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“Ensuring the Best Health Care for Veterans”TrANsITION Of CAre Combat inJured veteran, Combat veteran and veteranSOne of the focuses of The American Legion’s System Worth Saving Program for 2010-2011 was Service Member’s Transition ofCare from the Department of Defense (DoD) into the Department of Veterans Affairs (VA). The American Legion definedthree types of transitioning service members in this report:Combat Injured Veteran, Combat Veteran and Veteran.Once a service member sustains an injury in theater, their treatment process is initiated there. This is where combat lifesavercare is performed by a combat medic or corpsman. The combat medic or corpsman gives the injured soldier a Military AcuteConcussion Evaluation (MACE). According to the Defense andVeterans Brain Injury Center (DVBIC), the MACE screeningtest was designed for the acute evaluation of concussion. Thismethod is currently the only standardized and most widely usedprocess for evaluation of acute mild TBI (otherwise known asconcussion) in military operational settings. The MACE can beadministered by any level of medical provider (medic/corpsmanto physician) when there is suspicion of concussion. This test isadministered within the first 48 to72 hours following injury.The service member is then transported by ground ambulanceor helicopter to the next level of care, such as 332d Air ForceTheater Hospital at Balad Air Base Iraq where life-saving treatment is provided. The service member is then transported byaeromedical evacuation flight to Ramstein, Germany, wherecare will continue at Landstuhl Regional Medical Center. Following their treatment at Landstuhl Regional Medical Center,the service member is transported to the states where they areadmitted to a Military Treatment Facility.Combat injured veterans are those wounded, ill and injuredservice members that were injured in Operation EnduringFreedom (OEF), Operation Iraqi Freedom (OIF) or OperationNew Dawn (OND) on the battlefield and were treated at a Military Treatment Facility. Combat veterans are service memberswho served in theater during Operation Enduring Freedom(OEF), Operation Iraqi Freedom (OIF) or Operation NewDawn (OND) who can receive cost-free medical care for anycondition related to their service in theater for five years afterthe date of their discharge or release. In order to take advantage of these benefits, OEF/OIF/OND veterans need to enrollin VA’s health care system. Veterans are those service memberswho did not deploy to a combat theater and go through theregular transition process from DoD to VA.CoMBat InjureD Veteran (See Chart A)Medical evaluation Board (MeB)The MEB is the initial phase of the IDES that is convened to determine a service member’s medical and duty status. A servicemember is referred to a MEB by a unit commander or a physician when it is believed that he or she may possess one or moremedical conditions that cause him or her to fail to meet retention standards. A service member does not “apply” or self-referhimself or herself for evaluation by a MEB.MEBs are generally located at a service member’s treating military treatment facility (MTF). An exception to this might be ifa service member is at another military installation for medicaltreatment. In that instance, the installation providing medicaltreatment might conduct the service member’s IDES processing, rather than at his or her home station. Currently, DoDdoes not have a central website to provide additional information about the MEB program.Physical evaluation Board (PeB)The PEB, which is an administrative board, determines if theproposed unfitting medical condition(s) renders the servicemember inability to continue further service based on his or hermilitary grade, rank, or rating. A PEB will determine whethera service member will be retained in the armed forces. Eachbranch of service has its own criteria governing fitness for duty.For example, the Navy might require deployability, whereas theArmy does not require deployability as factor for retention. Ifthe PEB determines unfitness for duty, it will assign a disabilityrating based on the severity of the injury.The PEB, with a number of exceptions, uses the Department ofVeterans Affairs Schedule for Ratings of Disabilities (VASRD) asa guideline to determine disability ratings for unfitting medicalconditions. There are two types of PEBs— the informal and theformal PEB. The PEB, whether formal or informal, is composedof three people—a Board president, a personnel managementofficer, and a physician. When a reservist is being evaluated, aboard member must be a member of the Reserve Component.Currently, DoD does not have a central website to provide additional information about the PEB program.The American Legion has three MEB/PEB representatives at Walter ReedArmy Medical Center (Washington, DC), Brooke Army Medical Center (San Antonio, TX) and Fort Lewis (Tacoma, WA).The American Legion SyStem Worth Saving5

