Integrated Disability Evaluation System IDES Pilot Overview VA
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Integrated Disability Evaluation System IDES Pilot Overview VA

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IDES Pilot: Simply Stated. VISION: A seamless and transparent DES for all Servicemembers, administered jointly by DoD and VAGOALSLess complex and non-adversarialFaster, more consistent evaluations
Integrated Disability Evaluation System IDES Pilot Overview...

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1. Integrated Disability Evaluation System (IDES) Pilot Overview VA/DoD Joint Venture Conference October 2010 VHA/DoD Coordination Office Office of Legislative, Regulatory,?& Intergovernmental Affairs

2. IDES Pilot: Simply Stated VISION: A seamless and transparent DES for all Servicemembers, administered jointly by DoD and VA GOALS Less complex and non-adversarial Faster, more consistent evaluations & compensation Single medical exam & single-source disability rating Smooth transition to Veteran status A continuum of care: advocacy & expectation management

4. Problem: The Disability Evaluation Systems of VA and DoD are complex, confusing, and duplicative Solution: November 2007: Establish ?one-year? pilot in the National Capital Region Single physical exam based on both the MEB needs and SM claims Military Service determines Fit/Unfit for Line of Duty VA determines Disability Rating Initially in NCR (Walter Reed, Bethesda, Malcolm Grow AF Hospital) Includes all Servicemembers referred for Medical Evaluation Board (MEB) on or after November 26, 2007 IDES History PROBLEM: The Disability Evaluations Systems of the Departments are complex, confusing and duplicative VISION: A seamless and transparent DES, administered jointly by DoD & VA FEATURES / GOALS (Task Force, Audit and Study Recommendations) Less complex Faster, more consistent evaluations & compensation Single medical exam & single-source disability rating Seamless transition to Veteran status Continuum of care - advocacy & expectation management Updated Veterans Affairs Schedule for Rating Disability (VASRD) for signature GWOT injuriesPROBLEM: The Disability Evaluations Systems of the Departments are complex, confusing and duplicative VISION: A seamless and transparent DES, administered jointly by DoD & VA FEATURES / GOALS (Task Force, Audit and Study Recommendations) Less complex Faster, more consistent evaluations & compensation Single medical exam & single-source disability rating Seamless transition to Veteran status Continuum of care - advocacy & expectation management Updated Veterans Affairs Schedule for Rating Disability (VASRD) for signature GWOT injuries

6. IDES Facts In 2009, more than 19,215 disability exams were provided for Servicemembers. Top three most common conditions (broad categories): Musculoskeletal - 61% Mental - 22% Neuropsychological - 17% Service Connection Rating: For VBA, percentages are combined, not added, since total must be = 100%. Example: An 80% rating for one condition combined with a 60% rating for another equals 90%, not 140%. DoD and VA will typically grant a different combined total rating percentage. VA rates all Service Connected conditions (Title 38). DoD rates only Unfitting conditions (Title 10). Unfitting conditions are a subset of all Service Connected conditions

7. IDES Pilot Statistics 14,207 Service Members (SMs) enrolled in Pilot since November 2007 10,445 SMs currently in program Army: 6,436 USAF: 545 Navy: 1,209 USMC: 2,255 1842 SMs have completed all stages of process and received VA benefits letter (as applicable) 906 SMs have been found fit and returned to duty 537 removed from Pilot due to other reasons (dropped from rolls, transferred out area, admin action, etc.) * as of 9/27/2010

8. Average Case Statistics Pilot Goal: Time from MEB referral to delivery of VA benefits letter ? 295 calendar days compared to 540 days in Legacy System Current average days to process in Pilot: 299 days for Active Duty 302 days for RC/NG Average number of conditions referred (MEB) and claimed by SM: Army 9 Air Force 9 Navy 11 USMC 11

9. Pilot Phase I Expansion Sites The Departments approved the expansion schedule and sites shown here, subject to their operational readiness. The expansion sites include small, large, and remote installations. Training at each site includes education on both the current DES and the DES Pilot. Training is conducted by each Service, augmented by the DES Pilot Support Team which provides database training. The training session provides policy guidance as well as a hands on tutorial on the DES Pilot database to ensure consistent reporting of case processing data. Training for Camp Pendleton was conducted in conjunction with the standup of NMC San Diego in November 2008. Training conducted at February 2009 IOC sites is as follows: Vance AFB, January 14 & 15 NMC Bremerton, February 10 & 11 Fort Polk, February 10 & 11 The presence of a previously operating Benefits Delivery at Discharge program at all but two of these sites mean the VA has prepositioned resources it can apply to the DES Pilot. Many of these VA employees are already hosted at the military treatment facility, know the DoD personnel involved, and have established IT connections back to the VA. These things make the transition to the DES Pilot much easier. The Navy requested the expansion to Jacksonville be delayed until July 1 to allow a hospital construction project there to wrap up before launching the Pilot. We anticipate approving their request to delay expansion until later this summer. NB: Jacksonville Naval Hospital, FL is no longer under consideration as a DES pilot expansion site per VBA. ? The Departments approved the expansion schedule and sites shown here, subject to their operational readiness. The expansion sites include small, large, and remote installations. Training at each site includes education on both the current DES and the DES Pilot. Training is conducted by each Service, augmented by the DES Pilot Support Team which provides database training. The training session provides policy guidance as well as a hands on tutorial on the DES Pilot database to ensure consistent reporting of case processing data. Training for Camp Pendleton was conducted in conjunction with the standup of NMC San Diego in November 2008. Training conducted at February 2009 IOC sites is as follows: Vance AFB, January 14 & 15 NMC Bremerton, February 10 & 11 Fort Polk, February 10 & 11 The presence of a previously operating Benefits Delivery at Discharge program at all but two of these sites mean the VA has prepositioned resources it can apply to the DES Pilot. Many of these VA employees are already hosted at the military treatment facility, know the DoD personnel involved, and have established IT connections back to the VA. These things make the transition to the DES Pilot much easier. The Navy requested the expansion to Jacksonville be delayed until July 1 to allow a hospital construction project there to wrap up before launching the Pilot. We anticipate approving their request to delay expansion until later this summer. NB: Jacksonville Naval Hospital, FL is no longer under consideration as a DES pilot expansion site per VBA. ?

