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entitled 'VA Vocational Rehabilitation and Employment Program:
Improved Oversight of Independent Living Services and Supports Is
Needed' which was released on June 7, 2013.
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United States Government Accountability Office:
GAO:
Report to Congressional Requesters:
June 2013:
VA Vocational Rehabilitation and Employment Program:
Improved Oversight of Independent Living Services and Supports Is
Needed:
GAO Highlights:
Highlights of GAO-13-474, a report to congressional requesters.
Why GAO Did This Study:
The IL “track”—-one of five tracks within VA’s VR&E program—-provides
a range of benefits to help veterans with service-connected
disabilities live independently when employment is not considered
feasible at the time they enter the VR&E program. These benefits can
include counseling, assistive devices, and other services or
equipment. GAO was asked to review issues related to the IL track.
This report examines (1) the characteristics of veterans in the IL
track, and the types and costs of benefits they were provided; (2) the
extent to which their IL plans were completed, and the time it took to
complete them; and (3) the extent to which the IL track has been
administered appropriately and consistently across regional offices.
To conduct this work, GAO analyzed VA administrative data from fiscal
years 2008 to 2011, and reviewed a random, generalizable sample of 182
veterans who entered the IL track in fiscal year 2008. In addition,
GAO visited five VA regional offices; interviewed agency officials and
staff; and reviewed relevant federal laws, regulations, and agency
policies and procedures.
What GAO Found:
Of the 9,215 veterans who entered the Department of Veterans Affairs’
(VA) Independent Living (IL) track within the Vocational
Rehabilitation and Employment (VR&E) program in fiscal years 2008 to
2011, most were male Vietnam era veterans in their 50s or 60s. Almost
60 percent served in the U.S. Army, and fewer than 1 percent served in
the National Guard or Reserve. The most prevalent disabilities among
these veterans were post-traumatic stress disorder and tinnitus. GAO’s
review of 182 IL cases from fiscal year 2008 found that VR&E provided
a range of IL benefits to veterans. Among these cases, the most common
benefits were counseling services and computers. Less common benefits
included gym memberships, camping equipment, and a boat. GAO estimated
that VR&E spent nearly $14 million on benefits for veterans entering
the IL track in fiscal year 2008—-an average of almost $6,000 per IL
veteran.
Most veterans completed their IL plans, which identify their
individual goals to live independently and the benefits VR&E will
provide. About 89 percent of fiscal year 2008 IL veterans were
considered by VR&E to be “rehabilitated,” that is, generally, to have
completed their IL plans by the end of fiscal year 2011. VR&E
discontinued or closed about 5 percent of cases for various reasons,
such as the veteran declined benefits. Six percent of cases were open
at the end of fiscal year 2011. Because the complexity of IL cases
varied depending on veterans’ disabilities and needs, some cases were
fairly simple for VR&E to close. For example, one IL case only called
for the installation of door levers and a bathtub rail. Another more
complex case involved the provision of a range of IL benefits,
including home modifications. Rehabilitation rates across regions
varied from 0 to 100 percent, and regions with larger IL caseloads
generally rehabilitated a greater percentage of IL veterans. While IL
plans nationwide were completed in 384 days, on average, completion
times varied by region, from 150 to 895 days.
VR&E exercises limited oversight to ensure appropriate and consistent
administration of the IL track across its regions. First, some regions
may not be complying with certain case management requirements. For
instance, while VR&E is required to coordinate with the Veterans
Health Administration (VHA) on IL benefits, VR&E counselors have
difficulty obtaining timely responses from VHA. VHA physicians respond
to VR&E’s IL referrals late or not at all, resulting in delayed
benefits or VR&E providing the benefits instead of VHA. Second, VR&E
does not monitor regional variation in IL caseloads and benefits
provided. Instead, it has relied on its quality assurance reviews and
ad hoc studies, but these are limited in scope. Third, given
counselors have broad discretion in selecting IL benefits, VR&E’s
written policies for approving IL expenditures may not be appropriate
as regions were permitted to purchase a range of items without any
Central Office approval, some of which were costly or questionable.
For example, in one case, Central Office review would not have been
required for expenditures of $18,829 for a riding mower, which is
prohibited, and other items. Finally, VR&E’s system does not collect
IL costs and benefits provided. VR&E also lacks accurate data on the
number of IL veterans served. While the law currently allows 2,700
veterans to enter the IL track annually, data used to monitor the cap
are based on the number of IL plans developed, not on the number of
individual veterans admitted. Veterans can have more than one plan in
a fiscal year, so one veteran could be counted multiple times towards
the cap.
What GAO Recommends:
GAO recommends that VR&E explore options to enhance coordination with
VHA; strengthen its oversight of the IL track; and reassess its policy
for approving benefits. VA generally agreed with GAO’s conclusions and
recommendations.
View [hyperlink, http://www.gao.gov/products/GAO-13-474]. For more
information, contact Dan Bertoni at (202) 512-7215 or bertonid@gao.gov.
[End of section]
Contents:
Letter:
Background:
The IL Track Mainly Serves Older Veterans and Provides a Wide Variety
of Benefits:
Most Veterans Completed “Rehabilitation” but with Varying Time Frames:
VR&E Exercises Limited Oversight of the IL Track:
Conclusions:
Recommendations for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Objectives, Scope, and Methodology:
Appendix II: Statistical Analysis of Independent Living Plan
Rehabilitation Times:
Appendix III: List of Goods and Services Provided to Sample of
Independent Living Track Veterans from our Case File Review:
Appendix IV: Rehabilitation Rates by Regional Office, FY 2008
Independent Living Track Entrants:
Appendix V: Days to Complete Independent Living Plans, Veterans
Entering the Independent Living Track During FY 2008:
Appendix VI: Independent Living Track Caseload Nationwide and by
Regional Office, FY 2008-2011:
Appendix VII: Comments from the Department of Veteran Affairs:
Appendix VIII: GAO Contacts and Staff Acknowledgments:
Related GAO Products:
Tables:
Table 1: Categories of Goods and Services Provided to Independent
Living Track Veterans:
Table 2: Level of Approval Required for Construction and Non-
Construction-Related Expenditures in Independent Living Track Cases:
Table 3: Size of Sample of Independent Living Track Cases, by Strata
and Proportion of Population:
Table 4: Estimates from Cox Hazard Model of Time Spent in Independent
Living Plans, among Veterans Starting a Plan in FY 2008-2011:
Figures:
Figure 1: Location of the Vocational Rehabilitation and Employment
Program’s Regional and Satellite Offices:
Figure 2: The Vocational Rehabilitation and Employment Program’s Needs
Assessment and Independent Living Track Benefits Delivery Process:
Figure 3: Example of an Independent Living Plan Developed for a
Veteran:
Figure 4: FY 2008-2011 Independent Living Track Veterans, by Gender
and Age:
Figure 5: Independent Living Track Veterans during FY 2008-2011, by
War Era:
Figure 6: Independent Living Track Veterans during FY 2008-2011, by
Branch of Service:
Figure 7: Comparison of the 10 Most Prevalent Disabilities among
Independent Living Track Veterans from FY 2008-2011 and Veterans
Receiving Disability Compensation for FY 2011:
Figure 8: Examples of the Types of Goods and Services Provided in Four
of the Independent Living Track Cases GAO Reviewed:
Figure 9: Distribution of Independent Living Track Cases Reviewed by
Costs of Goods and Services Purchased for Veterans:
Figure 10: Status at the End of FY 2011 of Independent Living Track
Cases That Began in FY 2008:
Figure 11: Percentage of FY 2008 Independent Living Track Veterans
Rehabilitated, by Regional Office Based on Caseload:
Figure 12: Average Length of Time to Complete an Independent Living
Plan, by Regional Office Based on Caseload:
Figure 13: Average Time to Complete Independent Living Plans, by
Veteran Age Groups:
Figure 14: Estimated Probability of a Veteran Completing an
Independent Living Plan within Certain Time Periods, by Regional
Office Based on Caseload:
Figure 15: The Vocational Rehabilitation and Employment Program’s
Overall Independent Living Caseload from FY 2008-2011, by Regional
Office:
Figure 16: Number of and Statutory Cap on Veterans Entering the
Independent Living Track from FY 2008-2011:
Figure 17: Multivariate Failure Function Estimates from a Cox Hazard
Model of Time Spent in Independent Living Plans, FY 2008-2011:
Abbreviations:
IL: Independent Living:
PSAS: Prosthetics and Sensory Aids Service:
PTSD: Post-traumatic Stress Disorder:
SAH: Specially Adapted Housing:
QA: Quality Assurance:
VA: Department of Veterans Affairs:
VBA: Veterans Benefits Administration:
VHA: Veterans Health Administration:
VRC: Vocational Rehabilitation Counselor:
VR&E: Vocational Rehabilitation and Employment:
[End of section]
United States Government Accountability Office:
GAO:
441 G St. N.W.
Washington, DC 20548:
June 7, 2013:
The Honorable Bill Flores:
Chairman:
The Honorable Mark Takano:
Ranking Member:
Subcommittee on Economic Opportunity:
Committee on Veterans' Affairs:
House of Representatives:
The Honorable Bruce Braley:
House of Representatives:
The Honorable Marlin Stutzman:
House of Representatives:
The Department of Veterans Affairs' (VA) Vocational Rehabilitation and
Employment (VR&E) program, under the Veterans Benefits Administration
(VBA), administers five "tracks" that provide a wide range of services
and assistance to support veterans with service-connected
disabilities. Four of VR&E's five tracks are intended to help veterans
prepare for, find, and maintain suitable employment. If employment is
not considered a feasible goal for veterans when they enter the VR&E
program, they can be assigned to the Independent Living (IL) track for
separate, non-employment support within the VR&E program, and can
receive benefits such as counseling, assistive devices, and other
services or equipment to improve their ability to live independently.
By law, the number of veterans who can be assigned to the IL track
each year is limited. According to VA officials, there are currently
56 VA regional offices with responsibility for administering VR&E's IL
track,[Footnote 1] and almost 3,000 veterans nationwide were served in
this track during fiscal year 2011.
Given the limited information available on those who participate in
VR&E's IL track, you asked us to review issues related to the benefits
IL track veterans receive, and their outcomes. This report examines
(1) the characteristics of veterans who have participated in the IL
track, as well as the types and costs of benefits they were provided;
(2) the extent to which their IL plans were completed, and the time it
took to complete them; and (3) the extent to which the IL track has
been administered appropriately and consistently across regional
offices.
To provide information on the number, characteristics, and outcomes of
veterans who entered the IL track, as well as how long it took VR&E to
complete these cases, we analyzed VA administrative data from fiscal
years 2008 through 2011.[Footnote 2] We also used these data to
estimate the difference, if any, in the amount of time it took to
complete these cases across regional offices, as well as across groups
of veterans with various characteristics. To determine the types of
goods and services provided to veterans and the direct cost of these
benefits, we reviewed the case files of a random sample of 182
veterans who were assigned to the IL track at some point during fiscal
year 2008.
To obtain information about how the IL track has been administered, we
visited VA regional offices in San Diego, California; Atlanta,
Georgia; Detroit, Michigan; Philadelphia, Pennsylvania; and the
District of Columbia.[Footnote 3] We selected these sites because they
are geographically diverse and have had differing levels of IL
caseloads and rehabilitation rates. At each of these sites we
interviewed officials from VR&E, VA's Specially Adapted Housing (SAH)
program, and Prosthetic and Sensory Aids Service (PSAS), as well as
representatives from local veteran service organizations. We also
interviewed VR&E officials at the national level, and relied on our
case file review to determine the extent to which VR&E, SAH, and PSAS
coordinate in the provision of goods and services to IL track
veterans. Lastly, we reviewed relevant federal laws and regulations,
standards for internal controls and managerial cost accounting, as
well as VR&E policies, procedures, and other relevant studies and
documentation.
We conducted this performance audit from February 2012 to June 2013,
in accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe
that the evidence obtained provides a reasonable basis for our
findings and conclusions based on our audit objectives. Additional
information on our scope and methodology is provided in appendices I
and II.
Background:
VR&E's IL Track:
[Side bar]
VR&E’s Five Tracks At A Glance:
Employment-Related Tracks:
* Reemployment: For veterans who need assistance returning to their
previous employer.
* Rapid Access to Employment: For veterans with existing skills who
are looking for immediate employment.
* Self-Employment: For veterans who have the skills to start a
business, and for whom self-employment is the best or only option for
successful rehabilitation.
* Employment Through Long-Term Services: For veterans who need
specialized training and/or education to obtain employment.
Independent Living Track:
* Independent Living: For veterans who are unable to work and need
services to live more independently at the time they enter the VR&E
program.
[End of side bar]
VBA's VR&E program is responsible for implementing five tracks that
provide a variety of services and assistance to veterans with service-
connected disabilities. Four of the five tracks are designed to help
veterans prepare for, find, and maintain suitable employment. VR&E's
fifth track--the IL track--generally helps veterans maximize their
ability to live independently when the achievement of an employment
goal is not considered feasible at the time they enter the VR&E
program.[Footnote 4] To assist these veterans, the law allows VR&E
broad discretion in determining the types of services that can be
provided to address their needs.[Footnote 5] When assessing each
veteran, VR&E focuses not only on assisting veterans with activities
of daily living,[Footnote 6] but also on veteran's emotional needs and
avocational and leisure interests, among other areas.[Footnote 7]
Furthermore, unlike VR&E's employment-related tracks, the law caps the
number of veterans who can be admitted into the IL track annually.
While this number has increased over the years, the cap was 2,600
veterans in fiscal year 2011 and is currently 2,700.[Footnote 8] VR&E
anticipates an increase in future demand for IL benefits.
VR&E's Eligibility Requirements:
All veterans are required to meet VR&E's basic entitlement criteria
before they are assigned to one of its five tracks. To be entitled to
VR&E services, veterans must generally have at least a 20 percent
service-connected disability rating and be in need of rehabilitation
because of an employment handicap.[Footnote 9] The period of
eligibility for which veterans can receive benefits from VR&E is 12
years and begins on either (1) the date of separation from active
military duty, or (2) the date that VA notifies the veteran of his or
her service-connected disability rating. The 12-year eligibility
period may be deferred or extended if certain conditions prevent the
veteran from participating in a rehabilitation program or if a veteran
has a serious employment handicap.[Footnote 10] To be considered for
the IL track, veterans must meet all of VR&E's eligibility
requirements and be deemed currently unable to pursue an employment
goal.[Footnote 11]
VR&E's Structure and Administration:
VR&E's Central Office, located in Washington D.C., has responsibility
for several areas, including (1) overseeing the implementation of the
VR&E program, including the IL track, (2) developing program policies
and procedures, and regional guidance, and (3) formulating and
monitoring the agency's budget and program expenditures. Currently,
there are 56 VA regional offices with responsibility for administering
the IL track in their jurisdiction.[Footnote 12] Reporting to these
regional offices are 126 satellite offices that help ensure veterans
who do not live near a regional office are able to access VR&E
benefits, including those provided through the IL track (see figure 1).
Figure 1: Location of the Vocational Rehabilitation and Employment
Program's Regional and Satellite Offices:
[Refer to PDF for image: illustrated U.S. map]
Map depicts the geographic location of regional and satellite offices,
including the following regional offices:
Albuquerque, New Mexico;
Anchorage, Alaska;
Atlanta, Georgia;
Baltimore, Maryland;
Boise, Idaho;
Boston, Massachusetts;
Buffalo, New York;
Chicago, Illinois;
Cleveland, Ohio;
Columbia, South Carolina;
Denver, Colorado;
Des Moines, Iowa;
Detroit, Michigan;
Fargo, North Dakota;
Fort Harrison, Montana;
Hartford, Connecticut;
Honolulu, Hawaii;
Houston, Texas;
Huntington, West Virginia;
Indianapolis, Indiana;
Jackson, Mississippi;
Lincoln, Nebraska;
Little Rock, Arkansas;
Los Angeles, California;
Louisville, Kentucky;
Manchester, New Hampshire;
Milwaukee, Wisconsin;
Montgomery, Alabama;
Muskogee, Oklahoma;
Nashville, Tennessee;
Newark, New Jersey;
New Orleans, Louisiana;
New York, New York;
Oakland, California;
Philadelphia, Pennsylvania;
Phoenix, Arizona;
Pittsburgh, Pennsylvania;
Portland, Oregon;
Providence, Rhode Island;
Reno, Nevada;
Roanoke, Virginia;
Salt Lake City, Utah;
San Diego, California;
San Juan, Puerto Rico;
St. Louis, Missouri;
St. Paul, Minnesota;
St. Petersburg, Florida;
Seattle, Washington;
Sioux Falls, South Dakota;
Togus, Maine;
Waco, Texas;
Washington, D.C.[A];
White River Junction, Vermont;
Wichita, Kansas;
Wilmington, Delaware;
Winston-Salem, North Carolina.
Source: GAO analysis of VA data.
[A] The Washington Regional Office, located in the District of
Columbia, was recently designated the National Capital Region Benefits
Office in November 2012.
[End of figure]
The VR&E Officer in each regional office is responsible for ensuring
that the office complies with national policies and procedures for
monitoring performance to ensure VR&E's national rehabilitation rate
is met.[Footnote 13] In addition, this officer supervises regional
Vocational Rehabilitation Counselors (VRCs) who are responsible for
working directly with veterans to assess their IL needs and provide
benefits.[Footnote 14]
VR&E has established a formal process that all veterans must go
through to receive any of the benefits offered through its five tracks
(see figure 2). It is not possible to be assigned to any of the five
tracks without first applying and being accepted into the VR&E program.
Figure 2: The Vocational Rehabilitation and Employment Program's Needs
Assessment and Independent Living Track Benefits Delivery Process:
[Refer to PDF for image: process map]
Application processing:
1. Veteran applies for services through Vocational Rehabilitation and
Employment (VR&E).
2. VR&E reviews the veteran’s application, and military and VA records
to determine eligibility:
Eligible: continue;
Not eligible: case closed.
Evaluation and planning:
3. VR&E assesses veteran’s needs, skills, and abilities, and
determines whether they are able to work;
Able to work: go to #4;
Unable to work: go to #5.
4. Veteran assigned to one of four tracks:
* Reemployment: Return to past employer;
* Rapid Access to Employment: Help seeking immediate job;
* Self-Employment: Help starting a business;
* Employment through Long Term Services: Specialized training or
education to obtain a job.
5. Veteran considered for VR&E’s Independent Living (IL) track.
6. VR&E conducts a preliminary IL assessment that evaluates the
veteran’s needs in five areas:
* Activities of daily living;
* Alcohol and substance abuse;
* Housing situation;
* Personal/emotional/spiritual needs;
* Leisure and avocational needs.
No IL needs found: case closed;
Assessment finds IL needs: continue.
7. VR&E performs a comprehensive IL assessment.
IL goals not feasible[A]: case closed;
IL goals feasible: continue.
8. VR&E uses all assessment data to develop an IL plan for veteran.
Independent Living (IL) track:
9. The plan is reviewed and approved by the veteran and VR&E[B].
10. VR&E coordinates with other VA programs to provide the benefits in
veteran’s IL plan, buying any benefits unavailable in the other
programs.
11. VR&E monitors the veteran’s progress on their IL plan on a monthly
basis during their time in the IL track; Outcomes:
Goals not completed: Veteran’s case closed as “discontinued;”
Goals completed: Veteran’s case closed as “rehabilitated;”
At any time: Veteran can transition to one of VR&E’s four employment
tracks.
Source: GAO's analysis of VR&E's needs assessment and IL track
benefits delivery process.
[A] After both the preliminary and comprehensive IL assessments are
performed, a case may be closed if it is determined that the
achievement of IL goals are not feasible or if potential needs are not
identified. The VR&E officer must concur with this decision.
[B] IL plans must be approved by the VR&E officer, and in some cases
the Regional Director or VR&E’s Central Office, before any services
are provided.
[End of figure]
An individualized IL plan is developed for each veteran admitted to
the IL track.[Footnote 15] This plan identifies the veteran's IL
goals, the benefits (goods and services) VR&E will provide to help the
veteran meet those goals, estimated time frames for providing
benefits, and how improvements in the veteran's independence will be
measured, among other areas (see figure 3). In general, IL plans may
not exceed 24 months except under certain circumstances.[Footnote 16]
According to officials, there is also no statutory limit on the number
of IL plans a veteran can have. If additional IL needs emerge,
veterans can reapply to the VR&E program at any time[Footnote 17].
Figure 3: Example of an Independent Living Plan Developed for a
Veteran:
[Refer to PDF for image: table]
Program goal: Veteran will maximize functional independence in living:
Objective One: To increase cognitive skills such as memory and
concentration through use of cognitive rehabilitation exercises that
will be installed on a laptop computer.
Objective Two: Manage stress and anger levels through use of periodic
journaling on laptop computer. Veteran will discuss journal activities
with his social worker, [name], to determine progress for this
objective.
Objective Three: Work with a fiduciary for assistance with housing,
financial, and organizational issues.
Objective Four: Maintain stability of physical and mental health.
Services provided:
Objective One: Laptop computer with Captain’s Log Computerized
Cognitive Rehabilitation exercises installed on it and training to use
computer.
Objective Two: Laptop computer.
Objective Three: All services necessary to improve ability to manage
daily life activities despite the effects of the disability.
Objective Four: Treatment by occupational therapist, social worker,
and other medical professionals involved in the well-being of this
veteran.
Evaluation criteria:
Objective One: Veteran will develop basic computer skills, and learn
how to use Captain’s Log. Veteran will attend all scheduled training
and practice concepts learned.
Objective Two: Progress will be monitored through self-reports from
veteran and reports from his treating professionals.
Objective Three: Active participation and cooperation when working
with the fiduciary.
Objective Four: Veteran will keep all scheduled medical appointments
and follow treatment recommendations. Inform case manager of
additional appointment and follow-up referral needs.
Evaluation procedure:
Objective One: Review periodic counseling reports acquired from
treating professionals, [name of doctor], verbally or in writing
(CAPRI notes).
Objective Two: Review periodic counseling reports acquired from
treating professionals verbally or in writing.
Objective Three: Case Manager will monitor veteran’s progress through
monthly face-to-face visits or by telephone.
Objective Four: Case Manager will monitor veteran’s progress in
medical and mental health treatment by reviewing medical records
and/or speaking with treating professionals.
Evaluation schedule:
Objective One: At least once per month.
Objective Two: At least once per month.
Objective Three: At least once per month.
Objective Four: At least once per month.
Source: GAO analysis of example IL plan provided by VR&E.
[End of figure]
Furthermore, all IL plans are required to be reviewed and approved by
the veteran, the VRC, and the VR&E Officer before the veteran is
admitted to the IL track. Once the plan is approved, VRCs are required
to meet with the veteran on a monthly basis to track progress in
meeting the plan's goals. In addition, VRCs are required to coordinate
with other VA programs to determine if they can provide any of the
goods and services identified in the veteran's plan. The VA programs
that officials told us they regularly coordinate with are:
* VBA's Specially Adapted Housing (SAH) Program, which helps
servicemembers and veterans with certain service-connected
disabilities purchase or construct an adapted home, or modify an
existing home to accommodate a disability.[Footnote 18] These
modifications can include specially adapted bathrooms or the
installation of exit ramps.
* VHA medical centers, which provide a wide range of health-related
services to veterans, such as physical therapy and dental and
optometry services. In addition, VHA's Prosthetic and Sensory Aids
Service (PSAS) provides a variety of medical devices and equipment to
veterans, including artificial limbs, eyeglasses, hearing aids,
hospital beds, and wheelchairs.[Footnote 19] PSAS also administers the
Home Improvements and Structural Alterations grant to eligible
veterans for home modifications, such as the widening of bedroom or
bathroom doorways to allow wheelchair access.
