 

that get passed on and the individual finds himself or herself calling in and getting the runaround. 

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I mean, what we need is an advocate, whether it is DoD or VA 

or the joint effort—Mr. McDonald started going into that—but an 

ombudsman or an advocate or some coordinator that that person 

can go to when they are in trouble from start to finish. 

Mr. MEDVE. Sir, yes. Thank you for your question, again, Congressman. In IDES, when someone is enrolled in it, there is the 

PEBLO, the Physical Evaluation Board Liaison Officer. When that 

individual is referred is who greets them at the entrance to that 

process. That is the single point of contact that will shepherd them 

through IDES. As they are in each different stage, they are briefed 

by that person where they stand, whether they are medical, when 

their medical evaluations are done, when they are supposed to appear before any boards, all that. 

Once we get to a point where they are going to be determined 

to be separated, we, the VA sitting with the DoD PEBLO, we call 

the military service coordinators, that then sit down with the individual as a team and explain to that individual what their VA benefits are, so that is what happens inside the IDES. 

Mr. MCNERNEY. Does the servicemember or former 

servicemember get to check off on that and say that they are okay 

with that transition? 

Mr. MEDVE. I will defer to Mr. Neighbors since that gets into the 

military’s administrative process. 

Mr. NEIGHBORS. Absolutely, sir. At any point in time when an 

evaluation takes place, that servicemember has reclama capability 

at a number of venues. Each one of the services has a local board 

that does exactly what we are talking about here, which is the 

evaluation of their disability and the rating. They can then take 

that to a department-wide—excuse me, let me say this again. The 

service-wide board is more of a formal activity in which they make 

sure that the rulings have been applied equally across from the 

local board itself. 

If the servicemember doesn’t believe that is equitable, they actually can go to another level and they can actually go to what is 

called the Board of Correction for Military Records level, also. So 

there are a number of points that the person can say, you know 

what, this wasn’t fair, I need another look, and they can be reversed or they can be upheld as any kind of board would do, but 

yes, sir, there is. 

Mr. MCNERNEY. Okay. I am going to yield at this point. 

Mr. RUNYAN. I thank the gentleman. Mr. Walls. 

Mr. WALZ. Thank you, Mr. Chairman, for holding this hearing. 

Thank you both for being here. This issue of singles transition, like 

you, I feel like I have spent most of my adult life talking about it 

and trying to get us there and I am please to see both of you sitting 

here. It certainly is a move forward where we have both DoD and 

VA, and I know the things you have talked about and trying to get 

us there through electronic records, through the coordination and 

collaboration. It is not only the right thing to do. It will save us 

resources and money in the long run preparing for our veterans, 

and so I appreciate what both of you do, and I know that you are 

two representatives sitting there and if the Chairman will indulge 

me a bit, I am going to—I am very thankful, I think, listening to 

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the name of this hearing, honoring the Shared Commitment to 

Care for those who defend our freedom. 

I am thinking about this and watching the two of you set this 

idea of a handoff or whatever, there was some more news this week 

again. And those of you on this Committee, I have been here long 

enough, I certainly don’t turn to the sensational to highlight this, 

but I am going to highlight this issue of the discharges from DoD 

on personality disorder. 

I am truly troubled by this. If this is truly about honoring the 

Commitment to Care, this is the third hearing I have set here 

where we have talked on something like this. In 2007 we were 

going to get this fixed. We were going to get it fixed in 2010, September 15th, and there is a report today and my friends over at 

the Vietnam Veterans of America, through a Freedom of Information Act, were at it again. 

So we got soldiers. They go to war, they come back and they are 

being diagnosed with adjustment disorder or personality disorder. 

It gets stamped on their discharge papers, ‘‘Discharge for Personality Disorder.’’ They are denied VA benefits and that is on their 

permanent record to follow them for employment. 

So Mr. Neighbors, I know this is not your area of expertise, if 

I could say. I am not putting you on the spot for the entire Department of Defense, but I would like you to—what do you think when 

you hear this again because all the issues you are talking about, 

I don’t want to distract us from this very, the broader issue, but 

I do feel like I need to speak up for these 31,000. I do need to try 

and figure out how we right this wrong because the idea that you 

would be diagnosed with an adjustment disorder after being in Afghanistan, I don’t know, if I could just turn it over to you, and I 

thank you, and I know it is very general but it just troubles me. 

Mr. NEIGHBORS. I understand and I really appreciate the question. It is a very important issue. I am going to go out on the limb 

a little bit here and try to narrow it a little bit. I think what you 

are referring to is what has happened maybe at Madigan out on 

the West Coast. Am I correct on that or is it—— 

Mr. WALZ. Well, there was a new—I had the thing, we just had 

a Freedom of Information Act request and the study was put together on this from Vietnam Veterans of America. I will make sure 

we get a copy to you—— 

Mr. NEIGHBORS. Okay. 

Mr. WALZ. —to let you see that. But it is pretty much we are on 

the same pace as we have been in the last 10 years, releasing these 

folks. This came to our attention when Joshua Kors wrote the 

piece, ‘‘The Disposable Soldiers in the Nation.’’ 

We had three hearings on it again. Vietnam Veterans brought it 

up again, and it is probably the most striking example for me of 

how somebody does fall through the cracks or how we are not 

seamlessly to handing off folks and I am just curious on your part. 

Mr. NEIGHBORS. Okay. And I appreciate that, sir. 

Mr. WALZ. Yeah. 

Mr. NEIGHBORS. If I could, I would like to yield back to one of 

my SMEs that I have brought that I think can more, give you 

much—— 

Mr. WALZ. That would be greatly appreciated. 

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Mr. BURDETT. Councilman, I think you are calling an issue—I 

am Phillip Burdett. I work with—— 

Mr. RUNYAN. Would the gentleman, please, speak into the microphone, please. 

Mr. BURDETT. Councilman, I am Phillip Burdett and I am Mr. 

Neighbors’ colleague and we work in the IDES system. And particularly, I think the behavioral health issue that you’ve highlighted is a critical one for us. As we have made non-visible injuries 

a priority, we have seen them skyrocket in diagnosis, we struggle 

to hire behavioral health professionals, and I think the answer to 

your strategic question is how do we train those behavioral health 

professionals correctly and then how do we administer the policies 

and regulations, and we have made some great steps in 2010, think 

we had this issue fixed, and when it flares up, I think it comes 

back to training those behavioral health professionals, making sure 

we have the right and adequate ones at our bases’ posting stations, 

give them the diagnoses. 

Mr. WALZ. Are we benchmarking now because my question, I 

think what the public comes up to is how do you know that person 

came in with a preexisting condition of a personality disorder? How 

are you making that judgment? 

Mr. BURDETT. I think two issues come to mind here. It is such 

a new science in so many areas. We have talked of PTSD, directly 

the TBI, and then the manifestation of both of those conditions 

with the incredible physical problems at the same time, so as our 

diagnoses have skyrocketed, we have invested a tremendous 

amount, especially with our Assistant Secretary of Health Affairs. 

The investments in that have been significant. 

Now, we need to then recognize are we using some good medical 

standards across the board, are we then making sure that our doctors are using those diagnoses, following the regulations that we 

have implemented in the accordance with the laws that you have 

passed. We owe that. I think we have made a great effort in acknowledging what we know and don’t know about behavioral issues 

and then putting together solid policies and regulations. 

Mr. WALZ. And I appreciate that and I do acknowledge the 

progress we have made and this is a difficult area. And I guess my 

question is how do we right what I think is an egregious wrong for 

some for these folks? I think they went in and the horrific experience they experienced, they are coming out with what others have, 

which I would say in some cases is a normal reaction. They have 

been diagnosed with this, which is basically a black ball to them, 

that they are not welcome at the VA, they are not welcome at the 

employers. 

Do you have a suggestion? And I appreciate your candidness 

from both of you on this issue of trying to address it. 

Mr. BURDETT. I think, Congressman, I would say that I think 

that Mr. Neighbors highlighted is we have made this a 

servicemember centric policy and regulations since the beginning 

and the ability for a servicemember either on the VOD side of the 

equation or the VA side to then challenge and come back and open 

these cases and say I would like you to look at it again. Those have 

not been abridged. They have been extended. And the opportunity 

for those servicemembers to recognize, you know, I may have gotVACREP180 with DISTILLER

15 

ten out in 2004 and then had this condition that I need to have 

reevaluated. 

The VA has done fantastic work at making those avenues available to those veterans to come back and say, let us look at that 

case again. 

Mr. WALZ. You think it is too harsh where VVA (Vietnam Veterans of America) is just point blank calling these illegal discharges? 

Mr. BURDETT. I think the role of the VSOs is critical. I sometimes refer to them as our conscience, making sure, holding us accountable to make sure that we understand things. I appreciate 

their flexibility and also understanding that the behavioral health 

issue is such a new area of science for the medical community, for 

the policy makers, and then for the—— 

Mr. WALZ. Well, I am going to try and figure out a route to figure 

out how we get these folks back, how we give a fair shake at them 

because I think we got folks—and I say this again from the moral 

perspective, but also from an economic perspective. They are probably not working. Our suicide rates can be tied to some of this. 

There are just different issues that we have got to go back and capture them with the new data that has gone—and I will be the first 

to tell you that I think in the ten years in seeing what we were 

first doing in the war zones, what we are doing now, great kudos 

to everybody involved, behavioral health and integration. 

Mr. NEIGHBORS. I just want to add one other thing, Mr. Congressman, to what Mr. Burdett said, and that is the basic military 

training, you touched a little bit on preexisting conditions. There 

is a vast array of medical diagnoses—not diagnoses, evaluations 

that take place even as a person is coming in the door for basic 

military training in which you alluded to preexisting conditions. 

Those are all documented. 

Mr. WALZ. Why did we keep them then? 

Mr. NEIGHBORS. Oh, no, no. There is a wash out period there 

also, sir. 

Mr. WALZ. But you know, we got some of these folks that went, 

they served their time, some up to eight years, went to Iraq, came 

back and then they were stamped on their as a preexisting condition for personality disorder. Why the heck did we keep them if 

that was the case? Why didn’t we get them out otherwise? I mean, 

how do I respond to those people? You see where this is going? 

Mr. NEIGHBORS. I do. 

Mr. WALZ. And we are this close to a class action suit against 

DoD on this. You feel that coming. My case is I just want to correct 

the problem and make sure it doesn’t go forward. 

Mr. NEIGHBORS. And I understand completely, sir. Again, they 

have multiple avenues to go back to up to include Board of Corrections for military records, which I sat on for the Air Force. I saw 

many of those kinds of cases and saw some actually overturned 

also, so there are avenues for people. You are absolutely correct. 

There is more that needs to be done, and there are more things 

that I believe we can do and we are working on those with the 

services to move forward, but I do—— 

Mr. WALZ. You think the avenues exist without us getting—my 

take is is to help and figure out a channel through the proper existVACREP180 with DISTILLER

16 

ing process of appeals or rectifying these. You think those set out 

there and are ready to go? 

Mr. NEIGHBORS. I will be happy to work with you. Obviously, 

I—— 

Mr. WALZ. Yeah, and we will be following up with others, but I 

thank you, Mr. Chairman. I know you gave me extra time, but I 

want to thank both of you for your candidness and attempt to get 

out this. I appreciate it. 

Mr. RUNYAN. I thank the gentleman. Mr. Carnahan. 

Mr. CARNAHAN. Thank you, Mr. Chairman. I really just had one 

quick question I wanted to ask our two witnesses. I understand 

there have been some informal sessions for demobilized and separating National Guard and Reserve members. Can you talk about 

some of the unique challenges associated with educating and processing these servicemembers and do you have any thoughts on how 

to deal with them more effectively? Go ahead. Jump in. 

Mr. NEIGHBORS. I apologize. Sir, a great question. There is no 

doubt that there are differences, especially in timeliness as far as 

how servicemembers from the Guard Reserve come through the 

IDES specifically, but I do know that we are taking, as for us, especially Recovery Care Coordinators, and things have a standardized 

training regime. They all receive 40 hours of training or more to 

make sure that they are engaging with servicemembers, not only 

active duty, but Guard and Reserve, so that they understand all 

the processing the same. 

There is no doubt, as far as transition is concerned, 

servicemembers that are Guard Reserve have issues of employment 

that are in and out of their employment. There is a large—in fact, 

thank you, gentlemen, for the VOW Act that you graciously gave 

to the DoD last year. As far as transition is concerned, we are 

working very hard. Some of, I think, what answers what you are 

saying there is an involved in implementing that Act which we are 

working with the White House on right now. 

Many issues in making sure that Guards and Reservists get that 

exact same training that is funding, that it’s moving forward in the 

same way that the active duty is getting. We are working very 

hard with the VA in ensuring that that transition takes place. Does 

that kind of get to what we are talking here? 

Mr. CARNAHAN. Yeah. 

Mr. NEIGHBORS. Okay. All right, sir. 

Mr. MEDVE. Congressman, again, thanks for the question. In 

terms of overall in the process of demobilization, I know that we 

have VA reps at the de-mobe sites there to work people through to 

ensure they understand what they are eligible for. In terms of 

IDES, you know, we currently have a major effort going down on 

Pinellas Park with a number of Reservists’ records that are being 

gone through to determine whether or not they had profiles that 

had to be validated to see if they were such a level to require medically being separated from the service. We are working hand in 

hand with DoD. 

We have a number of Reservists and National Guard who do collect VA benefits when they are off of active duty, and as part of 

that process we share with the DoD as they are looking at these 

records in terms of medically separating people to validate condiVACREP180 with DISTILLER

17 

tions that exist and all that, so we have got good information sharing between the departments on that. 

But a Reservist going through IDES gets the same attention 

going through the process because they are still on active duty 

when they are going through IDES, so the PEBLO that I talked 

about before, they are walking them through the process. They 

have access to the military’s service coordinators that go through 

the process, so they are treated no different from our point of view, 

than active duty, somebody who is on active duty all the time. servicemen are going through the process. 

Mr. CARNAHAN. Thank you, gentlemen. I yield back. 

Mr. RUNYAN. Thank you, gentlemen—and on behalf of this Subcommittee, I thank you for your testimony and your time. Obviously, we have a lot of work ahead of us trying to make sure that 

we take care of our warriors, our true heroes of this country, so 

with that being said, I look forward to working with you on that 

and continuing to make this process what it truly deserves and 

needs to be. 

So with that being said, both of you are excused. Thank you. 

I want to call the second panel to the witness table at this time. 

At this time I welcome Dr. Gail Wilensky, a Senior Fellow with 

Project HOPE. Dr. Wilensky also served as a Commissioner on the 

Dole-Shalala Commission. And next we will hear from Mr. Ken 

Fisher, Executive Officer of the Fisher House Foundation. Mr. 

Fisher also served as a Commissioner on the Dole-Shalala Commission. And finally we will hear from Lieutenant General James 

Terry Scott who served on the Advisory Committee on Disability 

Compensation. 

We appreciate all of your attendance here today. Your complete 

and written statements will be entered into the hearing record. 

And Dr. Wilensky, you are now recognized for five minutes for 

your oral statement. 

STATEMENTS OF DR. GAIL WILENSKY, SENIOR FELLOW, 

PROJECT HOPE; KEN FISHER, CHIEF EXECUTIVE OFFICER, 

FISHER HOUSE FOUNDATION, INC.; LIEUTENANT GENERAL 

JAMES TERRY SCOTT USA, (RET.), CHAIRMAN, ADVISORY 

COMMITTEE ON DISABILITY COMPENSATION. 

STATEMENT OF GAIL WILENSKY 

Ms. WILENSKY. Thank you, Chairman Runyan and Ranking 

Member Mr. McNerney and Members of the Subcommittee. 

I am pleased to be here to talk about the transition from 

servicemember to veteran with particular emphasis on the Integrated Disability Evaluation System. 

As you mentioned, I am currently a Senior Fellow at Project 

Hope, an International Health Education Foundation. I also serve 

as a regent for the Uniformed Services University of the Health 

Sciences, USUHS. I have had the honor and privilege of being on 

the Dole-Shalala Commission as you mentioned. I was also a CoChair of the congressionally mandated study on the future of military health care and earlier in the decade I co-chaired the President’s task force to improve health care delivery for our Nation’s 

veterans, initially with your colleague, Gerald Solomon, who unforVACREP180 with DISTILLER

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tunately died early in that period, and then with John Paul Hammerschmidt. The views I am going to express are my own, however, 

not those of these other organizations. 

Before the introduction of the IDES, servicemembers needed first 

to separate from his or her service and then to enter the VA process, requiring as you have mentioned, two different exams. The 

process and criteria for determining fitness differed across services. 

They differed between the services and the VA. The result was real 

and as important, perceived differences, in equity across the services and between the services. 

It was frequently a lengthy process, as you have mentioned. It 

was also frequently a contentious process which was equally bound 

to have happen. 

The difference now with the IDES is that there is a single exam 

done by a VA certified physician that serves both as the basis for 

determining fitness to serve and also by the VA to establish a level 

of disability. The services continue importantly to determine fitness 

to service and the VA, the disability level. 

The time has been reduced substantially, although not as much 

as it should be. The goal that was talked about this morning of 295 

days is a substantial improvement. Initially, there has been some 

discussion of a goal of 100 days. That is obviously still a long way 

out. 

And there are some lengthy and inexplicable delays that occasionally reported. Last summer at a Senate hearing there was a 

discussion of a marine who had been in Afghanistan in 2010, lost 

both his arms and legs and had his papers sitting on someone’s 

desk for 70 days; clearly, not something acceptable to anyone. 

There are some questions that remain in my mind as somebody 

who had run Medicare and Medicaid in the early 1990s, as to why 

it is taking quite so long to fully roll out the IDES, until the fall 

of 2011. It has now happened and I am glad, but that length of 

time is inexplicable to me. 

There are also questions about what are the real goals of the program, and that means not just reducing time but what actually is 

it that you are trying to do. 

I also want to talk for a minute about another area where we 

had recommended change and that was the Disability and Compensation System, trying to make sure that it was speedy with, reduced inequities and, most importantly, helped veterans return to 

their productive lives as fully and completely as possible. 

We recommended a transition payment be made while individuals are receiving rehab and training, and that this was to be followed up by an earnings-loss estimate which may remain after 

training, but in our service-oriented information economy may not 

remain. There was also to be a quality-of-life payment recognizing 

that even if there was a loss, there was not a loss of earnings capability, there may well be a real quality of life decrement which 

should be compensated. 

Two of the young men on our Commission really fit into that 

role. One was getting an MBA at Harvard. One was having a double major at George Mason. Both of them would probably not experience earnings losses, but they had major injuries that would result in quality of life decrements. 

VACREP180 with DISTILLER

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We also need to make sure that other recommendations that we 

made in Dole-Shalala are carried out, making sure that care is 

available for those needs of PTSD and TBI services. We recognize 

that is going to be a challenge because of the shortage of mental 

health providers and professionals in the country in general and, 

therefore, afflicting those services as well. 

And we have recommended extending respite care and extending 

the FMLA, the Family Leave Act, for up to six months for spouses 

and parents of seriously injured people. This, of course, is going to 

be difficult in our fiscally challenged environment, but it is one 

that is important. 

Let me just end on a positive note. While the recommendations 

we made are important and we are glad to see some of them being 

carried out, we also noted that the problems were not quality-ofcare problems, but rather problems with the handoff, the 

transitioning from inpatient to outpatient, from active duty to veteran. 

We, of course, need to make sure that both are appropriate for 

our returning wounded warriors, but I would hate to have people 

think that it was a quality of care that we found wanting after 

2007. It was not. It was these other processes which we are pleased 

that you are taking on. 

Thank you. 

[THE PREPARED STATEMENT OF GAIL WILENSKY APPEARS IN THE

APPENDIX]

Mr. RUNYAN. Thank you very much. Mr. Fisher. 

STATEMENT OF KEN FISHER 

Mr. FISHER. Chairman Runyan, Members of the Committee, on 

behalf of Co-Chairs Dole and Shalala who could not be with us 

today, the Members of the Commission, and my fellow Commissioner Gail Wilensky, I appreciate the opportunity to appear before 

you today. 

Both as a Commissioner and as Chairman of the Fisher House 

Foundation, I have devoted the last 12 years of my life towards improving both the care and the quality of life of our military, those 

wounded, veterans and their families. Today’s hearing on the DES 

and the seamless transition are critical to this Nations’ security 

and I am proud to discuss my work on the Commission, recommendations and action steps, and how this system must be 

made simple, easily understandable and easier to navigate. 

But I must admit to being a bit confused. This is the greatest 

Nation on earth, with the greatest equipped and best trained military in the history of the world. What puzzles me is we are here 

five years after the roll out of this report. 

Before I begin, I feel compelled to preface my statement by explaining our mission. We were charged by President Bush to examine, evaluate, and analyze the care and process related to our returning wounded global war on terror servicemen and women. We 

looked at the system through the eyes of the wounded service people. We were solution driven. We held numerous field hearings, 

interviewed wounded, interviewed commanders, doctors, family 

VACREP180 with DISTILLER

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members as well as others who played a role in the recovery process. 

We not only examined problems and inadequacies but also looked 

for best practices that might help improve their care. Our goal was 

to simplify and help eliminate the log jam, which was the result 

of fighting lengthy two front wars with a VA that was already challenged by the weight of an intolerable bureaucratic system. And by 

doing this, we sought to eliminate the backlog and claims that had 

reached at the time approximately 800,000 to 900,000. 

While the living conditions at Walter Reed were indeed horrendous, this was only the tip of a massive iceberg. We found hundreds of troops waiting months for follow up appointments or 

awaiting the ratings process. This gap in benefits caused massive 

problems known to but a few. 

The Commission was given six months to evaluate the entire disability evaluation system and our findings were thoughtful, inclusive, and implementable. It was not our intention to put forth hundreds of recommendations that would have been difficult to implement or too expensive as a whole. 

And by the way, as a side bar I would like to join my colleague 

and say that I want to compliment this Nation’s military health 

care professionals whose work and use of the latest technologies resulted in a battlefield survivor rate of better than 95 percent, 

which is unprecedented. 

Today, five years after our report was made public, there has 

been progress, to be sure, but with all due respect, not nearly fast 

enough, and with not nearly enough sense of urgency. Tracking the 

results of the Commission has been difficult, as admittedly I would 

not expect the process to be transparent. But again, the task we 

were given with that of OEF/OIF, and I hope of its adoption would 

have moved the system along faster. 

Now, rather than go in and be redundant on points already covered, I would like to—we have heard about disability and the new 

IDES, although I feel that there are staffing problems which are 

causing problems in the implementation of IDES. I also am confused as to why a VA doctor would be doing a DoD physical, but 

I don’t want to get into that either at this point. 

What I would like to discuss is the—pardon me—is the PTSD 

and I would like to remove the word or the letter ‘‘D’’ because I 

don’t believe that post-traumatic stress is a disorder. We recommended lifetime treatment for post-traumatic stress. These men 

and women have endured multiple deployments, have been in intense urban fighting, often against civilian insurgents who too 

often hide behind innocent women and children. They have seen 

horrific injuries caused by IEDs. And the stigma associated with 

coming forward and asking for help leaves too many to suffer in silence, and if they are home, their families to suffer as well. 

We believed this was a major problem when our report was made 

public, and it has been for any servicemember who has fought in 

battle be it World War II, Korea, Vietnam or today. 

Today it is evident why this was a major recommendation. Five 

years after our report was made public, there have been well over 

1000 suicides, outpacing the civilian population, domestic violence, 

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and divorce, drug and alcohol abuse, homelessness, joblessness, all 

at unacceptable levels. 

Just the other day in USA Today, an article appeared discussing 

alcohol within the ranks of the Army and the fact that they have 

delayed for three years a confidential counsel program for treatment. They had begun a pilot program in 2009, but it was ended 

after a high dropout rate. According to the article, 25 percent had 

a drinking problem. 

In the interest of time, Mr. Chairman, I will end my statement 

there, and I thank you for the opportunity to appear here and look 

forward to your asking questions. 

[THE PREPARED STATEMENT OF KEN FISHER APPEARS IN THE APPENDIX]

Mr. RUNYAN. Thank you, Mr. Fisher. 

General Scott. 

STATEMENT OF LIEUTENANT GENERAL JAMES TERRY SCOTT 

(RET.) 

Lieutenant General SCOTT. Chairman Runyan, Ranking Member 

McNerney and Committee Members, it is a pleasure to appear with 

you today representing the Advisory Committee on Disability Compensation and the Veterans Disability Benefits Commission that 

met from 2005 to 2007 and reported out to you in October of that 

year. 

It is also a distinct honor to serve on a panel with Mr. Kenneth 

Fisher whose contributions to servicemembers and veterans are 

known and appreciated. 

