Military and Veterans Disability System: Worldwide Deployment of Integrated System Warrants Careful Monitoring
Published: 2011-05-04T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: This testimony discusses the efforts by the Departments of Defense (DOD) and Veterans Affairs (VA) to integrate their disability evaluation systems. Wounded warriors unable to continue their military service must navigate DOD's and VA's disability evaluation systems to be assessed for eligibility for disability compensation from the two agencies. GAO and others have found problems with these systems, including long delays, duplication in DOD and VA processes, confusion among servicemembers, and distrust of systems regarded as adversarial by servicemembers and veterans. To address these problems, DOD and VA have designed an integrated disability evaluation system (IDES), with the goal of expediting the delivery of VA benefits to servicemembers. After pilot testing the IDES at an increasing number of military treatment facilities (MTF)--from 3 to 27 sites--DOD and VA are in the process of deploying it worldwide. As of March 2011, the IDES has been deployed at 73 MTFs--representing about 66 percent of all military disability evaluation cases--and worldwide deployment is scheduled for completion in September 2011. This testimony summarizes and updates our December 2010 report on the IDES and addresses the following points: (1) the results of DOD and VA's evaluation of their pilot of the IDES, including updated data as of March 2011 from IDES monthly reports, where possible; (2) challenges in implementing the piloted system to date; and (3) DOD and VA's plans to expand the piloted system and whether those plans adequately address potential challenges.
section_title: What GAO Found
paragraphs: In summary, DOD and VA concluded that, based on their evaluation of the pilot as of February 2010, the pilot had (1) improved servicemember satisfaction relative to the existing "legacy" system and (2) met their established goal of delivering VA benefits to active duty and reserve component servicemembers within 295 and 305 days, respectively, on average. However, 1 year after this evaluation, average case processing times have increased significantly, such that active component servicemembers' cases completed in March 2011 took an average of 394 days to complete--99 days more than the 295-day goal. In our prior work, we identified several implementation challenges that had already contributed to delays in the process. The most significant challenge was insufficient staffing by DOD and VA. Staffing shortages and process delays were particularly severe at two pilot sites we visited where the agencies did not anticipate caseload surges. The single exam posed other challenges that contributed to delays, such as disagreements between DOD and VA medical staff about diagnoses for servicemembers' medical conditions that often required further attention, adding time to the process. Pilot sites also experienced logistical challenges, such as incorporating VA staff at military facilities and housing and managing personnel going through the process. DOD and VA were taking or planning to take steps to address a number of these challenges. For example, to address staffing shortages, VA is developing a contract for additional medical examiners, and DOD and VA are requiring local staff to develop written contingency plans for handling caseload surges. Given increased processing times, the efficacy of these efforts at this time is unclear. We recommended additional steps the agencies could take to address known challenges--such as establishing a comprehensive monitoring plan for identifying problems as they occur in order to take remedial actions as early as possible--with which DOD and VA generally concurred.

section_title: Letter
paragraphs: I am pleased to be here today to comment on the efforts by the  Departments of Defense (DOD) and Veterans Affairs (VA) to integrate  their disability evaluation systems. Wounded warriors unable to continue  their military service must navigate DOD’s and VA’s disability evaluation  systems to be assessed for eligibility for disability compensation from the  two agencies. GAO and others have found problems with these systems,  including long delays, duplication in DOD and VA processes, confusion  among servicemembers, and distrust of systems regarded as adversarial by  servicemembers and veterans. To address these problems, DOD and VA  have designed an integrated disability evaluation system (IDES), with the  goal of expediting the delivery of VA benefits to servicemembers. After  pilot testing the IDES at an increasing number of military treatment  facilities (MTF)—from 3 to 27 sites—DOD and VA are in the process of  deploying it worldwide. As of March 2011, the IDES has been deployed at  73 MTFs—representing about 66 percent of all military disability  evaluation cases—and worldwide deployment is scheduled for completion  in September 2011.