If the goods and services needed cannot be obtained through other VA
sources, the VR&E program will purchase them directly or contract for
them. VR&E considers veterans successfully "rehabilitated" when all
goals in their IL plan have been achieved, or if not all achieved,
when the following three conditions have been met: (1) the veteran has
attained a substantial increase in the level of independence; (2) the
veteran has maintained the increased level of independence for at
least 60 days; and (3) further assistance is unlikely to significantly
increase the veteran's level of independence.[Footnote 20]
"Rehabilitation" as described by VR&E does not necessarily mean that a
veteran's disability has improved, but rather that the goals in the
veteran's IL plan have been met to facilitate their independence.
Furthermore, VR&E considers cases in which veterans are not
successfully rehabilitated as "discontinued." When circumstances arise
that affect the ability of VR&E to provide the goods and services
identified in the IL plan to the veteran, VR&E can temporarily
"interrupt" the veteran's case until it becomes possible to continue.
The IL Track Mainly Serves Older Veterans and Provides a Wide Variety
of Benefits:
IL Serves Mainly Vietnam-Era Veterans and Those with Post-traumatic
Stress Disorder:
From fiscal years 2008 through 2011, the typical participant in the IL
track was an older male Vietnam-era veteran. Of the 9,215 veterans who
entered the IL track at some point during these years, most (67
percent) were males 50 years old or older. Most women in the IL track
were in their 40s or 50s (see figure 4). The gender and age
distributions of IL track veterans were similar to those of veterans
who were receiving VA Disability Compensation cash benefits. In fiscal
year 2011, about 92 percent of these veterans were male, and almost 68
percent were age 55 or older.
Figure 4: FY 2008-2011 Independent Living Track Veterans, by Gender
and Age:
[Refer to PDF for image: stacked vertical bar graph]
Age of IL track veterans: 20s;
Men: 79%;
Women: 21%;
Total: 260.
Age of IL track veterans: 30s;
Men: 75%;
Women: 25%;
Total: 669.
Age of IL track veterans: 40s;
Men: 74%;
Women: 26%;
Total: 1,551.
Age of IL track veterans: 50s;
Men: 85%;
Women: 15%;
Total: 2,726.
Age of IL track veterans: 60s;
Men: 95%;
Women: 5%;
Total: 3,219.
Age of IL track veterans: 70s;
Men: 96%;
Women: 4%;
Total: 503.
Age of IL track veterans: 80s;
Men: 97%;
Women: 3%;
Total: 259.
Age of IL track veterans: 90s;
Men: 100%;
Women: 0%;
Total: 20.
Source: GAO analysis of VA data.
Note: The number in this figure does not add to the 9,215 veterans who
entered the IL track during fiscal years 2008 through 2011 because
information on gender and age was missing in about 1 percent of these
cases.
[End of figure]
Most of the 9,215 veterans who entered the IL track during fiscal
years 2008 through 2011 served in the Vietnam War. However, there was
a slight increase in the number of "Global War on Terrorism" veterans--
including those who served during the war in Afghanistan as part of
Operation Enduring Freedom and the war in Iraq as part of Operation
Iraqi Freedom--from 13 percent in fiscal year 2008 to 16 percent in
fiscal year 2011 (see figure 5).
Figure 5: Independent Living Track Veterans during FY 2008-2011, by
War Era:
[Refer to PDF for image: vertical bar graph]
Number IL track veterans from that era and the percentage of that
year’s total IL track veterans from that era:
World War II:
2008: 62 (3%);
2009: 40 (3%);
2010: 49 (2%);
2011: 40 (2%).
Korean War:
2008: 93 (4%);
2009: 71 (3%);
2010: 77 (3%);
2011: 74 (3%).
Vietnam War:
2008: 1,215 (49%);
2009: 1,089 (48%);
2010: 1,008 (46%);
2011: 1,045 (46%).
Peacetime:
2008: 379 (15%);
2009: 366 (16%);
2010: 375 (17%);
2011: 373 (16%).
Gulf War:
2008: 385 (16%);
2009: 367 (16%);
2010: 372 (17%);
2011: 385 (17%).
Global War on Terrorism:
2008: 331 (13%);
2009: 327 (14%);
2010: 328 (15%);
2011: 364 (16%).
Source: GAO analysis of VA data.
[End of figure]
In addition, almost 60 percent of IL track veterans served in the U.S.
Army and less than 1 percent served in the National Guard or
Reserves.Forty-one percent served in the U.S Navy, U.S. Air Force, or
U.S. Marine Corps (see figure 6).
Figure 6: Independent Living Track Veterans during FY 2008-2011, by
Branch of Service:
[Refer to PDF for image: pie-chart]
Branch: Army;
Percentage: 58;
Number: 5,306.
Branch: Navy;
Percentage: 15;
Number: 1,393.
Branch: Air Force;
Percentage: 13;
Number: 1,204.
Branch: Marine Corps;
Percentage: 13;
Number: 1,166.
Branch: National Guard and Reserve across all services;
Percentage: 0.3;
Number: 31.
Branch: Other Branches of Service;
Percentage: 1.2;
Number: 115.
Source: GAO analysis of VA data.
Note: "Other" branches of service include the U.S. Coast Guard and
Merchant Marines.
[End of figure]
With regard to severity of service-connected disabilities, more than
three-quarters of IL track veterans had a combined service-connected
rating of at least 60 percent. Thirty-four percent of IL track
veterans had a combined service-connected disability rating of 100
percent.[Footnote 21] Many IL track veterans may have also been
eligible for the VA Disability Compensation program's Individual
Unemployability cash benefit.[Footnote 22] Indeed, 38 percent of IL
track veterans were eligible for this supplement to their disability
compensation payments. Moreover, of those IL track veterans who were
at least 60 years old, 85 percent had combined service-connected
disability ratings of at least 60 percent and more than a third had
combined ratings of 100 percent.
IL track veterans had a wide variety of service-connected
disabilities, and most had more than one. Regardless of disability
rating level, the most prevalent disabilities among this group were
Post-traumatic Stress Disorder (PTSD), tinnitus ("ringing in the
ears"), and hearing loss. As shown in figure 7, many of these
disabilities--7 of the top 10 we identified in these cases--are
similar to the most prevalent conditions among veterans rated by VA's
Disability Compensation program in fiscal year 2011.
Figure 7: Comparison of the 10 Most Prevalent Disabilities Among
Independent Living Track Veterans from FY 2008-2011 and Veterans
Receiving Disability Compensation for FY 2011:
[Refer to PDF for image: 2 horizontal bar graphs]
Veterans receiving VA disability compensation:
Tinnitus: 10.9%;
Hearing loss: 7.5%;
Post-traumatic stress disorder: 5.3%;
Limitation of flexion, knee: 3.9
Lumbosacral or cervical strain: 3.7%;
Tendon inflammation: 2.9%;
Degenerative arthritis of the spine: 2.8%;
Diabetes mellitus: 2.7%;
Limitation of motion of the ankle: 2.6%;
Scars, general: 2.5%.
IL participants:
Post-traumatic stress disorder: 39.5%;
Tinnitus: 26.3%;
Hearing loss: 22.8%;
Sciatic nerve paralysis: 21.3%;
Diabetes mellitus: 18.8%;
Scars, general: 15.6%;
Scars superficial, (tender): 12.3%;
Paralysis of the median nerve: 12.1%;
Degenerative arthritis of the spine: 11.8%;
Lumbosacral or cervical strain: 11.8%.
Source: GAO analysis of VA data.
[End of figure]
The IL Track Has Provided a Wide Range of Benefits:
Our review of the case files of 182 randomly selected IL track
veterans in fiscal year 2008 shows that they were provided a wide
range of goods and services to help them live independently. Goods and
services ranged from individual counseling and the installation of
ramps to improve accessibility of veterans' homes, to a boat, camping
gear, and computers intended by VA to help decrease veterans' social
isolation. Figure 8 provides examples of the types of benefits
provided in four IL track cases we reviewed. (See appendix III for a
complete list of goods and services we identified in 182 IL track
cases.)
Figure 8: Examples of the Types of Goods and Services Provided in Four
of the Independent Living Track Cases GAO Reviewed:
[Refer to PDF for image: table]
Veteran “A”:
Age: 62;
Service-connected disabilities:
* Combined: 90%;
* Posttraumatic stress disorder: 70%;
* Lumbosacral or cervical strain: 40%;
* Labyrinthitis: 30%;
* Irritable bowel syndrome: 10%;
* Tinnitus: 10%;
* Hearing loss: 0%.
Program goal:
Increase veteran’s social interaction and decrease isolation.
Objective 1: Increase interaction and improve relationships with
veteran’s family members;
Services: Purchase woodworking tools to facilitate woodworking
projects.
Objective 2: Maintain best possible health for veteran;
Services: Continued counseling and medical treatment from VA medical
center.
Veteran "B":
Age: 73;
Service-connected disabilities:
* Combined: 70%;
* Posttraumatic stress disorder: 70%.
Program goal:
Improve veteran’s independent living and psychosocial functioning.
Objective 1: Improve psychosocial functioning through facilitating
passion for, skills, and knowledge of fishing;
Services: Purchase an 18-foot Glasspro flat-bottom boat with motor and
trailer, and follow up support services.
Objective 2: Maximize psychological, social and physical functional
capabilities;
Services: Medical treatments through healthcare provider.
Veteran "C":
Age: 54;
Service-connected disabilities:
* Combined: 80%;
* Major depressive disorder: 70%;
* Irritable bowel syndrome: 30%;
* Sphincter control impairment: 10%.
Program goal:
Maximize independent living skills, heighten community involvement and
enhance quality of life.
Objective 1: Develop embroidery skills by attending classes and
utilizing an embroidery machine; and volunteer embroidery services to
family friends and public institutions;
Services: Provide embroidery machine and accessories, supplies, two
embroidery classes from an embroidery professional, and counseling and
guidance.
Objective 2: Continue attending scheduled medical appointments at the
NC cancer center, and request referrals from case manager as needed;
Services: Referral for medical, emergency dental, vision, and other
services as requested by veteran or deemed necessary by case manager.
Objective 3: Improve and maintain health by attending local gym at
least 3 times a week, make an effort to interact with others, and
reduce stress levels;
Services: Provide six month membership at local gym together with a
personal trainer.
Veteran "D":
Age: 48;
Service-connected disabilities:
* Combined: 100%;
* Stricture of rectum/anus: 100%;
* Ulcerative colitis: 0%.
Program goal:
Maximize independence in daily living and increase quality of life.
Objective 1: Develop computer skills and other leisure/avocational
activities;
Services: Purchase computer and accessories; ergo chair; adjustable
electric desk; foot rest/accessories; oversized easy chair with heat;
and two cooking classes.
Objective 2: Maximize organizationof home activities in kitchen
techniques and reduce reliance on others;
Services: Purchase double oven; microwave; mixer; food processor;
electric jar opener; utensils; and pots, pans, and other kitchen
accessories.
Objective 3: Maintain stability of veteran’s physical and mental
health;
Services: Provide individual and family counseling services (VA
medical center).
Objective 4: Move around in home while grooming and performing
activities of daily living;
Services: Provide grab bars and hand rails; elevate toilet, sink, and
washer/dryer; widen porch steps; purchase mobile kitchen; Tempur-Pedic
pillows and mattress; first aid kit; motion sensitive lighting; and
laundry cart on wheels.
Source: GAO analysis of IL track veterans' case files from fiscal year
2008.
[End of figure]
While VR&E can provide a wide range of benefits to IL track veterans,
VR&E's policy prohibits providing courses of study and training to
veterans that would lead to academic degrees, and purchasing certain
types of equipment, such as lawn tractors.[Footnote 23] Our review of
fiscal year 2008 IL cases shows instances where VR&E purchased lawn
tractors and a riding mower. However, VR&E officials told us that
there was no specific guidance prohibiting provision of such equipment
in that year.
As shown in table 1, we classified the wide range of goods and
services we found in the 182 IL track case files we reviewed into nine
general categories:
Table 1: Categories of Goods and Services Provided to Independent
Living Track Veterans:
Category: Adaptive equipment;
Category Definition: Non-electronic goods that aid in independent
living;
Examples:
* Mattresses;
* Elastic shoelaces;
* Grab bars;
* Medication dispensers.
Category: Assistive devices and technology;
Category Definition: Electronic goods used to improve veterans'
functional capabilities;
Examples:
* Lift chairs;
* Adjustable beds;
* Riding lawn mower/tractors;
* Snow blowers.
Category: Avocational/leisure equipment;
Category Definition: Goods used for hobbies or recreational activities;
Examples:
* Miter saw;
* Camping equipment;
* Boat;
* Silversmithing and engraving tools.
Category: Computer and camera equipment;
Category Definition: Goods related to the purchase of a computer or
camera;
Examples:
* Laptops;
* Printers;
* Memory cards;
* Video camcorder.
Category: Counseling services;
Category Definition: Social, vocational or psychotherapeutic services;
Examples:
* Rehabilitation services;
* IL training;
* Adjustment counseling;
* Psychotherapy.
Category: Education and training;
Category Definition: Education and training for "non-academic"
purposes;
Examples:
* Non-college degrees;
* Computer training;
* Apprenticeships;
* Driving lessons.
Category: Medical care and health-related services;
Category Definition: Services to improve veterans' health;
Examples:
* Dental care;
* Vision care;
* Gym memberships;
* Personal training.
Category: Residential adaptation and repair;
Category Definition: Goods and services related to home remodeling,
construction or repairs to enable veterans to access their homes more
easily;
Examples:
* Home construction;
* Ramp construction;
* Bath safety installations;
* Smoke detector.
Category: Other goods and services;
Category Definition: Goods and services that we were unable to
classify in one of the other categories listed;
Examples:
* IL equipment;
* Boat shipping service;
* Warranties for goods and services purchased;
* Riding lawn mower/tractors
* Snow blowers.
Source: GAO analysis of 182 case files of IL track veterans from
fiscal year 2008.
[End of table]
Although we were unable to estimate the number of times certain goods
and services were provided in the 182 IL track cases we reviewed,
[Footnote 24] we generally found that the most common type of goods or
services provided in the cases we reviewed were in three categories:
1) counseling, 2) education and training, and 3) computer and camera
equipment.
We were, however, able to estimate the costs of the goods and services
purchased for IL track cases. For all veterans who entered the IL
track in fiscal year 2008, we estimate that VR&E purchased a total of
almost $14 million in goods and services.[Footnote 25] The average
spent on purchases of goods and services per IL track case that year
was nearly $6,000.[Footnote 26] In the 182 IL track cases we reviewed,
the total amount VR&E spent on purchases of goods and services per
veteran varied from $20 to over $33,000. Nearly 40 percent of the 182
veterans received $4,000 or more on purchases of goods and services
(see figure 9).
Figure 9: Distribution of Independent Living Track Cases Reviewed by
Costs of Goods and Services Purchased for Veterans:
[Refer to PDF for image: horizontal bar graph]
Number of IL track cases:
Less than $500: 30;
$500 - $999: 15;
$1,000 - $1,999: 25;
$2,000 - $3,999: 42;
$4,000 - $5,999: 27;
$6,000 - $7,999: 9;
$8,000 - $9,999: 11;
$10,000 - $14,999: 13;
$15,000 - $19,999: 4;
$20,000 - $24,999: 4;
$25,000 or more: 2.
Source: GAO analysis of 182 case files of IL track veterans from
fiscal year 2008.
[End of figure]
Most Veterans Completed "Rehabilitation" but with Varying Time Frames:
Most Veterans in the IL Track are Ultimately Classified by VR&E as
"Rehabilitated":
Based on our analysis of IL track veterans who began only one plan
during fiscal year 2008, we found that most of these veterans were
classified by VR&E as "rehabilitated"--successfully reaching and
maintaining the goals identified in their IL plan.[Footnote 27] By the
end of fiscal year 2011, as shown in figure 10, about 89 percent of
veterans who began an IL plan in fiscal year 2008 had been classified
by VR&E as "rehabilitated." About 5 percent of cases were
"discontinued" or closed by VR&E because the rehabilitation goals in
the veteran's IL plan were not completed. The remaining 6 percent of
veterans' cases were still open at the end of fiscal year 2011.
Figure 10: Status at the End of FY 2011 of Independent Living Track
Cases That Began in FY 2008:
[Refer to PDF for image: pie-chart]
Rehabilitated: 89%;
Discontinued: 5%;
Open: 6%.
Source: GAO analysis of VA data.
[End of figure]
Of the 122 IL cases from fiscal year 2008 that had been discontinued,
we found that about half were discontinued because the veteran
declined benefits or did not respond when VA attempted to contact
them. Another 29 percent were discontinued because the veteran died.
Also, some VR&E officials and staff we spoke with during our site
visits told us that veterans may drop out of the IL track for other
reasons, such as their condition worsens or they experience family
problems.
Furthermore, while most veterans were classified by VR&E as
"rehabilitated," we found that the nature and complexity of IL plans
can vary based on veterans' individual disabilities and needs. As
such, some plans are easier for VR&E to close as rehabilitated than
others. For example, in one case we reviewed, the IL plan for a
veteran with rheumatoid arthritis only called for the purchase and
installation of eight door levers and a grab rail for the bathtub, so
that the veteran could enter the rooms of his home without pain or
assistance, and be able to safely enter and exit the bathtub without
fear of falling. Other cases were more complex to close as
rehabilitated because of the nature of services being provided to the
veteran. For instance, another case we reviewed called for providing a
veteran who used a wheel-chair with medical, dental, and vision care
as needed and about $24,000 in modifications to the veteran's home,
including modifying the veteran's bathroom, widening doors and
modifying thresholds, and installing an emergency exit ramp in a
bedroom.
While the overall IL rehabilitation rate nationwide of 89 percent is
fairly high, we found that the percentage of veterans who began an IL
plan in fiscal year 2008 and were rehabilitated by the end of fiscal
year 2011 varied by regional office.[Footnote 28] IL rehabilitation
rates in these cases ranged from 0[Footnote 29] to 100 percent across
regional offices, although about two-thirds of regional offices had
rehabilitated 80 percent or more of 2008 IL track veterans by the end
of fiscal year 2011. (See appendix IV for a complete list of
rehabilitation rates for all regional offices.) In addition, VR&E's IL
rehabilitation rate was higher in regional offices with larger IL
caseloads. Among veterans who entered the IL track in fiscal year
2008, an average of 90 percent were rehabilitated at offices with more
than 25 IL entrants, compared to an average of 79 percent at offices
with 25 or fewer IL entrants (see figure 11).[Footnote 30]
Figure 11: Percentage of FY 2008 Independent Living Track Veterans
Rehabilitated, by Regional Office Based on Caseload:
[Refer to PDF for image: vertical bar graph]
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 5 or less;
Percentage of veterans: 83%;
Number of regional offices with that caseload: 11.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 6 to 10;
Percentage of veterans: 76%;
Number of regional offices with that caseload: 9.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 11 to 25;
Percentage of veterans: 80%;
Number of regional offices with that caseload: 10.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 26 to 50;
Percentage of veterans: 84%;
Number of regional offices with that caseload: 10.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 51 to 100;
Percentage of veterans: 92%;
Number of regional offices with that caseload: 8.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): More than 100;
Percentage of veterans: 90%;
Number of regional offices with that caseload: 8.
Source: GAO analysis of VA data.
Note: This table represents those veterans with only one IL plan who
entered the IL track in fiscal year 2008 and who were rehabilitated by
the end of fiscal year 2011.
[End of figure]
The Time to Rehabilitate IL Track Veterans Varied by Regional Office
and Veteran Age:
Furthermore, we found that fiscal year 2008 IL track veterans
nationwide completed their IL plans, i.e., were classified
rehabilitated, in an average of 384 days (about 13 months).[Footnote
31] About 50 percent of these veterans completed their IL plans within
one year, 79 percent within 2 years, and 88 percent within 3 years.
Average days for these IL track veterans to complete their plans
varied by regional office from a low of 150 days at the St. Paul
Regional Office to a high of 895 days at the Roanoke Regional Office.
[Footnote 32] However, at most regional offices (49 of 53)[Footnote
33] the average time to complete IL plans ranged from 226 to 621 days
(8 to 21 months). (See appendix V for a complete list of
rehabilitation times for all regional offices.) Also, as shown in
figure 12, IL track veterans generally completed their plans in less
time at regional offices with larger IL caseloads than at offices with
smaller caseloads.
Figure 12: Average Length of Time to Complete an Independent Living
Plan, by Regional Office Based on Caseload:
[Refer to PDF for image: vertical bar graph]
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 5 or less;
Average number of days: 406;
Number of regional offices with that caseload: 11.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 6 to 10;
Average number of days: 407;
Number of regional offices with that caseload: 9.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 11 to 25;
Average number of days: 455;
Number of regional offices with that caseload: 10.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 26 to 50;
Average number of days: 402;
Number of regional offices with that caseload: 10.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): 51 to 100;
Average number of days: 372;
Number of regional offices with that caseload: 8.
Regional office caseload (Number of veterans beginning an IL plan in
fiscal year 2008): More than 100;
Average number of days: 375;
Number of regional offices with that caseload: 8.
Source: GAO analysis of VA data.
Note: This table represents those veterans who began one IL plan in
fiscal year 2008 and were rehabilitated by the end of fiscal year 2011.
[End of figure]
The average time for veterans to complete their IL plans also varied
by veteran age. The oldest veterans completed their plans slightly
more quickly than the youngest. More specifically, veterans who were
70 to 79 completed their plans in an average of 369 days, while those
who were 20 to 29 completed them in an average of 413 days (see figure
13).[Footnote 34]
Figure 13: Average Time to Complete Independent Living Plans, by
Veteran Age Groups:
[Refer to PDF for image: vertical bar graph]
Age of IL track veterans: 20 to 29;
Average number of days: 413;
Number of IL track veterans: 63.
Age of IL track veterans: 30 to 39;
Average number of days: 384;
Number of IL track veterans: 137.
Age of IL track veterans: 40 to 49;
Average number of days: 391;
Number of IL track veterans: 327.
Age of IL track veterans: 50 to 59;
Average number of days: 380;
Number of IL track veterans: 670.
Age of IL track veterans: 60 to 69;
Average number of days: 384;
Number of IL track veterans: 608.
Age of IL track veterans: 70 to 79;
Average number of days: 369;
Number of IL track veterans: 115.
Age of IL track veterans: 80 or older;
Average number of days: 392;
Number of IL track veterans: 65.
Source: GAO analysis of VA data.
Note: This table represents those veterans who began one IL plan in
fiscal year 2008 and were rehabilitated by the end of fiscal year 2011.
[End of figure]
GAO Analysis of Likelihood of Veterans Completing Their IL Plans:
Because differences in the length of time to complete IL plans could
have occurred by chance or be explained by many factors--including the
type and severity of disability or veteran age--we used a statistical
model to estimate the amount of time it would take certain groups of
IL track veterans to complete their IL plans while controlling for
type and severity of disability and other demographic characteristics.
[Footnote 35] (See appendix II for more detailed information on our
model and analysis.) The results of our model showed that the chance
of rehabilitation within 2 years varied by regional office. At four
regional offices the chance of being rehabilitated within 2 years was
less than 50 percent. At 18 offices the chance was between 50 and less
than 90 percent. At 16 offices the chance was 90 percent or greater.
