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Hearing Transcript on Transitioning Heroes: New Era, Same Problems?.
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TRANSITIONING HEROES: NEW ERA, SAME PROBLEMS?
HEARING BEFORE THE SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION JANUARY 21, 2010 SERIAL No. 111-55 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
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. |
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C O N T E N T S
January 21, 2010
Transitioning Heroes: New Era, Same Problems?
OPENING STATEMENTS
Chairman Harry E. Mitchell
Prepared statement of Chairman Mitchell
Hon. David P. Roe, Ranking Republican Member
Prepared statement of Congressman Roe
Hon. Timothy J. Walz
Hon. John J. Hall, prepared statement of
WITNESSES
U.S. Department of Defense, Hon. Noel Koch, Deputy Under Secretary of Defense, Wounded Warrior Care and Transition Policy
Prepared statement of Hon. Koch
U.S. Department of Veterans Affairs, Madhulika Agarwal, M.D., MPH, Chief Officer, Office of Patient Care Services, Veterans Health Administration
Prepared statement of Dr. Agarwal
American Legion, Joseph L. Wilson, Deputy Director, Health Care, Veterans Affairs and Rehabilitation Commission
Prepared statement of Mr. Wilson
Iraq and Afghanistan Veterans of America, Tom Tarantino, Legislative Associate
Prepared statement of Mr. Tarantino
Johnson, Staff Sergeant Sean D., USA, Aberdeen, SD
Prepared statement of Sergeant Johnson
Wounded Warrior Project, Captain Jonathan Pruden, USA (Ret.), Area Outreach Coordinator
Prepared statement of Captain Pruden
TRANSITIONING HEROES: NEW ERA, SAME PROBLEMS?
Thursday, January 21, 2010
U. S. House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:05 a.m., in Room 334, Cannon House Office Building, Hon. Harry E. Mitchell [Chairman of the Subcommittee] presiding.
Present: Representatives Mitchell, Walz, Adler, Hall, Roe, and Stearns.
OPENING STATEMENT OF CHAIRMAN MITCHELL
Mr. MITCHELL. Good morning, and welcome to the Subcommittee on Oversight Investigations hearing on "Transitioning Heroes: New Era, Same Problems?" This meeting will come to order.
I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks and submit statements for the record. Hearing no objection so ordered.
I would like to thank everyone for attending today’s Oversight and Investigations Subcommittee hearing entitled, "Transitioning Heroes: New Era, Same Problems?" Thank you especially to our witnesses for testifying today.
We are here today to address what both the U.S. Department of Defense (DoD) and the U.S. Department of Veterans Affairs (VA) are doing to assist the men and women of our armed forces to seamlessly transition back to civilian life. Time and again we have heard from our returning servicemembers expecting a smooth transition back to the lives they once lived only to find themselves lost in a complex and frustrating bureaucracy.
Today we will hear from a severely injured veteran, Staff Sergeant Sean Johnson who was hit by a mortar round in Iraq and is now completely blind. Although he has received excellent treatment at the Blind Rehabilitation Center in Chicago, he was never assigned a Federal Care Coordinator after contacting the VA almost a year ago.
In addition, Staff Sergeant Johnson and his family are experiencing the hardships of navigating through both the DoD system and VA system at the same time.
This is just one example of many. Staff Sergeant Johnson joins those veterans and their families who share the same concerns that our veterans service organizations (VSOs) will voice here today.
Additionally, as I have said before, outreach to our Nation’s veterans is an equally important task. Both the VA and DoD must ensure that veterans and their families are properly informed about the benefits and services they have earned when they return to civilian life.
We need to proactively bring the VA to our veterans, as opposed to waiting for veterans to find the VA. This is a critical part of delivering the care they have earned in exchange for their brave service.
The VA should be a place where veterans can easily, and with confidence, go for the help they seek, but the VA must also be willing to reach out to those veterans. Effective outreach will not only ensure better delivery of services for our veterans, but will also increase morale.
I am hopeful that today both the VA and DoD will shed light on what they are doing to make certain our veterans are receiving the best possible care available; they are being provided with the services and resources they have earned; and most importantly, that the two Departments are working together to ensure that these benefits earned are seamlessly delivered.
I believe that all my colleagues join me in being steadfast in our hopes that Secretary Shinseki, as he transforms the VA into a 21st century organization, will help eliminate the stigma that so many of our Nation’s veterans have placed upon the VA. We must ensure that both the VA and DoD are working together and providing veterans the services that they rightfully deserve.
Again, thanks to all our witnesses for testifying today, and we look forward to hearing your testimony.
Before I recognize the Ranking Member for his remarks I would like to swear in our witnesses. I ask that all witnesses please stand and raise their right hand.
[Witnesses sworn.]
Thank you. I would like to now recognize Dr. Roe for opening remarks.
[The prepared statement of Chairman Mitchell appears in the Appendix.]
OPENING STATEMENT OF HON. DAVID P. ROE
Mr. ROE. Thank you for yielding, Mr. Chairman.
I would first like to thank the Members of the first panel for their service to this country. Not only their military service, but their continued service by appearing here today to share their testimony and help us work towards a better transition for our Nation’s veterans.
Prior to this hearing, my staff provided me with a list of the hearings held by the Committee on Veterans’ Affairs over the past 10 years, totaling around 33 hearings. The topics have ranged from employment transition through the use of polytrauma centers, pre-and post-deployment heath assessments, sharing of electronic health records of our wounded servicemembers, transition assistance programs (TAPs) for Guard and Reserve forces, and the list goes on.
