Veterans Employment Services Abilities Centers Concept G Reilly Sample Only No Other Distribution

ABILITIES CENTER OF SOUTHERN NEW JERSEY, INC.

SNJ Veterans@Home

Southern New Jersey Veterans with Service-Connected Disabilities:
Meeting Employment Goals Through Community-Based Providers to Support
VA Vocational Rehabilitation and Employment Services

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Table of Contents

EXECUTIVE SUMMARY: ......................................................................................................................3
I. INTRODUCTION ......................................................................................................................6
II. MISSION OF VR&E..................................................................................................................6
III. DOES GRUELING PROCESS UNDERMINE INTENT TO BENEFIT VETERANS WITH SERVICE-RELATED
DISABILITIES? .......................................................................................................................................7
IV. VOCATIONAL REHABILITATION & EMPLOYMENT – IS SERVICE DELIVERY MEETING VETERANS’ NEEDS?
8
V. UNEMPLOYMENT AMONG VETERANS IN NEW JERSEY ............................................. 11
VI. POPULATION OF VETERANS IN NEW JERSEY.............................................................. 11
VII. ABILITIES CENTER PUTS PEOPLE TO WORK ............................................................... 11
VIII. PROJECTED INCREASE IN DISABILITY CLAIMS ........................................................... 13
IX. PTSD IS A FACTOR IN EMPLOYMENT: WILL REPORTED CASES INCREASE IN NEW JERSEY? 14
Stigma, Suicide – Was the VA Ready? ............................................................................................. 14
X. VETERANS ADMINISTRATION STUDY SUGGESTS PTSD AS OBSTACLE TO EMPLOYMENT AND
RECOMMENDS CWT ........................................................................................................................ 15
XI. SOUTHERN NEW JERSEY VETERANS: FILING A CLAIM FOR DISABILITY BENEFITS: 16
Sample inquiry for benefits: ................................................................................................................ 16
XII. SOLUTION: VOCATIONAL ASSESSMENTS, PILOT PROJECT, CAMDEN AND GLOUCESTER COUNTY
VHMC 17

Addendum (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@Home
2010 l Draft Version 8/2010
CONFIDENTIAL COPY FOR DISCUSSION PURPOSES, NOT FOR PUBLIC DISTRIBUTION

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EXECUTIVE SUMMARY:
Abilities Center of Southern New Jersey, Inc., a nonprofit 501c3, started in 1963, seeks to provide
outreach and alternative vocational services to veterans with service-connected disabilities who are
eligible to apply for vocational rehabilitation services under Title 38, U.S.C. Chapter 31. We propose
to pilot a service to support veterans and function in cooperation with the Camden and Gloucester
County VMACs. This concept paper is our invitation to collaborate in completing the conceptual
framework for our program. It is our objective to deliver the optimal level of services to veterans while
meeting the expectations of state and federal entities.

The Abilities Center’s mission is to provide workforce development services for people with
disabilities and other disadvantages that may be barriers to employment. We aspire to provide
outreach and services for veterans through the Camden and Gloucester County VMAC consistent
with Secretary Eric K. Shinseki’s objective: “to educate and empower Veterans and their families
through proactive outreach and effective advocacy.” (VA Strategic Plan 2010-2014, p 82) We call our
program SNJVeterans@Home –to support our nation’s heroes and cooperatively augment the
dedicated 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 of
the lowest percentages in the country of veterans who are collecting benefits. With the return of
veterans from Iraq and Afghanistan as well as the results of the 2010 census, the identified
population of veterans may increase. As of September 2009, there were 463,720 veterans counted in
New Jersey as of September 2009, including 31,525 in Camden County and 20,034 in Gloucester
County (source: Veteran’s Administration).

Nationally, the percentage of veterans reporting service-connected disabilities is higher among
veterans 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 - 12,942
veterans - as of April 29, 2009. (Veterans Administration Office of Policy and Planning, “Analysis of
Unique Veterans Utilization of VA Benefits & Services,” April 29, 2009.) Perhaps coincidentally, 11
percent of Gulf I veterans were benefited from Vocational Rehabilitation in 1998.

Anecdotally, through Veterans Health Affairs Philadelphia, we learned that as many as 9.000
veterans in southern New Jersey may be in need of vocational rehabilitation services, but VHA lacks
the resources to reach them. Their social service division was extraordinarily interested in Abilities
Center’s services to augment their efforts. We have the credentialed staff to deliver services and the
capacity to provide Compensated Work Therapy on site at our own facility as a transitional work
experience program.

There are several other compelling reasons to offer an alternative service for veterans with service-
connected disabilities:

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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 with
severe disabilities seek “Voc Rehab” in their quest to return to work. A CBS News investigation of
the Department of Veterans Affairs' (VA) concluded that the system is “beset with contracting and
staffing problems -- which often throws needless roadblocks in front of eligible veterans, and which
either tolerates or can't prevent wrongful benefit denials for some of the nation's most deserving
former warriors.”

