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Veterans Employment Services: Abilities Center of Southern New Jersey Solutions for Veterans with Service-...

Veterans Employment Services: Abilities Center of Southern New Jersey Solutions for Veterans with Service-
Connected Disabilities, Discussion of Barriers in Vocational Rehabilitation System, Local Solutions.

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  • 1. ABILITIES CENTER OF SOUTHERN NEW JERSEY, INC. SNJ Veterans@HomeSouthern New Jersey Veterans with Service-Connected Disabilities:Meeting Employment Goals Through Community-Based Providers to SupportVA Vocational Rehabilitation and Employment Services
  • 2. 2 Table of ContentsEXECUTIVE SUMMARY: ......................................................................................................................3I. INTRODUCTION ......................................................................................................................6II. MISSION OF VR&E..................................................................................................................6III. DOES GRUELING PROCESS UNDERMINE INTENT TO BENEFIT VETERANS WITH SERVICE-RELATEDDISABILITIES? .......................................................................................................................................7IV. VOCATIONAL REHABILITATION & EMPLOYMENT – IS SERVICE DELIVERY MEETING VETERANS’ NEEDS? 8V. UNEMPLOYMENT AMONG VETERANS IN NEW JERSEY ............................................. 11VI. POPULATION OF VETERANS IN NEW JERSEY.............................................................. 11VII. ABILITIES CENTER PUTS PEOPLE TO WORK ............................................................... 11VIII. PROJECTED INCREASE IN DISABILITY CLAIMS ........................................................... 13IX. PTSD IS A FACTOR IN EMPLOYMENT: WILL REPORTED CASES INCREASE IN NEW JERSEY? 14Stigma, Suicide – Was the VA Ready? ............................................................................................. 14X. VETERANS ADMINISTRATION STUDY SUGGESTS PTSD AS OBSTACLE TO EMPLOYMENT ANDRECOMMENDS CWT ........................................................................................................................ 15XI. SOUTHERN NEW JERSEY VETERANS: FILING A CLAIM FOR DISABILITY BENEFITS: 16Sample inquiry for benefits: ................................................................................................................ 16XII. SOLUTION: VOCATIONAL ASSESSMENTS, PILOT PROJECT, CAMDEN AND GLOUCESTER COUNTYVHMC 17Addendum (in a separate file if you are receiving this electronically): a. VA Facilities by Congressional District (may not include Camden clinic by date) b. NJ Veterans, Population and Expenditures by County c. Monday Morning Workload, VA Benefits August 18, 2010 d. Voc Rehab utilization, Veterans Benefits reports e. VA Benefits all (as of 7/2010) f. Current NJ resources for veterans g. Fact Sheets – Abilities Center (as needed)Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 3. 3EXECUTIVE SUMMARY:Abilities Center of Southern New Jersey, Inc., a nonprofit 501c3, started in 1963, seeks to provideoutreach and alternative vocational services to veterans with service-connected disabilities who areeligible to apply for vocational rehabilitation services under Title 38, U.S.C. Chapter 31. We proposeto pilot a service to support veterans and function in cooperation with the Camden and GloucesterCounty VMACs. This concept paper is our invitation to collaborate in completing the conceptualframework for our program. It is our objective to deliver the optimal level of services to veterans whilemeeting the expectations of state and federal entities.The Abilities Center’s mission is to provide workforce development services for people withdisabilities and other disadvantages that may be barriers to employment. We aspire to provideoutreach and services for veterans through the Camden and Gloucester County VMAC consistentwith Secretary Eric K. Shinseki’s objective: “to educate and empower Veterans and their familiesthrough proactive outreach and effective advocacy.” (VA Strategic Plan 2010-2014, p 82) We call ourprogram SNJVeterans@Home –to support our nation’s heroes and cooperatively augment thededicated efforts of the Veterans Administration and NJ Department of Veterans and Military Affairs.New Jersey has the ninth largest number of all veterans, third largest number of survivors, and one ofthe lowest percentages in the country of veterans who are collecting benefits. With the return ofveterans from Iraq and Afghanistan as well as the results of the 2010 census, the identifiedpopulation of veterans may increase. As of September 2009, there were 463,720 veterans counted inNew Jersey as of September 2009, including 31,525 in Camden County and 20,034 in GloucesterCounty (source: Veteran’s Administration).Nationally, the percentage of veterans reporting service-connected disabilities is higher amongveterans of Gulf-II (August 2001-2009) than other conflicts. Roughly 21 percent of Gulf War-era II(August 2001-2009) veterans reported having a service-connected disability in August 2009,compared with about 13 percent of all veterans. (American Community Survey, 2009)However, only 6 percent of Gulf II veterans accessed vocational rehabilitation service - 12,942veterans - as of April 29, 2009. (Veterans Administration Office of Policy and Planning, “Analysis ofUnique Veterans Utilization of VA Benefits & Services,” April 29, 2009.) Perhaps coincidentally, 11percent of Gulf I veterans were benefited from Vocational Rehabilitation in 1998.Anecdotally, through Veterans Health Affairs Philadelphia, we learned that as many as 9.000veterans in southern New Jersey may be in need of vocational rehabilitation services, but VHA lacksthe resources to reach them. Their social service division was extraordinarily interested in AbilitiesCenter’s services to augment their efforts. We have the credentialed staff to deliver services and thecapacity to provide Compensated Work Therapy on site at our own facility as a transitional workexperience program.There are several other compelling reasons to offer an alternative service for veterans with service-connected disabilities:Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 4. 