Our model also estimated that a veteran served by a regional office
with a large IL caseload had a higher probability of completing an IL
plan more quickly than a veteran served by an office with a small IL
caseload. More specifically, we determined that a typical IL track
veteran at an office with a total of 75 IL cases entering the IL track
during fiscal years 2008 through 2011 had a 48 percent chance of
completing an IL plan within 1 year and a 92 percent chance of
completing an IL plan within 3 years,[Footnote 36] while a veteran at
a regional office with 700 IL cases had a 57 percent chance of
completing an IL plan within 1 year and a 96 percent chance of
completing their plan within 3 years (see figure 14).[Footnote 37]
Finally, based on our model we estimated that older veterans had a
higher probability of completing an IL plan more quickly than younger
veterans. For example, a 75 year old veteran had a 41 percent chance
of completing an IL plan within one year, while a 30 year old veteran
had a 33 percent chance. We found no meaningful differences in the
time it takes to complete an IL plan as "rehabilitated" according to
veteran gender and most disability types. However, we found small
differences according to length of military service, education, and
combined service-connected disability rating (see appendix II).
Figure 14: Estimated Probability of a Veteran Completing an
Independent Living Plan Within Certain Time Periods, by Regional
Office Based on Caseload:
[Refer to PDF for image: 3 vertical bar graphs]
Regional office caseload (Number of veterans beginning one IL plan in
fiscal years 2008-2011): 75;
Estimated probability of a veteran’s rehabilitation within 1 year: 48%;
Estimated probability of a veteran’s rehabilitation within 2 years:
81%;
Estimated probability of a veteran’s rehabilitation within 3 years:
92%.
Regional office caseload (Number of veterans beginning one IL plan in
fiscal years 2008-2011): 150;
Estimated probability of a veteran’s rehabilitation within 1 year: 49%;
82%;
Estimated probability of a veteran’s rehabilitation within 3 years:
92%.
Regional office caseload (Number of veterans beginning one IL plan in
fiscal years 2008-2011): 275;
Estimated probability of a veteran’s rehabilitation within 1 year: 51%;
Estimated probability of a veteran’s rehabilitation within 2 years:
84%;
Estimated probability of a veteran’s rehabilitation within 3 years:
94%.
Regional office caseload (Number of veterans beginning one IL plan in
fiscal years 2008-2011): 700;
Estimated probability of a veteran’s rehabilitation within 1 year: 57%;
Estimated probability of a veteran’s rehabilitation within 2 years:
89%;
Estimated probability of a veteran’s rehabilitation within 3 years:
96%.
Source: GAO analysis of VA data.
Note: Estimates were calculated from a statistical model. See appendix
I and II for more information.
[End of figure]
VR&E Exercises Limited Oversight of the IL Track:
National oversight of VR&E's IL track is limited in four key areas:
(1) ensuring compliance with case management requirements; (2)
monitoring regional variation in IL track caseload and benefits
provided; (3) adequacy of policies and procedures for approving
expenditures on goods and services for IL track veterans; and (4)
availability of critical program management information.
Regional Offices May Not Be Complying With VR&E Case Management
Requirements:
Based on VR&E's compliance reports from two of the regional offices we
visited and interviews with staff in these offices, we found that some
offices may not be complying with certain VR&E case management
requirements governing the IL track. Specifically, some Vocational
Rehabilitation Counselors (VRC) are not fulfilling VR&E's requirement
to meet in-person each month with IL track veterans to monitor
progress in completing their IL plans.[Footnote 38] Site visit
monitoring reports[Footnote 39] from two regional offices we visited
indicated that these offices faced difficulties complying with this
requirement. According to these reports, some VRCs were not able to
schedule monthly in-person meetings with IL track veterans to check
their progress in completing their IL plans. In addition, VRCs we
spoke with during our site visits said that compliance with this
requirement continues to be a challenge due to the size of their
caseloads and the distances that they have to travel to meet with
veterans. While VR&E's Central Office acknowledges that it can be
challenging for some offices to comply with this requirement,
officials stated that face-to-face contact with IL track veterans is
extremely important due to the nature of their disabilities and the
need for more intensive rehabilitation services.[Footnote 40]
Furthermore, while VR&E and VHA both have policies that require them
to coordinate on the provision of goods and services for IL track
veterans, we found that some VRCs experience challenges in doing
so.[Footnote 41] Specifically, VA regulations governing VR&E's IL
track require that if a veteran needs special equipment and is
eligible for such equipment under another VA program, the items will
be provided under that program.[Footnote 42] Therefore, prior to VR&E
purchasing services for veterans, officials told us that VRCs are
required to refer cases to other VA providers, such as VHA's Home
Improvements and Structural Alterations (HISA) program and VA medical
centers, to determine whether veterans are eligible to receive the
goods and services identified in their plan from these providers. In
addition, VHA 's policy directive for coordinating with VR&E is
intended to ensure that all VR&E participants, including those in the
IL track, receive timely access to VHA health care services. The
directive requires medical center directors to (1) provide clinically
appropriate care to VR&E participants, (2) establish procedures to
manage these participants' timely access to care, and (3) ensure that
clinical staff are trained in these procedures, including how to alert
appropriate VBA officials when timeliness of care could be an issue,
among other requirements.[Footnote 43]
Despite these VR&E and VHA policies, our review of 182 IL track
records found some instances where VR&E purchased goods and services
that appear to be medically related, such as ramps and grab bars, and
could have been provided by VHA. There may have been little
coordination on IL track cases because, as VR&E officials and staff at
the five VA regional offices we visited told us, coordinating with VHA
medical center staff can be challenging. Several VRCs indicated that
when they refer IL track cases to VHA physicians to determine whether
any of the medical-related benefits identified in the IL plans--such
as grab bars, wheelchairs, and safety rails--had been or could be
provided by VHA, in many instances, VHA physicians do not respond or
respond too late. As a result, services for IL track veterans were
either delayed or purchased by VR&E instead of VHA. According to some
VHA staff, lack of or delays in coordination are sometimes due to
differences in VR&E rehabilitation goals and VHA long-term medical
goals for veterans. For example, VHA staff members mentioned they
would not approve VRCs' requests for lift chairs unless veterans
absolutely needed them because VHA staff members said their medical
goal is to promote continued mobility.
VR&E Does Not Systematically Monitor Variation in IL Track Caseload
Size and Benefits Provided:
While IL track caseload size and benefits vary across regions, VR&E
does not systematically monitor these variations. We found regional
differences in the size of IL caseloads, the range of needs covered in
a veteran's IL plan, and the types of goods and services provided. As
shown in figure 15, the total IL track caseload during fiscal years
2008 through 2011 ranged from over 900 cases in the Montgomery
Regional Office in Alabama to 4 cases in the Wilmington Regional
Office in Delaware. (See appendix VI for annual IL caseload data.)
While one would expect differences in caseload size based on the
number of veterans in an office's service area, some differences in IL
caseload could not be explained by the size of the veteran population
in an office's service area. For example, while the estimated size of
the veteran populations in Alabama and Massachusetts are similar,
Montgomery's IL caseload of over 900 veterans was more than 100 times
as large as Boston's IL caseload of 8 veterans. VR&E officials told us
they are aware that some offices have low IL participation levels, and
attributed some of the difference to factors, such as the presence of
specialized treatment centers in certain areas of the county that can
increase caseload numbers in those regions. However, evidence from our
site visits suggests that there may be other factors that drive the
number of veterans entering a region's IL track. For example,
officials from the Detroit Regional Office--which had the second
highest total IL caseload across fiscal years 2008 through 2011--
attributed the size of their caseload to their office's focus on IL
cases and community outreach efforts, including the involvement of
veteran service organizations. The Atlanta Regional Office also
mentioned that in addition to the size of the veteran population in
Georgia and the presence of army bases, the size of their IL caseload
is influenced by increased community interest in the IL track in
recent years, and the informal efforts of past IL participants to
provide information about the IL track to other veterans.
Figure 15: The Vocational Rehabilitation and Employment Program's
Overall Independent Living Caseload from FY 2008-2011, by Regional
Office:
[Refer to PDF for image: illustrated U.S. map]
Number of cases in 2011:
Albuquerque, New Mexico: 221.
Anchorage, Alaska: 12;
Atlanta, Georgia: 627;
Baltimore, Maryland: 41;
Boise, Idaho: 24;
Boston, Massachusetts: 8;
Buffalo, New York: 154;
Chicago, Illinois: 26;
Cleveland, Ohio: 181;
Columbia, South Carolina: 126;
Denver, Colorado: 146;
Des Moines, Iowa: 97;
Detroit, Michigan: 709;
Fargo, North Dakota: 45;
Fort Harrison, Montana: 25;
Hartford, Connecticut: 231;
Honolulu, Hawaii: 93;
Houston, Texas: 471;
Huntington, West Virginia: 58;
Indianapolis, Indiana: 360;
Jackson, Mississippi: 85;
Lincoln, Nebraska: 58;
Little Rock, Arkansas: 80;
Los Angeles, California: 251;
Louisville, Kentucky: 164;
Manchester, New Hampshire: 7;
Milwaukee, Wisconsin: 38;
Montgomery, Alabama: 908;
Muskogee, Oklahoma: 118;
Nashville, Tennessee: 78;
Newark, New Jersey: 259;
New Orleans, Louisiana: 74;
New York, New York: 702;
Oakland, California: 462;
Philadelphia, Pennsylvania: 82;
Phoenix, Arizona: 440;
Pittsburgh, Pennsylvania: 22;
Portland, Oregon: 56;
Providence, Rhode Island: 58;
Reno, Nevada: 89;
Roanoke, Virginia: 25;
Salt Lake City, Utah: 63;
San Diego, California: 144;
San Juan, Puerto Rico: 9;
St. Louis, Missouri: 166;
St. Paul, Minnesota: 31;
St. Petersburg, Florida: 523;
Seattle, Washington: 79;
Sioux Falls, South Dakota: 46;
Togus, Maine: 58;
Waco, Texas: 264;
Washington, D.C.[A]: 22;
White River Junction, Vermont: 11;
Wichita, Kansas: 18;
Wilmington, Delaware: 4;
Winston-Salem, North Carolina: 66.
Source: GAO analysis of VA data.
[A] The Washington Regional Office, located in the District of
Columbia, was recently designated the National Capital Region Benefits
Office in November 2012.
[End of figure]
Based on discussions with regional personnel and our review of the
results of past studies, IL plans and the goods and services provided
can also vary by region. According to VR&E officials, the law gives VA
broad discretion in defining the range of needs covered in an IL track
plan, as well as in choosing the types of goods and services required
to achieve the plan's goals. VR&E's policy does, however, prohibit the
agency from providing courses of study and training leading to
academic degrees, and purchasing certain types of equipment, such as
lawn tractors. As a result, some regions appear to develop IL plans
that address a broader range of needs while others elect to develop
more focused plans. Officials we spoke with during our site visits
also confirmed that regions differ in their approach to developing IL
plans, and in one region, officials commented that some regions may
develop simpler plans with fewer benefits to achieve VR&E's
rehabilitation goal. Moreover, VR&E's 2008 study of the IL track
reported that some regions relied repeatedly on the same types of
benefits to meet veterans' IL needs.[Footnote 44] For example, in the
New York and Hartford regional offices, nearly 90 percent of IL
participants were provided computer training. This was almost twice
the rate of Detroit--the office with the next highest rate of
providing veterans with computer training--in 44 percent of its IL
cases. Other offices focused more heavily on providing goods or
services to support veterans' avocational interests or on finding
veterans volunteer opportunities, while some consistently focused on
providing veterans with health club memberships. For example, the St.
Petersburg Regional Office accounted for 33 percent of veterans
receiving volunteer opportunities. In addition, the 2004 VR&E Task
Force report noted significant differences in field office philosophy
regarding the scope and administration of the IL track, and also
recommended providing VR&E Central Office greater "line-of-site
authority" over VR&E field operations.[Footnote 45] As noted earlier,
VBA's Office of Field Operations rather than VR&E's Central Office has
direct line of authority over regional VR&E staff and operations.
While VA officials acknowledged the existence of regional variation in
these areas, VR&E's current oversight approach may not be adequate to
ensure consistent administration of the IL track across regions. The
standards for internal control in the federal government emphasize the
need for federal agencies to have timely information to effectively
monitor and mitigate program risks.[Footnote 46] To oversee
administration of the IL track, VR&E has relied on the information
provided through its general quality assurance (QA) activities and a
series of periodic ad hoc studies. The QA activities are conducted by
each region as well as VR&E's QA staff located in Nashville,
Tennessee. However, these activities are limited in scope, frequency,
and how the information is used. At the national level, a team of VR&E
QA staff are required to perform periodic site visits to each VA
regional office at least every 3 years, although officials told us
they have not been able to meet this goal in recent years because of
budgetary constraints. This team also periodically reviews a sample of
veterans' records from VR&E's IL and employment tracks in selected
regions. After each site visit and case review, the QA team produces a
report for the particular region under review. The results of these QA
activities are not systematically compared across all regional offices
to identify any variations between offices or any similar problems.
In addition to these QA activities, VA has funded two studies over the
past several years on the VR&E program, including implementation of
the IL track, and a third is under way.[Footnote 47] In 2003, VA
appointed a task force to evaluate the overall VR&E program and
recommend ways service delivery could be improved. In 2008, as
mentioned, a study was issued by VR&E on the types of services
received by IL track participants and the impact those services had on
veterans.[Footnote 48] This study found, among other things, that IL
participants received a broad range of services, and that some
regional offices favored providing certain types of services to IL
track veterans. Finally, in October 2012, VR&E awarded a $7 million
contract for a study covering the IL track service delivery process,
barriers and incentives for field staff when considering the provision
of services, current and future training strategies, and other areas.
VR&E officials anticipate receiving the final results from this study
in July 2013.
VR&E Policy for Approving IL Track Expenditures Might Not be Adequate:
Considering the broad discretion VR&E provides to regions in
determining the range of needs covered in IL track plans and the types
of goods and services selected to meet these needs, VR&E’s current
policy for approving IL track expenditures may not be adequate. To
guard against fraud, waste, abuse, and mismanagement, the standards
for internal control emphasize the need for agencies to have
appropriate levels of supervision and controls in place to prevent one
individual from having responsibility for all key aspects of a
transaction or event.[Footnote 49] VR&E Central Office is responsible
for managing the program’s national budget. While officials told us
that VRCs are required to include all cost estimates when they submit
veterans’ IL plans to be reviewed and approved by the region’s VR&E
Officer, VR&E was unable to provide any written policy or guidance
that explicitly states this requirement for all IL expenditures.
[Footnote 50] VR&E’s current written policies allow each region to
unilaterally approve construction-related expenditures up to $25,000
per case and non-construction expenditures up to $100,000 per case
without approval from VR&E Central Office. In addition, VRCs can spend
up to $2,000 on construction-related expenditures and up to $25,000 on
non-construction expenditures without supervisory review of any kind
(see table 2). Under this policy, regional offices are permitted to
purchase a broad range of items without any Central Office approval,
resulting in some offices purchasing goods and services that may be
questionable or that are costly. For example, in one of the 182 IL
cases we reviewed, VR&E Central Office would not have been required to
approve total expenditures of $18,829 for a riding lawn mower—-which
VR&E policy prohibits[Footnote 51]-—and other IL goods and services
including a bed, bed frame, desktop computer, and woodworking
equipment. In another case, VR&E Central Office would not have been
required to approve total expenditures of $18,829 for a riding lawn
mower--which VR&E policy prohibits--and other IL goods and services
including a bed, bed frame, desktop computer, and woodworking
equipment. In another case, VR&E Central Office approval would not
have been required for the purchase of a boat, motor, trailer, and the
boat's shipping cost to Molokai, Hawaii, among other items, totaling
about $17,500.[Footnote 52] Without appropriate approval levels,
VR&E's IL track may be vulnerable to potential fraud, waste, and abuse.
Table 2: Level of Approval Required for Construction and Non-
Construction Related Expenditures in Independent Living Track Cases:
Required level of approval: No supervisory approval required;
Construction-related expenditures: Less than $2,000;
Non-construction related expenditures: Less than $25,000.
Required level of approval: Regional VR&E Officer;
Construction-related expenditures: [Empty];
Non-construction related expenditures: $25,000 to less than $75,000.
Required level of approval: Regional Office Director;
Construction-related expenditures: $2,000 through $25,000;
Non-construction related expenditures: $75,000 through $100,000.
Required level of approval: VR&E Central Office;
Construction-related expenditures: More than $25,000;
Non-construction related expenditures: More than $100,000.
Source: GAO analysis of VA policies.
[End of table]
VR&E Lacks Critical Information Needed for Oversight:
VR&E does not collect or report critical program management
information--such as the costs of goods and service purchased, the
types of benefits provided, and the number of IL veterans served--that
would help the agency in its oversight responsibilities. Specifically,
VR&E's Corporate WINRS case management system--commonly referred to as
"CWINRS"--lacks information on the total amount of funds VR&E expends
on IL benefits because the agency does not maintain specific cost
information on each of its five tracks or the key program areas these
tracks represent, which are employment services and independent
living. VR&E aggregates costs across all its tracks, despite VA's
managerial cost accounting policies that require the costs of products
and services to be captured for management purposes.[Footnote 53]
Federal financial accounting standards also recommend that costs of
programs be measured and reported.[Footnote 54] According to
officials, they do not collect cost information on the IL track alone
because they view the five tracks as a single program with the same
overarching goal--to help veterans achieve their employment goals.
However, in our 2009 report on the VR&E program,[Footnote 55] we
reported that VR&E serves veterans with fundamentally different
program goals and outcomes--those seeking to obtain employment and
those seeking to live independently.[Footnote 56] As a result, we
recommended that VR&E separately track its IL rehabilitation rate.
In addition, the CWINRS system does not collect information on the
types of IL benefits provided to veterans in a standardized manner
that can be easily aggregated and analyzed for oversight purposes.
Currently, VRCs are required to write in a description of the benefits
they purchased for IL track veterans in CWINRS. We found, however,
that the recorded descriptions lack consistency and vary in their
level of detail. In several of the IL track cases we reviewed, the
goods and services purchased were grouped together under a general
description, such as "IL equipment" or "IL supplies," without any
further details. In other cases, VRCs recorded each purchase
separately. For instance, in one case, the VRC created separate
entries for each item purchased, for example, "desktop computer,"
"computer desk," "Queen Mattress," "all in one printer," "USB cable
and ink," "threshold ramp," and "washer." In addition, we found that
controls for data entry are not adequate to ensure that all important
data is recorded.[Footnote 57] For example, we estimated that the
service provider field was either missing or unclear for one or more
services in about 15 percent of all IL cases that began in fiscal year
2008. Moreover, in another 7 percent of IL cases that began during
fiscal year 2008, we found that service provider data was unavailable
because CWINRS had overwritten veterans' 2008 IL plans with subsequent
plans. CWINRS only retains veterans' current IL plan.[Footnote 58]
Furthermore, CWINRS does not provide VR&E with the information it
needs to account for the actual number of IL track veterans it serves
to monitor its statutory entrant cap and program operations. The law
allows VR&E to initiate "programs" of independent living services and
assistance for no more than a specified number of veterans each year,
which is currently set at 2,700.[Footnote 59] A VR&E policy letter to
VA regional offices, dated December 14, 2010, states that "VR&E
Service will monitor new IL programs by tracking the number of
veterans entering independent living case status in each fiscal year
and notify the field of any necessary action if the 2,700 statutory
limit is being approached."[Footnote 60] However, in analyzing VR&E's
administrative data, we found that VR&E counts the number of IL plans
developed annually and not the number of individual veterans admitted
to the track. VR&E officials told us that the law does not limit the
number of IL plans that can be developed for a veteran in a single
fiscal year.[Footnote 61] Because multiple IL plans can be developed
for an individual veteran during the same fiscal year, veterans with
multiple plans are counted more than once towards the statutory cap by
CWINRS. Based on data from CWINRS, most (96 percent) of the 9,215
individual veterans in the IL track at some point during fiscal years
2008 through 2011 had only one IL plan, but 403 had more than one. The
highest number of IL plans developed for an individual veteran was
four, which occurred in two separate cases. From fiscal years 2008
through 2011, VR&E did not exceed the statutory cap (see figure 16).
Figure 16: Number of and Statutory Cap on Veterans Entering the
Independent Living Track from FY 2008-2011:
[Refer to PDF for image: vertical bar graph]
Fiscal year: 2008;
Statutory cap: 2,500;
IL track veterans who started that fiscal year: 2,465;
Percentage of cap used: 95%.
Fiscal year: 2009;
Statutory cap: 2,600;
IL track veterans who started that fiscal year: 2,260;
Percentage of cap used: 87%.
Fiscal year: 2010;
Statutory cap: 2,600;
IL track veterans who started that fiscal year: 2,209;
Percentage of cap used: 82%.
Fiscal year: 2011;
Statutory cap: 2,600;
IL track veterans who started that fiscal year: 2,281;
Percentage of cap used: 84%.
Source: GAO analysis of VA data.
[End of figure]
Moreover, VR&E officials indicated that they were unaware that CWINRS
was calculating the number of plans and not individual veterans. As a
result, VR&E lacks complete information on the number of veterans it
is serving through the IL track at any given time--information it
could use to better manage staff, workloads, and program resources.
According to the standards for internal control, it is important for
program managers to have reliable and timely "operational" information
to ensure agency goals are met, resources are used efficiently and
effectively, and requirements under various laws and regulations are
being complied with.[Footnote 62]
Finally, recent evaluations of CWINRS have determined that the system
does not meet VR&E's current needs and limits its oversight abilities
because important data elements are not captured to support the
agency's "evolving business needs."[Footnote 63] According to a 2012
VR&E report, VR&E plans to improve CWINRS by (1) increasing data
automation to reduce instances of human error, and (2) enhancing
system controls to improve the accuracy and comprehensiveness of the
data, among other improvements. However, it appears that the CWINRS
redesign will not enable VR&E to obtain data on IL track expenditures
from the system or to use the system to accurately and efficiently
track the types of goods and services the IL track provides. While
officials told us that they plan to modify the system to enable them
to track individual veterans served through the IL track, they could
provide no time frame for this project and noted that it could take up
to 3 years to obtain funding for it.
Conclusions:
VR&E's IL track can provide a wide range of benefits to help veterans
with service-connected disabilities maximize their ability to live
independently when the achievement of an employment goal is not
currently feasible. Under the law, each VA region has broad discretion
in determining the range and types of goods and services each IL track
veteran should receive. Consequently, adequate oversight at the
national level is extremely important in ensuring that IL track case
management requirements are met, the track is administered
consistently across regions, expenditures for goods and services are
appropriate, and critical IL track information is collected and used.
In this context and absent better coordination with VHA, VR&E will
continue to face challenges in ensuring goods and services for IL
track veterans are provided by VHA, when appropriate, in a timely
manner. With regard to VR&E's Central Office oversight, its current
policy governing the review and approval of expenditures might not
effectively mitigate the risk of fraud, waste, abuse, or mismanagement
inherent in activities, such as the development and implementation of
IL plans, where there are few limitations on the types and cost of
goods and services that can be provided. Furthermore, without
collecting information on cost and the types of benefits regional
offices provide to IL track veterans, and maintaining an information
system that ensures IL track data are recorded consistently and are
accurate and complete, VR&E cannot effectively oversee the performance
and activities of its IL track. Finally, as more servicemembers from
the conflicts in Iraq and Afghanistan transition into civilian life
and veterans' programs and as the overall veteran population ages, the
demand for IL services will likely increase. VR&E must, therefore, be
able to accurately count the number of individual IL track veterans
served to ensure it can effectively manage its cap and assess program
performance and resource needs.
