Comparison of Selected Recommendations of the President's Commission on Returning Wounded Warriors (the Dole-Shalala Commission) and the Veterans' Disability Benefits Commission

Comparison of Selected Recommendations of the
President’s Commission on Returning Wounded
Warriors (the Dole-Shalala Commission) and the
Veterans’ Disability Benefits Commission
March 10, 2008
Christine Scott
Specialist in Social Policy
Domestic Social Policy Division
Sarah A. Lister
Specialist in Public Health and Epidemiology
Domestic Social Policy Division

Comparison of Selected Recommendations of the
President’s Commission on Returning Wounded
Warriors (the Dole-Shalala Commission) and the
Veterans’ Disability Benefits Commission
This report compares selected recommendations of the President’s Commission
on Care for America’s Returning Wounded Warriors (PCCWW), often called the
Dole-Shalala Commission in reference to its co-chairs, and the Veterans’ Disability
Benefits Commission (VDBC). The VDBC was established in 2004 to study veterans’
benefits in a broad context. The PCCWW was established in 2007 following reports
of problems among injured servicemembers returning from Iraq and Afghanistan
with medical rehabilitation and access to benefits. The PCCWW was charged to
focus specifically on the needs of these individuals.
The recommendations presented in this report are those that relate to the
transition of injured servicemembers from military service to civilian life and/or
veteran status. This report does not examine certain other recommendations, such as
those in the VDBC report regarding benefits for survivors of deceased
servicemembers, or regarding evaluation of presumptive disability, i.e., establishing
service connection for certain long-term health effects of hazardous exposures. As
this report is limited to a comparison of the final recommendations of the PCCWW
and the VDBC, it will not be updated.

Overview ........................................................1
Charges to the Commissions.........................................2
Recommendations of the Commissions.................................3
Additional CRS Reports............................................4
List of Tables
Table 1. Comparison of Selected Recommendations
of the PCCWW and VDBC......................................5

Comparison of Selected Recommendations
of the President’s Commission on
Returning Wounded Warriors
(the Dole-Shalala Commission) and the
Veterans’ Disability Benefits Commission
This report compares selected recommendations of the President’s Commission
on Care for America’s Returning Wounded Warriors (PCCWW),1 often called the
Dole-Shalala Commission in reference to its co-chairs, and the Veterans’ Disability
Benefits Commission (VDBC).2 The recommendations presented are those that
relate to the transition of injured servicemembers from military service to civilian life
and/or veteran status. This report does not examine certain other recommendations,
such as those in the VDBC report regarding benefits for survivors of deceased
servicemembers, or regarding evaluation of presumptive disability, i.e., establishing3
service connection for certain long-term health effects of hazardous exposures.
Congress, the two commissions, and others have determined that certain
programs and systems that involve both the Department of Defense (DOD) and the
Department of Veterans Affairs (VA) are particularly problematic in providing
continuity and quality of care and services to injured servicemembers. In January
2008, Congress passed the National Defense Authorization Act for Fiscal Year 2008
(P.L. 110-181). Titles XVI and XVII of the act address matters related to the care
and treatment of servicemembers and former servicemembers (i.e., veterans) who
were wounded, or who contracted an illness, while serving on active duty. Among
the problems addressed in the act are the efficient maintenance and transfer of
servicemembers’ health and benefits records between the departments, and the
separate evaluations of disability by each department. Efforts to address these and
other transition problems were already under way in both departments, partly in
response to the recommendations of the PCCWW, the VDBC, and several other

1 President’s Commission on Care for America’s Returning Wounded Warriors (PCCWW),
Serve, Support, Simplify, main report, and subcommittee reports and survey findings, July

2007, at [].