My testimony summarizes and updates our December 2010 report on the  IDES and addresses the following points: (1) the results of DOD and VA’s  evaluation of their pilot of the IDES, including updated data as of March  2011 from IDES monthly reports, where possible; (2) challenges in  implementing the piloted system to date; and (3) DOD and VA’s plans to  expand the piloted system and whether those plans adequately address  potential challenges. A detailed explanation of our methodology  supporting our prior work (conducted between November 2009 and  December 2010) can be found in our December 2010 report. We updated  this performance audit from April to May 2011, in accordance with  generally accepted government auditing standards.
In summary, DOD and VA concluded that, based on their evaluation of the  pilot as of February 2010, the pilot had (1) improved servicemember  satisfaction relative to the existing “legacy” system and (2) met their  established goal of delivering VA benefits to active duty and reserve  component servicemembers within 295 and 305 days, respectively, on  average. However, 1 year after this evaluation, average case processing  times have increased significantly, such that active component  servicemembers’ cases completed in March 2011 took an average of 394  days to complete—99 days more than the 295-day goal. In our prior work,  we identified several implementation challenges that had already  contributed to delays in the process. The most significant challenge was  insufficient staffing by DOD and VA. Staffing shortages and process delays  were particularly severe at two pilot sites we visited where the agencies  did not anticipate caseload surges. The single exam posed other  challenges that contributed to delays, such as disagreements between  DOD and VA medical staff about diagnoses for servicemembers’ medical  conditions that often required further attention, adding time to the  process. Pilot sites also experienced logistical challenges, such as  incorporating VA staff at military facilities and housing and managing  personnel going through the process. DOD and VA were taking or planning  to take steps to address a number of these challenges. For example, to  address staffing shortages, VA is developing a contract for additional  medical examiners, and DOD and VA are requiring local staff to develop  written contingency plans for handling caseload surges. Given increased  processing times, the efficacy of these efforts at this time is unclear. We  recommended additional steps the agencies could take to address known  challenges—such as establishing a comprehensive monitoring plan for  identifying problems as they occur in order to take remedial actions as  early as possible—with which DOD and VA generally concurred.
subsections: section_title: Background
paragraphs: Under the existing, or “legacy” system, the military’s disability evaluation  process begins at a military treatment facility when a physician identifies a  condition that may interfere with a servicemember’s ability to perform his  or her duties. On the basis of medical examinations and the  servicemember’s medical records, a medical evaluation board (MEB)  identifies and documents any conditions that may limit a servicemember’s  ability to serve in the military. The servicemember’s case is then evaluated  by a physical evaluation board (PEB) to make a determination of fitness or  unfitness for duty. If the servicemember is found to be unfit due to medical  conditions incurred in the line of duty, the PEB assigns the servicemember  a combined percentage rating for those unfit conditions, and the  servicemember is discharged. Depending on the overall disability rating  and number of years of active duty or equivalent service, the  servicemember found unfit with compensable conditions is entitled to  either monthly disability retirement benefits or lump sum disability  severance pay.
In addition to receiving disability benefits from DOD, veterans with  service-connected disabilities may receive compensation from VA for lost  earnings capacity. VA’s disability compensation claims process starts  when a veteran submits a claim listing the medical conditions that he or  she believes are service-connected. In contrast to DOD’s disability  evaluation system, which evaluates only medical conditions affecting  servicemembers’ fitness for duty, VA evaluates all medical conditions  claimed by the veteran, whether or not they were previously evaluated in  DOD’s disability evaluation process. For each claimed condition, VA must  determine if there is credible evidence to support the veteran’s contention  of a service connection. Such evidence may include the veteran’s military  service records and treatment records from VA medical facilities and  private medical service providers. Also, if necessary for reaching a  decision on a claim, VA arranges for the veteran to receive a medical  examination. Medical examiners are clinicians (including physicians,  nurse practitioners, or physician assistants) certified to perform the exams  under VA’s Compensation and Pension program. Once a claim has all of  the necessary evidence, a VA rating specialist determines whether the  claimant is eligible for benefits. If so, the rating specialist assigns a  percentage rating. If VA finds that a veteran has one or more service- connected disabilities with a combined rating of at least 10 percent, the  agency will pay monthly compensation.