Recommendations for Executive Action:
The Secretary of Veterans Affairs should direct the Undersecretary for
Benefits to take the following actions:
1. Work with the Undersecretary for Health to explore options on ways
to enhance coordination to ensure IL track veterans' needs are met by
VHA, when appropriate, in a timely manner. This could include
improving staff education, response times to IL referrals, and the
provision of medically related goods and services.
2. Implement an oversight approach that enables VR&E to better ensure
consistent administration of the IL track across regions. In
developing this approach, consider ensuring that VR&E's CWINRS system:
* Tracks the total cost and types of benefits provided to each veteran
in the IL track by regional office.
* Accounts for the number of individual veterans served to ensure that
the agency has the information it needs to adequately manage the IL
track.
* Contains stronger data entry controls to ensure that IL track
information is recorded in a consistent manner and is accurate and
complete.
3. Reassess and consider enhancing the agency's current policy
concerning the required level of approval for IL track expenditures,
given the broad discretion individual regional offices have in
determining the types of goods and services IL track veterans receive.
Agency Comments and Our Evaluation:
We provided a draft of this report to the Secretary of Veterans
Affairs for review and comment. VA generally agreed with our
conclusions, and concurred with our three recommendations. VA’s
written comments are reproduced in appendix VII. In addition, VA
provided technical comments that we have incorporated in the report
where appropriate. With regards to our recommendation that VA enhance
coordination between VR&E and VHA on the provision of IL benefits to
veterans, VA noted there are efforts underway that will permit VR&E
counselors to make IL referrals to VHA providers through VHA’s
Compensation and Pension Record Interchange system, also referred to
as CAPRI. In addition to these efforts, we encourage VR&E and VHA to
continue to explore other options to enhance coordination, such as
engaging in staff education and training efforts to improve the timely
provision of IL benefits and prevent any duplication. Furthermore,
with regards to our recommendation to improve IL track oversight, VA
said that it will perform an assessment of its current IL track
oversight procedures and consider including enhancements to CWINRS.
Because having a sound information system plays such a critical role
in helping program managers monitor agency performance and operations,
we urge VA to take steps to prioritize enhancements to CWINRS.
Finally, VA noted that, in response to our recommendation that it
reassess its current policy for approving IL track expenditures, it
plans to make any needed improvements by March 2014. As part of its
assessment process, we believe that VA should review its existing cost-
thresholds for approving all IL expenditures, including non-
construction related expenditures, to ensure adequate oversight of
goods and services purchased for veterans.
We are sending copies of this report to the appropriate congressional
committees, the Secretary of Veterans Affairs, and other interested
parties. The report is also available at no charge on the GAO web-site
at [hyperlink, http://www.gao.gov].
If you or your staff members have any questions about this report,
please contact me at (202) 512-7215 or at bertonid@gao.gov. Contact
points for our Offices of Congressional Relations and Public Affairs
may be found on the last page of this report. Staff members who made
key contributions to this report are listed in appendix VIII.
Signed by:
Daniel Bertoni:
Director, Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Objectives, Scope, and Methodology:
The objectives of this report were to examine (1) the characteristics
of veterans who have participated in the IL track, as well as the
types and costs of benefits they were provided; (2) the extent to
which their independent living plans were completed, and the time it
took; and (3) the extent to which the IL track has been administered
appropriately and consistently.
To answer these objectives, we used a variety of methodologies, which
are described in greater detail below. Specifically, we analyzed VA
administrative data from fiscal years 2008 through 2011 to provide
information on the characteristics and outcomes of veterans who
participate in the IL track, and how long it takes to achieve these
outcomes. We also used statistical models to determine any differences
in rehabilitation times. In addition, to determine the types of
benefits provided and their costs, we conducted a case file review of
a random, generalizable sample of 182 veterans who started in the IL
track during fiscal year 2008. Lastly, to examine the administration
of the IL track, we visited five VA regional offices and interviewed
officials and staff from VR&E, Specially Adapted Housing (SAH),
Prosthetics and Sensory Aid Service (PSAS) under the Veterans Health
Administration (VHA), and veteran service organizations. We also
reviewed relevant federal laws and regulations, standards for internal
controls and managerial cost accounting, as well as VR&E policies,
procedures, and other relevant studies and documentation.
Analysis of VA Administrative Data:
We analyzed VA administrative data in the Corporate WINRS system--
commonly referred to as "CWINRS"--from fiscal years 2008 through 2011
to describe the characteristics and outcomes of veterans in the IL
track, and how long it takes veterans to achieve these outcomes.
[Footnote 64] We began our analysis in fiscal year 2008 because
officials told us the data was not reliable in previous years and
modifications were made to improve its reliability in fiscal year
2007. We assessed the reliability of the data by performing electronic
testing, reviewing existing documentation, and interviewing
knowledgeable agency officials. Based on these efforts, we found the
data to be sufficiently reliable for our purpose, unless otherwise
noted.
To identify our universe of 9,215 veterans who started in the IL track
during fiscal years 2008 through 2011, we counted the number of
individual veterans who had an "IL status" recorded in CWINRS during
our time frame.[Footnote 65] While veterans can enter into the IL
track more than once in a given fiscal year, we counted a veteran only
once if he or she had more than one IL status during these years. To
determine the characteristics of the 9,215 veterans who began in the
IL track during fiscal years 2008 through 2011, we examined several
demographic variables in CWINRS, including veterans' age, gender,
types of disabilities, and combined disability rating. Data on the war
era in which veterans served was obtained from VA's Benefits Delivery
Network.
To examine the outcomes of veterans in the IL track, we limited our
analysis to veterans who began only one IL plan at some point during
fiscal year 2008. This accounted for about 92 percent of the 2,465
veterans who began an IL plan during fiscal year 2008. The remaining 8
percent of veterans who had more than one plan were excluded from our
analysis because of potential data reliability issues associated with
how certain case actions were recorded. In our analysis of IL veteran
rehabilitation rates, we excluded veterans whose cases were
transferred to one of VR&E's employment tracks.
To estimate the difference in rehabilitation times across regional
offices and groups of veterans with various characteristics, we used
different statistical models. These "survival modeling" methods
allowed us to appropriately estimate rehabilitation probabilities at
various points in an IL plan, even when a significant proportion of
the cases are discontinued or in progress. Our models used the same VA
administrative data noted above for veterans in the IL track who began
only one IL plan at some point during fiscal years 2008 through 2011.
Consequently, our model results only apply to a subset of veterans,
which make up about 95 percent of the veterans who began in the IL
track during this time frame. For a detailed discussion of our
statistical models, see appendix II.
Analysis of IL Veteran Cases:
To obtain information on the types of benefits provided through the IL
track, as well as the costs and coordination of these benefits, we
conducted a case file review of a random, generalizable sample of 182
veterans whose cases started in the IL track at some point during
fiscal year 2008. To track and manage IL cases, VR&E utilizes both
paper records located at each regional office, and electronic case
records in the CWINRS system.For the purpose of our file review, we
used veterans' electronic records in CWINRS, and found the information
in these records to be sufficient for our purpose.[Footnote 66] We
selected fiscal year 2008 because it allowed us to follow veterans'
progress in the IL track beyond 24 months--the authorized benefit
duration time frame unless a six-month extension is approved.
We stratified our sample of 182 cases into three groups--those
veterans' whose cases were (1) rehabilitated, (2) discontinued, or (3)
still open.[Footnote 67] We used this approach to obtain information
on any differences in IL benefits and expenditures by veteran groups.
We also elected to use a sample design that mixes the features of a
proportional allocation and equal sample per stratum. Table 3 provides
more detailed information on our sample stratification.
Table 3: Size of Sample of Independent Living Track Cases, by Strata
and Proportion of Population:
Sample strata: Rehabilitated cases;
Number of Cases: 88.
Sample strata: Discontinued cases;
Number of Cases: 47.
Sample strata: Open cases;
Number of Cases: 47.
Sample strata: Total;
Number of Cases: 182.
Source: GAO analysis of VA data.
[End of table]
To produce population estimates from our sample of cases, information
collected from each case reviewed was weighted in the analysis to
account statistically for the total population of all IL track cases
started in fiscal year 2008. Because our estimates for the entire
population of IL track cases that started in fiscal year 2008 are
based on a probability sample of these cases, they are subject to
sampling error. To recognize the possibility that other samples drawn
from this population might yield different results, we express our
confidence in the precision of our sample's results as a 95 percent
confidence interval. A 95 percent confidence interval is expected to
include the actual value for the population in 95 out of 100 samples
drawn from the population. With regard to expenditures in IL track
cases, at the 95 percent confidence interval, the amount of total
expenditures across all IL track cases that started in fiscal year
2008 falls between $11.3 million and $16.6 million; the actual amount
expended, on average, in these cases falls between $4,835 and $7,104.
To conduct our case file review, we developed a web-based data
collection instrument to record information from the electronic
printouts VR&E provided us with of veterans' records. After these
records were collected, GAO staff members entered the information into
the electronic data collection instrument for each veteran case in our
sample. Once the data was entered, a second GAO staff member reviewed
each entry for clarity and accuracy. With regard to the types of
benefits provided to IL track veterans, we cannot generalize the types
of goods and services provided because we recorded in our data
collection instrument information on only eight goods and services
identified in each of the 182 IL case files we reviewed. However, we
were able to generalize information we obtained on IL track service
providers from the IL cases we reviewed because in less than 3 percent
of these cases, there were at least eight service providers. Our
estimate of the number of cases where service provider information was
missing, unclear, or overwritten in CWINRS may be slightly
understated. The 95 percent confidence interval for the 15 percent of
cases where the service provider information was unclear or missing
for one or more service ranged from 9 to 21 percent. The 95 percent
confidence interval for the 7 percent of cases we reviewed where one
or more service was overwritten in CWINRS ranged from 4 to 11 percent.
Regional Site Visits and Agency Interviews:
To better understand the extent to which the IL track is being
effectively administered, we visited five VA regional offices--San
Diego, California; Atlanta, Georgia; Detroit, Michigan; Philadelphia,
Pennsylvania; and the District of Columbia[Footnote 68]. We selected
these sites because they were geographically diverse, and have varying
levels of IL track participation and success in achieving VR&E's IL
rehabilitation goal. During each of our site visits, we interviewed
VR&E Officers and vocational rehabilitation counselors (VRCs) using a
standard set of questions to identify how IL cases were managed and
any factors that may have affected the administration of the IL track.
In particular, during our Detroit and Atlanta site visits, we
interviewed VRCs who specialized in working on IL cases. Moreover, we
obtained the perspectives of veteran service organizations that work
with IL track veterans at two regional offices we visited--Detroit and
Atlanta. Furthermore, we interviewed SAH and PSAS officials at the
national level and relied on our case file review to determine the
extent to which the IL track cases were referred to VA and non-VA
service providers. In addition, we interviewed SAH and PSAS staff
during our site visits to determine the extent to which VR&E, SAH, and
PSAS coordinate in the provision of goods and services to IL track
veterans.
[End of section]
Appendix II: Statistical Analysis of Independent Living Plan
Rehabilitation Times:
We used statistical models to estimate the difference in
rehabilitation times across regional offices and groups of veterans
with various characteristics. These "survival modeling" methods can
appropriately estimate rehabilitation probabilities at various points
in an IL plan, even when a significant proportion of the cases are
discontinued or in progress. In addition, survival methods allowed us
to estimate the unique association between rehabilitation times and
various other factors, described below. In this appendix, we describe
the data we used to fit the models and their structure, assumptions,
and estimates.
We estimated our models using VA administrative data on veterans who
began exactly one IL plan from fiscal years 2008 through 2011. Due to
the data reliability issues described in appendix I, our analysis
excluded veterans who began multiple IL plans during this period.
Consequently, our results only apply to this subset of 8,737 veterans,
who made up 94.8 percent of the original population.[Footnote 69] We
measured the length of time each veteran spent in his or her IL plan
as the duration between the start of the plan and one of three later
times: entering rehabilitation status, discontinuing the plan, or
being in progress on September 30, 2011, the end of our observation
period. We modeled rehabilitation as the outcome of interest, treating
discontinued or in progress plans as having rehabilitation times that
were censored. Among the veterans starting IL plans from fiscal years
2008 through 2011, 3.2 percent discontinued their IL plans prior to
rehabilitation, and 35.9 percent had plans that were in progress on
September 30, 2011. These data imply that 91.7 percent of the censored
observations were in-progress cases, which suggests that most of the
censoring is likely to be uninformative. We found no large differences
in the probability of dropping out of an IL plan across the covariates
we included in our models.
Model Structure and Assumptions:
We fit the data to several types of Cox proportional hazards models.
The primary model took the following form:
[equation]
[partial equation] denotes the hazard rate of rehabilitation at time t
after veteran i enters an IL plan, and [partial equation] denotes the
baseline hazard rate for the reference veteran with covariates equal
to zero, served by one of j = 1, 2, ...,36 regional offices. We
combined a number of offices that served less than 50 veterans into a
residual group, in order to ensure sufficient sample within each
office. The sample sizes within offices ranged from 58 to 908.
[partial equation] is a vector of the following covariates: age,
length of military service, and indicators for sex, branch of service,
era of service, education, year the IL plan began, partial vs. full
disability,[Footnote 70] and disability type.[Footnote 71] We coded
the covariates such that the baseline reference veteran was
substantively meaningful--a male Army veteran with a high school
education, who served in the Vietnam era, entered an IL plan in fiscal
year 2008, was processed by the Detroit Regional Office, and had a
full musculoskeletal disability--either by setting values of
categorical variables to the appropriate levels or by centering
continuous variables at their means. All categorical variables
included levels for missing data.
In this application, the proportional hazard structure of the model
implies that the instantaneous rate of rehabilitation at any time
during an IL plan, or the hazard, varies across values of the
covariates by a constant amount over time. For example, the model
assumes that rehabilitation rates vary by the same amounts among
veterans with different types of disabilities after 12 months, 18
months, or any other point in an IL plan. In our initial exploratory
data analysis, Kaplan-Meier estimates of the hazard and survival
functions suggested that the hazard was not proportional across
regional offices. Using an unstratified version of the model above
that included fixed effects for regional offices, we found that the
Schoenfeld residuals for many offices were correlated with time at a
sufficiently high level to reject the hypothesis that the hazard
functions were proportional across the covariates (p < .0001).
[Footnote 72] These results are consistent with our interviews and
document reviews suggesting that program administration varied across
offices, which could produce variation in hazard functions. (The body
of this report summarizes these administrative inconsistencies in more
detail.) For these reasons, we stratified the baseline hazard function
by regional office, and we used this version of the model to calculate
hazard rate ratios and elasticities, along with their standard errors,
in table 3. Under the stratified model, we failed to reject the
proportional hazards assumption for [partial equation]< .47.
The estimated rehabilitation (failure) probabilities discussed in the
body of this report came from a version of the model that did not
stratify by office and, instead, assumed office fixed effects. This
allowed us to calculate illustrative rehabilitation probabilities by
various follow-up points and for specific covariate values, without
having to produce 36 sets of estimates implied by separate hazard
functions for each office. The differences in the estimated
probabilities across covariate values should resemble estimates that
we would have calculated from the stratified model, because estimates
of and their variances were similar in both versions. The hazard rate
ratios and elasticities in table 3 are consistent with our estimated
rehabilitation probabilities in the body of the report. To calculate
these probabilities, we fixed the value of each covariate at its
sample mode or mean, depending on whether the variable was categorical
or continuous. For this profile of covariate values, we calculated
survival probabilities at various times using the estimated parameters
of the unstratified model, and transformed them to failure
probabilities by subtracting the survival estimates from 1.
We estimated a final version of the model that used neither office
strata nor fixed effects. This allowed us to estimate the association
between office workload, measured by the total number of IL plans
developed from fiscal year 2008 through 2011, and rehabilitation
timeliness. Stratifying the model by office or estimating fixed
effects would have absorbed the variation needed to estimate the
coefficient on workload, as an office-level covariate.
Results:
Table 3 provides estimates of b and hazard ratios derived from them,
along with standard errors and p values for the hypothesis that each
ratio equals 1. These estimates come from the stratified model above.
Figure 17 presents the failure functions implied by the separate
hazard functions the model assumes for each regional office. These
results are generally consistent with those discussed in the body of
this report, where we interpret the results in more detail.
Table 4: Estimates from Cox Hazard Model of Time Spent in Independent
Living Plans, among Veterans Starting a Plan in FY 2008-2011.
Variable: Age (years);
Hazard ratio: 1.0062;
Standard error: 0.0022;
Pr(Hazard ratio = 1): 0.005;
95% Lower bound: 1.0019;
95% Upper bound: 1.0106.
Variable: Length of service (years);
Hazard ratio: 1.0066;
Standard error: 0.0026;
Pr(Hazard ratio = 1): 0.012;
95% Lower bound: 1.0014;
95% Upper bound: 1.0117.
Variable: Era of service; Vietnam (Reference Group):
Gulf War;
Hazard ratio: 1.0375;
Standard error: 0.0572;
Pr(Hazard ratio = 1): 0.505;
95% Lower bound: 0.9312;
95% Upper bound: 1.1559.
Global War on Terror;
Hazard ratio: 1.0955;
Standard error: 0.0735;
Pr(Hazard ratio = 1): 0.174;
95% Lower bound: 0.9605;
95% Upper bound: 1.2495.
Korea;
Hazard ratio: 1.0179;
Standard error: 0.0869;
Pr(Hazard ratio = 1): 0.835;
95% Lower bound: 0.8611;
95% Upper bound: 1.2033.
Peacetime;
Hazard ratio: 0.9689;
Standard error: 0.0453;
Pr(Hazard ratio = 1): 0.499;
95% Lower bound: 0.8841;
95% Upper bound: 1.0618.
World War II;
Hazard ratio: 0.8559;
Standard error: 0.0956;
Pr(Hazard ratio = 1): 0.164;
95% Lower bound: 0.6876;
95% Upper bound: 1.0654.
Variable: Education; High school (Reference Group);
Less than high school;
Hazard ratio: 0.9295;
Standard error: 0.0773;
Pr(Hazard ratio = 1): 0.379;
95% Lower bound: 0.7897;
95% Upper bound: 1.0940.
Some college;
Hazard ratio: 0.9772;
Standard error: 0.0339;
Pr(Hazard ratio = 1): 0.507;
95% Lower bound: 0.9129;
95% Upper bound: 1.0461.
College;
Hazard ratio: 0.9137;
Standard error: 0.0486;
Pr(Hazard ratio = 1): 0.090;
95% Lower bound: 0.8232;
95% Upper bound: 1.0142.
Graduate;
Hazard ratio: 1.1443;
Standard error: 0.1224;
Pr(Hazard ratio = 1): 0.207;
95% Lower bound: 0.9280;
95% Upper bound: 1.4111.
Missing data;
Hazard ratio: 1.1732;
Standard error: 0.0501;
Pr(Hazard ratio = 1): 0.000;
95% Lower bound: 1.0790;
95% Upper bound: 1.2757.
Variable: Sex; Male (reference group);
Female;
Hazard ratio: 0.9967;
Standard error: 0.0527;
Pr(Hazard ratio = 1): 0.950;
95% Lower bound: 0.8985;
95% Upper bound: 1.1056.
Missing data;
Hazard ratio: 0.9292;
Standard error: 0.1184;
95% Lower bound: 0.565;
Pr(Hazard ratio = 1): 0.7238;
95% Upper bound: 1.1929.
Variable: Branch of service; Army (reference group);
Air Force;
Hazard ratio: 0.9147;
Standard error: 0.0410;
Pr(Hazard ratio = 1): 0.047;
95% Lower bound: 0.8377;
95% Upper bound: 0.9987.
Coast Guard/other;
Hazard ratio: 1.0007;
Standard error: 0.1173;
Pr(Hazard ratio = 1): 0.995;
95% Lower bound: 0.7953;
95% Upper bound: 1.2591.
Marines;
Hazard ratio: 1.0362;
Standard error: 0.0463;
Pr(Hazard ratio = 1): 0.425;
95% Lower bound: 0.9494;
95% Upper bound: 1.1311.
Navy;
Hazard ratio: 0.9655;
Standard error: 0.0400;
Pr(Hazard ratio = 1): 0.397;
95% Lower bound: 0.8902;
95% Upper bound: 1.0472.
Variable: Year entered IL plan; 2008 (reference group);
2009;
Hazard ratio: 0.8910;
Standard error: 0.0312;
Pr(Hazard ratio = 1): 0.001;
95% Lower bound: 0.8319;
95% Upper bound: 0.9543.
2010;
Hazard ratio: 0.7850;
Standard error: 0.0306;
Pr(Hazard ratio = 1): 0.000;
95% Lower bound: 0.7272;
95% Upper bound: 0.8473.
2011;
Hazard ratio: 0.7782;
Standard error: 0.0485;
Pr(Hazard ratio = 1): 0.000;
95% Lower bound: 0.6887;
95% Upper bound: 0.8793.
Variable: Severity of disability; Combined rating of 100 (reference
group);
Combined rating less than 100;
Hazard ratio: 1.0948;
Standard error: 0.0342;
Pr(Hazard ratio = 1): 0.004;
95% Lower bound: 1.0299;
95% Upper bound: 1.1638.
PT/missing data;
Hazard ratio: 0.7947;
Standard error: 0.0806;
Pr(Hazard ratio = 1): 0.023;
95% Lower bound: 0.6515;
95% Upper bound: 0.9694.
Variable: Type of disability;
Dental and oral conditions;
Hazard ratio: 1.0424;
Standard error: 0.0999;
Pr(Hazard ratio = 1): 0.665;
95% Lower bound: 0.8638;
95% Upper bound: 1.2578.
Gynecological conditions and Disorders of the breast;
Hazard ratio: 0.9499;
Standard error: 0.0883;
Pr(Hazard ratio = 1): 0.580;
95% Lower bound: 0.7916;
95% Upper bound: 1.1397.
Infectious diseases, immune Disorders and nutritional Deficiencies;
Hazard ratio: 0.9610;
Standard error: 0.0792;
Pr(Hazard ratio = 1): 0.629;
95% Lower bound: 0.8177;
95% Upper bound: 1.1294.
Muscle injuries;
Hazard ratio: 1.0206;
Standard error: 0.0666;
Pr(Hazard ratio = 1): 0.755;
95% Lower bound: 0.8981;
95% Upper bound: 1.1598.
Neurological conditions and Convulsive disorders;
Hazard ratio: 0.9767;
Standard error: 0.0375;
Pr(Hazard ratio = 1): 0.540;
95% Lower bound: 0.9059;
95% Upper bound: 1.0531.
Other sense organs;
Hazard ratio: 0.8735;
Standard error: 0.2290;
Pr(Hazard ratio = 1): 0.606;
95% Lower bound: 0.5225;
95% Upper bound: 1.4602.
The cardiovascular system;
Hazard ratio: 0.9355;
Standard error: 0.0343;
Pr(Hazard ratio = 1): 0.069;
95% Lower bound: 0.8705;
95% Upper bound: 1.0053.
The digestive system;
Hazard ratio: 0.9368;
Standard error: 0.0352;
Pr(Hazard ratio = 1): 0.083;
95% Lower bound: 0.8702;
95% Upper bound: 1.0085.
The ear;
Hazard ratio: 1.0109;
Standard error: 0.0334;
Pr(Hazard ratio = 1): 0.742;
95% Lower bound: 0.9475;
95% Upper bound: 1.0786.
