Thursday, November 18, 2010

I Hate The War

Who determines disability for veterans and active duty service members? The Defense Dept or the VA? The question matters because they grade differently, on different criteria. Currently, there is a test program, begun in November 2007, where the two evaluation systems are integrated.

US Senator Richard Burr explained this morning, "For any servicemembers whose medical conditions keep them from continuing to serve in the military, there must be an effective, hassle-free process to get them the benefits and services they need and help them to smoothly transition to civilian life. But, several years ago, it became very clear that the disability system at the Department of Defense and Department of Veterans Affairs was not living up that standard. In 2007, news reports, as well as several panels of experts, detailed how injured servicemembers had to go through a long, bureaucratic process at DoD, followed by a similar process at the VA, to find out what disability benefits they would receive. Wounded servicemembers and their families were becoming frustrated, confused and disappointed with both systems."

He was speaking at the Senate Veterans Affairs Committee briefing on the test program. Briefing the Committee were the Defense Dept's John Campbell, the VA's John Medve and the Government Accountability Office's Daniel Bertoni.

In his opening remarks, Chair Daniel Akaka declared this morning, "While streamlining the two systems is important, the implementation of this joint program has not been without problems. At a few pilot sites, VA staffing shortages, due to a lack of personnel to conduct disability medical examinations, caused significant delay in the processing of servicemembers. There were also personnel shortages at DoD among those responsible for guiding servicemembers through the new process. Issues of servicemember satisfaction and quality of life are also of concern. Other issues have been identified through Committee staff oversight and by the GAO in its draft report on the new process. These include problems with integrating VA staff at military installations, difficulty in having various I.T. systems work together, and ensuring that an adequate number of DoD physicians serve on Medical Evaluation Boards. The Committee needs to hear from VA and DoD on how these challenges are being addressed."

Again, Senator Daniel Akaka is the Chair. Richard Burr is the Ranking Member. Though there will be changes on the House Veterans Affairs Committee as leadership flips, the Senate Veterans Affairs Committee will remain in Democratic control with Daniel Akaka as Chair. The Committee will lose two current members serving on the Democrat side. Senator Roland Burris was appointed to former Senator Barack Obama's seat (when Barack went to the White House). He did not run for re-election so he will not be returning in the 112th Congress this January. Senator Arlen Specter attempted to run for re-election; however, Joe Sestak won the nomination in the primary race and matched up against Pat Toomey in the general election. The race for Burris' seat was also won by a Republican, Mark Kirk. The Committee will continue to have six Republican slots and 12 slots that the Democrats assign. 12 slots that the Democrats assign? Senators Joe Lieberman and Bernard Sanders generally vote and caucus with the Democrats but they are were not elected as Democrats. Lieberman now claims "independent" status while Sanders is a Socialist. In the case of the Senate's VA Committee, Sanders occupied one of the Democrats' Committee seats in the 111th Congress.

We'll excerpt this portion of the exchange.

Chair Daniel Akaka: Mr. Bertoni, in your opinion, are the Departments adequately addressing all the major problems that were identified during the pilot? I ask this because I'm concerned that some issues might not be fully addressed before it's rolled out to the rest of the military.

Daniel Bertoni: As noted in -- in our statement, I think that they made progress in several areas -- especially in regard to getting out in front of the staffing issues. That's a big one. Uh, I-I can't stress that one enough. There are a lot of moving parts, a lot of specialized services and skills and services they need and there's at least an acknowledgement that the staffing portion of this or the component of this is critical to success and we would agree with that. It's how we're going to get there that is a question to us. You can relocate, you can hire, you can bring in additional contractors but we would really like to see or need to see a service delivery plan or an operations plan going forward to discern how that's going to happen. And I-I appreciate the comment that you all may be looking back at the original 27 sites do sort of look at those issues because I think there are still lingering issues out there in regards to staffing that are very important. Beyond that, certainly the issue of monitoring. I think having good MI data at the local level as to what's happening with these particular sites. If things start to go awry, staffing shifts, attrition, problems with diagnoses, problems with exam summaries -- you can know this sooner, rather than later, and get out in front of that problem and come into play with remedial training, guidance, etc to sort of prevent some of these issues from getting worse. So there's an acknowledgement. There appears to be a plan. We haven't seen that operational plan but at least there's an acknowledgement that there's some issues to work on.

Chair Daniel Akaka: Thank you. Mr. Campbell and Mr. Medve, are you both able to track individual sites to determine if there are problems with staffing and insufficient medical exams. Mr. Campbell?

