Division: Office of Veterans Advocacy

DoD & VA Kick off New Interagency Coordination of Complex Care Effort
The Departments of Defense (DoD) and Veterans Affairs (VA) announced its ongoing effort to ease the transition for service members who require complex care management as they transition from the DoD system of health care to the VA or within each system. The effort is designed to ease the burden for service members and veterans, who have suffered illnesses or injuries so severe as to require the expertise provided by multiple care specialties throughout both Departments. “More than a decade of combat has placed enormous demands on a generation of service members and veterans–particularly those who have suffered wounds, injuries, or illnesses which require a complex plan of care,” said Dr. Karen Guice, Principal Deputy Assistant Secretary of Defense for Health Affairs, and Co-chair of the DoD-VA Interagency Care Coordination Committee (IC3). “These individuals require the complex coordination of medical and rehabilitative care, benefits, and other services to successfully transition from active duty to veteran status, and to optimally recover from their illnesses or injuries.”

“Our collaborative efforts with DOD have improved and enhanced the process of caring for our military members with serious illness, injuries, or disabilities as they recover and return to their communities. Great attention has been made to developing a system which focuses on continuity of care, holistic support services, and a ‘warm handoff’ for service members and veterans as they move from and between the military, the VA, and community health care systems. Our care coordinators now have at their fingertips tools and processes that improve and simplify the lines of communication for our wounded, ill, and injured service members and veterans who require complex care coordination, their families, and those who provide their care in both Departments,” said Dr. Linda Spoonster Schwartz, Assistant Secretary for Policy and Planning for the Department of Veterans Affairs, and Co-chair of the DoD-VA Interagency Care Coordination Committee (IC3). “This process will enhance and improve the quality of care and services for these veterans and their families now and in the future.”

The hallmark of the effort is the implementation of the role of Lead Coordinator. The Lead Coordinator will be a designated member of a service member’s care management team who will serve as the primary coordinator for that individual. The Lead Coordinator will offer personal guidance and assist the service member and their families in understanding the benefits and services to which they are entitled. Service members, veterans, and their families, working with their Lead Coordinator, will have someone to whom they can turn when they have a question or issue as they actively participate in their care. The first phase of Lead Coordinator Training was completed in November. It is expected a total of 1,500 DoD staff and 1,200 VA staff will serve as Lead Coordinators.

This effort comes as a result of the work of the DoD-VA IC3, established in 2012 to implement a joint, standard model of collaboration for the most complex cases of care that will require a warm handoff from the DoD to the VA system of care, as well as within the Departments, and is based on many of the best practices of collaboration that have been created over the last decade. This effort was enacted as policy by both departments in 2015, aligning more than 250 sub-policies to one, overarching policy that will govern the coordination of complex care cases that transition between the two departments. Coordination efforts are synchronized through the IC3 Community of Practice (CoP), a group representing more than 50 DoD and VA programs that provide specialty care, including rehabilitation services for the visually impaired and polytrauma centers. It will be the job of the Lead Coordinator to guide service members through the system, ensuring that they receive the care, benefits, and services they both require and to which they are entitled.

Care & Benefits for Veterans Strengthened By $182 Billion VA Budget
In his FY 2017 budget, President Obama is proposing $182.3 billion for the Department of Veterans Affairs (VA). Funding will continue to support the largest transformation in VA history; expand access to timely, high-quality health care and benefits; and advance efforts to end homelessness among veterans. “VA has before it one of the greatest opportunities in its history to transform the way it cares for our veterans who nobly served and sacrificed for our Nation,” said VA Secretary Robert A. McDonald. “As we work to become a more efficient, effective and responsive, veteran-centric department, we can’t do it alone; we need the help of Congress. This year, the VA submitted over 100 legislative proposals, including 40 new proposals to better serve veterans. Our goal is provide the best care to our veterans while removing obstacles or barriers that

prevent them from getting the care they deserve.”

The FY 2017 budget includes $78.7 billion in discretionary funding, largely for health care and $103.6 billion for mandatory benefit programs such as disability compensation and pensions. The $78.7 billion for discretionary spending is $3.6 billion (4.9%) above the 2016 enacted level, including over $3.6 billion in medical care collections from health insurers and veteran copayments. The budget also requests $70 billion, including collections, for the 2018 advance appropriations for medical care, an increase of $1.5 billion and 2.1% above the 2017 medical care budget request. The request includes $103.9 billion in 2018 mandatory advance appropriations for Compensation and Pensions, Readjustment Benefits, and Veterans Insurance and Indemnities benefits programs in the Veterans Benefits Administration.

