Military and Veterans Disability System: Pilot Has Achieved Some Goals, but Further Planning and Monitoring Needed

DOD addressed the concern about housing of servicemembers undergoing the IDES by issuing an exception to policy authorizing military departments to process initial trainees through the legacy disability evaluation system, rather than the IDES process. In the action memo authorizing this exception, DOD said that this change was intended to address the issue of housing and other issues, due to the additional time that servicemembers remain on active duty when processed through the IDES as compared to the legacy system. The policy exception states that trainees who are processed through the legacy disability evaluation system will be enrolled in the Benefits Delivery at Discharge/VA Quick Start programs to ensure that that they begin receiving VA benefits shortly after separation from military service. DOD officials said that since the policy exception was issued, the military departments have not reported concerns with the capacity to house servicemembers in the IDES.

DOD addressed the concern about military units' ability to absorb servicemembers undergoing the IDES by issuing an exception to policy authorizing the military departments to process initial trainees through the legacy disability evaluation system, rather than the IDES process. In the action memo authorizing this exception, DOD said that this change was intended to address challenges of command and control, housing, and other issues, due to the additional time that servicemembers remain on active duty when processed through the IDES as compared to the legacy system. The policy exception states that trainees who are processed through the legacy disability evaluation system will be enrolled in the Benefits Delivery at Discharge/VA Quick Start programs to ensure that that they begin receiving VA benefits shortly after separation from military service. DOD officials said that since the policy exception was issued, the military departments have not reported concerns with the ability to absorb servicemembers in the IDES.

DOD contracted with the Logistics Management Institute (LMI) to conduct a study on differences in diagnoses in response to our recommendation. In October 2011, LMI completed the study entitled "Diagnostic Differences in the DOD-VA Integrated Disability Evaluation System."

DOD contracted with the Logistics Management Institute (LMI) to conduct a study on differences in diagnoses in response to our recommendation. In October 2011, LMI completed the study entitled "Diagnostic Differences in the DOD-VA Integrated Disability Evaluation System."

VA updated the Veterans Tracking Application (VTA) in June 2012 to allow it and DOD to capture information on diagnostic disagreements. DOD subsequently provided training instructing PEB liaison officers to document disagreements using VTA's corrective action function. This information is used to generate weekly summaries, which can be used to spot trends in disagreements and adjust IDES processes and training accordingly. Before documenting diagnostic disagreements, the Army-which accounts for the majority of servicemembers in the IDES-has instructed its physicians to attempt to resolve disagreements with VA physicians. VA believes this has reduced the incidence of diagnostic disagreements.

VA updated the Veterans Tracking Application (VTA) in June 2012 to allow it and DOD to capture information on diagnostic disagreements. DOD subsequently provided training instructing PEB liaison officers to document disagreements using VTA's corrective action function. This information is used to generate weekly summaries, which can be used to spot trends in disagreements and adjust IDES processes and training accordingly. Before documenting diagnostic disagreements, the Army-which accounts for the majority of servicemembers in the IDES-has instructed its physicians to attempt to resolve disagreements with VA physicians. VA believes this has reduced the incidence of diagnostic disagreements.

Since our report was issued, the IDES monitoring report was revised to include more detailed information, including case processing times of individual VA rating offices. VA also developed an IDES Performance Dashboard, which tracks performance data at the local level for portions of the IDES for which VA is responsible. With regard to timeliness of VA exams, VA developed a report to identify IDES exams exceeding the timeliness goal. Senior VA leadership hold biweekly videoconference calls to discuss how to remedy outliers. As for sufficiency of exam summaries, VA added capabilities to the Veterans Tracking Application system to identify exam sufficiency issues, and DOD is using this data to determine how often insufficient exam summaries occur, in what types of medical conditions, and the length of time it takes to identify and address them. DOD and VA also hold meetings on a biweekly basis to share lessons learned, problem solve, and keep sites aware of future program changes and activities.

Since our report, DOD has revised its monitoring report to include more information, including information on case processing times of individual VA rating offices and PEBs. DOD also created an MEB Watchboard and PEB Watchboard to provide case management information, workload status, and the ability to monitor data integrity at local installations. DOD and VA have also revised the VTA tracking system to identify insufficient exam summaries. DOD has developed a method to use the data to determine how often insufficient exam summaries occur, in what types of medical conditions, and the length of time it takes to identify and address them. DOD and VA senior leadership also continue to hold meetings on a regular basis to discuss the status, progress, and future actions regarding the IDES. These include the Joint Executive Council, the Benefits Executive Council, the DES Improvement Working Group, and data summit sessions.