2 Veterans’ Disability Benefits Commission (VDBC), Honoring the Call to Duty: Veterans’
Disability Benefits in the 21st Century, October 2007, at [].
3 The PCCWW report does not contain recommendations regarding survivor benefits or
presumptive disability. These matters are addressed in VDBC recommendations 8.2 through

8.3, and 5.8 through 5.27, respectively.

commissions or task forces. These legislative and administrative actions constitute
the first wave of responses to the recommendations of these bodies. Further
congressional and administrative actions are anticipated. As this report is limited to
a comparison of the final recommendations of the PCCWW and the VDBC, it will
not be updated.
Charges to the Commissions
The commissions were given different charges. The PCCWW was established
by Executive Order 13426 in March 2007,4 and was to focus on the needs of a
specific population, namely, seriously injured servicemembers returning from combat
theaters in support of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF).
The commission was asked to look broadly at services and benefits provided by all
relevant Cabinet departments — principally the Departments of Defense (DOD) and
Veterans Affairs (VA) — as well as the private sector, and at a broad slate of services
and benefits, including health care, disability, traumatic injury, education,
employment, and other benefits. The PCCWW was to study individuals’ experiences
as servicemembers and, for those who were retired or separated from military service,
their transition from military to civilian and/or veteran status, problems in providing
services and benefits across that transition, and subsequent experiences in civilian
life. Though the PCCWW’s recommendations were to apply narrowly to seriously
injured OEF/OIF servicemembers, it could prove difficult, politically and
administratively, to implement the recommendations in this fashion. Doing so could
run counter to existing policies, such as compensating service-connected disabilities
equally whether or not they are combat related, and prioritizing groups of veterans
to receive VA health care.
The VDBC was established in Title XV of the National Defense Authorization
Act of 2004 (P.L. 108-136) to study benefits provided to veterans and their survivors
to compensate for service-connected disabilities and deaths. The VDBC was to
consider these benefits regardless of the time or manner in which a disability or death
occurred, and whether it occurred during a conflict or during peace time. While the
VDBC examined certain transition issues for injured OEF/OIF servicemembers who
were retired or separated from military service, this was not its principal focus. The
VDBC examined services and benefits for veterans across their lifespans, making a
more comprehensive assessment of the full complement of veterans’ benefits than
did the PCCWW, but a less comprehensive assessment of DOD services, benefits,
authorities and policies.

4 White House, “Executive Order: Establishing a Commission on Care for America’s
Returning Wounded Warriors and a Task Force on Returning Global War on Terror
Heroes,” March 6, 2007, at [


Recommendations of the Commissions
The PCCWW made six broad recommendations, each with several specific
action steps directed to the Congress, DOD and/or VA, and published a matrix of the

23 action steps in its main report.5 The six broad recommendations are as follows:

1. Implement comprehensive recovery plans for returning injured

2. Restructure the military and veterans disability and compensation systems.

3. Improve care for people with post-traumatic stress disorder (PTSD) and
traumatic brain injury (TBI).

4. Strengthen support for families.

5. Transfer patient information across the DOD and VA systems.

6. Support Walter Reed Army Medical Center (WRAMC) until its closure.

The VDBC made 113 recommendations, also directed to the Congress, DOD
and/or VA, designating 13 of them as priority recommendations.6 Recommendations
were made in the following broad categories:
!disability evaluation and compensation;
!determining eligibility for benefits;
!appropriateness of the benefits;
!appropriateness of the level of benefits;
!survivors and dependents;
!disability claims administration;
!transition; and
!establishing an executive oversight group to implement
The attached Table compares selected action steps from the PCCWW and
recommendations from the VDBC that relate to the transition of injured
servicemembers from military service to civilian life and/or veteran status. Since the
PCCWW focused on these individuals, all of its action steps are discussed, and the
table is organized according to the PCCWW’s six broad recommendations. The table
does not include all of the VDBC recommendations, but only those that relate to the
transition of injured servicemembers or that are otherwise comparable to
recommendations of the PCCWW. Each table entry notes the entity (Congress, DOD
and/or VA) to whom the recommendation is directed. Bracketed notations show the
relevant numbered recommendation(s) from the PCCWW and VDBC respectively.
Because the commissions had distinct charges and areas of emphasis, head-to-
head comparison of their recommendations must be made with care. For example,
the commissions largely agreed on the proposed end point for a revised disability

5 PCCWW main report, p. 28, table.
6 VDBC full report, pp. 378-395, and executive summary, pp. 12-15. One commissioner’s
separate views on four of the commission’s recommendations are published as Appendix
L in the full report.