As you can tell, helping our servicemembers move from the military to civilian life is of great importance to this Committee.
Concern in Congress about helping our servicemembers transition to civilian life didn’t start 10 years ago. During the 97th Congress, Congress codified this concept of DoD/VA sharing, now known as seamless transition in 1982 with passage of the Veterans Administration and the Department of Defense Health Resources Sharing and Emergency Operations Act. This act created the VA Care Committee to supervise and manage opportunities to share medical resources.
Today’s hearing will enable the Committee to review the various programs that have been instituted to assist our Nation’s veterans and wounded warriors in their transition to civilian life. We will be looking forward not only at the medical record exchange between VA and DoD, but also at the various other transition services, the use of polytrauma centers across the country, and programs available to assist our veterans.
This is not the first hearing to look at these items, and I am certain it will not be our last. We here in Congress must do everything we can to make certain that the transition our military personnel undergo is smooth, easy, and the programs available are truly helping our Nation’s veterans.
In the past it appears that any transition many servicemembers have encountered have not been exactly seamless, and certainly not easy or smooth.
Mr. Chairman, I appreciate you holding this hearing today, and I believe we have much to learn from the witnesses today.
Again, thank you, Mr. Chairman, and I yield back.
[The prepared statement of Congressman Roe appears in the Appendix.]
Mr. MITCHELL. Thank you. Mr. Walz?
OPENING STATEMENT OF HON. TIMOTHY J. WALZ
Mr. WALZ. Well thank you, Mr. Chairman and Ranking Member, and I will submit a statement to the record, but I want to thank both of you for holding this hearing and for our witnesses for being here. There is nothing more important that we do than to care for our veterans, and many of you in this room, and I know my colleagues up here, have heard me talk about seamless transition until I am blue in the face. There might be a reason for this. I just heard Dr. Roe talking about when we first started talking about this here, that is before I started basic training and did a 25-year career, and took some time off, and came to Congress, and here we sit today still talking about it.
It is unacceptable, it is not getting the care for our veterans, it is costing this country money, and it is undermining the faith in what we do for them. We have the capability, we have the technology. I am absolutely convinced that this is the fundamental systemic issue on claims backlogs, on many other issues, and so I want to congratulate the Chairman and the Ranking Member once again for tackling this issue.
It is complex and all of you who will testify today know that, but when we hear from Staff Sergeant Johnson, and I think you are going to hear some of the issues he faced is, no one in this country thinks that is acceptable. No one thinks it is acceptable. And the problem with it is, is that I think Tom Zampieri is out there somewhere from the Blinded Veterans of America, they can predict this every time what is going to happen, and they tell us exactly what the pitfalls are, exactly where the veteran is going to fall through the cracks, and then they give us suggestions on how to fix that.
And I hope now that this is the time. It feels like the momentum is there, and so I look forward to hearing from our witnesses on ways we can correct this. I yield back.
[No statement was submitted.]
Mr. MITCHELL. Thank you. At this time I would like to welcome Panel 1 to the witness table. Joining us on our first panel is Staff Sergeant Sean Johnson, an Operation Iraqi Freedom (OIF) veteran from South Dakota. Joseph Wilson, Deputy Director of Health Care, Veterans Affairs and Rehabilitation Commission, American Legion; Thomas Tarantino, Legislative Associate for Iraq and Afghanistan Veterans of America (IAVA); and Captain Jonathan Pruden, Area Outreach Coordinator for the Wounded Warrior Project (WWP). Each will have 5 minutes to make their presentation, but I also want them to know their complete statement will be entered into the record, but please keep it to 5 minutes. And I will ask in this order the speakers: Staff Sergeant Johnson, Mr. Wilson, Mr. Tarantino, and Captain Pruden.
Thank you again for being here, and first Staff Sergeant Johnson, would you please begin.
STATEMENTS OF STAFF SERGEANT SEAN D. JOHNSON, USA, ABERDEEN, SD (OIF VETERAN); JOSEPH L. WILSON, DEPUTY DIRECTOR, HEALTH CARE, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; TOM TARANTINO, LEGISLATIVE ASSOCIATE, IRAQ AND AFGHANISTAN VETERANS OF AMERICA; AND CAPTAIN JONATHAN PRUDEN, USA (RET.), AREA OUTREACH COORDINATOR, WOUNDED WARRIOR PROJECT
STATEMENT OF STAFF SERGEANT SEAN D. JOHNSON, USA
Sergeant JOHNSON. Chairman Mitchell, Ranking Member Roe, and the rest of the Committee. I thank you for giving me the invitation and the chance to give my testimony today. And I have to put in a disclaimer. I am not here in a military capacity, I am here as a veteran and a private citizen.
My name is Sean Johnson and I am 38 years old. I am a three-time deployed vet, Persian Gulf, Bosnia, and Iraq. And I was deployed to Iraq on October 19th, 2005. And between October 19th, 2005, and March 25th, 2006, I was exposed to four mortar blasts within 30 feet and a rocket blast, also within 30 feet. On March 25th, 2006, I was exposed to a mortar blast 10 feet away. I remember a bright light and a loud boom and that is it. It blew me 3 feet in the air and 7 feet back and I landed on my shoulders and my neck. I have received damage to my C-spine from C1 to C7. Before I got up, I was kind of paralyzed, I didn’t know what was going on. As I looked through my feet another mortar hit 25 feet away. The other blast I was able to shake it off, this blast I couldn’t. I didn’t hear for almost a day. I was dizzy, confused, I couldn’t see in the distance, I couldn’t see at night, I had headaches and abdominal pain.
