Testimony On Improving Outcomes for Servicemembers and Veterans

Testimony of: Nicholas J. Armstrong, Ph.D. Managing Director, Research and Data Institute for Veterans and Military Families Syracuse University

Before the: U.S. Senate Committee on Veterans’ Affairs Hearing on VA and DoD Collaboration: Improving Outcomes for Servicemembers and Veterans

November 3, 2021


Mr. Chairman, Ranking member, Members of the committee. I’d like to thank you for the opportunity to testify on the topic of improving the collaboration between the Departments of Defense (DoD) and Veterans Affairs (VA) for the purposes of improving the military-to-civilian transition.

My name is Nick Armstrong. I served eight years in the U.S. Army, including nearly three years deployed in Iraq, Afghanistan, and Bosnia with the 10th Mountain Division. After transitioning out, I attended Syracuse University as the University’s first Post-9/11 GI Bill recipient, where I eventually earned my PhD. Today, over a decade later, I am still at Syracuse University, serving as the Managing Director of Research and Data for the Institute for Veterans and Military Families (IVMF).

All this is to say, I understand the military-to-civilian transition, not only because I study it every day, but also because I lived it. I know firsthand how critical it is we as a nation “get transition right” for our service members and their families. Therefore, I’d like to start with a statistic. In 2018, the combined funding from the DoD, VA, Labor, and Small Business Administration devoted specifically to the Transition Assistance Program and its associated transition supports was approximately $182 million. With approximately 200,000 members separating from active service each year (excluding transition made by members of the guard and reserves), this equates to an investment of $910 per transitioning service member on the part of government, directed toward supporting a robust and successful transition to civilian life.

I say again: $910 worth of transition support per exiting service member. The contrast seems stark compared to the tens of thousands it costs to recruit and screen basic trainees, and the over $200 billion spent annually on post-service health, wellness, and benefit programs. It’s stark considering that research consistently shows a strong connection between a positive transition experience and better health and well-being outcomes later in life. The opposite is also true. A negative transition experience can linger for decades, sometimes spiraling into the most devastating outcomes such as homelessness or suicide. Even VA researchers have coined the initial period after separation as “the deadly gap” when transitioning veterans are more likely to die by suicide than others.

To improve the veteran’s transition experience, the DoD and VA must further integrate their efforts. However, this task is bigger than the VA or DoD alone, in fact it is bigger than the entirety of the federal government. Supporting military-to-civilian transition is a whole-of-the- nation task—one that government must lead, and in close partnership with the nonprofit and private sectors.

In recent years, this committee and those that serve in the VA and DoD have made great progress. Last year marked historic legislative achievements. Legislation like the Hannon Act and the Phil Roe and Johnny Isakson Veterans Healthcare and Benefits Improvement Act have the potential to significantly improve the way that the DoD and VA support the military-to- civilian transition. I want to thank you for passing this legislation, and for all the work this committee, the VA, and DoD are doing to ensure implementation of this legislation is both effective and timely.

My testimony will focus on three major recommendations for how DoD, the VA, and other key players can improve the way they work to improve military transition policy and service delivery.

First, I will call for legislation to institutionalize a National Veterans Strategy and expanded interagency process to spur broader collaboration from the VA and DoD to other key agencies, states, and the private and nonprofit sectors. The Joint Executive Committee (JEC) and Joining Forces Initiative provide good blueprints. These efforts, however, cannot wax and wane across administrations. Rather, there is an opportunity to reimagine how we might better align public and private sector resources supporting veterans—the Sea of Goodwill—within a whole-of- government framework that is codified in statute.

Second, we must find ways to expand collaboration and integration between VA medical centers and DoD installations, and between those entities and the communities where they reside. No matter who collaborates in Washington, service members, veterans, and their families engage services in their communities where they live, work, and raise families. Today, the VA and DoD have the opportunity to improve the way they integrate their work with the communities where they reside.

Finally, the DoD and VA must be empowered and resourced to expand and enhance credentialing and career training services for both transitioning service members and their spouses. Currently, both the DoD and VA operate some form of job training programs for this population, but research increasingly shows, many of the most valuable programs are those being delivered by the nonprofit sector informed by the changing needs of industry. This represents another opportunity for the VA and DoD to lean more on the nonprofit and private sector to deliver these services. Without collaboration with nonprofits and significant public- private partnerships, the DoD and VA may continue to duplicate services and undercut emerging innovations.

The future of our all-volunteer force depends on it. Today, one-third of 17-to-24 year old adults are unfit to serve in the military, less than 15 percent of young adults even want to serve, and now 79 percent of U.S. Army recruits come from a military family. If our all-volunteer force is to continue, it requires us to direct our limited resources—public and private—smartly on the military-to-civilian transition. The imperative is not only a moral obligation, but one of national security.