Mr. FISHER. Thank you. 

Lieutenant General SCOTT. The Advisory Committee is chartered 

by the Secretary of Veterans Affairs in compliance with Public Law 

110–389 to advise the Secretary with respect to the maintenance 

and periodic readjustment of the VA Schedule for Rating Disabilities. Our charter is to, ‘‘Assemble and review relevant information 

relating to the needs of veterans with disabilities; provide information relating to the character of disabilities arising from service in 

the Armed Forces; provide an on-going assessment of the effectiveness of the VA’s Schedule for Rating Disabilities; and to provide ongoing advice on the most appropriate means of responding to the 

needs of veterans relating to disability compensation in the future’’. 

Your letter asked me to testify on the Advisory Committee’s 

views regarding the transition from servicemember to veteran, with 

a particular focus on the implementation of the IDES. 

At the time the Veterans Disability Benefits Commission was 

created by the National Defense Appropriations Act of 2004 it was 

already apparent that the peacetime system for transitioning sick 

and injured servicemembers to veteran status was overwhelmed. 

From the outset, and well before the reprehensible situations at the 

Walter Reed Barracks and other locations were recognized, the 

Commission saw the need for a rapid and seamless process that 

protects the servicemember while he or she progressed to veteran 

status. Transition became one of the major issues studied by the 

Commission. Interim recommendations addressing transition issues 

were offered as deliberations progressed. 

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The VDBC examined the policies and processes within the Departments of Defense, Veterans Affairs, Labor, Health and Human 

Services, and the Social Security Administration that affected separation or retirement. Each of these entities plays a significant role 

in the transition of veterans and their families. 

Of the many recommendations the Commission made, many of 

them pertained to improving the transition process. I am providing 

for the record a list of the key transition recommendations and the 

status of their implementation as I understand it. 

Of the recommendations pertaining to transition of both the Veterans Disability Benefits Commission and the Advisory Committee 

on Disability Commission have offered, the one with the most potential to reduce the time to process claims and improve accuracy 

and consistency is the ongoing plan to revise the VASRD, the rating schedule. This complex, multi-year revision will incorporate 

current medical knowledge and technology as well as streamline 

the diagnosis, evaluation, and adjudication processes. 

Another key recommendation with potential long term positive 

effect is the movement to an electronic claims record. This is another example of an extremely complex challenge that VA has accepted and is working on. When fully implemented, it will simplify 

and expedite the claims process. As well, the Integrated Electronic 

Health Record which was mentioned in the previous testimony. 

The Advisory Committee on Disability Compensation took up 

where the VDBC left off on making recommendations for improvements to the systems and processes to transition servicemembers 

to veteran status. Particular emphasis has been on the injured and 

the ill servicemembers who are eligible for the IDES program. 

However, the scope of our activities, it covers all servicemen 

transitioning to veterans. 

Our recommendations have included specific statutory and regulatory changes such as increased family support services, educational, vocational training and rehabilitative support. Many of 

these recommendations have been adopted in whole or in part. We 

have recommended the VA undertake an in depth longitudinal and 

independent evaluation of the VR&E Program as soon as possible 

to determine the effectiveness of the program in serving disabled 

veterans. We believe there are significant opportunities for improving access offerings and management. 

We have offered recommendation for reducing a number of contact points a veteran must touch in order to understand and receive benefits, also mentioned in previous testimony. We are in the 

process of reviewing the availability of mental health programs for 

veterans. The Committee is also tasked to look at unique Reserve 

and National Guard transition issues and we recently added a U.S. 

Air Force Reserve medical officer to the Committee to assist us in 

that regard. 

The current IDES program incorporates many of the recommendations of the Veterans Disability and Benefits Commission 

and the Advisory Committee on Disability Compensation. It represents a tremendous effort on the part of VA and DoD to focus on 

the transition of members who are sick or injured to veteran status. 

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All parties, including the Congress, are frustrated by the average 

time still required to complete the transition. From the perspective 

of someone who has the opportunity to work on this effort over the 

last eight years, I do believe that progress is significant and more 

importantly that the progress will continue. 

On behalf of the Advisory Committee, thank you for the opportunity to testify on this important matter. 

[THE PREPARED STATEMENT OF LIEUTENANT GENERAL JAMES

TERRY SCOTT APPEARS IN THE APPENDIX]

Mr. RUNYAN. Thank you very much, General Scott, and I thank 

you for your service to this country and your continuing service to 

our heroes. I appreciate it. 

With that, we will begin a round of questioning. My first question is for Dr. Wilensky. In your testimony you mentioned the importance of recognizing that there are different functions that medical exams can serve and there are many different goals. How 

would you incorporate your suggestion of the ongoing periodic medical evaluations into a single disability exam process? 

Ms. WILENSKY: It is a good question, Mr. Chairman. The reason 

I mention that is having spoken with many medical officers, those 

currently and previously in the military, they reminded me of the 

different functions that a medical exam can fill, a physician maybe 

determining the diagnosis or the process of treatment and then the 

progress in terms of that individual over time, which may be on an 

ongoing basis. When it comes to an exam that is done in order to 

determine fitness to serve or a disability status, that is a moment 

in time. I mean, it is an important moment in time. It needs to be 

on a single basis as is being done. But it needs to be recognized 

within the context that there will be ongoing periodic evaluations, 

both in order to be able to treat the individual, whether he or she 

returns to duty or becomes a veteran, and also periodically should 

be done in order to establish whether or not the disability is continuing as it was initially established. 

It’s important to recognize that a single exam may include different components, it will be a snapshot and a moment in time, but 

it doesn’t mean that it is the only medical exam that will be occurring over time. If you have a medical problem, you would want to 

have your medical professional seeing you when carrying out the 

course of treatment. It is to recognize that the focus on having this 

one exam done by a VA certified physician is appropriate for the 

particular purpose of establishing fitness to serve or a VA disability 

as of that moment, but there will be, should be continuing medical 

exams over time for these other purposes. 

It’s really to remind people this is not once and never again will 

you have a medical exam because that would not provide optimal 

care. 

Mr. RUNYAN. Thank you for that. And also, talking about disability and payment steps as we begin to deal with the transition 

and then loss of earnings and finally quality of life, can you give 

your assessment of the current state of these steps and how we can 

improve that process? 

Ms. WILENSKY. Thank you very much, Mr. Chairman. This is an 

area that for me as an economist was particularly important. We 

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on our Commission recognize that the payment, the orientation and 

thinking of the disability payment was heavily tied to post-WorldWar-II thinking where the loss of a limb or a certain type of injury 

could have very major impacts on earnings-potentials of individuals 

of post World War II, Korean and Vietnam eras. 

We were recognizing that we are now in an information and 

service oriented economy. And what that means is that with the 

help of the VA, the GI bill and others, even seriously injured individuals can be helped to reach a higher functioning state with the 

proper support, both VRA for those who need vocational, but higher 

education for those who are in a position to do so, and may be able 

to reduce or eliminate any earnings loss per se. Even for those individuals, they may well merit a quality of life decrement payment 

such as was the case for two out of the three injured on our Commission. 

I mentioned in my testimony that the wife of a third individual, 

Tammy Edwards, her husband is not somebody who is ever going 

not to have a major earnings loss as well as a quality of life decrement, no matter how much training and education was provided 

because of the severity of his injuries, including brain injuries as 

well as major burns. 

So it is important to recognize that even in an information and 

service society, there will be people who will continue to have significant earnings losses and quality of life decrements. But for people, like, two of our members, they would not have earnings losses. 

They would require a lot of support, payments while they were 

going to school, as well as what was as expensive support for their 

education. 

To the best of my knowledge, we have not made much progress 

in this area, although as you know, there has been a significant improvement in the educational support to people post service. 

Mr. RUNYAN. I have one question for Mr. Fisher quickly. I assume you have communication insight into the world of Wounded 

Warrior support, obviously through your organization. What is the 

general feel in this area pertaining to how the DoD and the VA utilize and communicate to organizations such as The Fisher House? 

Obviously, a lot of what we are talking about today deals with the 

lack of communication or lack of knowing the pathway forward. 

Mr. FISHER. Thank you, Mr. Chairman, and I would say in general we have maintained a very, very good dialogue with both the 

DoD and the VA. It is necessary for us to do so because the way 

we determine where a house is located is by dealing with the VA 

or the Surgeons General. So communication for us is absolutely essential so that we don’t waste money. Every donation we get is precious. So we can’t afford to have a house built where it doesn’t belong. 

So the communication with the VA and the DoD has been fairly 

good in terms of our ongoing dialogue. 

Mr. RUNYAN. Thank you very much. With that, I recognize Mr. 

McNerney. 

Mr. MCNERNEY. Thank you, Mr. Chairman. 

Mr. Fisher, I would just like to thank you for dedicating so much 

of your life to the service of other people. 

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In your experience, what if anything can be done to ensure a better continuity of care for wounded warriors before they go home to 

live with their families, especially ones without PTSD and traumatic brain injuries? I know this is a tremendous burden on the 

families. Is there anything we could do or that the DoD or the VA 

could do to make that transition easier so the families can deal 

with this enormous burden? 

Mr. FISHER. Thank you, sir. I would, I think in my prepared 

statement I suggested that there potentially could be kind of a 

spousal education program upon deployment or as they entered the 

military and if a serviceman or woman enters the military as a single person and gets married while in the military, that their spouse 

at the time join a program. 

I think it is essential for the spouses to learn what the signs are 

or what to look for. They don’t always manifest themselves with violence off the bat or the screaming and mood swings and so forth. 

I think that sometimes it could be just, you know, something as 

simple as not sleeping at night after deployment. 

So I think some kind of a spousal educational program that 

would kind of educate them, let them know what the signs or what 

the early warning signs are when they come home. 

Mr. MCNERNEY. So this education would have to start before 

they come home basically. 

Mr. FISHER. Well, in terms of the spousal program, I would like 

to see something like that happen upon deployment before they 

leave, and I mean the first time, not if we are talking about multiple deployments. 

Mr. MCNERNEY. Thank you. Ms. Wilensky, I was struck by something you said, the starkness of your statement that the problem 

is in the handoff, not in the quality of care, but then you also said 

that the IDES exam is just a single point in time. Things change 

and so I would like to get your idea of how we could make this 

work better. I mean, you must have a vision of how this would 

work. 

Ms. WILENSKY. The good news, as I indicated, was that our observations, and that is supported by others as well, is that the actual quality of care being delivered. Once the person is in the place 

they are supposed to be, either active duty military or in the VA 

system, has been very good, and that the problems have occurred 

whenever they are making a change. There is not a single handoff. 

When they move from inpatient to outpatient care, there were 

major problems. It was why the Wounded Warrior Recovery Program was so important to put in place. And while that has reportedly helped, there are still concerns about whether it is completely 

getting the job done, whether those transitions and handoffs are occurring for the especially very seriously wounded as well as they 

need to be and whether that will continue as we go out because we 

are still seeing very seriously wounded individuals coming out of 

Afghanistan and other places. 

So it is not even there a single handoff. It is every time somebody 

moves to a different part of their care is when the problems have 

been occurring and those are the places where we remain vulnerable. 

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With regard to the point in terms of evaluation, something like 

a three year evaluation of a disability is appropriate, so that there 

can be an assessment as to how the person is progressing and the 

kinds of needs that they have at that point, and again it was the 

emphasis that this is not anything other than a snapshot. It needs 

to be a really good snapshot because you are making a decision 

about fitness to serve and disability for the person who is leaving 

the service, but it has to be a series of follow-on snapshots, and 

three years is the time that was recommended to us. 

Mr. MCNERNEY. Thank you. 

Ms. WILENSKY. We did, by the way with respect to your question 

to Mr. Fisher, specifically recommend for the families of those who 

are severely wounded that the legislation be passed to allow them 

a six month family leave period as well as extended respite care 

to the parents or spouse of the severely injured. 

Mr. MCNERNEY. Okay. I want to yield back to the Chairman. 

Mr. RUNYAN. I apologize to everyone. We just had a bill called 

in Natural Resources and I don’t have any other Members on my 

side, so we are going to have to go into a recess for about a half 

an hour and reconvene at that point. I apologize and we will be 

back shortly. Return at noon. 

[Recess.] 

Mr. RUNYAN. The Committee will again come to order and I 

apologize for the delay and appreciate your patience in working 

with this. I have a question for General Scott. Based on what you 

heard this morning in respect to DoD and the VA’s testimony on 

the progress of IDES as this point, generally how would you grade 

their progress with the recommendations of the Veterans Disability 

Benefits Commission? 

Lieutenant General SCOTT. Well, I think that both departments 

picked up on the problem after it was brought to their attention. 

As I said, it was pretty clear early on that some peacetime arrangement where the VA and the DoD was not satisfactory for large 

numbers of returning soldiers. 

Again, like you, sir, I was present when there was nothing, you 

know, when the VA and DoD essentially were not communicating 

at all about how to transition particularly injured or ill 

servicemembers, but all servicemembers to VA. 

It was basically, it was, well, here are your discharge papers, period. So I would say that I would give them a B to B+, and to get 

to an A they have got to reduce the average time, understanding 

that there are always going to be some cases that are just really 

complex, that are going to take an inordinate amount of time, and 

that makes the average, that runs the averages up. 

But I am pretty sure from what I heard this morning and from 

what I know from working with the VA in particular, that they are 

working to get these numbers down. And of course, numbers are 

not everything because we have got to be sure that we are taking 

care of the servicemember. As was said earlier, you have to be 

careful about trading off efficiency for effectiveness of speed for accuracy. 

Having said that though, I think that anyone who was testifying 

here or the backups would agree that we can do better and I can’t 

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tell you what the right number is, but I believe that these two departments are going to get it lower in that regard, so I give them 

a B to a B+ for progress certainly higher than that for an effort. 

Mr. RUNYAN. Thank you. Just one final question. Mr. Fisher, you 

talked about how the communication back to the departments is 

good. Are they providing you with the right amount of information 

and access to the wounded warriors to fulfill your mission? Or are 

there other things that you would like to be able to help? 

Mr. FISHER. No. We are being provided with the information and 

the access to the wounded warriors, absolutely. We are doing fine 

in terms of our interaction on that front. 

Mr. RUNYAN. Thank you for that. Okay. With that being said, 

again I apologize for the delay and I thank the panel for their testimony and look forward to continuing to have these discussions as 

we work to help our warriors transition into their life, so with that 

being said, the panel is excused. Thank you very much. 

I call the third panel up at this time. First we will hear from Mr. 

John Wilson, Legislative Director from Disabled American Veterans, and then we will be hearing from Mr. Phil Riley, the Senior 

Benefits Liaison for the Wounded Warrior Project, and then, Mr. 

Eric Greitens, the Chief Executive Officer from The Mission Continues. 

We appreciate your attendance today, and your complete and 

written statements will be entered into the hearing record. And 

Mr. Wilson, you are now recognized for five minutes for your oral 

statement. 

STATEMENTS OF JOHN WILSON, ASSISTANT LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; PHIL RILEY, 

SENIOR BENEFITS LIAISON, WOUNDED WARRIOR PROJECT; 

ERIC GREITENS, CHIEF EXECUTIVE OFFICER, THE MISSION 

CONTINUES. 

STATEMENT OF JOHN WILSON 

Mr. WILSON. On behalf of the Disabled American Veterans and 

our 1,200,000 million members all of whom are wartime and disabled veterans, I am pleased to be here today to testify before the 

Subcommittee on Disability Assistance and Memorial Affairs about 

the Integrated Disability Evaluation System or IDES. 

IDES is the result of a recommendation of several commissions, 

as we know, with the goal of DoD and VA creating a single, comprehensive standardized medical exam that the DoD administers 

serving DoD’S purpose of determining fitness and VA’s of determining initial disability ratings. 

A comparison between the DES pilot that was launched in 2007 

by the DoD and the VA, and the legacy DES found Active Component military members completed the pilot in an average of 289 

days, and Reserve Component military members completed it in an 

average of 270 days, compared to the legacy DES average of 540 

days. 

Surveys revealed significantly higher satisfaction among DES 

pilot participants from those in the legacy system, and on July 30, 

2010, the DoD Senior Oversight Committee Co-Chairs directed that 

IDES expand worldwide and it was by October of 2011. 

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While the DAV is generally pleased with the IDES, there are two 

topics I wish to address in my oral testimony. First, we are concerned about the military members going through the IDES not 

having ready access to representation from a veteran service organization as they did under the legacy DES. 

The issue of access to counsel to advise military members on the 

disability claims process is a concern of DAV and other VSOs and 

is also cited as a concern by the Recovering Warrior Task Force. 

The Task Force conducted surveys to determine the effectiveness of 

DoD programs and policies of for Recovering Warriors to include 

IDES. Their survey results reinforce the importance of providing 

legal counsel for the Medical Evaluation Boards as well as Physical 

Evaluation Boards. And even though the surveys clearly demonstrate the value of having legal counsel available throughout the 

disability evaluation process, the majority of Task Force focus 

group participants said they do not have any personal experience 

with or knowledge of these specialized legal services. 

As a result, they may be accepting PEB decisions that are not 

in their best interest, and the benefits they receive, may be less 

than what they would received have had if they understood the 

long term consequence of their acceptance of a particular PEB decision. 

We believe that all those going through the IDES process should 

have a clear understanding about it. That understanding would be 

best provided if they had access to the free assistance from certified 

representatives of VSOs who can not only explain the process and 

their rights, but can also act as their advocates. 

There has been some positive movement in this area that partially addresses VSO representation. The VA’s Integrated Disability Evaluation System Implementation Guide issued in December of last year states that VA Military Services Coordinators will 

‘‘explain the availability of Veterans Service Organizations and provide a VA Form 21–22, Appointment of Veterans Service Organization Claimant’s Representative, if the servicemember expresses interest.’’ 

While this is an improvement, we find it too passive. We recommend this guidance be modified so the Military services Coordinator explain the option of VSO representation whether or not the 

military member ‘‘expresses an interest.’’ 

The second area to address is the effectiveness of the Physical 

Evaluation Board Liaison Officers or PEBLOs, who are supposed to 

guide servicemembers through IDES on the DoD side of the process, to ensure they are aware of their options. 

The Task Force found that many participants had limited knowledge about the role of PEBLOs. More often than not, comments 

about PEBLOs were negative and military members seemed to expect them to be more of an advocate than they are. That is not 

their role. 

While DAV has received information from the field that indicates 

the performance of PEBLOs has improved generally, there have 

been occasions when PEBLOs have incorrectly advised members. 

Recently, a PEBLO advised a member that he could not personally 

appear before the Formal Physical Evaluation Board to appeal the 

Informal Physical Evaluation Board’s decision. This is clearly in 

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error. But one of DoD’s National Service Officers was able to provide the correct information to the member. 

And another case, a PEBLO incorrectly advised a master sergeant that he would received 10 percent as his retirement pay as 

a result of the IDES decision, even though he had been in the military 22 years. We clarified for the member that, in fact, he would 

be eligible for 55 percent of his base pay due to his 22 years of 

service, and that 10 percent that he would receive was his VA disability rating, not his retirement pay, and that would be offset. 

In order to prevent these types of errors and improve satisfaction 

levels, we believe it is imperative that training and quality control 

be reviewed and strengthened to make sure that VA is getting the 

rating decision right for the first time. 

As stated earlier, military members expect PEBLOs to be more 

of an advocate. The role of advocacy is key. Most servicemembers 

may not realize how complex the disability adjudication process is 

and have little time to learn, given the new time constraints. DAV 

believes that military members best interests would be served with 

greater access to the free assistance from representatives of VSOs 

who not only help them understand the claims’ process, but will 

also act as their advocates. 

Mr. Chairman, that concludes my testimony. I would be glad to 

answer any questions you may have. 

[THE PREPARED STATEMENT OF JOHN WILSON APPEARS IN THE APPENDIX]

Mr. RUNYAN. Thank you very much. 

Mr. Riley. 

STATEMENT OF PHIL RILEY 

Mr. RILEY. Chairman Runyan, Members of the Board, Subcommittee, rather, Wounded Warrior Project welcomes this opportunity to share our views in the Integrated Disability Evaluation 

System, IDES. 

As a Senior Benefits Liaison with Wound Warrior Project, it is 

my privilege to represent wounded, injured and ill as they go 

through the IDES leading to military retirement, separation or possible return to duty. 

Wounded Warrior Program recognizes that VA and DoD staffs 

have worked hard to improve disability evaluation process. We 

have seen some improvement, but much more work needs to be 

done to realize the goals set for IDES. 

As we see it, VA is meeting its commitments to IDES, but DoD 

has more work to do. IDES was created as a streamlining effort to 

replace separate DoD and separate VA medical evaluations and 

disability ratings. The goals were to create a less complex non-adversarial system that was faster, produced more consistent evaluations and compensation and led to a seamless transition from military to civilian life. In large part these critical and important goals 

have not yet been achieved. 

IDES begins with the warrior being referred to a Medical Evaluation Board or MEB for short. A board of several medical officers 

charged with evaluating, if the warrior is able to meet medical retention standards and return to full duty. When MEB determines 

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that the warrior does not meet retention standards, it makes recommendation to the final deciding authority, the Physical Evaluation Board or PEB. 

The MEB’s findings are documented in a narrative summary 

called the NARSUM. That summary (NARSUM) becomes the most 

important evidence the PEB uses. But in doing its work, the MEB 

does not examine or usually does not even meet with the 

servicemember. 

In our experience the critical summary the MEB prepares is 

often incomplete and inaccurate, and the servicemember has limited time to review and challenge the MEB summary. As a result, 

critical errors frequently go uncorrected. 

Allow me to share a case study from case experience of one of 

many wounded warriors we have worked with to illustrate some of 

these problems. The Army officer sustained a penetrating head injury in Iraq. Early in the course of his rehabilitation, he and his 

wife were pressured into signing papers and rushed him into the 

MEB and cut short some treatment. 

The NARSUM ultimately prepared by the MEB failed to include 

any description of the officer’s day-to-day functional impairment. 

Instead, it simply listed medical conditions. Even at that, one of 

those conditions, loss of the use of an arm was omitted from the 

critical document. 

Later, the warrior transition unit he was assigned to actively discouraged him from appealing the PEB decision as ‘‘that would slow 

the process down.’’ Their experience illustrates that IDES is subject 

to troubling, disruptive pressures. 

Overall, this profoundly wounded officer was prematurely pushed 

into a Medical Board process that produced a deeply flawed decision document that led to an erroneous decision and ultimately a 

lengthy but fortunately successful appeal. 

A less experienced young warrior with similar injuries and without the expert representation this officer secured might have fared 

much differently. It would be a mistake to judge IDES solely by 

reference to timeliness. That would overlook the dangers of moving 

too quickly, focusing only on the major unfitting conditions, at the 

expense of all medical conditions. Moving quickly often results in 

erroneous rating decisions and in servicemembers not getting needed medical care. 

IDES is highly vulnerable to quality control issues, incomplete 

exams, exam reports that fail to include new diagnosis, incomplete 

or insufficient NARSUMs and missing critical documentation. 

MEBs often don’t have the time to review a warrior’s medical 

records or do needed research on depth. The NARSUMs too often 

are not fully developed, not comprehensive and inaccurate, and too 

often fail to identify and fully document all of the warrior’s medical 

conditions or minimizes them. These problems are often due to 

pressures to move cases along but errors ultimately prove harmful 

to the warrior. Wounded warriors and caregivers themselves generally are both poorly informed and under represented in navigating IDES. 

In theory, the PEBLO, that is Physical Evaluation Board Liaison 

Officer, should close any information gaps. In reality some of those 

liaison officers don’t fully understand the system themselves and 

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have such large caseloads that they can’t provide adequate assistance to everyone. 

Also, there is considerable variability in the JAG’s expertise on 

the IDES and there are just not enough JAG officers with necessary expertise. 

For recommendations, the Wounded Warrior Project has a number of recommendations to offer to more fully realize the goals set 

for IDES. We urge the Committee to work with Armed Services 

Committee to spur the executive branch to make needed changes. 

High among the recommendations in our written submission, we 

urge that DoD be directed to re-engineer and institute quality controls on its part of the IDES process. 

In conclusion, today, almost five years after the bipartisan commission called for streamlining the complicated Disability Evaluation System, the goals and vision for that system have yet to be 

realized. 

Thank you for this opportunity to testify. 

[THE PREPARED STATEMENT OF PHIL RILEY APPEARS IN THE APPENDIX]

Mr. RUNYAN. Thank you very much. 

Mr. Greitens, you are now recognized. 

