the sergeant majors are now understanding that this is a problem that we have to take on as two departments and not just as one, and i think that education is happening. >> well, we still have a lot of work to do. >> yes, ma'am, we do. >> dr. rooney, there is no doubt that the events at madigan have shaken the trust and confidence of service members who will r in the disability evaluation system. i believe that transparency and sharing information about the ongoing re-evaluations that are happening today and actions from the army and d.o.d. are taking to remedy this situation will go a long ways towards restoring some trust in this system. i wanted to ask you today what we have learned from the investigations that the army is conducting into the forensic psychiatry unit at madigan. >> well, us a pointed out earlier, there have been 196 re-evaluations completed to date, of which 108 of those have been diagnosed as having ptsd where before they had not.

>> let me just say that they had been diagnosed with ptsd when they went through the evaluation they were told they did not and now going back and re-evaluating them once they have gone out saying yes, indeed, you did have ptsd. >> 108 of those -- >> more than half. >> yes. there are 119 deshld to be eligible for re-evaluation, 287 from the original group that was looked at, and that as you know the army actually opened the aperture up to see anyone who would have gone through the process while forensic psychiatrists were being used and that was 419 totally eligible for re-evaluation, and at this point there are three in progress and 12 being scheduled so what we've learned from that is clearly the proses that was put into place at that time did not function as originally designed. evidence did not show that there was a mean-spirited attempt but

really to create similar diagnoses, obviously that was something that has not occurred so the army has taken lessons from here and is actually going back to 2001 to re-evaluate all of the cases where we might have a similar situation. what we're doing from that point is not only learning from what army is doing and looking at these re-evaluations where we're using the new standards and in many ways advances in the medical and behavioral field to better diagnose ptsd. about 68% of the people in the disability evaluation process are from army. we will take the lessons learned from there and apply those across to all of the services. >> well, i really appreciate the army's announcement that they are now going to do a comprehensive work in the ptsd

and behavioral health services systemwide throughout the army. i believe that's a major first step for the army to be doing, but i did want to ask you, dr. rooney, i had been told by secretary mchugh about the issues at madigan were not systemwide and then the secretary announced a comprehensive review across all systems so if we didn't believe this was a systemwide problem, what led the army to look at a comprehensive review? >> secretary mchugh and i have had numerous conversations and i believe the use of the forensic psychiatrist was primarily isolated to madigan, and that's where i believe that comment of that it wasn't systemwide because that type of additional part of the process -- >> the forensic system wasn't systemwide, but systemwide we have issues with people not being diagnosed correctly. >> what we want to do is look across the system and ebb sure if we do have systems we can identify those and we're able to get those back into the system so i believe at this point it's very much a forward leaning approach to say we need to look

across the system, not that we're convinced that similar problems existed but that it's the right thing to do for the individual since, as you pointed out, we saw a number of these re-evaluations and ended up with diagnosis change so it's the right thing for our people to do to look across. >> okay. i think it's extremely important that we find anybody who was misdiagnosed and get them care so we'll be continuing to focus on this. >> absolutely. >> with that, let me turn it over to senator boozman. >> yes, ma'am, with your permission what i'd like to do is go ahead and defer to senator burr and come back and question when it's appropriate. >> okay. >> i thank my colleague and thank you for this hearing and mr. gingrich, i share your cold. it's not fun. dr. rooney, do you disagree with the gao's testimony today? >> sir, we look at the gao as a

partner to help us evaluate how we're doing. i think they brought up some very good points in their report. of course, when you're using statistics we may look a little differently at a particular statistic, however, i will say that there was nothing in there that we didn't think really helped us further understand where emphasis needs to be. where there are improvements we've been open are saying this is a system that needs significant improvements. i think the gao very much said the same thing, so we are looking to continue to work with them, take the information they provided, and it gives us a road map to make sure as we're putting resources to it, we take their report, plus our own internal analysis that goes even deeper than theirs to say are these improvements -- are they resources making improvements to this system which we all know and totally agree -- >> do you disagree with any of the testimony of gao? >> no, sir. in fact, i look forward to the discussions we had before the testimony and the report because i believe any time somebody

gives you insights into what you're doing that you can take care of one more vet reason or service member to make their life better and in this transition process we need to look at it and make it happen. >> we're all in agreement we're just south of 400 days in the cycle of of the process, 395, i think, 394. in may 2011 the secretary of defense and secretary of affairs committed to the ides so that it could be completed in 150 kays and went further to agree to explore options to agree for it to be 75 days. now, i've had too many of these hearings. we have them every year, and we hear the same thing. oh, gosh, look at what we're doing. now i've heard the most glowing progress report from both of you. and then i get the realities and things haven't changed.