10. Pilot Phase II Sites: Phase II Expansion took place January- March 2010 at these sites: Fort Bragg Fort Benning Fort Riley Ft. Lewis (Madigan AMC) Fort Hood, TX Portsmouth Naval Hospital

11. VHA Role in DES Establishes VHA relationship with future Veterans as well as Military leaders who may not understand VA and its Administrations. The purpose of the pilot expansion was to test approaches in different locations. Each site is looked at individually with the resources assessed at the local VBA Regional Office and the local VAMC and VISN level. Resources needed are?impacted by?a number of variables: Number and types of exams needed, both as estimated by Services and VBA based on historic data; also by actual data once each site is activated. Other factors include HR issues (recruitment/retention), training, space, location, travel, weather, medical record information, and availability of recent diagnostic testing results, etc.

12. VHA Role in DES Exams: VHA goal: provide majority of general medical exams VHA and VBA developed templates for all C&P exams and certification process for?all providers conducting exams Work collaboratively with the Services for specialty exams Exam results are provided as ?medical evidence? for VBA rating board and DoD Physicians use to develop Narrative Summary (NarSum) for the MEB/PEB process to determine Fitness for Duty VBA MSC (Military Service Coordinator): Assures that Servicemembers are ?registered? with VHA during pilot and ?enrolled? upon separation, as they desire (based on where they will call ?home?)

13. What Departments have accomplished thus far? One Comprehensive Physical Examination Meets VA?s criteria for disability examinations Meets Services? need for determination of fitness Occurs early in the process; forms the basis of the NARSUM/MEB and VA?s rating if Service member is found unfit for continued service 2. One Rating Organization Determines Disability Rating Serves as the basis for ratings to determine nature of separation and amount of disability compensation All service-connected (SC) conditions combine for VA rating (compensation) Unfitting conditions combine for DoD rating (nature of separation) 3. Expeditious payment of benefits on the first day allowed by law after separation.

14. Potential IDES Challenges (Part 1) Thinking Old process while in the New Need accurate forecast of case volume Who/Where will exams be conducted Transportation of Servicemembers to VA Exam Timely completion of NARSUM following VA exams Expansion of PEBLO/Case Manager, MSC, and exam schedulers duties Need for ?Diagnostic Alignment? between referred conditions and VA exam diagnoses

15. Potential IDES Challenges (part 2) Align diagnostic testing, currency of evidence Fast tracking cases (Catastrophic cases & Headquarters directed) Time required for provider credentialing and privileging IT connectivity, CAC cards, Base access for VA staff Acquiring complete record copies of STRs Billing procedures for cost-sharing MoU

16. Keys to Success (page 1?) Strong and Involved Leadership to create an Environment for Success Knowledge and emphasis on process adherence Roles, Responsibilities, and Accountability Communication between all internal stakeholders: PEBLOs and MSCs VA examiners and MTF MEB physicians PEBs and DRAS No one entity ensures success or causes failure The DES Team = Physicians, Patient Admin, Parent Commands and VHA and VBA Communication with Stakeholder Communities Local Commands, Patients, Families, VSOs, MTF Staff and VA Staff PSAs, Articles, Posters, Town Hall meetings, etc?. Monitor the process and plug the leaks! ? communicate issues and challenges to next level of Leadership, and if needed higher, before problems raise to political or media levels

17. Keys to Success (page 2?) PEBLOs & VA MSCs knowledge and collaboration a must! Examiner Education (initial and recurring) a must! Three S?s Staffing numbers adequate to process cases Space allocation is adequate Staff is co-located (PAD, PEBLOs, & MSCs) whenever possible Parent Command awareness and support Patient availability NMA/Commander?s Letters and LODDs Patient and Family support Ensure Servicemember participates in exit interview with VA MSC before leaving installation IT issues ? CAC access; equipment/security/connectivity; AHLTA/CHCS/VISTA access for both Departments

18. The Way Ahead ? Expansion On-going Review Process and Expansion Planning since fall of 2009: all Military Services represented; VBA, VHA and OPP actively engaged Planning Matrix revised to assess potential expansion sites Military Installations and Treatment Facilities complete DoD section of matrix VBA & VHA complete VA sections of matrix Certification will be required by VA and DoD by designated officials to assure readiness is met. DES After Action Report (AAR) for Phase I used to help new sites learn from experienced sites

19. Current Expansion: Phase III, Stage 1 Phase III, Stage 1 sites which are being planned now include: Tripler AMC Los Angeles AFB Vandenberg AF Edwards AFB Patrick AFB Langley AF Hickam AFB Eielson AFB Pope AFB Maxwell AFB McChord AFB Robins AFB Fairchild AFB Beaufort MCAS Lemoore NAS Cherry Point MCAS Jacksonville NAS Quantico MCB Pearl Harbor NavSta Mountain Home AFB Oak Harbor NH 29 Palms MCAGCC Seymour Johnson AFB


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