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Hearing Transcript on Findings of the Veterans' Disability Benefits Commission.

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FINDINGS OF THE VETERANS' DISABILITY BENEFITS COMMISSION

 



 HEARING

BEFORE  THE

COMMITTEE ON VETERANS' AFFAIRS

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

FIRST SESSION


OCTOBER 10, 2007


SERIAL No. 110-52


Printed for the use of the Committee on Veterans' Affairs

 

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COMMITTEE ON VETERANS' AFFAIRS

BOB FILNER, California, Chairman

 

CORRINE BROWN, Florida
VIC SNYDER, Arkansas
MICHAEL H. MICHAUD, Maine
STEPHANIE HERSETH SANDLIN, South Dakota
HARRY E. MITCHELL, Arizona
JOHN J. HALL, New York
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
SHELLEY BERKLEY, Nevada
JOHN T. SALAZAR, Colorado
CIRO D. RODRIGUEZ, Texas
JOE DONNELLY, Indiana
JERRY MCNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota

STEVE BUYER,  Indiana, Ranking
CLIFF STEARNS, Florida
JERRY MORAN, Kansas
RICHARD H. BAKER, Louisiana
HENRY E. BROWN, JR., South Carolina
JEFF MILLER, Florida
JOHN BOOZMAN, Arkansas
GINNY BROWN-WAITE, Florida
MICHAEL R. TURNER, Ohio
BRIAN P. BILBRAY, California
DOUG LAMBORN, Colorado
GUS M. BILIRAKIS, Florida
VERN BUCHANAN, Florida

 

 

 

 

Malcom A. Shorter, Staff Director


Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined.

 

       

C O N T E N T S
October 10, 2007


Findings of the Veterans' Disability Benefits Commission

OPENING STATEMENTS

Chairman Bob Filner
    Prepared statement of Chairman Filner
Hon. Steve Buyer, Ranking Republican Member
    Prepared statement of Congressman Buyer
Hon. Stephanie Herseth Sandlin, prepared statement of
Hon. Ginny Brown-Waite, prepared statement of
Hon. John T. Salazar, prepared statement of
Hon. John Boozman, prepared statement of


WITNESSES

Veterans' Disability Benefits Commission, Lieutenant General James Terry Scott, USA (Ret.), Chairman
    Prepared statement of General Scott


SUBMISSIONS FOR THE RECORD

Lamborn, Hon. Doug, a Representative in Congress from the State of Colorado, statement
Miller, Hon. Jeff, a Representative in Congress from the State of Florida, statement
Mitchell, Hon. Harry E., a Representative in Congress from the State of Arizona, statement


MATERIAL SUBMITTED FOR THE RECORD

Post Hearing Questions and Responses for the Record:

Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to LTG James Terry Scott, USA (Ret.), Chairman, Veterans' Disability Benefits Commission, letter dated October 16, 2007


FINDINGS OF THE VETERANS' DISABILITY BENEFITS COMMISSION


Wednesday, October 10, 2007
U. S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.

The Committee met, pursuant to notice, at 10:02 a.m., in Room 334, Cannon House Office Building, Hon. Bob Filner [Chairman of the Committee] presiding.

Present:  Representatives Filner, Brown of Florida, Snyder, Michaud, Herseth Sandlin, Hall, Hare, Berkley, Salazar, Rodriguez, Donnelly, McNerney, Space, Walz, Buyer, Moran, Brown of South Carolina, Boozman, Brown-Waite, Bilbray, and Bilirakis.

OPENING STATEMENT OF CHAIRMAN FILNER

The CHAIRMAN.  Good morning.  I call to order this meeting of the House Committee on Veterans' Affairs.  We have an especially important, helpful, and I hope productive hearing with the members of the Veterans' Disability Benefits Commission chaired by Lieutenant General James Terry Scott.

We thank all of you for joining us today, and we want to thank the Commission for its work for over two years. Chairman Scott was telling me that you would meet for several days each month and more frequently in recent months.  So it has been a big commitment and we thank all of you for that and trying to draw together a mass of information to help us improve this system.

We thank you for the report that you have produced and are glad that you felt this call to duty. You met many, many times with all of the stakeholders and I think that you have tried to fashion a report that honors the sacrifices that our men and women in uniform have made.

The Veterans' Disability Benefits Commission was established by the National Defense Authorization Act of 2004 out of recognition of the impact that the current conflicts of Operating Enduring Freedom (OEF) and Operating Iraqi Freedom (OIF) would have on our resources in both the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD).

It was our hope, and I think you have met that hope, that you would provide recommendations to increase the efficiency and effectiveness of providing benefits and services to our veterans, their dependents, and survivors in a manner that reflects the dignity of their service.

Your report became even more relevant once the conditions at Walter Reed were reported and people became very knowledgeable of some of the defects of our system, especially the growing backlog of the claims at the VA.  And you address this in a very timely manner as it turns out because the Nation is focused on these issues.

Just as we did in the 1990s when Congress, the Administration, veterans service organizations (VSOs), and stakeholders partnered to place greater emphasis on turning the Veterans Health Administration (VHA) into a world-class, technologically adept entity, I think your report tells us that we must devote the same resources and brain power to turning around the Veterans Benefits Administration (VBA) to become a world-class, technologically adept, 21st century organization.

So I look forward to working with you and your Commission and the VA to make that a reality because we have to do this.

As you point out, as we continue to give full resources to the war, let us not forget the warrior and the warrior's family.  Our men and women should not only get first-class weapons to fight and receive third-class benefits after fighting, we must make them all first class.