4 1. If the unknown number of southern New Jersey veterans report having a service- connected disability is even half the national rate (13%), there may be thousands of veterans in southern New Jersey in need of services; 2. Accessing vocational rehabilitation services under Title 35 can be a complex multi- layered process, requiring the veteran have a disability of at least 10% following by the separate application for entitlement to receive vocational rehabilitation Chapter 31 services. It is a more difficult approval process than the other benefits under Title 38, endured by a group intrinsically challenged – veterans with a service-connected disability. 3. Claims for veterans disability benefits top 550,000; over 37percent have been pending for over 125 days. This logjam can potentially cause delays for new claims. Scholars in public finance predicted it over 3 years ago to accelerate and reach a breaking point. 4. The return of military who have been deployed at least twice and who may have a diagnosis of PTSD, as supported by UMNJ’s study. 5. The geographic location of Veterans Health (VHA), Veterans Benefits (VBA), Vet Centers, and Vocational Rehabilitation for veterans living in the seven-country region of southern New Jersey is distant and scattered across two states. Veterans who have a service-connected disability most often have not just a few but several conditions, including physical. There is no VA Medical Center in southern New Jersey. A veteran who requires outpatient surgery for a service-connected disability may take a shuttle bus to Wilmington and still need documents from Philadelphia to be sent to Newark to accompany his vocational rehabilitation application. 6. There remains a population of 2500 homeless veterans throughout the state who may benefit from vocational rehabilitation services and need to be identified in Camden and Gloucester counties. 7. We have observed that PTSD medical questionnaires for primary care physicians emphasize “employment problems” among veterans diagnosed. Asking a veteran to wait weeks or months for services means aggravating the same “employment problems”.Independent of our observations, the media has examined the tragic results when veterans withsevere disabilities seek “Voc Rehab” in their quest to return to work. A CBS News investigation ofthe Department of Veterans Affairs (VA) concluded that the system is “beset with contracting andstaffing problems -- which often throws needless roadblocks in front of eligible veterans, and whicheither tolerates or cant prevent wrongful benefit denials for some of the nations most deservingformer warriors.”Abilities Center of Southern New Jersey, Inc. is a viable nonprofit community-based entity tocollaborate with selected organizations and agencies. As providers, Abilities Center’s focus is onserving the veterans, their families and the community-at-large. Our status as a nonprofit creates anideal partnership among federal and state entities.Abilities Center is also a NISH affiliate and key vocational services are CARF-accredited. CARF is theCommission on Accreditation of Rehabilitation Facilities and the standard-bearer for excellence.Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 5. 5Driven by mission, not profit, Abilities Center’s culture is flexible and results-oriented with attention torelationships and cost-effective services. Abilities Center’s vocational assessments can be deliveredon site or at mobile locations. This may be optimal for veterans with PTSD.The state of New Jersey will also benefit from Abilities Center’s role. Every veteran who becomesemployed becomes a tax-paying resident. Together, we can honor America’s heroes and theirfamilies through outreach, transitional services, and jobs.Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 6. 6I. IntroductionVeterans with service-connected disabilities in southern New Jersey who seek vocationalrehabilitation services face a logjam of claims processing for benefits and systemic barriers in theVeterans Administration VR&E application process.Abilities Center of Southern Jersey, Inc. a 501 C3 established in 1967, proposes to pilot outreach andvocational rehabilitation services to augment the Veterans Benefits and Veterans Health Affairs (VBAand also as it provides certain services, i.e., Compensated Work Therapy, a program under VR&Eadministered under VHA.)Reasons to address this promptly include but are not limited: VRE process of application and service delivery; The backlog of disability claims; Unemployment rate of returning militia in transition and veterans here; The projected number of veterans who have a diagnosis of PTSD, those who may be re- evaluated under new criteria under disability claims (7/15/2010; PTSD and its effect on employment; Number of families affected among all