And then I went into the hospital in May of 2006, and I was there for 7 days. A trauma surgeon was in charge of my case, and they concentrated on the abdominal pain. Sent me back and forth to Germany twice, and they couldn’t figure it out. And they said it has got to be a gastrointestinal problem.
Well, in between these trips to Germany they gave me antibiotics and stopped antibiotics, so I ended up with a serious infection. And I was sent back to the States to Fort Riley, Kansas. I was placed in the med hold there.
There were all kinds of problems there. I had to launch seven Congressional complaints, and I was told at one time that if I stopped talking to my Congressmen, they would actually treat me.
Fort Riley, the doctors there want to take care of their patients. They don’t want to make referrals, they don’t want Walter Reed or Brooke Army Medical Center (BAMC) to evaluate their patients, they want to treat them themselves. It is a type of an ego problem I believe.
After the Congressional complaints, I did receive treatment at Walter Reed for pain, and at that time I got back to Fort Riley and they said we can’t help you anymore. And at that time they sent me home, because the program, the Community Based Health Care Organization (CBHCO) that you guys created, they said my case was too complex and they couldn’t help me anymore. And the Reserves, had hands tied.
I have had an Medical Evaluation Board (MEB) waiting for 2 years, and I just started it now. And they told me would take another 2 years to get through it. They are making me drill, and basically I go to drill and they pay me to sit in a small room to do nothing.
I did not receive the transition of care. I wasn’t contacted by a Federal Recovery Coordinator, I wasn’t contacted by anybody. I had to copy my medical records on paper, take them to the VA, and at that point they entered them into their system, then they started all over again. Checking the abdominal pain. And then somebody referred me to the polytrauma doctors because of the blast injury. And they said, well you have a head injury, you have severe post-traumatic stress disorder (PTSD), and at that point I was treated, and then my vision loss came about a year later.
I was seen by one optometrist and a couple of ophthalmologists. They said my eyes are fine. The VA spent thousands of dollars to send me to a neuro-ophthalmologist and she said my eyes are—my optic nerves are dead. When we came back the Compensation and Pension (C&P) panel said, no, that doesn’t count. My question is, why did they spend thousands of dollars to get an expert opinion and they don’t use it?
So you are going through comp and pension exams unnecessarily over and over again before you get your benefits, and that just adds to the backlog. Not only that, but if they keep going back to a lower level of care, they won’t be able to correct the problem.
It really bothers me that it took 21 months to figure out a traumatic brain injury (TBI). Twenty-one months. I went through all the Army treatment, I went through part of the VA treatment, and it took them 21 months to discern that it was a traumatic brain injury, and that is really scary. Because you can’t get the treatment that you need timely enough to benefit you.
The Federal Recovery Coordinators, we didn’t even know about them. Nothing was ever said to us. And 4 years later I got a call from one the night before last. Two to 4 years later. There is no transition between case managers in the DoD side, and case managers in the VA side. None. There was no transition. If I wouldn’t have brought my paperwork they wouldn’t know what was going on. And there are a lot of younger soldiers that don’t know that, don’t know to copy their paperwork, or aren’t given the opportunity to stay and get their disability. They are given a severance check and sent off. I know it has happened several times. I have talked to people in the med holds about it, and it is just shameful. You know, they put the burden on the VA instead of taking care of the soldier and then transferring him. There is no seamless transition, it is just not there.
And one of the suggestions that I have, the Vision Center of Excellence needs to be staffed and needs to be—the building needs to be created at Bethesda and they need to get that done. They were given $6 million in the last round of money that was handed out and nothing has been done. They need to get that building up, they need to get the staff, because they are the ones who are going to do the trauma research and the eye research, which is what the injuries are coming out of Iraq and Afghanistan. The number of eye injuries is staggering, and it is happening 2 years after the injury. So it is not something that happens right away.
And the scary part is, the benefits, Traumatic Servicemembers Group Life Insurance (TSGLI). If you are past 730 days they don’t pay out the money, and that is a legislative thing, the DoD put that disclaimer in there. Well if you have eye injuries and you go blind 2 1/2 years later there is no help for you, and that is the money that is supposed to help you get started on getting your house done, getting your bills paid.
The other thing that I would like to see, and I think it would help, is the Caregiver Bill, and I believe that was brought up and it is in the Senate and the House. My wife has given me tremendous care and looked out for me, and it is really a strain. A strain on my children, a strain on her work, and she may end up losing her job because she has to be gone all the time to take care of me. I can’t go to doctor’s appointments without her because I don’t remember what goes on. And I suggest that that may be a fix.
And there needs to be red flag system. There needs to be. For TBI and seriously injured soldiers. They need to be in polytrauma care, and they need to be taken care of. And not a year down the road. The Federal Recovery Coordinators, they need to be there right away to make sure that the patients are getting the care they need. Because up until now there are hundreds, maybe a thousand soldiers like me who get left behind. It is unacceptable.
You have people that aren’t getting the care they need, and they are getting left behind or slipped through the cracks, and you sit there for 4 years to get a med board that probably takes 3 days. Four years later. I was injured on the battlefield. Four years later. They still haven’t given me a Purple Heart. You know, things like that, where soldiers are waiting, and there is no need for that. The care is there, it just needs to get the soldiers to the care. And the doctors are strained. The doctors are strained, the nurses are strained because of the overloaded system. And I understand they added four or five Federal Recovery Coordinators just recently this past week and they are overloaded. You have 100,000 people that are potentially patients and you have 20 Federal Recovery Coordinators. How effective is that?