The American LegionSyStem Worth SavingFor more information or if you have questions regarding theMEB/PEB process, please contact the National Security/ForeignRelations division at nsfr@legion.org.Integrated Disability evaluation System (IDeS)In November 2007, DOD and VA began piloting the IDES, a jointdisability evaluation system, to eliminate duplication in their separate systems and expedite receipt of VA benefits for wounded, ill,and injured service members. The pilot program for disabilitycases originated at the three major military treatment facilities inthe National Capital Region, (Walter Reed Army Medical Center, National Naval Medical Center Bethesda, and Malcolm Grow(Andrews) Air Force Medical Center). The IDES merges DODand VA evaluation processes, so that service members begin theirVA disability claim while they undergo their DOD disabilityevaluation, rather than sequentially, making it possible for themto receive VA disability benefits shortly after leaving military service. The IDES merges DOD and VA’s separate exam processesinto a single exam process that is conducted to VA standards. Italso consolidates DOD and VA’s separate rating phases into oneVA rating phase. In addition, the IDES provides VA case managers to perform outreach and nonclinical case management andexplain VA results and processes to service members.VA and DoD worked together to increase the number of sites forthe IDES program from 21 to 27 in 2010. The six new sites areFort Riley, Fort Benning, Fort Lewis, Fort Hood, Fort Bragg, andPortsmouth Naval Hospital. The IDES simplifies the process fordisabled Service members transitioning to veteran status, improvesthe consistency of disability ratings, and improves customer satisfaction. Currently, both DoD and VA do not have a central websiteto provide additional information about the IDES program.The American Legion has MEB/PEB Representatives at WalterReed Army Medical Center, Brooke Army Medical Center and FortLewis to assist transitioning service members with the MEB/PEBprocess. For more information, contact The American Legion National Security Foreign Relation Commission at nsfr@legion.org.Benefits Delivery at Discharge (BDD)The Benefits Delivery at Discharge (BDD) Program allows aservice member to apply for disability compensation benefitsfrom the Department of Veterans Affairs (VA) prior to retirement or separation from military service. BDD is offered toaccelerate receipt of VA disability benefits, with a goal of providing benefits within 55 days after release or discharge fromactive duty. BDD allows a service member with at least 60 days,but not more than 180 days, remaining on active duty to file aVA disability claim prior to separation. BDD requires a minimum of 60 days to allow sufficient time to complete the medi-6cal examination process (which may involve multiple specialtyclinics) prior to separation from service. To fully participatein the BDD Program, you must submit VA Form 21-526, alongwith a copy of your service treatment records (or original), andbe available to attend and complete all phases of the VA/DoDmedical separation examination prior to leaving the area.According to the American Legion’s national BDD staff, thereare several challenges that they encounter with this program.There is a significant need for additional resources, funding andstaff to meet the 55-day standard and maintain the timelinessof processing claims. The rating Regional Office (RO) has torely on the proper development of the BDD claim at the variousintake sites. If the intake site fails to properly develop the claimthe BDD rating RO has to complete the development, whichcould delay the rating. Another challenge is service membersleaving the area prior to all examinations being completed. Ifthey do, it requires the rating RO to reschedule the exams, delaying the final rating. The staff further noted that a better effort needs to be made to let the Reserve service members awareof the BDD program. Oftentimes the active duty members areable to utilize the services right away and the Reserve servicemembers have