veterans who may not be served; The geographic availability of various services is scattered across the river and north to Newark; Unknown outcomes when veterans do not seek services, including homeless veterans (estimated 2500 in NJ) Veterans who are not eligible by reasons of discharge qualifier who require services Low number of veterans who are eligible, apply and are entitled (in contrast to state population); Low number of veterans who complete VR&E’s employment goals in contrast to the number who are in educational programs and may not be actively seeking employment every year during the 48-month period of entitlement. Potential under-utilization of Compensated Work Therapy, based on VA literature and inferred by Abilities Center’ s discussions with VHA social service staff. Homeless veterans, who continue to number in the thousands.Southern New Jersey veterans with service-connected disabilities who seeking vocationalrehabilitation services may wait months to benefit. The backlog of veterans’ disability claims hascreated a logjam that stands at 550,000 claims pending approval, 37.4% of which have been pendingfor over 125 days.II. Mission of VR&EThe mission of the Vocational Rehabilitation and Employment Program (VR&E), under title 38, U.S.C.chapter 311 , is to provide comprehensive services and assistance to enable veterans with service-connected disabilities and employment handicaps obtain stable and suitable employment. Also underTitle 38 is Chapter 36, which provides vocational counseling to any veteran within the first 12 monthsafter discharge. It is a separate application and a swifter process than vocational rehabilitation. (Note:Chapter 30 is the post 9/11 GI bill for higher education.)Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 7. 7Vocational rehabilitation, often under scrutiny for how it meet theneeds of veterans with service-connected disabilities, appears tobe getting stuck in a quagmire of VBA (Veterans Benefit “It is the veteran who incurs theAdministration) benefits claims processing. most devastating service- connected injury who will oftenMilitary in transition have several programs which may facilitate be the least able to comply withbenefits processing. One faster track is the Benefits Delivered at rigidly enforced filing deadlines,”Discharge (BDD), administered by the VA in cooperation with theDepartment of Defense. Although helpful, BDD is not sufficient. Judge Haldane Mayer, in hisAs recently as February 2010, the (General Accounting Office) dissent and for two colleaguesGAO was critical of its lack of tracking tools and therefore not for US Court of Appeals for theenough information about the veterans after discharge. In Federal Circuit in Washington,addition, nearly 17 percent of all VA benefits claims contain re Mr. Henderson.errors. Chairman of the House Committee on Veterans’ AffairsCommittee Bob Filner (D-CA) has asserted that the quality ofdisability ratings continues to undermine the entire disabilityclaims process for veterans.2III. Does Grueling Process Undermine Intent To "As we express our gratitude,Benefit Veterans With Service-Related Disabilities? we must never forget that Lincoln’s words “ care for him who shall have borne the highest appreciation is not tothe battle and for his widow and his orphan” inscribed on utter words, but to live by them."the walls of the Veteran’s Administration headquartrs in — John Fitzgerald KennedyWashington, DC , expresses our nation’s gratitude.However, what the veterans endure to receive benefits isoften unacceptable; the process of filing for disabilitiesbenefits can be grueling.“Eligible” for benefits does not mean “entitled”. The veteran with a service-connected disability whoseeks vocational rehabilitation services must complete the disability compensation process and be“rated” with at least a 10% disability before he or she is eligible to apply.Unsubstantiated by data, common sense suggests many veterans are deterred because of thecumbersome process; it is time-consuming and grossly inconvenient for an unemployed veteran witha service-connected disability to pursue to the application stage.After the veteran has satisfied the requirement to check off at 10% or greater rating, the application isfilled out and received by the VR&E Regional Office. There, it is reviewed and developed. Thevocational rehabilitation sets up a face-to-face assessment in the course of determining entitlementto participate or denial. The veteran may have an employment handicap (20% disability) or a seriousemployment handicap (10%) but that is not sufficient. The reasons for denying entitlement vary. Theveteran’s plan may not be approved as a realistic goal, for example. If the plan is not approved, theveteran may be referred to other resources. For purposes of compensation, veterans are consideredGail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 8. 8unable to work, generally, when, due to the service-connected condition, his or her earned annualincome is less than the poverty threshold, For example, in 1980,the threshold was $4,190; in 2009, it was $10,991.A recent change sets up yet another potential obstacle: the veteran must cooperate as it states in thefinal rule adopted by the VA this past January 2010: “Section 21.50(d) provides that if an individualdoes not cooperate, even after reasonable attempts are made to secure cooperation, VA will suspendthe initial evaluation process and that individual will not be considered inducted into a rehabilitationprogram. Section 21.50(d) will also include references to §§ 21.632 and 21.634 regarding satisfactoryand unsatisfactory conduct and cooperation.” 