STATEMENT OF RUTH A. FANNING
DIRECTOR, VOCATIONAL REHABILITATION & EMPLOYMENT SERVICE
VETERANS BENEFITS ADMINISTRATION
BEFORE THE SENATE COMMITTEE ON VETERANS' AFFAIRS
February 5, 2008
Mr. Chairman and members of the Committee, thank you for inviting me to appear before you today to discuss VA's Vocational Rehabilitation and Employment ( VR&E) program. My testimony will provide an overview of VR&E with specific emphasis on Independent Living services and the Five-Track Employment Process. I will discuss VR&E services provided to veterans and servicemembers, including members of the Guard and Reserves, and the structure and importance of VR&E's relationships with the Veterans Benefits Administration ( VBA), Veterans Health Administration ( VHA), the Department of Labor, and the Department of Defense in carrying out VR&E's role in the recovery and rehabilitation of servicemembers and veterans with serious injuries. I will also address how recommendations from the President's Commission on Care for America's Returning Wounded Warriors and the Veterans' Disability Benefits Commission would impact VR&E. I am pleased to be accompanied by Ms. Kristen Day, Chief Consultant, Care Management and Social Work, Veterans Health Administration.
VR&E provides service-disabled veterans and servicemembers awaiting medical discharge from active military duty with the necessary services to assist them in preparing for, finding, and maintaining suitable employment or achieving independence in their daily living. Veterans with service-connected disabilities are provided with a full range of services including vocational planning, case management, training to build job skills, and job placement assistance.
Five Tracks to Employment
In response to recommendations made by the VR&E Task Force in 2004, VR&E Service implemented the Five-Track Employment Process. The Five-Track Employment Process standardizes the VR&E program orientation practices; integrates veterans, counselors, and employment professionals through a comprehensive evaluation phase; and places emphasis on employment early in the rehabilitation process. The Five-Track Employment Process enables veterans to make informed choices through one of five employment options, including re-employment with a previous employer, rapid access to employment through job-readiness preparation and incidental training opportunities, self-employment for those who wish to own their own businesses, employment through long-term services that include formal training and education programs leading to a suitable employment goal, and services to maximize independence in daily living for veterans who are currently unable to work or participate in other programs of vocational rehabilitation.
In 2005, VR&E Service stationed 72 employment coordinators at VA regional offices across the country. Over the past two years, the number of employment coordinators has increased to 83. The primary function of the employment coordinator is to provide veterans with services to enhance job-readiness skills and to offer job referral and placement services. The employment coordinator also works closely with the Department of Labor-funded Disabled Veterans Outreach Program Specialists and Local Veterans' Employment Representatives.
Additionally, VR&E Service established Career Resource Centers - "job labs" - within each regional office and developed an on-line employment website on the Internet at VetSuccess.gov. VR&E Service developed working partnerships and signed memoranda of understanding ( MOUs) with Federal, State, and private-sector employers who have agreed to train and hire veterans participating in the VR&E Program. These resources and initiatives have provided vital vocational and employment support to program participants, enabling them to make positive training and employment decisions leading to successful employment outcomes.
VR&E also continues to partner with the Department of Labor VETS program to assist veterans to achieve their employment goals. As recommended by the 2004 Task Force, VR&E and Department of Labor entered into an MOU in 2005 and moved forward to establish a joint work group to standardize procedures, develop joint reporting and performance methods, and implement a national model for enhanced collaboration. At the end of January, a joint demonstration project was launched in eight offices to move forward with implementation of all joint work group recommendations.
VR&E may initiate programs of independent living services to eligible veterans for whom achievement of a vocational goal is not currently reasonably feasible. Independent living services are intended to help veterans reach the point when a vocational goal or participation in an extended evaluation is reasonably feasible or assist veterans to become more independent in daily living within their families and communities.
Independence in daily living translates to the ability of a veteran to live and function within family and community either without the services of others or with a reduced level of those services. Services are tailored to each veteran's needs and may include a discrete service or a comprehensive program of services necessary to achieve maximum independence in daily living.