Abilities Center of Southern New Jersey, Inc. is a viable nonprofit community-based entity to
collaborate with selected organizations and agencies. As providers, Abilities Center’s focus is on
serving the veterans, their families and the community-at-large. Our status as a nonprofit creates an
ideal partnership among federal and state entities.

Abilities Center is also a NISH affiliate and key vocational services are CARF-accredited. CARF is the
Commission on Accreditation of Rehabilitation Facilities and the standard-bearer for excellence.
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Driven by mission, not profit, Abilities Center’s culture is flexible and results-oriented with attention to
relationships and cost-effective services. Abilities Center’s vocational assessments can be delivered
on 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 becomes
employed becomes a tax-paying resident. Together, we can honor America’s heroes and their
families through outreach, transitional services, and jobs.

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I. Introduction
Veterans with service-connected disabilities in southern New Jersey who seek vocational
rehabilitation services face a logjam of claims processing for benefits and systemic barriers in the
Veterans Administration VR&E application process.

Abilities Center of Southern Jersey, Inc. a 501 C3 established in 1967, proposes to pilot outreach and
vocational rehabilitation services to augment the Veterans Benefits and Veterans Health Affairs (VBA
and also as it provides certain services, i.e., Compensated Work Therapy, a program under VR&E
administered 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 vocational
rehabilitation services may wait months to benefit. The backlog of veterans’ disability claims has
created a logjam that stands at 550,000 claims pending approval, 37.4% of which have been pending
for over 125 days.
II. Mission of VR&E
The 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 under
Title 38 is Chapter 36, which provides vocational counseling to any veteran within the first 12 months
after 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.)
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Vocational rehabilitation, often under scrutiny for how it meet the
needs of veterans with service-connected disabilities, appears to
be getting stuck in a quagmire of VBA (Veterans Benefit “It is the veteran who incurs the
Administration) benefits claims processing. most devastating service-
connected injury who will often
Military in transition have several programs which may facilitate be the least able to comply with
benefits processing. One faster track is the Benefits Delivered at rigidly enforced filing deadlines,”
Discharge (BDD), administered by the VA in cooperation with the
Department of Defense. Although helpful, BDD is not sufficient. Judge Haldane Mayer, in his
As recently as February 2010, the (General Accounting Office) dissent and for two colleagues
GAO was critical of its lack of tracking tools and therefore not for US Court of Appeals for the
enough 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’ Affairs
Committee Bob Filner (D-CA) has asserted that the quality of
disability ratings continues to undermine the entire disability
claims process for veterans.2

III. 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 “...to care for him who shall have borne the highest appreciation is not to
the 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 Kennedy
Washington, DC , expresses our nation’s gratitude.
However, what the veterans endure to receive benefits is
often unacceptable; the process of filing for disabilities
benefits can be grueling.
“Eligible” for benefits does not mean “entitled”. The veteran with a service-connected disability who
seeks 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 the
cumbersome process; it is time-consuming and grossly inconvenient for an unemployed veteran with
a 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 is
filled out and received by the VR&E Regional Office. There, it is reviewed and developed. The
vocational rehabilitation sets up a face-to-face assessment in the course of determining entitlement
to participate or denial. The veteran may have an employment handicap (20% disability) or a serious
employment handicap (10%) but that is not sufficient. The reasons for denying entitlement vary. The
veteran’s plan may not be approved as a realistic goal, for example. If the plan is not approved, the
veteran may be referred to other resources. For purposes of compensation, veterans are considered
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unable to work, generally, when, due to the service-connected condition, his or her earned annual
income is less than the poverty threshold, www.census.gov/hhes/www/poverty. 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 the
final rule adopted by the VA this past January 2010: “Section 21.50(d) provides that if an individual
does not cooperate, even after reasonable attempts are made to secure cooperation, VA will suspend
the initial evaluation process and that individual will not be considered inducted into a rehabilitation
program. Section 21.50(d) will also include references to §§ 21.632 and 21.634 regarding satisfactory
and unsatisfactory conduct and cooperation.” 3
If he or she does apply, and the decision is unfavorable, it can be appealed through another series of
steps and rigid filing deadlines.
If the veteran chooses to take his or her appeal to the U. S. Court of Appeals for Veterans Claims, the
deadlines are fixed as the result of a U.S. Supreme Court decision4 on jurisdiction, not veterans, two
years ago. Previously, there was some lenience.