STATEMENT OF ERIC GREITENS 

Mr. GREITENS. Thank you. Mr. Chairman, Congressman 

Carnahan, Members of the Subcommittee, thank you for the opportunity to testify this morning as the Founder and CEO of The Mission Continues. The Mission Continues is a national nonprofit organization that challenges veterans to serve and lead in communities 

across America. 

We believe that any system that is designed to create successful 

transitions for veterans, will only work if veterans are recognized 

for the immense abilities that they bring back to their communities. We have learned that by focusing on these strengths, despite 

some of the most severe disabilities, we can facilitate successful 

transitions from warrior to citizen. 

As a Navy SEAL, I served four tours in the Global War on Terrorism. On my last deployment in Iraq, my unit was hit by a suicide truck bomb. I was treated at the Fallujah surgical hospital and 

returned to full duty 72 hours later, but some of my friends—some 

of whom were standing an arms length from me—were hurt far 

worse than I was. 

When I returned home, I visited them and went to Bethesda 

Naval Hospital to visit other wounded servicemembers. When I 

asked them, ‘‘What do you want to do when you recover,’’ each one 

of them said, ‘‘I want to return to my unit.’’ Their bodies had been 

injured, but their spirit of service had endured. 

My experience at Bethesda that day was not unique. In a recent 

survey of post-9/11 veterans, 92 percent strongly agreed or agreed 

that serving their community is important to them. 

At The Mission Continues we create successful transitions by 

challenging veterans to continue their service and engaging them 

in six-month fellowships at nonprofit and public service organizations in their communities. Today, an Army specialist from the 

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82nd Airborne now trains service dogs for the disabled; an airman 

now serves at a women’s shelter; a Marine Corps sergeant now 

builds homes with Habitat for Humanity. 

During their fellowships, our veterans are provided with stipends 

and mentors, and are engaged in a comprehensive curriculum designed to achieve one of three post-fellowship goals. They go on to 

full-time employment, full-time education, or participate in an ongoing role of service in their communities. To date, we have awarded fellowships to 255 post-9/11 veterans, who have served with 168 

organizations across the country. 

For example, in Mississippi County, Arkansas, Anthony Smith 

served his fellowship working with under-privileged youth. In 2004, 

Anthony was serving as a major in the Army when he was hit by 

a rocket-propelled grenade. After spending 64 days in a medically 

induced coma, he awoke to find that he was blind in one eye, had 

lost his right arm underneath the elbow, and that parts of his leg, 

hip and spinal cord were damaged. Like many of the veterans that 

we work with, his transition was difficult, and he started to doubt 

whether or not he was needed here at home. 

After Anthony became a Mission Continues Fellow, he found a 

renewed sense of purpose. Through his fellowship, Anthony is 

using martial arts to mentor at-risk youth. Using pushups, modeling patience, and teaching self-control, Anthony teaches character 

lessons to dozens of students every day. 

In two independent research reports, the George Warren Brown 

School of Social Work at Washington University has found that 

nearly 80 percent of the participants in our program reported that 

serving in the community had a positive effect on their future employability, performance, and promotion; 86 percent of participants 

reported transferring their military skills to civilian employment; 

and 100 percent of fellows reported that they will probably or definitely stay involved in volunteer activities and public service in the 

future. 

Mr. Chairman, Congressman Carnahan, the story of this generation of veterans is still being written. Some have a tendency to rely 

on PTSD figures, unemployment statistics, and suicide rates to tell 

us how our veterans are transitioning. But these statistics do not 

tell the whole story. These statistics do not capture a veteran’s desire to continue to serve and their willingness to lead in communities upon their return. 

They do not tell the story of Shawn, an Army veteran who is now 

a youth football coach in Massachusetts, or April, the Army veteran 

who serves as a mentor to refugee children in the Chicago classrooms. 

Across America veterans are serving again. In fact, the majority 

of the members in this Committee have Mission Continues fellows 

serving in their district or neighboring districts. And last year, 

with our fellows as examples, The Mission Continues engaged over 

15,000 Americans to spend a day of service with veterans in their 

communities. Our Mission Continues fellows are enduring leaders 

who have overcome pain and turned it into wisdom. They are veterans whose commitment to our country did not end on the battlefield. 

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In order for veterans to transition successfully, communities 

across America must begin to recognize the service they still have 

to give. We believe that when the story of this generation of veterans is written, it will not only be a story of the wars they have 

fought overseas; it will also be a story of the homes built, the parks 

restored, the young minds engaged by veterans whose mission continues here at home. 

Mr. Chairman, we are grateful for your support and the support 

of this Subcommittee. I would welcome any questions that you or 

other Members may have. Thank you. 

[THE PREPARED STATEMENT OF ERIC GREITENS APPEARS IN THE

APPENDIX]

Mr. RUNYAN. Thank you, Mr. Greitens. I appreciate that. I thank 

you for your service and what you are doing to help our servicemen 

and women. On a personal note, I am fortunate enough to have in 

my district office a wounded warrior. I would say she is probably 

one of the top employees we have around there and she deals with 

all of our veterans case work. 

Mr. GREITENS. Yes. 

Mr. RUNYAN. And does a very good job at it. So I agree with pretty much everything you said. 

Mr. GREITENS. Thank you. 

Mr. RUNYAN. Especially as to on how motivated these individuals 

are, and how giving and service oriented they are. 

Mr. GREITENS. Yes. 

Mr. RUNYAN. Mr. Wilson, I have a question for you. Do you think 

the VA and DoD have adequately taken the recommendations of 

the various Commission reports into account and of those recommendations, which of those recommendations have or have not 

been implemented? 

Mr. WILSON. There are certainly a number of recommendations 

that the Commission has put forward. One of the ones that we 

were most concerned about had to do with the single comprehensive exam, letting the VA, in fact, do what they do best, which is 

evaluate disabilities and provide overall rating examinations. They 

have now done that and generally it seems to be an effective program. There continues to be concerns with the DoD and VA staffing levels for physicians in order to make sure the exams are being 

timely that the narrative summaries are fully developed by the 

DoD, and again that there are a sufficient number of physicians on 

staff to make this as timely as possible. 

The other issue is JAG representation. It is critical for an individual to know their legal rights. You have to have a sufficient 

number of JAG officers, Judge Advocate Generals, to advise personnel about what those rights are. They may not fully understand 

them, and that is a concern to us. The staffing levels of the 

PEBLOs is also a concern because they need to have a certain 

number of PEBLOs in order to manage the cases. 

PEBLOs are asked to address issues that are cross functional 

which leads to some of the problems that I alluded to in my testimony. 

VACREP180 with DISTILLER

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Mr. RUNYAN. And in talking about knowing your rights, whether 

it is getting to a JAG or dealing with a PEBLO, do you see the possibility of the VSO having a role in that? 

Mr. WILSON. Yes, sir. In my written testimony, I highlight some 

statistics that we had for DAV exclusively and other Veteran Service Organizations could provide additional information I am sure. 

We have seen a steady decline in the number of individuals we 

have represented over the years since the implementation of the 

IDES program. Now, that may be as a result of individuals thinking that a 30 percent disability rating with VA is good. It gives me 

retirement so I move on. 

Our concern is that 30 percent may not be an accurate rating of 

their disabilities and some of those individuals who may have gotten a 10 or 20 and severance pay instead, may not have received 

an accurate rating of disabilities either. It depends on what information you provide and how well it is documented in your medical 

record, of course. 

Veterans Service Organizations can advise military members on 

the IDES and are excellent at doing so. That is DAV’s forte, as a 

matter fact. 

Mr. RUNYAN. Thank you. 

Mr. Riley, if you could identify one fundamental problem with 

the IDES program that should be addressed immediately, what 

would that be? 

Mr. RILEY. The NARSUM preparation needs much better quality 

control by DoD and the Services. 

Mr. RUNYAN. Okay. In dealing with how the VA and the DoD, 

and the contrast between recovering warriors that have the long 

delays and those others that are expedited right through it, how do 

we bring that gap together where it is more consistent, because obviously some of them do need to be expedited, but there is always 

going to be a breakdown there and try to, obviously cut that 

down—I think you mentioned or someone in the other panel mentioned we would like it to be at 100 days if we could. How do we 

get there? 

Mr. RILEY. I think that is a question that the medical command 

has to come to grips with but basically if there are serious conditions, not just unfitting conditions that need treatment, the treatment should be given, and there should be some control over that, 

instead of just pushing them through as soon as they have gotten 

identified as unfitting or several unfitting conditions and making 

it go fast at that point. The other thing, of course, is getting good 

advice to some of the people to make sure they make the most of 

their medical treatment availability, don’t miss their appointments 

and administrative things of that nature. 

Mr. RUNYAN. Thank you. Mr. Greitens, I just have one question 

for you, specifically because you deal with a lot of these wounded 

warriors day in and day out. What is the feedback you get from 

them about this program? 

MR. GREITENS. Sir, generally, with this program there has been 

a lot of—— 

Mr. RUNYAN. Is your mic on? 

Mr. GREITENS. Yes, sir. Yes, sir. With this program, what we 

have seen from a number of veterans, certainly a broad spectrum 

VACREP180 with DISTILLER

35 

of responses, but I think with many of the veterans there has been 

frustrations, though with this process, and the frustration, sir, is 

that as they are coming back, it is not just dealing with the system 

for getting a solid disability rating. The larger point is that there 

is not a clear avenue for them out of this process, so there in a disability process. But the question is, of course, for them, what comes 

next. 

Our answer at The Mission Continues is that you can continue 

your service to your country as you come back, and of course we 

need to have answers to them both around employment and education. 

And what we believe is that in order for this transition process 

to be successful, what those veterans have to see very early on is 

that there is this light at the end of tunnel, and one of the things 

that I would recommend, we found that oftentimes the very best 

people who can actually advocate for and work with wounded veterans are oftentimes wounded veterans themselves because they 

have been through the process, they have lived through it and one 

of the things that they can also offer to their colleagues is some 

hope that at the end of this process there is a way to turn this pain 

into wisdom, there is a way to turn the suffering and the strength, 

and there is a way for them to continue their mission of public 

service to their country, sir. 

Mr. RUNYAN. Thank you very much. 

Mr. GREITENS. Yes, sir. 

Mr. RUNYAN. Mr. Carnahan. 

Mr. CARNAHAN. Thank you, Mr. Chairman. I want to start with 

Mr. Wilson and Riley and really follow up on the things you 

touched on about getting a good advice and to what extent that you 

mentioned, Mr. Riley, the shortage of JAG officers, but also, Mr. 

Wilson, you mentioned the legal counsel that is available through 

your organizations. How are those coordinated and are there ways 

that that can begin, try to maximize the resources that are out 

there to be sure they are getting that good advice in the process? 

Mr. WILSON. To address the issue of access to Disabled American 

Veterans, representatives or other certified Veteran Service Organizations, we know when we look at the guidance currently available from DoD and VA, the VA and Military Services Coordinator, 

his task, as I said in my testimony, with the task of letting you 

know you have an interest, that there are VSOs who can assist 

you. 

Having an interest is a concern to us. If a person is rather passive in their discussion, the VA Military Services Coordinator may 

not pick up on the fact that, yes, they would like to know about 

this, so we would prefer that it would be very direct information 

sharing from the VA’s Military Services Coordinator. We also believe strongly that the PEBLO who is supposed to be key to driving 

the train on the DoD side of this process, also clearly lets them 

know that Veteran Service Organizations are available to assist 

them as well. You don’t have to be a veteran in order to get Veteran Service Organization representation and that shift thinking of 

someone on active duty versus thinking of themselves as soon to 

be veterans may be a part of a problem. As individuals are going 

through this IDES process which is new to them, they are learning 

VACREP180 with DISTILLER

36 

as they go. They get many months of training through the various 

military specialties but they don’t get very many months of training when it comes to the IDES process, They are focused first, getting healthy. Later in the healing process they focus on, what they 

are going to do when they get out of the military. In trying to make 

that transition they then come to understand they need legal representation which we can provide. 

Mr. CARNAHAN. And let me ask Mr. Riley to respond as well. 

Mr. RILEY. Well, I find that oftentimes when I meet Wounded 

Warriors families and the warriors in the wards that they really 

want to know something about the benefits process, but they don’t 

know who to ask, and they don’t get information right up front. 

First of all, I think, when you have got seriously wounded people, 

you need to get information right up front and we do a number of 

bedside briefings and what have you if we are allowed to. 

The PEBLO gives basically a PowerPoint briefing to the 

servicemember, and unfortunately most of the time we don’t get engaged until we have been called in by someone who is concerned 

about their narrative summary and also they don’t take advantage 

of the JAGMEB/PEB Officers. There are some good JAGs and real 

trusted JAGs out there now, but there weren’t a few years ago, and 

soldiers tend to resist, thinking that they have got a lawyer that 

is not on their side when it is a government lawyer, but now they 

actually have MEB and PEB lawyer JAGs that are very helpful. I 

have worked several cases in conjunction with JAG officers and 

that has worked very well. 

So what I would finally say is if the Department of Defense 

would encourage and bring us on to do more, we could really help 

with the success of the IDES process. 

Mr. CARNAHAN. Thank you. Let me turn to Mr. Greitens. You 

mentioned this avenue out of the process which I think obviously 

is a critical component. What is the biggest challenge that you have 

found for your fellows in being able to get to that avenue? 

Mr. GREITENS. Yes, you know, well, Congressman, one of the 

challenges is, is to make sure that as a community organization, 

that we have the opportunity to work with men and women who 

are interested in this program. Over 50 percent of our recommendations are coming from Mission Continues Fellows and 

Mission Continues alumni who are saying to their servicemembers, 

saying to men and women who they are in the hospital with, this 

really changed my life, you should get in touch with The Mission 

Continues. 

We have, at present, a number of excellent advocates, individuals 

in the VA system who have seen their patients go on to become 

Mission Continues Fellows. But one of the challenges at present is 

that for an organization like The Mission Continues or other organizations that offer services to help veterans make this transition, 

there is no central way to become accredited as a high quality service organization that can actually work within the DoD and the 

VA. 

And so what happens is that for many small nonprofit organizations who might have a national footprint but don’t have the ability 

to go to every military base around the country, right now you 

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would have to get an individual memorandum of understanding to 

work on that base. 

One of the things that would be incredibly helpful is if there is 

a joint VA and DoD process that could accredit organizations who 

are often very high quality services. As you know, Congressman, 

there also is a great number of veterans organizations that are out 

there. Not all of them provide high quality services, and so if the 

VA and the DoD create an accreditation process, it would help 

these organizations to get that accreditation. It would kind of serve 

as a way to certify organizations who could help with this transition. 

Mr. CARNAHAN. Thank you. 

Mr. GREITENS. Yes, sir. 

Mr. CARNAHAN. I have got a couple more that I want to ask you 

about and that Chairman has given me leave to ask a few others. 

Mr. GREITENS. Yes, sir. 

Mr. CARNAHAN. But to your point. 

Mr. GREITENS. Yes, sir. 

Mr. CARNAHAN. About the VA and DoD, the role that they are 

playing in helping to do that now, and sort of where is that room 

for improvement, if you could elaborate on what you just talked 

about. 

Mr. GREITENS. Yes, sir. I think just to elaborate and what I 

would like to see is a joint process by which the VA and the DoD 

come up with a certain criteria that organizations need to meet in 

order to be accredited to provide services to servicemembers and returning veterans. Currently, that process oftentimes varies from 

base to base. It can sometimes vary from hospital to hospital. 

And so, in the same way The Mission Continues today, it is a 

Better Business Bureau accredited charity. The Better Business 

Bureau has 20 standards that we have to meet in order to get that 

accreditation. I think there is some room here for the Secretary of 

the VA and the Secretary of Defense to put together a joint Committee which would then say these are the standards that organizations have to meet in order to be welcome both on military bases 

and in VA institutions. 

Mr. CARNAHAN. I think that is a great idea and I think it is a 

conversation really worth digging into. And also I wanted to follow 

up and ask within what you do, do you see actions that Congress 

could do to better assist community-based organizations like yours 

to again help with this transition? 

Mr. GREITENS. Thank you, Congressman. I think there are probably two things that Congress can do. One is, I think, because of 

the sort bully-pulpit power that individual members have, Congress has, that this Subcommittee has, I think it is very important 

for us to get the message out to the public about the capabilities 

that this generation of veterans has. Too often when people think 

about veterans, if you pulled ten people off of the street right now 

and you asked them to give you their top ten words about veterans, 

they would certainly say service, they would certainly say honor. 

But somewhere in that list of ten, they would also say post-traumatic stress disorder, they would say traumatic brain injury, they 

would say unemployment, they would say suicide. 

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And I believe, Congressman, that we have a battle on our hands 

right now to determine what the future, what the legacy of this 

generation of veterans is going to be. So first, I think there is a 

kind of bully pulpit function of individual congressmen going out 

and talking about the wounded warriors who they have, who are 

doing incredible work, and let us get that message in front of the 

public about the capabilities that these men and women have. 

Secondly, my team and some of our other partners in the veterans service space right now are exploring ways that we might actually engage with existing Federal programs, existing Federal dollars that would help to enable veterans to begin to serve again in 

their communities. 

Our plan is to do this research and then come back to you, Congressman, and come back to the Subcommittee with a set of recommendations about how Congress could actually help to facilitate 

veterans coming home and continuing to serve in their communities and executing these successful transitions, and we welcome 

the opportunity to follow up with your staff and the staff of this 

Subcommittee on those ideas. Thank you so much. 

Mr. CARNAHAN. Thank you. 

Mr. RUNYAN. I just have one final question, for Mr. Wilson. In 

your written testimony, you stated that overall satisfaction rates 

are higher in the IDES program than the legacy DES program. 

Other than improved processing times, specifically what else is 

there that is moving that line? 

Mr. WILSON. I think it would be interesting to see what the individuals who are going through the processes themselves have 

thought thus far. If I recall correctly, they would like to have a better understanding of who their advocate is in this process, who is 

that person. How would the DoD and the VA go about improving 

this so that it is very clear to an individual that their advocate is 

going to be a certain single individual that they can go to? That 

is one area, I think, that is of great interest to us, and we would 

hope that the briefings are provided are not death by PowerPoint, 

but in fact but are given by PEBLO’s who are well trained and understand the process well enough to explain IDES clearly. 

So quality control of the work done by PEBLOs or a Military 

Services Coordinators, or others, requires continued review and assessment. 

Mr. RUNYAN. I was looking to end on a positive note, other than 

the speed at which we do it, of the new system, what would that 

be, or isn’t there one? 

Mr. WILSON. Oh, are there positives with new system besides the 

speed? Yes, sir. We are very pleased with the fact that we now 

have a single comprehensive exam done by VA, since they are experts in this area of providing disability ratings. It is much more 

efficient than it was previously and the combining of efforts and 

eliminating repetition or competition between the DoD and VA. No 

longer are disability ratings done by the DoD and then by the VA 

taking out unnecessary steps in this process. That has made a significant improvement. Timeliness has improved as well, and I 

think satisfaction rates are higher with this program, as a result 

of those kinds of modifications. 

Mr. RUNYAN. Thank you. You don’t have any questions, do you? 

VACREP180 with DISTILLER

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I want to, gentlemen, on behalf of this Subcommittee, I want to 

thank each of you for your testimony and we welcome working closer with you in addressing these issue that have an enormous impact on our American veterans and you all are excused now. I recognize Mr. Carnahan for a closing statement. 

Mr. CARNAHAN. Just again, Mr. Chairman, thank you for your 

leadership on the Committee and I want to thank our witnesses, 

all three panels today. This is, I think, been a really good overview. 

Some really good positive ideas have come out of this and we really 

look forward to working with you to be sure we can get these implemented. Thanks again. 

Mr. RUNYAN. With that, I ask unanimous consent that all members have five legislative days to revise and extend their remarks 

and include any extraneous material. 

Hearing no objection, so ordered. I thank the members for their 

attendance today, and this hearing is now adjourned. 

[Whereupon, at 12:59 p.m. the Subcommittee was adjourned.] 

VACREP180 with DISTILLER

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A P P E N D I X 

Prepared Statement of Hon. Jon Runyan, Chairman 

Remarks 

Good morning and welcome everyone. This oversight hearing of the Subcommittee 

on Disability Assistance and Memorial Affairs will now come to order. 

We are here today to examine the current framework in the ongoing efforts to 

streamline the transition process between active duty soldier to veteran. 

The lynchpin of this streamlining process has been the implementation of the Integrated Disability Evaluation System, otherwise known as ‘‘I.D.E.S.’’ This program 

was created in December 2007 following the recommendations of the Veterans’ Disability Benefits Commission, and the President’s Commission on Care for America’s 

Returning Wounded Warriors, otherwise known as the Dole/Shalala Commission. 

I.D.E.S.’s goal is to improve the timeliness, effectiveness, and transparency of the 

former legacy DES review process, which had been in place for 60 years prior. In 

October of 2010, VA and DoD worked in concert to begin the permanent shift to 

I.D.E.S around the country in 139 locations. The ultimate objective remains to fully 

close the gap which occurs between separation from active duty service and receipt 

of VA benefits and compensation. 

I am pleased to see progress being made to meet this objective under the new system, specifically, helping to cut the transition time between active duty and veteran 

status. However, there are several issues and unforeseen problems which need to 

be addressed. 

First, issues with processing times remain problematic. Whereas some Recovering 

Warriors experience lengthy delays in their attempt to navigate through the IDES 

system, others are rushed through without receiving the proper medical attention 

that they need. 

Second, many Recovering Warriors report that they find the IDES process to be 

extremely confusing and difficult to understand. Further efforts must be made to 

work directly with our Recovering Warriors to ensure that they are making the 

right decision for themselves, their families and their futures. 

Finally, IDES is not as simple in practice as the various Commission Reports 

were hoping it would be when it was first proposed. Now, nearly five years after 

its inception, it is important for both VA and DoD to continue evaluating the system 

and their efforts to achieve its goals of increasing transparency, improving consistency, and eliminating duplicate processes. 

As a new generation of active duty servicemen and women return home from conflicts oversees, we must be prepared to meet our commitment to see that their transition to civilian and veteran life is as efficient and simple as possible. It is our duty 

to see that their service is honored as best as our resources will permit. 

It is my hope that this oversight hearing will shed some light on some of the problems we have encountered in the implementation of IDES so that we may work together to find the best solutions possible. 

I want to thank the VA, the DoD, the present VSOs, Dr. Wilensky, Mr. Fisher, 

and General Scott for their valuable input as we work together to find important 

solutions. 

I welcome today’s witnesses and would now call on the Ranking Member for his 

opening statement. 

f 

Prepared Statement of Hon. Jerry McNerney, 

Ranking Democratic Member 

Thank you, Mr. Chairman. I would like to thank you for holding today’s hearing. 

VACREP180 with DISTILLER

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The purpose of this hearing is to focus on the transition process of 

servicemembers to veterans, with a particular focus on the implementation of the 

Integrated Disability Evaluation System (IDES), a joint VA/DoD examination and 

records integration effort initiated in 2007 as a result of the fallout from deplorable 

conditions and disjointed care of Wounded Warriors at Walter Reed Army Hospital. 

This hearing will allow us to not just assess the effectiveness of the Integrated 

Disability Evaluation System (IDES), but other components of the Pre-Discharge 

Program established by the Departments of Defense (DoD) and Veterans Affairs 

(VA), and to streamline servicemembers’ transition from active duty to veterans’ status. 

Today’s discussion on IDES also follows up on our work implementing the Veterans’ Benefits Improvement Act of 2008, Public Law 110–389, which also paved the 

way for a number of initiatives targeting the VA claims backlog. 

In 2007, the Dole-Shalala Commission, set recommendations for the care of 

wounded warriors, and concluded that it is not enough to merely patch the system 

for transition to civilian life, as has been done in the past. The experiences of our 

men and women returning home complaining about a lack of a clear outline of the 

access to care, benefits, and services available to them highlighted the need for fundamental changes in the care management and disability systems. 

The Dole-Shalala findings marked the siren call for the creation of the Disability 

Evaluation System—a joint effort between DoD and VA to move to a one-exam platform, which today we know as the Integrated Disability evaluation System or IDES. 

We must make every effort to focus our resources toward assisting transitioning 

servicemembers with the comprehensive, coordinated care and benefits they deserve. This must occur at the very beginning of a servicemember’s reintegration. 

To this end, any member of the Armed Forces who has seen active duty—including those in the National Guard or Reserves—is eligible to apply for VA disability 

benefits prior to leaving military service through the Benefits Delivery at Discharge, 

Quick Start, or IDES pre-discharge programs. 

During the application process, servicemembers can get help in completing forms 

and preparing other required documentation from VA personnel located at their 

bases. Additionally, IDES combines the health exam required by the DoD upon 

exiting the military and the VA disabilities assessment exam into a single process, 

albeit for different purposes. 

