New disability process set to expand soon
By William H. McMichael - Staff writer
Posted : Friday Nov 7, 2008 10:56:58 EST
A limited test of a streamlined system to more speedily and equitably evaluate wounded and injured troops will be expanded over the next seven months from the Washington, D.C., area to 16 additional bases in the continental U.S., Pentagon and Department of Veterans Affairs officials say.
The pilot program, which officials emphasize is a work in progress, aims to replace the cumbersome evaluation system exposed by the 2007 Walter Reed scandal with a single exam and disability rating that officials say is cutting in half the time spent in the system from the initial recommendation for medical evaluation to the point of either medical separation or return to duty.
Launched 11 months ago at three Washington-area military hospitals and expanded to three more since Oct. 1, the program has shown enough promise to warrant an expansion in areas outside Washington, said Tom Pamperin, deputy director of VA’s compensation and pension service, and Sam Retherford, the Pentagon’s director of officer and enlisted personnel management.
“It was an improvement, and we met all the major objectives” of the pilot program, Retherford said.
But, he added, “We’d hadn’t really stressed the pilot, because inside the National Capitol region, you get all kinds of support from senior leadership to make things happen. We also needed a diverse set of data on the Guard and reserve ... and we wanted to see if the pilot procedures could work — because it’s very resource-demanding — in areas across the DoD.”
That data, he said, will better inform decisions on the program’s future and on recommendations for any needed legislative changes to Congress. A final report to Congress is due in March; a decision to expand the program to all bases could follow, he said.
The sheer numbers alone will provide plenty of stress; Retherford said he expects the expansion to add more than 500 cases per month to the system, which in the Washington area is now handling a total of around 600, according to VA. The moves will also serve to broaden the base of pilot program-trained case managers and other personnel critical to improving service, he said.
Over the next seven months, according to Pamperin, the pilot program is projected for expansion to:
•Fort Stewart, Ga., Nov. 30.
•Camp Pendleton, Calif., Jan. 31.
•Bremerton Naval Hospital, Wash.; Vance Air Force Base, Okla.; and Fort Polk, La., Feb. 28.
•Jacksonville Naval Hospital and MacDill Air Force Base, Fla.; Nellis Air Force Base, Nev.; Camp Lejeune, N.C.; Fort Richardson and Fort Wainwright, Alaska, March 31.
•Elmendorf Air Force Base, Alaska; Fort Drum, N.Y., Apr. 30.
•Travis Air Force Base, Calif.; Fort Carson, Colo.; and Brooke Army Medical Center, Texas, May 31.
The program was begun in November 2007 at Walter Reed Army Medical Center in Washington, D.C.; National Naval Medical Center in Bethesda, Md.; and Malcolm Grove Medical Center at Andrews Air Force Base, Md. It was expanded Oct. 1 to hospitals at Fort Belvoir, Va., and Nov. 1 to Fort Meade, Md., and Balboa Naval Medical Center, San Diego, Pamperin said.
One problem identified during the controversy at Walter Reed was the long delay service members experienced in the processing and receipt of VA benefits. Under the pilot program, the delays appear to have been significantly reduced.
As of Oct. 26, a total of 779 service members had entered the D.C.-area pilot program, Pamperin said. All received one physical exam from a VA-qualified provider using VA’s evaluation standards — normally a two-part ordeal with differing standards. Under the pilot program, the exam is administered as part of the standard Medical Evaluation Board, which determines a member’s fitness for duty.
Of the 779 troops, 73 were found fit for and returned to duty, while 611 remain in the program, with some yet to be evaluated and others having received ratings and awaiting discharge.
A total of 46 were retired — nearly all of them medically retired — and 15 were awarded severance pay and separated from the service. Of this group, Pamperin said, all but three were awarded VA benefits on the day they separated.
One of the three took an additional week because of a severance pay issue, he said; the physical or mental condition of the other two required fiduciary assistance and more time to complete, he said.
Service members rated at 30 percent disabled or higher are medically retired; those rated at 10 or 20 percent are separated with severance pay.
Two of the troops were separated without being awarded severance pay. Pamperin said such cases involve unfitting conditions considered zero percent disabling or conditions judged to be pre-existing.
The remaining 32 members left the program for a variety of reasons. Two died, some were administratively separated and some moved out of the Washington area, Pamperin said.
All service members who have been evaluated in the pilot program received VA’s decision on their disability percentage the same day they had the finding of the Physical Evaluation Board. After the MEB renders its decision, the PEB decides whether to retain or separate the service member, Pamperin said.
When the pilot program was launched, officials also said they hoped to cut in half the amount of time spent in the system. “It’s actually a little bit better than that,” Pamperin said of the pilot program results.
Time spent in the Washington-area pilot, in which a member’s VA claim is processed concurrently with the Defense Department evaluation, runs from 180 to 220 days, according to Retherford. In the current system, which requires an additional physical and rating on top of that already conducted by the service, processing through the VA system alone takes about 180 days, he said.
“What used to be sequential and long is now in parallel,” he said.
The pilot program also gives service members enhanced rights of appeal. Previously, a service member could appeal to the PEB the conditions considered unfitting, and the fitness determination.
Under the pilot program, when a service member rebuts that determination, the PEB notifies VA, which initiates a Decision Review Officer Process that considers a service member’s medical evidence or legal argument about the application of the ratings schedule. VA’s decision is then binding on the PEB, Pamperin said.
If the early numbers are any indication, service members in the pilot program are more satisfied with the new system. As of Oct. 28, only 33 out of more than 200 service members rated have asked for a formal Physical Evaluation Board, Pamperin said.
In customer satisfaction surveys taken in the Washington-area pilot, Retherford said, “We got great marks for professionalism, transparency [and] case management. We still got remarks [to the effect of], `I’m not satisfied with the outcome.’ There’s a lot more to be done there.”
A somewhat parallel legislative effort fell short last year. The pilot program, officials say, is the best the Pentagon and VA can do without new laws.
“We are continuing to expand the pilot program within the current existing legal authorities,” Pamperin said.
VA is preparing an interim report on the pilot program for Congress, he said.
Thursday, November 13, 2008
New disability process set to expand soon