The U.S. Court of Appeals for Veterans Claims applied it and denied Mr. Henderson, a veteran with a
mental 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 veteran
from the Korean War who served on the front lines. (He is
currently appealing to the Supreme Court.) While this
does not have a direct bearing on services in southern If a man does his best, what
New 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. Patton

IV. Vocational Rehabilitation & Employment – Is
Service Delivery Meeting Veterans’ Needs?

Outside the application phase, the vocational rehabilitation process and its program have raised
concerns 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.7
2) 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 . 8
3) 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. 10

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5) 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 and
hardships; the state suffers other costs. The veteran who might have successfully completed
vocational rehabilitation services and found a job is unemployed. The veteran who bearing the agony
of Post-Traumatic Stress Disorder (PTSD) may fear stigma that holds back many veterans from
seeking help for mental disorders. He or she may be hurtling toward a crisis in readjustment.

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Arguably, this is speculation, yet the presumption that veterans can wait for services is also
guesswork.

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V. Unemployment among Veterans in New
Jersey
The national unemployment rate of Reserve and
National Guardsmen, who often had jobs when they
deployed, has quadrupled since 2007 and rose to 14.7
by March 2010. The unemployment rate (all) in New
Jersey is currently 9.5 percent, but it is about 3 points
higher among veterans. Among vets younger than 24
the gap is even wider: they're 40 % more likely to be
unemployed than everybody else in their age group.

New Jersey's Army National Guard members have
been especially affected. The statewide unit went into active duty in September 2008, leaving their
jobs just as the recession was taking hold. Among 3,000 troops who deployed to Iraq last year, 18
percent are out of work, according to a poll of the second Battalion, 113th Infantry, conducted by the
unit's Command Sgt. Maj. Tom Clark. The New Jersey Guard is undertaking a survey to learn more.

VI. Population of Veterans in New Jersey
How many veterans “count” in New Jersey? Based on the American Community Survey, 7.6 percent
of 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 Veteran
Medical 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 in
New Jersey, including 20,034 in Gloucester County and 31,525 in Camden County. Statewide, also
according to Veterans Affairs, the amount spent on all veterans for voc ational rehabilitation/education
is $80476. In Gloucester County, it is $2186. In Camden County, it is $8078. State and county data
are available here - www1.va.gov/VETDATA/docs/GDX/GDX_FY09_2.xls (hyperlinked and hard
copy in addendum). We speculate that the
number of veterans will change with the “final”
tally for the 2010 census and, as deployed
troops return from Iraq, the potential number of
military transitioning to veteran status who
remain in New Jersey.11

VII. Abilities Center Puts People to Work

Abilities Center of Southern New Jersey, a
501c3 community rehabilitation provider for 47
years, has a mission to provide workforce
development services to people with disabilities
and other disadvantages. We focus on prompt
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attention to our consumers.
Within our mission, we provide the broadest array of services to the greatest number of counties in
southern 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 in
sustained competitive employment over the past five years, seeking job retention as well as
placement to evaluate our success.

Accreditation: Abilities Center is CARF-accredited, meaning it has met the highest standard services
by the Commission on Accreditation of Rehabilitation Services.

AbilityOne - NISH – we have a recent affiliation under NISH, National Industries for the Severely
Disabled. NISH, a national nonprofit agency, has the mission to create employment opportunities for
people 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 the
name AbilityOne.

Veterans -Target Population: We deliver an array of services that is already suitable or can be
modified to serve veterans. The most vulnerable – those who are service-disabled – are at the top of
our priorities. Among veterans who may be eligible for services, we are particularly concerned about
these 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.

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There are undoubtedly other veterans who may benefit; this describes our internal leadership
assessment (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 is
associated with all wars, not only Iraq and Afghanistan. For veterans of the Persian Gulf War, it is
estimated to be 9%-24%. 12 The criteria to diagnose PTSD changed on July 16, 2010. Mentally
traumatized veterans will no longer face the need to prove a stressor in the war zone. A diagnosis
from a mental health specialist in the veteran’s system and presence in a war zone is sufficient. This
change may result in more veterans initially diagnosed with PTSD and through the review of cases
that were previously denied.

VIII. Projected Increase in Disability Claims

The VA system is already stressed by claims. There has been a steady increase in VA’s pending
claim backlog since the end of FY 2004 when there were 321,458 rating cases pending. In its
most recent “Monday Morning Report”, the VA indicates there are 566,151 claims pending and
211,953 pending over 125 days or 37.4 percent. There have been promises and plans to remedy the
situation but claims continue to flood the VA offices.