In the meantime, in an effort to provide even greater transition assistance, more 

elements and players, like the Federal Recovery Coordination Program have been 

added to assist our wounded warriors. 

I know the intent of these programs are well-meaning, and have helped numerous 

veterans across the country. But I still hear from veterans in my district who have 

gone through these programs, and continue to experience significant delays, confusion and other problems with effective reintegration. 

In fact, to that end, I would like to mention that Mr. Barrow has a helpful bill 

pending before the Health Subcommittee, H.R 3016, that would improve reintegration efforts and require that the Federal Recovery Coordination Program operate 

jointly under both DoD and VA. 

Since its full implementation at the end of 2011, IDES has been expanded from 

3 military bases to more than 139 sites globally and nationally. 

With the drawdown of troops over the next few years, I am particularly concerned 

by the fact that the average processing times takes 400 days, and that there are 

about 200,000 servicemembers already in the system. We don’t need another backlog and want to avoid that outcome at all costs. 

I look forward to having an open dialogue with the panels here today, and with 

my colleague, on ways to overcome challenges within the IDES system, and accelerate processing without sacrificing quality. Separating servicemembers should not 

wait more than a year for their assessments and benefits. 

It is my hope that through our examination of the IDES and other pre-discharge 

programs today, coupled with the electronic integration and other business reformation efforts accomplished over the last few years, we will continue to improve and 

transform today’s VA claims processing system and help our servicemembers successfully transition back into our communities. And NOT into another backlog. 

I look forward to hearing from all of our esteemed witnesses. Thank you, Mr. 

Chairman. I yield back. 

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f 

42 

Prepared Statement of Hon. Russ Carnahan 

Thank Chairman Runyan and Ranking Member McNerney for recognizing me 

here today. 

This isn’t the normal Subcommittee that I sit on, but today I am proud to have 

an organization from my district that I’ve had the pleasure of working with testifying before this Committee. I’d like to use my opening remarks to recognize and 

introduce to the Committee Eric Greitens of the Mission Continues. 

The Mission Continues is truly a remarkable organization that empowers veterans to transform their lives and the lives of others by participating in community 

service fellowships. These Mission Continues fellows serve six months at community 

non-profit organization and afterwards either obtain full-time employment, pursue 

higher education or a permanent role of service. This is truly a remarkable program 

that not only gives veterans a much needed sense of purpose following military service, but also eases an often extremely difficult transition to civilian life. 

And as an organization that is run by a Navy Seal and many former members 

of the military, the Mission Continues has a keen understanding of the many challenges facing our servicemembers when they return home. As this organization continues to make this model more accessible and available to veterans across our 

country, my colleagues and I stand ready to continue to support them in this lifechanging work. 

With that, Mr. Chairman, I again thank you for recognizing me, and I look forward to hearing the testimony of not only the Mission Continues, but the other organizations who are present here today to talk about this important issue. 

f 

Prepared Statement of John P. Medve 

Good morning Chairman Runyan, Ranking Member McNerney, and Members of 

the Subcommittee. My name is John Medve, Executive Director of the Department 

of Veterans Affairs (VA) Office of VA–DoD Collaboration within VA’s Office of Policy 

and Planning. I am pleased to be joined by Mr. Jim Neighbors from the Department 

of Defense (DoD). My testimony will focus on the status of the transition process 

from DoD to VA, with an emphasis on the Integrated Disability System (IDES), the 

Federal Recovery Coordination Program (FRCP), and Veterans Affairs Schedule for 

Ratings Disabilities (VASRD) modernization. I will provide the Subcommittee with 

an overview of the status of the IDES, the process used to transition the wounded, 

ill, and injured who are unfit for continued military service. I will also provide an 

overview of care coordination efforts designed to assist severely wounded, ill, and 

injured servicemembers and Veterans through recovery, rehabilitation, and reintegration as it relates to the FRCP, and explain how VA and DoD are communicating about additions and revisions to the VASRD. 

Integrated Disability System (IDES) 

VA and DoD’s joint efforts have resulted in improvements and created an integrated disability process for servicemembers who are being medically retired or separated. 

Much has been accomplished to improve the DoD disability process in the wake 

of the issues identified at the Walter Reed Army Medical Center in 2007. In early 

2007, VA and DoD partnered to develop a modified, integrated Disability Evaluation 

System (DES) and a DES Pilot was launched in November 2007. This new, joint 

process was designed to eliminate the duplicative, time consuming, and often confusing elements of the separate disability processes within VA and DoD. The goals 

of the joint process were to: (1) increase transparency of the process for the 

servicemember; (2) reduce the processing time; (3) improve the consistency of ratings for those who are ultimately medically separated; and (4) reduce the benefits 

gap that existed between the point of separation or retirement and before receipt 

of VA disability compensation. Authorization for the DES Pilot was included in the 

National Defense Authorization Act for Fiscal Year 2008. 

The DES Pilot was launched at three operational sites in the National Capital Region (NCR): Walter Reed Army Medical Center, National Naval Medical Center, and 

Malcolm Grow Medical Center on Andrews Air Force Base. The DES Pilot was recognized as a significant improvement over the legacy DES process, and, as a result 

of the Senior Oversight Committee (SOC) findings and the desire to extend the benefits of the Pilot to more servicemembers, VA and DoD expanded the Pilot. By the 

end of March 2010, the DES Pilot had expanded to 27 sites and covered 47 percent 

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

DES Pilot and rename it IDES. Senior leadership of VA, the Services, and the Joint 

Chiefs of Staff strongly supported this plan and the need to expand the benefits of 

this improved process to all servicemembers. Expansion and full implementation of 

IDES was completed by September 30, 2011. Currently, there are 139 IDES sites 

operational worldwide, including the original 27 DES Pilot sites. 

In contrast to the DES legacy process, the IDES provides a single set of disability 

examinations and a single-source disability rating, used by both Departments in 

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

separated. As a result, VA can deliver benefits in the shortest period allowed by law 

following discharge thus reducing the ‘‘benefit gap’’ that previously existed under 

the legacy process, i.e., the lag time between a servicemember separating from DoD 

due to disability and receiving his or her first VA disability payment. This also prevents the servicemember from having to navigate the VA disability system on his 

or her own after separation. The DoD/VA integrated approach has also eliminated 

many of the sequential and duplicative processes found in the legacy system. Yet, 

there is more to be done. 

To monitor our overall performance for the IDES process, VA and DoD track the 

performance of the core processes on a bi-monthly basis for the over 25,000 

servicemembers in IDES. In addition, VA’s Chief of Staff conducts bi-monthly internal Video Teleconferences (VTCs) with Central Office and Field Executive staff. VA 

also has joint monthly VTCs with both Army and Navy/Marine Corps to discuss site 

performance and general collaboration opportunities. 

VA is responsible for four core processes within IDES: claims development, medical examination, proposed rating, and VA benefits. VA average processing time for 

VA core processes has decreased from 186 days in February 2011 to 134 days as 

of February 2012. The VA target for combined processes is 100 days of the 295 day 

combined VA–DoD target. While VA is currently meeting the goals for claims development and medical examinations, it is still falling short of meeting the standards 

for developing the proposed rating and the delivery of VA benefits. To address these 

shortcomings, VA assigned additional raters to Disability Rating Activity Sites 

(DRAS), increasing the number of Ratings Veterans Service Representative (RVSRs) 

to 167 among the three IDES rating sites in Seattle, Baltimore and Providence, 

which represents a 35 per cent increase in personnel. To address the timeliness of 

benefit delivery, VA identified a process to receive servicemember separation data 

electronically. This functionality is scheduled to be deployed in May of this year. 

Despite the overall reduction in combined processing time achieved to date, challenges remain and there is room for significant improvement in IDES execution. 

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

Warriors and Veterans through an improved IDES. As such, VA believes that its 

continued partnership with DoD is critical and is nothing less than our 

servicemembers and Veterans deserve. 

Federal Recovery Coordination Program (FRCP) 

The FRCP was created in October 2007 in direct response to the Dole-Shalala 

Commission’s recommendation for improved care coordination for seriously wounded, ill and injured. The FRCP is designed to work and interact with existing military and VA health care teams, case managers, benefit coordinators, other Federal 

agencies and the private sector. FRCP provides seamless support from the 

servicemember’s arrival at the initial Military Treatment Facility (MTF) in the 

United States through the duration of his or her recovery, rehabilitation, and reintegration. The FRCP staff at the policy level coordinates with their DoD counterparts under the umbrella of the Joint Executive Council. The FRCP is an integral 

part of VA and DoD efforts to address issues raised about the coordination of care 

and transitions between the two Departments for recovering servicemembers. Federal Recovery Coordinators (FRCs) are located in 12 facilities across the country including four MTFs, two VA Medical Centers, three VA Polytrauma Centers, and 

three Wounded Warrior Program offices. 

FRCs assist severely wounded, ill, and injured servicemembers, Veterans and 

their families through each client’s recovery, rehabilitation, and reintegration. They 

are Masters-prepared nurses or clinical social workers who provide high-level care 

coordination for their clients. The FRC creates a Federal Individual Recovery Plan 

(FIRP) for each client based on the goals expressed by the client, with input from 

his or her family and/or caregiver and health care team. To show greater transparency with servicemembers and Veterans, the FIRP is available through the 

eBenefits portal 24 hours a day, seven days a week. eBenefits is a web-based toll 

that is now available all servicemembers and Veterans and currently has over 1.2 

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million subscribers. FRCs provide client-centric assistance by coordinating all clinical and non-clinical care, benefits, and services, that are aligned with their clients’ 

FIRP goals, regardless of medical diagnosis, geographic location of injury or illness 

or place of medical treatment. Clients remain enrolled in the program as long as 

there is a perceived need and benefit to the client. FRCP is unique to other programs in that once a FRC is assigned to a client, the FRC is the constant point of 

contact for that client throughout all transitions. 

Veterans Affairs Schedule for Ratings Disabilities (VASRD) 

The VA Schedule for Rating Disabilities (VASRD) is the regulatory framework 

through which VA provides Veterans with compensation for diseases and injuries 

they incur while serving our Nation. It is this rating schedule that guides the disability rating personnel of VA and DoD in making the correct determination of the 

compensation benefit level applicable for a Veteran’s service-connected condition(s). 

The VASRD contains disability percentages ranging from 0 to 100% that translate 

into monthly compensation for Veterans based, by statute, on ‘‘the average impairments of earning capacity.’’ (38, U.S.C., section 1155) VA is proactively updating and 

comprehensively revising the entire VASRD, which currently includes 15 body systems. This effort is the result of an October 2009 Secretarial directive to revise and 

update all parts of the VASRD, using current medical science and econometric earnings loss data. The update process is statutorily required under Section 1155 of Title 

38, which states that ‘‘[t]he Secretary shall from time to time readjust this schedule 

of ratings in accordance with experience.’’ VA has partnered with DoD and the academic community to collaborate on revisions to the rating schedule. The collaboration involves public forums in which medical experts, members of the Advisory Committee on Disability Compensation, DoD officials, Veterans Service Organizations, 

and other stakeholders provide input and subsequently form working groups to substantively revise the rating schedule. 

While the public forums and working groups gather input from these important 

entities, under title 38 U.S.C., section 1155, VA has ultimate responsibility for adjustments to the VASRD. The Veterans Benefits Administration (VBA) has implemented a project management plan detailing the organizational, developmental, and 

supporting processes to modernize the rating schedule by 2016. The plan calls for 

eight medical officers and six attorneys to work with the subject-matter experts and 

cross-agency working groups as described above. The public forum and working 

group system is based on a methodology consistent with the Institute of Medicine’s 

method of involving medical subject matter experts across disciplines, agencies, and 

private sectors. During this ongoing update process, VBA is engaged in a seamless 

partnership with VHA. 

The VA remains fully committed to meeting the needs of our Nation’s heroes and 

their families. VA and DoD are partners and will 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 Wounded Warriors and their families. While we are pleased with 

the quality of effort and progress made to date with our joint collaboration, we fully 

understand our two Departments have a responsibility to continue to improve these 

efforts. 

Thank you again for your support to our wounded, ill, and injured 

servicemembers, Veterans, and their families. This concludes my testimony and I 

will be happy to respond to any questions. 

f 

Prepared Statement of James G. Neighbors 

Chairman Runyan, Ranking Member McNerney, and members of the Subcommittee, thank you for inviting us to testify before you on the care and transition 

of our recovering Service members from the Department of Defense (DoD) to the Department of Veterans Affairs (VA). Taking care of our wounded, ill and injured Service members is one of the highest priorities of the Department, the Service Secretaries and the Service Chiefs. The 2007 revelations regarding Walter Reed Army 

Medical Center were a stark wakeup call for us all. During the past five years, DoD 

has worked in tandem with VA to improve policies, procedures, and legislation that 

impacts the care of our wounded warriors. 

Due to efforts by both Departments, we have reached important milestones in improving care for our recovering Service members. These milestones include a new 

disability evaluation system and improved case management that are the result of 

a programmatic cohesion with VA that is better than ever before. More so than at 

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any other time in our Nation’s history, separating Service members are greeted by 

more comprehensive mental and physical care; by greater opportunity for education, 

and by a deeper societal commitment to ensuring their welfare. 

The Department’s leaders continue to work to achieve the highest level of care 

and management and to standardize care among the Military Services and with 

other Federal agencies, while maintaining focus on the individual. 

Disability Evaluation System/Integrated Disability Evaluation System 

The genesis of the Disability Evaluation System (DES) was the Career Compensation Act of 1949, and it remained relatively unchanged until November of 2007. As 

a result of public concern and congressional interest, the joint DoD and VA SOC 

chartered a DES pilot designed to create a ‘‘Service member-centric’’ seamless and 

transparent DES. The DES pilot implemented many of the changes recommended 

by groups like the Veterans’ Disability Benefits Commission and the President’s 

Commission on Care For America’s Returning Wounded Warriors to the degree allowed within current law. 

The pilot launched at the three major military medical treatment facilities (Walter Reed Army Medical Center, National Naval Medical Center, Bethesda, and Malcolm Grow Air Force Medical Center) in the National Capital Region on November 

21, 2007, and successfully created a seamless process that delivers DoD benefits to 

wounded, ill and injured Service members and VA benefits to Veterans as soon as 

possible following release from duty. We found the DES Pilot to be a faster, fairer 

and more efficient system. As a result, in July 2010, the Deputy Secretary of Defense and Deputy Secretary of Veterans Affairs directed worldwide implementation 

to start in October 2010 and to complete in September 2011. On December 31, 2010, 

the pilot officially ended and the first Integrated Disability Evaluation System 

(IDES) site became operational. 

The IDES, similar to the pilot, streamlines the DES process so that the Service 

member receives a single set of physical disability examinations conducted according 

to VA examination protocols, proposed disability ratings prepared by VA that both 

DoD and VA can use, and processing by both Departments to ensure the earliest 

possible delivery of disability benefits. Both Departments may use the VA protocols 

for disability examination and the proposed VA disability rating to make their respective determinations. Under Title 10 authority, DoD determines fitness for duty 

and compensates for unfitting conditions incurred in the line of duty, while under 

Title 38 authority, VA compensates for all disabilities resulting from disease or injury incurred or aggravated in line of duty during active military, naval, or air service for which a disability rating of ten percent or higher is awarded, and also determines eligibility for other VA benefits and services. The IDES permits both Departments to provide disability benefits at the earliest point allowed under both titles. 

It is important to point out that Service members who separate or retire (non-disability) may still apply to the VA for service-connected disability compensation. 

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

181, also required the Department to utilize the VA Schedule for Rating Disabilities 

(VASRD). While the Department recognizes that the VA Secretary has ultimate responsibility and decision authority for the content of the VASRD, we believe DoD 

should have more developmental input, given the direct connection between the 

VASRD ratings and the decision to place Service members on the medical retirement list with annuities, benefits and healthcare. We appreciate VA’s outreach to 

include DoD in the body system rating update review that began last year and the 

Services’ participation through their subject matter experts. DoD plans to continue 

to participate in VA’s public meetings as DoD and VA leadership continue discussing how to strengthen DoD’s role in the VASRD rewrite process. We look forward to finalizing a memorandum of understanding with VA, which will formalize 

DoD’s active voice in the future development and modernization of the VASRD. 

In summary, the IDES features a servicemember-centric design, a simplified process, more consistent evaluations and compensation, a single medical exam and disability rating, seamless transition to Veteran status, case management advocacy, 

and establishment of a Service member relationship with the VA prior to separation. It also provides increased transparency through better information flow to 

servicemembers and their families and a reduced gap between separation/retirement 

from Service to receipt of VA benefits. 

As of early this month, IDES enrollment is 24,957 Service members (66 percent 

Army, 13 percent Marines, 10 percent Navy, and 11 percent Air Force). Since November 2007, cumulative enrollment has been 44,451, with 14,249 completing the 

process and receiving benefits. Including Service members who are returned to duty 

by the process, active component Service member IDES completion time averages 

370 days as of February 2012, Reserve Component members averaged 358 days, and 

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Guard members averaged 396 days. These averages are above our targeted goals 

but still are significantly lower than the 1940-era legacy system it replaced. 

This past year, the Department partnered closely with the VA to implement the 

IDES at all 139 DES sites worldwide; however, we recognize the need to do better 

in the areas of timeliness to complete the process. This year our focus will be on 

such timeliness improvements. We have made significant policy adjustments to remove impediments, implemented procedural improvements, enhanced oversight and 

assistance to the Military Departments, and added resources that should improve 

Military Department performance in this area, including increasing legal support to 

advise and counsel Service members undergoing disability evaluation. We will continue to enhance our emphasis on leadership, resourcing and execution of the IDES 

to handle increased volume while decreasing the time spent in the process. 

The Departments are looking closely at the stages of the system that are outside 

of timeliness tolerances and are developing other options to bring these stages within goal by December 2012 as the Secretaries of Defense and Veterans Affairs have 

directed. We are fully committed to working closely with Congress to explore new 

initiatives to further advance the efficiency and effectiveness of the disability evaluation process. 

Recovery Coordination Program 

The Recovery Coordination Program (RCP) was established by the FY08 NDAA, 

and was further defined by the Department of Defense Instruction (DoDI) 1300.24, 

entitled ‘‘Recovery Coordination Program.’’ The Department has implemented many 

of the changes recommended by the President’s Commission on Care For America’s 

Returning Wounded Warriors to the degree allowed within current law. The FY 

2008 NDAA and the DoDI 1300.24 together provide a comprehensive policy on the 

care and management of recovering Service members, including the assignment of 

a Recovery Care Coordinator (RCC) to help wounded, ill and injured Service members and families through the phases of recovery, rehabilitation and reintegration 

utilizing a Comprehensive Recovery Plan (CRP) that has been developed in coordination with the Recovery Team. The policy also provides for standardized training, 

and a caseload ratio of not more than 40 recovering Service members per RCC. 

Currently, there are 171 RCCs in 84 locations worldwide, placed within the Army, 

Navy, Marines, Air Force, United States Special Operations Command and Army 

Reserves Wounded Warrior Programs. More than 3,800 Service members and families have the assistance of an RCC, whose responsibilities include ensuring the Service member’s non-medical needs are met, and assisting in the development and implementation of the CRP. An automated solution was developed to increase efficiencies for RCC’s to be able to maximize their time and service provision to our 

Service members and their families. Each RCC receives more than 40 hours of Department-sponsored standardized training, including information on roles and responsibilities and concepts for developing the CRP. After the October 2011 training, 

90 percent of students rated the instruction and course materials as ‘‘excellent.’’ Additionally, we are now beginning to train Army ‘‘Advocates’’ in order to bring their 

program into compliance with the legislative mandate that every recovering Service 

member be provided a DoD-trained RCC. This training is continually enhanced 

based on feedback from participants. The Department is committed to ensuring 

redundancies are mitigated with other agencies. We believe the Federal Recovery 

Coordination Program (FRCP) and the DoD programs are complementary and if 

there are perceived redundancies, we do not believe that is indicative of a problem. 

Over the past five years, we have increased the numbers of RCCs available to provide care coordination to our recovering Service members, and looking ahead, each 

Military Service will continue to identify and resource their requirements for additional RCCs. Following are descriptions of three priorities that play important parts 

in recovering members’ recovery process. The RCP has expanded to include several 

other portfolios, many of them identified as key priorities for the non-medical care 

management of recovering Service members during a Wounded Warrior Care Coordination Summit held in March 2011. 

The Wounded Warrior Education and Employment Initiative (E2I) operates on a 

regional basis and engages recovering Service members early in the recovery process 

to identify their skills, career opportunities that match those skills, and any additional skills they may need for success as they recover and prepare to leave service. 

The E2I process relies on collaboration with the Service Wounded Warrior Programs 

and the VA, operating under a Memorandum of Understanding to provide VA’s vocational rehabilitation services earlier in the recovery process than ever before. 

The Operation Warfighter program (OWF) works to place wounded, ill and injured 

Service members in non-paid Federal internship opportunities that positively impact 

their rehabilitation and augment career readiness by building resumes, exploring 

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employment interests, obtaining formal on-the-job training, and gaining valuable 

Federal government work experience. There are currently more than 500 OWF interns working in approximately 75 Federal agencies and sub-components around the 

country, with a total of more than 2,500 placements in 105 agencies and sub-components since the inception of the program. Going forward, the Regional Coordinators 

will continue to focus on local and regional outreach to strengthen relationships 

with Federal agencies to improve and enhance internship and employment opportunities for wounded, ill and injured Service members. 

The Military Adaptive Sports Program engages wounded, ill and injured Service 

members early in individualized physical activities outside of traditional therapy 

settings, inspiring recovery and encouraging new opportunities for growth and 

achievement. This new initiative is being implemented throughout the Department, 

in partnership with the Services and the United States Olympic Committee. The 

goals of the program include increasing awareness and participation in adaptive 

sports and recreation at the Service-level, preparing athletes for participation in 

competitive events such as the Warrior Games, and providing a seamless transition 

of participation from this program into VA’s National Veteran’s Sports program. 

These measures when taken together, substantially and materially affect the life 

experience of our men and women in uniform and the families who support them. 

Our work to improve the care of recovering Service members, especially as they 

transition from DoD to VA, is the core of our efforts to provide those who have sacrificed so much with the care and benefits they deserve. Despite the significant 

achievements, we should not underestimate what remains to be done as we care for 

a new generation of Veterans who have served under very difficult circumstances 

for sustained periods. We will continue to work with our colleagues at VA and 

throughout the government to provide our servicemembers with the highest quality 

care and treatment. Taking care of our wounded, ill and injured Service members 

is one of the highest priorities for the Department, the Service Secretaries, and the 

Service Chiefs. 

Special Compensation for Assistance with Activities of Daily Living 

We recognize the strength of military families and caregivers of recovering Service 

members. If a Service member returns home wounded, ill or injured, the military 

family and caregiver are the glue that holds everything together during a Service 

member’s recovery and transition—which can often be confusing, frightening, and 

overwhelming. On August 31, 2011 DoD promulgated policy, authorized by Public 

Law 111–84, to compensate all catastrophically wounded, ill, or injured Service 

members, with line of duty-related medical conditions, who needed caregiver assistance to live outside a resident medical facility or who required supervision to prevent harm to themselves or others. This policy, enacted through DoDI 1341.12, Special Compensation for Assistance in Activities of Daily Living (SCAADL), gives 

qualified Service members monthly compensation to help offset the economic burden 

borne by their primary caregivers providing non-medical care, support and assistance. As of February 29, 2012, 505 Service members have received the SCAADL 

compensation. 

Transition Assistance Program (TAP) 

Today’s Veterans face a number of challenges in making the transition to civilian 

life among these is embarking on a productive post-military career. For every success story of a Veteran who has turned skills developed in the military into success 

in the civilian workplace, there are, as President Obama has said, stories of Veterans who come home and ‘‘struggle to find a job worthy of their experience and 

worthy of their talent.’’ We see these struggles most clearly in high unemployment 

rates for Veterans. As we draw down from the wars in Iraq and Afghanistan and 

we make difficult decisions about our future force structure in light of the fiscal 

challenges the Nation faces, the situation becomes more urgent with the increased 

number of Service members—particularly young Service members—departing the 

military. 

Making a firm commitment to employ America’s Veterans, in August 2011, the 

President called for the creation of a Task Force led by the DoD and VA with and 

other agencies including the DoL, Department of Education (DoE), Department of 

Commerce, Small Business Administration, and the Office of Personnel Management, to develop proposals to maximize the career readiness of all servicemembers. 

