VA Vocational Rehabilitation and Employment Program:

Improved Oversight of Independent Living Services and Supports Is Needed

GAO-13-474: Published: Jun 7, 2013. Publicly Released: Jun 7, 2013.

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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.

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 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.

For more information, contact Dan Bertoni at (202) 512-7215 or bertonid@gao.gov.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: The Department of Veterans Affairs' (VA) Veterans Benefits Administration (VBA) has taken steps and explored options to enhance its coordination with the Veterans Health Administration (VHA). Specifically, VBA has worked with VHA to develop an automated referral system, allowing counselors to make referrals to VHA providers electronically. In addition, the system allows referrals for the Home Improvement and Structural Alteration grants and for evaluations of independent living needs. VA conducted and completed a 60-day pilot. The agency now plans to implement the system nationwide by January 2015.

    Recommendation: The Secretary of Veterans Affairs should direct the Undersecretary for Benefits to 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. This could include improving staff education, response times to IL referrals, and the provision of medically related goods and services.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: The Department of Veterans Affairs' (VA) Veterans Benefits Administration (VBA) reviewed its oversight procedures for the Independent Living (IL) track as part of its Independent Living Business Process Reengineering Study, which was completed in August 2014. Since that time, VR&E has implemented enhancements to VBA's case management system for the IL track (called "CWINRS") to facilitate the analysis of IL rehabilitation plans and services provided to veterans. In addition, VR&E counselors are now required to enter detailed information for each objective in new rehabilitation plans into this system. Furthermore, VR&E conducted a nationwide pilot/survey of IL service delivery and costs in September 2014, and is considering other future policy adjustments based on final recommendations from the Independent Living Business Process Reengineering Study.

    Recommendation: The Secretary of Veterans Affairs should direct the Undersecretary for Benefits to implement an oversight approach that enables VR&E to better ensure consistent administration of the IL track across regions. In developing this approach, consider ensuring that VR&E's CWINRS system: (1) Tracks the total cost and types of benefits provided to each veteran in the IL track by regional office. (2) Accounts for the number of individual veterans served to ensure that the agency has the information it needs to adequately manage the IL track. (3) Contains stronger data entry controls to ensure that IL track information is recorded in a consistent manner and is accurate and complete.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: The Department of Veterans Affairs' Veterans Benefits Administration (VBA) assessed the requirements for all Independent Living (IL) plans, and performed a study of the IL track, which was completed in August 2014. VR&E also completed its implementation of enhancements to CWINRS, the case management system used to track veterans in the IL track. Data analysis will be conducted quarterly to examine the scope of IL services and determine the need for policy changes or corrective actions. In addition, VR&E developed new cost approval guidelines for IL construction and home modifications. VR&E anticipates approving these guidelines in December 2014.

    Recommendation: The Secretary of Veterans Affairs should direct the Undersecretary for Benefits to reassess and consider enhancing the agency's current policy concerning the required level of approval for IL track expenditures, given the broad discretion individual regional offices have in determining the types of goods and services IL track veterans receive.

    Agency Affected: Department of Veterans Affairs

 

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