In November 2007, DOD and VA began piloting the IDES. The IDES merges  DOD and VA processes, so that servicemembers begin their VA disability  claim while they undergo their DOD disability evaluation, rather than  sequentially, making it possible for them to receive VA disability benefits  shortly after leaving military service. Specifically, the IDES:    Merges DOD and VA’s separate exam processes into a single exam process  conducted to VA standards. This single exam (which may involve more  than one medical examination, for example, by different specialists), in  conjunction with the servicemembers’ medical records, is used by military  service PEBs to make a determination of servicemembers’ fitness for  continued military service, and by VA as evidence of service-connected  disabilities. The exam may be performed by medical staff working for VA,  DOD, or a private provider contracted with either agency.
Consolidates DOD and VA’s separate rating phases into one VA rating  phase. If the PEB has determined that a servicemember is unfit for duty,  VA rating specialists prepare two ratings—one for the conditions that DOD  determined made a servicemember unfit for duty, which DOD uses to  provide military disability benefits, and the other for all service-connected  disabilities, which VA uses to determine VA disability benefits.
Provides VA case managers to perform outreach and nonclinical case  management and explain VA results and processes to servicemembers.
section_title: Pilot Evaluation Results Were Promising, but Degree of Improvement was Unknown, and Timeliness Has Since Worsened
paragraphs: In August 2010, DOD and VA officials issued an interim report to Congress  summarizing the results of their evaluation of the IDES pilot as of early  2010 and indicating overall positive results. In that report, the agencies  concluded that, as of February 2010, servicemembers who went through  the IDES pilot were more satisfied than those who went through the  legacy system, and that the IDES process met the agencies’ goals of  delivering VA benefits to active duty servicemembers within 295 days and  to reserve component servicemembers within 305 days. Furthermore, they  concluded that the IDES pilot has achieved a faster processing time than  the legacy system, which they estimated to be 540 days.
Although DOD and VA’s evaluation results indicated promise for the IDES,  the extent to which they represented an improvement over the legacy  system could not be known because of limitations in the legacy data. DOD  and VA’s estimate of 540 days for the legacy system was based on a small,  nonrepresentative sample of cases. Officials planned to use a broader  sample of legacy cases to compare against pilot cases with respect to  processing times and appeal rates; however inconsistencies in how  military services tracked information and missing VA information (i.e., on  the date VA benefits were delivered) for legacy cases, precluded such  comparisons.
While our review of DOD and VA’s data and reports generally confirmed  DOD and VA’s findings as of early 2010, we found that not all of the service  branches were achieving the same results, case processing times increased  between February and August 2010, and other agency goals are not being  met. Since our December report, processing times have worsened further  and the agencies have adjusted some goals downward.
Servicemember satisfaction: Our reviews of the survey data as of early  2010 indicated that, on average, servicemembers in the IDES pilot had  higher satisfaction levels than those who went through the legacy process.  However, Air Force members—who represented a small proportion (7  percent) of pilot cases—were less satisfied. Currently, DOD and VA have  an 80-percent IDES satisfaction goal, which has not been met. For  example, 67 percent of servicemembers surveyed in March 2011 were  satisfied with the IDES. Satisfaction by service ranged from 54 percent for  the Marine Corps to 72 percent for the Army.
Average case processing times: Although the agencies were generally  meeting their 295-day and 305-day timeliness goals through February 2010,  the average case processing time for active duty servicemembers  increased from 274 to 296 days between February and August 2010.  Among the military service branches, only the Army was meeting the  agencies’ timeliness goals as of August, while average processing times for  each of the other services exceeded 330 days. Since August 2010,  timeliness has worsened significantly. For example, active component  cases completed in March 2011 took an average of 394 days—99 days over  the 295-day target. By service, averages ranged from 367 days for the Army  to 455 days for the Marine Corps. Meanwhile, Reserve cases took an  average of 383 days, 78 days more than the 305-day target, while Guard  cases took an average of 354 days, 49 days more than the target.