In coordination with our VA, DoL, and DoE partners, DoD’s implements and sustains a comprehensive plan to ensure all transitioning Service members have the 

support they need and deserve when leaving the military. This includes working 

with other agencies in developing a clear path to civilian employment; admission 

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up of an independent business entity or non-profit organization. The effort is fully 

aligned with the VOW to Hire Heroes Act of 2011. It is also consistent with DoD’s 

commitment for keeping faith with all of our military members and their families, 

providing them a comprehensive set of transition tools and support mechanisms as 

they complete their service to our Nation. 

Interagency Electronic Health Data 

The collaborative Federal partnership between DoD and VA has resulted in increased integration of healthcare services to Service members and Veterans. DoD 

and VA spearhead numerous interagency electronic health data sharing activities 

and are delivering IT solutions that significantly improve the secure sharing of appropriate electronic health information. 

Today’s interagency health information exchange (HIE) capabilities leverage the 

existing electronic health records (EHRs) of each Department. As both Departments 

are currently addressing the need to modernize their EHRs, we are working together to synchronize planning activities and identify a joint approach to modernization. 

Current HIE sharing capabilities do support data sharing between DoD and VA. 

The Federal Health Information Exchange (FHIE), Bidirectional Health Information 

Exchange (BHIE), and the Clinical Data Repository/Health Data Repository (CHDR) 

support continuity of care for millions of Service members and Veterans by facilitating the sharing of health care data as beneficiaries move beyond DoD direct care 

to the VA. The data shared includes information from DoD’s inpatient documentation system which is in use in DoD’s inpatient military treatment facilities, including Landstuhl Regional Medical Center, Germany, the evacuation and treatment 

center Service members pass through if they have a medical problem while deployed 

in the current theater of operations. The health data shared assists in continuity 

of care and influences decision-making at the point of care. 

Transmission of Data from Point of Separation: At separation, FHIE provides for 

the one-way electronic exchange of historic healthcare information from DoD to VA 

for Service members who have separated since 2001. On a monthly basis DoD sends: 

inpatient and outpatient laboratory results; radiology reports; outpatient pharmacy 

data; allergy information; discharge summaries; consult reports; admission/discharge/transfer information; standard ambulatory data records; demographic data; 

pre- and post-deployment health assessments (PPDHAs); and post-deployment 

health reassessments (PDHRAs). To date, DoD has transmitted health data on more 

than 5.8 million retired or separated Service members to VA. Of those, approximately 2.3 million have presented to VA for care, treatment, or claims determination. This number grows constantly as health information on recently separated 

Service members is extracted and transferred to VA monthly. 

Access to Data on Shared Patients: For shared patients being treated by both DoD 

and VA, the Departments maintain the jointly developed Bidirectional Health Information Exchange (BHIE) system that was implemented in 2004. Unlike FHIE, 

which provides a one-way transfer of information to VA when a Service member 

separates from the military, the two-way BHIE interface allows clinicians in both 

Departments to view, in real-time, health data (in text form) from the Departments’ 

existing health information systems. Accessible data types include allergy, outpatient pharmacy, inpatient and outpatient laboratory and radiology reports, demographic data, diagnoses, vital signs, problem lists, family, social, and other history, 

questionnaires and Theater clinical data, including inpatient notes, outpatient encounters and ancillary clinical data, such as pharmacy data, allergies, laboratory results and radiology reports. 

Use of BHIE continues to increase. As of January 2012, there is data available 

on more than 4.3 million shared patients, including over 293,340 Theater patients, 

available through BHIE. 

To increase the availability of clinical information on a shared patient population, 

VA and DoD collaborated to further leverage BHIE functionality to allow 

bidirectional access to inpatient discharge summaries from DoD’s inpatient documentation system. Use of this inpatient documentation system at Landstuhl Regional Medical Center plays a critical role in ensuring continuity of care and supporting the capture and transfer of inpatient records of care for recovering Service 

members. Information from these records including inpatient consultations, operative reports, history and physical reports, transfer summary notes, initial evaluation 

notes, procedure notes, evaluation management notes, pre-operative evaluation 

notes, and post-operative evaluation and management notes are accessible stateside 

to DoD providers caring for injured Service members and to VA providers caring for 

injured Service members and Veterans. DoD’s inpatient documentation system is 

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now operational at all 59 DoD inpatient sites; ensuring inpatient documentation is 

available from all DoD inpatient beds. 

Recent improvements to BHIE include the completion of hardware, operating system, architecture, and security upgrades supporting the BHIE framework and its 

production environment. This technology refresh, completed in January 2011, resulted in improved system performance, and reliability. 

Exchange of Pharmacy and Allergy Data: The Clinical Data Repository (CDR)/ 

Health Data Repository (HDR) interface (called ‘‘CHDR’’) supports interoperability 

between AHLTA’s CDR and VA’s HDR, enabling bidirectional sharing of standardized, computable outpatient pharmacy and medication allergy data. Since 2006, VA 

and DoD have been sharing computable outpatient pharmacy and medication allergy data through the CHDR interface. Exchanging standardized pharmacy and 

medication allergy data on patients supports improved patient care and safety 

through the ability to conduct drug-drug and drug-allergy interaction checks using 

data from both systems. 

The Departments have exchanged computable outpatient pharmacy and medication allergy data on over 1.4 million patients who receive healthcare from both systems. 

Wounded Warrior Image Transfer: To support our most severely wounded and injured Service members transferring to VA Polytrauma Rehabilitation Centers 

(PRCs) for care, DoD sends radiology images and scanned paper medical records 

electronically. Walter Reed National Military Medical Center and Brooke Army 

Medical Center are providing scanned records and radiology images electronically 

for patients transferring to VA PRCs in Tampa, Richmond, Palo Alto, Minneapolis, 

and San Antonio. From 2007 to the present, images for more than 480 patients and 

scanned records for more than 585 severely wounded warriors have been sent from 

DoD to VA at the time of referral. 

Virtual Lifetime Electronic Record: The Departments are firmly focused on enhancing our electronic health data sharing and expanding capabilities to share information with the private sector through Nationwide Health Information Network 

(NwHIN) and the Virtual Lifetime Electronic Record (VLER). NwHIN will enable 

the Departments to view a beneficiary’s healthcare information not only from DoD 

and VA, but also from other NwHIN participants. To create a virtual healthcare 

record—and achieve the VLER vision—data will be pulled from EHRs and exchanged using data sharing standards and standard document formats. A standards 

based approach will not only improve the long-term viability of how information is 

shared between the Departments, but will also enable the meaningful exchange of 

information with other government providers and with civilian providers, both of 

which account for a significant portion of care delivered to the Departments’ beneficiaries. 

VLER is being implemented iteratively through an operational pilot using incremental sets of functionality. The VLER pilot sites are demonstrations of exchanges 

of electronic health information between VA, DoD and participating private sector 

providers. The pilot continues to provide evidence of the power and effectiveness of 

coordinated development between the Departments for increasing the secure sharing of electronic health information while leveraging existing EHR capabilities. 

DoD’s VLER pilot is underway in San Diego, California; Tidewater, Virginia; Puget 

Sound, and Spokane, Washington. In addition, VA is participating in seven other 

pilots with the private sector to expand the VLER capability. 

The Integrated Electronic Health Record (iEHR): In 2011, DoD and VA committed 

to establishing and refining an integrated electronic health record (iEHR). The 

iEHR will enable DoD and VA to align resources and investments with business 

needs and programs. Going forward, a joint, common EHR platform will be implemented. Maintenance of AHLTA and VistA throughout the deployment lifecycle of 

the iEHR will ensure continuity of operations. 

DoD and VA will purchase commercially available components for joint use when 

possible and cost effective. The iEHR will leverage open source and traditional approaches to software acquisition to foster innovation and expedite delivery of products to the user. 

The Departments anticipate that iEHR capabilities will evolve from existing service oriented architecture (SOA) compliant capabilities, commercial off-the-shelf 

(COTS), open source, and custom systems. The use of agile development for the 

iEHR will allow the Departments to deliver capabilities to customers at a more 

rapid pace. 

The DoD/VA Interagency Program Office (IPO) serves as a single point of accountability and execution for the iEHR and VLER Health initiatives to help ensure synchronization of these efforts. 

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World-Class Medical Care in the National Capital Region 

The Department completed its largest and most complex Base Realignment and 

Closure (BRAC) projects in history on time last Fall in the National Capital Region 

(NCR). These BRAC projects closed and transitioned Walter Reed Army Medical 

Center and inpatient capabilities at Joint Base Andrews to expanded facilities at 

Bethesda, establishing the Walter Reed National Military Medical Center 

(WRNMMC), and a replacement hospital at Fort Belvoir (FBCH). Today, wounded, 

ill, and injured Service members and their families receive care in 3 million square 

feet of world-class new and renovated facilities, with 160,000 new equipment items 

and the latest medical technologies available. 

These BRAC projects were one part of the larger transformation of Military Medicine in the NCR. The NCR has the largest concentration of healthcare assets in the 

Military Health System. It contains a mix of nearly 40 Army, Navy, and Air Force 

Medical Treatment Facilities (MTFs), has 550,000 eligible beneficiaries and 12,000 

staff, and runs on an annual operating budget of almost $1.5 billion. Its primary 

medical mission is care for wounded, ill, and injured Service members, and it receives over 70% of the critical care air transports returning from theater. In order 

to reduce redundancies inherent in operating three separate Service systems and increase effectiveness and efficiency, the Department directed the establishment of an 

Integrated Healthcare Delivery System (IDS) in the NCR to be managed by the 

Joint Task Force National Capital Region Medical (JTF CapMed). 

JTF CapMed has command authority over NCR MTFs. The presence of command 

authority provides a singular authority to drive the transformational change necessary to control unnecessary duplication among the Services and to increase interoperability. This improves responsiveness to our patients by aligning authority, responsibility, and accountability to a single entity that can make changes necessary 

to improve care. As an example, JTF CapMed has consolidated and co-located appointment and referral processes in the NCR to standardize appointment and referral processes. This has improved services by eliminating the confusion of multiple 

appointment processes at different MTFs in the NCR and has increased the access 

to care by offering appointments at any MTF in the NCR in order to meet patient 

needs. The JTF’s efforts have saved the Department $109 million through contract 

execution and $114 million in cost avoidance through equipment re-use program. 

Consolidation of the workforces at WRNMMC and FBCH and authorities sufficient 

to implement shared services will enable further efficiencies and economies of scale 

that will ultimately result in contractor and civilian personnel savings of approximately $60 million per year in fiscal year 2011 dollars. 

The NCR also has a specific congressional mandate to provide world-class 

healthcare through the NCR IDS. As discussed in the Comprehensive Master Plan 

provided to Congress, JTF CapMed is implementing the NCR IDS to provide more 

effective and efficient healthcare in the NCR and is overseeing projects at Bethesda 

required to achieve the world-class facility standards required by the NDAA for FY 

2010. The President has fully funded these efforts in his Budget Request for FY 

2013. 

Post-Traumatic Stress and Traumatic Brain Injury 

The VA–DoD Integrated Mental Health Strategy focuses on developing community organization collaboration and partnerships, such as with the National Institutes of Health and the American Psychological Association. Part of this work involves the creation of a network of experts on mental health issues, to include 

PTSD, so that there are coordinated efforts to improve access, quality, effectiveness, 

and efficiency of services for servicemembers, veterans and their families by sharing 

information and resources that enable partners to stay current with the changing 

science base and recommended best practices. 

The Substance Abuse and Mental Health Services Administration in the Department of Health and Human Services (HHS) maintains strong partnerships with VA 

and DoD to prepare community behavioral health care systems to provide trauma 

informed services that reflect an understanding of military culture, servicemembers’ 

experiences, the range of post-trauma effects, and the effects of traumatic brain and 

other physical injuries. This is primarily accomplished through SAMHSA’s Service 

Members, Veterans, and their Families Policy Academies, through which SAMHSA 

has provided—and continues to provide—intensive technical assistance to 23 States, 

two Territories, and the District of Columbia to help them enhance their behavioral 

health systems. 

Additionally, SAMHSA’s National Child Traumatic Stress Network (NCTSN) has 

developed training materials for behavioral health providers who encounter veterans 

or servicemembers with traumatic brain injury. These materials were developed in 

collaboration with the VA Palo Alto Health Care Polytrauma Program. This twoVACREP180 with DISTILLER

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hour comprehensive training is available through the NCTSN’s Learning Center 

Military Families. 

In addition, to establish a network of public and private sector expertise in TBI, 

the Department of Defense has fostered collaboration with inter-Service working 

groups (Air Force, Army, Marine Corps, and Navy) together with other Department 

centers to include the Defense Centers of Excellence for PH and TBI and the Defense and Veterans Brain Injury Center (DVBIC) and the National Intrepid Center 

of Excellence (NICoE) and the Department of Veterans Affairs (VA). In addition, 

other Federal agencies such as the CDC and NIH have been collaborating partners 

to further the field of TBI and leverage expertise held within each agency. The 

working groups have further included public sector expertise through consensus conferences. The collaborative working group and consensus conference process has 

worked to define best practices for diagnosis and treatment of co-occurring disorders 

following TBI with focus on mild TBI. The collaborative working group has developed clinical recommendations for vestibular disturbances, vision disturbances, and 

endocrine dysfunction following TBI. These recommendations are intended to provide guidance to primary care providers in the MHS regarding the consideration 

and referral process for Service members with co-occurring disorders following mild 

TBI. The collaborative network efforts also addressed needs in the deployed setting 

with the revision of clinical practice recommendations/ algorithms for concussion 

management in the deployed setting. Finally, collaborations with professional sports 

organizations have been developed to help further common goals of addressing barriers to seeking care for TBI related issues. 

The development of a TBI repository of information for and by various Federal 

agencies via the Federal Interagency Committee has recently been established. This 

will include the following: mild TBI Translation (mTBI) Grand Rounds (research to 

clinical practice) through collaboration with Johns Hopkins Institutes; development 

of DoD centric common outcome measures and/or common data elements in partnership with US Navy and Marine Corps EpiData Center and the Health Analysis Department. 

The Department and VA have also produced a suite of co-branded education materials and curricula to train clinicians regarding the effective use of VA/DoD clinical 

support tools based on clinical practice guidelines for disorders such as Major Depressive Disorders, mild TBI, Co-Occurring Conditions, and Substance Use Disorder. 

Additionally, the Department has conducted a needs assessment survey for Behavioral Health and TBI providers as well as provided guidelines for training providers 

in evidence-based best practices for PTSD. 

The Department produced materials for insertion into Joint Professional Military 

Education based on the Chairman Joint Chief of Staff’s Special Areas of Emphasis. 

These materials will be used to provide line leadership with core components for a 

myriad of topics including PH and TBI. DoD has added a 60-minute overview of PH 

and TBI in the DoD briefing into the DoD APEX Senior Executive Service Orientation, a two-week requirement for all new executives to the Department. 

The DoD and VA have partnered on the Integrated Mental Health Strategy, specifically by releasing the Operation Enduring Families curriculum, information, and 

support for Afghanistan and Iraq veterans and their families. The curriculum resides online at VA and Military OneSource websites. This guide was designed to assist parents, other family members and health care providers in addressing the 

mental and emotional health needs of military children through topic-specific, agerelated, public-domain literature. Additionally, since its rollout in July 2010, 711 

providers have been trained on the Defense and Veterans Brain Injury Center 

(DVBIC) family caregiver curriculum, a congressionally mandated guide that serves 

as a roadmap for those caregivers of patients with severe and penetrating brain injury. 

In response to the DoD Mental Health Task Force recommendation to address 

continuity of care, DoD developed the inTransition program. This program provides 

servicemembers experiencing a transition (location change, change in status or 

health care system) with a coach to motivate them to remain in treatment. Available 24/7, these coaches are master’s level clinical staff trained in deployment- and 

readjustment- related issues. Between February 2011 and February 2012, the number of inTransition cases increased from 392 to 1660, an increase of over 300%. Of 

the servicemembers referred to the program, 95% accepted the referral and 100% 

of those who completed a program survey reported the assistance they received from 

the inTransition Program increased the likelihood that they would continue their 

treatment. 

The Center for Deployment Psychology (CDP), a Uniformed Services University 

center, has conducted workshops for civilian providers throughout the United 

States. To date over 2300 civilian providers have attended these weeklong workVACREP180 with DISTILLER

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shops. These workshops include information on the identification, diagnosis and 

treatment of PTSD and other frequently occurring psychological health issues such 

as depression, substance use disorders, and suicide. An additional 1200 civilian providers have attended shorter workshops that train evidence-based treatments for 

treating PTSD. TBI is also a topic presented to address these challenges in Service 

members and Veterans. 

Lastly, the VA and DoD jointly develop Clinical Practice Guidelines (CPGs) to 

serve as one means of communicating the state of the evidence to clinical providers 

in the field. VA/DoD CPGs are publically available through either Army Medical 

Command Quality Management Division’s website (https:// 

www.qmo.amedd.army.mil/pguide.htm) or the VA’s Office of Quality and Safety 

website (http://www.healthquality.va.gov/). An expert multidisciplinary panel of VA 

and DoD providers developed the VA/DoD CPGs recommendations by conducting a 

comprehensive and rigorous review of the currently available studies on psychotherapy and medication. Since the passage of the NDAA 2008, the VA and DoD 

have jointly developed or revised CPGs for Depression, PTSD, mTBI, Opioid Therapy for Chronic Pain, Substance Use Disorder, and Bipolar Disorder. 

The dissemination of existing TBI clinical guidelines and recommendations to various involved providers are conducted in various formats. The most powerful dissemination modality is through the Service TBI program managers who are leading 

the 56 Army TBI programs, 6 Navy TBI programs and Air Force TBI teleconsultations and joint programs. Ongoing resources are provided in the form of a national 

level resource fact sheet for military case managers as well as information and educational opportunities via the Military TBI Case Management Quarterly Newsletter 

to promote and advance access to care. The nationwide dissemination of the Case 

Management of Concussion/mild TBI Guidance Document was conducted across the 

MHS. Technology is widely utilized to disseminate TBI information as well. The release of the Mild TBI Pocket Guide mobile application for the iPhone and Android 

smartphones and the Co-occurring Conditions Toolkit: Mild TBI Psychological 

Health mobile application for the iPhone and Android smartphones disseminated 

this information to a new market of users. Additionally six mTBI web-based case 

studies via MHS Learn for DoD, the VA Employee Education System and civilian 

healthcare professionals have been released. The web-based case studies use patient 

vignettes as a way in which to educate healthcare professionals about the clinical 

recommendations contained within the VA/DoD mild TBI/concussion clinical practice 

guideline. The technology-based efforts reported more than 4700 downloads of the 

Mild TBI Pocket Guide mobile application and more than 500 downloads of the Cooccurring Conditions Toolkit mobile application. To improve future efforts of dissemination the Department utilized the Interactive Customer Service Evaluation to 

obtain user feedback. 

Conclusion 

While we are pleased with the quality of effort and progress made, we fully understand that there is much more to do. We have, thus, positioned ourselves to implement these provisions and continue our progress in providing world-class support 

to our Service members and Veterans while allowing our two Departments to focus 

on our respective core missions. Our dedicated, selfless Service members, Veterans 

and their families deserve the very best, and we pledge to give our very best during 

their recovery, rehabilitation, and return to the society they defend. 

Mr. Chairman, thank you again for your generous support of our wounded, ill, 

and injured Service members, Veterans and their families. I look forward to your 

questions. 

Executive Summary 

Department of Defense Prepared Statement for House Veterans’ Affairs Committee Disability Assistance and Memorial Affairs Subcommittee 

Hearing on Active, Guard, Reserve, and Civilian Personnel Programs 

The IDES features a Service member-centric design, a simplified process, more 

consistent evaluations and compensation, a single medical exam and disability rating, seamless transition to Veteran status, case management advocacy, and establishment of a Service member relationship with the VA prior to separation. It also 

provides increased transparency through better information flow to servicemembers 

and their families and a reduced gap between separation/retirement from Service 

to receipt of VA benefits. 

As of early this month, IDES enrollment is 24,957 Service members (66 percent 

Army, 13 percent Marines, 10 percent Navy, and 11 percent Air Force). Since November 2007, cumulative enrollment has been 44,451, with 14,249 completing the 

process and receiving benefits. Including Service members who are returned to duty 

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by the process, active component IDES completion time averages 370 days as of 

February 2012, Reserve Component members averaged 358 days, and Guard members averaged 396 days. These averages are above targeted goals but still are significantly lower than the 1940-era legacy system it replaced. 

The Recovery Coordination Program (RCP) was established by the FY08 NDAA. 

Recovery Care Coordinators (RCC) are assigned to help wounded, ill and injured 

Service members and families through the phases of recovery, rehabilitation and reintegration. Currently, there are 171 RCCs in 84 locations worldwide; more than 

3,800 Service members and families have had the assistance of an RCC. 

The Special Compensation for Assistance in Activities of Daily Living program 

was established by the FY10 NDAA to provide qualified Service members with 

monthly compensation to help offset the economic burden borne by their primary 

caregivers providing non-medical care, support and assistance. As of February 29, 

2012, 505 Service members have received the compensation. 

Today’s Veterans face a number of challenges in making the transition to civilian 

life, and among these is embarking on a productive post-military career. As a result, 

the President created a Task Force led by the DoD and VA to develop proposals to 

maximize the career readiness of all Service members. The effort is fully aligned 

with the VOW to Hire Heroes Act of 2011 and is consistent with DoD’s commitment 

for keeping faith with all of our military members and their families, providing 

them a comprehensive set of transition tools and support mechanisms. 

The collaborative Federal partnership between DoD and VA has resulted in increased integration of healthcare services to Service members and Veterans. DoD 

and VA spearhead numerous interagency electronic health data sharing activities 

and are delivering IT solutions that significantly improve the secure sharing of appropriate electronic health information. Today’s interagency health information exchange capabilities leverage the existing electronic health records (EHRs) of each 

Department as we both address the need to modernize our EHRs, by synchronizing 

planning activities and identify a joint approach to modernization. 

The Department of Defense has fostered collaboration with inter-Service working 

groups and Department centers such as the Defense Centers of Excellence, the Defense and Veterans Brain Injury Center (DVBIC), the National Intrepid Center of 

Excellence (NICoE), and the Department of Veterans Affairs (VA). The collaborative 

working group has developed clinical recommendations to provide guidance to primary care providers in the Military Health System regarding the consideration and 

referral process for Service members following mild TBI and addressed needs in the 

deployed setting. Collaborations with professional sports organizations have been 

developed to help further common goals of addressing barriers to seeking care for 

TBI related issues. 

f 

Prepared Statement of Gail R. Wilensky, Ph.D 

Mr. Chairman and Members of the Veterans’ Affairs Subcommittee on Disability 

Assistance and Memorial Affairs: Thank you for inviting me here to testify about 

the transition from servicemember to Veteran, with a particular focus on the implementation of the Integrated Disability Evaluation System (IDES). 

I am currently a senior fellow at Project HOPE, an international health education 

foundation that works to make health care available to people around the globe. I 

am also a Regent for the Uniformed Services University of the Health Sciences 

(USUHS). I have previously served as a Commissioner on the 2007 President’s Commission on the Care for America’s Returning Wounded Warriors (Dole/Shalala Commission), a co-chair for the Congressionally-mandated study on the Future of Military Health Care (2007–2008) and also as a co-chair on the 2001–2003 President’s 

Task Force to Improve Health Care Delivery for our Nation’s Veterans. The views 

I am presenting here reflect my training as an economist as well as the experiences 

I have had on these commissions and task forces. However, my testimony today reflects my personal views and not necessarily the views of Project HOPE or any of 

the other organizations with which I have been associated or continue to be associated. 

I am here primarily to discuss the need for an integrated disability evaluation 

system and what has been reported about its early implementation as well as to 

remind the Committee about the restructured compensation system that the Dole/ 

Shalala Commission also recommended should be implemented. I will also briefly 

review some of the other issues that need to be considered in order to facilitate the 

transition from active duty servicemember to veteran status. Most of these are not 

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new issues but rather have been recommended by various groups over the course 

of at least the last decade. 

The Problem 

Before the introduction of the Integrated Disability Evaluation System, a 

servicemember needed to first separate from his or her service, with discharge papers in hand, before entering the VA process. Thus, two exams were required—one 

from the military services that determined fitness to serve and a second exam from 

the VA to determine a disability rating for purposes of compensation. 

The process and the criteria for determining fitness to serve differed across services and the process for determining disability differed between the services and the 

VA, which raised perceptions of equity of treatment across the different services. 

Also, servicemembers could potentially be rated at one level by their service and at 

another level by the VA, again raising questions of equity as well as causing confusion. In addition, these multiple steps ensured that the process was long and frequently contentious—averaging some 540 days. 