With a medical care budget of $68.6 billion, including collections, the VA is positioned to continue expanding health care services to its millions of veteran patients. Health care is being provided to over 922,000 veterans who served in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn/Operation Inherent Resolve (OIR) and Operation Freedom’s Sentinel (OFS). Major spending categories within the health care budget are $12.2 billion for care in the community; $8.5 billion for long-term care; $7.8 billion for mental health; $1.6 billion for homeless veterans; $1.5 billion for Hepatitis-C treatments; $725 million for caregivers; $601 million for spinal cord injuries; and $284 million for traumatic brain injuries.

The President’s budget ensures care and other benefits are available to veterans when and where they need them. Among the programs that will expand access under the proposed budget are $12.2 billion for care in the community compared to

$10.5 billion in 2015, a 16% increase; $1.2 billion in telehealth funding, which helps patients monitor chronic health care conditions and increases access to care, especially in rural and remote locations; $515 million for health care services specifically designed for women, an increase of 8.5% over the present level; $836 million for the activation of new and enhanced health care facilities; $900 million for major and minor construction projects, including funding for seismic corrections, two new cemeteries, and two gravesite expansions; and $171 million for improved customer service by providing an integrated services delivery platform.

The President’s Budget provides for continued implementation of the Veterans Benefits Administration’s (VBA) robust Transformation Plan–a series of people, process, and technology initiatives–in 2017. This plan will continue to systematically improve the quality and efficiency of claims processing. Major claims transformation initiatives in the budget invest $323 million to bring leading-edge technology to claims processing, including $180 million ($143 million in Information Technology and $37 million in VBA) to enhance the electronic claims processing system–the Veterans Benefits Management System (VBMS); and $143 million for Veterans Claims Intake Program (VCIP) to continue conversion of paper records, such as veterans’ medical records, into electronic images and data in VBMS.

In addition, the President’s budget supports increasing VBA’s workforce to address staffing needs so it can continue to improve the delivery of benefits to veterans. As VBA continues to receive and complete more disability compensation rating claims, the volume of non-rating claims correspondingly increases. The request for $54 million for 300 additional full-time equivalent employees (FTE) and claims processing support will allow the VBA to provide more timely actions on non-rating claims.

The current appeals process is complicated and ineffective, and veterans on average are waiting about 5 years for a final decision on an appeal that reaches the Board of Veterans’ Appeals, with thousands waiting much longer. The 2017 Budget proposes a Simplified Appeals initiative–legislation and resources–to provide veterans with a simple, fair, and streamlined appeals process in which they would receive a final appeals decision within one year from filing an appeal by 2021. The Budget requests $156 million and 922 FTE for the Board, an increase of $46 million and 242 FTE over 2016, as a down payment on a long-term, sustainable plan to improve services to veterans.

The Administration has made the ending of veteran homelessness a national priority. The budget requests $1.6 billion for programs to prevent or reduce veteran homelessness, including $300 million for Supportive Services for Veteran Families (SSVF) to promote housing stability; $496 million for the HUD-VASH program, wherein the VA provides case management services for at-risk veterans and their families and HUD provides permanent housing through its Housing Choice Voucher program; and $247 million in grant and per diem payments that support temporary housing provided by community-based organizations.

The 2017 budget continues the largest Department-wide transformation in the VA’s history through the MyVA initiative, which is changing the VA’s culture, processes, and capabilities to put the needs, expectations, and interests of veterans and their families first. MyVA has developed five objectives fundamental to the transformation of VA: 1) improving the veterans’ experience; 2) improving the employee experience; 3) improving support service excellence; 4) establishing a culture of continuous performance improvement; and 5) enhancing strategic partnerships. To aid in this transformation, the Department established the Veterans Experience Office (VEO). The VEO will represent the voice of veterans and their families in Departmental governance; design and implement customer-centric programs to make interactions with the VA easier; and support the VA’s “mission owners” in carrying out MyVA improvements across the system.