I guess the biggest thing I want you to know is that people are falling through the cracks and this needs to be addressed. And the Federal Recovery Coordinators, they need to have access to get this taken care of. The severely injured soldiers can’t wait.
You know, if you are blind in the VA, if you are not permanent and total they won’t give you the benefits of a vehicle payment, or a house grant. They give a certain amount of money for your house to be structured. They won’t give it to you unless you are permanent and total. Well blind soldiers need to have that money so that they can make their houses safe and their lives better, not to wait endlessly through exams and exams and exams to finally get permanent and total. That needs to be done right away.
You know, there are five neuro-ophthalmologists in the country. If they say you are blind, you are not going to get better, then they need to accept that.
And I hope that by my testifying today that some of the problems are out there, and you can come up with ways to help. And I hope that my testimony has helped bring things to light.
And I speak not for myself today, but for all the soldiers that can’t be here to speak, that are falling through the cracks and not getting the care they need, and not getting the care they need in a timely manner.
And I want to thank you for the opportunity to be here today, and I will answer any questions that I can. And I appreciate you giving me a little extra time to give my testimony, as it is a little difficult to summarize when you have a vision problem. So that is all I have and I will answer any questions that I can. Thank you.
[The prepared statement of Sergeant Johnson appears in the Appendix.]
Mr. MITCHELL. Thank you very much. Mr. Wilson?
Mr. WILSON. Chairman Mitchell and Members of the Subcommittee, thank you for the opportunity to present the American Legion’s views on seamless transition issues. Currently, there are approximately 23.4 million veterans in the United States; of that total, 7.8 million are enrolled in the VA health care system. VA treats 5.8 million veterans at more than 150 hospitals and 800 plus clinics.
As we examine the transition process, the American Legion, in its efforts to ensure transitioning servicemembers receive continuous/seamless care, has determined that veterans are facing various challenges, which may irrevocably deter any chance of a successful and smooth transition back into their local communities.
An example of challenges include incomplete Post Deployment Health Reassessment questionnaires or PDHRA, inability to fully share medical records among the Department of Defense and VA health care facilities, lack of space at VA medical facilities, and shortage of staff, to include nurses and physicians.
VA and DoD both play important roles in the transition process. As women and men return from Iraq and Afghanistan facing uncertainty with injuries and illnesses, the American Legion contends that closer oversight must be placed on various programs, such as the PDHRA and Federal Recovery Coordination Program, or FRCP, that have been implemented to ensure no one falls through the cracks. We ask Congress to assess these roles to ascertain the appropriateness of functional tools required to accommodate the Nation’s veterans, their families, and the complex issues they are met with.
DoD and VA have created and implemented various programs to support each servicemember and veterans as they transition from active duty to civilian life to include the PDHRA.
The PDHRA program was established to identify and address servicemembers health concerns that emerge over time following deployments. To be in compliance with DoD’s policy, each military service must electronically submit PDHRA questionnaires to DoD’s central depository. However, a recent audit disclosed that the central depository did not contain questionnaires for approximately 23 percent of the 319,000 OEF/OIF, Operation Enduring Freedom or Operation Iraqi Freedom, servicemembers who returned from theater. This means approximately 72,000 servicemembers were without questionnaires in the repository. The response to the absence of the questionnaires concluded that DoD does not have reasonable assurance that servicemembers, to whom the PDHRA requirement applies, were given the opportunity to fill out the questionnaire and identify as well as address health concerns that could emerge over time following deployment.
The American Legion believes the administration of the PDHRA is essential to the success of the servicemembers transition, because the results would disclose telltale signs of debilitating illnesses, such as the disorders that plague many veterans who have gone undiagnosed at separation from active duty.
Next the Federal Recovery Coordination program. The American Legion would also like to ensure that the FRCP is successfully assisting all recovering servicemembers and veterans suffering from severe wounds, illnesses, and injuries, as well as their families in accessing the care, services, and benefits provided through specifically, DoD and VA.
There are more challenges transitioning servicemembers and veterans face. There have been various reports of critical challenges involving veterans who have recently departed from active-duty service. These challenges, as reported by RAND, includes barriers to mental health care access in community settings. More to specify it was discovered that military servicemembers and veterans are often reluctant to seek mental health care. The mental health workforce has insufficient capacity.
The American Legion recently passed Resolution No. 29, Improvements to Implement a Seamless Transition, which recognized gaps in services, and has consistently advocated improvements be made to the process of servicemembers in their transition from active duty to civilian life. The American Legion continues to express that servicemembers and their families are easily overwhelmed when dealing with the bureaucracy of multiple departments. However, a more expeditious process that explicitly focuses on moving servicemembers from point A to point B, i.e., DoD to VA, respectively, would ensure timely and accessible care.
The American Legion believes it is extremely vital that this Nation’s servicemembers, before their departure, should be placed in a comparable or full duplex capable, fully compatible, DoD/VA database with appointment reminders to ensure their transition isn’t stifled by the unknown; after all, active-duty servicemembers have been conditioned to be directed to all military appointments and events.
Upon separation from service these newly transitioned veterans may continue to have the expectation that everything will be set up for them. Both DoD and VA are working to ensure servicemembers and veterans successfully receive information and treatment respectively.