3If he or she does apply, and the decision is unfavorable, it can be appealed through another series ofsteps and rigid filing deadlines.If the veteran chooses to take his or her appeal to the U. S. Court of Appeals for Veterans Claims, thedeadlines are fixed as the result of a U.S. Supreme Court decision4 on jurisdiction, not veterans, twoyears ago. Previously, there was some lenience.The U.S. Court of Appeals for Veterans Claims applied it and denied Mr. Henderson, a veteran with amental disorder, the opportunity to have his case heard -- only 15 days past the deadline of 120 days.Mr. Henderson, who was discharged with a diagnosis of paranoid schizophrenia in 1952, is a veteranfrom the Korean War who served on the front lines. (He iscurrently appealing to the Supreme Court.) While thisdoes not have a direct bearing on services in southern If a man does his best, whatNew Jersey, it is noted as a hurdle the veteran cannot else is there?control. It is an obstacle any veteran might face. General George S. PattonIV. Vocational Rehabilitation & Employment – IsService Delivery Meeting Veterans’ Needs?Outside the application phase, the vocational rehabilitation process and its program have raisedconcerns from various circles:1) The Congressional Research Service (CRS) recently posed “questions of interest” about the vocational rehabilitation program with respect to outreach, marketing, and program success (of those who participate).56 This is consistent with our observations about the number of participants. The different CRS report queried about about how many veterans apply, have a rehabilitation plan developed and completed it.72) The 2007 Veterans Employability Research Survey , Veterans Administration study which, led by an outside contractor, explored similar questions and made several recommendations to increase retention . 83) The Vets Commission made numerous recommendations in its 554-page compendium. Honoring the Call to Duty: Veterans’ Disability Benefits in the 21st Century 9 to improve VR&E;4) Recommendations included by Vets Commission: VA should monitor and evaluate trends in its disability program and conduct research on employment among veterans with disabilities. 10Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 9. 95) In its Summary of A 21st Century System for Evaluating Veterans for Disability Benefits, the Institute of Medicine (contracted by the Vets Commission) made these suggestions, which are relevant to Abilities Center’s, see below:  “Our survey data suggests two interesting facts: (1) many of the veterans who appear to be having the most difficulties are also those who show the greatest resistance to coming in for services, and (2) certain demographic are consistently associated with these “at-risk” veterans. We believe it is possible to develop an outreach program, perhaps an extension of the existing Military Support Program, which could contact these veterans by phone or mail soon after their return to ask, “How’s it going?”  6) The Inspector Generals’ audit in 2007 revealed that VR&E. in seeking to stay within the “cap” of 2500 for Independent Living underutilized it and kept veterans who were eligible waiting.7) The Newark regional office lost about 16 percent of its staff between fiscal year 2001 and 2004. Newark Regional Office had been criticized for inaccurate work and unacceptable time lags processing claims. See (Combined Assessment Program Review of the VA Regional Office Newark, New Jersey; Rpt #02-01259-148, 2002). Because of its poor performance, the Newark regional office lost jurisdiction over claims from veterans in seven southern New Jersey counties to the Philadelphia regional office. It continues to have jurisdiction over vocational rehabilitation claims.In the meantime, lives put on the line to protect our country become lives put on hold.Without alternative services, the veteran with service-connected disabilities suffers delays andhardships; the state suffers other costs. The veteran who might have successfully completedvocational rehabilitation services and found a job is unemployed. The veteran who bearing the agonyof Post-Traumatic Stress Disorder (PTSD) may fear stigma that holds back many veterans fromseeking help for mental disorders. He or she may be hurtling toward a crisis in readjustment.Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 10. 10Arguably, this is speculation, yet the presumption that veterans can wait for services is alsoguesswork.Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 11. 11V. Unemployment among Veterans in NewJerseyThe national unemployment rate of Reserve andNational Guardsmen, who often had jobs when theydeployed, has quadrupled since 2007 and rose to 14.7by March 2010. The unemployment rate (all) in NewJersey is currently 9.5 percent, but it is about 3 pointshigher among veterans. Among vets younger than 24the gap is even wider: theyre 40 % more likely to beunemployed than everybody else in their age group.New Jerseys Army National Guard members havebeen especially affected. The statewide unit went into active duty in September 2008, leaving theirjobs just as the recession was taking hold. Among 3,000 troops who deployed to Iraq last year, 18percent are out of work, according to a poll of the second Battalion, 113th Infantry, conducted by theunits Command Sgt. Maj. Tom Clark. The New Jersey Guard is undertaking a survey to learn more.VI. Population of Veterans in New JerseyHow many veterans “count” in New Jersey? Based on the