you have met some improvement in certain areas. i commend you on that, the timeliness goals in areas have been better, but the reality is that we've got a broken system and we're years into it. and i hear testimony where we are starting to begin to review our business processes. why did it take five years to get to this? what can you convey to me today that's concrete that tells me a year from now we're not going to be at 393 days when you said earlier we're instituting i.t. changes this summer that will improve our times by 30 or 40 -- i thought you were going to say percent, and you said days. so, now, my expectations are, if we implement what you just said, we're going to be down to 360 days which exceeds the secretary

of v.a. by 110 days over what their goal was for today. so share something with me that is telling me that we are actually going to do this. >> sir, that was one of the steps. the i.t. solutions are not the only steps. in addition, it was indicating that army has hired 1,218 people, so we're also adding people to the process. >> is this the first individuals that we hired in the five years to plus up? >> it's the largest group of people that we've hired. >> we've hired people. we've plussed up. and the overall time of completion went up, not down. >> many of these changes, sir, are fairly recent. >> okay. lieutenant general bostick, the army deputy chief of staff, recently called the ides process fundamentally flawed, adversarial and disjointed.

do you agree with him? >> i've sat next to my colleague many times and we've had the discussions. and i believe that we're both acknowledging that it is a system that while initially designed and conceived to be one that was smooth and transparent and easy, we have not achieved that result. >> so what are we doing to change it? >> as both my colleague and i have indicated, at this point we are literally looking case by case. we are following cohorts through each step of the process to see when we add people to it, are we actually improving the times. i'm not saying we're not able to improve it for those already in the system but we have to make sure that we're tracking the new ones in and say did we cut that time down? it is going step by step through that process. >> i don't want to seem adversarial, doctor. i think we're all after the same goal. but you just agreed with a statement that general bostick made where he basically said this system can't be fixed. now if you agree with that, my question is very simple.

is it time for us to start over again, to take a blank sheet of paper and say how do we design this in a way for the benefits of the service members? the number one priority, number one priority for both. i don't question that. who are caught in a system that is unacceptable today from a standpoint in the length of time, from the standpoint of the accuracy that senator murray talked about. and i guess, you know, my question to you would be if given a blank slate, would the army design ides the same way, or would you do it differently? and if your answer is differently, then for god sake's, let's do it. tell us what we can do to be partners to change this in a way that it works versus to keep a structure of something that individuals who are involved in it like general bostick say fundamentally flawed, adversarial, disjointed. that's not the relationship we

want with our service members that are going through. the chairman has been very kind to me. i just want to ask one last question, and this is to mr. gingrich. you made the statement, i think, in your testimony that v.a. has the capacity to make compensation as early as they choose to after a service member is discharged. is that accurate? >> we can make compensation the day after they're discharged. that is correct, senator. >> the day after? >> right. by law we cannot do compensation until they have been discharged. >> how long on average has it taken for the first v.a. check to arrive for a service member who went through the ides is discharged from the military, not the decision letter from the

v.a. but the actual check? >> right now it's taking too long. it's taking about 60 days. part of the reason -- it's not an excuse, but part of the reason is we do it by month. so if the person is discharged before the pay system is set up, you've eaten 30 days. we're working through that. and i think one of the things that the vta will give us is they'll give us the information we need electronically at the discharge so we can speed that process up. i'm very confident that we're going to get very close to the 30-day goal. and by the way, vta, dan and i talked. vta will be in place in june. and that process will not only allow us to track the payment, it will also allow us to track the ratings and the discrepancies in the ratings. >> the chair has been very kind, and i appreciate it. and i would ask would you share with us the data that shows us that 60-day average for payment. >> i will do that, sir. >> thank you, chair. >> thank you very much, senator tester? >> thank you, madam chair. i want to go back to what senator burr was asking about.

and i'll start with you, dr. rooney. do things need to be changed at ides? >> yes. >> mr. gingrich, do things need to be changed at ides? >> yes, sir. >> could you, and i don't want to know them now, but could you get back to the committee with your recommendations on what needs to be changed in ides? >> yes. >> yes, sir. >> okay. i would anticipate that the changes would add to this simplifying and consolidating as your goals were when this was set up between the v.a. and d.o.d., would it not? i just want to make sure that the changes would add to the simplification. yes? >> yes. >> yes, sir. >> good. >> mr. bertoni, as you look at

ides right now, its goal was to simplify and consolidate. has it simplified was the first question. >> i would say yes. >> okay. >> when you look at what was happening under the legacy system versus now, it's much more simpler. >> much simpler. is there an opportunity through this system to get feedback from service members and address their questions and concerns about this? is that part of the system? >> there is a survey mechanism whereby service members are surveyed after each phase of the process, the medical evaluation board, physical evaluation board and transition phase, yes. >> okay. so -- and that's pretty user friendly from your perspective? >> i don't know about user friendliness. it's four questions per phase, 12 questions. our concern is the limited number of folks who are actually receiving that survey. in principle, everyone is

eligible to receive it. but if you don't opt to do that early on at the med phase, you're excluded from the latter phase. so we're really limiting the number of folks who are having an opportunity to weigh in on their experience in regards to timeliness, transparency and other factors. >> do you think it would be important to get that in to be expanding the opportunities? >> i think it absolutely would be a good idea to revise and look at how they're surveying service members right now. >> i don't want to get out of my lane here, but i'm going to for a second with madigan. you said 198 folks. 108 had their diagnosis changed. were those people -- was their rating done under ides? >> many of them were. some of them were under the old process. so those that were before roughly '08 would have been before the old process. >> okay. so how many of the 198 -- do you have those figures broke out?