We all know about the claims backlog, whether from the regional offices or the Board of Veterans' Appeals or the U.S. Court of Appeals for Veterans Claims, have become intolerable, leading to long waiting times, and unmanageable, frankly, given the funding shortfalls that have been apparent over the last decade.

But I think we have a system that could be improved as you point out, and the employees and dedicated people who work for the VA will be able to achieve what you want with additional resources and the changes.

The Veterans Benefits Administration, on their web site and in their training, I assume, talk about a covenant that they make, a covenant that says we are the leaders in one of our Nation's most vital and idealistic service organizations.  Because we serve veterans and their dependents, our mission is sacred.

And it quotes both President Lincoln and General Omar Bradley, words that many of us have come to know.  Of course, Lincoln's famous phrase, "To care for him who shall have borne the battle and for his widow and his orphan."  General Bradley in 1947 said, "We are dealing with veterans, not procedures, with their problems, not ours."

And that covenant further states as we carry out this mission, we willfully enter into a covenant with one another to always be guided by the fundamental principles of accountability, integrity, and professionalism.  These principles form the foundation of leadership and service to America's veterans.  That is what the VBA says is its covenant.

So we want to extend that covenant, devote all our resources, brain power, and willpower, man and woman power to improve the current system of delivery of benefits so we optimize the outcomes for everyone.

We have the privilege to be able to serve our veterans and their families.  You have honored them with your long study, and I think you have given us a lot of work to do to follow-up. We will give you all the time you need to explain what you have done and if you would like to introduce and call on any of the Commission members.

Mr. Buyer, I would recognize you for an opening statement.

[The statement of Chairman Filner appears in the Appendix.]

OPENING STATEMENT OF HON. STEVE BUYER, RANKING REPUBLICAN MEMBER

Mr. BUYER.  Thank you very much.

General Scott, thank you for being here and congratulations to you and to your Commissioners who are also here with you.  I consider you and your Commissioners patriots and nobles.  You have taken on a great cause on behalf of Congress to look at these issues that best affect America's most sacred asset, those men and women who put on the uniform and are somehow hurt, harmed or injured in some way, whether it be in the workplace, during peace, or in combat operations.

Let us also never forget the families, the ones who kept the watch fires burning, and their children.  And that is why we have looked to you on what upgrades, if necessary, must be done. 

So I commend all of you for your dedication and your work over the past two and a half years.  Your efforts required many long hours discussing these issues in meetings and pouring over an array of complex materials to arrive at the recommendations you have presented to us.

I heartily agree with the eight guiding principles that you identified.  These principles provide a sound basis for considering any recommendations for improvement to veterans' benefits.  Clearly you and your fellow Commissioners share my sentiments that veterans, the men and women of the Armed Forces, are among our Nation's most finest citizens.

We are in a long war against global terrorism.  The enemy we encounter has its sights set on objectives it hopes to accomplish for many years from now.  It is our grandchildren they also plan to oppress.  We have no choice but to engage those who despise free will and wish to destroy us and the freedom we cherish. 

It is imperative that we maintain a military that is capable of swift response and world-wide theater operations.  To do so, we must continue to attract the caliber of people our military has now, and those who must serve should be confident that they and their families will be cared for should harm come their way.

Early during the initial review of your report, I could see the Commission understood this fact very well.  The Commission wisely focused on the veterans' long-term issues such as the need to revamp the disability, retirement, and compensation systems. 

It has been my long-standing view that we must modernize the VA and establish a transition process that is seamless in its efficiencies between DoD and VA.  The Commission's report, along with the recommendations of the Dole-Shalala Task Force, is a big step toward attaining this goal.

So I look forward to hearing your testimony.  We will carefully consider all the Commission's recommendations and hopefully use those we determine are most beneficial as a guide to meaningful and long-term policies to improve the lives of veterans and their families.

Mr. Chairman, I suggest this Committee consider the Commission's priority recommendations first and those that are determined to be meritorious should receive prompt legislative action.

Also, Mr. Chairman, along with the recommendations from the Dole-Shalala Task Force, there appear to be potential PAYGO issues as we consider the Commission's recommendations.  While we may not have to grapple with these questions today, we must be mindful of them.  As Congress and the Administration move forward, we must deal with the funding issues that pertain to these recommendations.

I also have one last bit of housework and a friendly recommendation to the Chairman.  You have had some very good hearings here over the summer and we have been holding these hearings on Wednesday at ten o'clock.  This is a Committee and many of us have a lot of issues going on in a lot of different committees.  My recommendation to the Chairman is to hold a hearing like this at ten a.m. on Thursday so that these hearings could be better attended by the members.  And that is my friendly recommendation to you.

And I thank you and I yield back the time.

The CHAIRMAN.  Thank you, Mr. Buyer.  I always welcome friendly recommendations.  I would just amend one part of your statement.  We are an A+ Committee, not a C Committee. 

I understand what you meant in terms of scheduling, but most of us are here because we think, excluding yourself, it is such an important Committee.  But we will look at the scheduling issues that you have raised.

General Scott, thank you again for being with us and you have the floor.  And if you would maybe introduce some of your Commission members who are with us today so we can thank them also.

STATEMENT OF  LIEUTENANT GENERAL JAMES TERRY SCOTT, USA (RET.), CHAIRMAN, VETERANS' DISABILITY BENEFITS COMMISSION; ACCOMPANIED BY RAY WILBURN, EXECUTIVE DIRECTOR, VETERANS' DISABILITY BENEFITS COMMISSION

General SCOTT.  Chairman Filner, Ranking Member Buyer—

The CHAIRMAN.  Make sure that microphone is on, please.

