In November 2007, DOD and VA began piloting the IDES, a joint disability  evaluation system, to eliminate duplication in their separate systems and  expedite receipt of VA benefits for wounded, ill, and injured  servicemembers. 1). 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. Average case processing times: The agencies have been meeting their 295- day and 305-day timeliness goals for much of the past 2 years, but the  average case processing time for active duty servicemembers has steadily  increased from 274 days in February 2010 to 296 days, as of August 2010. While still an improvement over the 540-day estimate for the legacy  system, the agencies missed their timeliness goal by 1 day. Although DOD and VA’s evaluation results indicate promise for the IDES,  the extent to which the IDES is an improvement over the legacy system  cannot 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. Pilot Sites Experienced Several Challenges

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 10 sites we visited reported  experiencing staffing shortages and related delays to some extent, in part  due to workloads exceeding the agencies’ initial estimates. These staffing shortages contributed to delays in the IDES process. 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, far exceeding the agencies’  goal to complete the exams in 45 days. 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. DOD and VA Expansion Plans Incorporate Many Lessons Learned but Do Not Address All Challenges

DOD and VA plan to expand the IDES to military facilities worldwide on  an ambitious timetable—to 113 sites during fiscal year 2011, a pace of  about 1 site every 3 days. In preparing for IDES expansion military-wide, DOD and VA have many  efforts under way to address challenges experienced to date, though their  efforts have yet to be implemented or tested. The matrix also asks sites to anticipate any  surges in caseloads and to provide a written contingency plan for dealing  with them. Ensuring sufficient DOD MEB physician staffing: DOD does not yet  have strategies or plans to address potential shortages of physicians to  serve on MEBs. 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. As DOD and VA move to implement the IDES worldwide, they have some  mechanisms in place to monitor challenges that may arise in the IDES,  such as regular reporting of data on caseloads, processing times, and  servicemember satisfaction, and preparation of an annual report on  challenges in the IDES. DOD and VA are currently taking steps to address  many of these challenges. We have draft recommendations aimed at helping DOD and VA further  address challenges surfaced during the pilot, which we plan to finalize in  our forthcoming report after fully considering agency comments.
Why GAO Did This Study

Since 2007, the Departments of Defense (DOD) and Veterans Affairs (VA) have been pilot 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. This testimony is based on GAO's ongoing review of the IDES pilot and draft report, which is currently with DOD and VA for agency comment. GAO conducted this review pursuant to the National Defense Authorization Act for Fiscal Year 2008. This review specifically examined: (1) the results of the agencies' evaluation of the IDES pilot, (2) challenges in implementing the IDES pilot to date, and (3) whether the agencies' plans to expand the IDES adequately address potential future challenges. To address these questions, 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, DOD and VA concluded that, 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. While these results are promising, average case processing times have since steadily increased--for example, for active duty servicemembers, the average has increased from 274 days in February 2010 to 296 days in August 2010. At 296 days, 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 servicemembers. 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 processing times, as well as appeal rates. In piloting the IDES, DOD and VA have run into several implementation challenges that have 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. For example, at one of these sites, due to a lack of medical examiners, 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 disagreements between DOD and VA medical staff about diagnoses for servicemembers' medical conditions. Cases involving such disagreements 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. As DOD and VA move forward with plans to expand the IDES worldwide, they have taken steps to address a number of these challenges; however, these mitigation efforts have yet to be tested, and not all challenges have been addressed. For example, 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. On the other hand, the agencies have not yet developed strategies for ensuring sufficient military physicians to handle anticipated workloads. Significantly, DOD and VA do not have a comprehensive monitoring plan for identifying problems as they occur--such as staffing shortages and disagreements about diagnoses--in order to take remedial actions as early as possible. GAO has draft recommendations aimed at helping DOD and VA, as they move forward with IDES expansion plans, to further address challenges surfaced during the pilot, which GAO plans to finalize in the forthcoming report after fully considering agency comments.