It is the American Legion’s contention that the interaction between DoD and VA be heightened, most importantly, by complete shared access of medical records of servicemembers and veterans, as well as assessments of this relationship.
Let us remember that there is no pause button for veterans. Every moment is critical and must be treated as such. Although the World War II veterans’ population is diminishing at approximately 1,000 daily; other veterans, to include those from the Vietnam era to current OEF/OIF are presenting to VA with old and new issues. Complacency and communication between DoD and VA and implementation of programs can never be relative.
The American Legion hereby reiterates its position and urge careful oversight of effective communication between DoD and VA to include verbal and written, as well as full implementation of programs to ensure no one is left behind during the transition process.
Mr. Chairman and Members of the Subcommittee, the American Legion sincerely appreciates this opportunity to submit testimony, and looks forward to working with you and your colleagues to ensure all servicemembers are met with the best of health care upon transitioning into the community. Thank you.
[The prepared statement of Mr. Wilson appears in the Appendix.]
Mr. MITCHELL. Thank you. Mr. Tarantino?
Mr. TARANTINO. Mr. Chairman, Ranking Member, and Members of the Subcommittee, on behalf of Iraq and Afghanistan Veterans of America’s 180,000 members and supporters, I would like to thank you for the opportunity to speak before you today.
As an OIF veteran with 10 years of service in the Army, I have seen firsthand the difficulties that many veterans face when transitioning from servicemember to veteran for both the wounded warrior who is torn from service due to their extraordinary sacrifice or the young veteran who spent most of their formative years in uniform, the transition can be difficult.
At a time when most of our civilian peers have begun to hit their professional stride, many of us now must start over, and this transition is felt by all, but none more acutely than the brave men and women who have sacrificed blood and limb for the country and who now must enter a world that does not fully understand their needs.
Veterans of Iraq and Afghanistan may regularly receive excellent care in the ever-expanding polytrauma system. And while these centers can provide excellent care for servicemembers and veterans, there is a noticeable drop in the quality of care when transitioning to community-based institutions near the veterans home of record.
Additionally, the quality of services for disabled veterans near their home generally does not match the standards of care that a veteran receives at a polytrauma center, and no where is this more true for veterans who are in the National Guard and Reserve component.
Additionally, IAVA is concerned with the structure of some adaptive services benefits that many veterans use after leaving polytrauma care. Veterans are being forced into debt because of shortcomings in the benefits and the services that the VA provides.
Currently, benefits for adaptive housing and automobiles are stuck at 1970’s funding levels, and most are just one-time deals. With about 80 percent of OIF and OEF veterans under the age of 30, a veteran living with permanent disabilities will more than likely require more than one automobile in his or her life. The current rate may have bought a van equipped with adaptive modifications back in 1972. Today, that same amount might get you a mid size Kia with no adaptive technology.
These veterans are left to pay the difference, and we cannot tolerate a benefits system that requires a veteran to incur debt just to perform everyday functions.
Also, many veterans wounded in Iraq and Afghanistan are not homeowners and must return to their family homes to recover. They are then faced with the choice during their critical time in their recovery to choose between adapting the home that they are recovering in, or save that benefit for the home that they will eventually settle.
The need for these services is obvious and the figures that require upgrading are absolutely known, so there is no excuse for leaving a veteran with substandard benefits.
VA social workers play an indispensible role in the treatment of veterans recovering from multiple traumatic injuries, and the VA must rapidly expand their numbers. As more and more OIF and OEF veterans enter the VA health system, their overall needs will continue to inundate the overworked and understaffed cadre of social work professionals within the VA system. Private sector social workers, on an average, work on a caseworker to client ratio of 1 to 10 to 1 to 15. In comparison, in-house VA social workers operate at a ratio near 1 to 35. The VA must address this issue before the ratios expand further, and these caseworkers cannot properly address the needs of our veterans and their families under these currently crushing workloads.
For spouses and dependents of veterans who gave the last full measure of devotion to this country, the VA provides educational benefits under Chapter 35, the Survivors’ and Dependents’ Education Assistance Act or DEA. In 2008, the VA reported that over 80,000 family members took advantage of this program, more than the number of reservists using Chapter 1606, and unlike the generous Post-9/11 GI Bill or the recently increased Montgomery GI Bill, DEA provides a paltry sum of just over $900 a month, which will cover less than 60 percent of the cost of an education.
IAVA believes that DEA benefit rates should be aligned with those of the new GI Bill, and if we don’t what will end up happening is a two-tiered benefits system. One tier our family members were able to attend college because they qualified for the Gunnery Sergeant Fry Scholarship under the Post-9/11 GI Bill. The second tier are those forced to use DEA who take out student loans just to pay for a community college.
Now since 2008, we have seen a noticeable shift in how the VA educates veterans about the benefits and services that we are talking about today. I have personally met with representatives from the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the VA Business Office to discuss how they can better reach out to veterans of Iraq and Afghanistan. There has been a visible improvement with online and television advertisement, but there is a clear lack of coordination between VA departments. Within the VA, I firmly believe that there is talent, will, and desire to change the passive nature of VA communication; however, there are still substantial cultural and structural hurtles that must be overcome.
IAVA believes that in order for the VA to conduct effective outreach to let these veterans know what is available to them it must centralize its efforts and speak as one Department of Veterans Affairs.