Goals to process 80 percent of cases in targeted time frames: DOD and  VA had indicated in their planning documents that they had goals to  deliver VA benefits to 80 percent of servicemembers within the 295-day  (active component) and 305-day (reserve component) targets. For both  active and reserve component cases at the time of our review, about 60  percent were meeting the targeted time frames. DOD and VA have since  lowered their goals for cases completed on time, from 80 percent to 50  percent. Based on monthly data for 6 months through March 2011, the  new, lower goal was not met during any month for active component  cases. For completed Reserve cases, the lower goal was met during one of  the 6 months and for Guard cases, it was met in 2 months. The strongest  performance was in October 2010 when 63 percent of Reserve cases were  processed within the 305-day target.
section_title: Pilot Sites Experienced Several Challenges
paragraphs: Based on our prior work, we found that--as DOD and VA tested the IDES  at different facilities and added cases to the pilot--they encountered  several challenges that led to delays in certain phases of the process.
Staffing: Most significantly, most of the sites we visited reported  experiencing staffing shortages and related delays to some extent, in part  due to workloads exceeding the agencies’ initial estimates. The IDES  involves several different types of staff across several different DOD and  VA offices, some of which have specific caseload ratios set by the  agencies, and we learned about insufficient staff in many key positions.  With regard to VA positions, officials cited shortages in examiners for the  single exam, rating staff, and case managers. With regard to DOD  positions, officials cited shortages of physicians who serve on the MEBs,  PEB adjudicators, and DOD case managers. In addition to shortages cited  at pilot sites, DOD data indicated that 19 of the 27 pilot sites did not meet  DOD’s caseload target of 30 cases per manager. Local DOD and VA  officials attributed staffing shortages to higher than anticipated caseloads  and difficulty finding qualified staff, particularly physicians, in rural areas.  These staffing shortages contributed to delays in the IDES process.
Two of the sites we visited—Fort Carson and Fort Stewart—were  particularly challenged to provide staff in response to surges in caseload  that occurred when Army units were preparing to deploy to combat zones.  Through the Army’s predeployment medical assessment process, large  numbers of servicemembers were determined to be unable to deploy due  to a medical condition and were referred to the IDES within a short period  of time, overwhelming the staff. These two sites were unable to quickly  increase staffing levels, particularly of examiners. As a result, at Fort  Carson, it took 140 days on average to complete the single exam for active  duty servicemembers, as of August 2010—much longer than the agencies’  goal to complete the exams in 45 days. More recently, Fort Carson was  still struggling to meet goals, as of March 2011. For example, about half of  Fort Carson’s active component cases (558 of 1033 cases) were in the MEB  phase, and the average number of days spent in the MEB phase by active  component cases completed in March 2011 was 197 days, compared to a  goal of 35 days.
Exam summaries: Issues related to the completeness and clarity of single  exam summaries were an additional cause of delays in the VA rating phase  of the IDES process. Officials from VA rating offices said that some exam  summaries did not contain information necessary to determine a rating. As  a result, VA rating office staff must ask the examiner to clarify these  summaries and, in some cases, redo the exam. VA officials attributed the  problems with exam summaries to several factors, including the  complexity of IDES pilot cases, the volume of exams, and examiners not  receiving records of servicemembers’ medical history in time. The extent  to which insufficient exam summaries caused delays in the IDES process  is unknown because DOD and VA’s case tracking system for the IDES does  not track whether an exam summary has to be returned to the examiner or  whether it has been resolved.
Medical diagnoses: While the single exam in the IDES eliminates  duplicative exams performed by DOD and VA in the legacy system, it  raises the potential for there to be disagreements about diagnoses of  servicemembers’ conditions. For example, officials at Army pilot sites  informed us about cases in which a DOD physician had treated members  for mental disorders, such as major depression. However, when the  members went to see the VA examiners for their single exam, the  examiners diagnosed them with posttraumatic stress disorder (PTSD).  Officials told us that attempting to resolve such differences added time to  the process and sometimes led to disagreements between DOD’s PEBs and  VA’s rating offices about what the rating should be for purposes of  determining DOD disability benefits. Although the Army developed  guidance to help resolve diagnostic differences, other services have not.