A National Veterans Strategy and Expanded Interagency Process

Why A National Veterans Strategy?

Eight years ago, IVMF published a research-based report outlining the economic, social, and national security imperatives for a National Veterans Strategy. These arguments still hold as firm today as they did then. And how we as a nation support the military-to-civilian transition provides the perfect use case.

Ultimately, service members transition to their local communities upon separation, not simply from one government agency to another. In some instances, those in transition may engage supportive services from a host of public, private, and social sector organizations. In other cases, they engage with few or none at all, and for some, with adverse consequences. It follows that the military-to-civilian transition requires DoD and VA coordination, yet it goes beyond their sole responsibility and reach. In other words, DoD and VA coordination is without question necessary, but still insufficient by itself to fully reintegrate service members back in civilian life.

Despite the noteworthy progress that has been made to TAP over the last decade, and recent suicide prevention legislation, the scope of challenges facing veterans and their families has fostered duplication of effort and a confusing marketplace. For example, last year the GAO documented 45 programs across the federal government delivered by 11 different agencies supporting the employment transitions of service members and veterans. Many of these lack robust monitoring and evaluation, and several had no defined goals or outcomes whatsoever. We should note that the GAO report only covered federal government programs. There are literally hundreds of nonprofit and private sector led career preparation and training programs operating under the DoD SkillBridge authority and several operating at a national scale—with measurable outcomes.

Furthermore, we’ve learned that enduring interagency coordination typically requires not only sustained leadership from the highest level, the White House, but also Congressional authorization and funding to last. Consider the Veterans Employment Initiative (VEI) that was established by executive order under President Obama in 2009 to expand employment opportunities for veterans in the federal government. In our assessment of this initiative for the Office of Personnel Management, we learned that executive orders might spur short-term interagency collaboration but lack the authority to sustain long-term inter-agency work. Over time, progress toward achieving VEI goals waned due to inconsistent participation by senior officials.

Challenges with inconsistent leadership representation have affected the JEC in the past as well. In another case study on enterprise government, we found that the JEC has at times lacked the necessary representative authority required to drive cross-agency policy implementation forward. For it to work well, both agencies must continue sending senior representatives with sufficient decision-making authority.

All this to drive home the point that we need not simply a two-agency centric, but rather an enduring whole-of-government strategy and process. One that can set priorities, allocate resources, and synchronize effort across the federal enterprise. One that aligns federal efforts with state and local government and the private and nonprofit sectors to optimize impact. And one that can endure across administrations.

How Would a National Veterans Strategy Work?

Today, a blueprint for this process exists in the form of the Joining Forces initiative in the White House. Recently, Joining Forces released a report laying out a series of government-wide goals with specific action items for federal agencies beyond DoD and VA. In the introduction to the report, President Biden touches on a number of key points to include the need for a government-wide strategy, and the commitment of multiple agencies. It’s clear that the Administration recognizes this need and is taking substantive steps to make supporting the transition experience a whole-of-government effort.

However, Joining Forces is one initiative of one administration. We can no longer afford interagency collaboration only when the sitting administration recognizes a need for it. Past interagency efforts have come and gone under changing administrations. Congress should take action to institutionalize an interagency process like Joining Forces through legislation, giving this process the authority and budget to affect lasting positive change on the transition experience of service members and their families. This process can build off both Joining Forces and the current JEC process but should include broader representation of senior administration leadership from all agencies with a stake in supporting military-to-civilian transition, and leadership directly from the White House.

Perhaps most importantly, this process must also include the nonprofit and private sectors in its makeup. Too often, government acts as if it is the sole service provider in the transition policy space, when realistically, it is one of tens of thousands of providers that veterans and their families interact with daily. In a society with an all-volunteer force, it is the responsibility of our national community to support transition, both as our moral obligation and to sustain our own security. We should look to the UK model, and their Armed Forces Covenant, which not only sets a government-wide strategy, but thoroughly includes the nonprofit and private sector as a part of that strategy.

Better transition and veteran policy requires engagement with employers and nonprofit providers in communities where veterans are accessing services. Otherwise, government risks failing to capture innovation, further duplicating effort, or worse, disadvantaging veterans by delivering programs misaligned with the rapidly evolving needs of employers and the broader economy.

Finally, as currently constructed, interagency processes make it nearly impossible to evaluate our transition programming effectively. Last year, Congress passed legislation that commissioned a longitudinal study and expanded interagency data sharing between agencies to evaluate TAP. But evaluating TAP and other transition programs should not always require an act of Congress. Instead, interagency program evaluation must be a continuous part of our service delivery efforts.