General SCOTT.  —it is my pleasure to be with you today.  And I will introduce the seven Commissioners that were able to be here, seven of the other twelve:  Commissioner Brown; Commissioner Joeckel; Commissioner Jordan; Commissioner Livingston; Commissioner Matz; Commissioner McGinn; and Commissioner Wynn.

As you stated, sir—

The CHAIRMAN.  We want to thank all of them, you know.  If you would just stand up so we can thank you, all of you.

[Applause.]

The CHAIRMAN.  By the way, I do not know if you were going to say it, but on your web site, amongst your members are two Congressional Medal of Honor recipients, two Distinguished Service Crosses, nine Silver Stars, six Distinguished Flying Crosses, five Bronze Stars for Valor, thirteen Purple Hearts, and eight Combat Infantry Badges or Combat Action Ribbons, so—

[Applause.]

The CHAIRMAN.  —it is obviously a very distinguished group.

General SCOTT.  Well, sir, as you mentioned, the Commission was established to study the benefits and services that are provided to compensate and assist veterans and their survivors for disabilities and deaths attributable to military service.

Specifically we were tasked to examine and make recommendations concerning the appropriateness of such benefits, the appropriateness of the level of such benefits, and the appropriate standard for determining whether a disability or death of a veteran should be compensated.

We conducted an extensive and comprehensive examination of the issues relating to veterans' disability benefits.  This is the first time that we know of that the subject has been studied in depth by an outside entity since the Bradley Commission in 1956.

We identified 31 issues for study.  We made every effort to ensure that our analysis was evidenced based and data driven.  And we engaged two well-known organizations to provide medical expertise and analysis, the Institute of Medicine (IOM) of the National Academies of Science and the Center for Naval Analyses (CNI) Corporation.  Both offered tremendous assistance to us, particularly the IOM in the fields of medicine for which the Commission members probably were less prepared than we could have been.

So we are offering 113 recommendations covering wide spectrums of veterans' disability benefits issues to ensure that the benefits fairly and uniformly compensate all service-disabled veterans and their families.

Some recommendations are inexpensive, some are not.  Some can be adopted by the VA and/or DoD.  Others will require involvement of the Department of Labor and the Social Security Administration.  Others will require legislation.

The Commission understands that not all recommendations can be adopted immediately.  We have identified 14 recommendations that in our judgment are higher priority.  We hope the Congress and the departments will carefully consider all recommendations, however.

Brief summary of our findings.  VA compensation currently paid to disabled veterans is generally adequate to offset average impairment of earnings.  A comparison with the earnings of veterans who are not service disabled demonstrated that disability causes lower earnings and employment levels at all levels of severity and all types of disabilities.

The amount of compensation is generally sufficient to offset loss of earnings except for three groups of veterans, those whose primary disability is PTSD or post traumatic stress disorder and other mental disorders, those who are severely disabled at a young age, and those who are granted maximum benefits because their disabilities make them unemployable.

The Commission particularly focused on the issues concerning the care for the severely injured such as amputees and those with a traumatic brain injury or TBI.  We have not demonstrated that we are prepared to provide adequate care and support for these veterans.

The families of the severely injured are assisting in the care and rehabilitation of these wounded warriors.  Some are sacrificing jobs, careers, homes, health insurance, and facing tremendous impact on their own health in order to support their injured family members.  We recommended that Congress should provide some healthcare and caregiver allowances for these families.

Quality of Life.  We believe that the level of compensation should be based on the severity of the disability and should make up for the average impairments of earnings capacity and the impact of the disability on functionality and quality of life.  It should not be based on whether it occurred during combat or combat training or on the geographic location of an injury or whether the disability occurred during wartime or a time of peace.

Current compensation payments do not provide a payment above that required to offset earnings loss.  Therefore, there is no current compensation for the impact of disability on the quality of life for most veterans.

While permanent quality of life measures are developed, studied, and implemented, we recommend that compensation payments be increased up to 25 percent with priority to the more seriously disabled.

The VA Rating Schedule.  The Commission concluded that the current VA schedule for rating disabilities which is used to evaluate veterans' severity of disability has not been adequately revised since 1945.  We recommend that the rating schedule be updated as soon as possible but certainly within the next five years.

As a matter of priority, this update must include specific criteria for the evaluation and rating of traumatic brain injury and all mental disorders.  The schedule should also be revised to account for new diagnostic classifications, new medical criteria, and medical advances.

In addition, VA should create a process for keeping the rating schedule up to date including publishing a time table and creating an Advisory Committee for revising the medical criteria for each body system.

Post Traumatic Stress Disorder.  The Commission believes that a holistic approach to PTSD should be established that couples compensation, treatment, and vocational assessment.  We also believe that reevaluation should occur every two to three years to gauge treatment effectiveness and to encourage wellness.

Individual Unemployability (IU).  Veterans with service-connected disabilities rated 60 percent or more but less than 100 percent and who are unable to work due to their disabilities can be granted what is known as individual unemployability and be paid at the 100 percent rate. 

The number of such veterans has increased by 90 percent over the past few years causing considerable attention.  Our analysis found that the increase is largely explained by the aging of the cohort of Vietnam veterans and the worsening of their service-connected disabilities.  As the rating schedule is revised, specific focus should be given to the criteria for PTSD and other mental disorders so that IU, individual unemployability, does not need to be awarded so frequently.  And I might add that the same goes for other disabilities.  We would hope that a revision of the rating schedule would dramatically decrease the requirement for individual unemployability.

Presumptions.  When there is evidence that a condition is experienced by a sufficient cohort of veterans, a presumption can be established so that it is presumed to be the result of military service.  This has been done for radiation exposure, Agent Orange defoliant in Vietnam, and other conditions.