American Community Survey, 7.6 percentof the population in New Jersey is classified as veterans, but in Camden and Gloucester counties,veterans comprise 9.1 percent of the population. In District 1, which includes Camden’s VeteranMedical Clinic, it is slightly higher - 9.3 percent of the population is veterans.Another source, United States Veterans Affairs, as of September 2009, counted 463,720 veterans inNew Jersey, including 20,034 in Gloucester County and 31,525 in Camden County. Statewide, alsoaccording to Veterans Affairs, the amount spent on all veterans for voc ational rehabilitation/educationis $80476. In Gloucester County, it is $2186. In Camden County, it is $8078. State and county dataare available here - (hyperlinked and hardcopy in addendum). We speculate that thenumber of veterans will change with the “final”tally for the 2010 census and, as deployedtroops return from Iraq, the potential number ofmilitary transitioning to veteran status whoremain in New Jersey.11VII. Abilities Center Puts People to WorkAbilities Center of Southern New Jersey, a501c3 community rehabilitation provider for 47years, has a mission to provide workforcedevelopment services to people with disabilitiesand other disadvantages. We focus on promptGail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 12. 12attention to our consumers.Within our mission, we provide the broadest array of services to the greatest number of counties insouthern New Jersey, including: Vocational Assessments (Short-Term Mobile And Long-Term On Site) Community-Based Employment Center-Based Transitional Employment And Work Experience, School-To-Career Postsecondary Transitional Planning Job Placement in Competitive Employment with Support.We are currently the largest provider of supported employment in the state of New Jersey.Whom we serve: Abilities Center serves over 800 consumers annually and has placed over 500 insustained competitive employment over the past five years, seeking job retention as well asplacement to evaluate our success.Accreditation: Abilities Center is CARF-accredited, meaning it has met the highest standard servicesby the Commission on Accreditation of Rehabilitation Services.AbilityOne - NISH – we have a recent affiliation under NISH, National Industries for the SeverelyDisabled. NISH, a national nonprofit agency, has the mission to create employment opportunities forpeople with severe disabilities by securing Federal contracts through the Javits-Wagner-O’Day(JWOD) Program for its network of community-based, nonprofit agencies. JWOD was replaced by thename AbilityOne.Veterans -Target Population: We deliver an array of services that is already suitable or can bemodified to serve veterans. The most vulnerable – those who are service-disabled – are at the top ofour priorities. Among veterans who may be eligible for services, we are particularly concerned aboutthese four groups (not necessarily in this order): 1) Deployed troops returning home from Operation Iraqi Freedom who are in transition from active duty to veteran status; 2) Veterans with a service-connected disability who may be difficult to locate or identify, including veterans who survived other wars and homeless veterans. 3) Veterans who have been identified but must navigate a cumbersome route –geographically and administratively - to obtain any services. The veteran may be physically unable to leave his or her home. 4) Veterans who have requested services, as individuals or through family members.Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 13. 13There are undoubtedly other veterans who may benefit; this describes our internal leadershipassessment (which includes informed opinions in our network) are potentially most in need. Notably,within all three groups, there are an unknown number of veterans diagnosed with PTSD. It isassociated with all wars, not only Iraq and Afghanistan. For veterans of the Persian Gulf War, it isestimated to be 9%-24%. 12 The criteria to diagnose PTSD changed on July 16, 2010. Mentallytraumatized veterans will no longer face the need to prove a stressor in the war zone. A diagnosisfrom a mental health specialist in the veteran’s system and presence in a war zone is sufficient. Thischange may result in more veterans initially diagnosed with PTSD and through the review of casesthat were previously denied.VIII. Projected Increase in Disability ClaimsThe VA system is already stressed by claims. There has been a steady increase in VA’s pendingclaim backlog since the end of FY 2004 when there were 321,458 rating cases pending. In itsmost recent “Monday Morning Report”, the VA indicates there are 566,151 claims pending and211,953 pending over 125 days or 37.4 percent. There have been promises and plans to remedy thesituation but claims continue to flood the VA offices.PROJECTED INCREASE IN DISABILITY CLAIMS (MODERATE SCENARIO) 13Disability 2006 2007 2008 2009 2010 2011 2012BenefitsDischarged 118758 118758 118758 118758 118758 118758Cumulative 118758 237517 356275 475034 593792 712551EligibleClaimantsExisting 526355 52655 526355 526355 526355 526355 526355dischargednon claimantsNewly 118758 237517 356275 475034 593792 712551dischargedTotal potential 645113 763,872 882,630 1,001,389 1,120,147 1,238,906newClaim rateNew claims 22% 22% 22% 27% 33% 35% 44% Current 104819 104819 104819 104819 104819 104819 104819benefiariesTotal Claims 104819 245131 312497 392777 485973 592083 643743(number)Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 14. 