Some of the independent living services that VA provides include training in activities of daily living, training in skills needed to improve an individual's ability to live more independently, attendant care during a period of transition, transportation when special arrangements are required, peer counseling, housing integral to participation in a program of special rehabilitation services through an approved independent living center or program, training to improve awareness of rights and needs, assistance in identifying and maintaining volunteer or supported employment, services to decrease social isolation, and adaptive equipment that increases functional independence.
As examples of some of the independent living services provided in collaboration with VHA, I would like to highlight four programs: The Home Improvements and Structural Alterations ( HISA) and Specially Adapted Housing ( SAH) grant programs, VA's Automobile Adaptive Equipment program, and the Visually Impaired Services Team ( VIST) program.
Benefits and services related to housing through the Independent Living Program may include adaptations that VA is unable to provide under the HISA or SAH grant programs. The Vocational Rehabilitation Counselor works closely with the Veterans Health Administration ( VHA) and/or the SAH agent to conduct assessments and procure services and equipment to address housing-related independent living needs. VHA can provide HISA grants up to $1,200 for nonservice-connected veterans or up to $4,100 for service-connected veterans who need modifications to their homes to facilitate entry and provide access within the home. The Specially Adaptive Housing ( SAH) program provides assistance to veterans with specific loss or loss of use of upper and lower extremities, and blindness when accompanied by loss, or loss of use, of an extremity. The SAH grant can be used up to three different times as long as the total does not exceed $50,000. Additionally, a veteran can use a "temporary residence" grant of up to $14,000 if a family member owns the home.
VA's Automobile Adaptive Equipment program helps veterans or servicemembers who are service-connected for the loss or loss of use of one or both feet or hands, or who have service-connected ankylosis of one or both knees or one or both hips. Veterans with severe burns resulting in a rating of loss of use of their extremities also qualify. Automobile Adaptive Equipment allows veterans with serious disabilities to live more independently and pursue employment by permitting eligible disabled persons to enter, exit, or operate a motor vehicle. The program can provide, among other things, power steering, brakes, windows, doors, mirrors, seats, automatic transmission, van lifts, wheelchair and scooter lifts, shipping costs, and other special equipment necessary to the individual.
VA's VIST offers a wide variety of services, including visual exams, devices to assist with daily living, and computer provision and training, to veterans with visual impairments. VA also offers an array of prosthetic devices and services for patients based upon such factors as enrollment, medical evaluations, and prescriptions. VA assumes responsibility for repairs to the equipment provided. As a result of VIST services, veterans with serious visual impairments are able to work and live more independently.
When a servicemember or veteran experiences a traumatic or serious injury, every area of his or her life is potentially affected. Serious disabilities, including amputations, burns, spinal cord injuries, traumatic brain injuries, and associated mental disorders, require extensive care and often prolonged recovery periods. Medical services dominate at the onset of an injury, and other transition needs emerge as stabilization and recovery progresses. Adjustment to disabilities due to the traumatic or serious injuries is multifaceted and highly individual. Adjustment issues may include changes in personal relationships, social and economic status, vocational status, and adaptation to the physical changes associated with disability.
Many severely wounded veterans and active-duty servicemembers are initially treated at a VA Polytrauma Rehabilitation Center ( PRC). Vocational rehabilitation is often an important component of services provided for those treated within the Polytrauma System of Care. Younger veterans particularly benefit from an approach to rehabilitation emphasizing a return to employment and independent living from the very beginning of the treatment process. VR&E program specialists and rehabilitation specialists with Spinal Cord Injury, the Traumatic Brain Injury ( TBI)/Polytrauma programs, and/or the Compensated Work Therapy ( CWT) programs collaboratively provide vocational services, including vocational counseling services and educational support regarding benefits. CWT is a program in which veterans are placed in jobs, and then receive treatment to help them keep these positions. It is integrated with other components of treatment. Most veterans receiving CWT services have mental health diagnoses, but may also have traumatic brain injury.
After the intensive medical rehabilitation phase, VR&E services continue as an integral part of seriously disabled servicemembers' or veterans' adjustment and reintegration into their communities. Working together with military treatment facilities, the Department of Labor, VHA, and other VBA personnel, VR&E provides an optimal program of vocational rehabilitation and employment services to assist with seamless transition from military to civilian life.