The Commission asked IOM to review the existing process for making these decisions and IOM recommended a detailed, comprehensive, and transparent framework based on scientific principles.  Our Commission believes that this framework will improve the process.  We have some concern over the use of the term causal effect as the standard as opposed to the existing standard for association of effect.

I might add parenthetically that this was one of the finest reports that the IOM did for the Commission.  And if you have the opportunity to read just one of these other reports that were furnished by the CNAC or the IOM, I would recommend this report on presumptions.  Dr. Samet from Johns Hopkins chaired it and I think you will find it clear, lucid, and it helps get the medicine back into presumptions and the politics out of it.

Moving along, sir, Transition.  The Commission recommends a realignment of the DoD disability evaluation process used to separate retired servicemembers who are not fit for military duty.  The military services, Army, Navy, and Air Force, should determine whether a servicemember is fit for duty and VA should determine the level of disability of servicemembers who are found unfit for duty.  This will ensure equitable and consistent ratings.

We believe that DoD should also mandate that separation examinations be performed on all servicemembers to ensure that known conditions at the time of discharge are documented.

I might add, sir, that the Navy already does this.  And we strongly recommend that the other services do it because it gives you a book end.  There is an entry physical when a person comes on active duty and there should be an exit physical when they go off.  And it would make it tremendously easier to work the claims in the VA system if this data were available to the people that have to make the decisions.

Regarding concurrent receipt of military retirement and VA disability compensation, the Commission's study found these to be two different programs with entirely different missions.  DoD retirement recognizes years of service and VA disability payments compensate for impairment in earnings and should compensate for impact on quality of life.

Over time, Congress should eliminate the ban on concurrent receipt for all military retirees and for all servicemembers who are separated from the military due to service-connected disabilities.  Priorities should be given to veterans who separate or retire with less than 20 years of service and with a service-connected disability rating of 50 percent or greater or with a disability as a result of combat.

Payment offsets should also be eliminated for survivors of those who die in service or retirees who die of service-related causes so that these survivors can receive both VA dependency and indemnity compensation and DoD's survivor's benefit plan.

Compatible Electronic Information Systems.  VA and DoD should expedite their efforts to implement compatible electronic information systems.  We believe that this is one of the most important actions that can be taken.  Not only will this improve claims processing, but it will enhance the ability to share medical records and avoid some of the unfortunate cases that slip through the cracks during transition from DoD to VA.

Claims Processing.  We have devoted a significant amount of the report to claims processing.  I will just say here that we studied the existing processing system for disabled veterans and we are very disappointed by the burdensome bureaucracy and the delays that our veterans face.

Therefore, we recommend that VA establish a simplified and expedited process using best practices and maximum use of information technology to improve the claims cycle.

Again, sir, we talked in great deal about that in the body of the report.

So we generally agree with the advice recently presented by the Dole-Shalala Commission.  We differ on some small points.  We believe that all disabilities and injuries should be compensated based on the severity of the disability and naval to combat or combat-related injuries.

In conclusion, sir, the Commission believes that if our recommendations are implemented, a system for future generations of disabled veterans and their families will be established that will ensure seamless transition and improve their quality of life.  It is our hope that the President, the Congress, the VA, and the DoD take this opportunity to create a veterans disability benefits system that will adapt as the needs of future veterans change and grow.

Speaking on behalf of all the Commissioners, it has been an honor and a privilege to serve our current and future veterans through this effort.  And I would like to personally thank each member of the Commission and the Commission staff for their hard work and professionalism.

And, sir, I would be happy to take some questions.  I would ask that our executive summary be accepted into the record.  And I would also ask that the Executive Director of the study be allowed to join me at the table for the question session.

[The statement of General Scott appears in the Appendix. The Veterans' Disability Benefits Commission Report will be retained in the Committee files.  A copy of the report can be obtained from the Commission's website at http://www.vetscommission.org/pdf/FinalReport10-11-07-compressed.pdf .]

The CHAIRMAN.  Without objection, so ordered.  And if the Executive Director would come forward.

Again, thank you so much, General.  That was a very concise but important summary.

We will start comments with Ms. Brown from Florida.

Ms. BROWN OF FLORIDA.  Thank you, Mr. Chairman, and thank you for holding this hearing.

And thank you, General Scott, for your service to the country and your service on this Commission.

As you know, Congress established this Commission in 2004 when the war was still beginning and we did not know much about what would become the signature injury of the war in Iraq and Afghanistan—Traumatic Brain Injury. 

I appreciate the hard work you, your Commissioners and staff did to fulfill the requirement and mandates we gave you.

The very first of your priority recommendations states that the VA should immediately begin to update the current rating schedule.  Your investigation into the rating schedule seemed to indicate that it works generally well, except for the lack of responsiveness regarding PTSD and mental health.

While I am disappointed in this, I am not surprised, considering the lack of enthusiasm in the private healthcare insurance industry to fund mental health.

Reading over your recommendations, it seems as though the major need for Congress is to be involved in more funding.  You have my 100 percent support of it and I think most Members on this Committee would do the same.  Thank you for your work. 

And I guess my question is, many of your recommendations have been addressed by this Committee in one way or another over the past few years.  The President's Commission on Care for American Returning Wounded Warriors known as the Dole-Shalala Commission recommended many of the same things you have, only more concisely.

Do you have any thoughts, more detail that you want to go into, comparison of the reports and, you know, your recommendations in comparison to their recommendations?

General SCOTT.  Yes, ma'am.  And thank you for the question.

We reviewed three other Commissions that met essentially during this long time frame that our Commission was meeting.  We also provided raw data that our analysis was turning up as we went along to each of these Commissions that were meeting.

