The Integrated Disability Evaluation System

In November 2007, DOD and VA began piloting the IDES, a joint disability  evaluation system to eliminate duplication in their separate systems and to  expedite receipt of VA benefits for wounded, ill, and injured  servicemembers. Pilot Evaluation Results Are Promising, but the Degree of Improvement Achieved Is Unknown

		DOD and VA’s Evaluation Shows That the Pilot Is Achieving Some of Its Goals

In their planning documents for the IDES pilot, DOD and VA stated that  they were basing their evaluation of the effectiveness of the IDES pilot on  whether it has achieved three key goals relative to the legacy process:  increased servicemember satisfaction, improved case-processing time, and  a reduction in servicemember appeal rates. In this report, the agencies  concluded that 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. However, while the agencies have  largely met their overall goal to increase servicemember satisfaction and  met their timeliness goal as of February 2010, since that time, case  processing times have been steadily increasing as the caseload has  increased. I for further information). Among these were insufficient staffing,  challenges in conducting the single exams, logistical challenges related  integrating VA staff, as well as housing and managing servicemembers  going through the IDES. Officials at most of the 1 pilot sites we visited said they have experienced staffing shortages to a t  least some extent, with a few sites—Fort Ca particular—experiencing severe shortages. For example, as of August 2010, exams at  Fort Carson have taken an average of 140 days to complete for active duty servicemembers, according to the agencies’ data, far from achieving their  goal to complete single medical exams within 45 days (see fig. II for processing times for reserve component members). As a result,  they lacked key information, such as the servicemember’s medical history  and results of laboratory tests. DOD and VA Expansion Plans Address Some Though Not All Challenges

		DOD and VA Have Incorporated Many Lessons Learned into Their Planning for Worldwide Expansion of the IDES but Lack Concrete Plans for Addressing Some Challenges

DOD and VA plan to expand the IDES to sites worldwide on an ambitious  timetable—to 113 sites during fiscal year 2011, a pace of about 1 site every  3 days. However, piloting of the system at 27 sites has revealed several significant  challenges that require careful management attention and oversight before  DOD and VA expand the system military-wide. DOD and VA currently have mechanisms to track numbers of cases  processed, timeliness, and servicemember satisfaction, but they do not  routinely monitor factors—such as staffing levels relative to caseload,  disagreements about diagnoses, and insufficient exam summaries—that  can delay the process. Recommendations for Executive Action

To ensure that the IDES is sufficiently staffed and that military treatment  facilities are prepared to house personnel in the IDES, we recommend that  the Secretary of Defense direct the military services to conduct thorough  assessments prior to each site’s implementation of the IDES of the  following three issues:  the adequacy of staffing of military physicians for completing MEB  determinations at military treatment facilities; contingency plans should  be developed to address potential staffing shortfalls, for example, due to  staff turnover or caseload surges;  the availability of housing for servicemembers in the IDES at military  facilities; alternative housing options should be identified if sites do not  have adequate capacity; and  the capacity of organizational units to absorb servicemembers undergoing  the disability evaluation; plans should be in place to ensure  servicemembers are appropriately and constructively engaged. DOD and VA generally concurred  with our recommendations. Each agency also provided technical  comments, which we incorporated as appropriate. Staff members who made key contributions in  this report are listed in appendix V.

Appendix I: Objectives, Scope, and Methodology

In conducting our review of the integrated disability evaluation system  (IDES) piloted by the Departments of Defense (DOD) and Veterans Affairs  (VA), our objectives were to examine (1) the results of DOD and VA’s  evaluation of the IDES pilot, (2) challenges in implementing the piloted  system to date, and (3) DOD and VA plans to expand the piloted system  and whether those plans adequately address potential challenges. We also reviewed  the relevant requirements of the National Defense Authorization Act of  2008 as it pertains to this review. We also analyzed  Army data on appeals in order to illustrate the limitations of DOD’s plan to  compare only appeals to the informal PEB in the pilot and legacy systems  and not take into account appeals of rating decisions to VA. We conducted  this analysis using the legacy data and pilot case data as of early 2010,  since DOD and VA’s weekly reports do not contain information on appeals  to VA.

	Identifying Challenges in Implementing the IDES at Pilot Sites

To identify challenges in implementing the IDES during the pilot phase, we  visited 10 of the 27 military treatment facilities participating in the pilot.
Why GAO Did This Study

Since 2007, the Departments of Defense (DOD) and Veterans Affairs (VA) have been testing a new disability evaluation system designed to integrate their separate processes and thereby expedite veterans' benefits for wounded, ill, and injured servicemembers. Having piloted the integrated disability evaluation system (IDES) at 27 military facilities, they are now planning for its expansion military-wide. Part of the National Defense Authorization Act for Fiscal Year 2008 required GAO to report on DOD and VA's implementation of policies on disability evaluations. This report examines: (1) the results of the agencies' evaluation of the IDES pilot, (2) challenges in implementing the IDES pilot to date, and (3) whether DOD and VA's plans to expand the IDES adequately address potential future challenges. GAO analyzed data from DOD and VA, conducted site visits at 10 military facilities, and interviewed DOD and VA officials.

What GAO Found

In their evaluation of the IDES pilot as of February 2010, DOD and VA concluded that it had improved servicemember satisfaction relative to the existing "legacy" system and met their established goal of delivering VA benefits to active duty and reserve component servicemembers within 295 and 305 days, respectively, on average. While these results are promising, average case processing times have steadily increased since the February 2010 evaluation. At 296 days for active duty servicemembers, as of August 2010, processing time for the IDES is still an improvement over the 540 days that DOD and VA estimated the legacy process takes to deliver VA benefits to members. However, the full extent of improvement of the IDES over the legacy system is unknown because (1) the 540-day estimate was based on a small, nonrepresentative sample of cases and (2) limitations in legacy case data prevent a comprehensive comparison of timeliness, as well as appeal rates. Piloting of the IDES has revealed several implementation challenges that have contributed to delays in the process, the most significant being insufficient staffing by DOD and VA. Staffing shortages were severe at a few pilot sites that experienced caseload surges. For example, at one of these sites, due to a lack of VA medical staff, it took 140 days on average to complete one of the key features of the pilot--the single exam--compared with the agencies' goal to complete this step of the process in 45 days. The single exam posed other challenges that contributed to process delays, such as exam summaries that did not contain sufficient information for VA to determine the servicemember's benefits and disagreements between DOD and VA medical staff about diagnoses for servicemembers' medical conditions. Cases with these problems were returned for 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. As DOD and VA prepare to expand the IDES worldwide, they have made preparations to address a number of these challenges, but these efforts have yet to be tested, and not all challenges have been addressed. To address staffing shortages and ensure timely processing, VA is developing a contract for additional medical examiners, and DOD and VA are requiring local staff to develop written contingency plans for handling surges in caseloads. However, the agencies lack strategies for meeting some key challenges, such as ensuring enough military physicians to handle anticipated workloads. They also do not have a comprehensive monitoring plan for identifying problems as they occur--such as staffing shortages and insufficiencies in medical exams--in order to take remedial actions as early as possible.

What GAO Recommends

GAO is making several recommendations to improve DOD and VA's planning for expansion of the new disability evaluation system, including developing a systematic monitoring process and ensuring that adequate staff is in place. DOD and VA generally concurred with GAO's recommendations and provided technical comments that GAO incorporated into the report as appropriate.