The IDES 

Under the IDES, there is a single, comprehensive exam by VA certified physicians. A single-source disability rating is used that determines both for the purpose 

of fitness for continuing military service and also serves as the basis for the VA to 

rate the level of disability. Each military service continues to determine whether 

someone is able to continue military service. 

Service members who are unable to return to active duty are referred to a medical 

evaluation board, assigned a physician evaluation board liaison officer whose job is 

to help them through the process. Each servicemember is also assigned a VA military service coordinator to help them navigate through the VA system. 

The stated goal is to get the process done in 100 days. The estimates I have seen 

reported are that the former 540- day process was closer to 295 days as of mid 2011, 

indicating a clear improvement but also a time frame that is not as expeditious as 

might be desired. There are also still reports of inexplicable and frustrating delays 

such as was reported last summer at a Senate hearing where the application of a 

Marine who had lost both his arms and legs in Afghanistan in 2010 sat on a desk 

for 70 days, requiring a Senator’s personal intervention in order to get it dislodged. 

Preliminary Assessment of the IDES 

While the overall process is still relatively early in its implantation stage—having 

only gone fully live in the fall of 2011—there are some observations that can be 

made at this stage. 

First, it is unclear why it has taken so long to get to this stage of the implementation process. The IDES was developed in 2007 in order to shorten the process of 

transition from active duty to veteran status. It followed from multiple recommendations that the Department of Defense and Veterans Administration use a single 

comprehensive standardized medical exam—including a recommendation from the 

Dole/Shalala Commission but certainly not limited to that Commission. While it is 

true that the Defense Department published guidance for a voluntary, expedited 

Disability Evaluation System in early 2009 for servicemembers that had sustained 

catastrophic injuries, the full IDES was not implemented until later in 2011. 

Having run the Medicare and Medicaid programs in the early 1990’s, I would 

agree that piloting a new system before taking it on-line is a reasonable and prudent step. Why it should take from 2007 until the fall of 2011 for a full transfer 

to the IDES is unclear to me. 

Second, shortening the time to process a disability claim is important but the time 

involved per se is only part of the issue. Clearly agreeing on its function and making 

sure that this is fulfilled is a necessary step as well. Some ways that would shorten 

the process may not improve its fairness, such as eliminating a servicemember’s 

right of appeal. 

Third, while the use of a single disability exam makes sense, it is important to 

recognize that there are different functions that medical exams serve, even though 

they may provide overlapping data fields. They can serve to define a course of clinical treatment, providing information about diagnoses and progress as opposed to 

a medical exam that is a single snapshot ‘‘finder of fact’’ that determines a level of 

disability. Both uses suggest the need for ongoing, periodic medical evaluations but 

done for different purposes. 

Restructuring the Disability and Compensation System 

The Dole/Shalala Commission also recommended a complete restructuring of the 

disability and compensation system. The purpose of the recommendation was to simplify the disability determination and compensation process, eliminate parallel acVACREP180 with DISTILLER

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tivities, reduce inequities and perhaps, most importantly, provide a basis for veterans to return to productive lives as fully and quickly as possible. 

Like the present system, the Commission advocated having the Defense Department determine fitness to serve. For those who are deemed ‘‘not fit’’, the Commission recommended that the DoD provide a pension that reflects a payment for the 

years served. The payment should be determined only by the individual’s rank and 

the length of service. Those who are not fit because of combat-related injuries 

should receive TRICARE as should their dependents. 

The VA should continue to have the responsibility for establishing the disability 

rating and compensation and benefits that follow from it. The VA should initiate 

its education and training programs as early as possible and adopt a policy of reviewing disability states on a three year basis. 

The proposed restructuring of the VA disability payments was to work in steps. 

First, there would be a ‘‘transition payment’’. This payment would be to cover living 

expenses for injured veterans and their families. It would be defined as three 

months of base pay in the event there is not further rehab going on or a longer term 

payment for living expenses if the veteran continues in some form of rehab or education program. 

Second, following the completion of the rehab or education program, the disabled 

veteran would receive an ‘‘earnings-loss’’ payment in order to make up for any lower 

earning capacity that might remain after training, should that occur. In many cases, 

there should not be an earnings loss. 

Third, a ‘‘quality of life’’ payment would be made to compensate for ‘‘non-work related’’ effects in the event of permanent physical or mental combat-related injuries. 

The purpose of these steps is to support and encourage the injured veteran to advance as completely as possible using education and rehab and then to assess the 

effect on both earnings capacity and quality of life. It is recognition that in an information and service economy such as we have today, even significantly injured veterans may be able to be helped to a position where they would not experience an 

earnings-loss but would still be entitled to a quality of life payment. 

Two of the commissioners on the Dole-Shalala Commission were examples of how 

VA or GI Bill financed education could put someone in such a position. Marc 

Giammatteo, an Army Captain had been severely wounded in his leg while in Iraq. 

He was also attending Harvard Business School, getting an MBA and spending his 

summer working at an investment bank. Jose Ramos was a Navy Corpsman who 

had also been serving in Iraq and had lost his right arm to the shoulder. He was 

completing a double major in Arabic and national security at George Mason. Both 

of these individuals should be in a position where they would not experience an 

earnings loss but would experience a quality of life decrement. On the other hand, 

Tammy Edwards, also on the Commission, is the wife of an Army enlisted man who 

was severely burned and experienced a brain injury while on active duty. His earnings loss would be significant in addition to his quality of life decrement. 

Other Areas Needing Strengthening 

As important as integrating the disability evaluation and restructuring the disability and compensations payment are to facilitating the transition from active 

duty to veterans’ status, there are other areas that need to be strengthened. Among 

the most important of these is making sure adequate care is available for any veteran who is experiencing PTSD or TBI. The DoD and the VA have been working 

hard to improve the prevention, diagnosis and treatment of both PTSD and TBI but 

much remains to be done. In addition, reducing the stigma associated with PTSD 

remains a problem for both active duty and veteran populations. 

A major problem for both the Defense Department and the VA is that there is 

a national shortage of mental health professionals just as there is a national shortage of primary care professionals. Nonetheless, both departments will need to aggressively work on resolving this problem as aggressively and creatively as they can. 

It would also be helpful to provide programs to family members and caregivers to 

help them understand and deal with PTSD and TBI. Any efforts that can be undertaken to prevent PTSD and TBI from occurring, would be well worth-while on many 

fronts. 

Efforts also need to continue to strengthen support for families. We had recommended expanding Defense Department respite care and extending the Family 

and Medical Leave Act for up to six months for spouses and parents of the seriously 

injured. The latter is especially a challenge in our currently constrained fiscal environment. 

One of the most heartening findings of the Dole/Shalala Commission was that the 

quality of care provided to the wounded servicemembers was of very high quality. 

Most of the problems that occurred, occurred during the ‘‘hand-offs’’—that is, the 

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transitioning from inpatient to outpatient status, from one facility to a second facility or from active duty to veteran status. Both the Defense Department and the VA 

have worked hard to reduce these problems and to simplify the path to recovery but 

more still needs to be done for our returning wounded warriors. 

Thank you Mr. Chairman. I would be happy to answer any questions you or the 

Committee may have. 

Executive Summary: 

Before the introduction of the Integrated Disability Evaluation System (IDES), 

servicemembers first needed to separate from his or her service and then to enter 

the VA process, requiring two different exams. The process and criteria for determining fitness differed across services and the process for determining disability differed between the services and the VA. The result was real and perceived differences in equity of treatment across services and between the services as well as 

a lengthy and frequently contentious process. 

The IDES produces a single exam, done by a VA certified physician that serves 

both as the basis for determining fitness to serve and to establish a level of disability. The services continue to determine fitness to serve; the VA determines the 

disability level. 

The result has been to cut the time from about 540 days to less than 295 days. 

It is a substantial reduction but far from the stated goal of 100 days. In addition, 

occasional lengthy and inexplicable delays are still reported. Several issues remain. 

First, why did it take so long to have the IDES fully rolled-out—from its development in 2007 until the fall of 2011? Second, shortening the time is important but 

clear agreement on the functions and goals of the disability evaluation program is 

equally important. Some questions remain here as well. The need also remains for 

ongoing, periodic medical evaluations to determine whether initial levels of disability continue in the future. 

The Dole/Shalala Commission, where I was a commissioner, also recommended 

the complete restructuring of the disability and compensation system. Like the 

IDES, the goal was to simplify the disability determination, reduce parallel activities and inequities and most importantly, provide a basis for veterans to return to 

productive lives as fully and quickly as possible. To do this, we recommended a 

‘‘transition payment’’ that would provide living expenses to the disabled veteran and 

their families during rehab, training and education. This was to be followed by an 

estimate of earnings-loss which may remain after training and/or education has 

been completed and which would also be accompanied by a quality of life payment, 

if appropriate. This division recognized that in an information and service economy, 

disabilities that previously would have produced earnings losses may no longer do 

so but quality of life decrements may continue. Three of the commissioners provided 

examples of how these differences might work. 

Other areas also need strengthening to facilitate the transition from active duty 

servicemember to veteran. These include assuring that care is available to any veteran experiencing PTSD or TBI and working to reduce the stigma attached to both 

of these. The ongoing shortage of mental health professionals in the U.S. will make 

this a challenge. Efforts are also needed to continue strengthening support for families. We had recommended expanding respite care and extending FMLA for up to 

six months for spouses and parents of the seriously injured. The latter is a challenge 

in our fiscally-constrained environment. 

On a positive note, most of the problems that were identified during the work of 

the Dole/Shalala Commission concerned the ‘‘hand-off’’ process and not the quality 

of care actually delivered. We need to ensure that both are appropriate for our returning wounded warriors. 

f 

Prepared Statement of Kenneth Fisher 

Chairman Runyon, Members of the Committee: 

On behalf of co-chairs Dole and Shalala who could not be with us today, the members of the commission, and my fellow commissioner Gail Wilensky, I appreciate the 

opportunity to appear before you today. Both as a commissioner and a Chairman 

of the Fisher House Foundation, I have devoted the last 12 years of my life towards 

improving both the care and the quality of life of our military, those wounded, veterans and their families. Today’s hearing on the DES and the seamless transition 

are critical to this Nations security and I am proud to discuss my work on the commission, its recommendations and action steps, and how this system must be made 

simple, easily understandable and easier to navigate. But I must admit to being a 

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bit confused. We are the greatest Nation on earth, with the best equipped and the 

best trained military in the history of the world. What puzzles me is the fact that 

it has been five years since the findings of Dole Shalala and we are still having 

hearings on the same issues as 2007. 

Before I begin, I feel compelled to preface my statement by explaining our mission. We were charged by President Bush to examine, evaluate, and analyze the 

care and process related to our returning wounded global war on terror servicemen 

and women. We looked at the system through the eyes of the wounded service people. We were solution driven, and held numerous field hearings, interviewed wounded, base commanders, doctors and family members as well as others who played a 

role in the recovery process. We not only examined the problems and inadequacies 

but also looked for best practices that might help improve their care. Our goal was 

to simplify and help eliminate the log jam, which was the result of the fighting 

lengthy two front wars with a VA that was already challenged by the weight of an 

intolerable beaurocratic system. By doing this, we sought to eliminate the back log 

and claims that had reached approximately 800,000–900,000. 

While the living conditions at Walter Reed were indeed horrendous, this was only 

the tip of a massive iceberg. We found hundreds of troops waiting months for follow 

up appointments or awaiting the rating process. This gap in benefits caused massive 

problems known to but a few. 

The commission was given six months to evaluate the entire disability evaluation 

system and our findings were thoughtful, inclusive, and easily implementable. It 

was not our intention to put forth hundreds of recommendations that would have 

been difficult to implement or too expensive as a whole. 

And as a side bar, I would like to compliment our Nation’s world class military 

healthcare professionals whose work and use of the latest technologies resulted in 

a 95% battlefield survivor rate. 

Today, five years after our report was made public, there has been progress, to 

be sure, but, and with all due respect, not nearly fast enough, and the appearance 

that there is no real sense of urgency. Tracking the results of the commission has 

been difficult, as admittedly I would not expect the process to be transparent. But 

again, we were given the task of OEF/OIF, with the hope that its adoption would 

have moved the system along faster. 

Our recommendations were short and to the point. 

Our first recommendation called for a recovery care coordination program – a plan 

to smoothly guide and support servicemembers from start to finish. This would 

apply to both the VA and the DoD. I believe this has been implemented, although 

I cannot speak to its success. On this I would have to differ to our VA and DoD 

representatives. In the interest of time I thought we would focus on the four issues 

that I think are crucial. 

Our second recommendation called for an overhaul of disability. Our plan called 

for one physical administered by DoD who then determines fitness to serve. If separation is required, they are compensated on rank and length of service, and then 

they are moved to the VA who determines their rating and benefits along with a 

series of payments. The joint DoD VA plan that is currently in use is the Integrated 

Disability Evaluation System which is now out of the pilot program and is in use 

system wide as they phase out the legacy program over the next two years. It calls 

for one physical administered by the VA. The DoD component is done simultaneously - they determine fitness to serve through the MEB and PEB. The VA rating 

systems apply, and the entire process is designed to eliminate the benefit gap. Pilot 

programs were able to take the legacy process of 500 days down to 300, but as the 

system was expanded – the waiting time climbed back to 500 days. 

According to the GAO, there are some glaring weaknesses – chief among them 

staffing issues. In addition, VA doctors are having integration issues at DoD facilities, which come as no surprise to me. There were disagreements in diagnosis, 

which is not uncommon – but it does add more time to the process. And I must 

admit to being a bit confused as to why VA doctors are performing the DoD physical. I believe an Army doctor, for example, is better suited to determining whether 

a soldier is fit to serve. This also frees up VA doctors not only to treat the younger 

veterans as they enter the VA but also an older set of veterans who are reentering 

the VA system. But I cannot emphasize enough - in the private sector the best possible plans are just words on paper if there isn’t enough qualified people to implement said plan. This is an over simplified written in the interest of time constraints. 

This includes recovery care people as well PEBLO’s and other crucial personnel. 

Another important recommendation highlighted is the incompatibility of the DoD 

and VA IT systems and as our report put it, this alone is not the silver bullet. However, if information could be transmitted this way, the veterans would have less 

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paper work, and find out what is available to them much faster at the push of a 

button. We believed that information sharing was critical to the help of the system. 

We recommended life time treatment for PTSD. These men and women have endured multiple deployments; have been in intense urban fighting, often against civilian insurgents who too often hide behind innocent women and children. They 

have seen horrific injuries caused by IED’s. And the stigma associated with coming 

forward and asking for help leaves too many to suffer in silence and if they are 

home their families do suffer as well. We believed this was a major problem when 

our report was made public, and it has been for any servicemember who fought in 

battle be it World War II, Korea, Vietnam or today. 

Today it is evident why this was a major recommendation. Five years after our 

report was made public, there have been well over 1000 suicides - out pacing the 

civilian population, domestic violence, and divorce, drug and alcohol abuse, homelessness, joblessness, are all at unacceptable levels. Just the other day in USA 

Today, an article appeared discussing alcohol within the ranks of the Army, and the 

fact that they have delayed for three years a confidential counsel program for treatment. They had begun a pilot program in 2009, but it was ended after high dropout 

rates. According to the article, 25% have a drinking problem. 

The issue’s importance is self explanatory because of the collateral damage it 

causes. Here again, staffing shortages are at the heart of the issue, as with disability. We need to consider engaging the private sector to help with has become 

the signature wound of this war. The stigma has not completely vanished, and this 

wound is the worst kind because it cannot be seen until after it manifests itself. 

Perhaps we need to reexamine screening before and after deployment, and I believe a spousal educational program is vital. They are the first line of defense, and 

if they know what to do after seeing their loved one’s behavior change. 

I believe that progress has been made in our family support recommendation, as 

the family medical leave act has been extended to six months, and the VA now offers a caregiver stipend to the caregiver. 

Military families bear burdens that the average American has no concept of. And 

for too long, military families bear their stress either alone or with other military 

families. When one gets wounded, that stress can be unbearable. The private sector 

has stepped up and numerous foundations are in action and I would encourage Congress, the DoD and the VA to find the ones that work and embellish them, not impede them by making them part of the intolerable beaurcracy that exists system 

wide. They have the infrastructure, boots on the ground, and the overwhelming desire to help. There will always be unmet needs, but public private partnerships can 

bridge that gap, and paint the way to the future. 

Mr. Chairman, This concludes my statement. In the interest of time, I tried to 

keep the nuts and bolts of our report to a minimum, and the fact that most people 

are already familiar with our report, judging by the criticism it generated. It was 

always our intention to have Congress and the Veterans Service Organizations 

weigh in and while they objected to certain parts of our report, it must be emphasized that the needs of today’s young veterans are immediate and this new generation of veterans are coming into the system by the thousands. Times are different, 

their wounds are different, but I assure you had we had the time we would have 

examined all veterans because anyone who has worn this Nation’s uniform deserves 

the best we have to offer. A thank you for your service is not enough anymore. I 

am now ready to answer any questions you may have. 

f 

Prepared Statement of James Terry Scott, LTG USA (RET) 

Mr. Chairman and Members of the Subcommittee: It is my pleasure to appear before you today representing the Advisory Committee on Disability Compensation 

and the Veterans Disability Benefits Commission that met from 2005 to 2007 and 

reported out to you in October of that year. 

The Advisory Committee is chartered by the Secretary of Veterans Affairs under 

the provisions of 38 U.S.C. in compliance with P.L. 110–389 to advise the Secretary 

with respect to the maintenance and periodic readjustment of the VA Schedule for 

Rating Disabilities. Our charter is to ‘‘(A)ssemble and review relevant information 

relating to the needs of veterans with disabilities; provide information relating to 

the character of disabilities arising from service in the Armed Forces; provide an 

on-going assessment of the effectiveness of the VA’s Schedule for Rating Disabilities; 

and provide on-going advice on the most appropriate means of responding to the 

needs of veterans relating to disability compensation in the future’’. 

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Your letter asked me to testify on the Advisory Committee’s views on the transition from servicemember to Veteran, with a particular focus on the implementation 

of the Integrated Disability Evaluation System (IDES). 

First, a bit of background. At the time the Veterans Disability Benefits Commission was created by the National Defense Appropriations Act of 2004 it was already 

apparent that the peacetime system for transitioning sick and injured 

servicemembers to Veteran status was overwhelmed. From the outset, and well before the reprehensible situations at the Walter Reed Barracks and other locations 

were recognized, the Commission recognized the need for a seamless and rapid transition process that protected the servicemember while he or she progressed to Veteran status. Transition became one of the major issues studied by the Commission. 

Interim recommendations addressing transition issues were offered as deliberations 

progressed. 

The Veterans Disability Benefits Commission (VDBC) 

examined the policies and processes within the Departments of Defense, Veterans 

Affairs, Labor, Health and Human Services, and the Social Security Administration 

that affected military separation or retirement. Each of these entities plays a significant role in the transition of Veterans and their families. 

Of the 113 recommendations the Commission made, many of them pertained to 

improving the transition process. I am providing for the record a list of the key transition recommendations and the status of their implementation as I understand it. 

4.4 and 4.5: VA should develop a process for updating disability examination 

work sheets and mandate the use of approved templates. (This is currently 

being addressed by the adoption of Disability Benefit Questionaires for the use 

of VA and non-VA medical examiners.) 

4.10: VA and the DoD should conduct a comprehensive multidisciplinary medical, psychological, and vocational evaluation of each Veteran applying for disability compensation at the time of service separation. (This is partially addressed by the IDES system for sick or injured servicemembers and by the expanded TAP briefings. Complete physical exams for all separating 

servicemembers are still not required.) 

4.23: VA should immediately begin to update the current rating schedule beginning with those body systems addressing the evaluation and rating of PTSD 

and other mental disorders and of traumatic brain injury and then proceed 

through the other body systems until the Rating Schedule has been comprehensively revised. (This is currently being addressed by VA with a projected completion in 2016.) 

5.7: DoD should require a mandatory benefits briefing to all separating military 

personnel, including Reserve and National Guard members prior to discharge 

from active service. (This is being partially addressed by the services and VA 

through expanded TAP briefings.) 

5.28: VA should develop and implement new criteria specific to posttraumatic 

stress disorder in the VA Schedule for Rating Disabilities. (This has been done 

and is awaiting approval.) 

6.9: Access to vocational rehabilitation should be expanded to all medically separated servicemembers. (Programs have been expanded but universal access 

has not been achieved.) 

6.10: All service disabled veterans should have access to vocational rehabilitation and employment services. (These programs have been expanded, but are 

still not available to all service disabled veterans.) 

7.11: VA and DoD should adopt a consistent and uniform policy for rating disabilities, using the VA Schedule for Rating Disabilities (VASRD). (This has 

largely been accomplished by DoD accepting the VASRD. It is an integral part 

of the IDES.) 

7.13: VA and DoD should realign the disability evaluation process so that the 

services determine fitness for duty and servicemembers who are found unfit are 

referred to VA for disability rating. All conditions that are identified as part 

of a single, comprehensive medical examination should be rated and compensated. (The IDES system has adopted this procedure.) 

10.1: VA and DoD should enhance the Joint Executive Council’s strategic plan 

by including specific milestones and designating an official to be responsible for 

ensuring that the milestones are reached. (This has been fully implemented by 

VA and DoD.) 

10.3: DOL and SSA should be included in the Joint Executive Council to improve the transition process. (DOL participation in transition and in follow up 

has greatly increased.) 

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1 Veterans’ Disability Benefits Commission, October 2007, page 376 

2The President’s Commission on Care for America’s Returning Wounded Warriors (July 2007), 

page 7. 

10.4: To facilitate seamless transition, Congress should adequately fund and 

mandate the Transition Assistance Program (TAP) DoD-wide to ensure that all 

servicemembers are knowledgeable about benefits before leaving the service. 

(Expansion of TAP is a major ongoing effort in VA today). 

10.5: Benefits Delivery and Discharge (BDD) should be available to all disabled 

exiting servicemembers (to include National Guard, Reserve, and medical hold 

patients). (Progress unknown). 

10.6: DoD should mandate that separation examinations be performed on all 

servicemembers. (While progress has been made, this is still not a requirement 

in all services for all separating members. While requiring resources, this policy 

will pay great dividends in future years by providing a clear picture of physical 

and mental condition at separation which can be used in determining serviceconnection for disability. 

10.8: DoD should expand existing programs that translate military occupational 

skills, experience, and certification to civilian employment. (Progress unknown.) 

10.11: VA and DoD should expedite development and implementation of compatible information systems including a detailed project management plan that 

includes specific milestones and lead agency assignment. (This complex issue is 

under development.) 

Of the recommendations pertaining to transition that both the Veterans Disability 

Benefits Commission and the Advisory Committee on Disability Compensation have 

offered, the one with the most potential to reduce the time to process claims and 

improve accuracy and consistency is the ongoing plan to revise the VASRD. This 

complex, multi-year revision will incorporate current medical knowledge and technology as well as streamline the diagnosis, evaluation, and adjudication processes. 

Another key recommendation with potential long term positive effect is the movement to an electronic claims record. This is another extremely complex challenge 

that the VA has accepted and is working. When fully implemented it will simplify 

and expedite the claims process. 

The Current IDES program incorporates many of the recommendations from the 

Veterans Disability Benefits Commission and the Advisory Committee on Disability 

Compensation. It represents a tremendous effort on the part of VA and DoD to focus 

on the transition of servicemembers who are sick or injured to Veteran status. All 

parties, including the Congress are frustrated by the average time still required to 

complete the transition. However, from the perspective of someone who has had the 

opportunity to contribute to this effort over the last eight years, I believe the 

progress is significant and, more importantly, that the progress will continue. 

On behalf of the Advisory Committee, thank you for the opportunity to testify on 

this important matter. 

f 

Prepared Statement of John L. Wilson 

Mr. Chairman and Members of the Subcommittee: 

On behalf of the Disabled American Veterans (DAV) and our 1.2 million members, 

all of whom are wartime disabled veterans, I am pleased to be here today to testify 

before the Subcommittee on Disability Assistance and Memorial Affairs and address 

the implementation of the Integrated Disability Evaluation System (IDES). DAV is 

actively engaged in providing claims assistance to military members before they 

leave active duty with our 30 Transition Service Officers (TSOs) assisting over 

55,900 servicemembers in 2011 and our 250 National Service Officers (NSOs) representing over 259,000 veterans, their families and survivors for that same period. 