Early intervention services for a seriously disabled OEF/ OIF servicemember or veteran begins with a VR&E Vocational Rehabilitation Counselor directly contacting the individual to inform him or her about available benefits. This initial contact may occur while the servicemember is receiving treatment at a military treatment facility ( MTF), a VA Medical Center, or the individual's home. VHA Social Work Case Managers help coordinate meetings between patients, families, and VBA counselors to begin the application process for veterans. Active duty servicemembers can also benefit from applying for housing grants, vehicle modifications, and VR&E benefits. VR&E staff is equipped to go anywhere necessary to deliver the initial orientation and provide assistance to the wounded warrior and his or her family. Each PRC also has a VBA representative assigned to the program who visits patients and families on a regular basis.
This initial contact allows for the vocational rehabilitation process to begin earlier, during medical rehabilitation, and enables the veteran to make the transition quickly to work or to a program of employment services after he or she is discharged and ready to pursue vocational goals. This early intervention also gives hope to veterans as they adjust to their disabilities and plan for their futures. Research indicates that veterans realize better employment outcomes when vocational rehabilitation is provided in the context of an overall mental or behavioral health treatment plan.
Once the eligible servicemember or veteran completes the initial orientation and the vocational assessment, a plan of services is developed to assist in meeting the individual's vocational or independent living goals. In developing the rehabilitation plan, VR&E staff work closely with MTF and VHA personnel, communicating with medical teams to obtain current information about the veteran's physical capacities and projected recovery timelines. Working in collaboration with VHA, the Vocational Rehabilitation Counselor obtains specialized assessments, including functional capacity evaluations, neuropsychiatric evaluations, and psychiatric evaluations to ensure rehabilitation planning takes disability issues fully into account. Throughout the planning and rehabilitation phase of veterans' VR&E programs, VHA is a vital partner in providing ongoing medical, dental, vision, and mental health care, as well as meeting specialized prosthetic needs. VR&E and VHA also partner to provide ongoing in-service training to staff to maintain VR&E counselors' awareness of current medical trends and to provide ongoing program updates to both VR&E and VHA.
Direct vocational counseling services address the vocational or independent living needs of the veterans and active duty servicemembers. These services are available at PRCs through the Polytrauma Vocational Rehabilitation Program, the VR&E program, and the VHA CWT program, and include: vocational evaluation, career exploration, functional assessment, vocational counseling, education about available resources, training, job placement assistance, and compensated work therapy placements. Working collaboratively, the Polytrauma Vocational Rehabilitation Program and the local CWT program provide linkage to VR&E benefits for both independent living program services and education training/employment services, and VR&E refers veterans for services through the CWT program when appropriate. Vocational services for patients with TBI, spinal cord injuries, burns, polytrauma, and other serious injuries are effectively coordinated through VBA and VHA programs to achieve a coordinated course of care, treatment, and rehabilitation.
Outreach to servicemembers is also provided through the Transition Assistance Program ( TAP) and Disabled Transition Assistance Program ( DTAP) at the time servicemembers with disabilities are leaving the military. Through the TAP program, servicemembers are informed about the broad range of VA benefits available to them, including VR&E benefits. DTAP provides more detailed benefits information geared toward servicemembers with disabilities, including a detailed orientation about VR&E and all available services. The goal of DTAP is to encourage and assist potentially eligible servicemembers to make informed decisions about VA's vocational rehabilitation and employment benefits. Full DTAP information is also available on VR&E's vet.success.gov internet site. This site includes all orientation materials from DTAP and the standard VR&E Five Tracks to Employment orientation.
VR&E will collaborate with the new Federal Recovery Coordinators to ensure seamless and timely delivery of services. The Federal Recovery Coordinators provide seriously injured veterans or servicemembers with the opportunity to consult a VR&E counselor. The results of this discussion will be included in the veteran's or servicemember's Federal Individual Recovery Plan (FIRP), which describes the objectives and resources needed to assist him or her in achieving lifelong needs and goals through recovery, rehabilitation, and reintegration.
Eligible servicemembers who have been determined by VA to have a disability of at least 20 percent are entitled to an evaluation of VR&E benefits regardless of their expected discharge date. Vocational rehabilitation services are introduced to servicemembers during VA educational and vocational counseling available to servicemembers anticipating discharge from the military for any reason. While a servicemember cannot participate in VR&E services until VR&E eligibility is determined, educational and vocational counseling services provide an opportunity to begin the counseling and evaluation process, allowing vocational rehabilitation and employment services for disabled servicemembers and veterans to progress more quickly once eligibility for the VR&E program has been established.