14 “No place is familiar enough to completely shed combat vigilance,” wrote Dr. Jonathan Shay, a psychiatrist at the Department of Veterans Affairs Outpatient Clinic, Boston, writing about soldiers experiencing PTSD.Total Claims 0.093 2.27 2.89 3.63 4.49 5.47 5.95(Sbn)This is not a recent development. The problems associated with claims processing, from delays toinaccuracies, precedes current operations in Iraq and Afghanistan, despite recommendations forstructural changes. 14 “Rating” dominates the process: in June 6, 2009, there were 722,901 claimspending in VBA, 409,362 of which were rating cases.Benefits claim processing is beyond our control. It is another aspect of the process the veterans withservice-connected disabilities endure in their pursuit of services, including vocational rehabilitationChapter 31.IX. PTSD Is A Factor In Employment: Will Reported Cases Increase In New Jersey? PTSD is already a consideration before deployment. 15For example, as it applies to the NJ National Guard, investigators from New Jersey Department of Veterans and Military Affairs, University of Medicine and Dentistry of New Jersey, Mental and Physical Health Status of New Jersey National Guard Troops Prior to Deployment to Iraq. concluded that that the Guard members with one or more tours were significantly more likely to suffer from depression and PTSD than those with no previous tours and that among those with PTSD who are deployed, 22 percent, In addition, Veterans Administration’s Best Practice Manual for Posttraumatic Stress Disorder (PTSD) Compensation and Pension Examinations cites numerous examples of how PTSD is manifested in civilian work settings and affects employment. 16Stigma, Suicide – Was the VA Ready? As of September 2004, the GAO reported that the VA did not have the information it needed from the Department of Defense to prepare for the increase in veterans with PTSD. The GAO recommendation, with which the DoD agreed, was that the VA GAO recommends that VA determineGail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 15. 15 the total number of veterans receiving VA PTSD services and provide facility specific information to VA medical facilities and Vet Centers. Veterans, many of whom may still feel there is a stigma associated by reporting symptoms of PTSD, are still not seeking treatment. They are displaying the same symptoms as their counterparts from the Vietnam era. Dr. Matthew Friedman, executive director of the Department of Veterans Affairs’ National Center for Post-Traumatic Stress Disorder (PTSD), wrote in The New England Journal of Medicine “Thoughts of suicide are common symptoms of combat PTSD….Many combat veterans think daily of suicide” and Vietnam veterans assert that “twice as many of their brethren have died by suicide since the war than died at the hands of the enemy.” Dr. Shay references a three-stage approach therapists use in working with veterans with PTSD, pioneered by Harvard Medical School psychiatrist Judith Herman. It focuses on (1) establishment of safety, sobriety, and self-care; (2) trauma-centered work that constructs a personal narrative and of grieving; and (3) Several types of rehabilitative and reconnecting with people, communities, ideals and ambitions. cognitive therapies, counseling, and medications have shown It is significant that Dr. Herman also considers long-term promise in treating both injuries. unemployment to be prolonged trauma. 17 However, some service members continue to face barriers to care, including stigma and limited Are southern New Jersey’s veterans’ needs sufficiently met? access to services. Veterans Preparation for the return of veterans who may suffer symptoms organizations report that long of PTSD might create a sense of urgency to address the waiting lists, lack of informationmultifarious needs, including counseling and also employment. about where to find treatment, Yet veterans seeking services for PTSD in New Jersey are first long distances to providers, and routed (online, after providing a zip code) to East Orange, NJ or limited clinic hours create barriers Lyons, NJ. The names and phone numbers of two practitioners, to getting care. When care is not also in North Jersey, are listed. A suicide hotline is listed. There readily available, the “window of opportunity” may be lost. 1 are no links to employment services or other information leading to help in southern New Jersey. As it categorizes services, the VA web site leads veterans in New Jersey to resources in New Jersey but these are sometimes inaccurate (since southern New Jersey veterans have official designated site in Philadelphia for health and benefits but not voc rehab) and/or impractical, since they route the veteran to distant providers far from home. This is consistent with the position of the National Council on Disabilities, which has articulated its recommendations. (See text box, left.)X. Veterans Administration Study Suggests PTSD as Obstacle to Employment andRecommends CWT Compensated Work Therapy is a transitional work experience shown to be effective with the population of veterans diagnosed with PTSD. The VA funded a study resulting in this publication, Posttraumatic stress disorder, and employment in veterans participating in Veterans Health Administration Compensated Work Therapy18 Their findings suggest that PTSD is a significantGail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 16. 