to wait and go through the long process.In terms of case completion, the BDD national staff reports thatbetween October 2009 and September 2010, the Salt Lake City,UT office completed 10,511 BDD claims and Winston/Salem,NC office completed 12,072 claims. Between October 2010and May 2011, the Salt Lake City, UT office has completed 6,671BDD claims and Winston/Salem has completed 6,919 claims.Salt Lake City has a current inventory of 4,056 BDD claimsand Winston/Salem has 5,869. In addition, the national staffexpressed the concern that the lack of an integrated medical record between DoD and VA have resulted in serious setbacks inthe claims process.For more information about the BDD program, please visit VA’swebsite at: ral/bdd brochure.pdf. To reach The American LegionBDD Representatives in the Winston Salem, NC and Salt LakeCity, UT office for assistance, please contact the VA&R divisionat var@legion.org.Va Liaison ProgramThe VA Liaison Program now has 33 liaisons serving at 18 military treatment facilities. The VA Liaisons are integrated withstaff at the Military Treatment Facility (MTF) sites to coordinatecare and provide onsite consultation about VA resources andtreatment options, and a majority of them are co-located withthe military’s own case managers. A standardized referral formthat outlines the patient’s medical needs is provided by the MTFThe American Legion SyStem Worth Saving

“Ensuring the Best Health Care for Veterans”case manager to the VA Liaison with attached medical records,so the service member can be registered into VA’s ComputerizedPatient Record System.The program helps injured Active Duty, National Guard orReserve Service members receive care that VA uniquely specializes in, and also aids service members who are separatingfrom the military in the transition process to VA. For less severely injured service members, VA also has Liaisons co-locatedwith Army Warrior Transition Units (WTUs), which supportwounded Soldiers requiring rehabilitative care at some MTFsites. The VA Liaison offers care where appropriate, or if servicemembers are transitioning out of the military, the Liaison willmake contact with their local hometown VA, enroll them, helpschedule appointments or inpatient beds, and have a contactnumber ready for when they leave the MTF. Each VA Liaison isbased out of the Veterans Affairs Medical Center (VAMC) thatis located nearest to each participating MTF, and the partnership is outlined in a local Memorandum of Agreement.VA Liaisons participate in video teleconferencing between MTFand VA staff, and coordinate referrals with the OEF/OIF/ONDProgram Manager at the receiving VAMC. Each VA Medical Center has an OEF/OIF/OND Care Management Team, inwhich a program manager serves as the contact point for referrals from the MTF and coordinates the transition of care, and acase manager provides further services to help manage the careof severely ill or injured patients.For more information on the VA Liaison program, please visitVA’s website at: http://www.oefoif.va.gov/valiaisons.asp.operation enduring Freedom/operation IraqiFreedom/operation new Dawn (oeF/oIF/onD) Care Management ProgramIn October 2007, the Department of Veterans Affairs (VA) established the OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) Care Management Program in the Officeof Patient Care Services located in VA Central Office. The program addresses the needs of wounded and ill service membersand veterans as they return from deployment and transitionfrom the DoD health care system to the VA system of care. In2010, VHA expanded the OEF/OIF program to include Operation New Dawn (OND) veterans. Under VHA’s OEF/OIF/OND Care Management Program, each VA Medical Center hasan OEF/OIF/OND Care Management team in place to coordinate patient care activities and ensure that service membersand veterans are receiving patient-centered, integrated care andbenefits. Severely injured OEF/OIF/OND veterans are provided with a case manager and any other OEF/OIF/OND veteranmay be assigned a case manager upon request or as indicated bya positive screening assessment. For more information, pleasevisit VA’s website: http://www.oefoif.va.gov/.Federal recovery Care Coordination ProgramThe Federal Recovery Care Coordination is a process that assesses, plans, implements, coordinates, monitors, and evaluatesthe benefits and services required to meet the client’s goals regardless of client location, health status and types of injuries orillness. The FRC program includes advocacy, communication,assets and