John Campbell: I would like to make the point that no site will go into IOC unless it passes a series of-of strict tests. We have checklists. We're looking at the sites weekly, those that are in - in prepartion for the expansion, we're looking at them weekly to make sure that they pass these tests. And once the sites go live, we will be monitoring them as well. So I believe that it's probably fair to say that no service member is going to be endangered. We're not racing to get the sites complete so we can adhere to some timeline. This is really a criterian driven basis and we - we feel comfortable that we have sufficient safeguards built in that the sites will not go live until they're ready.

Chair Daniel Akaka: Mr. Medve?

John Medve: Senator, thank you for the question. And I'd like to echo what Mr. Campbell said. I mean we have instituted as a base of lessons learned from the pilot sites a certification process that now has a much more robust understanding of the requirement that will inform staffing decisions. During the pilot site, I think we used about a year's worth of data and it turned out not to include things like how many deployment cycles sites had gone through which had an impact on the number of cases and the type of cases that sites went in, which impacted the type of examinations that needed to be done . So we now use a multi-year view of that. Obviously, our understanding as we've gone through has increased and we are developing robust staffing plans for the oncoming sites. And, again, just to reiterate what - what Mr. Campbell said, and we made it clear to all sites that unless there is the capability and the capacity to move forward, they are not to move forward with this.

Chair Daniel Akaka: Thank you, Mr. Campbell. I'm concerned that VA may bear a disproportionate burden in administering this program. Can you respond with your thoughts on that?

John Campbell: Yes, sir. I'd be happy to. We have signed -- the DoD and VA have signed a memorandum of understanding -- an agreement -- to share these costs equitably and the process is one where the costs will be allocated as - as they - as they become live costs and then, at the end of this period, we will look at whether we owe the VA money or they - they owe us money?

Chair Daniel Akaka: Senator Burr, your questions.

Ranking Member Richard Burr: Thank you, Mr. Chairman. Mr. Bertoni, VA and DoD have estimated that the IPDES system is faster than the old legacy disability process. Now their estimate is the old legacy process was 540 days. But you noted, and I quote, "The extent to which the IPDES is an improvement over the legacy system cannot be known because of the limitations in the legacy data." And that the 540 day estimate, again I quote, "is based on a small non-representative sample of cases." And, first of all, can you explain for the record how many cases were used to come up with the 540 day estimate?

Daniel Bertoni: Yeah. I - I believe that originated with the original table-top exercise way back in 2007 where I think there were 70 cases where -- across all services where they went in and looked at the average processing time for those kind of cases and came up with a number for DoD's side of the shop and that was about 300 days. And then they extrapolated to the VA side with an average of can take up to 200 days and to process a VA claim and tack that on to the overall total so they came up with the 540 day average. We had some concern with that. It's not as rigorous as we would like. We tried to reconstruct it on our own and we found very quickly that it was an apples to oranges comparison by trying to bring in the various services in the Army. It really wasn't possible in terms of the quality and the integrity of the data. We did do our own analysis of the Army data which we felt was sufficient to do this type of analysis. And Army being -- representing 60% of the IPDES cases? Pretty substantial if we could verify that and we did our analysis and were able to determine that it came out to about 369 days to complete that IPDES portion of the process. Recongnize that it would be reasonable to assume that it could possibly take up to 200 days to complete the VA rating side. So, uh, fairly reasonable estimate -- not entirely rigorous.

We didn't have space for the hearing in today's snapshot and I was also throwing most of the afternoon and evening and not in the mood to go through my notes from the hearing. If you're a veteran or the family member (includes domestic partner or same-sex spouse) of one -- community member or visitor -- and you think the hearing needs to be noted in a snapshot, drop an e-mail and I'll include it in tomorrow's. Normally it would make the snapshot but, again, I was sick. Also I took notes throughout so we can emphasize another section if we cover this in tomorrow's hearing (Sherrod Brown had interesting questions -- I think Burr was more on the mark in the second round in terms of the immediate concerns of veterans and their families -- and Mike Johanns took it to "nuts and bolts" in either the first round or the second and we can utilize that as well). Let's say 3:00 pm EST is the cut off time because I won't be in the e-mails and I don't want those who are reading them (Martha, Shirley, Eli, Heather and who knows who else) to be going through those up to the last minute.

It's over, I'm done writing songs about love
There's a war going on
So I'm holding my gun with a strap and a glove
And I'm writing a song about war
And it goes
Na na na na na na na
I hate the war
Na na na na na na na
I hate the war
Na na na na na na na
I hate the war
Oh oh oh oh
-- "I Hate The War" (written by Greg Goldberg, on The Ballet's Mattachine!)

Last week, ICCC's number of US troops killed in Iraq since the start of the illegal war was 4430. Tonight it is still [PDF format warning] 4430.

The e-mail address for this site is