The Independent Review Group on Rehabilitative Care and Administration at Walter Reed and the National Naval Medical Center directed by the Secretary of Defense, the Task Force on Returning Global War on Terror  Heroes chaired by Secretary Nicholson, the Returning Wounded Warriors, the PCCWW also known as the Dole-Shalala Commission, and our own, and we did a side-by-side comparison of findings and recommendations.  And we found that in most areas, there was pretty much agreement on what should be done.  And as you mentioned, ma'am, some of these things have been around for a while.

Where I think we probably put a little more time into some of these areas, let me talk briefly.  Quality of life.  One of the things that we did, we had a survey done of disabled veterans to try to get some insight as to what the impact of their disabilities at different levels was on the quality of life. 

And because of the time that we had to do this, we were able to do these surveys and do some analysis that the other commissions were not, although the Bradley Commission and Dole-Shalala Commission both recommended that some accommodation be made for quality of life of the veterans.

We spent a good bit of time, and it is certainly in the big book, it is not in the summary, on vocational rehabilitation and employment (VR&E).  We think that that is an under-emphasized area.  It is quite obvious to all of us that the goal is to return the veteran to as near whole as can be done and reintegrate them into the society to the maximum extent it can be done.  And we think some emphasis on vocational rehabilitation and employment is probably needed in that regard.

I will not go into the line by line, but let me just say that in most areas, there was a concurrence among these reports. We did not look at Walter Reed.  It was not in our charter.  We did not look at the specifics of medical care for individual cases.  We looked at medical care as a very important veterans' disability benefit, but we did not get into it.

As the Chairman mentioned, you worked that pretty hard in years past, so we did not really get into it except to say that where the post traumatic stress disorder and other mental problems are concerned, we believe there should be more engagement by the medical profession and we believe that the clinicians who make these diagnoses, we need to be sure that they are trained and experienced in making these diagnoses.  And we are a little uneasy about the level of that expertise and experience among the clinicians that are making diagnoses.

Now, we also recommended that the adjudicators, the people that look at a claim and try to determine what is the level of disability, have access to medical expertise so that without having to send the whole paper file about that thick all the way back to the veterans' health side of it to get it reevaluated.  In other words, they should have some quick way of getting some medical advice to assist them in the adjudication.

And, again, that impacts in a very large way on this claims backlog and trying to make the system smoother and work more quickly to the advantage of the veteran.

Did I answer your question, ma'am?

Ms. BROWN OF FLORIDA.  Yes, sir.  And my time is up.  But can you say a word about the caregiver because I think it is such an important point that so many of the injured, when they go home, if it was not for the caregiver, they just cannot make it.  And we do not have a system in place to assist the caregiver in any way.

General SCOTT.  That is right, ma'am.  And we recommended that VA be authorized to provide family services and to extend healthcare and allowances to caregivers.

Another way of addressing that would be to eliminate the Survivor Benefit Plan/Dependency and Indemnity Compensation (SBP/DIC) offset and to allow pending claims and to eliminate the TRICARE co-pays and deductibles for the families of severely injured people.

So we have addressed that in several different places throughout the body of the report.  And I am hopeful that your staff can pull that together and make it into something that you find useful in trying to offer some relief to these families.

Ms. BROWN OF FLORIDA.  Thank you so much, General Scott.

I yield back the balance of my time.

The CHAIRMAN.  Is that side-by-side comparison included in the report or is that an additional thing that you can provide us?

General SCOTT.  It was hastily put together when it became apparent that I was not well enough versed on all the detail from the other commissions.

The CHAIRMAN.  If you can provide that to us, that would be wonderful.

General SCOTT.  We would be happy to provide it for the record.

[The Commission side-by-side comparison appears in Enclosure 1 in the post-hearing questions for the record, which appear in the Appendix.]

The CHAIRMAN.  Thank you.

Mr. Brown, you have the floor.

Mr. BROWN OF SOUTH CAROLINA.  Thank you, Mr. Chairman.

And I, too, would like to thank the members of this Commission and particularly, General Scott, for your involvement. 

And if I could have the liberty, Mr. Chairman, to say a few words about one of my constituents that is on the Commission, General James Livingston, who is one of the Medal of Honor recipients and also a great friend to the veterans.

And also in the audience is Mr. John Vogel.  John, would you stand up.  He is former Under Secretary and former Director of the VA Hospital in Charleston.  He is also a constituent of mine now.

But I really do appreciate the report and particularly one item I would like to expand upon is the H.R. 5089, General, which I have cosponsored for, I guess, about the last four years now trying to basically eliminate the survivor benefit offset.  And I appreciate you bringing that as part of your recommendation and we certainly will consider the other 112 recommendations you brought forward.  And thank you for your service and to all the other members of the Commission.

The CHAIRMAN.  Thank you, Mr. Brown.

Mr. Snyder?

Mr. SNYDER.  Thank you, Mr. Chairman.

Mr. Chairman and General Scott, I wanted to acknowledge Nick Bacon, who is not with us today from Arkansas, is one of the Medal of Honor recipients that was on the Commission.  And he is another example of a veteran who for the rest of his professional life has been working on issues involving veterans.

I also appreciate what you all have said about you think the benefits need to be based on the disability and not necessarily the geography or how they were caused.  Senator Dole and I had that discussion when he was here a week or two ago.  And I gave him an example of, you know, somebody, a painter at the Little Rock Air Force Base who falls off a ladder and suffers traumatic brain injury.  We would hate to have side-by-side two households of one family getting a whole different benefit because of how they were injured.  So I appreciate the position that you all have taken.