PROJECTED INCREASE IN DISABILITY CLAIMS (MODERATE SCENARIO) 13

Disability 2006 2007 2008 2009 2010 2011 2012
Benefits

Discharged 118758 118758 118758 118758 118758 118758
Cumulative 118758 237517 356275 475034 593792 712551
Eligible
Claimants
Existing 526355 52655 526355 526355 526355 526355 526355
discharged
non claimants
Newly 118758 237517 356275 475034 593792 712551
discharged
Total potential 645113 763,872 882,630 1,001,389 1,120,147 1,238,906
new
Claim rate
New claims 22% 22% 22% 27% 33% 35% 44%

Current 104819 104819 104819 104819 104819 104819 104819
benefiaries
Total Claims 104819 245131 312497 392777 485973 592083 643743
(number)
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“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 to
inaccuracies, precedes current operations in Iraq and Afghanistan, despite recommendations for
structural changes. 14 “Rating” dominates the process: in June 6, 2009, there were 722,901 claims
pending 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 with
service-connected disabilities endure in their pursuit of services, including vocational rehabilitation
Chapter 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. 16

Stigma, 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 determine

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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 and
Recommends 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 significant

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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.

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XII. Solution: Vocational Assessments, Pilot Project, Camden and Gloucester County
VHMC

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 vulnerable
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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.

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Endnotes and other references

1
Title 38, Code of Federal Regulations, Chapter 31. A service-connected disability is condition that has
resulted from or was aggravated by an injury or illness while the veteran was serving on active duty in the
military. § 21.40 Basic entitlement to vocational rehabilitation benefits and services. An individual meets
the basic entitlement criteria for vocational rehabilitation benefits and services under this subpart if VA
determines that he or she meets the requirements of paragraph (a), (b), (c), or (d) of this section. For
other requirements affecting the provision of vocational rehabilitation benefits and services, see §§21.41
through 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, Coordinator
Specialist in Veterans Policy January 13, 2010
2
Hall Calls For VA and DoD to Better Track Promising Programs
VA Fails to Monitor Timelines on Pre-Discharge Claims Processing February 26, 2010
3
Federal Register 3163-3165 (3 page), January 21, 2010, as it affects 38CFR21
4
Strict Deadlines, Disabled Veterans and Dismissed Cases, Adam Liptak, NYT, April 5, 2010.
http://www.nytimes.com/2010/04/06/us/06bar.html
5
CRS Issue Statement on Veterans Benefits. Sidath Viranga Panangala, Coordinator Specialist in Veterans
Policy, January 13, 2010.
6
Veterans Affairs: Benefits for Service-Connected Disabilities. Douglas Reid Weimer Legislative Attorney
American 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, Christine
Scott 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 Abt
Associates Inc. 4550 Montgomery Avenue Suite 800 North Bethesda, MD 20814-3343 The 2007 Veterans
Employability Research Survey (VERS) was conducted to determine the factors that impact veterans'
employability resulting from participation in the VR&E Program. The study consists of a nationally
representative survey of veterans who have applied to the VR&E Program, but who discontinued the
program at various points as well as a comparison group of veterans who have completed the program.
9
Veterans Disability Benefits Commission 2007 Established Pursuant
http://search.yahoo.com/r/_ylt=A0oG7iLwLDhOcQ4ASFhXNyoA;_ylu=X3oDMTEybmhpMTdlBHNlYwNzcgR
wb3MDNARjb2xvA2FjMgR2dGlkA0RGRDVfODY-
/SIG=12l7to5h3/EXP=1312325968/**http%3a//www.scribd.com/doc/42087220/FinalReport10-11-07-
Compressed to Public Law 108-136
10
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 Veterans
Universe: Civilian population 18 years and over

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20

Data Set: 2006-2008 American Community Survey 3-Year Estimates
Survey: American Community Survey, Puerto Rico Community Survey
12
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 Of
Providing Veterans Medical Care and Disability Benefits.” Linda Bilmes
John F. Kennedy School of Government - Harvard University
January 2007
14
Veterans Benefits: Further Changes in VBA’s Field Office Structure could help improve disability

claims processing”, GAO-06-149, December 2005
15
Repeated OEF and OIF deployments may adversely affect the military readiness of New Jersey National
Guard combat soldiers. “Effects of repeated deployment to Iraq and Afghanistan on the health of New
Jersey 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 2010
16
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
same

Other references include multiple reports General Accounting Office, Inspector General Congressional
Research Service, Journal of the American Medical Association, VA publications, including primary care
physician instructions re exam and queries re PTSD, evaluation forms. Journal articles, including Military
deployment to the Gulf War as a risk factor for psychiatric illness among US troops NANCY FIEDLER, PhD
Department of Environmental and Occupational Medicine, University of Medicine and Dentistry of New
Jersey (UMDNJ) and Robert Wood Johnson Medical School (RWJMS), Piscataway, New Jersey, USA.

In addition, Harvard University public finance, Kennedy School of Government; Portland Oregon University
PTSD, UMDNJ reports, US Census, American Community Survey data is referenced. Statements in this
proposal supported as cited. If there are errors or incomplete information, full citations will be provided
upon request.

SNJ Veterans@Home

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