The Veterans Choice Act provides $5 billion to increase veterans’ access to health care by hiring more physicians and staff and improving the VA’s physical infrastructure. It also provides $10 billion through 2017 to establish a temporary program (the Veterans Choice Program) to improve access to health care by allowing eligible veterans who meet certain wait-time or distance standards to use eligible health care providers outside of the VA system. In 2017, the VA will use the Choice Act funds in concert with annual appropriations to meet VA staffing and infrastructure needs and expand non-VA care to veterans who are eligible for the Veterans Choice Program. The VA plans to spend $1.4 billion in 2016 and $853 million in 2017 to support more than 9,700 new medical care staff hired through the Choice Act; $980 million in 2016 and $116 million in 2017 to improve VA facilities.

The budget also includes $286 million to administer the VA’s system of 134 national cemeteries, including additional funding for operations of new cemeteries and the National Shrine program to raise and realign gravesites; $4.3 billion for information technology (IT), including investments to strengthen cybersecurity, modernize veterans’ electronic health records, improve veterans’ access to benefits, and enhance the IT infrastructure; and $125 million for state cemetery grants and state extended care grants. The 2017 budget also requests an additional $23 million and 100 FTE for the Office of Inspector General (OIG) to enhance oversight and assist the OIG in fulfilling its statutory mission and making recommendations that will help the VA improve the care and services it provides.

The VA operates the largest integrated health care system in the country; the tenth largest life insurance program in the Nation, with $1.3 trillion in coverage; monthly disability compensation, pensions, and survivors benefits to 5.3 million beneficiaries; educational assistance or vocational rehabilitation benefits and services to nearly 1.2 million students; mortgage guaranties to over 2 million homeowners; and the largest cemetery system in the Nation

Statement from VA Secretary on the Need to Reform the Veterans’ Appeals Process
Last week I presented to the Senate Veterans Affairs’ Committee the way forward for the important transformation of the Department of Veterans Affairs—what we call MyVA. We aim to improve our care and services to all veterans. In order to do that, I made clear that we would need Congress’ help in legislating a fair, streamlined, and comprehensive process for new appeals, as well as providing much needed resources to address the current pending inventory of appeals. I look forward to working with all stakeholders to design an appeals process that better serves veterans. VA will need legislation and resourcing to put in place a simplified appeals process that enables the Department to resolve the majority of our appeals in a reasonable timeframe for veterans.

The appeals process we currently have set in law is failing veterans—and taxpayers. Decades worth of law and policy layered upon each other have become cumbersome and clunky. Most importantly, it is now so antiquated that it no longer serves veterans well, as many find it confusing and are frustrated by the endless process and the associated length of time it can take to get an answer.

In 2012, VA made the commitment to end the disability claims backlog. It took too long for veterans to receive a decision on their claim. Our commitment has resulted in transformational change. The disability claims backlog has been driven down to fewer than 82,000, from a peak of 611,000 in March 2013. At the same time, we have fully transitioned to a paperless, electronic processing system, eliminating 5,000 tons of paper a year. Last year, we decided 1.4 million disability compensation and pension claims for Veterans and survivors – the highest in VA history for a single year and that comes on the heels on two previous record-breaking years of productivity. As VA has become more efficient in claims processing, the volume of appeals has increased proportionately. While it remains true that 11-12 percent of veterans who receive a disability rating file for an appeal, more processed claims means more appeals. This is VA’s next challenge.

The current pending inventory of appeals stands at more than 440,000 and is estimated to grow rapidly. Right now, veterans who file an appeal wait an average of three years for appeals to be resolved by the Veterans Benefits Administration (VBA), and an average of five years for appeals that reach the Board of Veterans Appeals’ (Board), with thousands lasting much longer. That’s unacceptable. We are applying lessons learned from the transformative change that allowed us to reduce the disability claims backlog. Like our work with the claims processing, the appeals process will need changes in people, process and technology. Upgraded technology will make changes to our mail system and paper records, and incorporate some efficiencies in the way appeals are managed and processed. Retraining and increased staff will be necessary. But they will not be enough. We must also look critically at the many steps in the current complex appeals process used by VA and by veterans and their advocates to design a process that better serves veterans.

A new appeals process would provide veterans with the timely and fair appeals decisions they deserve, and adequate resourcing that permits the VBA and the Board to address the growing inventory of appeals.