compensation system, namely, that DOD would evaluate the fitness of injured
servicemembers for continued duty, while VA would evaluate for disability
compensation. But the commissions differed in their priorities for implementing this
revised system, reflecting their focus on different populations. When comparing
PCCWW and VDBC recommendations, it must be borne in mind that unless
otherwise stated, PCCWW recommendations would apply, at least initially, only to
injured OEF/OIF servicemembers and veterans, while VDBC recommendations
would apply to all servicemembers or veterans, including those from previous
conflicts, who are otherwise eligible for the service or benefit being discussed.
Additional CRS Reports
The following CRS Reports discuss the variety of DOD and VA programs and
benefits that are addressed by the commissions and referred to in this report:
!CRS Report RL33991, Disability Evaluation of Military
!CRS Report RL33537, Military Medical Care: Questions and
!CRS Report RS22366, Military Support to the Severely Disabled:
Overview of Service Programs;
!CRS Report RL33446, Military Pay and Benefits: Key Questions
and Answers;
!CRS Report RL33449, Military Retirement, Concurrent Receipt,
and Related Major Legislative Issues;
!CRS Report RL33985, Veterans’ Benefits: Issues in the 110th
!CRS Report RL33993, Veterans’ Health Care Issues;
!CRS Report RL33113, Veterans Affairs: Basic Eligibility for
Disability Benefit Programs;
!CRS Report RL33323, Veterans Affairs: Benefits for
Service-Connected Disabilities;
!CRS Report RS22666, Veterans Benefits: Federal Employment
!CRS Report RS22804, Veterans’ Benefits: Pension Benefit
!CRS Report RL34371, “Wounded Warrior” and Veterans
Provisions in the FY2008 National Defense Authorization Act;
!CRS Report RL34169, The FY2008 National Defense Authorization
Act: Selected Military Personnel Policy Issues;
!CRS Report RL31760, The Family and Medical Leave Act: Recent
Legislative and Regulatory Activity; and
!CRS Report RL34055, Walter Reed Army Medical Center:
Realignment Under BRAC 2005 and Options for Congress.

Table 1. Comparison of Selected Recommendations of the PCCWW and VDBC
ProvisionPCCWW RecommendationsVDBC Recommendations
ewDOD and VA: Develop integrated care teams of healthcare, social workDOD and VA: Create an intensive case management program for
and vocational rehabilitation staff, to coordinate health care and access toseverely disabled veterans, with a lead agency. [10.3]
benefits for servicemembers. Create individual Recovery Plans for each
seriously injured servicemember, including plans developed retroactively
for any servicemembers injured since the beginning of OEF or OIF who
may still benefit from them. Develop a corps of trained Interagency
Recovery Coordinators to implement the Recovery Plans. [1]
iki/CRS-RL34408e manager/RecoveryDOD and VA: Interagency Recovery Coordinators should be officers inThe commission does not comment specifically on the affiliation or
g/wordinatorthe Commissioned Corps of the U.S. Public Health Service, in thecredentials of the proposed lead agency.
s.orDepartment of Health and Human Services, cross-trained by DOD and
leakVA. [1]
httposed end stateCongress, DOD, and VA: Completely restructure the disability andCongress, DOD, and VA: Realign the disability evaluation process so
compensation systems, so that DOD, through its service branches,that the service branches determine fitness for duty, and servicemembers
maintains authority to determine fitness for continued military service,who are found unfit are referred to VA for disability rating. All
and VA determines disability ratings and all resulting compensation andconditions that are identified as part of a single, comprehensive medical
benefits. If DOD finds the servicemember unfit, DOD provides annuityexamination should be rated and compensated. [Priority
payments based solely on rank and years of service. VAs disabilityRecommendation 7.12] (Recommended actions to achieve this end state
system compensates for transition costs and lost quality of life in additionfollow. See, in particular, “Restructure VA disability payments.”)
to lost earnings potential. [2] (Recommended actions to achieve this end
state follow. See, in particular, “Restructure VA disability payments.”)
Congress: Clarify the objectives of the DOD and VA disabilityVA: The VDBC makes 21 additional recommendations regarding
programs. [2]administration of the proposed disability compensation system. [4.3 -