information management. The program also promotes an integrated approach to effectively manage medical andsocial conditions for wounded, ill or injured service members,veterans, and their families across transitions.In order to be eligible for this program, the service member hasto be in an acute care setting within a military treatment facility; considered at risk for psychosocial complication or self orcommand referred based on perceived ability to benefit from arecovery plan. The service member may also if eligible if theyhave been diagnosed or referred with Spinal Cord Injury, Burns,Amputation, Visual Impairment, Traumatic Brain Injury (TBI)or Post Traumatic Stress Disorder (PTSD).An assigned Federal Recovery Coordinator will develop a Federal Individualized Recovery Plan with input from the multidisciplinary health care team, the service member or veteran, andtheir family or caregiver. They track the care, management andtransition of a recovering service member or veteran throughrecovery, rehabilitation and reintegration.For more information about the Federal Recovery Care Coordinator Program, please go to: a System of CareThe Polytrauma System of Care (PSC) is an extensive medicalsystem that provides medical rehabilitation, coordination ofsupport, and also information tool for active duty, veterans andtheir family members. This specialized treatment of rehabilitation consists of Traumatic Brain Injury (TBI) and Polytraumacase management. There are currently four lead PolytraumaRehabilitation Centers (PRC) located in Richmond, Virginia;Tampa, Florida; Minneapolis, Minneapolis and Palo Alto, California and a fifth being established in San Antonio, Texas. Thereare also twenty-two (22) Polytrauma Network Sites (PNS),eighty (80) Polytrauma Support Clinic Teams (PSCT) and fifty(50) Polytrauma Points of Contact (PPOC) located at VA Medical Centers across the U.S. providing a continuum of integratedcare for soldiers and veterans. The PRC’s receives referrals fromthe Medical Treatment facilities (MTF) Walter Reed, BethesdaNaval, Brooke Army Medical Center.The American Legion SyStem Worth Saving7

The American LegionSyStem Worth SavingReferrals from Military Treatment Facility Provided by: Senior Social Workers Nurse Case Manager PhysicianOutreach to the Veterans Affairs (VA) Facilities Provided by: Social Work Services (SWS) Nationwide sharing National teleconferences (education, dissemination, policesand new initiatives) Community Colleges, local Army Reserve, National GuardUnits Community Organizations Post Deployment Health Reassessment (PDHR’s) InactiveReady Reserve (IRR) Muster, Yellow RibbonMedical Records Shared through: DOD sends electronic filesVideo-teleconferencingDirect access from the SWSElectronic Bi-directional Health Information ExchangeOutreach to the Veterans/Families Provided by: Transition Patient Advocate (Liaison between veterans, theirfamilies and staff) OEF/OIF/OND ManagerCase Management/Seamless Transition to Veterans AffairsMedical Center (VAMC) Tracking of non-severely injured, severely injured throughthe Case Management Referral and Tracking Application(CMTRA) database Military liaison embedded to support active duty patients One case manager for individual veteran Phone conferences, video teleconferencing, direct telephone,scheduling appointments, assignment of case-manger Life Long case management as long as PMR needs continue(monthly, quarterly, semi-annually or annual basis Individualized follow-up plan for all veteransCoMBat Veteran (See Chart B)Military veterans, including Reservists and National Guard members, who served in combat theater after November 11, 1998, including veterans of Iraq and Afghanistan, are eligible to receive fiveyears of enhanced enrollment eligibility for VA health care services,which provides cost-free health care from VA for conditions thatare potentially related to their service in the theater of operations.VA has a number of programs, services and outreach for combatveterans including: Health Resource Center, Health EligibilityCenter and the Seven Touches of VA Outreach program.8the Health resource CenterIn 2002, VA established the Health Resource Center (HRC) as anational contact

Salem VA Medical Center (Salem, VA) 61 Hunter Holmes McGuire VA Medical Center (Richmond, VA) 64 VIsN 7 Atlanta VA Medical Center (Decatur, GA) 67 Charlie Norwood VA Medical Center (Augusta, GA) 69 VIsN 8 Bay Pines VA Healthcare System (Bay Pines, FL) 73 Orlando VA Medical Center (Orlando, FL) 76 James A. Haley Veterans' Hospital (Tampa, FL) 79