The endocrine system;
Hazard ratio: 1.1015;
Standard error: 0.0447;
Pr(Hazard ratio = 1): 0.017;
95% Lower bound: 1.0173;
95% Upper bound: 1.1926.
The eye;
Hazard ratio: 0.9667;
Standard error: 0.0495;
Pr(Hazard ratio = 1): 0.509;
95% Lower bound: 0.8745;
95% Upper bound: 1.0688.
The genitourinary system;
Hazard ratio: 0.9612;
Standard error: 0.0362;
Pr(Hazard ratio = 1): 0.294;
95% Lower bound: 0.8928;
95% Upper bound: 1.0349.
The hemic and lymphatic systems;
Hazard ratio: 1.1455;
Standard error: 0.1385;
Pr(Hazard ratio = 1): 0.261;
95% Lower bound: 0.9038;
95% Upper bound: 1.4518.
The musculoskeletal system;
Hazard ratio: 0.9498;
Standard error: 0.0310;
Pr(Hazard ratio = 1): 0.115;
95% Lower bound: 0.8909;
95% Upper bound: 1.0126.
The respiratory system;
Hazard ratio: 0.9973;
Standard error: 0.0427;
Pr(Hazard ratio = 1): 0.950;
95% Lower bound: 0.9171;
95% Upper bound: 1.0845.
The skin;
Hazard ratio: 0.9840;
Standard error: 0.0314;
Pr(Hazard ratio = 1): 0.612;
95% Lower bound: 0.9243;
95% Upper bound: 1.0474.
VA regional office strata included.
Source: GAO statistical analysis of VA administrative data.
Note: N = 8,655, with 5,252 failures. Estimates of "hazard ratios" are
exponentiated coefficients from a Cox hazard model, with reference
groups as indicated. For the continuous covariates, age and length of
service, the entries imply elasticities. For the disability type
covariates, the entries represent the proportional change in the
hazard of completing an IL plan for a veteran who has the listed
disability, compared to a veteran who does not have the disability.
(The disability types are not mutually exclusive and exhaustive
groups, because veterans can have more than one type of disability).
[End of table]
Figure 17: Multivariate Failure Function Estimates from a Cox Hazard
Model of Time Spent in Independent Living Plans, FY 2008-2011:
[Refer to PDF for image: stacked horizontal bar graph]
Regional office: Reno;
Percentage chance of being rehabilitated after 1 year: 84%;
Percentage chance of being rehabilitated after 2 years: 100%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: Phoenix;
Percentage chance of being rehabilitated after 1 year: 82%;
Percentage chance of being rehabilitated after 2 years: 100%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: Muskogee;
Percentage chance of being rehabilitated after 1 year: 80%;
Percentage chance of being rehabilitated after 2 years: 97%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: Waco;
Percentage chance of being rehabilitated after 1 year: 77%;
Percentage chance of being rehabilitated after 2 years: 93%;
Percentage chance of being rehabilitated after 3 years: 95%.
Regional office: Montgomery;
Percentage chance of being rehabilitated after 1 year: 75%;
Percentage chance of being rehabilitated after 2 years: 96%;
Percentage chance of being rehabilitated after 3 years: 97%.
Regional office: Albuquerque;
Percentage chance of being rehabilitated after 1 year: 73%;
Percentage chance of being rehabilitated after 2 years: 97%;
Percentage chance of being rehabilitated after 3 years: 98%.
Regional office: Louisville;
Percentage chance of being rehabilitated after 1 year: 70%;
Percentage chance of being rehabilitated after 2 years: 89%;
Percentage chance of being rehabilitated after 3 years: 97%.
Regional office: Newark;
Percentage chance of being rehabilitated after 1 year: 68%;
Percentage chance of being rehabilitated after 2 years: 96%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: New York;
Percentage chance of being rehabilitated after 1 year: 66%;
Percentage chance of being rehabilitated after 2 years: 95%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: Atlanta;
Percentage chance of being rehabilitated after 1 year: 59%;
Percentage chance of being rehabilitated after 2 years: 91%;
Percentage chance of being rehabilitated after 3 years: 98%.
Regional office: Hartford (CT);
Percentage chance of being rehabilitated after 1 year: 59%;
Percentage chance of being rehabilitated after 2 years: 92%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: San Diego;
Percentage chance of being rehabilitated after 1 year: 57%;
Percentage chance of being rehabilitated after 2 years: 83%;
Percentage chance of being rehabilitated after 3 years: 90%.
Regional office: Houston;
Percentage chance of being rehabilitated after 1 year: 56%;
Percentage chance of being rehabilitated after 2 years: 84%;
Percentage chance of being rehabilitated after 3 years: 96%.
Regional office: St. Louis;
Percentage chance of being rehabilitated after 1 year: 55%;
Percentage chance of being rehabilitated after 2 years: 74%;
Percentage chance of being rehabilitated after 3 years: 85%.
Regional office: Columbia (SC);
Percentage chance of being rehabilitated after 1 year: 55%;
Percentage chance of being rehabilitated after 2 years: 73%;
Percentage chance of being rehabilitated after 3 years: 89%.
Regional office: Huntington (WV);
Percentage chance of being rehabilitated after 1 year: 55%;
Percentage chance of being rehabilitated after 2 years: 95%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: Togus (ME);
Percentage chance of being rehabilitated after 1 year: 54%;
Percentage chance of being rehabilitated after 2 years: 95%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: Philadelphia;
Percentage chance of being rehabilitated after 1 year: 54%;
Percentage chance of being rehabilitated after 2 years: 90%;
Percentage chance of being rehabilitated after 3 years: 96%.
Regional office: Nashville;
Percentage chance of being rehabilitated after 1 year: 53%;
Percentage chance of being rehabilitated after 2 years: 86%;
Percentage chance of being rehabilitated after 3 years: 96%.
Regional office: Little Rock;
Percentage chance of being rehabilitated after 1 year: 52%;
Percentage chance of being rehabilitated after 2 years: 77%;
Percentage chance of being rehabilitated after 3 years: 87%.
Regional office: Jackson (MS);
Percentage chance of being rehabilitated after 1 year: 52%;
Percentage chance of being rehabilitated after 2 years: 78%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: New Orleans;
Percentage chance of being rehabilitated after 1 year: 52%;
Percentage chance of being rehabilitated after 2 years: 75%;
Percentage chance of being rehabilitated after 3 years: 86%.
Regional office: Salt Lake City;
Percentage chance of being rehabilitated after 1 year: 51%;
Percentage chance of being rehabilitated after 2 years: 85%;
Percentage chance of being rehabilitated after 3 years: 92%.
Regional office: Winston-Salem;
Percentage chance of being rehabilitated after 1 year: 51%;
Percentage chance of being rehabilitated after 2 years: 80%;
Percentage chance of being rehabilitated after 3 years: 94%.
Regional office: Seattle;
Percentage chance of being rehabilitated after 1 year: 46%;
Percentage chance of being rehabilitated after 2 years: 97%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: Denver;
Percentage chance of being rehabilitated after 1 year: 41%;
Percentage chance of being rehabilitated after 2 years: 91%;
Percentage chance of being rehabilitated after 3 years: 99%.
Regional office: Providence;
Percentage chance of being rehabilitated after 1 year: 41%;
Percentage chance of being rehabilitated after 2 years: 74%;
Percentage chance of being rehabilitated after 3 years: 87%.
Regional office: Indianapolis;
Percentage chance of being rehabilitated after 1 year: 38%;
Percentage chance of being rehabilitated after 2 years: 73%;
Percentage chance of being rehabilitated after 3 years: 92%.
Regional office: Honolulu;
Percentage chance of being rehabilitated after 1 year: 36%;
Percentage chance of being rehabilitated after 2 years: 91%;
Percentage chance of being rehabilitated after 3 years: 100%.
Regional office: Portland (OR);
Percentage chance of being rehabilitated after 1 year: 34%;
Percentage chance of being rehabilitated after 2 years: 74%;
Percentage chance of being rehabilitated after 3 years: 74%.
Regional office: Detroit;
Percentage chance of being rehabilitated after 1 year: 29%;
Percentage chance of being rehabilitated after 2 years: 78%;
Percentage chance of being rehabilitated after 3 years: 95%.
Regional office: St. Petersburg;
Percentage chance of being rehabilitated after 1 year: 29%;
Percentage chance of being rehabilitated after 2 years: 69%;
Percentage chance of being rehabilitated after 3 years: 89%.
Regional office: Oakland;
Percentage chance of being rehabilitated after 1 year: 25%;
Percentage chance of being rehabilitated after 2 years: 85%;
Percentage chance of being rehabilitated after 3 years: 93%.
Regional office: Los Angeles;
Percentage chance of being rehabilitated after 1 year: 21%;
Percentage chance of being rehabilitated after 2 years: 64%;
Percentage chance of being rehabilitated after 3 years: 87%.
Regional office: Cleveland;
Percentage chance of being rehabilitated after 1 year: 19%;
Percentage chance of being rehabilitated after 2 years: 44%;
Percentage chance of being rehabilitated after 3 years: 68%.
Regional office: Des Moines;
Percentage chance of being rehabilitated after 1 year: 18%;
Percentage chance of being rehabilitated after 2 years: 41%;
Percentage chance of being rehabilitated after 3 years: 65%.
Regional office: Lincoln;
Percentage chance of being rehabilitated after 1 year: 13%;
Percentage chance of being rehabilitated after 2 years: 39%;
Percentage chance of being rehabilitated after 3 years: 46%.
Regional office: Buffalo;
Percentage chance of being rehabilitated after 1 year: 10%;
Percentage chance of being rehabilitated after 2 years: 47%;
Percentage chance of being rehabilitated after 3 years: 67%.
Source: GAO statistical analysis of VA data.
Note: We did not estimate the probability of a veteran being
rehabilitated at regional offices where fewer than 50 veterans began
IL plans during fiscal years 2008 through 2011.
[End of figure]
[End of section]
Appendix III: List of Goods and Services Provided to Sample of
Independent Living Track Veterans from our Case File Review:
The table below lists the goods and services that were recorded in the
182 cases we reviewed in the CWINRS system.
Counseling Services: Goods and Services Provided:
"(1) Specialized Contractial Counseling Services 637";
Frequency: Counseling Services: 5.
"(1) Specialized Contractual Counseling";
Frequency: Counseling Services: 1.
"(1) Specialized Contractual Counseling Services 637, Vocational,
Educational, Psychological or Personal adjustment counseling which I";
Frequency: Counseling Services: 3.
"(1) Specialized Independent Living Services 638";
Frequency: Counseling Services: 1.
"(1) Specialized Rehabilitation Service 631";
Frequency: Counseling Services: 9.
"(1) Specialized Rehabilitation Services";
Frequency: Counseling Services: 6.
"(1) Specialized Rehabilitation Services 631, Specialized services
involving unique skills and techniques, such as learning di";
Frequency: Counseling Services: 3.
"(1) Specialized contractual counseling services 637;
IILP Initial Assessment";
Frequency: Counseling Services: 1.
"(1)Special contractual Counseling";
Frequency: Counseling Services: 1.
"(316) Contract Counseling Assistance 451";
Frequency: Counseling Services: 1.
"(339) Special Services 532";
Frequency: Counseling Services: 1.
"(343) Rehab SErvices 556";
Frequency: Counseling Services: 13.
"(343) Rehab Services";
Frequency: Counseling Services: 1.
"(343) Rehab Services 556, All services not otherwise described to
advance the objectives of the rehabilita";
Frequency: Counseling Services: 9.
"(343) Rehab Services 556; Connections Vocational Services; IILP Evals;
All service not otherwise described to advance the objectives of the
rehabilita";
Frequency: Counseling Services: 2.
"(372) Independent Living Services 644, Provide Independent Living
services (i.e. IL Evaluation, Occupational Therapy Ev";
Frequency: Counseling Services: 1.
"(372) Psychotherapy 667;
provide psychotherapy and adjustment counseling";
Frequency: Counseling Services: 4.
"Adjustment Counseling 113";
Frequency: Counseling Services: 1.
"Rehab Services";
Frequency: Counseling Services: 5.
"Rehabilitation Counseling Services 158, Specialized counseling
services as required to assist and support veteran in ful";
Frequency: Counseling Services: 1.
"SRS/IL Special Rehab Service/Independen Li";
Frequency: Counseling Services: 29.
"SRS/V Special Rehab Service/Vocaational; Center for Independent
Living; IL Case Mgmt";
Frequency: Counseling Services: 1.
"SRS/V Special Rehab Service/Vocational";
Frequency: Counseling Services: 31.
"Special Rehab Service/Independent Living";
Frequency: Counseling Services: 7.
"Special Rehab. Srvs/Indepen. Living 24";
Frequency: Counseling Services: 1.
"Special Services";
Frequency: Counseling Services: 1.
"Special rehab service/Independent Living";
Frequency: Counseling Services: 1.
"Specialized Counseling Services 176";
Frequency: Counseling Services: 1.
Medical Care and Health Related Services: Goods and Services Provided:
"Cora Coleman Senior Center; 9 month swim membership";
Frequency: Counseling Services: 1.
"Dr. Sandoval; Eye exam";
Frequency: Counseling Services: 1.
"Exercise gym membership";
Frequency: Counseling Services: 1.
"Express Healthcare";
Frequency: Counseling Services: 1.
"Gym Membership-6 Months";
Frequency: Counseling Services: 1.
"Medical ID bracelet purchase and delivery";
Frequency: Counseling Services: 1.
"Medical care;
SRS/M Special Rehab Services/Medical";
Frequency: Counseling Services: 1.
"Medical, Dental, Vision/Related Services 169, Comprehensive
evaluation of medical, dental, or vision difficulties and provisio";
Frequency: Counseling Services: 3.
"Milwaukee VA Medical Center";
Frequency: Counseling Services: 2.
"Personal Trainig Session-Master Level";
Frequency: Counseling Services: 1.
"Personal Training - 24 Sessions";
Frequency: Counseling Services: 1.
"Providence;
yoga membership fees - initial";
Frequency: Counseling Services: 1.
"Senior gym membership, and seniro swim membership";
Frequency: Counseling Services: 1.
"SRS/M Special Rehab Service/Medical";
Frequency: Counseling Services: 40.
"The Providence Institute;
yoga class";
Frequency: Counseling Services: 1.
"VA Medical Center - Ann Arbor";
Frequency: Counseling Services: 1.
"VA Medical Center - Detroit";
Frequency: Counseling Services: 2.
"VA Outpatient Clinic - Mare Island";
Frequency: Counseling Services: 1.
"VAMC--Westside";
Frequency: Counseling Services: 1.
"YMCA East Belleville Center; YMCA Membership; YMCA annual fee";
Frequency: Counseling Services: 1.
"YMCA Memebership";
Frequency: Counseling Services: 1.
"yoga classes";
Frequency: Counseling Services: 1.
Residential Adaption and Repair: Goods and Services Provided:
"(317) Independent Living Residence Adaptation 645";
Frequency: Counseling Services: 2.
"(317) Independent Living Residence Adaptation 645, Residential
adaptations to allow a veteran to complete ILP";
Frequency: Counseling Services: 1.
"A&E services for home modification per ILP";
Frequency: Counseling Services: 1.
"Basic construction as approved on IL plan";
Frequency: Counseling Services: 1.
"Ch 31 One Time Miscellaneous Items Purchase--Reconstruction of front
porch per IL plan";
Frequency: Counseling Services: 1.
"Gould's Discount Medical --Home Improvements";
Frequency: Counseling Services: 1.
"Herrera Engineering; house modifications; special contractual
services";
Frequency: Counseling Services: 1.
"Home Mod Eval";
Frequency: Counseling Services: 1.
"Home Reab Equipment --Supply and set up bath mods (up)";
Frequency: Counseling Services: 1.
"Home Rehab Equipment --custom railing";
Frequency: Counseling Services: 1.
"Home modification: Railing for steps";
Frequency: Counseling Services: 1.
"Home safety evaluation";
Frequency: Counseling Services: 1.
"Kohler & Lentz Construction; Home modifications for IL case";
Frequency: Counseling Services: 1.
"Labor for installing shower grab bar and locksets";
Frequency: Counseling Services: 1.
"Lumber for ramp construction";
Frequency: Counseling Services: 1.
"Mobile Home Stuff Store, Inc;
Plumbing repairs: complete water supply replumbing";
Frequency: Counseling Services: 1.
"Plans for modification";
Frequency: Counseling Services: 1.
"Provide & install toilet area grab bars w/fasteners";
Frequency: Counseling Services: 1.
"Provide and insall shower grab bar w/fasteners";
Frequency: Counseling Services: 1.
"Stair railing";
Frequency: Counseling Services: 1.
"Veterans Assistance Network; wood handrails; 18 in grab bars;
installation grab bar";
Frequency: Counseling Services: 1.
"buyrailings.com; stair railing w/brackets";
Frequency: Counseling Services: 1.
"ramp installation";
Frequency: Counseling Services: 1.
"set up and instruct on stair glides";
Frequency: Counseling Services: 1.
set up and supply bath mods;
Frequency: Counseling Services: 1.
"threshold Ramp";
Frequency: Counseling Services: 1.
"scaffolding";
Frequency: Counseling Services: 1.
"smoke detectors/fire extinguisher/co2 detector";
Frequency: Counseling Services: 1.
Education and Training: Goods and Services Provided:
"Computer Instruction 13";
Frequency: Counseling Services: 1.
"Driving Lessons";
Frequency: Counseling Services: 1.
IHL Institute of Higher Learning;
Frequency: Counseling Services: 1.
"IHL Institutions of Higher Learning";
Frequency: Counseling Services: 38.
"IHL Institutions of Higher Learning - for period 2/5/08-7/23/08";
Frequency: Counseling Services: 1.
"IHL Institutions of Higher Learning; 24 training session";
Frequency: Counseling Services: 1.
"IHL Institutions of Higher Learning (College books)";
Frequency: Counseling Services: 1.
"IHL Institutions of Higher Learning; Central Community College-
Hastings Degree";
Frequency: Counseling Services: 1.
"Individual/Independent Instruction/Trg 164";
Frequency: Counseling Services: 1.
Jewish Vocational Services; non college degree;
Frequency: Counseling Services: 4.
"Kendall & Davis, Inc.; computer training";
Frequency: Counseling Services: 1.
"Mastering MS Office Made Easy (CD-ROM version)";
Frequency: Counseling Services: 1.
"NCD Non-College Degree";
Frequency: Counseling Services: 10.
"OJT On the Job Training/Apprenticeship";
Frequency: Counseling Services: 5.
"PC Training 02/08-04/08";
Frequency: Counseling Services: 1.
"Solano County Community College";
Frequency: Counseling Services: 1.
"Training";
Frequency: Counseling Services: 2.
"Tutorial services 182";
Frequency: Counseling Services: 1.
"University of Alaska, Fall Term";
Frequency: Counseling Services: 2.
"Computer Instruction 13";
Frequency: Counseling Services: 1.
"Computer Training 11/8/07-2/1/08";
Frequency: Counseling Services: 1.
computer training;
Frequency: Counseling Services: 8.
"1-year audio book subscription (2 CDs/month)";
Frequency: Counseling Services: 1.
"2 computer innstruction books";
Frequency: Counseling Services: 1.
Assistive Devices and Technology: Goods and Services Provided:
"Adapter";
Frequency: Counseling Services: 1.
"Adapter/converter";
Frequency: Counseling Services: 1.
"All Temperature system; IL-Heating System";
Frequency: Counseling Services: 1.
"Amplified phone with 911 pendent";
Frequency: Counseling Services: 1.
"Ariens Snowblower";
Frequency: Counseling Services: 1.
"Audio Equipment and Software";
Frequency: Counseling Services: 1.
"CPI*Contour living web; wedge cushions/with massage; shipping charge";
Frequency: Counseling Services: 1.
"Cap Tel phone for hearing impaired";
Frequency: Counseling Services: 1.
"Ch 31 non-Contractual Speicial ...\r\n";
Frequency: Counseling Services: 1.
Computer Evaluation Services 21, Technical evaluation for computer
hardware and software needs;
Frequency: Counseling Services: 2.
"Computer installation";
Frequency: Counseling Services: 1.
"Computer repair";
Frequency: Counseling Services: 1.
"Cub Cadet Bagger";
Frequency: Counseling Services: 1.
"Cub Cadet Riding Lawn Mower";
Frequency: Counseling Services: 1.
"Exercycle";
Frequency: Counseling Services: 1.
"Forced Heater";
Frequency: Counseling Services: 1.
"GPS System";
Frequency: Counseling Services: 1.
"Installation of Camera Security System";
Frequency: Counseling Services: 1.
"KID 1240 talking dictionary with headphones";
Frequency: Counseling Services: 1.
"Kendall & Davis; notebook computer";
Frequency: Counseling Services: 1.
"King size adjustable bed with massage";
Frequency: Counseling Services: 1.
"Lift chair with heat and massage";
Frequency: Counseling Services: 1.
"McGavic Outdoot power equipment;
lawn tractor and delivery";
Frequency: Counseling Services: 1.
"Metal Detection Club Mem. 1 yr,";
Frequency: Counseling Services: 1.
"Pride GL 358M lift chair w/set up and delivery";
Frequency: Counseling Services: 1.
"Quick 2008 software";
Frequency: Counseling Services: 1.
"Security system per IILP";
Frequency: Counseling Services: 1.
"Sleep number bed w/frame";
Frequency: Counseling Services: 1.
"Solutions4Sure - HP IPAQ";
Frequency: Counseling Services: 1.
"Spinlife - hoyer hyrdaulic patient lifter";
Frequency: Counseling Services: 1.
"Sports authority; Treadmill, delivery & assembly, 4 yr warranty";
Frequency: Counseling Services: 1.
"Surge protector";
Frequency: Counseling Services: 1.
"True Freedom Mobility; Lift chair";
Frequency: Counseling Services: 1.
"US Computers Inc; Shipping/handling fees for computer and furnitures";
Frequency: Counseling Services: 1.
"Washer";
Frequency: Counseling Services: 1.
"Wireless router";
Frequency: Counseling Services: 1.
"day Timer Smartech";
Frequency: Counseling Services: 1.
"lawn tractor";
Frequency: Counseling Services: 1.
"massagin seat cushion";
Frequency: Counseling Services: 1.
"one snowblower";
Frequency: Counseling Services: 1.
"set and instruct on 4 wheel scooter";
Frequency: Counseling Services: 1.
"set and instruct on scooter lift with swing arm";
Frequency: Counseling Services: 1.
"set and instruction for lift chair";
Frequency: Counseling Services: 1.
"speakers";
Frequency: Counseling Services: 1.
"washer/dryer";
Frequency: Counseling Services: 1.
"Electric Jar Opener";
Frequency: Counseling Services: 1.
Adaptive Equipment: Goods and Services Provided:
"All in one accessibility - adaptive equipment";
Frequency: Counseling Services: 1.
"24-Inch Grab Bar for Commode";
Frequency: Counseling Services: 1.
"ALI*AMIMED INC.; Backrest air obusforme grey; shipping charge";
Frequency: Counseling Services: 1.
"Alex Orthopedic; Walking Cane; Shipping charge";
Frequency: Counseling Services: 1.
"Appointment book";
Frequency: Counseling Services: 1.
"Automobile seat cushion";
Frequency: Counseling Services: 1.
"Big-Handle Cup";
Frequency: Counseling Services: 1.
"Bowl, blue";
Frequency: Counseling Services: 1.