See, the average veteran doesn’t understand the difference between VHA and VBA. The average American certainly doesn’t understand. When I wait an entire semester for my GI Bill check to come, I am not upset with the VBA, I am upset at the VA. When I wait 2 months to get a medical appointment, I am not upset at the VHA, I am upset at the VA. If the VA ever wants to effectively improve its communications, it must speak to the veteran population and the American people clearly and avoiding government jargon.
Thank you once again for the chance to communicate our opinions on several of the issues facing veterans of Iraq and Afghanistan, and we look forward to continuing to work with the Committee, and I appreciate your time and attention. Thank you.
[The prepared statement of Mr. Tarantino appears in the Appendix.]
Mr. MITCHELL. Thank you. Mr. Pruden?
STATEMENT OF CAPTAIN JONATHAN PRUDEN
Captain PRUDEN. Mr. Chairman and Members of the Subcommittee, thank you for inviting Wounded Warrior Project to share its perspective on issues of seamless transition between the Departments of Defense and the VA.
I was an Army captain who in 2003, became one of the first improvised explosive device casualties of Operation Iraqi Freedom. I have made that transition myself. Now after 20 operations at seven different hospitals, including amputation of my right leg, I work as an Area Outreach Coordinator for the Wounded Warrior Project. I work with hundreds of warriors around the southeast covering Florida, Georgia, Alabama, and South Carolina.
Over the past 6 years, I have witnessed DoD and VA making significant strides in care coordination and information sharing. This Subcommittee’s steady focus on these issues has helped to achieve greater seamlessness for wounded warriors. But even the most well coordinated, seamless handoff from DoD to VA will not change the fact that for many wounded warriors this transition feels like they have been thrown off a cliff.
While the two departments can take pride in certain areas of real progress, wounded warriors leaving the service continue to face programmatic, cultural, and structural barriers at the VA. It is critical, in our view, that those barriers be toppled and that key VA programs and service-delivery mechanisms be re-engineered with the goal of having wounded warriors thrive physically, psychologically, and economically.
Currently the VA does not provide wounded warriors 21st century help that they need. As you know, many are not only combating co-occurring PTSD and substance-use issues, but co-occurring traumatic brain injuries, burns, amputations. Often, they are dealing with the constellation of issues which is pain, anger, depression, unemployment, lack of employment opportunity, and lack of permanent housing. In some cases these issues and behavioral health problems have resulted in run-ins with the law.
VA has an array of programs targeted at specific problems, but little in the way of a holistic coordinated approach to turn these lives around. It must move in the direction of providing wraparound services that integrate the work of VA’s Health and Benefits Administrations. Much work also needs to be done within those administrations to make existing programs more veteran centric.
Let me cite a few examples. Too many veterans under VA care for PTSD or other mental health conditions are still simply being given pills to manage their symptoms despite a policy that emphasizes a goal of recovery and rehabilitation rather than just symptom management. This needs to change.
OIF/OEF veterans who are struggling with PTSD need good clinical care, but they also need support and mentoring from peers who have made strides in battling the same demons. We urge the VA employ OIF/OEF veterans at every medical center to provide such peer support, as well as to do outreach to the many who have been reluctant to seek treatment.
To offer another example, our own work with wounded warriors has highlighted the difficulties facing those who have PTSD and need in-patient treatment. VA’s in-patient programs don’t have uniform admission criteria. Each facility seems to set its own criteria. Too often warrior’s circumstances don’t fit those inflexible criteria for specialized PTSD care and they are denied admission to these programs they so vitally need.
In short, rather than veteran-centered care this seems to be more like barrier-centered care. A veteran centric systems would not, as some facilities do, impose rigid requirements that a veteran must have had success in out-patient therapy for 3 to 6 months to qualify for admission, must have had no suicidal attempts or suicidal ideation even for the past 6 months, must first complete out-patient anger management before they can receive treatment, must first be substance abuse free for a certain amount of time, and must first be interviewed, and if accepted, may be admitted at a later date.
Tragically many OIF/OEF veterans who are suffering with severe PTSD are hanging on by a fingernail, and they don’t have months to wait to receive the in-patient care.
Wounded Warrior Project field staff has considerable experience in helping OIF/OEF veterans get needed mental health care from VA facilities, but we have encountered great difficulty with placements when veteran’s conditions pose a relatively urgent need for specialized in-patient treatment. The most pronounced of these cases have involved veterans who have been jailed because of behaviors linked to PTSD and substance abuse, and whose cases have come before a judge who is willing to having the veteran undergo treatment rather than incarceration.
In several cases, however, VA medical center personnel who have attempted to facilitate such placements have been stymied by long waiting lists at specialized in-patient facilities inside their VISN. On numerous occasions, our field staff have inquired on behalf of our warriors about in-patient PTSD placement options beyond the confines of a particular VISN, only to learn that VA staff have no central repository of information or clearinghouse to turn to, to find out about programs that exist outside of their Veterans Integrated Services Network (VISN) or their immediate area.
I am aware of one case where in Tuscaloosa, Alabama, there were 125 individual veterans on a waiting list for a dual diagnosis substance abuse PTSD program. One hundred eighty miles away in Jackson, Mississippi, was an analogous program with empty beds the next week. The two programs didn’t know the other one exist because there was a VISN line between them, and this is unacceptable.
We have urged the Department of Veterans Affairs to establish a clearinghouse on these programs to provide relatively real-time patient and placement information. To date; however, this recommendation has elicited no response.
To cite another area, employment is certainly key to successful reintegration. Yet in programs targeted at helping veterans gain Federal employment, wounded warriors encounter troubling obstacles even at the VA, the one agency you would expect to go the extra mile in employing veterans.