i guess what i want to get at is to have over half the folks not get the proper rating is to say that it doesn't match up with our goals is an understatement. the question is ides actually the assessment for the disability, or is it not doing as good a job as the old system? >> actually, those people before, since i said most of them were before '08, that would be the old system. >> yes. >> and it also is adding the forensic psychiatrists in it which is a different aspect to the system. so the new process, and frankly the protocols and the fact that our departments have an integrated mental health strategy for how to do this should have and by all data that we have seen improved that significantly under the new process. >> okay. so does that mean all the folks that got rated before 2008 we should call them back up and have them re-rated?

>> in essence, that's what the army is doing at this point. and we're going to take the lessons learned, as i indicated to senator murray and see if we need to do that across the other services. >> and what about the other rp branches of service? >> a large number of the ones who were misdiagnosed had their diagnosis changed inaccurately were after 2008, after the forensic psychology system was put in place. >> okay. i appreciate that. i just -- i mean we get -- we get a lot of calls on this kind of stuff. and although i appreciate folks calling their senator to get this squared away, what it tells me is there is an inherent problem here. and so -- and then when you combine that with the fact that we've got misdiagnosis over 50%, we've got to -- i mean, that's not acceptable. it's got to be fixed. and if it's a fact that we bring

in a forensic psychologist and that fixes the problem, that tells me and we're talking one person, right? >> actually, that was the issue was adding that additional layer. that's when the initial diagnosis were changed. and then we had a review again. so that piece, adding forensic psychiatrist in the process has been stopped, and that does not occur any place across the department. >> all right. i mean -- look, i've got a lot of questions. my time is long passed. well, i look forward to your recommendations on what can be done to improve ides. i certainly appreciate the work you're trying to do. but we're not where we need to be by a long shot. and so, i mean, when i heard your testimony, there was good stuff here, and you should be touting the stuff you do well. but man, oh, man, we've got a long ways to go. and i mean, don't you think? >> absolutely.

>> and so how do we get to a point? what do we need to do? is it manpower? is it more professional people? what is it? we got folks coming back, and the numbers are going to get more and more with the afghanistan drawdown, which is good. but the question is these folks need help. they need help early. that really saves money long term, especially with unseen injuries, and where do we go? i mean, where do we go to get this fixed? >> sir, as you indicated earlier on, i believe we're going to get back to you with specific recommendations that we're seeing from our teams going out as to how we continue to move this forward. >> i look forward to that. thank you for your testimony. thank you for your work. >> thank you very much. mr. bertoni, who -- who is in charge of the -- we have d.o.d. here. we have v.a. who? is there a person that is actually in charge of the whole process? >> i would say the secretaries

would say that they were in charge of this process. >> the secretary of defense and -- >> in partnership with capable folks under them tasked with doing a very difficult thing. >> so i guess the question i've got, generally, things work better when there is a person, you know, to oversee. is there a person that the secretary of defense and secretary of the v.a. have designated to have the authority to get some of these things worked out? >> i know mr. gingrich has been pegged as the man to address many aspects of this process. >> so do you have authority over d.o.d. also or just v.a.? >> sir, i don't have authority over d.o.d., but we have been working remarkably well in partnership, and i don't say that loosely. i sit down with the vice chiefs of staff of the army, for example, because that's 68%. and we sit down monthly. we sit down at different levels in v.a. with the army, and we're

working through this. i think part of the issue to address the problem is we didn't have a very good dashboard mechanism prior to when we fully implemented ides in september of last year. we now have a mechanism we can go to every single facility. 116 of our senior executives get up from my vtcs, and the army has the same thing when we do it together. we can go installation by installation, individual by individual, which we couldn't track before. i know it sounds something like we're not moving. but when we get the vta in place, we'll be able to track every individual, where they are in the system, what kind of rating they got, and where they're going. >> i don't mean to interrupt. i guess -- i guess, you know, in business and in general things, you like for a person to be accountable. >> i'm accountable directly to this. >> i understand that, but i guess i would like to see