ProvisionPCCWW RecommendationsVDBC Recommendations
use of disabilityCongress, DOD, and VA: PCCWW recommends enhancements ofCongress, DOD, and VA: Benefits should be awarded solely according
disability compensation selectively for combat-injured OEF/OIFto the severity of the disability, regardless of whether the injury was
servicemembers. [2]incurred or the disease was contracted during combat or training, or in
wartime or peacetime. [5.3]
le medicalDOD and VA: Develop a single comprehensive, standardized medicalDOD and VA: Servicemembers being considered unfit by DOD should
inationexamination, to be administered by DOD, that would serve both DOD’sbe given a single, comprehensive examination, and all identified
fitness evaluation, and VAs initial determination of disability. [2]conditions should be rated and compensated. [Priority Recommendation
7.12] Conduct a comprehensive multidisciplinary medical,
psychological, and vocational evaluation of each veteran applying for
disability compensation at the time of service separation. [4.10]
iki/CRS-RL34408DOD: Mandate that separation examinations be performed on all
g/wservicemembers. [10.6]
leak-evaluation ofbilityVA: Re-evaluate veterans disability status every 3 years. [2]VA: Re-evaluate individuals with PTSD every 2 — 3 years to gaugetreatment effectiveness and encourage wellness. [Priority
://wikiRecommendation 5.30]
http AdministrationVA: Update and keep current the VASRD to reflect injuries seen inVA: Update the VASRD, beginning with mental health and neurological
or RatingOIF/OEF injured servicemembers, and modern concepts of the impact ofbody systems, to prioritize the revision of schedules for PTSD, other
bilities (VASRD)disability on quality of life. Post-traumatic stress disorder (PTSD) andmental disorders, and TBI. After establishing priorities for revision of
traumatic brain injury (TBI) are mentioned specifically. The commissionthe remaining systems, revise the remainder of the schedule, completing
does not stipulate a specific timetable for revisions. Update the VASRDthe revision for all body systems within five years. [Priority
to reflect modern understanding of PTSD and TBI. [2]Recommendation 4.23] Develop specific VASRD rating criteria for
PTSD. [Priority Recommendation 5.28]
assessment of DODNo comparable recommendation.DOD: Reassess any such ratings of servicemembers to determine if they
bility ratings of are equitable. [7.11]

ProvisionPCCWW RecommendationsVDBC Recommendations
idualNo comparable recommendation.VA: Eligibility for IU benefits should have a consistent basis. Revise the
ployability (IU)VASRD to accommodate individual inability to work in basic rating,
without need for IU rating. Reduce IU benefits gradually rather than
terminating abruptly. [4.12 and Priority Recommendations 7.4 and 7.5]
ructure VA disabilityCongress: Restructure VA disability payments to include transitionCongress: Disability compensation should compensate for: (1) work
entspayments, earnings-loss payments, and quality of life payments. (Seedisability; (2) loss of ability to engage in non-work life activities; and (3)
additional information for each below.) Transition payments wouldloss of quality of life. [4.1, 4.2, 4.3]
cover living expenses for disabled veterans and their families.
Earnings-loss payments would begin when transition payments end, and
iki/CRS-RL34408cease when Social Security benefits for retirement begin. Earnings loss
g/wpayments are intended to make up for any lower earning capacity
s.orremaining after training. Quality of life payments would compensate for
leaknon-work-related effects of permanent physical and mentalservice-connected disabilities. [2]
://wikisition paymentsVA: Provide transition payments to disabled veterans and their families,Congress: Create a severely disabled stabilization allowance that would
httpeither three months of base pay for those returning to their communitiesallow for up to a 50% increase in basic monthly VA compensation for up
without receiving continued rehabilitation, or, for those receivingto 5 years to address the real out-of-pocket costs above the compensation
longer-term rehabilitation or education and training programs,rate at a time of need, to supplement, to the extent appropriate, any
longer-term payments to cover family living expenses. Commission acoverage under Traumatic Servicemembers Group Life Insurance. [7.7]
study to determine appropriate longer-term payment levels. [2]
l MonthlyNo comparable recommendation.Congress: Consider increasing Special Monthly Compensation benefits,
mpensationwhere appropriate, to address the more profound impact on quality of life
of the disabilities subject to special monthly compensation. [6.1 and
Priority Recommendation 7.8]