Moreover, PEB officials we spoke with noted that there is no guidance on  how disagreements about servicemembers’ ratings between DOD and VA  should be resolved beyond the PEBs informally requesting that the VA  rating office reconsider the case. While DOD and VA officials cited several  potential causes for diagnostic disagreements, the number of cases with  disagreements about diagnoses and the extent to which they have  increased processing time are unknown because the agencies’ case  tracking system does not track when a case has had such disagreements.
Logistical challenges integrating VA staff at military treatment  facilities: DOD and VA officials at some pilot sites we visited said that  they experienced logistical challenges integrating VA staff at the military  facilities. At a few sites, it took time for VA staff to receive common access  cards needed to access the military facilities and to use the facilities’  computer systems, and for VA physicians to be credentialed. DOD and VA  staff also noted several difficulties using the agencies’ multiple  information technology (IT) systems to process cases, including redundant  data entry and a lack of integration between systems.
Housing and other challenges posed by extended time in the military  disability evaluation process: Although many DOD and VA officials we  interviewed at central offices and pilot sites felt that the IDES process  expedited the delivery of VA benefits to servicemembers, several also  indicated that it may increase the amount of time servicemembers are in  the military’s disability evaluation process. Therefore, some DOD officials  noted that servicemembers must be cared for, managed, and housed for a  longer period. The military services may move some servicemembers to  temporary medical units or to special medical units such as Warrior  Transition Units in the Army or Wounded Warrior Regiments in the Marine  Corps, but at a few pilot sites we visited, these units were either full or  members in the IDES did not meet their admission criteria. In addition,  officials at two sites said that members who are not gainfully employed by  their units and left idle are more likely to be discharged due to misconduct  and forfeit their disability benefits. However, DOD officials also noted that  servicemembers benefit from continuing to receive their salaries and  benefits while their case undergoes scrutiny by two agencies, though some  also acknowledged that these additional salaries and benefits create costs  for DOD.
section_title: Deployment Plans Address Many, but not All, Challenges
paragraphs: DOD and VA are deploying the IDES to military facilities worldwide on an  ambitious timetable—expecting deployment to be completed at a total of  about 140 sites by the end of fiscal year 2011. As of March 2011, the IDES  was operating at 73 sites, covering about 66 percent of all military  disability evaluation cases.
In preparing for IDES expansion militarywide, DOD and VA had many  efforts under way to address challenges experienced at the 27 pilot sites.  For example, the agencies completed a significant revision of their site  assessment matrix—a checklist used by local DOD and VA officials to  ascertain their readiness to begin the pilot—to address areas where prior  IDES sites had experienced challenges. In addition, local senior-level DOD  and VA officials will be expected to sign the site assessment matrix to  certify that a site is ready for IDES implementation. This differs from the  pilot phase where, according to DOD and VA officials, some sites  implemented the IDES without having been fully prepared.
Through the new site assessment matrix and other initiatives, DOD and VA  planned to address several of the challenges identified in the pilot phase.
Ensuring sufficient staff: With regard to VA staff, VA planned to increase  the number of examiners by awarding a new contract through which sites  can acquire additional examiners. To increase rating staff, VA filled vacant  rating specialist positions and anticipates hiring a small number of  additional staff. With regard to DOD staff, Air Force and Navy officials told  us they added adjudicators for their PEBs or planned to do so. Both DOD  and VA indicated they plan to increase their numbers of case managers.  Meanwhile, sites are being asked in the assessment matrix to provide  longer and more detailed histories of their caseloads, as opposed to the  1-year history that DOD and VA had based their staffing decisions on  during the pilot phase. The matrix also asks sites to anticipate any surges  in caseloads and to provide a written contingency plan for dealing with  them.