One component of a national veterans strategy should involve implementing a unified framework for program evaluation to know how well programs are performing, how they might improve, and how they are serving the unique needs of specific subpopulations. The Joining Forces report rightly calls this out as a primary goal. However, these efforts for interagency program evaluation and data sharing must endure well beyond the Biden Administration. The efforts carried out by Joining Forces in the coming years must be made a regular practice across the federal government for veteran and military transition policy.

Enhance Collaboration Between DoD, VA, and Communities

Why does VA and DoD need to focus on Community Collaboration?

Today, through our AmericaServes initiative, the IVMF works closely with nonprofit providers, local government agencies, and in several locations, even VA facilities and DoD installations. Through this effort we’ve helped more than a dozen communities bring together available health and social services into an integrated system of care, with a single point of entry for veterans, transitioning service members, and their families seeking services.

One key observation from our work is that effective collaboration with VA Medical Centers (VAMC) and DoD installations are almost entirely a function of local leadership. This works well in some communities where VAMC and installation leadership are open to collaboration with local nonprofit providers in their community.

In Pittsburgh, for example, the VAMC is an active participant within the broader care coordination network. Veterans accessing medical care at the Pittsburgh VA can be electronically referred out to other human and social service providers to address social needs such as employment, legal, and housing—and vice versa. This is not always the norm. Not all VAMCs participate in our networks, when those networks represent an excellent opportunity to connect with newly transitioned veterans not yet enrolled in VA Health Care. At the same time, many beneficiaries of VA Health Care are potentially missing out on needed social services to complement their medical care.

The same is true for the Veterans Benefits Administration. Veteran Service Organizations (VSOs) can help veterans understand what benefits they’re eligible for, then directly access those benefits. This requires benefits advisors to not only help veterans obtain financial benefits but work collaboratively with local nonprofit providers in the community that can meet other immediate needs of the veteran and their family.

The VA should study barriers and opportunities to work with social service providers and integrate health and social care in communities. This is because emerging research suggests hospitals must become better integrated with the network of social service providers in communities, to ensure the whole spectrum of social determinants of health are addressed, and to prevent downstream negative outcomes that have both human and financial cost.

One study assessed the role of Area Agencies on Aging (AAA) in integrating the delivery of health and social services for the elderly. Researchers looked at counties where AAAs (which provide many social services to elderly people) partnered with local hospitals. Partnerships between hospitals and these social service providers were associated with a $136 decrease in Medicare spending per beneficiary annually. As poor mental health was associated with higher healthcare spending as a whole, this decrease in spending per beneficiary may represent better mental and physical health, in part driven by better collaboration between the health and social sectors. Further, partnerships between AAAs and hospitals were associated with a 0.5 percentage point drop in avoidable nursing home use.

It is important to note that necessary research like the study described above requires the sharing of data between healthcare entities, community providers, and research and evaluation partners. The VA should expand the way it partners with universities and local nonprofits that have valuable data on the wellbeing of veterans not captured through the VA’s healthcare system. In order to understand the social determinants of veteran health, the VA will need to expand its sources of data and evidence.

One example of this work is an initiative between the IVMF and VA’s Center for Health Equity Research and Promotion (CHERP), also based in Pittsburgh. Sharing data between the VA and the IVMF’s AmericaServes program allows researchers to better understand how the social determinants of health affect veterans’ overall wellbeing. More initiatives like this are needed.

How do we integrate VA and DoD Efforts into Communities?

This research speaks to both the improvement in health outcomes and the financial cost savings that can come from these partnerships. Medicare and Medicaid are now aware of this opportunity and are using a variety of pilot programs to encourage collaboration between participating health providers and nonprofits. The VA has similar power with the network of VAMCs across the country. Pushing VAMCs to collaborate with local community providers to coordinate health and social services is not only consistent with the behavior of the other major U.S. healthcare providers, but also supported by research.

Currently, in our network in greater Pittsburgh, the IVMF is trying to understand how social and health services can interact and support each other. With IVMF support, the PAServes network and the Allegheny County Department of Human Services are now actively sharing utilization data to evaluate how veteran clients are navigating between county and nonprofit health and social services.

By the same token, DoD has to do more to coordinate services for military families before and during transition with community providers near installations. This means better connectivity between the services and the communities where service members are transitioning to and from. This is a recommendation that comes from a National Academy of Sciences report commissioned by the DoD, which calls for greater coordination of services for the military family unit, particularly at the point of transition. This includes working with local VAMCs, helping families stay connected with health resources in communities, but also with nonprofit providers. In our AmericaServes networks, on the occasions where military installation services worked with our community hubs, their ability to support service members and their families during transition is significantly enhanced. These partnerships allow installations to connect service members and their families with services that not only support their needs but help them acclimate to their community.