ProvisionPCCWW RecommendationsVDBC Recommendations
ality of life paymentsVA: Move swiftly to update and keep current the disability ratingCongress: Review ancillary benefits to determine where additional
schedule (see the prior reference to the VASRD) to reflect currentbenefits could improve disabled veterans quality of life. [6.1 and
injuries and modern concepts of the impact of disability on quality ofPriority Recommendation 7.8] While the program is revised to
life. [2]accomplish this, consider an immediate increase (up to 25%) in disability
compensation. [7.6]
cational rehabilitationVA: Develop flexibility within the program by allowing veterans toCongress and VA: Require vocational assessment in the determination
suspend training or attend part-time, with the approval of the Recoveryof eligibility for Individual Unemployability (IU) benefits. [4.14]
Coordinator and vocational counselor. Provide bonuses for completion
of stages of vocational training. [2]VA: Review the 12-year limitation for vocational rehabilitation for
iki/CRS-RL34408service-connected veterans and, when appropriate, revise the limitation
g/won the basis of current employment data, functional requirements, and
s.orindividual vocational rehabilitation and medical needs. [4.12] Develop
leakand test incentive models to promote vocational rehabilitation and areturn to gainful employment among veterans for whom this is a realistic
://wikigoal. [4.13]
httpcareCongress: Establish lifetime Tricare benefits eligibility for allDOD: Remove Tricare requirements for copays and deductibles for
combat-injured servicemembers found unfit for continued service, andseverely injured servicemembers and their families. [10.17]
their dependents. [2] (Currently, this benefit is available only to those
found unfit with disability ratings of 30% or greater.)
The commissions proposed end state would eliminate DOD disabilityCongress: Eliminate the ban on concurrent receipt. VDBC recommends
D and VA disabilitypayments, having DOD provide an annuity payment, similar to militarythat servicemembers who are separated before 20 years of service for
itsretired pay, based on rank and years of service, with only the VAbeing medically unfit receive DOD retirement and VA disability benefits
providing a disability payment. [2]concurrently (i.e., without offset), regardless of their disability rating,
and that priority be given to veterans separated or retired with fewer than
20 years of service and either a service-connected disability rating greater
than 50%, or a combat-related disability. [Priority Recommendation
6.14] Eliminate the Survivor Benefit Plan/Dependency and Indemnity
Compensation offset for survivors of retirees and in-service deaths.
[Priority Recommendation 8.2]

ProvisionPCCWW RecommendationsVDBC Recommendations
l Security benefitsCongress: In restructuring VA disability compensation, earnings lossCongress: For severely injured veterans, consider eliminating the Social
compensation would end upon retirement and receipt of Social SecuritySecurity Disability Insurance (SSDI) eligibility requirement of having
retirement benefits. Compensation for lost quality of life would continueworked a minimum number of quarters. [10.16]
in retirement. [2]
DOD and VA: Include the Department of Labor and the Social Security
Administration in the Joint Executive Council to improve the transition
process. [10.2] Make transitioning servicemembers aware of SSDI.
SDCongress: Enable all Iraq and Afghanistan veterans who need PTSDVA: Develop a “holistic approach” to PTSD, involving treatment,
iki/CRS-RL34408care to receive it from the VA, without waiting for enrollment orcompensation, and vocational assessment, and including closer
g/wdisability evaluation, and regardless of their priority status. [3]coordination of the Veterans Health Administration (VHA) and Veterans
s.orBenefits Administration (VBA), with re-examinations conducted every
leaktwo to three years. [Priority Recommendation 5.30] The commission alsomakes recommendations regarding benefits, training and certification of
://wikiraters, and data collection and research, including research on therelationship between military sexual assault and PTSD. [5.29 - 5.33]
force and trainingDOD and VA: Establish and expand networks of experts in PTSD andVA: Establish a standardized training program for clinicians who
TBI, to expand training, and to develop or disseminate clinical practiceconduct psychiatric evaluations for compensation and pension physical
guidelines. Both departments must work to reduce the stigma associatedexams [5.32], and a certification program for raters who handle PTSD
with PTSD. [3]claims. [5.33]
DOD: Address shortages of mental health professionals. [3]
VA: Update the VASRD to reflect modern understanding of PTSD andVA: Develop specific VASRD rating criteria for PTSD, and prioritize the
TBI. [2]revision of criteria for other mental disorders and TBI. [Priority
Recommendations 4.23 and 5.28]