I want to ask two or three specific questions.  It has been several years, I do not remember, Mr. Buyer, if it was under your chairmanship, but we had a group of Iraqi veterans with fairly severe disabilities and one or two of them testified that they made the decision not to stay in the service even though they think that they—at least one of them thought he could have even though he had an artificial limb because of apprehension about subsequent loss of disability income if he stayed in the service.

Did you all address that issue or how did you address that issue?

General SCOTT.  My recollection is that we never really talked about the impact, the financial impact of someone who elected to stay in the service and, therefore, decided to forego VA compensation at that time.

But as you point out, sir, the advances in medicine and I would say advances in how the services view disabilities has led us to a position where we have a number of people who are staying in.

I am aware of two officers from Vietnam who lost a foot or a leg and who were allowed to stay on active duty and now it is a routine thing to evaluate what the person can do for us in the future and, if possible, retain him on active duty.

Mr. SNYDER.  I think your report deals with this issue of incentives or disincentives for getting better.

General SCOTT.  Right.

Mr. SNYDER.  And we would not want our incentive to be that you better get out of the service rather than try to stay in and finish your career even though you may have lost one or two or even three limbs or had severe injuries in other faculties.  If there is a way they can be accommodated to complete their military career, that may be an issue that we need to follow along as we make changes.

General SCOTT.  Sir, I think the issue in the servicemember's mind might be how will this affect my opportunity for promotion and future tenure.  If a person believes that he or she would be allowed to progress, then the financial incentive would be on the side of staying in the service, I would think.

Mr. SNYDER.  I wanted to ask a specific question.  I have not read the full report.  You have a very obviously thoughtful report.  You put a lot of time into it.  It is a very, very complex issue which is why this was set up.  I am on the House Armed Services Committee, why this Commission was set up.

Did you all come to any kind of ballpark annualized cost estimate if everything that you all recommended was implemented and you have recommended doing this over several years' time, let us suppose five years from now, or what the annualized, your rough estimate of what the cost would be in new dollars?

General SCOTT.  Well, for starts, we did, in fact, cost out the major recommendations—

Mr. SNYDER.  Right.

General SCOTT.  —using data from the Congressional Budget Office or from wherever it was available.  And I would be the first to say that they were ballpark figures.  In other words, I could not attest—

Mr. SNYDER.  No, no.  I understand.

General SCOTT.  —to the precise accuracy of them.  But in terms of the quality of life recommendations we made, we did a hypothetical that said that at the 100 percent disability level, if you increase that person's compensation by 25 percent and then scaled it back and down to the 10 percent disability level where it was 2.5 percent, that we came up with a total amount of annual compensation additive of about $3 billion.

But, again, our hypothetical was if you gave the full 25 percent quality of life kicker to the 100 percent disabled and you scaled that back down as the level of disability was reduced down to 10 percent and you gave them essentially what amounts to quality of life addition of $3.00 a month—

Mr. SNYDER.  Now, that is for that one provision.  What if everything is in, all your major recommendations, what would be the total?  You have got concurrent receipt recommendations and SBP recommendations and—

General SCOTT.  Well, you know, I am going to have to provide that for the record.  We can do a quick try to add them up here, but I have it broken down by recommendation, but I have not aggregated it.  But we will provide it for you.

[The Commission cost estimates for major recommendations appears in Enclosure 1 in the post-hearing questions for the record, which appear in the Appendix.]

Mr. SNYDER.  Thank you for your service.  This is a very complex issue and your report obviously deals with this in a very comprehensive way.  And the Congress is going to need to digest this and move forward on this.  But your report is a great, great start to this.  Thank you.

Thank you, Mr. Chairman.

The CHAIRMAN.  Thank you.

Mr. Bilirakis, you have the floor.

Mr. BILIRAKIS.  Thank you, Mr. Chairman.  I appreciate it.

General Scott, as you may know, my father, Congressman Mike Bilirakis, played a role in establishing the Veterans' Disability Benefits Commission during negotiations on the concurrent receipt.

I have continued my father's work in this matter and introduced legislation to provide for full concurrent receipt of military retired pay and VA disability compensation.

Therefore, I was pleased to read the Commission's recommendations pertaining to the concurrent receipt issue.  I am sure that the Commission's positive recommendations on this issue will greatly help in the fight to eliminate the unfair offset between the military retired and VA disability compensation.

Along the way to enacting the concurrent receipt and disability payment which was established in Public Law, Congress enacted several other measures including the Combat Related Special Compensation Program.  I have heard from some retirees that they find the myriad of different benefits confusing. 

In the Commission's deliberations on the concurrent receipt issue, did you consider whether or not concurrent receipt benefits should be simplified?

General SCOTT.  The quick answer is, yes, sir, we did.  And I think you will find in the report a very detailed discussion of the overlaps that are in the present system now and the gaps that exist in it.

Mr. BILIRAKIS.  Okay.  Thank you very much.

I would like to talk to you maybe privately a little more detailed.

General SCOTT.  Yes, sir.

Mr. BILIRAKIS.  Thank you.

General SCOTT.  Glad to.

The CHAIRMAN.  Thank you.

Mr. Michaud, who chairs our Health Subcommittee.

Mr. MICHAUD.  Thank you very much, Mr. Chairman, for having this hearing.

And I, too, want to thank the Commissioners for all your hard work.

In the report, and I would like to quote a part of it, and that quote says, "Little interaction between the Veterans Health Administration which examines veterans for evaluation of severity of symptoms and treats veterans with PTSD and the Veterans Benefit Administration which assign disability ratings and may or may not require periodic reexamination."

This report talks about a new holistic approach to PTSD that would couple treatment, compensation, and vocational assessment. 

