This report is part of a project on post-9/11 veterans in America produced by the Carnegie-Knight News21 program. The Arizona Center for Investigative Reporting is pleased to provide a series of these stories, many of which have ties to Arizona, for our readers.
“Back Home: The Challenges Facing Post-9/11 Veterans Returning from the Wars in Iraq and Afghanistan” was produced by News21, a national investigative reporting project involving top college journalism students across the country and headquartered at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University.
By Hannah Winston, News21
The Department of Veterans Affairs and the Department of Defense spent at least $1.3 billion during the last four years trying unsuccessfully to develop a single electronic health-records system between the two departments — leaving veterans’ disability claims to continue piling up in paper files across the country, a News21 investigation shows.
This does not include billions of other dollars wasted during the last three decades, including $2 billion spent on a failed upgrade to the DOD’s existing electronic health-records system.
For a veteran in the disability claims process, these records are critical: They include DOD service and health records needed by the VA to decide veterans’ disability ratings and the compensation they will receive for their injuries. Stacks of paper files — including veterans’ evidence from DOD of their military service and injuries — sit at VA regional offices waiting to be processed instead of being readily accessible in electronic files.
Although Congress repeatedly has demanded an “integrated” and “interoperable” electronic health-records system, neither the DOD nor the VA is able to completely access the other’s electronic records. Meanwhile, each has spent hundreds of millions of dollars on upgrades to its information technology and on attempts to improve interoperability between their systems.
At a July hearing before the House Armed Services Committee and the House Committee on Veterans’ Affairs, Rep. Jeff Miller, R-Fla., said he was disappointed and frustrated by the years of promises and billions of dollars spent without interoperable health records. “The only thing interoperable we get are the litany of excuses flying across both departments every year as to why it has taken so long to get this done,” said Miller, the chairman of the Veterans Affairs Committee.
The National Defense Authorization Act for 2008 mandated that the DOD and VA secretaries “develop and implement electronic health-record systems or capabilities that allow for full interoperability of personal health information between the Department of Defense and the Department of Veterans Affairs.”
In 2011, the DOD and VA decided the solution would be to create a single electronic healthcare record together. But after two years and more than $1 billion spent on a single, joint integrated electronic health record between the DOD and VA, the department’s two secretaries in February canceled the plan with little explanation.
“It’s frustrating. It’s been inefficient for service members to have to hand-deliver records from one system to another when they get out of the military,” then-Defense Secretary Leon Panetta said at the time. “It doesn’t make a hell of a lot of sense.”
Instead of a joint system, Panetta said the two agencies would upgrade their own electronic health-record systems and build software that would allow the two systems to talk with each other to exchange files. “As President (Barack) Obama directed in 2009, we can and we must do better.”
Panetta said the new direction would allow the departments to meet the president’s goal and do it for a lower cost. But records show the cost may not be lower.
Meanwhile, the VA has moved to invest $12 billion over five years on an entirely new project called Transformation Twenty-One Total Technology, or T4, to upgrade its own technologies. Those upgrades are supposed to include interoperable software that can be used between the VA and DOD.
According to contract data gathered by News21, the VA began paying companies for the project in July 2011, at the same time money still was still being spent by both the DOD and VA on the single, joint health care records system.
In fact, one of the VA’s contractors, Harris Corp., has a multiyear contract with the VA worth $80.3 million to create software allowing the two departments’ systems to communicate with each other, a deal that was signed almost a year before the DOD and VA gave up on a single electronic health record.
The DOD also is looking for a replacement for its health record system. The 2014 DOD budget requests $466.9 million for “initial outfitting” and “replacement and modernization” of its current health care record.
Sen. Patty Murray, D-Wash., a member of the Committee on Veterans’ Affairs, told News21 in an email statement that she is concerned about the future of electronic health records shared between DOD and VA.
“While it is not easy to get the government’s two largest bureaucracies to work together efficiently, I have been very troubled about the effort to develop systems to allow communication between VA and DOD’s medical records,” she said. “I am especially concerned DOD spent hundreds of millions of tax dollars — and thousands of staff hours over the last few years — trying to create an integrated IT platform with the VA only to announce they were unable to come to a solution.”
For a disability claim to be processed in 125 days, a goal outlined in a Jan. 25 VA report, the files must be electronic, which means all paper records must be scanned into the system.
The VA scanning system — Veterans Benefits Management System (VBMS) — cost $480 million between 2009 and 2012, yet the VA never set deadlines for the records to be scanned. As of early July, only about 30 percent of paper claims had been scanned — that’s 165 million pieces of paper, according to the VA.
That represents about one-third of the entire paper workload, which does not include the estimated 26,000 service members who will make their way home within the next year from Afghanistan. Nor does it include veterans who have yet to file disability claims.
Those pieces of paper can make or break a veteran’s chance of getting the correct disability compensation. The compensation can help offset costs such as rent and car payments for those who may not be able to work because of issues they suffer, such as post-traumatic stress disorder or chronic back pain. All are common among veterans who served in Iraq and Afghanistan.
In 2012, the average time a claim waited for evidence to be processed – which includes those health and service records from DOD as well as physical exams – was 206.7 days, according to Veterans Benefits Administration documents. Gathering evidence is the longest part of the claims process.
DOD health records make their way to the VA within 45 days, DOD spokeswoman Cynthia O. Smith told News21 in an email. She wrote that, although the records are available electronically on request, all DOD records are transferred on paper to the VA. Yet, DOD Undersecretary of Defense for Acquisition, Technology and Logistics Frank Kendall contradicted her, saying most records are transferred electronically.
The VA did not say how it receives records from the DOD.
The National Defense Authorization Act for 2008 also called for the creation of an agency to fix the interoperability problems between the VA and DOD. The Interagency Program Office was established as the “single point of accountability” between the two departments.
Debbie Filippi, the first director of the office, said restrictions from the VA and DOD, as well as a minimal budget, kept the office from making progress during her two-year tenure. “It takes time to turn an aircraft carrier,” she said.
Filippi retired in 2011, before this February’s cancellation of the joint electronic health-record project. “The hope had fizzled out and then re-gathered,” she said. “And then it broke apart again.”
In March, Allison Hickey, undersecretary of the Veterans Benefits Administration, told members of Congress there is an agreement in place requiring the DOD to provide “100-percent-complete service treatment and personnel records in an electronic, searchable format.”
The VBA estimates such a move would cut the claims backlog time by anywhere from 60 to 90 days.
An amendment to the 2014 National Defense Authorization Act, proposed by Rep. Ann Kirkpatrick, D-Ariz., would require the DOD to provide complete service treatment records to the VA within 90 days of a service member leaving the military. “No doubt in my mind our veterans will be better served by an electronic system,” Kirkpatrick told News21.
The Janus Joint Legacy Viewer, a cloud-based medical records system that allows DOD and VA medical records to be displayed on one screen, launched at nine sites in July. David Waltman, the VA’s chief user experience architect of the integrated electronic health record, said the department is exploring the use of the Janus Joint Legacy Viewer to help in the claims process. He said it will ultimately be tested at regional offices this year, but only two employees at each office will have training and access.
Rep. Phil Roe, R-Tenn., in May introduced legislation requiring the VA and DOD to revive plans for the single, integrated health record system. “You don’t spend a billion dollars and say we can’t do it,” Roe told News21 in a phone interview.
“This is one we have to get right,” he said. “Not for my generation, but for future soldiers I don’t even know.”