There are existing examples of successful programs trying to bridge this gap, and these programs deserve attention and resources. For example, the ETS sponsorship program represents one of the first programs that meaningfully connects a separating servicemember at their final duty station with a VA-trained sponsor embedded in the community they transition to. These ETS sponsors support the service member by connecting them with local VA and community resources upon arriving. The IVMF is formally collaborating with VA researchers in an ongoing pilot program evaluation of the ETS Sponsorship program in Texas. Fully integrated programs like these that pull together DoD, VA, and local community partners, are the future of transition support.

Expand Credentialing and Job Training Offerings Through Public-Private Partnerships

At the center of a successful military-to-civilian transition is a successful career transition. Ensuring that both transitioning service members and their spouses find meaningful careers after service is a fundamental building block of post-service well-being for decades to come. A quality job provides purpose, identity, and the financial means for the veteran family to address their needs and thrive.

For this reason, six years ago the IVMF launched the Onward to Opportunity program, now the largest career skills program operating under the DoD SkillBridge Authority. Onward to Opportunity provides career exploration curriculum, employment skills, and access to industry- recognized certifications to 11,000 transitioning service members, veterans, and spouses every year—at no cost. The program operates on 19 military installations across the country and provides virtual training to participants in all 50 states.

Today, demand for programs like Onward to Opportunity outpace the capacity of nonprofits to supply them. Two major barriers exist preventing programs like Onward to Opportunity from providing full services to everyone that requires them. First, collaboration between DoD installations and nonprofits depends greatly on installation command leadership. This leads to inequities in who has easiest access to programs like Onward to Opportunity. Transitioning service members separating from installations without a presence of career skills program providers may interact with a less robust set of transition supports.

In addition, new research suggests lack of access to these types of programs can impact the employment outcomes of transitioning service members. According to the Veterans Metrics Initiative, service members who utilized credentialing and job training programs during transition were nearly twice as likely to find a job than those who did not.

Credentials are the worker’s currency in the modern-day economy. Our efforts must be focused on helping transitioning service members and spouses gain credentials that, when matched with their military experience, make them competitive in the modern-day job market. However, DoD and VA must do more to support the efforts of nonprofit providers already delivering these programs. In particular, the VA greatly expanded its job training offerings in the past year following the pandemic. However, government should not be delivering these programs alone, instead entering into public-private partnerships with successful nonprofit providers already doing so.

Relatedly, the second major barrier facing many nonprofits providing these services is financial sustainability. To this point, private philanthropy funded many of the initiatives supporting the career transitions of service members. As a result, programs like Onward to Opportunity had to develop robust program evaluation and measurement capabilities to meet the demands of private philanthropic funders. Nonprofit programs that can provide evidence of their success are a worthy recipient of DoD and VA investment. As noted above, there are currently 45 different programs aimed at supporting the career transition of service members across the federal government, many of which lack robust outcome measures and program evaluation, and some that offer duplicative services. Before starting any new federal employment programs for transitioning service members, DoD and VA must conduct a coordinated assessment of the existing programs and make honest determinations about where funds might be better spent in partnership with the public sector as opposed to direct government service delivery.

Last year, Congress passed legislation to create a VA transition grants program, sending dollars to community-based organizations supporting transition. This is an excellent first step and Congress should ensure the swift and effective implementation of these grants. However, DoD must be financially and programmatically involved in these partnerships as well. Not only is it a moral imperative that DoD ensure their service members are equipped for post-service careers, but it is also good financial policy. The most recent available data suggests DoD spends more on unemployment insurance claims for unemployed transitioning service members (about $300 million) than it does on all of its career transition programs (this also impacts readiness and national security). New legislation like the Onward to Opportunity Act doubles down on the commitment of the VA’s transition grants and brings DoD to the table as financially invested in this effort.

Conclusion

Serving the veterans of tomorrow requires us to improve the transition process today. Ensuring an all-volunteer force for our nation’s future requires us to set transitioning service members and veterans up for success in the present. Action is required, and success in our reach.

Ultimately, DoD and VA collaboration will only improve with a permanent, congressionally mandated interagency process broader than these two agencies alone. With backing from Congress, and leadership from the White House, an interagency council positioned to bring all the resources and power of the federal government to bear against the challenges faced by transitioning service members and their families is the only way forward.

For those who have worn the uniform in our nation’s defense, a happy and thriving post-service life is possible. But it depends on our ability to ensure their transition from military-to-civilian life goes smoothly, setting them up for decades of success. This depends not only on the collaboration of DoD and VA, but on the collaboration of every federal agency, and the nonprofit sector as well.

Thank you.

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