"Colders, Inc.; Bed & Chair - Independent Living";
Frequency: Counseling Services: 1.
"Chair";
Frequency: Counseling Services: 2.
"Colder's; TempurPedic King Size Solution Mattress and Box Sp;
HTC-1650 Massage Chair";
Frequency: Counseling Services: 1.
"Computer chair";
Frequency: Counseling Services: 1.
"Deluxe swivel seat cushion, UpEasy lifting cushion seat assist (plus
shipping)";
Frequency: Counseling Services: 1.
"Dry Erase Board & Calendar";
Frequency: Counseling Services: 1.
"E-Pill 7-day organizer/reminder sys";
Frequency: Counseling Services: 1.
"Elastic Shoelaces";
Frequency: Counseling Services: 1.
"Ergonomic Office & Shop Stool";
Frequency: Counseling Services: 1.
"Eyemasters;
eye glasses";
Frequency: Counseling Services: 1.
"Frame, Lenses";
Frequency: Counseling Services: 1.
"Gallon Tipper";
Frequency: Counseling Services: 1.
"Glide rail & shower wand,PT-WR28R,LABOR";
Frequency: Counseling Services: 1.
"Grab bar specialists, Inc.; handi-grip portable grab bar and
shipping";
Frequency: Counseling Services: 1.
"Handicap aid equipment";
Frequency: Counseling Services: 1.
"IL Adaptive Equipment\r\nCh 31 Special Equipment";
Frequency: Counseling Services: 1.
"IL Adaptive equipment, Shipping and Handling\r\nCh 31 Special
Equipment";
Frequency: Counseling Services: 1.
"Kitchen Cart w/3 Shelves and Casters";
Frequency: Counseling Services: 1.
"Lamp for independent living and surge protector";
Frequency: Counseling Services: 1.
"MAXIAUDS; CO2 Alarm; shiping charge";
Frequency: Counseling Services: 1.
"Medication dispenser, phone, printer, mouse";
Frequency: Counseling Services: 1.
"Mother Earth Design INC.; Trigger point pillow; shipping charge";
Frequency: Counseling Services: 1.
"Office furniture";
Frequency: Counseling Services: 1.
"Ontime supplies; ergonomic chair, dry erase board";
Frequency: Counseling Services: 1.
"Organizing service";
Frequency: Counseling Services: 1.
"Perching Stool, Height Adjustable, 250lb Capacity";
Frequency: Counseling Services: 1.
"Pill Container AM PM";
Frequency: Counseling Services: 1.
"Pill box with alarm, grab bars";
Frequency: Counseling Services: 1.
"Portable Lift Cushion, 250 1b Capacity";
Frequency: Counseling Services: 1.
"ProMED;
Tempurpedic bed";
Frequency: Counseling Services: 1.
"ProMed;
Long-handled bath brush";
Frequency: Counseling Services: 1.
"Queen Matt, Box, Tempura Symphony pillow";
Frequency: Counseling Services: 1.
"Queen mattress";
Frequency: Counseling Services: 1.
"Rehab Engineering Inc.; Large Handle cups; walker, 3-inch wheels,
300lbs. capacity; 24-inch grab bar, inside tub";
Frequency: Counseling Services: 1.
"Rolling laundry cart & ergonomic grabber";
Frequency: Counseling Services: 1.
"SENIORSHOPS.COM; Safety bed rail";
Frequency: Counseling Services: 1.
"Sit/Stand Stool";
Frequency: Counseling Services: 1.
"Sliding Shelves (for Bathroom Cabinet)";
Frequency: Counseling Services: 1.
"Small Stool";
Frequency: Counseling Services: 1.
"Sock/Stocking Aid";
Frequency: Counseling Services: 1.
"Special equipment--one-handed jar opener, suction cup plates, suction
cup bowls";
Frequency: Counseling Services: 1.
"Stocking Aid w/Loops";
Frequency: Counseling Services: 1.
"Stool";
Frequency: Counseling Services: 1.
"Trio Jar and Bottle Opener";
Frequency: Counseling Services: 1.
"Tub safety bar and lever door handles (QTY 6)";
Frequency: Counseling Services: 1.
"Universal Opener";
Frequency: Counseling Services: 1.
"Vocational Resource Services; good grips eating utensils; sock assist;
elastic shoelaces";
Frequency: Counseling Services: 1.
"Vocational Resource Services; locking elevated toilet seat w/arms;
special equipment";
Frequency: Counseling Services: 1.
"Walker Furniture;
mattress, frame and bed cover";
Frequency: Counseling Services: 1.
"adaptive aids";
Frequency: Counseling Services: 1.
"computer desk";
Frequency: Counseling Services: 1.
"desk and chair";
Frequency: Counseling Services: 1.
"desk chair";
Frequency: Counseling Services: 1.
"grab bar";
Frequency: Counseling Services: 1.
"laundry cart";
Frequency: Counseling Services: 1.
"non Skid Mat";
Frequency: Counseling Services: 1.
"rolling stool with s/h";
Frequency: Counseling Services: 1.
"set up and instruct for K adj bed.";
Frequency: Counseling Services: 1.
sock aid;
Frequency: Counseling Services: 1.
"www.themedicalclub.com;
HC-SP-S 1119 Super pole and shipping";
Frequency: Counseling Services: 1.
Computer and Camera Equipment: Goods and Services Provided:
"Adaptive computer system";
Frequency: Counseling Services: 1.
"Adobe Photoshop";
Frequency: Counseling Services: 1.
"Camera, case, warranty, & Adobe Elements";
Frequency: Counseling Services: 1.
"Camera, fash card, carea kit";
Frequency: Counseling Services: 1.
"Camera, memory card";
Frequency: Counseling Services: 1.
"Camera/Peripherals";
Frequency: Counseling Services: 1.
"Carrying case (for laptop) & surge protector";
Frequency: Counseling Services: 1.
"Computer";
Frequency: Counseling Services: 1.
"Computer & peripherals";
Frequency: Counseling Services: 1.
"Computer ILLP";
Frequency: Counseling Services: 2.
"Computer Masters;
Computer System (IL)";
Frequency: Counseling Services: 1.
"Computer Set up-Intenet";
Frequency: Counseling Services: 1.
"Computer System, desk & chair";
Frequency: Counseling Services: 1.
"Computer and printer and accessories";
Frequency: Counseling Services: 1.
"Computer hardware/software and computer desk/chair";
Frequency: Counseling Services: 1.
"Computer speakers";
Frequency: Counseling Services: 1.
"Computer system with 19 inch moniter, printer software";
Frequency: Counseling Services: 1.
"Computer, Printer, Monitor, and Web Cam";
Frequency: Counseling Services: 1.
"Computer, flash, microsoft office pro 07";
Frequency: Counseling Services: 1.
"Computer/Printer/Accessories/Recliner/Computer cha";
Frequency: Counseling Services: 1.
"Computer/Printer/Peripherals";
Frequency: Counseling Services: 3.
"Dell - desktop, surge protector, and printer";
Frequency: Counseling Services: 1.
"Dell Desk top computer";
Frequency: Counseling Services: 1.
"Dell Laptop computer package";
Frequency: Counseling Services: 1.
"Dell all in one printer";
Frequency: Counseling Services: 1.
"Dell computer, Printer, surge protector";
Frequency: Counseling Services: 1.
"Dell;
monitor and desktop";
Frequency: Counseling Services: 1.
"Desktop computer system";
Frequency: Counseling Services: 1.
"Digital Camera";
Frequency: Counseling Services: 1.
"Epson Photo inkjet printer";
Frequency: Counseling Services: 1.
"Flash Drive";
Frequency: Counseling Services: 2.
"IILP - Computer equipment";
Frequency: Counseling Services: 1.
"IILP - Digital Photography Equipment";
Frequency: Counseling Services: 1.
"Internet Service";
Frequency: Counseling Services: 1.
"Internet fees and wireless card";
Frequency: Counseling Services: 1.
"Journey Ed; PhotShop CS4";
Frequency: Counseling Services: 1.
"Laptop and Accessories";
Frequency: Counseling Services: 1.
"Laptop computer";
Frequency: Counseling Services: 1.
"Laptop computer system, 3-year warranty";
Frequency: Counseling Services: 1.
"Laptop, case,surge prot, flash drive";
Frequency: Counseling Services: 1.
"MS Office Home and Student 2007";
Frequency: Counseling Services: 1.
"Microsoft Office Proffessional Upgrade Software";
Frequency: Counseling Services: 1.
"Milwaukee PC - 75; Laptop computer system";
Frequency: Counseling Services: 1.
"Nikon Coolpix Digital Camera";
Frequency: Counseling Services: 1.
"Nikon Speedlight Flash for digital camera";
Frequency: Counseling Services: 1.
"Norton AntiVirus 2008";
Frequency: Counseling Services: 1.
"Office Depot; PC";
Frequency: Counseling Services: 1.
"PC";
Frequency: Counseling Services: 1.
"Printer";
Frequency: Counseling Services: 1.
"Staples; computer and accessories";
Frequency: Counseling Services: 1.
"Staples; computer assories";
Frequency: Counseling Services: 1.
"Toshiba laptop computer system";
Frequency: Counseling Services: 1.
"US Computers Inc; desktop computer system; monitor 19 in LCD;
HP printer all-in-one";
Frequency: Counseling Services: 1.
"Video Camcorder kit";
Frequency: Counseling Services: 1.
"XPS One, Red--Dell Desk Top computer";
Frequency: Counseling Services: 1.
"adapted computer";
Frequency: Counseling Services: 1.
"all in one printer";
Frequency: Counseling Services: 1.
"cable for computer purchased";
Frequency: Counseling Services: 1.
"computer";
Frequency: Counseling Services: 4.
"computer printer/cables";
Frequency: Counseling Services: 1.
"computer w/19 inch monitor, 4n1 printer + internet";
Frequency: Counseling Services: 1.
"computer, printer";
Frequency: Counseling Services: 1.
"computer, printer, associated supplies";
Frequency: Counseling Services: 1.
"desktop computer system";
Frequency: Counseling Services: 1.
"digital camera, case, warranty";
Frequency: Counseling Services: 1.
"laptop computer and printer";
Frequency: Counseling Services: 1.
"laptop printer";
Frequency: Counseling Services: 1.
"monitor, camera, headset";
Frequency: Counseling Services: 1.
"printer, cable, delivery";
Frequency: Counseling Services: 1.
"quicken and mavis";
Frequency: Counseling Services: 1.
"software-printer";
Frequency: Counseling Services: 1.
"usb cable and ink";
Frequency: Counseling Services: 1.
Avocational/Leisure Equipment: Goods and Services Provided:
"Elite Duo 1500 Workbench and excess weight charge";
Frequency: Counseling Services: 1.
"Windward boats; glasspro boat, motor, trailer";
Frequency: Counseling Services: 1.
"10" table saw, delivery";
Frequency: Counseling Services: 1.
"12 inch dualbevel slide mitersaw 77-141-614 Bosc";
Frequency: Counseling Services: 1.
"2hp soft start fixed and plunge base router";
Frequency: Counseling Services: 1.
"6 Tool Cordless Combo Kit";
Frequency: Counseling Services: 1.
"Craftsman 10 inch table saw";
Frequency: Counseling Services: 1.
"Craftsman fixed base router/table combo";
Frequency: Counseling Services: 1.
"Embroidery Machine & Accessories, Classes";
Frequency: Counseling Services: 1.
"Jarvi Facetron; Facitron Machine with grit; shipping";
1. Frequency: Counseling Services:
"Music Production Equipment";
Frequency: Counseling Services: 2.
"Rikon 18 inch bandsaw, excess weight charge";
Frequency: Counseling Services: 1.
"Rikon 6 inch jointer";
Frequency: 1.
"Searrs; rts bit saw nailer plnr sander warrenties";
Frequency: 1.
"Sears; router and table and warrenty";
Frequency: Counseling Services: 1.
"Shopsmith Mark V";
Frequency: 1.
"Tracrac T3B portable miter saw sta Bosch";
Frequency: 1.
"drill press, protection agreement, shipping";
Frequency: 1.
"The Rock Shed; Thumlers tumbler; 5lbs 60/90 grit; 5lbs 120/220 grit";
Frequency: 1.
"(IL books) Audio Books";
Frequency: 1.
"8 Spools of Thread";
Frequency: 1.
"Accessory Kit, Bench Clamp and shipping for workbench";
Frequency: 1.
"Bagpipe Accessories";
Frequency: 1.
"Bagpipe Uniform & Accessories";
Frequency: 1.
"Blick Art - acrylic paint and supplies";
Frequency: 1.
"Bosch Tool Kit";
Frequency: 1.
"Cookbooks";
Frequency: 1.
"Fishing equipment";
Frequency: 1.
"Metal detector items";
Frequency: 1.
"Models";
Frequency: 1.
"Silversmithing and Engraving Tools/Equipment";
Frequency: 1.
"Trailer hitch";
Frequency: 1.
"Vibration reduction lens";
Frequency: 1.
"Walmart; camping equipment";
Frequency: 1.
"car rack";
Frequency: 1.
Other Goods and Services:
"Ch 31 Books";
Frequency: 1.
"Supplies";
Frequency: 1.
"(1) Specialized Equipment Acquisition 589";
Frequency: 1.
"3 year extended laptop warranty";
Frequency: 1.
"3-month membership, Dickinson Parks & Recreation";
Frequency: 1.
"3-month membership, West River Community Center";
Frequency: 1.
Abilities Group;
Frequency: 2.
"Assistive Technological Services 599";
Frequency: 2.
"Center for Independent Living";
Frequency: 2.
"Club T.E.A.M ";
Frequency: 1.
"Delivery";
Frequency: 1.
"Downing Properties LLC ";
Frequency: 1.
"Equipment and Installtion Fee";
Frequency: 1.
"Equipment for IL";
Frequency: 1.
"IL Equipment";
Frequency: 1.
"IL Supplies, Shipping and Handling\r\nCh 31 Special Equipment";
Frequency: 1.
"IL equipment & ship";
Frequency: 1.
"Installation ILLP";
Frequency: 1.
"Maids PO#Julia 300; Tub rails; shipping charge";
Frequency: 1.
"Membership";
Frequency: 1.
"Merry Maids; maid services; fee, intial; Refrigerator cleaning";
Frequency: 1.
"PROMED; IL Purchases";
Frequency: 1.
"ProMED; IL Equipment";
Frequency: 1.
"Service Charge";
Frequency: 1.
"Set-up and Shipping (for exercycle)";
Frequency: 1.
"Shipping and Handling";
Frequency: 1.
"Shipping/delivery charges for CD-ROM";
Frequency: 1.
"Independence Inc.";
Frequency: 1.
"VR&E/28 ";
Frequency: 1.
"Voc Rehab Panel, PO 348-08-039 dtd 7/23/08";
Frequency: 1.
"Ship Boat to Molokai";
Frequency: 1.
"warranty";
Frequency: 1.
Cub Cadet Bagger”
Frequency: 1.
“Ariens Snowblower”
Frequency: 1.
“Cub Cadet Riding Lawn Mower”
Frequency: 1.
“McGavic Outdoot power equipment; lawn tractor and delivery”
Frequency: 1.
“lawn tractor”
Frequency: 1.
“one snowblower”
Frequency: 1.
Source: GAO analysis of 182 case files of veterans entering the IL
track during fiscal year 2008.
[End of table]
[End of section]
Appendix IV: Rehabilitation Rates by Regional Office, FY 2008
Independent Living Entrants:
National;
Entrants with One IL Plan: 2,274;
Transfers to a VR&E Employment Track: 34;
Rehabilitated: 1,987;
Discontinued: 122;
Open: 131;
Rehabilitation Rate: 89%.
Regional office: Muskogee;
Entrants with One IL Plan: 35;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 35;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: Reno;
Entrants with One IL Plan: 13;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 12;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: Togus;
Entrants with One IL Plan: 9;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 9;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: Huntington;
Entrants with One IL Plan: 5;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 4;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: Boise;
Entrants with One IL Plan: 4;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 4;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: Wichita;
Entrants with One IL Plan: 3;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 2;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: Roanoke;
Entrants with One IL Plan: 2;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 2;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: Pittsburgh;
Entrants with One IL Plan: 2;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 2;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: San Juan;
Entrants with One IL Plan: 2;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 2;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: Manchester;
Entrants with One IL Plan: 2;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 2;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 100%.
Regional office: Montgomery;
Entrants with One IL Plan: 202;
Transfers to a VR&E Employment Track: 2;
Rehabilitated: 198;
Discontinued: 1;
Open: 1;
Rehabilitation Rate: 99%.
Regional office: Hartford;
Entrants with One IL Plan: 77;
Transfers to a VR&E Employment Track: 2;
Rehabilitated: 74;
Discontinued: 1;
Open: 0;
Rehabilitation Rate: 99%.
Regional office: Louisville;
Entrants with One IL Plan: 64;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 62;
Discontinued: 0;
Open: 1;
Rehabilitation Rate: 98%.
Regional office: Newark;
Entrants with One IL Plan: 59;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 58;
Discontinued: 0;
Open: 1;
Rehabilitation Rate: 98%.
Regional office: Atlanta;
Entrants with One IL Plan: 119;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 114;
Discontinued: 3;
Open: 2;
Rehabilitation Rate: 96%.
Regional office: Phoenix;
Entrants with One IL Plan: 141;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 135;
Discontinued: 6;
Open: 0;
Rehabilitation Rate: 96%.
Regional office: San Diego;
Entrants with One IL Plan: 41;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 38;
Discontinued: 1;
Open: 1;
Rehabilitation Rate: 95%.
Regional office: Nashville;
Entrants with One IL Plan: 18;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 17;
Discontinued: 0;
Open: 1;
Rehabilitation Rate: 94%.
Regional office: Denver[A];
Entrants with One IL Plan: 66;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 62;
Discontinued: 3;
Open: 1;
Rehabilitation Rate: 94%.
Regional office: New York;
Entrants with One IL Plan: 161;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 149;
Discontinued: 10;
Open: 1;
Rehabilitation Rate: 93%.
Regional office: Waco;
Entrants with One IL Plan: 69;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 64;
Discontinued: 2;
Open: 3;
Rehabilitation Rate: 93%.
Regional office: Philadelphia;
Entrants with One IL Plan: 26;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 24;
Discontinued: 1;
Open: 1;
Rehabilitation Rate: 92%.
Regional office: Honolulu;
Entrants with One IL Plan: 37;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 34;
Discontinued: 3;
Open: 0;
Rehabilitation Rate: 92%.
Regional office: Milwaukee;
Entrants with One IL Plan: 20;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 18;
Discontinued: 1;
Open: 1;
Rehabilitation Rate: 90%.
Regional office: Seattle;
Entrants with One IL Plan: 29;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 25;
Discontinued: 3;
Open: 0;
Rehabilitation Rate: 89%.
Regional office: Salt Lake City;
Entrants with One IL Plan: 27;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 24;
Discontinued: 1;
Open: 2;
Rehabilitation Rate: 89%.
Regional office: Columbia;
Entrants with One IL Plan: 26;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 23;
Discontinued: 0;
Open: 3;
Rehabilitation Rate: 88%.
Regional office: Detroit;
Entrants with One IL Plan: 131;
Transfers to a VR&E Employment Track: 3;
Rehabilitated: 113;
Discontinued: 7;
Open: 8;
Rehabilitation Rate: 88%.
Regional office: Houston;
Entrants with One IL Plan: 73;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 63;
Discontinued: 8;
Open: 1;
Rehabilitation Rate: 88%.
Regional office: Oakland;
Entrants with One IL Plan: 163;
Transfers to a VR&E Employment Track: 5;
Rehabilitated: 138;
Discontinued: 12;
Open: 8;
Rehabilitation Rate: 87%.
Regional office: Albuquerque;
Entrants with One IL Plan: 88;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 76;
Discontinued: 11;
Open: 1;
Rehabilitation Rate: 86%.
Regional office: Winston-Salem;
Entrants with One IL Plan: 22;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 19;
Discontinued: 2;
Open: 1;
Rehabilitation Rate: 86%.
Regional office: St. Paul;
Entrants with One IL Plan: 7;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 6;
Discontinued: 1;
Open: 1;
Rehabilitation Rate: 86%.
Regional office: Baltimore;
Entrants with One IL Plan: 7;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 6;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: 86%.
Regional office: Indianapolis;
Entrants with One IL Plan: 79;
Transfers to a VR&E Employment Track: 4;
Rehabilitated: 64;
Discontinued: 4;
Open: 7;
Rehabilitation Rate: 85%.
Regional office: St. Louis;
Entrants with One IL Plan: 24;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 19;
Discontinued: 2;
Open: 2;
Rehabilitation Rate: 83%.
Regional office: Buffalo;
Entrants with One IL Plan: 20;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 16;
Discontinued: 0;
Open: 4;
Rehabilitation Rate: 80%.
Regional office: Portland;
Entrants with One IL Plan: 20;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 15;
Discontinued: 2;
Open: 2;
Rehabilitation Rate: 79%.
Regional office: St. Petersburg;
Entrants with One IL Plan: 116;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 90;
Discontinued: 4;
Open: 21;
Rehabilitation Rate: 78%.
Regional office: Sioux Falls;
Entrants with One IL Plan: 9;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 7;
Discontinued: 0;
Open: 2;
Rehabilitation Rate: 78%.
Regional office: Fort Harrison;
Entrants with One IL Plan: 4;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 3;
Discontinued: 1;
Open: 0;
Rehabilitation Rate: 75%.
Regional office: Boston;
Entrants with One IL Plan: 4;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 3;
Discontinued: 1;
Open: 0;
Rehabilitation Rate: 75%.
Regional office: Los Angeles;
Entrants with One IL Plan: 97;
Transfers to a VR&E Employment Track: 5;
Rehabilitated: 67;
Discontinued: 9;
Open: 16;
Rehabilitation Rate: 73%.
Regional office: Providence;
Entrants with One IL Plan: 18;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 13;
Discontinued: 1;
Open: 4;
Rehabilitation Rate: 72%.
Regional office: Jackson;
Entrants with One IL Plan: 7;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 5;
Discontinued: 1;
Open: 1;
Rehabilitation Rate: 71%.
Regional office: Anchorage;
Entrants with One IL Plan: 7;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 4;
Discontinued: 0;
Open: 2;
Rehabilitation Rate: 67%.
Regional office: Little Rock;
Entrants with One IL Plan: 26;
Transfers to a VR&E Employment Track: 1;
Rehabilitated: 16;
Discontinued: 4;
Open: 5;
Rehabilitation Rate: 64%.
Regional office: Lincoln;
Entrants with One IL Plan: 16;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 10;
Discontinued: 4;
Open: 2;
Rehabilitation Rate: 63%.
Regional office: Fargo;
Entrants with One IL Plan: 8;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 5;
Discontinued: 2;
Open: 1;
Rehabilitation Rate: 63%.
Regional office: Des Moines;
Entrants with One IL Plan: 21;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 13;
Discontinued: 2;
Open: 6;
Rehabilitation Rate: 62%.
Regional office: New Orleans;
Entrants with One IL Plan: 7;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 4;
Discontinued: 1;
Open: 2;
Rehabilitation Rate: 57%.
Regional office: Chicago;
Entrants with One IL Plan: 4;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 2;
Discontinued: 2;
Open: 0;
Rehabilitation Rate: 50%.
Regional office: Cleveland;
Entrants with One IL Plan: 35;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 17;
Discontinued: 4;
Open: 14;
Rehabilitation Rate: 49%.
