Veterans can reapply  to the VR&E program at any time. In addition, almost 60 percent of IL track veterans served in the U.S.  Army and less than 1 percent served in the National Guard or Reserves. 6). Regardless of disability rating level, the most  prevalent disabilities among this group were Post-traumatic Stress  Disorder (PTSD), tinnitus (“ringing in the ears”), and hearing loss. For all veterans who entered the IL track in  fiscal year 2008, we estimate that VR&E purchased a total of almost $14  million in goods and services. By the end of fiscal year  2011, as shown in figure 10, about 89 percent of veterans who began an  IL plan in fiscal year 2008 had been classified by VR&E as “rehabilitated.”  About 5 percent of cases were “discontinued” or closed by VR&E  because the rehabilitation goals in the veteran’s IL plan were not  completed. For  example, in one case we reviewed, the IL plan for a veteran with  rheumatoid arthritis only called for the purchase and installation of eight  door levers and a grab rail for the bathtub, so that the veteran could enter  the rooms of his home without pain or assistance, and be able to safely  enter and exit the bathtub without fear of falling. While the overall IL rehabilitation rate nationwide of 89 percent is fairly  high, we found that the percentage of veterans who began an IL plan in  fiscal year 2008 and were rehabilitated by the end of fiscal year 2011  varied by regional office. The average time for veterans to complete their IL plans also varied by  veteran age. VR&E Exercises Limited Oversight of the IL Track

National oversight of VR&E’s IL track is limited in four key areas: (1)  ensuring compliance with case management requirements; (2) monitoring  regional variation in IL track caseload and benefits provided; (3)  adequacy of policies and procedures for approving expenditures on  goods and services for IL track veterans; and (4) availability of critical  program management information. Regional Offices May Not Be Complying with VR&E Case Management Requirements

Based on VR&E’s compliance reports from two of the regional offices we  visited and interviews with staff in these offices, we found that some  offices may not be complying with certain VR&E case management  requirements governing the IL track. VR&E Does Not Systematically Monitor Variation in IL Track Caseload Size and Benefits Provided

While IL track caseload size and benefits vary across regions, VR&E  does not systematically monitor these variations. To oversee administration of the IL track,  VR&E has relied on the information provided through its general quality  assurance (QA) activities and a series of periodic ad hoc studies. Under  this policy, regional offices are permitted to purchase a broad range of  items without any Central Office approval, resulting in some offices  purchasing goods and services that may be questionable or that are  costly. For example, in one of the 182 IL cases we reviewed, VR&E  Central Office would not have been required to approve total  expenditures of $18,829 for a riding lawn mower—which VR&E policy  prohibits—and other IL goods and services including a bed, bed frame,  desktop computer, and woodworking equipment. A VR&E policy letter to VA regional offices, dated  December 14, 2010, states that “VR&E Service will monitor new IL  programs by tracking the number of veterans entering independent living  case status in each fiscal year and notify the field of any necessary action  if the 2,700 statutory limit is being approached.” However, in analyzing  VR&E’s administrative data, we found that VR&E counts the number of IL  plans developed annually and not the number of individual veterans  admitted to the track. Based on  data from CWINRS, 403 (4 percent) of the 9,215 veterans beginning an IL  plan during fiscal years 2008 through 2011 had more than one plan  during that time. Conclusions

VR&E’s IL track can provide a wide range of benefits to help veterans  with service-connected disabilities maximize their ability to live  independently when the achievement of an employment goal is not  currently feasible. Work with the Undersecretary for Health to explore options on ways to  enhance coordination to ensure IL track veterans’ needs are met by  VHA, when appropriate, in a timely manner. VA generally agreed with our conclusions, and  concurred with our three recommendations. With regards  to our recommendation that VA enhance coordination between VR&E and  VHA on the provision of IL benefits to veterans, VA noted there are efforts  underway that will permit VR&E counselors to make IL referrals to VHA  providers through VHA’s Compensation and Pension Record Interchange  system, also referred to as CAPRI. Appendix I: Objectives, Scope, and Methodology

The objectives of this report were to examine (1) the characteristics of  veterans who have participated in the IL track, as well as the types and  costs of benefits they were provided; (2) the extent to which their  independent living plans were completed, and the time it took; and (3) the  extent to which the IL track has been administered appropriately and  consistently. Analysis of IL Veteran Cases