IDES is the result of a recommendation of several commissions, including the Veterans’ Disability Benefits Commission, 1 and the President’s Commission on Care for 

America’s Returning Wounded Warriors, which stated that the ‘‘DOD and VA should 

create a single, comprehensive, standardized medical examination that the DOD administers. It would serve DOD’s purpose of determining fitness and VA’s of determining initial disability level.’’ 2

The Disability Evaluation System (DES) pilot project was launched in 2007 by the 

Department of Defense (DOD) and the Department of Veterans Affairs (VA). Using 

lessons learned from that pilot, the legacy DES began the transition to IDES in October 2010 to include a total of 140 locations, with the goal of expediting the delivery of VA benefits to all out-processing military members. 

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3Department Of Defense Task Force On The Care, Management, And Transition of Recovering 

Wounded, Ill, And Injured Members of the Armed Forces, Disability Evaluation System, page 

D–34. 4Statement of John R. Campbell, Deputy Under Secretary of Defense (Wounded Warrior Care 

and Transition Policy), Department of Defense, before Senate Committee on Veterans’ Affairs 

Hearing on Review of the VA And DOD Integrated Disability Evaluation System (November 18, 

2010). 5 IDES Trifold Brochure 

A comparison between the DES pilot and legacy DES found Active Component 

military members completed the pilot in an average of 289 days, and Reserve Component military members completed it in an average of 270 days, compared to a legacy DES average of 540 days. Surveys revealed significantly higher satisfaction 

among DES pilot participants. On July 30, 2010, the DOD Senior Oversight Committee co-chairs directed that IDES expand worldwide. 3

The legacy DES was replaced with the IDES in four stages 4 and was fully deployed by October 2012. 

• Stage I–West Coast and Southeast (October–December 2010)—28 Sites 

• Stage II–Mountain Region (January–March 2011)—24 Sites 

• Stage III–Midwest and Northeast (April–June 2011)—33 Sites 

• Stage IV–Outside Continental United States (OCONUS) (July–September 

2011)—28 Sites 

• Total IDES locations when complete: 140 

Under this system, military members are referred to IDES when their continued 

service is curtailed as a result of a physical or mental health condition and they 

are placed on a medical profile making them ineligible for deployment or unable to 

carry out the duties of their rank or military specialty. The following chart depicts 

the revised time lines for each step of the IDES process: 

As a result of treatment and being on medical profile, military members are evaluated by a Medical Evaluation Board (MEB), which is typically comprised of at least 

two physicians. If the MEB determines that the member has a medical condition 

that is incompatible with continued military service, an MEB Narrative Summary 

is prepared and the case is referred to a Physical Evaluation Board Liaison Officer 

(PEBLO). 

PEBLOs guide servicemembers through the IDES process to ensure they are 

aware of the options available to them and to help with the many decisions they 

need to make while still in on active duty. The PEBLO compiles administrative 

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data, informs military members of the IDES process and the MEB, and then refers 

them to the VA Military Services Coordinator (MSC). 

The VA MSC then meets with the military members to advise them about the 

next phase of the IDES process, assist in completion of documentation, establish a 

formal VA disability claim, and initiate case development. The VA MSC requests 

the appropriate VA medical examinations, monitors their progress, provides copies 

of the completed examination reports to the PEBLO, and completes any additional 

development actions as needed. 

Once the medical examinations are completed, the VA MSC provides them to the 

PEBLO and the VA Disability Evaluation System Rating Activity Site (D–RAS) 

which prepares the proposed disability rating. The PEBLO incorporates the medical 

examination results in the IDES case file and provides it to the MEB convening authority. The MTF then conducts an MEB and provides the results back to the 

PEBLO, including the results of the MEB’s response to any rebuttal of the member 

about the MEB findings. The PEBLO then provides a copy of the MEB findings, to 

include the completed VA medical examination results, to the military member and 

forwards the case to the PEB administrator if the MEB did not return the military 

member to duty. The PEB administrator prepares and provides the member’s case 

to the Informal PEB (IPEB). 

The IPEB is typically comprised of a two- or three-member board. The IPEB adjudicates the case and requests the D–RAS provide the proposed ratings for the military members’ conditions that the IPEB has determined to be unfit. The D–RAS 

prepares the proposed disability ratings, and reconsideration of the proposed ratings, if the military member requested this. Once all information is received, the 

IPEB decides whether the member can continue in the military. If so, they are designated ‘‘fit’’ and returned to duty. If not, they are found ‘‘unfit.’’ There are three 

broad types of medical separations the member can receive as a result of being 

found unfit: separated without severance pay, separated with severance pay, or retirement. 

Once the military member is informed of the IPEB’s decision, they can either accept those findings or appeal the decision to the Formal Physical Evaluation Board 

(FPEB). The FPEB is comprised of a three-member board, two personnel officers 

and a physician. They review all the information that the IPEB had, with the added 

feature of the member being able to personally appear before the FPEB and offer 

additional evidence. The FPEB then holds a hearing, weighs the prior evidence, the 

member’s testimony as well as any new evidence presented, and renders its recommendation. The member can accept the decision of the FPEB, or request reconsideration of the proposed ratings. Just as with the IPEB, there are three broad 

types of medical separations the member can receive: separated without severance 

pay, separated with severance pay, or retirement. 

Military members have a final appeal option of the FPEB findings regarding fitness for duty through all subsequent levels allowed by their branch of service, such 

as the Department of the Navy Council of Review Boards and the Department of 

the Air Force Personnel Council. 

The three types of medical separations, separated without severance pay, separated with severance pay, or retirement, can result in several types of medical discharges. Specifically, those who receive a disability rating of 20 percent or less receive a Discharge With Severance Pay or DWSP. Those whose medical conditions 

were found to exist prior to military service and found unfit can be ‘‘discharged 

under other than Chapter 61, title 10 or (DUOT) without disability compensation 

if their conditions existed prior to service and were not permanently aggravated 

through military service. Those who receive a disability rating of 30 percent or more 

may receive Permanent Retirement, or be placed on the Temporary Disability Retired List and reevaluated at least every 18 months until their conditions become 

stable with a final disability rating decision rendered at the five year point. An exception would be mental disorders due to traumatic stress on active duty which require re-evaluation within six months after discharge, if assigned a disability rating 

of not less than 50 percent. 

While DAV is generally pleased with the IDES, we are concerned about certain 

aspects of the program. One area is servicemembers participating in IDES not having ready access to representation from a veterans service organization (VSO) in the 

same manner as they did under the legacy DES. 

The issue of access to counsel to advise military members on the VA disability 

claims process was cited as a concern by the Recovering Warrior Task Force 

(RWTF). The RWTF is charged with conducting an assessment of the effectiveness 

of DOD programs and policies for Recovering Warriors (RWs). In recommendation 

19, the RWTF found during RWTF onsite visits that legal personnel indicated that 

they were greatly understaffed. The Army, Navy, and Marine Corps provide legal 

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6DOD Recovering Warrior Task Force Report, September 2, 20111, page 22. 

7 Ibid. 

8 Ibid, RWTF Service member focus group results. March/April 2011, page 43. 

9 VA Integrated Disability Evaluation System Guide, December, 2011, page 16. 

counsel for both MEB and PEB. The Air Force provides specific legal counsel only 

for the PEB. Air Force base level legal counsel can address IDES issues prior to 

PEB. However, the Air Force is the service with the lowest satisfaction with legal 

counsel and the only service who’s IDES participants were not more satisfied than 

their legacy DES participants. These survey results reinforce the importance of providing legal counsel for the MEB as well as the PEB. 6 The relationship between 

access to legal counsel and satisfaction with the IDES process is clear. Despite survey results demonstrating the value of having legal counsel available throughout 

the disability evaluation process, the majority of RWTF focus group participants 

said they lacked personal experience with or knowledge of these specialized legal 

resources. 7

Most military members undergoing the discharge evaluation process may not be 

aware of the complexities of the disability adjudication and retirement systems. As 

a result, they may be accepting PEB decisions that are not in their best interest 

and/or the benefits they receive may be less than what they would have been had 

they understood the long-term consequences of their decision to accept a particular 

PEB decision. As stated in the latest RWTF report, ‘‘Service members going through 

the IDES process often do not have a clear idea about where they are going and 

what their futures hold.’’ 8

Most servicemembers may not know how complex the IDES disability adjudication is and we believe their best interests would be served if they had access to the 

free assistance from certified representatives from VSOs who can not only provide 

them with a full understanding about the process and their rights but also act as 

their advocates. DAV, in accordance with DAV Resolution 177, and also with the 

other co-authors of The Independent Budget has urged the DOD and VA to address 

this observed gap in IDES and expand VSO access. 

DAV was actively engaged in the legacy DES but VSOs were excluded when the 

program was redesigned and replaced with IDES. Under the legacy DES, our TSOs 

represented 282 military members before DOD’s Physical Evaluation Boards from 

July 2008 to June 2009 but those numbers have declined to 92 from July 2009 to 

June 2010 and to 22 from July 2010 to June 2011. This change was based on the 

DOD and VA’s focus on speeding the delivery of benefits so they could be placed 

in the hands of separating military personnel closer to the time of their discharge. 

Just as with the larger disability claims process and its current focus of ‘‘breaking 

the back of the backlog,’’ IDES is similarly focused. It is our view that while speed 

is an important factor, any claim, whether while on active duty or as a veteran 

should be done right the first time with an emphasis on timeliness and rating decision accuracy. 

DAV brings vast experience and expertise about claims processing with our service officers holding powers of attorney for hundreds of thousands of veterans and 

their families. Our NSOs and TSOs continue to be actively engaged in informing 

military members of their eligibility for VA and DOD benefits though briefings at 

Transition Assistance Program classes. We also provide assistance to those who request accelerated receipt of their VA disability benefits under VA’s Benefits Delivery 

at Discharge (BDD) and Quick Start. To participate in BDD the military member 

must apply within 180 days of discharge but no less than 60 days. If they are closer 

than 60 days from separation then they can use Quick Start. We assisted over 

55,900 military members in 2011 under these three programs. As a result, DAV and 

other VSOs play an integral part in the claims process and undeniably make the 

VA’s job easier by helping veterans prepare and submit better claims, requiring less 

time and resources for them to be developed and adjudicated. If provided broader 

access, we can make the DOD’s job easier as well by ensuring military members 

going through IDES do have a clear idea about where they are going and what their 

futures hold. 

There has been some positive movement that partially addresses VSO access. The 

VA Integrated Disability Evaluation System Implementation Guide states that VA 

Military Services Coordinators (VA MSCs) will ‘‘explain the availability of Veterans 

Service Organizations and provide a VA Form 21–22, Appointment of Veterans 

Service Organization Claimant’s Representative, if the Service member expresses interest in this resource.’’ 9 While this is an improvement, we recommend this guidance be modified so the VA MSCs explain the option of representation by a VSO 

during IDES, whether or not the military member expresses an interest. Given the 

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10DOD Recovering Warrior Task Force Report, September 2, 20111, page 21. 

many issues that the member has to handle at this important juncture, changing 

this interchange to a more positive exchange may be more productive. 

While the guidance to VA MSCs is in the right direction, there has been no such 

change from the DOD directing PEBLOs to raise VSO representation as an option 

at any point in the process. Therefore, we recommend that PEBLOs be required to 

inform military members about the option of VSO representation as well. Having 

PEBLOs provide this option earlier in the IDES process, and on the DOD side of 

the rating process, would help ensure that military members know that VSOs are 

available to represent them not just with the VA but also with the DOD as their 

disability claim is processed. 

The last area to address is the effectiveness of the PEBLOs. The RWTF found in 

its work with focus groups that many participants had limited knowledge as to the 

role of the PEBLO. Although several spoke favorably, more often than not comments 

about PEBLOs were negative. Military members seemed to expect them to be more 

of an advocate that they were. 10 Twenty-eight percent of RWs responding to the 

RWTF mini-survey indicated that the PEBLO was very or extremely helpful, while 

32 percent indicated the PEBLO was moderately helpful. These statistics would indicate that, while 60 percent of respondents had a favorable impression of PEBLOs, 

a significant minority of 40 percent did not have a favorable impression. 

The RWTF mini-survey results are in contrast with the more positive survey findings of the DOD Office of Wounded Warrior Care and Transition Policy (WWCTP). 

They found PEBLO customer service earned 79 percent to 88 percent satisfaction 

ratings across the services. DOD WWCTP also found that 65 percent of survey respondents indicated that the PEBLO managing their case was helpful or very helpful to them. 

While DAV has received information from the field that indicates the performance 

of PEBLOs has continued to improve generally, there are occasions in which 

PEBLOs have incorrectly advised members on what their actual disability ratings 

are. Recently, a PEBLO advised a member that he could not personally appear before the Formal Physical Evaluation Board to appeal the IPEBs decision. This was 

clearly in error, but one of DAV’s NSOs was able to provide the correct information 

to the member. In order to prevent these types of errors and improve satisfaction, 

we believe it is imperative that the training and quality control be reviewed and 

more closely monitored. 

Mr. Chairman, this concludes my testimony. I would be glad to answer any questions you may have. 

f 

Prepared Statement of Phil Riley 

Chairman Runyon, Ranking Member McNerney, and Members of the Subcommittee: 

Wounded Warrior Project (WWP) appreciates your holding this hearing and welcomes the opportunity to share our perspective on the Integrated Disability Evaluation System (IDES) – a critical, but still troubled pathway in the transition from 

servicemember to veteran. 

I am Phil Riley, a Senior Benefits Liaison with WWP. In that capacity, it is my 

privilege to assist wounded, ill, and injured servicemembers in navigating the confusing road from medical evaluations to the critical benefits’ determinations associated with their military retirement or separation. As a retired Army Colonel who 

has worked with the disability evaluation process for some six years, including time 

as a veteran’s service officer, it’s my assessment – and that of WWP – that much 

more work is needed to close the wide gap between the goals underlying IDES and 

realization of those goals. We believe VA is doing its part in the IDES process. In 

our view, the Department of Defense (DoD) needs to do more remedial work. 

IDES, of course, has its roots in the problems wounded warriors experienced 

under the so-called ‘‘legacy Disability Evaluation System,’’ the DES. Under that system servicemembers whose injuries or medical conditions rendered them no longer 

fit for continued military service went through a very lengthy multi-stage processes, 

with both DoD and VA conducting their own separate medical evaluations and subsequent disability rating processes. Under DES, servicemembers routinely experienced many-months’ waits between discharge from service and receiving their first 

VA benefits payment as well as inconsistencies in how servicemembers’ injuries 

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1 U.S. Medicine, Wait Times Heading in Wrong Direction in New Integrated Disability System; VA Blames ‘Transition Difficulties’’’ July 2011; Kimberly Hefling, The Associated Press, 

‘‘Claim Processing Keeps Injured Troops Waiting,’’ May 18, 2011. 2Tom Philpott, ‘‘Disability Evaluation Reforms Seen Falling Short,’’ Army Times, March 31, 

2011. 3The President’s Commission on Care for America’s Returning Wounded Warriors, July 2007, 

p. 6. 4 Id. at 7. Service members found unfit due to their combat-related injuries would then receive 

payment for years served and comprehensive health care coverage for themselves and their families through DoD’s TRICARE program. Id. 5 Id. 

6 Id. at 6. 

7 Is This Any Way to Treat our Troops? Part III: Transition Delays: Hearing Before the H. 

Committee on Oversight and Government Reform, 112th Cong. (2011) (prepared statement of 

Lynn Simpson, Acting Principal Deputy Undersecretary of Defense for Personnel and Readiness, 

U.S. Department of Defense). 8 Id. 

9 Integrated Disability Evaluation System Pilot Overview, presentation at VA/DOD Joint Venture Conference, October 2010, available at: http://www.tricare.mil/dvpco/downloads/lvjvc/ 

Day2-1045—JVConfVADODSpecialtyPanelIDES.ppt 10 U.S. GAO, Military and Veterans Disability System: Worldwide Deployment of Integrated 

System Warrants Careful Monitoring, GAO–11–633T (Washington, D.C., May 2011), 4. 11 U.S Department of Veterans Affairs Budget Request for Fiscal Year 2013: Hearing Before 

the H. Committee on Veterans’ Affairs, 112th Cong. (2012) (prepared statement of Hon. Eric K. 

Shinseki, Secretary, U.S. Department of Veterans Affairs). 

were evaluated in the two systems. 1 In 2007, it took an average of 540 days under 

the legacy DES for a servicemember to clear both DoD and VA disability-evaluation 

processes. 2

The bipartisan Commission on Care for America’s Returning Wounded Warriors 

(‘‘the Dole-Shalala Commission’’), formed in that year, urged that DES be overhauled. Among its findings, the Commission reported that fewer than 50% of 

servicemembers understood the DoD disability evaluation system, and that only 

38% of active duty and 34% of the reserve component were ‘‘somewhat’’ satisfied 

with it. 3 The Commission recommended that the two departments ‘‘create a single, 

comprehensive, standardized medical evaluation that DoD administers,’’ 4 with DoD 

maintaining its authority to determine fitness-to-serve and VA becoming solely responsible for setting disability ratings and awarding compensation. 5 Its recommendation aimed to update and simplify the disability determination and compensation process by eliminating parallel activities and to reduce inequities. 6

Creation of IDES and the Goals of an Integrated System 

The Commission’s work was carried forward by the congressionally-established 

Wounded, Ill and Injured Senior Oversight Committee (SOC) which ultimately instituted a more modest reform to integrate the two systems which resulted in establishing a pilot integrated disability evaluation system. The vision was ‘‘to create a 

servicemember-centric, seamless and transparent DES’’ 7 by developing a jointly-conducted military medical evaluation process under which servicemembers receive a 

single set of physical disability evaluations and disability ratings, conducted and 

prepared by VA, with simultaneous processing by both departments—using VA protocols for disability examinations and VA disability ratings to make their respective 

determinations—to ensure the earliest possible delivery of disability benefits. 8 The 

goals of the new IDES process were to create: (1) a less complex and non-adversarial 

system; (2) faster, more consistent evaluations and compensation; (3) a single medical exam and a single-source disability rating; and (4) a smooth transition to veteran status. 9 The IDES pilot began in the National Capital Region in November 

2007 with a goal of reducing the time (from referral of a case to the DoD medical 

evaluation board to delivery of VA benefits) to 295 days for active duty and 305 days 

for reserve component servicemembers. 10 Following a phased expansion of the IDES 

pilot over about a year and a half period, IDES became fully operational as of October 2011. 11 Under the new IDES process, a servicemember is to receive a full medical examination conducted by the VA, which is used as the basis for determining 

both fitness for continued duty in military service and entitlement to DoD benefits 

and VA compensation. 

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12 A doctor is to refer a case to the MEB only upon satisfaction that all has been done medically to improve the condition(s). Department of Defense, Wounded, Ill and Injured Compensation and Benefits Handbook, October 2011, 17. 13 Id. If a servicemember’s condition includes a mental health condition, a mental health care 

provider should be on the panel, as well. Id. 14 Id. 15 If the MEB determines a servicemember does meet medical retention standards (or will be 

able to perform full duties within one year) the servicemember may return to duty. 16Walter Reed Army Medical Center PEBLO Office, Integrated Disability Evaluation System 

Quick Series Review Guide. 17DoD regulations list minimum requirements for PEB membership and leaves the exact determination of who sits on the board for each military department to decide. Department of Defense, Wounded, Ill and Injured Compensation and Benefits Handbook, October 2011, 18. 18 Id. 19The PEB will determine a servicemember’s disposition—return to duty, separation, or permanent or temporary retirement. Department of Defense, Wounded, Ill and Injured Compensation and Benefits Handbook, October 2011, 18. 20Walter Reed Army Medical Center PEBLO Office, Integrated Disability Evaluation System 

Quick Series Review Guide. 

The IDES Process 

The IDES process, while differing in detail from service to service, begins with 

a servicemember’s treating physician 12 or unit commander making a referral to a 

Medical Evaluation Board (MEB). That board, generally composed of medical care 

professionals, 13 evaluates the servicemember’s injuries and ongoing treatment to determine if the Member is able to meet medical retention standards and return to 

full duty – and, if not, to make a recommendation (to a Physical Evaluation Board 

(PEB)) as to whether he or she is fit for continued service following medical treatment. From the start of the MEB referral, the servicemember is to be assigned a 

Physical Evaluation Board Liaison Officer (PEBLO) to help assist him/her throughout the IDES process. The PEBLO is responsible for assembling all the information 

included in the servicemember’s DES case file: all medical records, test results, and 

exams performed for the MEB; letters from a servicemember’s chain of command 

related to how the condition impacts duty; and other personnel records the MEB 

may require. 14

The MEB does not conduct formal hearings, and the servicemember is not afforded the opportunity to appear before the board. If the MEB determines that a 

servicemember does not meet medical retention standards, it will forward that recommendation to a PEB. 15 The MEB results and recommendation are documented 

in a narrative summary (NARSUM) which becomes the single most important piece 

of evidence the PEB uses. After the servicemember receives the MEB’s NARSUM, 

the PEBLO will review it with the servicemember. A servicemember may ask for 

an Independent Medical Review (IMR) and/or a Judge Advocate General (JAG) 

counselor to review the NARSUM to ensure it is fully developed and accurate. 16 The 

servicemember does have the opportunity to submit a rebuttal to be considered by 

the MEB. Far too often, in our view, the response to the rebuttal is ‘‘no changes 

accepted.’’ 

In the second phase of the process, the informal PEB (IPEB) will evaluate the 

servicemember’s fitness for duty. Generally, the IPEB is comprised of three people, 

with a mix of military and civilian members, including at least one physician and 

one nonmedical officer. 17 Again, the servicemember does not attend this meeting. 18

Using the packet compiled by the PEBLO, the IPEB will review the medical records, 

the NARSUM, personnel evaluations, and letters from the commander and vote as 

to whether the servicemember is fit to continue service. 19 The PEBLO will then notify the servicemember of the findings of the IPEB. If the IPEB makes a determination of fitness, the servicemember has 10 calendar days to accept the decision and 

return to duty or offer a rebuttal and request a formal PEB. If the IPEB determines 

a servicemember is unfit, he/she has 10 calendar days to decide on a course of action; the options are (1) to accept the decision, (2) accept the decision but request 

a reconsideration of the VA disability rating, (3) offer a rebuttal and request a formal PEB, or (4) request both a formal PEB and reconsideration of the VA disability 

rating. 20 If a servicemember requests a formal PEB, he/she is allowed to appear before the board with legal representation. The formal PEB hearing must conduct a 

de novo review– all factual questions must be addressed as if for the first time. The 

formal PEB’s decision may change from the IPEB. The formal PEB will then notify 

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21 Id. If the Service member appeals the formal PEB findings, the appropriate military department considers the appeal and returns to duty, separates, retires, or assists the servicemember 

to complete an inter-Service transfer, if appropriate and approved. Under Secretary of Defense, 

Integrated Disability Evaluation System Directive-Type Memorandum 11–015, Dec. 2011. 

quarters receives the final PEB determination, the servicemember may be separated, medically retired, or returned to duty. 21

A servicemember found to be unfit by the PEB will still receive two separate disability ratings under the new IDES process: (1) a rating by the PEB that evaluates 

only those conditions deemed to make the servicemember unfit for duty (which determines whether or not the servicemember will qualify for medical retirement and 

what benefits the servicemember is eligible to receive from DoD), and (2) a VA rating of all service-connected conditions (whether the conditions make the 

servicemember unfit for duty or not). Both the DoD and VA ratings are to be based 

on the VA Schedule for Rating Disabilities (VASRD). 

IDES Goals versus IDES in Practice 

In our view, IDES should be judged by reference to the goals it was to achieve 

– a less complex, non-adversarial system that operates more quickly and with greater transparency and consistency to provide a smooth transition to veteran status. 

Even today, however, our Wounded Warriors still encounter great difficulty in navigating a system they find to be highly complicated, difficult to understand, unnecessarily contentious, and often ponderously slow. We at WWP who have been representing these servicemembers see a serious lack of quality-control in a system 

often marked by inconsistent practices, decisions based on incomplete or inaccurate 

medical records, and wide variability in the reliability of information and advice furnished to servicemembers confronting difficult, life-changing circumstances. 

Case Examples 

The experiences of two warriors, with whom we at WWP have worked, illustrate 

the kinds of problems we’re describing. In both instances, these warriors are at a 

sensitive stage of the process and requested that we omit reference to their names. 

The Officer: The first, an Army officer sustained a penetrating head injury in Iraq. 

