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Witness Testimony of Hon. Donna E. Shalala, President's Commission on Care for America's Returning Wounded Warriors, Co-Chair, (Fomer Secretary of the U.S. Department of Health and Human Services)

Good morning Chairman Filner, Congressman Buyer, and distinguished members of the Committee. Thank you for giving me the opportunity to testify today, along with my fellow Co-Chair, Senator Bob Dole, about the recommendations our Commission  presented to the President in late July.

It was a true privilege to serve on the President’s Commission on Care for America’s Returning Wounded Warriors, especially with Senator Dole, whose knowledge and dedication was an inspiration to us all. We were joined by a stellar group of commissioners, each of whom gave their full energy and attention to the critical mission we faced.

As you know, we had an extremely short time frame to complete our mission – but, we were propelled by a sense of urgency that the issues before us required.  Mr. Chairman and members of the Committee, we know you share this sense of urgency and that’s why we are so pleased to be with you today to discuss not only our recommendations, but the critical need to implement them.

We have been truly heartened by the response our report has received in the White House, the halls of Congress and throughout the country.  The nation has rallied behind the need to help those who have put their lives on the line in service to our country – and we are optimistic that Congress and the Administration will move quickly to respond to this need by enacting our recommendations.

As we were reminded again by the article in Saturday’s Washington Post, the problems facing our injured service men and women have not gone away.  Congress and the Administration have spent a great deal of time the past few weeks discussing the future of the war in Iraq.  And while this is a debate that our nation must have, I implore you not to forget about those who have already sacrificed so much – our injured men and women.  They need to be front and center in Congressional debate and within the Administration. 

The story of Staff Sgt. John Daniel Shannon as told in the Washington Post is a story that we heard throughout our time with the Commission -  a story of numerous case managers none of who held sole responsibility for spearheading an integrated care system – a story of lost paperwork and frustration – and a story of a disability system that was in desperate need of repair. 

It’s stories like this that sparked the creation of our Commission – and stories like this that should and must drive immediate Congressional and White House action.

This past July, it was the Commission’s honor to present to the President, Congress and the public, six groundbreaking patient and family centered recommendations that make sweeping changes in military and veterans’ health care and services. The recommendations include the first major overhaul of the disability system in more than 50 years; creation of recovery plans with recovery coordinators; a new e-Benefits website; and guaranteeing care for post traumatic stress disorder from the VA for any service member deployed to Iraq and Afghanistan. Our report - Serve, Support, Simplify (hold up report) - is a bold blueprint for action that will enable injured service members to successfully transition, as quickly as possible, back to their military duties or civilian life.  Our report calls for (and I quote) “fundamental changes in care management and the disability system.” I respectfully request that this report be submitted for the record.

Specifically, our six recommendations will:

  • Immediately Create Comprehensive Recovery Plans to Provide the Right Care and Support at the Right Time in the Right Place
  • Completely Restructure the Disability Determination and Compensation Systems
  • Aggressively Prevent and Treat Post-Traumatic Stress Disorder and Traumatic Brain Injury
  • Significantly Strengthen Support for Families
  • Rapidly Transfer Patient Information Between DoD and VA
  • Strongly Support Walter Reed By Recruiting and Retaining First Rate Professionals Through 2011

Our six recommendations do not require massive new programs or a flurry of new legislation. We identify 34 specific action steps that must be taken to implement the six recommendations. Only six of these 34 items require legislation, and that’s what we will focus on today. A complete list of the action steps for the six recommendations is included on the last page of my testimony.

I will summarize the first three actions that require legislation, and, then, Senator Dole will cover the remaining three.

The first is to improve access to care for service members with Post-Traumatic Stress Disorder.

We call on Congress to authorize the VA to provide lifetime treatment for PTSD for any veteran deployed to Iraq or Afghanistan in need of such services.    This “presumptive eligibility” for the diagnosis and treatment of PTSD should occur regardless of the length of time that has transpired since the exposure to combat events. 