As you know, Mr. Chairman, service-connected disabled veterans are entitled to a ten-point preference in Federal hiring, but those extra points seem to give our warriors little or no practical help. Instead, the complex hurdles of the KSAOs (Knowledge, Skills, Abilities and Other characteristics) in demonstrating ones qualifications for a particular Federal job often knock qualified warriors out of contention, even in the VA. Surely the Department could establish some mechanisms to help overcome these hurdles.
Mr. MITCHELL. Captain, could you wrap this up?
Captain PRUDEN. Yes, sir.
Mr. MITCHELL. Thank you.
Captain PRUDEN. In short, Mr. Chairman, to achieve its ultimate goals of seamless transition it will not only require work to bring VA and DoD closer to fill the gaps, but a substantive transformation within the VA to insure that this is the most successful and well-adjusted generation of veterans ever.
Thank you. That concludes my testimony.
[The prepared statement of Captain Pruden appears in the Appendix.]
Mr. MITCHELL. Thank you very much. There are a couple questions I want to ask, and first to Staff Sergeant Johnson. Did I understand you correctly that you are still going to Reserve meetings?
Sergeant JOHNSON. Yes. I was put in a transients, trainees, holdees and students (TTHS) holding cell, and they told me that until my MEB is over and they give me a disability rating that I have to go to monthly drills. And like I said, I go into a room, I sit there, that is it.
Mr. MITCHELL. How long after you returned home did you become blind?
Sergeant JOHNSON. About a year.
Mr. MITCHELL. About a year?
Sergeant JOHNSON. Year and a half.
Mr. MITCHELL. Could this have been prevented?
Sergeant JOHNSON. No. From the blast injury my optic nerves already started to die, and the TBI had affected?my brain so it can’t comprehend what my eyes are seeing, so according to what they told me it couldn’t have been prevented, but the eye services would have helped tremendously.
Mr. MITCHELL. In that time period there could have been some transition to knowing what was going to happen, instead nothing happened until after you actually became blind?
Sergeant JOHNSON. Yes.
Mr. MITCHELL. And did I hear you say that you have not even received your Purple Heart yet?
Sergeant JOHNSON. Correct.
Mr. MITCHELL. And how many years has that been?
Sergeant JOHNSON. Four years.
Mr. MITCHELL. Four years? Thank you.
Let me ask Mr. Wilson something. What are the top two concerns for veterans that you hear from in your organization transitioning from DoD?
Mr. WILSON. I actually heard those issues yesterday, during a site visit at one of the four Level 1 polytrauma centers in Tampa, transitioning, and screening.
Mr. MITCHELL. They what?
Mr. WILSON. Servicemembers/veterans have no knowledge of the program. We have heard that some weren’t screened extensively. So screening and pretty much ignorance of VA programs or even the transition from DoD to VA itself.
Mr. MITCHELL. So even if the VA comes—and they will testify I am sure—that they have all these programs, the problem is the veterans don’t know about them.
Mr. WILSON. The American Legion conducts site visits at VAMC's from January to June; we write that publication and we disseminate it to all 535 Congressional Members. If one evaluates the VA they are going to find very good programs. DoD, very good programs.
Again, the problem is the transition from DoD to VA and/or the communication between the two, which begins also with medical records. Yesterday there was a doctor speaking on really good new patient programs, I asked him about challenges. He stated, “The challenge is getting records from DoD.” I asked, “Well how do you do it? Do you do it the conventional way?” He says, “Exactly, the conventional way, and that takes lots of time.”
Being an old computer guy I know there is such technology as duplex capability. There has to be more oversight on this. I mean it is frustrating now even to computer users who don’t use computers that often, they know that there is a program that will allow both DoD and VA to communicate with one another.
Mr. MITCHELL. Thank you. Mr. Tarantino. What complaints do you hear most from veterans who are in the process of transitioning?
Mr. TARANTINO. Well, I think what we are hearing is definitely that there is a lack of communication, and this is not just for servicemembers leaving active duty, this is particularly for servicemembers in the National Guard and the Reserve. I know myself, I would have never gone to see the VA if an old sergeant major who was going through the Army Alumni Program with me hadn’t grabbed me and said, “You know, sir, right now you are young, you are macho, and you are stupid. When you get to be my age you are going to be old, you are going to be less macho, and you will probably still be stupid, but you are going to be in pain and you are going to need to know what is available to you.” And the VA does not make itself known to active duty or to the Reserve component.
And what we are seeing especially in the National Guard and the Reserve component, is that soldiers get these invisible injuries, they get discharged 48 to 72 hours after they leave Bagdad, and now they are home, they are drilling, and they need care, and they have to go to the VA. But there is no mechanism to bring them back into the fold of the DoD and say, okay, you are injured, you need a medical retirement, or we need to take care of you.
In many cases we are seeing members, Iraq and Afghanistan veterans that are 70 to 80 percent VA disabled that are getting called up out of the IRR back onto active duty because the DoD has absolutely no idea that these guys were injured. And that is the big nightmare scenario that we are seeing with our membership.
Mr. MITCHELL. Thank you. And one last question to Captain Pruden. Do you think that the Office of Wounded Warrior Care and Transition Policy is on the right track? What improvements could be made?
Captain PRUDEN. From what I know I think they are on the right track. I think they have made some very substantial improvements over the past several years here, and the addition of five more Federal Recovery Care Coordinators is certainly a step in the right direction.