somebody accountable for the whole system, and you might be that person, but it's not fair to you, you know, if you really don't have authority to see it through. so i personally think that the two secretaries need to designate somebody that's got the authority. now we don't do that very well thing. where do you see the bottleneck, mr. bertoni? is it that they can't be seen, or is it a decision-making process after they are seen? >> i've said here many times since 2007 and talked about this whole program process. it comes down to i think three critical things -- people, processes and technology. on many of these sites, there was a sense of urgency following walter reed. there was a rush to stand them up. they didn't have proper technology. they didn't have proper people in sufficient processes in place. staff to service member ratios was insufficient in many

respects. they were stood up anyways. the servicemen came. they were overwhelmed. and i think this system is paying for it to this day. processes. we've identified throughout the last several years areas with process that appeared to be inefficient. clearly, we're causing backlogs and inefficiencies. they in partnership, the d.o.d. and v.a. have addressed some of them, not all. we keep pressing that they do. last of all, technology, we have an integrated evaluation system, but the systems part hasn't caught up. we have processes that are combined. we have decision-making that's combined, but the systems haven't caught up with the process or the demands of the end user. >> so do you feel like, really, in follow-up to mr. burr's comments, do you feel like the framework that we have now, the ides is such that we can meet the goals that we're -- >> it's a simpler system. it's more transparent in how it

operates. it's sort of like a funnel. you take a funnel, you pour water into it, water comes out the other end, it works. but if you pour water into the funnel too quickly, too fast, you'll very quickly find out where the inefficiencies are. that's what is happening. we've had rapid increases in inputs and enrollments, and the inefficiencies and the bottlenecks in this system are becoming readily apparent. and they need to get behind it with some of this mapping and business redesign. >> my concern is that we have a culture somewhat that just is difficult to deal with these things. i have -- i'm approached by people all the time that are are just separating out of v.a., just retiring, and it's not uncommon, you know, to wait a year before you start drawing your retirement. so, you know, that's without all of this other stuff going on. so, again, i think we've got some real problems that we need to look at.

and i would welcome also, and i think it's important that you understand that i'm with you. but i do think that it is important that we get some feedback as to how we can help you to streamline that process and similar processes. thank you. thank you, madam chair. >> thank you. senator johanns. >> madam chair, thanks for holding this hearing. you can tell the frustration of the committee members, and in this town sometimes it's harder to find bipartisanship, as we all know. i'll guarantee that frustration is very bipartisan. everybody is frustrated. i don't care which end you -- of the dais you sit on. and here's my concern. i was looking at some of the numbers. mr. bertoni, you talked about them a little bit in your testimony.

overall average time to complete ides active components of military, the goal is 295 days. we're at 395. but atfest belvidere, it's 595 days. that's stunning. the active duty members who complete ides within the 295-day goal, the goal is 60%. actual results are 18%. at ft. meade, it's zero percent, nobody, nobody. overall average time to complete ides for guard member, excluding those who return to duty. agency's goal is 305 days. 408 days is the actual. 651 days at ft. carson. it's just nearly embarrassing to go through these statistics.

and the concerning thing for me is that i don't hear anything today that makes me feel, gosh, we're going to turn the corner here. in fact, i must admit quite the opposite. i'm going to walk away from this hearing very, very worried that the system is imploding, that whatever we have done to try to get on top of the system just isn't working. so mr. bertoni, let me just ask you a very, very direct question. how long is it going to take -- one year, two years, five years -- to actually see progress to meeting these goals? >> i can't give you a specific time frame. i would say that one thing that the services and v.a. are dealing with is enrollments are

up significantly, doubling each year. 2009 there were 4,000 enrollments. 2010 about 9,000. and last year 19,000. so we have multitudes coming into this program very rapidly, and that's going to increase going further. so they really do need to continually look at their processes and look for streamlining opportunities. we have said all along they need to get their staff-to-service member ratios aligned with what they think they need to be doing. again, automation. you can leverage so much with automation accounts for many people. there are things in play. they must continue to look at what they're doing and to look for efficiencies. and to their credit, more recent data in the med phase shows that data is trending more positively over the last six months. the v.a. medical exam, they had never been able to meet that goal. at the time of the review was at 70 days. as of this month they're at 39

days, under the 45-day goal. so there is some positive trending in meb. that's the good news. the bad news is most cases are being pushed further to the ped. and those processing times are rapidly increasing. they have a 120-day goal. and they're starting to push against that threshold. so what is going on there and causing the inefficiencies there? what are they doing to create efficiencies? you can learn from those. this mapping exercise, this business process re-engineering exercise i think could be valuable. should they have done it earlier? yes. they could have done it before each major phase, and i think they would have been in better position. so i can't give you a time frame, but i'm hopeful next year the numbers will be better if i'm here. >> do you agree with -- let me ask the two other witnesses. do you think you're turning the corner? >> sir, i'm absolutely convinced we're turning the corner. we've gotten our production up. we can do about