Regional office: Washington[B];
Entrants with One IL Plan: 2;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 0;
Discontinued: 1;
Open: 1;
Rehabilitation Rate: 0%.
Regional office: White River Junction;
Entrants with One IL Plan: 0;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 0;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: n.a.
Wilmington;
Entrants with One IL Plan: 0;
Transfers to a VR&E Employment Track: 0;
Rehabilitated: 0;
Discontinued: 0;
Open: 0;
Rehabilitation Rate: n.a.
[End of table]
Source: GAO analysis of VA data.
[A] The Denver Regional Office includes totals for the Cheyenne,
Wyoming office. This office is considered a satellite office of Denver.
[B] The Washington Regional Office, located in the District of
Columbia, was renamed the National Capital Region Benefits Office in
November 2012.
Note: This table represents those veterans with only one IL plan who
entered the IL track in fiscal year 2008 and who were rehabilitated by
the end of fiscal year 2011. We calculated the IL rehabilitation rate
using open IL cases, as well as those cases that were closed by VR&E
as “rehabilitated” or “discontinued.” We did not include IL track
veterans who were transferred to another VR&E employment track. VR&E
calculates the IL rehabilitation rate using only closed cases.
[End of table]
[End of section]
Appendix V: Days to Complete Independent Living Plans, Veterans
Entering the Independent Living Track During FY 2008:
Regional Office: Roanoke;
Number of veterans completing their IL plan: 2;
Minimum: 888;
Mean: 895;
Median: 895;
Maximum: 906.
Regional Office: Buffalo;
Number of veterans completing their IL plan: 16;
Minimum: 263;
Mean: 676;
Median: 771;
Maximum: 1,151.
Regional Office: Des Moines;
Number of veterans completing their IL plan: 13;
Minimum: 142;
Mean: 621;
Median: 657;
Maximum: 1,147.
Regional Office: Chicago;
Number of veterans completing their IL plan: 2;
Minimum: 413;
Mean: 621;
Median: 621;
Maximum: 829.
Regional Office: Denver[A];
Number of veterans completing their IL plan: 62;
Minimum: 0;
Mean: 581;
Median: 628;
Maximum: 931.
Regional Office: Sioux Falls;
Number of veterans completing their IL plan: 7;
Minimum: 183;
Mean: 581;
Median: 449;
Maximum: 1,026.
Regional Office: New Orleans;
Number of veterans completing their IL plan: 4;
Minimum: 168;
Mean: 581;
Median: 614;
Maximum: 924.
Regional Office: Los Angeles;
Number of veterans completing their IL plan: 67;
Minimum: 110;
Mean: 577;
Median: 566;
Maximum: 1,289.
Regional Office: St. Petersburg;
Number of veterans completing their IL plan: 90;
Minimum: 102;
Mean: 552;
Median: 522;
Maximum: 1,121.
Regional Office: Seattle;
Number of veterans completing their IL plan: 25;
Minimum: 150;
Mean: 548;
Median: 533;
Maximum: 1,180.
Regional Office: Jackson;
Number of veterans completing their IL plan: 5;
Minimum: 278;
Mean: 533;
Median: 405;
Maximum: 913.
Regional Office: Portland;
Number of veterans completing their IL plan: 15;
Minimum: 194;
Mean: 526;
Median: 511;
Maximum: 1,209.
Regional Office: Cleveland;
Number of veterans completing their IL plan: 17;
Minimum: 0;
Mean: 515;
Median: 343;
Maximum: 1,154.
Regional Office: San Juan;
Number of veterans completing their IL plan: 2;
Minimum: 343;
Mean: 500;
Median: 500;
Maximum: 657.
Regional Office: Togus;
Number of veterans completing their IL plan: 9;
Minimum: 223;
Mean: 486;
Median: 310;
Maximum: 1,114.
Regional Office: Columbia;
Number of veterans completing their IL plan: 23;
Minimum: 110;
Mean: 482;
Median: 321;
Maximum: 1,172.
Regional Office: Honolulu;
Number of veterans completing their IL plan: 34;
Minimum: 18;
Mean: 457;
Median: 508;
Maximum: 1,052.
Regional Office: Oakland;
Number of veterans completing their IL plan: 138;
Minimum: 55;
Mean: 453;
Median: 457;
Maximum: 917.
Regional Office: Detroit;
Number of veterans completing their IL plan: 113;
Minimum: 0;
Mean: 446;
Median: 416;
Maximum: 975.
Regional Office: Indianapolis;
Number of veterans completing their IL plan: 64;
Minimum: 4;
Mean: 446;
Median: 416;
Maximum: 1,304.
Regional Office: Lincoln;
Number of veterans completing their IL plan: 10;
Minimum: 0;
Mean: 446;
Median: 555;
Maximum: 793.
Regional Office: Anchorage;
Number of veterans completing their IL plan: 4;
Minimum: 131;
Mean: 442;
Median: 497;
Maximum: 646.
Regional Office: Milwaukee;
Number of veterans completing their IL plan: 18;
Minimum: 66;
Mean: 431;
Median: 398;
Maximum: 909.
Regional Office: Houston;
Number of veterans completing their IL plan: 63;
Minimum: 22;
Mean: 420;
Median: 358;
Maximum: 1,129.
Regional Office: Boise;
Number of veterans completing their IL plan: 4;
Minimum: 66;
Mean: 409;
Median: 274;
Maximum: 1,030.
Regional Office: Providence;
Number of veterans completing their IL plan: 13;
Minimum: 4;
Mean: 398;
Median: 303;
Maximum: 986.
Regional Office: Philadelphia;
Number of veterans completing their IL plan: 24;
Minimum: 4;
Mean: 380;
Median: 387;
Maximum: 796.
Regional Office: Salt Lake City;
Number of veterans completing their IL plan: 24;
Minimum: 7;
Mean: 380;
Median: 325;
Maximum: 906.
Regional Office: Muskogee;
Number of veterans completing their IL plan: 35;
Minimum: 40;
Mean: 369;
Median: 292;
Maximum: 1,085.
Regional Office: Fargo;
Number of veterans completing their IL plan: 5;
Minimum: 0;
Mean: 369;
Median: 321;
Maximum: 738.
Regional Office: Nashville;
Number of veterans completing their IL plan: 17;
Minimum: 128;
Mean: 365;
Median: 321;
Maximum: 836.
Regional Office: Winston-Salem;
Number of veterans completing their IL plan: 19;
Minimum: 0;
Mean: 362;
Median: 300;
Maximum: 1,264.
Regional Office: Manchester;
Number of veterans completing their IL plan: 2;
Minimum: 340;
Mean: 362;
Median: 362;
Maximum: 387.
Regional Office: Baltimore;
Number of veterans completing their IL plan: 6;
Minimum: 0;
Mean: 358;
Median: 435;
Maximum: 771.
Regional Office: Wichita;
Number of veterans completing their IL plan: 2;
Minimum: 124;
Mean: 358;
Median: 358;
Maximum: 592.
Regional Office: Atlanta;
Number of veterans completing their IL plan: 114;
Minimum: 69;
Mean: 351;
Median: 292;
Maximum: 1,103.
Regional Office: New York;
Number of veterans completing their IL plan: 149;
Minimum: 22;
Mean: 340;
Median: 336;
Maximum: 942.
Regional Office: Hartford;
Number of veterans completing their IL plan: 74;
Minimum: 0;
Mean: 329;
Median: 307;
Maximum: 836.
Regional Office: Little Rock;
Number of veterans completing their IL plan: 16;
Minimum: 80;
Mean: 325;
Median: 208;
Maximum: 763.
Regional Office: Pittsburgh;
Number of veterans completing their IL plan: 2;
Minimum: 215;
Mean: 318;
Median: 318;
Maximum: 416.
Regional Office: Albuquerque;
Number of veterans completing their IL plan: 76;
Minimum: 37;
Mean: 310;
Median: 270;
Maximum: 891.
Regional Office: Waco;
Number of veterans completing their IL plan: 64;
Minimum: 84;
Mean: 310;
Median: 256;
Maximum: 1,249.
Regional Office: Fort Harrison;
Number of veterans completing their IL plan: 3;
Minimum: 194;
Mean: 310;
Median: 292;
Maximum: 446.
Regional Office: San Diego;
Number of veterans completing their IL plan: 38;
Minimum: 153;
Mean: 307;
Median: 292;
Maximum: 544.
Regional Office: Newark;
Number of veterans completing their IL plan: 58;
Minimum: 26;
Mean: 300;
Median: 248;
Maximum: 829.
Regional Office: Louisville;
Number of veterans completing their IL plan: 62;
Minimum: 44;
Mean: 296;
Median: 219;
Maximum: 891.
Regional Office: St. Louis;
Number of veterans completing their IL plan: 19;
Minimum: 55;
Mean: 296;
Median: 172;
Maximum: 1,147.
Regional Office: Phoenix;
Number of veterans completing their IL plan: 135;
Minimum: 51;
Mean: 289;
Median: 252;
Maximum: 731.
Regional Office: Huntington;
Number of veterans completing their IL plan: 4;
Minimum: 47;
Mean: 267;
Median: 270;
Maximum: 475.
Regional Office: Montgomery;
Number of veterans completing their IL plan: 198;
Minimum: 44;
Mean: 234;
Median: 208;
Maximum: 1,085.
Regional Office: Boston;
Number of veterans completing their IL plan: 3;
Minimum: 91;
Mean: 226;
Median: 278;
Maximum: 307.
Regional Office: Reno;
Number of veterans completing their IL plan: 12;
Minimum: 80;
Mean: 205;
Median: 186;
Maximum: 446.
Regional Office: St. Paul;
Number of veterans completing their IL plan: 6;
Minimum: 0;
Mean: 150;
Median: 99;
Maximum: 329.
Source: GAO analysis of VA data.
[A] The Denver Regional Office includes totals for the Cheyenne,
Wyoming office. This office is considered a satellite office of Denver.
Note: This table represents those veterans with only one IL plan who
entered the IL track during fiscal year 2008 and were rehabilitated by
the end of fiscal year 2011. The White River Junction and Wilmington
regional offices had no IL track entrants during fiscal year 2008. The
Washington Regional Office, renamed the National Capital Region
Benefits Office in November 2012, had two entrants during fiscal year
2008, but neither were rehabilitated by the end of fiscal year 2011.
[End of table]
[End of section]
Appendix VI: Independent Living Track Caseload Nationwide and by
Region Office, FY 2008-2011:
Number of Veterans Who Entered the IL Track by Region, FY 2008-2011:
Regional office: National;
Overall IL Entrant Count 2008-2011: 9,215;
2008: 2,465;
2009: 2,260;
2010: 2,209;
2011: 2,281.
Regional office: Montgomery;
Overall IL Entrant Count 2008-2011: 908;
2008: 215;
2009: 264;
2010: 189;
2011: 240.
Regional office: Detroit;
Overall IL Entrant Count 2008-2011: 709;
2008: 148;
2009: 172;
2010: 202;
2011: 187.
Regional office: New York;
Overall IL Entrant Count 2008-2011: 702;
2008: 178;
2009: 177;
2010: 179;
2011: 168.
Regional office: Atlanta;
Overall IL Entrant Count 2008-2011: 627;
2008: 128;
2009: 99;
2010: 204;
2011: 196.
Regional office: St. Petersburg;
Overall IL Entrant Count 2008-2011: 523;
2008: 121;
2009: 104;
2010: 146;
2011: 152.
Regional office: Houston;
Overall IL Entrant Count 2008-2011: 471;
2008: 82;
2009: 138;
2010: 113;
2011: 138.
Regional office: Oakland;
Overall IL Entrant Count 2008-2011: 462;
2008: 181;
2009: 118;
2010: 86;
2011: 77.
Regional office: Phoenix;
Overall IL Entrant Count 2008-2011: 440;
2008: 147;
2009: 114;
2010: 93;
2011: 86.
Regional office: Indianapolis;
Overall IL Entrant Count 2008-2011: 360;
2008: 93;
2009: 71;
2010: 116;
2011: 80.
Regional office: Waco;
Overall IL Entrant Count 2008-2011: 264;
2008: 74;
2009: 61;
2010: 52;
2011: 77.
Regional office: Newark;
Overall IL Entrant Count 2008-2011: 259;
2008: 68;
2009: 62;
2010: 68;
2011: 61.
Regional office: Los Angeles;
Overall IL Entrant Count 2008-2011: 251;
2008: 101;
2009: 72;
2010: 41;
2011: 37.
Regional office: Hartford;
Overall IL Entrant Count 2008-2011: 231;
2008: 82;
2009: 56;
2010: 53;
2011: 40.
Regional office: Albuquerque;
Overall IL Entrant Count 2008-2011: 221;
2008: 95;
2009: 47;
2010: 32;
2011: 47.
Regional office: Cleveland;
Overall IL Entrant Count 2008-2011: 181;
2008: 36;
2009: 55;
2010: 25;
2011: 65.
Regional office: St. Louis;
Overall IL Entrant Count 2008-2011: 166;
2008: 27;
2009: 40;
2010: 41;
2011: 58.
Regional office: Louisville;
Overall IL Entrant Count 2008-2011: 164;
2008: 66;
2009: 50;
2010: 32;
2011: 16.
Regional office: Buffalo;
Overall IL Entrant Count 2008-2011: 154;
2008: 24;
2009: 25;
2010: 54;
2011: 51.
Regional office: Denver[A];
Overall IL Entrant Count 2008-2011: 146;
2008: 68;
2009: 25;
2010: 37;
2011: 16.
Regional office: San Diego;
Overall IL Entrant Count 2008-2011: 144;
2008: 41;
2009: 47;
2010: 25;
2011: 31.
Regional office: Columbia;
Overall IL Entrant Count 2008-2011: 126;
2008: 27;
2009: 32;
2010: 34;
2011: 33.
Regional office: Muskogee;
Overall IL Entrant Count 2008-2011: 118;
2008: 35;
2009: 17;
2010: 29;
2011: 37.
Regional office: Des Moines;
Overall IL Entrant Count 2008-2011: 97;
2008: 25;
2009: 42;
2010: 10;
2011: 20.
Regional office: Honolulu;
Overall IL Entrant Count 2008-2011: 93;
2008: 38;
2009: 13;
2010: 24;
2011: 18.
Regional office: Reno;
Overall IL Entrant Count 2008-2011: 89;
2008: 13;
2009: 7;
2010: 32;
2011: 37.
Regional office: Jackson;
Overall IL Entrant Count 2008-2011: 85;
2008: 7;
2009: 27;
2010: 27;
2011: 24.
Regional office: Philadelphia;
Overall IL Entrant Count 2008-2011: 82;
2008: 28;
2009: 21;
2010: 15;
2011: 18.
Regional office: Little Rock;
Overall IL Entrant Count 2008-2011: 80;
2008: 33;
2009: 15;
2010: 20;
2011: 12.
Regional office: Seattle;
Overall IL Entrant Count 2008-2011: 79;
2008: 30;
2009: 25;
2010: 10;
2011: 14.
Regional office: Nashville;
Overall IL Entrant Count 2008-2011: 78;
2008: 20;
2009: 17;
2010: 20;
2011: 21.
Regional office: New Orleans;
Overall IL Entrant Count 2008-2011: 74;
2008: 10;
2009: 12;
2010: 15;
2011: 37.
Regional office: Winston-Salem;
Overall IL Entrant Count 2008-2011: 66;
2008: 25;
2009: 18;
2010: 13;
2011: 10.
Regional office: Salt Lake City;
Overall IL Entrant Count 2008-2011: 63;
2008: 28;
2009: 16;
2010: 14;
2011: 5.
Regional office: Huntington;
Overall IL Entrant Count 2008-2011: 58;
2008: 6;
2009: 8;
2010: 20;
2011: 24.
Regional office: Togus;
Overall IL Entrant Count 2008-2011: 58;
2008: 9;
2009: 19;
2010: 10;
2011: 20.
Regional office: Providence;
Overall IL Entrant Count 2008-2011: 58;
2008: 19;
2009: 16;
2010: 17;
2011: 6.
Regional office: Lincoln;
Overall IL Entrant Count 2008-2011: 58;
2008: 18;
2009: 35;
2010: 5;
2011: 0.
Regional office: Portland;
Overall IL Entrant Count 2008-2011: 56;
2008: 22;
2009: 10;
2010: 7;
2011: 17.
Regional office: Sioux Falls;
Overall IL Entrant Count 2008-2011: 46;
2008: 11;
2009: 22;
2010: 6;
2011: 7.
Regional office: Fargo;
Overall IL Entrant Count 2008-2011: 45;
2008: 8;
2009: 19;
2010: 11;
2011: 7.
Regional office: Baltimore;
Overall IL Entrant Count 2008-2011: 41;
2008: 7;
2009: 14;
2010: 14;
2011: 6.
Regional office: Milwaukee;
Overall IL Entrant Count 2008-2011: 38;
2008: 20;
2009: 6;
2010: 6;
2011: 6.
Regional office: St. Paul;
Overall IL Entrant Count 2008-2011: 31;
2008: 9;
2009: 12;
2010: 7;
2011: 3.
Regional office: Chicago;
Overall IL Entrant Count 2008-2011: 26;
2008: 7;
2009: 10;
2010: 4;
2011: 5.
Regional office: Fort Harrison;
Overall IL Entrant Count 2008-2011: 25;
2008: 4;
2009: 9;
2010: 3;
2011: 9.
Regional office: Roanoke;
Overall IL Entrant Count 2008-2011: 25;
2008: 2;
2009: 4;
2010: 10;
2011: 9.
Regional office: Boise;
Overall IL Entrant Count 2008-2011: 24;
2008: 4;
2009: 2;
2010: 14;
2011: 4.
Regional office: Pittsburgh;
Overall IL Entrant Count 2008-2011: 22;
2008: 2;
2009: 3;
2010: 4;
2011: 13.
Regional office: Washington;
Overall IL Entrant Count 2008-2011: 22;
2008: 4;
2009: 2;
2010: 4;
2011: 12.
Regional office: Wichita;
Overall IL Entrant Count 2008-2011: 18;
2008: 3;
2009: 0;
2010: 4;
2011: 11.
Regional office: Anchorage;
Overall IL Entrant Count 2008-2011: 12;
2008: 8;
2009: 1;
2010: 1;
2011: 2.
Regional office: White River Junction;
Overall IL Entrant Count 2008-2011: 11;
2008: 0;
2009: 3;
2010: 5;
2011: 3.
Regional office: San Juan;
Overall IL Entrant Count 2008-2011: 9;
2008: 2;
2009: 0;
2010: 3;
2011: 4.
Regional office: Boston;
Overall IL Entrant Count 2008-2011: 8;
2008: 4;
2009: 3;
2010: 1;
2011: 0.
Regional office: Manchester;
Overall IL Entrant Count 2008-2011: 7;
2008: 2;
2009: 2;
2010: 1;
2011: 2.
Regional office: Wilmington;
Overall IL Entrant Count 2008-2011: 4;
2008: 0;
2009: 1;
2010: 1;
2011: 2.
Source: GAO's analysis of VA administrative data.
[A] The IL entrant total for the Denver Regional Office includes the
total number of veterans who entered the Cheyenne, Wyoming office.
This office is considered a satellite office of Denver.
[End of table]
[End of section]
Appendix VII: Comments from the Department of Veteran Affairs:
Department of Veterans Affairs:
Washington, DC 20420:
May 22, 2013:
Mr. Daniel B. Bertoni:
Director, Education, Workforce:
and Income Security Issues:
U.S. Government Accountability Office:
441 G Street, NW:
Washington, DC 20548:
Dear Mr. Bertoni:
The Department of Veterans Affairs (VA) has reviewed the Government
Accountability Office's (GAO) draft report, "VA Vocational
Rehabilitation and Employment Program: Improved Oversight of
Independent Living Services and Supports Is Needed" (GAO-13-474) and
generally agrees with GAO's conclusions and concurs with GAO's three
recommendations to the Department.
The enclosure specifically addresses GAO's three recommendations and
provides general and technical comments, and an action plan for each
recommendation. VA appreciates the opportunity to comment on your
draft report.
Sincerely,
Signed by:
Jose D. Riojas:
Interim Chief of Staff:
Enclosure:
Department of Veterans Affairs (VA) Comments to Government
Accountability Office (GAO) Draft Report:
"VA Vocational Rehabilitation And Employment Program:
Improved Oversight of Independent Living Services and Supports Is
Needed" (GA0-13-474):
General Comments:
To address the needs of Veterans with the most severe disabilities who
participate in independent living (IL) services, the Veterans Benefits
Administration's (VBA) Vocational Rehabilitation & Employment (VR&E)
Service collaborates with the Veterans Health Administration (VHA) at
both the local and national levels. VHA Directive 2010-022 establishes
policy on VR&E program support. Implementation of this policy is the
responsibility of each VHA medical center Director. Ensuring effective
compliance is a cooperative effort between the VHA medical center
Director and the VBA regional office (RO) Director.
The IL services provided to each Veteran are unique. Information about
the type of benefit provided by the RO would be insufficient to
determine the appropriateness of planned services. Similarly, dollar
values alone are not informative as the cost of provided services is
determined by the needs of the Veteran, available resources, and
locally-determined pricing considerations. Procedures governing the
oversight of expenditures for Veterans receiving IL services exceed
those for other rehabilitation plans. VBA reviews of IL cases find
that fiscal payments are consistent with regulatory guidelines.
Throughout the report, GAO cites findings from cases that entered IL
case status in 2008. However, VR&E believes that many of the issues
found in these cases have been addressed by the policy guidance,
oversight, and training provided to field staff during the past 5
years.
The objective of the current VBA IL Business Process Reengineering
study is to comprehensively examine current IL service delivery,
including best practices, within the VR&E program and the private
sector. At the conclusion of this study, there will be a detailed plan
for transformation and implementation of procedures to facilitate the
highest quality IL service delivery.
GAO Recommendation: The Secretary of Veterans Affairs should direct
the Undersecretary for Benefits to take the following actions:
Recommendation 1: Work with the Undersecretary for Health to explore
options on ways to enhance coordination to ensure IL track veterans'
needs are met by VHA, when appropriate, in a timely manner. This could
include improving staff education, response times to IL referrals, and
the provision of medically related goods and services.
VA Response: Concur. The Veterans Benefits Administration (VBA) and
Veterans Health Administration (VHA) will continue to work together to
improve the coordination of services and ensure the needs of
Vocational Rehabilitation & Employment (VR&E) participants are met
expeditiously, as required in VHA Directive 2010-022.
VR&E counselors currently access VHA's Compensation and Pension Record
Interchange (CAPRI) system to obtain information related to the
scheduling of consultations and appointments.
In addition, VBA worked with VHA to develop an automated referral
system in CAPRI enabling VR&E counselors to make referrals to VHA
providers electronically and improve the timeliness of requests.
Included in the system capabilities are referral requests for VHA Home
Improvement and Structural Alteration grants and for evaluations of
independent living (IL) needs. Electronic confirmation for requests
and verification of completions will also be available. A 60-day pilot
of the system will be conducted by the fourth quarter of fiscal year
2013. Upon completion of the pilot, it is VBA's and VHA's intention to
implement the new process nationally. Target Completion Date: March
31, 2014.
Recommendation 2: Implement an oversight approach that enables VR&E to
better ensure consistent administration of the IL track across
regions. In developing this approach, consider ensuring that VR&E's
CWINRS system:
* Tracks the total cost and types of benefits provided to each veteran
in the IL track by regional office;
* Accounts for the number of individual veterans served to ensure that
the agency has the information it needs to adequately manage the IL
track;
* Contains stronger data entry controls to ensure that IL track
information is recorded in a consistent manner and is accurate and
complete.