I would like to see again a more seamless handoff to the VA. I would like to see case managers who are—as Secretary Shinseki created the Seamless Transition Patient Advocate (TPA) Program doing the handoffs from the VA to DoD, unfortunately a lot of those slots were filled by social workers with no DoD experience, but a lot of experience in finding employment in the VA. And so I would like to see, again, TPAs be able to do their job and reach across and work directly with DoD to pull them into the new system.
Mr. MITCHELL. Thank you. Dr. Roe?
Mr. ROE. Thank you, Mr. Chairman. Just a comment to Mr. Tarantino. In your testimony you had concerns raised over the 1970s, and rightly so, funding level of the adaptive housing grants, and I want to make certain that you are aware that Congressman John Boozman who is on the Committee and Ranking Member of the Subcommittee of Economic Opportunity, introduced legislation that would increase funding, H.R. 1169, from the small housing grants of $12,000 to $36,000 and the larger housing grants from $60,000 to $180,000. The bill would also increase automobile grants up to $33,000.
So I understand that there are some PAYGO issues with this obviously that have to be worked through, but I think all the Members on this Committee will look favorably toward that. So I just wanted to pass that along.
You know, and the Chairman has been here one term, but you know you haven’t been here a lot of terms when your group goes to Great Lakes, Illinois, in January, which is what we did. When other people are going to Hawaii, we went to Great Lakes.
And what I keep hearing. I have been in the infantry, I have been to Afghanistan and spent a week there, been to Walter Reed and now to Great Lakes, and we have a VA in my hometown, so I have a pretty good idea, but I am still having a problem getting my arms around this. And after 33 hearings we are still hearing the same thing. And I think it is time to sit down. And I agree with you all, I see a VA at home that is trying to do the right thing. I go to a Walter Reed and I see them doing great work with the veterans there and the rehab with the wounded warriors. No doubt about it, as a physician I am amazed at the recovery that a lot of these wounded warriors are achieving now. But it is not coordinated where the left hand and the right hand knows what is going on. It is not because people are not trying. I absolutely believe that.
But I am going to ask any one of you if you will take this pass and just tell us, is it beginning when the warrior—and I believe that what we need is, is when a soldier signs up that that soldier needs to have—be in the VA system that day, and I think they need to have one record. And I think, Mr. Wilson, you are absolutely right, you've got information here and information here and nobody can share the information. So I am beginning to get my arms around on what we need to do, but just to comment on my statement. Mr. Wilson you can start if you would like, or Mr. Tarantino.
Mr. WILSON. Okay. You know, I had mentioned and it was in the testimony that the role of DoD and VA must be that of "safety net catalyst." Titled terminology epitomizes a respective program. For example, we notice that the term "seamless transition" they pretty much shied away from; it's now called "continuum of care." Seamless transition, I think the terminology holds us to a standard, and I will give you an analogy. VA's nursing home care facilities are now called community living centers. The American Legion has visited many, over 50 in this Nation, and they are holding to that standard, I think it’s even better, because they are trying to pretty much help that veteran who is transitioning identify with their respective community by transforming the nursing home facility into a main street type community facility. So with VA, everything may be in a name. So seamless transition makes us aware of this process. Before it was called seamless transition as I said the name was changed to continuum of care, and I think we shied away from that level boost.
Mr. ROE. Let me interrupt for just a second because I don’t have much time left. But I know when I got out of the Army basically I gave myself my own physical to get out, because I wanted out, like most of us do. And I think that is what happens when you said we are young and stupid. I think you are right about that.
Would it help when a veteran ETS’s (Expiration of Term of Service) from the military if the VA were there at the time of separation and to prepare that veteran to move on? And I know I was given a physical, but is everybody given a physical on the way out the door? Do you have a record when you leave the military, are you examined by a physician or a physician assistant or whatever and get a complete physical exam before you leave so that you have that information when you leave? Because, see I think if you are injured, the best time to find out how bad your injury is, and it may change. As you pointed out, as you get older things change. But you at least at that point in time you would know exactly what was wrong with that soldier. And Captain Pruden or Mr. Tarantino. Either one. Captain?
Captain PRUDEN. I think that having a pre-release physical is vital as part of this. But I will tell you that servicemembers who are coming off active duty currently because of enhanced oversight and programs that have been implemented in the last 6 years, do have a whole array of briefings about benefits that are available to them as they leave the service. Oftentimes there is a bit of information overload. They don’t remember most of what is told them. They have 100 forms they have to sign. And so they leave the service having heard one time this thing that goes in one ear, out the other. They don’t recognize that they will need that in the future.
So I think again, it is critical the VA be there doing outreach as these guys are coming into the VA system. And you know, when the OIF/OEF folks are coming into the VA and enrolling in the VA, that they have the best primary care physicians around. As you guys know, the primary care managers at the VA are sort of the gatekeepers to all of their specialty care and will be the primary folks interacting with our wounded warriors and our veterans. And if nurse case managers—OIF/OEF nurse case managers could have override capabilities to put wounded warriors and veterans with appropriate primary care managers instead of sort of leftovers after—older veterans talk, and they know who the best doctors at the VA are.
Mr. ROE. Not only veterans talk.
Captain PRUDEN. Yeah. But they know who the best doctors are at the VA, and so there is a waiting list to get on with that primary care manager. The newest nurse case managers and the least experienced and perhaps maybe not the best physicians in the VA are the ones who have open slots typically, and oftentimes these warriors are assigned to folks who don&rsquo
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