16 obstacle to employment, even after adjusting for potentially confounding factors including service era and service in various theaters of operations. VHA is currently renewing its commitment to evidence- based mental health treatment, including increased amounts and types. Compensated Work Therapy, a recommended intervention, is underutilized. (See addendum)XI. Southern New Jersey Veterans: Filing a Claim for Disability Benefits:Sample inquiry for benefits: Here in New Jersey, as troops return from Operation Iraqi Freedom, what happens to those needing services? We learned the process from the Veterans Insurances and sought to experience it, first- hand. Based on our own inquiry (8/19/2010) to the “800” number responding to all 57 Regional Offices, this is the process. 1) For a veteran seeking vocational rehabilitation services and who lives in the zip code 08035, the Newark Regional Office is the RO for the claim. The location is 84 miles from zip code 08035. 2) After calling an “800” number, the information is provided through an automated system. We called back for more specific information. 3) A representative, “Mary”, answered our questions. We were notified the interaction may be recorded for quality purposes. Mary affirmed that a veteran could file online or, perhaps with the help of, e.g., a military service person, fill it out and mail it to the Regional Office. 4) After the claim is reviewed, an assessment is done in Newark. We asked the question three different ways because the information about voc rehab services was so ambiguous. 5) The representative answers to how and where vocational rehabilitation services may be delivered if approved was summed up as “it depends.” The veteran would have to talk to his or her “counselor.” Assessments are done face-to-face in Newark. One trip to Newark may not seem inordinately inconvenient is it insurmountable for some veterans who are presumed to have service-disabilities to get to Newark? If there is any flexibility with respect to location of the assessment, should the instructions be more definitive than “it depends”? Once the application is sent, to determine the status of a pending claim, veterans are instructed to call and follow the recorded instructions; there is no online service that juncture. The mix of direct calling and fragmented online services impedes the veteran in the process.Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 17. 17XII. Solution: Vocational Assessments, Pilot Project, Camden and Gloucester CountyVHMC As a community-based provider rendering local solutions, then, we envision these initial solutions: 1) Establishing a fee-for-service in the VA outpatient clinics in the Camden VA Outpatient Clinic and Veterans Health Clinic at Gloucester County (642GD). 2) We also seek to locate veterans in these areas who do are not enrolled for medical care at the clinics. This service would expand in response to the need to finding and serving veterans who require employment services. This would start with vocational assessments to pre-determine eligibility similar to the voc rehab process but differently designed to start the process of finding and getting a job sooner. 3) Preliminarily, we believe there is potential other collaborative efforts, as well as for a compensated work therapy program within the Abilities Center as a demonstration site. We have the experience, capability, accreditation, and physical space for a number of veterans for this purpose. Just as the clinics serve a need in Camden and Gloucester, a vocational rehabilitation site that meets the needs of veterans is paramount. Currently, a veteran with a broken leg, as recounted in a recent news story, may live in New Jersey, take a VA shuttle to Wilmington for surgery, and have other providers in Philadelphia. The news story did not indicate that the veteran also sought vocational rehabilitation, in which case he might be taking another detour. 4) Raising public awareness is crucial. We have attached information regarding other military and veterans resources, including the fine military service organizations and Vet Centers. It is our intention to raise public awareness and stimulate a conversation among these organizations, centers, and persons about vocational rehabilitation and how veterans are served. Our purpose in reporting our observations about the current system is to underscore the need for alternative services for veterans. Eliminating systemic barriers in the VA system for veterans with service-connected disabilities is beyond the scope of our mission or capacity. Reducing the backlog of claims is equally beyond our domain. We cannot effect the changes between the VA and DoD or open communication between the VBA and VHA. Dedicated public servants operate these facilities and given the size of the various entities, it is remarkable so much is accomplished. We are community rehabilitation partners, prepared to augment services. We do aspire to work with everyone on all levels as appropriate to our role. Our proposal is not a criticism of other vocational programs extended to veterans. It appears to us that there is a perception all veterans are being easily served and that is not true. They are not even being identified. We also applaud the opportunities provided for veterans who may segue from vocational counseling and swiftly enter community college. However, we want to be certain that the most vulnerableGail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 18. 18 veterans - the ones who may need other services before they are ready to enter college or a training program, the ones who have a service-connected disability – are identified, served and given the means to get back to work.Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 19. 