Could you, Mr. Chairman, go into greater detail of how this approach would be implemented, what benefits it would bring, and how we could minimize the potential unintended negative incentives in the treatment of PTSD or other mental health disabilities.

General SCOTT.  Sir, we discussed the rationale behind our conclusions and recommendations in some detail in the big book there.  But the perception of a disincentive would be addressed by coupling treatment, compensation, and vocational rehabilitation and assessment and with periodic reevaluation.  I believe that would address that perception.

The perception, as you know, to be sort of short and blunt about it is that people who get themselves diagnosed with PTSD and then go off and collect a benefit for the rest of their life and we did not really find that to be an accurate perception, but it is there and has to be dealt with.

But we really believe that if we come up with this holistic approach that really combines treatment, compensation, and vocational assessments and training and periodic reevaluation that that will take care of the perception and it will also perhaps give us an opportunity to get some more insights on the disease of PTSD.

As an aside, sir, I was not particularly satisfied that the body of literature on PTSD and the methodology that the VHA uses to diagnose it and the VBA uses to adjudicate the level of disability was necessarily sound.  I believe that, speaking for myself now, I believe a whole lot more education and training is needed by the people that do it. 

I think you need to be sure that you have got the right sort of clinician doing the diagnosis and you have got the right sort of training in the adjudicator who tries to make a determination of, well, is this PTSD and, if so, how bad is it, and are there other co-morbidity factors like depression or maybe bipolar or something like that that affects this, and then what should the treatment regimen be.

The medical literature that we had access to differentiated between curing PTSD and making it better.  In other words, there seems to be a general concurrence that it is treatable and that there will be relapses and remittances throughout a period of time, but it is treatable.  And so that is where we were headed with our recommendations, sir.

Mr. MICHAUD.  Thank you very much.

I yield back, Mr. Chairman.

The CHAIRMAN.  Thank you, Mr. Michaud.

Mr. Boozman, you are recognized.

Mr. BOOZMAN.  Thank you.

First of all, General, I want to thank you and the rest of your Commissioners for the outstanding job and all of the hard work.  And I know that this was a lot of hard work and we really appreciate you all stepping forward and answering the call as you have so many times in all of your all's careers.  So thank you very much.

I have a statement that I would like to put in the record, Mr. Chairman, if that is okay.

[The statement of Congressman Boozman appears in the Appendix.]

The CHAIRMAN.  Thank you. 

And all Members may have any statements put in the record.

[The statements of Congresswoman Herseth Sandlin, Congresswoman Brown-Waite, and Congressman Salazar appear in the Appendix.]

Mr. BOOZMAN.  Thank you.

Let me just ask, do you agree with the VR&E's Task Force recommendation that the program should, and I quote, "Place priority on disabled veterans who have the most serious disabilities that impact quality of life and employment?"  And if so, and I think you do, how do we implement that priority?

General SCOTT.  Well, we spent a fair amount of space in the report talking about vocational rehabilitation.  And what we found is that the number of counselors is inadequate to ensure that the targeted 125 cases per counselor can be met. 

We found that the number of applicants and participants has increased, but the number of veterans who are successfully rehabilitated by VA standards has remained constant over the years and we are kind of puzzled about that. 

The conclusion that we made was that vocational rehabilitation is not accomplishing its goal, again, if you agree with us that the goal is to return the disabled veteran to as near a normal life as they can have both in the economy and as an individual.

We made several recommendations to enhance the service to disabled veterans.  In the report, they are on page 76, 77 and 195.  Some of the thoughts would be additional employment counseling and screening IU applicants for vocational rehabilitative possibilities.

We recommended access to vocational rehabilitation for medically separated servicemembers, not just the tremendously disabled, but for all.  We think that there should be some incentives to vocational rehabilitation and we spell them out in some more detail.

And also, we were not convinced that there had been very much real research on employment among disabled veterans.  A lot of it seemed to be just hypotheticals as to what the employment among disabled veterans is.

Some of the data we turned up in our analysis and our surveys got at the different levels of employment in certain groups.  For instance, as should probably come as no surprise, the disabled veterans with mental disabilities had a very low employment rate, whereas those with physical disabilities had a higher rate.  And it varied based on the level of disability.

So basically, the implementation of our recommendation is going to require some additional staffing and funding for the VR&E, but we really think that is a good place to spend some money in terms of getting people back into the society to the extent that it can be done.

And also it may require some legislation because we think employment counseling should be expanded from what our understanding of the requirement for that is.

Does that answer your question, sir?

Mr. BOOZMAN.  Yes, sir, very much. 

The Commission noted that the VA does not collect long-term data on VR&E participants.  Would you recommend that VA conduct a longitudinal study of voc rehab participants with regular reports to Congress on the outcomes of, you know, the cohort being followed?  Is that something that you could support?

General SCOTT.  Well, we think it is something that the data should be gathered on.  In other words, at the moment, it is too easy to declare this veteran is rehabilitated and then move on.  And nobody ever goes back to see what transpired, how long did this rehabilitation last, was this converted into a long-term employment opportunity or was it just at the moment that the person was employed so they declared it a success and moved on.

So that is why we think a longitudinal study would be quite helpful in determining what is the long-term effect of a vocational rehabilitation program.

Mr. BOOZMAN.  Good.  Thank you.  And, again, thank you to all of your Commissioners.

Thank you, Mr. Chairman.

The CHAIRMAN.  Mr. Walz?

Mr. WALZ.  Thank you, Mr. Chairman.

And, General Scott, thank you so much and to all the Commissioners.  I cannot tell you as a Member of this Committee, as a veteran, and as an American citizen who is concerned about this how pleased I am with the work you have done and how optimistic I am on this issue.