Ensuring the sufficiency of single exams: VA has been revising its exam  templates to better ensure that examiners include the information needed  for a VA disability rating decision and to enable them to complete their  exam reports in less time. VA is also examining whether it can add  capabilities to the IDES case tracking system that would enable staff to  identify where problems with exams have occurred and track the progress  of their resolution.
Ensuring adequate logistics at IDES sites: The site assessment matrix  asks sites whether they have the logistical arrangements needed to  implement the IDES. In terms of information technology, DOD and VA  were developing a general memorandum of agreement intended to enable  DOD and VA staff access to each other’s IT systems. DOD officials also  said that they are developing two new IT solutions—one intended to help  military treatment facilities better manage their cases, another intended to  reduce multiple data entry.
However, in some areas, DOD and VA’s efforts to prepare for IDES  expansion did not fully address some challenges or are not yet complete.  For these areas, we recommended additional action that the agencies  could take, with which the agencies generally concurred.
Ensuring sufficient DOD MEB physician staffing: DOD does not yet  have strategies or plans to address potential shortages of physicians to  serve on MEBs. For example, the site assessment matrix does not include  a question about the sufficiency of military providers to handle expected  numbers of MEB cases at the site, or ask sites to identify strategies for  ensuring sufficient MEB physicians if there is a caseload surge or staff  turnover. We recommended that, prior to implementing IDES at MTFs,  DOD direct military services to conduct thorough assessments of the  adequacy of military physician staffing for completing MEB  determinations and develop contingency plans to address potential  shortfalls, e.g. due to staff turnover or caseload surges.
Ensuring sufficient housing and organizational oversight for IDES  participants: Although the site assessment matrix asks sites whether they  will have sufficient temporary housing available for servicemembers going  through the IDES, the matrix requires only a yes or no response and does  not ensure that sites will have conducted a thorough review of their  housing capacity. In addition, the site assessment matrix does not address  plans for ensuring that IDES participants are gainfully employed or  sufficiently supported by their organizational units. We recommended that  prior to implementing the IDES at MTFs, DOD ensure thorough  assessments are conducted on the availability of housing for  servicemembers and on the capacity of organizational units to absorb  servicemembers undergoing the disability evaluation; alternative housing  options are identified when sites lack adequate capacity; and plans are in  place for ensuring that servicemembers are appropriately and  constructively engaged.
Addressing differences in diagnoses: According to agency officials, DOD  is currently developing guidance on how staff should address differences  in diagnoses. However, since the new guidance and procedures are still  being developed, we cannot determine whether they will aid in resolving  discrepancies or disagreements. Significantly, DOD and VA do not have a  mechanism for tracking when and where disagreements about diagnoses  and ratings occur and, consequently, may not be able to determine  whether the guidance sufficiently addresses the discrepancies. Therefore,  we recommended that DOD and VA conduct a study to assess the  prevalence and causes of such disagreements and establish a mechanism  to continuously monitor diagnostic disagreements. VA has since indicated  it plans to conduct such a study and make a determination by July 2011  regarding what, if any, mechanisms are needed.
Further, despite regular reporting of data on caseloads, processing times,  and servicemember satisfaction, and preparation of an annual report on  challenges in the IDES, we determined that DOD and VA did not have a  systemwide monitoring mechanism to help ensure that steps they took to  address challenges are sufficient and to identify problems in a more timely  basis. For example, they did not collect data centrally on staffing levels at  each site relative to caseload. As a result, DOD and VA may be delayed in  taking corrective action since it takes time to assess what types of staff are  needed at a site and to hire or reassign staff. DOD and VA also lacked  mechanisms or forums for systematically sharing information on  challenges, as well as best practices between and among sites. For  example, DOD and VA have not established a process for local sites to  systematically report challenges to DOD and VA management and for  lessons learned to be systematically shared systemwide. During the pilot  phase, VA surveyed pilot sites on a monthly basis about challenges they  faced in completing single exams. Such a practice has the potential to  provide useful feedback if extended to other IDES challenges.