ProvisionPCCWW RecommendationsVDBC Recommendations
No comparable recommendation.Congress: Authorize and fund VA to establish and provide support
services for the families of severely injured veterans similar to those
provided by DOD, such as counseling, travel and per diem benefits, and
assistance with employment and health care when relocating to assist an
injured servicemember. [10.12]
Congress: Provide lifetime Tricare comprehensive health care andCongress: Extend eligibility for VAs aide and attendant benefit to
tspharmacy benefits to servicemembers found unfit because ofseverely injured active-duty servicemembers who are in medical hold or
combat-related injuries, and their dependents. [2] Make combat-injuredTemporary Disability Retired List (TDRL) status pending discharge.
servicemembers eligible for respite care and aide and attendant care in[6.3] Adjust the amount of payment for aid and attendance to fully pay
DOD’s Tricare Extended Care Health Option program. [4]for the extent of assistance required. [6.2] Extend eligibility for the VAs
Civilian Health and Medical Program to caregivers, and create a
iki/CRS-RL34408caregiver allowance for caregivers of severely disabled veterans. [8.1]
s.orDOD: Eliminate Tricare co-pays and deductibles for severely injured
leakservicemembers and their families. [10.17]
ining and counselingDOD and VA: Provide families of servicemembers who requireSee recommendation 10.12 (in general) above.
://wikilong-term personal care with appropriate training and counseling for their
httpcaregiving roles. [4]
mily and MedicalCongress: Lengthen the FMLA period for job-protected unpaid leaveNo comparable recommendation.
ve Act (FMLA)from the current 12 work weeks to 6 months (26 weeks) for otherwise
eligible spouses and parents caring for injured servicemembers. [4]
eneralDOD and VA: Within 12 months, make patient data more accessibleDOD and VA: Expedite development and implementation of
(initially, in viewable form). All essential health, administrative, andcompatible information systems including a detailed project management
benefits data must be immediately viewable by any clinician, alliedplan that includes specific milestones and lead agency assignment.
health professional, or program administrator who needs it. Continue the[Priority Recommendation 10.11] Improve electronic information record
work under way to create a fully interoperable information system thattransfers and address issues of lost, missing, and unassociated paper
will meet the long-term administrative and clinical needs of all militaryrecords. [10.10]
personnel over time. Develop a plan for a user-friendly, tailored web
portal with services and benefits information for service-members,DOD: To expedite claims processing, provide an authenticated electronic
veterans, and family members. [5]DD 214 form to VA. [10.9]

ProvisionPCCWW RecommendationsVDBC Recommendations
ng-term health effectsNo comparable recommendations.DOD and VA: Improve the data linkage between the electronic health
hazard exposuresrecord data systems used by DoD and VA, including capabilities for
handling individual soldier exposure information in individual health
records. [5.23] Develop a data interface that allows VA to access the
electronic exposure data systems used by DoD. [5.25] Additional
recommendations regarding processes to define service-connected
illnesses that may arise many years following exposure. [5.8-5.27]
DOD: Assure that WRAMC has the resources it needs to maintain aNo comparable recommendations.
standard of excellence in both inpatient and outpatient care. Implement
tailored incentive packages to encourage civilian health care and
administrative professionals to continue working there and to enable
iki/CRS-RL34408recruitment of new professionals, as needed. [6]
s.ornduct-relatedNo comparable recommendation.Congress: Change the character-of-discharge standard to require that
leakrgewhen an individual is discharged from his or her last period of active
://wikiservice with a bad conduct or dishonorable discharge, it bars all benefits.[5.1]
No strictly comparable recommendation. For injured servicemembers,Congress: Adequately fund and mandate the Transition Assistance
itsthe requirement for case management (see discussion of caseProgram throughout the military to ensure that all servicemembers are
management / recovery plans above) would enhance servicemembersknowledgeable about benefits before leaving the service. [10.4]
knowledge of and access to benefits for which they were eligible. [1]
DOD: Require a mandatory benefits briefing to all separating military
personnel, including Reserve and National Guard components, prior to
discharge from service. [5.7]
DOD and VA: Benefits Delivery at Discharge should be available to all
disabled separating servicemembers, to include National Guard, Reserve,
and medical hold patients. [10.5] Make transitioning servicemembers
aware of Social Security Disability Insurance. [10.15]