The current conflicts involve intense urban fighting, often against civilian combatants, and many service members witness or experience acts of terrorism.  Five hundred thousand service members have been deployed multiple times.  The longer service members are in the field, the more likely they are to experience events, which can lead to symptoms of PTSD.  The consequences of PTSD can be devastating.  The VA is a recognized leader in the treatment of combat-relatedPTSD, with an extensive network of specialized inpatient, outpatient, day hospital, and residential treatment programs.    Therefore, we ask that any veteran of the Iraq or Afghanistan conflicts be able to obtain prompt access to the VA’s extensive resources for diagnosis and treatment.

Next, we ask Congress to strengthen support for our military families.  

In our travels across the country, it become abundantly clear that we not only needed to help the severely injured, we needed to help their loved ones too.  These loved ones are often on the front lines of care and they are in desperate need of support.  Therefore, we call upon  Congress to make service members with combat related injuries eligible for respite care and aide and personal attendant benefits.  These benefits are provided in the current Extended Care Health Option program under TRICARE.    Presently, DoD provides no other benefit for care-giving.  Yet we know that many families are caring for their injured service member at home – and many of these service members have complex injuries.  These families, forced into stressful new situations, don’t need more anxiety and confusion, they need support. Families are unprepared to provide 24/7 care.  Those that try, wear out quickly.  By providing help for the caregiver, families can better deal with the stress and problems that arise when caring for a loved one with complex injuries at home.    

We also recommend that Congress amend the Family and Medical Leave Act (FMLA) to extend unpaid leave from 12 weeks to up to six months for a family member of a service member who has a combat-related injury and meets other FMLA eligibility requirements. According to initial findings of research conducted by the Commission, approximately two-thirds of injured service members reported that their family members or close friends stayed with them for an extended time while they were hospitalized; one in five gave up a job to do so. 

Getting family members to the bedside of an injured service member is not the problem.  The services have developed effective procedures to make this happen, and the private sector has stepped up to provide temporary housing.  Because most injured service members recover quickly and return to duty, the family member’s stay may be short.  However, for those whose loved one has incurred complex injuries, the stay may last much longer.  Extending the Family and Medical Leave Act for these families will make a tremendous difference in the quality of their lives.  Congress enacted the initial Family and Medical Leave Act in 1993, when I was Secretary of Health and Human Services.  Since then, its provisions have provided over 60 million workers the opportunity to care for their family members when they need it most – without putting their jobs on the line.

We were pleased to see that the Senate has already unanimously passed the Support for Injured Service Members Act which implements this recommendation.  We hope the House of Representatives will quickly follow suit.

Mr. Chairman, having served in government a good deal of my life, I believe that government can work to improve the lives of its citizens. But sometimes, people of good will want to solve a problem and their idea of a fix is to add a program or a new regulation. What we’ve done is strip some of that away to simplify the system, to go back to basic principles and to make necessary programs more patient and family centered.

Above all, our recommendations are doable.  Whether requiring Congressional legislation or implementation by DOD or VA, we made sure that what we were recommending could be acted upon quickly.  Our seriously injured service members must not be made to wait. They deserve a health care system that truly serves, supports and simplifies. 

On behalf of the Commission, I want to thank the Committee again for the opportunity to discuss our recommendations.  And because those of you who know me know I don’t mince words, I leave the Committee – and the Administration - with these three simple words – Just do it!    And, Mr. Chairman and members of this distinguished Committee, I know that through your leadership, our recommendations WILL become a reality for our service members and their families.

 Thank you and I look forward to joining Senator Dole in answering your questions. 

"Serve, Support, Simplify, Report of the President's Commission on Care for America's Returning Wounded Warriors Report," July 2007

"Serve, Support, Simplify, Report of the President's Commission on Care for America's Returning Wounded Warriors,  Subcommittee Reports and Survey Findings," July 2007