He has had a long remarkable rehabilitative journey, and his wife was by his side 

through the course of his painfully slow recovery. As he gradually regained lost 

function, the couple could begin to think and worry about the future. As she explained it, given her role as a full-time caregiver, his injury deprived two collegeeducated people of the ability to work. ‘‘Don’t worry,’’ he was told, ‘‘you’ll be 100%; 

you’ll be fine.’’ That misplaced expression of confidence reflected a widespread misconception that inured soldiers would collect both retirement pay and VA disability 

compensation. But, as they ultimately learned—with VA compensation offsetting 

military retired pay – a 100% disability rating represented only 60% of his monthly 

military income. The couple faced a very confusing choice as to whether to elect to 

receive military retirement pay or Combat Related Special Compensation. Making 

a prudent decision required understanding the relationship between, and the calculations regarding, (1) DoD military retirement, (2) VA compensation, (3) VA special monthly compensation, and (4) DoD Combat Related Special Compensation. The 

couple came to realize that Army personnel who help the wounded navigate the system are not necessarily knowledgeable on the interrelationship between those financial pieces, and at times those advising them were not helpful. In fact, their JAG, 

finance office, and PEBLO gave the couple conflicting information on the critical 

point: would a wounded soldier receive both military retired pay and VA compensation concurrently? Each was unaware of how the above four compensation programs 

offset each other. Confusion on such a basic point of information highlights the dilemma facing servicemembers with often severe multiple injuries. 

Not only are key decisions facing a warrior in the course of the IDES process confusing, but the information from which critical determinations are made is often incomplete or even inaccurate. In the officer’s case, for example, the NARSUM failed 

to include any description of his day-to-day functional impairment, but simply set 

out a list of his medical conditions. Even at that, one of those conditions – loss of 

use of an arm – was omitted from this critical document. An Independent Medical 

Review was, in fact, critical of the NARSUM and included the reviewing physician’s 

observation regarding a section listing residuals from TBI— 

‘‘[It] is hard to read and almost incomprehensible to the military physician: it 

is crucial to remember that these reports are intended for the audience of the 

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PEB and servicemember. The writing should be unequivocal and precise, which 

is not the case here.’’ 

While the MEB accepted some of the officer’s points of rebuttal, the Board did not 

rewrite the NARSUM, which was ultimately the basis of the PEB’s determination. 

While IDES was intended to foster a smooth transition, it is subject to troublingly 

disruptive pressures. For example, the Warrior Transition Unit to which the officer 

was assigned worked intrusively and applied pressure – to include harassing the 

PEBLO—to hurry the process along. Similarly, while the IDES process provides appeal rights, their experience was that the WTU actively discouraged him from appealing the PEB decision, as that would slow the process down. These weren’t isolated experiences. Earlier in the course of his rehabilitation, the couple was subjected to pressure to sign papers that resulted in cutting short still-needed rehab 

care (against medical advice) and rushing him into the MEB process. 

While IDES was designed to achieve greater timeliness, the officer’s experience 

was but the officer’s experience in that regard was of a heavy-handed military attempting to push him through prematurely where that early haste led to errors, culminating in a lengthy appeal process that was compounded by long delays in getting 

needed VA examinations. 

This mature, college-educated couple’s rough journey through the IDES process 

certainly calls into question how well a much less sophisticated young warrior with 

similar injuries and without expert representation might have fared. 

The Master Sergeant: An Army Reserve Master Sergeant with a 24-year military 

career sustained multiple severe physical injuries, a traumatic brain injury, and developed chronic post-traumatic stress disorder after the Humvee under his command 

was hit by a roadside bomb in Iraq in 2005. This servicemember endured a long, 

rough road to recovery that included 26 surgeries and over a hundred medical procedures, and that (among other disabling conditions) resulted in loss of function in the 

dominant hand due to severed nerves. 

Given the voluminous body of medical records that had been compiled by the time 

the MEB process was initiated in 2010, the Sergeant made sure to bring those 

records – which filled a large suitcase – to the meeting with the PEBLO and asked 

for the opportunity to review the MEB packet before it was forwarded to the Board. 

This packet was not made available for the Sergeant to review. Moreover, the VA 

physician who carried out the MEB physical exam had been provided only with a 

single medical record file, and even expressed frustration about the inability to conduct the physical exam properly without further records. Upon contacting the 

PEBLO about the missing medical records, the Sergeant was told, ‘‘if additional 

records are needed, the VA doctors will request them from the MTF.’’ 

In February 2011, the Sergeant received a 137-page NARSUM; despite its length, 

it omitted several service-connected conditions. The Sergeant was overwhelmed by 

having to review this very lengthy technical document in seven days. This was compounded by not being able to get a face-to-face meeting with the PEBLO. A JAG 

officer whom the Sergeant asked for help provided only a limited review of the case 

that didn’t allay the concerns; an effort to secure additional JAG assistance at another installation was rebuffed. The Sergeant was later referred to another JAG officer, who seemed stretched thin with a large backlog of cases, but who did eventually 

assist in drafting a request for an independent medical review (IMR), but the IMR 

wasn’t done because the PEBLO failed to accurately explain the IMR process to the 

local primary care Air Force doctor who was to conduct the IMR. An IMR was finally done in April 2011, but involved only a review of the NARSUM without any 

review of the Sergeant’s medical treatment records, and resulted simply in upholding the flawed NARSUM. Although the extended process appeared to be nearing an 

end, the Sergeant was informed by the PEB doctor in July 2011 that disability ratings could not be completed without additional pictures of the injuries. It was only 

in January 2012 that the Sergeant got notice that VA had ‘‘recommended’’ a 100% 

rating but with a final decision deferred pending review of medical records regarding service-connection for other medical conditions. The adjudicative process was 

completed with assignment of a 100% rating 24 months after the Sergeant’s unit 

commander requested MEB initiation. 

Timeliness and Lack of Quality-Control 

IDES was intended to improve the timeliness of the disability-evaluation process, 

but rather than realizing the 300-day goal for moving a servicemember through the 

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22Seamless Transition: Improving VA/DOD Collaboration: Hearing Before the S. Veterans’ Affairs Committee, 112th Cong. (2011) (statement of Hon. William J. Lynn, III, Deputy Secretary, 

U.S. Department of Defense). 23 U.S. GAO, Military and Veterans Disability System: Worldwide Deployment of Integrated 

System Warrants Careful Monitoring, GAO–11–633T (Washington, D.C., May 2011), 7. 24 Id. 

25 Interview with Jerry Johnson. 26 ‘‘A complete physical examination must be recorded in the MEB.’’ AR 40–400 (27 January 

2010); 

‘‘The overall effect of all disabilities present in a soldier whose physical fitness is under evaluation must be considered.’’ AR 635–40, sec. 3–1b. 27 Under Secretary of Defense, Integrated Disability Evaluation System Directive-Type Memorandum 11–015, Appendix 8, Attachment 4, Dec. 2011; Department of Defense Instruction 

1332.38, July 2006. 

system, the process is apparently taking an average of nearly 400 days. 22 To assess 

IDES solely by reference to timeliness, however, is to overlook the dangers inherent 

in moving too quickly – and in doing so, foreclosing the servicemember from getting 

needed medical care and increasing the risk of prejudicial error. In fact, the IDES 

process is particularly vulnerable to what amounts to quality-control issues—incomplete examinations, examination reports that fail to include new diagnoses, incomplete or insufficient NARSUMs, and missing critical documentation. Such problems 

– sometimes attributable to pressures to move cases along – ultimately contribute 

to delay and adversely affect the ultimate disability rating determination. WWP 

often hears from warriors, especially those in Reserve and National Guard units, 

who cite long delays in the system, and of having to fight to get needed medical 

treatment. 

Delays encountered during the MEB process can have a compound effect, resulting in medical exams ‘‘expiring’’ or no longer being accurate, requiring nurse casemanagers and PEBLOs to order new exams. Too often warriors’ medical and mental 

health conditions are incompletely diagnosed or not even assessed during medical 

exams, resulting in incomplete exam summaries and delays in needed care. As a result, examiners must take extra time to clarify the summaries, and in some cases, 

redo the exam. 23

While substituting a VA evaluative medical examination for what had been duplicative separate DoD and VA exams under the legacy system was to have saved 

time, IDES has not eliminated sharp differences of view between the two departments. 24 On that point, my experience and that of others representing 

servicemembers is aptly captured by the following observations: 

‘‘The MEB places no value in the results of the VA examination. There are many 

cases in which VA has diagnosed PTSD and other conditions as moderate to severe, and the MEB disregards the findings and bases it on their own evaluation. 

MEB review of the Service Member’s medical treatment records is also not thorough in many cases. The system is full of cases where the treating Psychiatrist 

and the Examining Psychiatrist at the VA are overruled by the Doctors on the 

MEB. Often the same thing is done in Orthopedic departments. VA documents 

the severity of the Service Member’s disability by reference to its effect on a variety of normal daily activities including ability for exercise, sports and effect on 

a job. The MEB consistently disregards these findings and minimizes them in 

the so-called ‘Consolidation of Inconsistencies.’ What is obvious is that the MEB 

has reached a decision often prior to the VA examination and refuses to take the 

VA examination into proper consideration.’’ 25

Given the MEB’s mode of operation, the Board findings – documented in the 

NARSUM—are often flawed. While the NARSUM is the single most important document describing a warrior’s physical and mental limitations, it is rarely fully developed, comprehensive, or accurate. Too often the MEB process either fails to identify 

and fully document in the NARSUM all of the warrior’s medical conditions, or it 

minimizes them. It is particularly troubling, in this regard, that MEBs routinely fail 

to take the time to review a servicemember’s complete medical records or to research those records in depth. In addition, the military seldom affords 

servicemembers the complete physical examination required by regulation. 26 By 

law, the armed forces are required to document all service-connected medical conditions, medically acceptable for a VA disability rating. 27 However, MEBs, in preparing the NARSUM, routinely fail to include the servicemember’s medically acceptable conditions, and focus only on those conditions affecting the servicemember’s 

ability to serve. The upshot of that narrow focus and resultant omissions is to make 

it more difficult for the servicemember to establish service-connection for disabilities 

that are incurred in service but simply not noted in the NARSUM. These failures 

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28Tom Philpott, ‘‘Disability Evaluation Reforms Seen Falling Short,’’ Army Times, March 31, 

2011. 29 Id. 30 Beldock 31 In our experience, at least one JAG officer and a paralegal are stationed in the military 

treatment facilities to assist when MEBs take place. 

also have an impact ‘‘downstream’’ – increasing the number of appeals in the 

already- backlogged VA adjudication system. 

In contrast to the many instances in which warriors experience long delays in 

moving through the MEB/PEB process, we see instances such as discussed above, 

where warriors are seemingly rushed through the process, many of them National 

Guard and Reserve members. These circumstances inevitably create problems ranging from incomplete treatment to erroneous disability ratings. WWP is working with 

several warriors who were referred to the MEB while still undergoing treatment or 

had developed new medical problems, and as a result received an incomplete 

NARSUM. In such instances, the MEB process should be delayed or stopped. All 

medical conditions should be diagnosed and treated before the MEB process even 

begins. 

Dual-Adjudication Undercuts the Goal of a Timely, Streamlined System 

One of the most critical barriers to a timely, streamlined system is that IDES retains the redundancy of a dual-adjudication process. Army Surgeon General, LTG 

Eric Schoomaker, in testifying before the Senate Appropriations Subcommittee on 

Defense, acknowledged that the system ‘‘remains complex and adversarial,’’ and 

warriors ‘‘still undergo dual adjudication where the military rates only unfitting conditions and the VA rates all service-connected conditions.’’ 28 At the same hearing, 

the then-Undersecretary of Defense for Personnel and Readiness described the ideal 

system as one that would produce ‘‘a single evaluation based upon one medical 

record.’’ 29 Eliminating this redundancy would represent an important reform, but 

would not alone eradicate the range of problems warriors encounter in moving 

through the disability evaluation system. Substantive errors in decision-making go 

unaddressed in those many cases when the PEBLO assisting the warrior is not adequately trained and the warrior is either lacks representation or is not effectively 

represented. 

IDES Leaves Too Many Ill-informed and Unrepresented 

Generally, warriors and their family members are uninformed or do not understand the IDES process. The system’s complexity leads some to become cynical, as 

in the case of one Wounded Warrior who commented, ‘‘they make it convoluted and 

you get so frustrated that you want to give up. I’ve never been as stressed out as 

I am in this process.’’ 30 Servicemembers’ lack of understanding of the process also 

contributes to flawed case-adjudication. With the failure to inform servicemembers 

at the outset of the MEB referral of the importance of their medical records and 

the need for supporting documentation, many are wholly unprepared for the challenge associated with establishing service-connection. 

In theory, the military’s assignment of a PEBLO to each servicemember undergoing the IDES process should close the information-gap. Beginning with an initial 

briefing before the servicemember’s first physical examination for the MEB, the 

PEBLO’s role is to inform the service-member of what to expect at various phases 

of the process, assist the servicemember in gathering medical information and documentation, and review the MEB and PEB determinations with the servicemember. 

The reality, however, is that some of these officers do not fully understand the system or have such large caseloads they can’t provide each servicemember adequate 

instruction and assistance. While the nature of the process requires the PEBLO to 

maintain an ongoing flow of information to the servicemember, warriors often report 

that they rarely hear from their PEBLO. But even under the best of circumstances, 

the PEBLO acts as the servicemember’s counselor and liaison, but that officer is not 

the servicemember’s advocate before the MEB or PEB. 

Servicemembers do have access to JAG representation 31, and some efforts have 

been made to provide training for the JAGs. In our view, however, there is wide 

variability in the level of expertise on IDES issues among JAGs, and certainly not 

enough JAGs have the necessary expertise. Servicemembers themselves often express reluctance to avail themselves of the assistance of a JAG officer, often based 

on the perception that a military/government lawyer may not represent their best 

interests. 

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Not only is the servicemember generally unrepresented but that individual is not 

afforded the opportunity to appear before the MEB to discuss his health status. Accordingly, the MEB’s development of a narrative summary is based, and dependent, 

on the medical records available to the MEB, and its interpretation of those records. 

Lack of representation is especially problematic at the point that the servicemember 

receives the MEB determination, because the individual is given just seven working 

days to review and appeal the NARSUM before it is forwarded to the PEB for a 

determination of fitness, separation, or military retirement. This is an unreasonably 

limited period of time for an individual to obtain reliable advice or counsel, particularly in the often complex cases that involve multiple severe injuries, let alone 

enough time for many warriors to review and comprehend NARSUM findings and 

the significance of omissions or inaccuracies in that document. The servicemember 

has only an additional five days within which to seek an IMR to challenge the 

NARSUM before the case moves to the PEB, and is not afforded the option of providing evidence from a specialist of his/her own. In contrast, the IMR - generally 

performed by a physician under contract to DoD—is less than ‘‘independent,’’ and 

is seldom a specialist able to address specific issues. In our experience, very few 

such reviews come back with any change in determination; yet our own reviews 

often show strong bases for an IMR to challenge the findings. 

WWP’s representation of growing numbers of Wounded Warriors through this 

process has highlighted problems under IDES, but has also led us to develop solutions. We offer the following recommendations in the belief that the IDES system 

can and must be materially improved, and urge this Committee to work with the 

Armed Services Committee to spur the Executive Branch to make needed changes. 

WWP Recommendations 

(1) Direct DoD and VA to provide (i) better instruction and outreach on IDES for 

warriors and their caregivers, and (ii) better instruction on IDES for warrior 

transition unit and other pertinent staff who work with warriors and their 

families and caregivers. 

(2) Direct DoD to re-engineer, and institute quality-controls on, the ‘‘front-end’’ of 

the IDES process to— 

(a) Provide procedures and safeguards to protect servicemembers, and particularly National Guard and Reserve members, from being pushed into and 

rushed through the MEB process. 

(b) Ensure that the MEB process is not begun until optimum medical care has 

been provided and the servicemember’s conditions have been diagnosed, and 

that such process will be deferred under circumstances where a significant 

new medical condition develops. 

(c) Ensure that NARSUMs are fully developed and accurately document all service-connected medically acceptable conditions of a warrior, to include (i) requiring MEBs to review thoroughly all medical records, and (ii) providing opportunities for the servicemember to meet with the MEB. 

(d) Allow ample time for a warrior to review his/her NARSUM with the assistance of an advocate and/or a medical provider (to include additional time for 

servicemembers with multiple, severe injuries). 

(e) Provide substantially improved avenues for effective assistance to and representation of servicemembers undergoing physical and mental health disability evaluations, including expanding the number – and improved training—of PEBLOs and JAGs, and encouraging the use of certified veterans’ 

service officers throughout the IDES process. 

(f) Provide servicemembers the opportunity and sufficient time to obtain a review of the NARSUM and all pertinent medical records by a specialist(s) of 

the servicember’s choosing, and the opportunity to present such specialist 

findings in rebuttal. 

(3) Adopt the key recommendation of the Dole-Shalala Commission by establishing a single adjudication system with a single agency responsible for disability evaluation that would not only provide needed consistency, but help realize a more streamlined, timely process. 

(4) Ensure leadership and oversight at the highest level to achieve the required 

system re-engineering and quality-control measures to realize the goals of 

IDES. 

Conclusion 

WWP believes that, whatever the injury, every warrior going through the IDES 

process should receive comprehensive medical treatment, full and fair adjudication 

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of their medical conditions and disability evaluation, and accurate compensation for 

service-related health conditions. Today, almost five years after a bipartisan commission called for streamlining the complicated disability evaluation system that so 

poorly served Wounded Warriors, the goals envisioned for that system have yet to 

be realized. WWP recognizes that VA and DoD staffs have devoted much time and 

effort to improving the disability evaluation process, but more must be done to 

produce a system worthy of our Wounded Warriors and the sacrifices they have 

made. We call for a re-engineering of IDES processes, and institutionalization of 

quality-controls along with continuing Congressional oversight, as the pathway to 

meeting this obligation to our warriors. 

Reevaluating the transition from servicemember to Veteran: Honoring a 

shared commitment to care for those who defend our freedom 

Overview of Wounded Warrior Project Testimony 

The Integrated Disability Evaluation System (IDES) was intended to create: (1) 

a less complex, non-adversarial system; (2) faster, more consistent evaluations and 

compensation; (3) a single medical exam and a single-source disability rating; and 

(3) a smooth transition to veteran status. In large part, those critically important 

goals have yet to be achieved. While VA has done its part, DoD still has much work 

to be done. 

DoD must address both structural and operational problems in the IDES. These 

include: (1) artificial timelines that create pressures to prematurely push 

servicemembers into the medical-evaluation process and result in their being rushed 

through the Medical Evaluation Board (MEB) process; (2) an MEB process that relies on reviewing only partial and often-incomplete medical records (and does not 

even meet with the servicemember) to produce an often-incomplete and inaccurate 

narrative-summary, which is the most critical evidence considered by the final 

decisional authority; (3) resultant errors in the narrative summary that make it 

more difficult ultimately to establish service-connection and that have the effect of 

increasing the number of appeals in an already clogged VA adjudication system; (4) 

lack of sufficient time for the servicemember to understand and challenge the content or accuracy of that decision document; (5) lack of a meaningful mechanism for 

the Member to secure a truly independent medical review of key decision documents; and (6) wide disparity in the extent of effective assistance and representation 

of members in the IDES process. 

We urge the Committee to work with the Armed Services Committee to spur the 

Executive Branch to make needed changes. Among those recommendations, we urge 

that DoD be directed to re-engineer and institute quality-controls on the ‘‘front-end’’ 

of the IDES process. Among those needed steps, DoD must provide safeguards to 

protect servicemembers from being pushed into and rushed through the MEB process. That process should not begin until optimum medical care has been provided 

and the servicemember’s conditions have been diagnosed. System changes are badly 

needed to ensure that narrative summaries are fully and accurately developed, to 

include requiring MEBs to review thoroughly all medical records, and provide opportunities for the servicemember to meet with the MEB. Servicemembers also need 

more time to review the MEB summary, and need greater access to effective representation and assistance, as well as the opportunity to have the summary reviewed by a specialist of the servicemember’s choosing. 

WWP recognizes that VA and DoD staffs have devoted much time and effort to 

improving the disability-evaluation process, but more must be done to produce a 

system worthy of our Wounded Warriors and the sacrifices they have made. We call 

for a re-engineering of IDES’ processes, and institutionalizing quality-controls along 

with continuing Congressional oversight as the pathway to meeting the obligation 

owed our warriors. 

f 

Prepared Statement of Eric Greitens, Phd 

Mr. Chairman and Members of the Subcommittee, thank you for the opportunity 

to testify this morning as the Founder and CEO of The Mission Continues. The Mission Continues challenges veterans to serve and lead in communities across America. 

We believe that any system that is designed to create successful transitions for 

veterans, will only work if veterans are first recognized for the immense abilities 

that they bring back to their communities. We have learned that by focusing on 

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these strengths, despite some of the most severe disabilities, we can facilitate successful transitions from warrior to citizen. 

As a Navy SEAL, I served four tours in the Global War on Terrorism. On my last 

deployment in Iraq, my unit was hit by a suicide truck bomb. I was treated at the 

Fallujah surgical hospital and returned to full duty 72 hours later, but some of my 

friends - some of whom were standing an arms length from me - were hurt far worse 

than I was. 

When I returned home, I visited them and went to Bethesda Naval Hospital to 

visit other wounded Marines. As all of you know, when you meet with our wounded 

servicemembers, you are often talking with young men and women, the balance of 

their lives still before them. I asked each of them about their units, their hometowns, their deployments, and when I asked, ‘‘What do you want to do when you 

recover?’’ Each one of them said, ‘‘I want to return to my unit.’’ Their bodies had 

been injured, but their spirit of service had endured. 

My experience at Bethesda that day was not unique. In a recent survey of post9/11 veterans, 92% strongly agreed or agreed that serving their community is important to them. 

At The Mission Continues we create successful transitions by engaging returning 

veterans to continue their service by engaging them in six-month fellowships at nonprofit and public service organizations in their communities: an Army specialist 

from the 82nd Airborne now trains service dogs for the disabled; a Marine Corps 

sergeant now builds home with Habitat for Humanity; an enlisted airman who now 

serves her fellowship as a support attendant at a women’s shelter. During their Fellowships, our veterans are provided with stipends, mentors, and broad curriculum 

to achieve one of three post-Fellowship goals. They go on to full-time employment, 

full-time education, or participate in an ongoing role of service in their communities. 

To date, we have awarded Fellowships to 255 post-9/11 veterans, who have served 

with 168 organizations across the country. 

For example, in Mississippi County, Anthony Smith served his Fellowship working with under-privileged youth. In 2004, Anthony was serving as a major in the 

Army when he was hit by a rocket-propelled grenade. After spending 64 days in a 

medically induced coma, he awoke to find that he was blind in one eye, had lost 

his right arm underneath the elbow, and that parts of his leg, hip and spinal cord 

were damaged. Like many of the veterans that we work with, his transition was 

difficult, and he started to doubt whether or not he was needed here at home. 

After Anthony became a Mission Continues Fellow, he found a renewed sense of 

purpose. Through his Fellowship, Anthony is using martial arts to mentor at-risk 

youth. Daily, dozens students from his community enter Anthony’s dojo. Using 

pushups, modeling patience, and teaching self-control, Anthony teaches lessons in 

his community everyday. 

In two independent research reports, the George Warren Brown School of Social 

Work at Washington University has found that nearly 80% of the participants in 

our program felt that serving in the community had a positive effect on their future 

employability, performance, and promotion, or that it instigated them to make a career change. In fact, 86% of participants reported transferring their military skills 

to civilian employment and 100% of Fellows reported that they will probably or definitely stay involved in volunteer activities and public service in the future. 

Mr. Chairmen and Members present, the story of this generation of veterans is 

still being written. We have a tendency to rely on PTSD figures, unemployment statistics, and suicide rates to tell us how our veterans are transitioning from the military to civilian life. But these statistics do not tell the whole story. These statistics 

do not capture a veteran’s desire to continue to serve and the willingness to lead 

in communities upon their return. 

They do not tell the story of Jake, a former Marine who now coordinates rescue 

missions to international disasters; or April, the Army veteran from Chicago, who 

serves as a mentor to refugee children in the classroom. Across America, veterans 

are serving again. In fact, the majority of the members in this Committee have Mission Continues Fellows serving in their district or neighboring districts. And last 

year, with our Fellows as examples, The Mission Continues engaged over 15,000 

Americans to spend a day of service with veterans in their communities. Our Mission Continues Fellows are enduring leaders who have overcome pain and turned 

it to wisdom. They are veterans whose commitment to our country did not end on 

the battlefield. 

In order for veterans to transition successfully, communities across America must 

begin to recognize the service they still have to give. We believe that when the story 

of this generation of veterans is written, it will not only be a story of the wars they 

have fought overseas; it will also be a story of the homes built, the parks restored, 

the young minds engaged by veterans whose mission continues here at home. 

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Mr. Chairman, we are grateful for your support and the support of this Subcommittee. I would welcome any questions that you or other Members may have. 

Thank you. 

Æ 

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