The Disability Evaluation System: Process Improvement for Service Members with Disabilities

By: Terri Lukach, FHP&R Staff Writer

Apart from the wars in which the Nation is now engaged, treatment of the wounded and their care and reintegration into everyday life is the Department’s highest priority. Fortunately for those who have suffered physical or other disabilities in service to our country, it is also the priority of the Department of Veterans Affairs (VA). The goal of both departments is a cooperative and uninterrupted continuum of care and support as Service members transition from active duty to veteran status. For the past several years, both departments have worked to improve collaboration at all levels.

One fundamental challenge to getting wounded Service members the compensation they deserve has been the two different systems the departments have been using to rate disabilities. The Department of Defense (DoD) has traditionally rated disability based on fitness for military service while the VA rates disability based on fitness for civilian employability – a difference that has often produced considerable frustration for Service members and their families. Other challenges have included different sets of information, different vocabularies, and no single, accessible electronic database of information.

To overcome these impediments, and to provide easier, quicker access to benefits, the DoD and the VA launched a joint VA/DoD Disability Evaluation System (DES) pilot program in 2007. Starting with three sites in the National Capital Region, the pilot was later expanded to include 18 military installations of all Services. In 2008, six more installations brought the total to 27 nationwide. With more than 27,000 Service members entering the DES process every year, the 27 sites account for more than 13,000 medical evaluations each year or about 47 percent of the annual case load.

The pilot program had three goals: A single disability exam with standards used by both departments; a single disability rating calculated by VA but applied by both departments according to applicable laws; and expeditious payment of VA benefits within 30 days of a member’s separation from service.

Recently, Mr. Robert Hite of the Veterans Affairs Program Coordination Office within the Office of the Assistant Secretary of Defense (Health Affairs), and Mr. Keith Limbacher, Deputy Division Chief of the Change Management Division in the Office of the Under Secretary of Defense for Personnel and Readiness, discussed the issues associated with the availability and sharing of paper-based medical records and ways to improve how both Departments manage medical records to better support the transitioning Service member.

In the near term, they said, the goal is a “bridge solution” that would create an electronic repository for health record information. The “bridge” would leverage DoD’s existing electronic health record (EHR) capability through digitization, eliminate the need to print documents out of AHLTA, and create a web-based portal for VA and other stakeholder access.

Another goal is to create an enterprisewide image sharing capability for all types of artifacts and images (A&I) including radiographs, photographs, waveforms, audio files, video and scanned documents and global access to A&I repositories.

Benefits of the system would include electronic access to medical and dental records via a one-stop DoD portal that would display information requested from authorized DoD and VA users, including the Service member. Regular verification of the records by both Service members and providers would ensure accuracy and accountability.

Eliminated would be the overprocessing of hybrid records; the mailing of Service member records from place to place, which would also reduce costs and eliminate the possibility of losing records en route; transferring records between Departments – DoD would retain ownership and physical control; the reworking and interfiling of incomplete, loose, or late records at VA; and the handling and storage of records, which would also reduce labor and costs.

While much remains to be done, much has been accomplished in the ongoing effort to fulfill our promise to provide the very best care and support to those who have sacrificed so much to keep our Nation strong and free.