To identify challenges as they arise in all DOD and VA facilities and offices  involved in the IDES and thereby enable early remedial action, we  recommended that DOD and VA develop a systemwide monitoring  mechanism. This system could include continuous collection and analysis  of data on DOD and VA staffing levels, sufficiency of exam summaries, and  diagnostic disagreements; monitoring of available data on caseloads and  case processing time by individual VA rating office and PEB; and a formal  mechanism for agency officials at local DOD and VA facilities to  communicate challenges and best practices to DOD and VA headquarters.  VA noted several steps it plans to take to improve its monitoring of IDES  workloads, site performance and challenges—some targeted to be  implemented by July 2011—which we have not reviewed.
section_title: Concluding Observations
paragraphs: By merging two duplicative disability evaluation systems, the IDES has  shown promise for expediting the delivery of VA benefits to  servicemembers leaving the military due to a disability. However, we  identified significant challenges at pilot sites that require careful  management attention and oversight. We noted a number of steps that  DOD and VA were undertaking or planned to undertake that may mitigate  these challenges. However, the agencies’ deployment schedule is  ambitious in light of substantial management challenges and additional  evidence of deteriorating case processing times. As such, it is unclear  whether these steps will be sufficiently timely or effective to support  militarywide deployment. Deployment time frame notwithstanding, we  continue to believe that the success or failure of the IDES will depend on  DOD and VA’s ability to quickly and effectively address resource needs  and resolve challenges as they arise, not only at the initiation of the  transition to IDES, but also on an ongoing, long-term basis. We continue to  believe that DOD and VA cannot achieve this without a robust mechanism  for routinely monitoring staffing and other risk factors.
Chairman Chaffetz and Ranking Member Tierney, this concludes my  prepared statement. I would be pleased to respond to any questions that  you or other Members of the Subcommittee may have at this time.
section_title: GAO Contact and Staff Acknowledgment
paragraphs: For further information about this testimony, please contact Daniel  Bertoni at (202) 512-7215 or bertonid@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on the  last page of this testimony. In addition to the individual named above, key  contributors to this testimony include Michele Grgich, Greg Whitney, and  Daniel Concepcion. Key advisors included Bonnie Anderson, Mark Bird,  Sheila McCoy, Patricia Owens, Roger Thomas, Walter Vance, and Randall  Williamson.
section_title: Related GAO Products
paragraphs: Military and Veterans Disability System: Pilot Has Achieved Some  Goals, but Further Planning and Monitoring Needed. GAO-11-69.  Washington, D.C.: December 6, 2010.
Military and Veterans Disability System: Preliminary Observations on  Evaluation and Planned Expansion of DOD/VA Pilot. GAO-11-191T.  Washington, D.C.: November 18, 2010.
Veterans’ Disability Benefits: Further Evaluation of Ongoing Initiatives  Could Help Identify Effective Approaches for Improving Claims  Processing. GAO-10-213. Washington, D.C.: January 29, 2010.
Recovering Servicemembers: DOD and VA Have Jointly Developed the  Majority of Required Policies but Challenges Remain. GAO-09-728.  Washington, D.C.: July 8, 2009.
Recovering Servicemembers: DOD and VA Have Made Progress to Jointly  Develop Required Policies but Additional Challenges Remain.  GAO-09-540T. Washington, D.C.: April 29, 2009.
Military Disability System: Increased Supports for Servicemembers and  Better Pilot Planning Could Improve the Disability Evaluation Process.  GAO-08-1137. Washington, D.C.: September 24, 2008.
DOD and VA: Preliminary Observations on Efforts to Improve Care  Management and Disability Evaluations for Servicemembers.  GAO-08-514T. Washington, D.C.: February 27, 2008.
DOD and VA: Preliminary Observations on Efforts to Improve Health  Care and Disability Evaluations for Returning Servicemembers.  GAO-07-1256T Washington, D.C.: September 26, 2007.
Military Disability System: Improved Oversight Needed to Ensure  Consistent and Timely Outcomes for Reserve and Active Duty Service  Members. GAO-06-362. Washington, D.C.: March 31, 2006.
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