The research that you did and the analysis is truly complex, but you did it in such a way that I am hoping, and I think everyone up here would agree, that we actually move forward on these critical issues because this is a very emotional issue.

And I spent yesterday at a field hearing up in Mr. Hall's district, with Representative Lamborn, and it was on this disability claims problem.  And the stories there are heartbreaking.

A Marine Sergeant who was unable to get his benefit claim processed and during the time that he waited, approximately three years, his life degenerated into substance abuse and bankruptcy and family problems.

Once the claim process kicked in, once he started getting the help, once he started moving forward, this young Marine is moving his life forward and we know how critical that is.

With that being said, and, as I say, I am optimistic on this and looking at this claims processing and backlog, your recommendation 9.1, I am looking at this and the report of the Veterans Claims Adjudication Commission talks about it is perceived as inefficient, untimely, inaccurate, and so on. 

I turn the page and I look at a task force here, a Processing Task Force for 2001 needs to be revised.  I look at the Institute of Medicine.  Says it is not efficient and fair.  They deserve that.  The Center for Naval Analysis and what the American public and what the veterans are seeing is the same old story again. 

You have done a fantastic job of pointing out things that need to be addressed, things that I think we all intuitively thought but needed the analysis to back it up in a comprehensive manual.  It is here in front of us. 

I am looking at figure 9.1 on page 306 in here that shows me how we can reduce that claims backlog.

General, can you tell me if it is you and you are telling Congress, and I know your recommendations are in here, but sum it up, can we get this done?  Can we reduce this claim backlog?  How specifically are we going to do that? 

And I can tell you that I can feel it from yesterday from Sergeant Lassos the impact of doing that is going to be immeasurable.  So if you could walk me through that for just a second and talk to this Committee about how that is going to happen and the charge that you are giving to us and put that onus of responsibility on us to make this happen.

General SCOTT.  Well, first, the good news, sir.  The VBA has been authorized to hire, I believe it is 3,000 additional adjudicators over the next year and a half.  That is a start.

Now, the question is, how quickly can they be trained to do the work?  One of the real problems with the claims backlog is initial inaccuracies in the claims processing which results in appeal after appeal after appeal and it goes up to the Board of Veterans Appeals or the Court of Appeals for Veterans Claims.  And it gets kicked all the way back down and it starts over and the file is either mailed or Fed-Ex'd from one of these entities to another.  It cannot be done electronically at the moment.

So it is more people in the right place.  You know, as the cliché says where the rubber meets the road.  Training and education and standardization of the claims processing process and the processors with the goal of reducing the errors that occur initially which just compound as it goes on and in many cases, that makes up what the problems are.

The atrocious figure of the 800 plus days is for appeals claims.  And for new claims that are in pretty good shape, it is still nothing to brag about, but it is somewhere in the 177 or something like that.  But at any rate, we have got to reduce the error rate that results in all these appeals.

There are some possibilities for, and we mentioned in the report, best practices of business and some information technology.  But it has been pointed out by the Dole-Shalala Commission IT is not the silver bullet.  It would be a great assistance for the movement of these claims around, but it is a matter of best practices. 

And why can't an adjudicator open a claim on a computer, send that forward?  Obviously there is some subjectivity involved because every person is different.  But there is a lot of it that is not really subjective.  So, you know, if they just get into best business practice, train people, keep them on the job, keep them doing the adjudication, I think that is probably as key as anything else is.

Then, as you well know, sir, the judicial requirements as well as regulatory requirements get pretty complicated.  The "Veterans Claims Assistance Act" has, according to the Under Secretary for Benefits, in some ways slowed the process down because it caused them to do certain things that slow the process down. 

So let me give you an example.  A veteran gets a letter and the first four or five pages is indecipherable legalese.  Finally, on the last page, it tells the veteran what he or she has got to do.  Surely we can come up with a letter that meets the legal parameters that tells the veteran in the first or second paragraph, hey, bud, here is what you have got to do to get this thing moving and, you know, just things like that.

Again, we made a lot of recommendations.  But on the other hand, you know, what we think should happen is that the VBA's feet should be held to the fire since you have given them more assets of 3,000 more people and set up some goals for reducing it and then help them legislatively as they come forward with legitimate requirements or legitimate things that would help the process.

But, a lot of it is inside the VBA and I have had this conversation with VA and with the Under Secretary for Benefits.  And they agree.  So it is really multifaceted.  It is people.  It is training.  It is standardizations.  It is best business practice.  It is finding those documents and processes that can be simplified and still stay within the law or change the law in some cases to make it a little bit easier to do.

But right now it is so complicated that it is a wonder to me that anyone is ever able to get a claim processed.

Mr. WALZ.  I agree.  Well, thank you, General.  And you can be sure that those recommendations are going to sink in up here and we want to see it too.  So thank you.

I yield back, Mr. Chairman.

The CHAIRMAN.  Thank you.

Ms. Brown-Waite?

Ms. BROWN-WAITE.  Thank you very much.

And thank you, General, and all the members of your Commission for putting together a very good report.

Your comment on the initial inaccuracy reminded me of a case that I was involved in in my district where I swear those raters once it was stamped as rejected that all the way down the line, nobody opened up that folder where that initial error was made.

And when I read through it, and I saw the man and know him, I said this is absolutely wrong.  I think that happens far too many times.  It is almost like maybe we should mandate that they sign their initials at the bottom that they actually read what is in the folder.  You know, maybe it is the college professor in me coming out, but that happens, I am afraid, far too often.  And I appreciate your addressing that.

On page six of the summary, you indicated that you did a survey of disabled veterans and survivors.  What was the number of people who were actually surveyed and what was the error rate?

Gene