OEF/ OIF Priority Services
To ensure timely services, each regional office has designated a VR&E OEF/ OIF case coordinator to track all OEF/ OIF claims and implement priority processing of their vocational rehabilitation claims. Within one business day of receiving an OEF/ OIF VR&E application, the assigned office contacts the servicemember or veteran by phone to offer an initial appointment within five business days. If the servicemember or veteran cannot be reached by phone, the office schedules an appointment within ten business days by mailing an appointment letter to the servicemember or veteran.
For servicemembers and veterans who are recovering from catastrophic disabilities and who need independent living services in addition to planning for their vocational goals, an extended evaluation period may be needed. Individuals who are so severely disabled that a decision cannot be made about whether an employment goal is currently feasible may be provided an extended evaluation of more than the basic 12 months. VR&E Service has authorized field managers to approve extended evaluations for OEF/ OIF servicemembers and veterans up to a total of 18 months.
Another tool to assist the injured servicemember or veteran is the "Coming Home to Work" ( CHTW) initiative. The CHTW initiative began in September 2004 as a VA Office of Human Resources pilot at Walter Reed Army Medical Center. In November 2005, responsibility for CHTW was transferred to VR&E Service and became an integral part of VR&E's early intervention and outreach efforts to OEF/ OIF servicemembers. CHTW was initially established at eight major MTFs and later expanded to 13. CHTW has provided opportunities for eligible servicemembers to obtain work experience, develop skills needed to make the transition to civilian employment, determine the suitability of potential careers, and make the transition into competitive employment positions.
The need for early VR&E outreach through CHTW extends beyond the major MTFs. Department of Defense assigns injured servicemembers pending medical separation to health care facilities across the country. In order to meet the increased need for early VR&E outreach, CHTW is now being expanded to all VR&E field offices. This expansion involves developing a solid working relationship with the military chain of command, government agencies, and the VA local service delivery team. Close coordination and collaboration are vital to the success of VR&E early outreach efforts for disabled servicemembers and veterans.
National Guard and Reserve members receive the same VR&E benefits as all other servicemembers and veterans with a VA-rated disability, but VR&E provides additional outreach to these groups to ensure their awareness of available benefits and to expedite their enrollment and participation in the VR&E program.
Outreach includes participation in various welcome home events for Guard and Reservists; coordination with the National Guard Transition Assistance Advisors; and forming partnerships with Warrior Transition Units (WTUs) to provide outreach and early access to VA benefits. We also provide regular briefings to the Army Community Based Healthcare Organizations, Navy personnel, Navy Physical Evaluation Board Liaison Officers, and Army Medical Hold transition services personnel.
Veterans Disability Benefits Commission
The Veterans Disability Benefits Commission recently reviewed VA benefits and made several recommendations to enhance services for transitioning disabled OEF/ OIF veterans. Many of these recommendations would impact VR&E services provided to servicemembers and veterans, and several would require legislative changes. We are currently in the process of evaluating the Commission's recommendations and formulating appropriate responses or actions, as appropriate, but are not prepared to discuss such matters at today's hearing.
President's Commission on Care for America's Returning Wounded Warriors
VR&E received additional recommendations from the President's Commission on Care for America's Returning Wounded Warriors. This commission's recommendations included extending the maximum number of months that a veteran may participate in a VR&E program to 72 months. The extension was recommended to accommodate part-time attendance or temporary suspension of participation in a rehabilitation program. Current program regulations allow part-time attendance up to 96 months.
The Commission recommended financial support for VR&E participants through a system of transition payments and payment of an incentive to encourage program completion. The Commission also recommended that VA conduct a six-month study to address several recommendations, including administration of transition payments. VBA worked with the VA Office of Policy and Planning to contract for this study. VA has advanced a legislative proposal to implement the recommendations made by the Commission on Care of America's Returning Wounded Warriors.
Mr. Chairman, this concludes my statement. I would be pleased to answer any questions from you or any of the other members of the Committee.