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. 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. 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. For example, active component  cases completed in March 2011 took an average of 394 days—99 days over  the 295-day target. Pilot Sites Experienced Several Challenges

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. These staffing shortages contributed to delays in the IDES process. These two sites were unable to quickly  increase staffing levels, particularly of examiners. 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. 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. As of March 2011, the IDES  was operating at 73 sites, covering about 66 percent of all military  disability evaluation cases. This differs from the  pilot phase where, according to DOD and VA officials, some sites  implemented the IDES without having been fully prepared. For these areas, we recommended additional action that the agencies  could take, with which the agencies generally concurred. 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. 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. 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. Related GAO Products

Military and Veterans Disability System: Pilot Has Achieved Some  Goals, but Further Planning and Monitoring Needed.
Why GAO Did This Study

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.

What GAO Found

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.