To obtain information on the types of benefits provided through the IL  track, as well as the costs and coordination of these benefits, we  conducted a case file review of a random, generalizable sample of 182  veterans whose cases started in the IL track at some point during fiscal  year 2008. We estimated our models using VA administrative data on veterans who  began exactly one IL plan from fiscal years 2008 through 2011.
Why GAO Did This Study

The IL "track"--one of five tracks within VA's VR&E program--provides a range of benefits to help veterans with service-connected disabilities live independently when employment is not considered feasible at the time they enter the VR&E program. These benefits can include counseling, assistive devices, and other services or equipment. GAO was asked to review issues related to the IL track. This report examines (1) the characteristics of veterans in the IL track, and the types and costs of benefits they were provided; (2) the extent to which their IL plans were completed, and the time it took to complete them; and (3) the extent to which the IL track has been administered appropriately and consistently across regional offices.
To conduct this work, GAO analyzed VA administrative data from fiscal years 2008 to 2011, and reviewed a random, generalizable sample of 182 veterans who entered the IL track in fiscal year 2008. In addition, GAO visited five VA regional offices; interviewed agency officials and staff; and reviewed relevant federal laws, regulations, and agency policies and procedures.

What GAO Found

Of the 9,215 veterans who entered the Department of Veterans Affairs' (VA) Independent Living (IL) track within the Vocational Rehabilitation and Employment (VR&E) program in fiscal years 2008 to 2011, most were male Vietnam era veterans in their 50s or 60s. Almost 60 percent served in the U.S. Army, and fewer than 1 percent served in the National Guard or Reserve. The most prevalent disabilities among these veterans were post-traumatic stress disorder and tinnitus. GAO's review of 182 IL cases from fiscal year 2008 found that VR&E provided a range of IL benefits to veterans. Among these cases, the most common benefits were counseling services and computers. Less common benefits included gym memberships, camping equipment, and a boat. GAO estimated that VR&E spent nearly $14 million on benefits for veterans entering the IL track in fiscal year 2008--an average of almost $6,000 per IL veteran.
Most veterans completed their IL plans, which identify their individual goals to live independently and the benefits VR&E will provide. About 89 percent of fiscal year 2008 IL veterans were considered by VR&E to be "rehabilitated," that is, generally, to have completed their IL plans by the end of fiscal year 2011. VR&E discontinued or closed about 5 percent of cases for various reasons, such as the veteran declined benefits. Six percent of cases were open at the end of fiscal year 2011. Because the complexity of IL cases varied depending on veterans' disabilities and needs, some cases were fairly simple for VR&E to close. For example, one IL case only called for the installation of door levers and a bathtub rail. Another more complex case involved the provision of a range of IL benefits, including home modifications. Rehabilitation rates across regions varied from 0 to 100 percent, and regions with larger IL caseloads generally rehabilitated a greater percentage of IL veterans. While IL plans nationwide were completed in 384 days, on average, completion times varied by region, from 150 to 895 days.
VR&E exercises limited oversight to ensure appropriate and consistent administration of the IL track across its regions. First, some regions may not be complying with certain case management requirements. For instance, while VR&E is required to coordinate with the Veterans Health Administration (VHA) on IL benefits, VR&E counselors have difficulty obtaining timely responses from VHA. VHA physicians respond to VR&E's IL referrals late or not at all, resulting in delayed benefits or VR&E providing the benefits instead of VHA. Second, VR&E does not monitor regional variation in IL caseloads and benefits provided. Instead, it has relied on its quality assurance reviews and ad hoc studies, but these are limited in scope. Third, given counselors have broad discretion in selecting IL benefits, VR&E's written policies for approving IL expenditures may not be appropriate as regions were permitted to purchase a range of items without any Central Office approval, some of which were costly or questionable. For example, in one case, Central Office review would not have been required for expenditures of $18,829 for a riding mower, which is prohibited, and other items. Finally, VR&E's system does not collect IL costs and benefits provided. VR&E also lacks accurate data on the number of IL veterans served. While the law currently allows 2,700 veterans to enter the IL track annually, data used to monitor the cap are based on the number of IL plans developed, not on the number of individual veterans admitted. Veterans can have more than one plan in a fiscal year, so one veteran could be counted multiple times towards the cap.

What GAO Recommends

GAO recommends that VR&E explore options to enhance coordination with VHA; strengthen its oversight of the IL track; and reassess its policy for approving benefits. VA generally agreed with GAO's conclusions and recommendations.