19 Endnotes and other references1 Title 38, Code of Federal Regulations, Chapter 31. A service-connected disability is condition that hasresulted from or was aggravated by an injury or illness while the veteran was serving on active duty in themilitary. § 21.40 Basic entitlement to vocational rehabilitation benefits and services. An individual meetsthe basic entitlement criteria for vocational rehabilitation benefits and services under this subpart if VAdetermines that he or she meets the requirements of paragraph (a), (b), (c), or (d) of this section. Forother requirements affecting the provision of vocational rehabilitation benefits and services, see §§21.41through 21.46 (period of eligibility), §21.53 (reasonable feasibility of achieving a vocational goal), and§§21.70 through 21.79 (months of entitlement).CRS Issue Statement on Veterans’ Benefit Sidath Viranga Panangala, CoordinatorSpecialist in Veterans Policy January 13, 20102 Hall Calls For VA and DoD to Better Track Promising ProgramsVA Fails to Monitor Timelines on Pre-Discharge Claims Processing February 26, 20103 Federal Register 3163-3165 (3 page), January 21, 2010, as it affects 38CFR214 Strict Deadlines, Disabled Veterans and Dismissed Cases, Adam Liptak, NYT, April 5, 2010. CRS Issue Statement on Veterans Benefits. Sidath Viranga Panangala, Coordinator Specialist in VeteransPolicy, January 13, 2010.6 Veterans Affairs: Benefits for Service-Connected Disabilities. Douglas Reid Weimer Legislative AttorneyAmerican Law Division Updated May 15, 2008 RL33323. See also CRS ReportRL33113, Veterans Affairs:Basic Eligibility for Disability Benefit Programs, by Douglas Reid See also Disability Evaluation, ChristineScott and Sidath Viranga Panangala, October 21, 2008, Congressional Research Service.8 2007 Veterans Employability Research Survey Final Report February 8, 2008 Prepared for U.S.Department of Veterans Affairs 810 Vermont Avenue, NW Washington, DC 20420 Prepared by AbtAssociates Inc. 4550 Montgomery Avenue Suite 800 North Bethesda, MD 20814-3343 The 2007 VeteransEmployability Research Survey (VERS) was conducted to determine the factors that impact veteransemployability resulting from participation in the VR&E Program. The study consists of a nationallyrepresentative survey of veterans who have applied to the VR&E Program, but who discontinued theprogram at various points as well as a comparison group of veterans who have completed the program.9 Veterans Disability Benefits Commission 2007 Established Pursuant;_ylu=X3oDMTEybmhpMTdlBHNlYwNzcgRwb3MDNARjb2xvA2FjMgR2dGlkA0RGRDVfODY-/SIG=12l7to5h3/EXP=1312325968/**http%3a// to Public Law 108-13610 Honoring the Call to Duty: Veterans’ Disability Benefits in the 21st Century, Veterans Commission 2006.11 United States -- Congressional Districts by State; and for Puerto Rico (110th Congress)GCT2101. Percent of the Civilian Population 18 Years and Over Who Are VeteransUniverse: Civilian population 18 years and overGail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION
  • 20. 20Data Set: 2006-2008 American Community Survey 3-Year EstimatesSurvey: American Community Survey, Puerto Rico Community Survey12 Bartone, P.T. (2000). Hardiness as a resiliency factor for United States forces in the Gulf War. In D.Paton (Ed.), Posttraumatic stress intervention: Challenges, issues, and perspectives (pp. 115-133).Springfield, IL: Charles C. Thomas.13 (Table directly copied from “Soldiers Returning From Iraq and Afghanistan: The Long-Term Costs OfProviding Veterans Medical Care and Disability Benefits.” Linda BilmesJohn F. Kennedy School of Government - Harvard UniversityJanuary 200714 Veterans Benefits: Further Changes in VBA’s Field Office Structure could help improve disabilityclaims processing”, GAO-06-149, December 200515 Repeated OEF and OIF deployments may adversely affect the military readiness of New Jersey NationalGuard combat soldiers. “Effects of repeated deployment to Iraq and Afghanistan on the health of NewJersey Army National Guard troops: implications for military readiness” Kline, Anna; Falca-Dodson, Maria;Sussner, Bradley; Ciccone, Donald S;Chandler, Helena K; Callahan, Lanora; Losonczy, Miklos AF:Affiliation American Journal of Public Health, vol. 100, no. 2, pp. 276-283,February 201016 Best Practice Manual for Posttraumatic Stress Disorder (PTSD), Compensation and Pension Examination,Patricia Watson, Ph.D.National Center for PTSD (lead author), et al.17 Hardest Times, the Trauma of Long-Term Unemployment, Thomas Cottle, Praeger Publishers, CT, 2001.18 sameOther references include multiple reports General Accounting Office, Inspector General CongressionalResearch Service, Journal of the American Medical Association, VA publications, including primary carephysician instructions re exam and queries re PTSD, evaluation forms. Journal articles, including Militarydeployment to the Gulf War as a risk factor for psychiatric illness among US troops NANCY FIEDLER, PhDDepartment of Environmental and Occupational Medicine, University of Medicine and Dentistry of NewJersey (UMDNJ) and Robert Wood Johnson Medical School (RWJMS), Piscataway, New Jersey, USA.In addition, Harvard University public finance, Kennedy School of Government; Portland Oregon UniversityPTSD, UMDNJ reports, US Census, American Community Survey data is referenced. Statements in thisproposal supported as cited. If there are errors or incomplete information, full citations will be providedupon request.Gail Cammero Reilly,Abilities Center of Southern New Jersey, inc.SNJ Veterans@Home2010 l Draft Version 8/2010CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION