Average case now drags on for more than a year
Five years after launching a combined effort to cut the time it takes to complete disability evaluations and begin paying benefits to wounded, injured and ill troops, it now takes the Defense and Veterans Affairs departments an average of 100 days longer to close a case.
The Integrated Disability Evaluation System was launched in 2008 to combine the separate DoD and VA systems into one and cut the time it takes to complete to 295 days for active-duty troops and 305 days for reserve-component members.
Instead, the average completion times for cases have risen sharply, to 394 days for active-duty troops and 420 days for reservists, according to a new report by the GAO, the investigative arm of Congress.
The main choke points: Medical Evaluation Boards conducted by the services, and the transition from military to VA care.
Medical boards are supposed to be completed within 100 days, but now take 181 days to complete -- up from 126 in 2009. A scant 16 percent of active-duty troops got through medical boards in 100 days or less, GAO said.
Staffing shortages were the primary cause of delay, GAO reported. “One facility noted they have seven doctors but would need 11 additional doctors and 10 technician assistants to process cases,” the report says.
At the end of the process, when troops shift from DoD to VA, case management is another cause of delay.
Instead of handling 20 cases at a time, some VA case managers are handling 75.
“Liaisons are often working overtime and weekends to keep up with cases,” GAO noted. The average active-duty member needs 76 days to complete the transition process out of the military, a full month longer than the 45-day goal. Only 17 percent of active-duty cases are closed in that time.
GAO did note that some transition delays are neither the fault of DoD nor VA. Because wounded and injured troops can take terminal leave during that time or may choose not to leave service immediately for personal reasons, meeting the 45-day goal for the transition phase can be challenging, the report says.
Near the end of their service, troops may wish to extend to keep kids in school to the end of a term, to complete Transition Assistance Program classes or vocational training or physician appointments, among other reasons, GAO noted.
Because a substantial amount of time in the transition phase may be personally beneficial to troops, DoD is now reporting time in IDES with and without the transition phase, GAO said.
Auditors also faulted surveys of troops who go through the system, which show that about two-thirds are satisfied with it. But the GAO said the way DoD interprets the survey results may reflect higher satisfaction rates than is actually the case.
Stuck in limbo
Marine Reserve Maj. Michael Gist is among those stuck in IDES, which was designed to reduce the bureaucracy associated with the disability evaluation system.
Gist should be nearing the end of the tunnel after spending more than a year in the system, but he’s nowhere close.
After being improperly released from medical hold in September 2011, he has waged bureaucratic warfare with his command, the Wounded Warrior Regiment and Marine Corps headquarters to get a ruling on his reactive arthritis, which developed in 2009 after he contracted an illness in Africa.
A Navy judge advocate general ruled Aug. 17 that Gist should have been allowed to stay on active duty until a board declared whether he was fit to serve.
“If people would let the system run and were honest brokers, there would be no delays,” Gist said. “But the problem is that the system gets manipulated, and the time drags on and no one speaks up about it.”
Retired Army Col. Scott Johnson said he believes the system is particularly daunting for junior enlisted troops.
Johnson got through IDES fairly easily -- a testament, he said, to his ability to dispute an initial MEB assessment. But he worries young enlisted troops often don’t question what they are told.
“I spent seven or eight years referring soldiers to the system, and then when I was part of it, I was shocked -- it started with the poorest physical of my career,” he said.
Johnson has amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. But while it should have been clear cut, it still wasn’t a slam dunk.
“If the first step isn’t right, none of it will be,” he said. “I can only imagine what’s happening to soldiers who don’t know the system, lack experience and unwittingly trust it.”
18 months and counting
Johnson’s concerns are reflected in the case of Army Reserve Staff Sgt. Stefanie Mason, who has been in IDES for about 18 months -- far above goal and well above average for reservists. She is now, at last, in the transition phase after receiving a 100 percent disability rating for head injuries suffered in an accident in Afghanistan.
But she had to fight her initial MEB assessment, which listed her as male, rather than female, and misidentified her injuries, said her mother, Paulette Mason.
“They just cut-and-pasted it from someone else and never checked it. And there were many other errors. I pity the poor soldier who goes through [IDES] without help,” Paulette Mason said.
Retired Army Lt. Col. Mike Parker, a longtime advocate for disabled troops, said he sees many cases handled “shoddily at the start,” which then stall in the Medical Evaluation Board.
The timeline averages will come down “if you do it right the first time,” Parker said.
“I’ve seen cases where if they had done it correctly [at the start], it would have saved six months.”
Not the first sign of problems
IDES was initially tested in 2007 at three locations with 701 enrollees; last year, it was in place at 112 military treatment facilities.
DoD and VA have embarked on several initiatives to improve the system. The Army, with almost two-thirds of new IDES cases in 2011, has hired more medical examiners, and VA is “increasing resources for completing exams and disability ratings,” GAO said. But auditors said the results to date have been uneven and more time is needed to assess the full impact of the changes.
In a written response to the report, defense officials said they agree with the GAO’s three recommendations:
*The DoD and VA secretaries should work together to develop a timeline for finishing an ongoing review of the IDES business process.
*The departments should develop a plan to continuously monitor and fix the Veterans Tracking System, the data system that supports IDES.
*Satisfaction surveys should be more carefully monitored and interpreted.
VA concurred with those recommendations but deferred to the Pentagon on developing a time frame to complete the IDES business review.
In his official response to the report, VA Chief of Staff John Gingrich noted that while VA has provided input to the business review, DoD has the lead on that initiative -- and has cut VA out of the loop.
“At this time, the full scope or current status” of the business review “has not been disclosed to VA,” Gingrich wrote.
That news vexed Sen. Patty Murray, D-Wash., chairwoman of the Senate Veterans’ Affairs Committee, who has pressed DoD and VA to work together to solve IDES issues.
Murray told Military Times in a Sept. 24 email that she is concerned about communication between the two departments.
The GAO report “shows that DoD and VA continue to struggle to work together and the result has been wait times that continue to grow longer,” Murray said.
“The IDES process is intended to be a joint system. VA and DoD must work collaboratively, not just in words but in actions, if they are going to make real changes for our service members and veterans.”
GAO: Troops may not like IDES that much
Troops in the Integrated Disability Evaluation System may be less pleased with the process than Defense Department surveys indicate, the Government Accountability Office says.
Those surveys, featuring questions with responses on a five-point scale ranging from “extremely satisfied” to “extremely dissatisfied,” show that 67 percent of active-duty members and 65 percent of National Guard and reserve members report being satisfied with the process. But if more conservative calculations are used -- including whether service members are extremely dissatisfied with one phase of IDES but content with others, and counting a “meh” response as “dissatisfied” rather than “satisfied” -- the GAO said satisfaction rates drop to 24 percent for active-duty troops and 25 percent for reservists.
“While not incorrect, DoD’s scale can mask pockets of service member dissatisfaction,” auditors wrote. “Measuring satisfaction, or even dissatisfaction, in different ways may provide a more complete picture of satisfaction and how it varies in different circumstances and may reveal areas where DoD could focus on improving management and performance.”
GAO also found that DoD’s satisfaction rates did not vary much among service members.
Auditors said that could mean all troops get consistent treatment in IDES, which is good news -- or that the surveys don’t measure opinions in enough detail to discriminate.
“Either way, such results provide little insight into identifying areas for improvement or effective practices,” GAO said.
GAO recommended expanding the surveys to include wider samplings and/or exit interviews.
In response, defense officials cited some “inaccuracies” with GAO’s assessment of the surveys but generally concurred with the report’s recommendations.
DoD’s method of surveying troops who have gone through IDES leaves out some who don’t complete one of the full phases of the process, and it counts surveyed troops as “satisfied” if the average of their responses is higher than 3 on a 5-point scale. GAO researchers counted troops as “satisfied” only if all their responses were a 4 or above. The difference is substantial:
Active-duty -- DoD: 67.4%, GAO: 23.7%
Guard/reserve -- DoD: 63.5%, GAO: 24.6%
Source: Government Accountability Office analysis of Defense Department and Veterans Affairs Department data
October 8, 2012