VA Response: Concur. VBA will review the current oversight procedures
and conduct a thorough assessment of areas that can be strengthened to
ensure consistent administration of the IL track across regions. While
funding does not currently exist for CWINRS enhancements to support
this effort, VBA will consider whether ad hoc reports can be developed
in the absence of CWINRS enhancements. VBA will also consider
preparing business requirements for future enhancements to CWINRS for
implementation in future years. The assessment and proposal for a new
oversight approach for the IL track will be completed by September 30,
2013, and implemented by March 31, 2014.
Recommendation 3: Reassess and consider enhancing the agency's current
policy concerning the required level of approval for IL track
expenditures, given the broad discretion individual regional offices
have in determining the types of goods and services IL track veterans
receive.
VA Response: Concur. VBA has extensive review requirements for all
plans of IL services. Currently, all plans of IL services must be
approved by the VR&E Officer before any services are provided or
expenditures are authorized. This oversight is unique among VR&E
rehabilitation plans and provides the local manager an opportunity to
question or obtain additional justification for both proposed services
and the resulting costs.
When home modifications are part of the IL plan, construction costs
exceeding $2,000 must also be approved by the Director at the regional
office (RO). From September 5, 2007, to December 3, 2010, VR&E Service
reviewed all IL cases with construction costs that exceeded $2,000.
The high approval rate, quality of supporting documentation, and
compliance with acquisition procedures found in these cases supported
decentralization of the approval process to the local level.
Construction costs that exceed $25,000 must be approved by the
Director, VR&E Service. Non-construction cost-threshold approvals for
IL cases are consistent with those for other rehabilitation plans,
which also contain a range of services at various cost levels.
VBA finds merit in reassessing the current policy to identify areas
that can be strengthened. While the existing policy includes a great
deal of cost-threshold approvals, there may be room for improvement in
the consistent application across ROs in determining the types of
goods and services IL Veterans receive. VBA will consider results and
recommendations from the current contracted assessment of the IL
program in this assessment. The assessment of current policy and
implementation of any enhanced policies or procedures will be
completed and implemented by March 31, 2014.
[End of section]
Appendix VIII: GAO Contacts and Staff Acknowledgments:
Contact:
Daniel Bertoni, (202) 512-7215 or bertonid@gao.gov.
Acknowledgments:
In addition to the contact listed above, individuals making key
contributions to this report were Clarita Mrena (Assistant Director),
James Bennett, Melinda Bowman, David Chrisinger, Mary Ann Curran,
David Forgosh, Danielle Giese, Angela Jacobs, Mitch Karpman, John
Lack, Kirsten B. Lauber, Karen O'Conor, James Rebbe, Martin Scire,
Almeta Spencer, Jeff Tessin, Jack Warner, and Ashanta Williams.
[End of section]
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Reporting Needed to Enhance Program Effectiveness. [hyperlink,
http://www.gao.gov/products/GAO-13-29]. Washington, D.C.: December 13,
2012.
VA Health Care: Spending for and Provision of Prosthetic Items.
[hyperlink, http://www.gao.gov/products/GAO-10-935]. Washington, D.C.:
September 30, 2010.
Veteran Affairs: Opportunities Exist to Improve Potential Recipients'
Awareness of the Temporary Residential Adaption Grant. [hyperlink,
http://www.gao.gov/products/GAO-10-786]. Washington, D.C.: July 15,
2010.
Veterans Affairs: Implementation of Temporary Residence Adaptation
Grants. [hyperlink, http://www.gao.gov/products/GAO-09-637R].
Washington, D.C.: June 15, 2009.
Federal Information System Controls Audit Manual (FISCAM). [hyperlink,
http://www.gao.gov/products/GAO-09-232G]. Washington, D.C.: February
2009.
VA Vocational Rehabilitation and Employment: Better Incentives,
Workforce Planning, and Performance Reporting Could Improve Program.
[hyperlink, http://www.gao.gov/products/GAO-09-34]. Washington, D.C.:
January 26, 2009.
VA Vocational Rehabilitation and Employment: Service Contract
Management Is Improving, but Challenges Remain. [hyperlink,
http://www.gao.gov/products/GAO-07-568R]. Washington, D.C.: April 23,
2007.
Managerial Cost Accounting Practices: Leadership and Internal Controls
Are Key to Successful Implementation. [hyperlink,
http://www.gao.gov/products/GAO-05-1013R]. Washington, D.C.: September
2, 2005.
VA Vocational Rehabilitation and Employment Program: GAO Comments on
Key Task Force Findings and Recommendations. [hyperlink,
http://www.gao.gov/products/GAO-04-853]. Washington, D.C.: June 15,
2004.
Internal Controls Management and Evaluation Tool. [hyperlink,
http://www.gao.gov/products/GAO-01-1008G]. Washington, D.C.: August
2001.
Managing For Results: Barriers to Interagency Coordination.
[hyperlink, http://www.gao.gov/products/GAO/GGD-00-106]. Washington,
D.C.: March 29, 2000.
Standards for Internal Control in the Federal Government. [hyperlink,
http://www.gao.gov/products/GAO/AIMD-00-21.3.1]. Washington, D.C.:
November 1999.
[End of section]
Footnotes:
[1] VA officials told us that the Washington Regional Office, located
in the District of Columbia, was recently designated the “National
Capital Region Benefits Office” in November 2012. For the purposes of
our review, we will refer to this office as one of VA’s regional
offices. The Manila Regional Office in the Philippines was not
included in our review because it does not administer the IL track.
[2] To assess the reliability of these data, we interviewed
knowledgeable officials and performed electronic tests to identify
missing or erroneous data. We determined the data to be sufficiently
reliable for our purpose, unless otherwise noted.
[3] Our review of IL track administration did not include reviewing
the quality of internal or external assessments the VR&E program uses
to determine the suitability of veterans for employment or the extent
to which veterans' activities of daily living may be limited.
[4] Although not officially admitted into the IL track, veterans in
VR&E's other tracks can receive IL services that may assist them in
meeting their rehabilitation goals.
[5] Under 38 U.S.C. § 3120(d), a veteran's IL program "shall consist
of such services…as the Secretary determines necessary to enable such
veteran to achieve maximum independence in daily living."
[6] ADLs are basic activities that individuals perform on a daily
basis, such as bathing, feeding, and dressing themselves.
[7] According to VA officials, IL services that “support emotional
needs and/or avocational and leisure interests may be included in IL
plans only when gains in independence are an anticipated result.”
[8] The Veterans' Benefits Act of 2010 increased the cap to 2,700
effective "with respect to fiscal years beginning after the date of
enactment of this Act." Pub. L. No. 111-275, § 801, 124 Stat. 2864,
2888. Because the enactment date of the Act was October 13, 2010
(fiscal year 2011), the cap of 2,700 veterans would have become
effective starting in fiscal year 2012.
[9] 38 U.S.C. § 3102(1)(A)(i) and (B). The law defines an employment
handicap as an impairment, resulting in substantial part from a
service-connected disability of a veteran's ability to prepare for,
obtain, or retain employment consistent with the veteran's abilities,
aptitudes, and interests. 38 U.S.C. § 3101(1). Veterans with a 10
percent service-connected disability may also be eligible to receive
VR&E services if they have a serious employment handicap, which is
defined as a significant impairment, resulting in substantial part
from a service-connected disability rated at 10 percent or more, of a
veteran's ability to prepare for, obtain or retain employment
consistent with his or her abilities, aptitudes and interests. 38
U.S.C. §§ 3102(2) and 3101(7).
[10] For veterans rated at 10 percent and veterans beyond their 12-
year basic period of eligibility, the finding of a serious employment
handicap is necessary to establish entitlement to VR&E services.
[11] 38 U.S.C. 3102 and 3120(b).
[12] While VR&E's Central Office oversees regional offices that
administer the IL track, it does not have direct line authority over
regional staff. VBA's Office of Field Operations maintains this
responsibility.
[13] VR&E has two performance measures for its IL rehabilitation rate.
VR&E's fiscal year 2011 IL rehabilitation target was 92 percent, and
its strategic target (or long-term goal) was 95 percent.
[14] VRCs work directly with veterans participating in all of VR&E's
five tracks, not just the IL track.
[15] An employment-related plan is developed for veterans who are
admitted to one of VR&E's other four tracks.
[16] 38 U.S.C. § 3105(d), 38 C.F.R. § 21.76(b). An additional period
of 6 months is allowed if it would enable veterans to substantially
increase their level of independence in daily living. In addition,
VR&E officials stated that they may extend the duration up to 36
months for veterans with severe disabilities who served on active duty
after September 11, 2001.
[17] Specific criteria must be met before approving new plans for IL
services. These criteria include meeting requirements for
participation in a program of IL services, and the worsening of the
veteran’s condition or other changes in the veteran’s circumstances
resulting in a substantial loss of independence. 38 C.F.R. § 21.284(b).
[18] VBA's Loan Guaranty Program administers two grants--the Specially
Adapted Housing (SAH) grant and Special Housing Adaptation (SHA)
grant--to help address the housing needs of veterans with service-
connected disabilities.
[19] To receive medical devices and equipment through PSAS, VRCs must
submit a service request to the veterans' VHA primary care physician.
If the primary physician concurs with the VRC's request, he or she
will submit a referral to PSAS to meet the veterans' needs.
[20] 38 C.F.R. § 21.283(e).
[21] VA pays monthly disability compensation to veterans with service-
connected disabilities--injuries or diseases incurred or aggravated
while on active military duty--according to the severity of the
disability. VA's ratings are awarded in 10 percent increments, from 0
to 100 percent. Veterans with multiple disabilities receive a single
composite (or combined) rating.
[22] Veterans of any age determined to be "unemployable" because of a
combined service-connected disability rating between 60 and 90
percent, can qualify for an increase in their disability compensation
to the amount paid to veterans with a combined service-connected
disability rating of 100 percent.
[23] VR&E's policy letter 28-13-08 states that the agency does not
have the authority to purchase or rent automobiles, trucks, or other
similar "conveyances" for veterans. Also, while VR&E may provide
mobility aids such as wheelchairs to veterans, tractors or mowers
should never be approved as a mobility aid.
[24] See appendix I for more information on the limits of our case
file review.
[25] For confidence intervals for these estimates, see appendix I.
[26] The median cost spent per IL track case that year was about
$3,900. At the 95 percent confidence interval, the amount of median
expenditures per veteran who started an IL track case in fiscal year
2008 falls between $3,071 and $4,452. For additional confidence
intervals for these estimates, see appendix I.
[27] VR&E officials told us that the law does not limit the number of
IL plans VR&E can develop for a veteran, and as a result, veterans can
have more than one plan. For our analysis, we included veterans who
began only one plan during fiscal year 2008. Of the 2,465 veterans who
began an IL plan during fiscal year 2008, 2,274—about 92 percent—had
only one IL plan. In addition, our analysis excludes 34 veterans who
entered the IL track during fiscal year 2008 but whose cases were
subsequently transferred to another one of VR&E’s employment tracks.
We found that less than 1 percent of IL cases transferred to one of
VR&E’s employment tracks. See appendix I for more information about
our analyses.
[28] We calculated this rate based on both closed and open IL cases
for veterans beginning the IL track during fiscal year 2008. In our
calculation of the IL rehabilitation rate, we did not include IL track
veterans who were transferred to another VR&E employment track. In
contrast, VR&E calculates its IL rehabilitation rate using only those
IL cases that were closed as “rehabilitated” or “discontinued” during
a fiscal year.
[29] In the Washington D.C. Regional Office, which VA now refers to as
the National Capital Region Benefits Office, two veterans entered the
IL track during fiscal year 2008. One case was discontinued, and one
case was open at the end of fiscal year 2011.
[30] Twenty-six regional offices had more than 25 veterans enter the
IL track during fiscal year 2008, while 30 offices had 25 or fewer
veterans enter the IL track during the same time period. Two offices
had no IL track entrants that year.
[31] Our analysis of the amount of time to rehabilitate IL
participants is based on the 2,274 veterans who had a single IL plan
developed in fiscal year 2008. These veterans represent about 92
percent of the total 2,465 veterans entering the IL track in fiscal
year 2008.
[32] The St. Paul Regional Office had nine veterans enter the IL track
during fiscal year 2008, while the Roanoke Regional Office had two
veterans enter that year.
[33] We reported the average time to complete IL plans for 53 of VA’s
56 regional offices because two offices did not have veterans begin
the IL track in fiscal year 2008. Another office had two IL track
veterans begin during this period, but these veterans were not “
rehabilitated.”
[34] While there was no clear pattern for the time it took veterans to
complete their IL plans based on veterans’ combined service-connected
disabilities, totally disabled veterans took about a month longer on
average to complete their IL plans than non-totally disabled veterans.
[35] Our model is based on the experiences of veterans who entered the
IL track during fiscal years 2008 through 2011 and had only one IL
plan during this time period. We used our model to estimate the
probability of a veteran being rehabilitated within 2 years if the IL
plan was begun at a regional office that had at least 50 IL cases
during fiscal years 2008 through 2011.
[36] In general, programs of independent living may not exceed 24
months except under certain circumstances. An additional 6 months is
allowed if it would enable veterans to substantially increase their
level of independence in daily living. In addition, VR&E officials
stated that they may extend the duration up to 36 months for veterans
with severe disabilities who served on active duty on or after
September 11, 2001.
[37] Our model shows that VR&E's rehabilitation rate increases by 4.3
percent for each additional 100 cases a regional office completes. The
margin of error associated with these estimates ranged from 3.3 to 5.4
percent at the 95 percent confidence level.
[38] VR&E’s policy manual states that contact via telephone, email, or
mail can be used as alternatives when necessary. Department of
Veterans Affairs, Vocational Rehabilitation and Employment, Chapter 9:
Guidelines for the Administration of An Independent Living Plan, VR&E
manual, Part IV, Section C, Chapter 9.
[39] VR&E’s Quality Assurance (QA) Program at the national level
periodically performs file reviews and site visits of selected
regional offices to assess service delivery and compliance with VA
regulations, procedures, and other directives. After the QA review or
site visit, a report is provided to the regional office under review
that summarizes the key results and findings.
[40] According to officials, the monthly in-person meeting requirement
is only for the IL track, not VR&E's other employment-related tracks.
[41] VRCs we interviewed during our site visits reported relatively
few challenges coordinating with SAH because not many IL cases are
referred to this program for home modifications. In particular, we
found in the 182 IL cases we reviewed that less than 3 percent were
referred to SAH. VRCs commented that many veterans do not qualify for
the SAH's home modification grants because of their eligibility
requirements.
[42] 38 C.F.R § 21.216(b).
[43] Department of Veterans Affairs, Veterans Health Administration,
VHA Directive 2010-022, Vocational Rehabilitation: Chapter 31
Benefits, Timely Access to Health Care Services (May 14, 2010).
[44] United States Department of Veterans Affairs, Vocational
Rehabilitation & Employment Services: Independent Living Participant
Study (September 26, 2008).
[45] VA Vocational Rehabilitation and Employment Task Force. Report to
the Secretary of Veterans Affairs: The Vocational Rehabilitation and
Employment Program for the 21ST Century Veteran (2004).
[46] The standards for internal control in the federal government
state that it is important for federal agencies to have timely
information to help ensure efficient and consistent program
administration. In addition, it is also critical for federal agencies,
including those with highly decentralized program operations, to
comprehensively identify risks that may impede their ability to
achieve program goals. See GAO, Internal Control Management and
Evaluation Tool, [hyperlink, http://www.gao.gov/products/GAO-01-1008G]
(Washington, D.C.: August 2001).
[47] VA is also mandated by Congress to conduct a longitudinal study
of individuals in VR&E's programs, including the IL track, to
determine the long-term outcomes of program participants. Results from
this study are required to be reported to the House and Senate
Veterans' Affairs Committees on an annual basis. Veterans' Benefits
Improvement Act of 2008, Pub. L. No. 110-389, § 334, 122 Stat. 4145,
4172.
[48] United States Department of Veterans Affairs, Vocational
Rehabilitation & Employment Services: Independent Living Participant
Study (September 26, 2008).
[49] [hyperlink, http://www.gao.gov/products/GAO-01-1008G].
[50] VR&E's guidelines for the administration of an independent living
plan state that VRCs are required to obtain appropriate approval if IL
costs exceed $25,000--not that all IL costs are required to be
approved. See Vocational Rehabilitation Manual. M28, Part IV, Subpart
iv, Chapter 9 (December 29, 2006). Similarly, a 2010 VR&E policy
letter requires VRCs to obtain regional or Central Office approval of
construction costs that exceed certain thresholds, but not for all
construction costs. Veterans Benefits Administration, Review of
Requests for Independent Living (IL) Construction Costs in Excess of
$2,000, VR&E Letter 28-11-05 (December 3, 2010).
[51] In 2008, the provision of riding lawn mowers was not specifically
prohibited by VR&E policy.
[52] The case record indicates that the veteran was provided a boat to
"significantly improve independent living and psychosocial
functioning". At the time of assessment, the VRC noted that the
veteran, who suffered from PTSD, was socially isolated but had an
interest in fishing. However, the veteran's old boat "rotted away,"
and the cost for purchasing a new one was high. The VRC noted in the
case file that because the veteran received a new boat, he was less
depressed and his relationships with family and friends improved.
[53] VA's policy states that managerial cost accounting should be
performed to measure and report the costs incurred by the agency.
Specifically, each administration and its units should identify the
cost of products and services provided. For example, in the case of a
VHA medical center, the cost of a product or service may include a
laboratory test, a medical ward bed, or a counseling session. The goal
of this effort is to identify the product or service at the level in
which it is rendered to an external customer, such as a veteran
receiving benefits from a VA program. Department of Veterans Affairs
Managerial Cost Accounting: VA Financial Policies and Procedures,
volume III, chapter 3 (July 2010).
[54] According to these standards, managerial cost accounting is a
fundamental part of an agency's financial management system, and each
agency and its units should report the costs of their activities on a
regular basis. This cost information can be used by Congress and
federal executives in making decisions about allocating federal
resources, authorizing and modifying programs, and evaluating
performance. The cost information can also be used by program managers
in making managerial decisions to improve operating economy and
efficiency. Statement of Federal Financial Accounting Standards 4:
Managerial Cost Accounting Standards and Concepts..
[55] GAO, VA Vocational Rehabilitation and Employment: Better
Incentives, Workforce Planning, and Performance Reporting Could
Improve Program, [hyperlink, http://www.gao.gov/products/GAO-09-34]
(Washington, D.C.: January 26, 2009).
[56] According to VR&E officials, some veterans in the IL track
progress to a point where they may be able to pursue employment in one
of VR&E's employment-related tracks; however, as noted earlier in this
report, very few veterans make this transition--less than 1 percent of
the 8,812 IL track veterans who had one plan during fiscal years 2008
through 2011.
[57] The standards for internal control emphasize the need to have
controls over computerized information systems to ensure the data
entered is complete and accurate [hyperlink,
http://www.gao.gov/products/GAO-01-1008G]. In addition, GAO's federal
information system controls audit manual states that agencies should
establish procedures to provide reasonable assurance that all inputs
into the application have been authorized, accepted for processing,
and accounted for; and any missing or unaccounted for source documents
or input files have been identified and investigated. GAO, Federal
Information System Controls Audit Manual (FISCAM), [hyperlink,
http://www.gao.gov/products/GAO-09-232G] (Washington, D.C.: February
2009).
[58] For confidence intervals for these estimates, see appendix I.
[59] 38 U.S.C. § 3120(e). According to agency officials, "IL plans"
are the same as "programs" of independent living services and
assistance.
[60] According to VR&E officials, entering "independent living case
status" means that the veteran is admitted into the IL track. For more
information on VR&E's policy, see Department of Veterans Affairs,
Veterans Benefits Administration, Increase in New Independent Living
(IL) Programs Allowed by Congress, VR&E Letter 28-11-06 (December 14,
2010).
[61] VR&E officials indicated that another IL plan may need to be
developed to address subsequent needs that arise from a new medical
condition or the progression of an existing one.
[62] "Operational" information could include the number of individual
veterans being served. Furthermore, these standards state that all
pertinent information should be identified, captured, and distributed
in an efficient and timely manner. GAO, Standards for Internal Control
in the Federal Government, [hyperlink,
http://www.gao.gov/products/GAO/AIMD-00-21.3.1] (Washington, D.C.:
November 1999).
[63] Department of Veterans Affairs, Vocational Rehabilitation and
Employment (VR&E) Case Management Portal Project, Version 1.0, Case
Management Portal, Business Requirements Document (September 26, 2012).
[64] VR&E has used the CWINRS system since 2001 to track veteran cases
through its process and to manage program costs. The "WINRS" part of
the acronym represents the first 5 regional offices that tested the
original system. These offices include Waco, Texas; Indianapolis,
Indiana; Newark, New Jersey; Roanoke, Virginia; and Seattle,
Washington.
[65] VR&E uses a "case status" approach to track veterans' movement
through its process in the CWINRS system. Those veterans who are found
eligible for IL benefits enter what VR&E refers to as the "IL Status"
in the CWINRS system. Veterans officially enter this status once an IL
plan has been agreed upon and approved by the veteran, counselor, and
VR&E Officer.
[66] We conducted pretests at the Washington, D.C. regional office and
at VR&E headquarters to compare the information found in veterans'
paper and electronic records. We found the electronic case records to
be sufficient for our purpose. Certain cost information is required to
be entered into CWINRS. Nonetheless, we did request a physical copy of
the closure report for each veteran in our sample. These reports
summarize veterans' participation in the IL track.
[67] Veterans in the IL track are considered by VR&E to be
"rehabilitated" when either all goals of the IL plan have been
achieved, or if not achieved, when (1) the veteran has attained
substantial increase in the level of independence, (2) the veteran has
maintained the increased level of independent for at least 60 days,
and (3) further assistance is unlikely to significantly increase the
veteran's level of independence. For veterans who are unable to
successfully complete the IL track, their cases are entered into a
"discontinued status" where they are closed. Veterans' cases that are
still ongoing are classified as open.
[68] VA officials told us that Washington Regional Office, located in
the District of Columbia, was recently designated the National Capital
Region Benefits Office in November 2012. For the purpose of our
review, we will refer to this office as one of VA’s regional offices.
Furthermore, our review of IL track administration did not include
reviewing the quality of internal or external assessments the VR&E
program uses to determine the suitability of veterans for employment
or the extent to which veterans’ activities of daily living may be
limited.
[69] This group also excluded veterans who transferred to a VR&E
employment track and veterans who had more than one instance of
rehabilitation. Missing data on age and length of service further
reduced our sample size to 8,655 veterans for modeling purposes.
[70] We defined partially disabled veterans as those having combined
VA disability ratings of less than 100 percent. Fully disabled
veterans had ratings of 100 percent.
[71] We linked each numeric disability code in our sample to one of 16
categories of disabilities defined by VA regulations.
[72] Schoenfeld residuals measure the difference between each observed
covariate value for a failure at time t minus the expected value of
the covariate. The expected value is taken over the probability
distribution of failure probabilities at t for units in the risk set.
[End of section]
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Katherine Siggerud, Managing Director, siggerudk@gao.gov:
(202) 512-4400:
U.S. Government Accountability Office:
441 G Street NW, Room 7125:
Washington, DC 20548.
Public Affairs:
Chuck Young, Managing Director, youngc1@gao.gov:
(202) 512-4800:
U.S. Government Accountability Office:
441 G Street NW, Room 7149:
Washington, DC 20548.
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