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Witness Testimony of Karen Gillette, RN, MSN, GNP, U.S. Department of Veterans Affairs, Federal Recovery Coordinator, Providence Department of Veterans Affairs Medical Center

Good morning Chairwoman Buerkle, Ranking Member Michaud, and Members of the Committee.  My name is Karen Gillette, and I am a Federal Recovery Coordinator (FRC) from Providence, Rhode Island.  Thank you for inviting me today to tell you what I do as a FRC to assist recovering Servicemembers, Veterans and their families as they heal and return home.  My testimony will focus on my roles and responsibilities in the service of my clients.

Overview

I have been a FRC since 2008. My current active caseload includes 55 clients, all in different stages of recovery and reintegration. Some of my clients have been recently injured and are still being treated at military treatment facilities, while others are receiving care at private rehabilitation facilities. I have clients, now Veterans, who were injured several years ago and continue to need assistance with Veterans’ benefits, case management issues at their local Department of Veterans Affairs (VA) facility, vocational rehabilitation benefits, or help finding community resources in their local area. In addition to my caseload, I also have clients on my inactive case list that occasionally contact me with questions or to just let me know how they are doing.

My experience in this field stems from my clinical and administrative experiences as a nurse practitioner and nurse executive, and from the extensive Federal Recovery Coordination Program (FRCP) training and education on Veterans benefits programs, military programs, TRICARE, social security, Department of Labor programs and VA programs. FRCs attend quarterly training at different sites including VA’s polytrauma facilities around the country. We have met with the staff at Walter Reed Army Medical Center, National Naval Medical Center, Quantico, and at Veterans Benefits Administration (VBA) Regional Offices. We have had training on mediation, coaching, mentoring and motivational interviewing. My experience and training have helped me to establish a good working relationship with families, and to gain experience in the Veterans Health Administration (VHA) system and a working knowledge of VBA policy and resources.

My caseload consists of referrals from many different sources. Referrals come from VA case managers, military personnel, caregivers, community and charitable organizations, and clients, who also refer other Wounded Warriors to our program. I have Army Wounded Warrior (AW2), Air Force Wounded Warrior (AFW2) and Marine District Injured Support Cells (DISC) staff who ask me to assist with their clients having problems with reintegration into the community. I also make sure to ask these sources if there are any other cases they are aware of where my services might be beneficial.

I currently work with case managers located in over 35 VA Medical Centers (VAMC).  These include Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) case managers, polytrauma coordinators, spinal cord injury/disability coordinators, community nurse coordinators, home-based primary care staff, social workers in VA’s community living centers, as well as health care providers. We collaborate to share resources, suggestions and information that meet the client’s needs. I work closely with fee basis staff and prosthetic department staff, speech therapists and other members of the physical medicine and rehabilitation staff at local VAMCs and clinics. I work with VBA personnel who manage the compensation claims, vocational rehabilitation and fiduciary needs of my clients at VBA sites around the country.  Beyond VA, I work with staff at the Social Security Administration, state disability and Medicaid case managers and TRICARE and military nurse case managers on a regular basis.

I stay in close contact with the different wounded warrior program representatives, and we discuss resources and options that might be of benefit to shared clients. We collaborate closely and make sure the right person is doing what is needed. I work with recovery care coordinators on some cases that we share. I usually focus on VHA and VBA issues and the recovery care coordinators focus on military administrative detail. Our collaboration is effective and complementary.

As a FRC, I provide many informational briefings about the program at national conferences. I have staffed FRCP booths at a variety of meetings and conferences and have used that opportunity to discuss the program with attendees. I attend Veterans Integrated Service Network-level training and conferences in New England and try to stay in contact with VA’s polytrauma coordinators. I have also attended military conferences to discuss the role of the FRC in a client’s treatment and recovery.

I would now like to share with you some examples of the issues I handle on a typical workday.

My workday begins by reviewing my work list, notes, tasks, phone calls and e-mail so that I can prioritize the day’s issues. My goal, however, is to ensure that all of my clients are moving closer to the goals established on their Federal Individual Recovery Plan (FIRP).

In one case, I collaborated with VA staff in getting a client with severe traumatic brain injury (TBI) admitted to a VA polytrauma rehabilitation facility to be evaluated for admission to an emerging consciousness program. The family was relocating, and they were interested in having the client receive care at a VAMC close to their new home. The mother provides 24/7 in-home care for the client, who is minimally conscious but has been showing increased awareness over the last 6 months. I conducted a conference call with the closest VA polytrauma team to the family’s intended place of relocation to review the client’s case.

In another case, I spoke to an active duty Servicemember’s mother about the Servicemember’s progress at a private rehabilitation facility, and we discussed future possibilities with her for the next phase of his recovery. I then called the Servicemember’s medical case manager at the military treatment facility to discuss future transfer plans for this client from the private rehabilitation facility back to the military treatment facility, and then on to a VA polytrauma facility. The medical case manager agreed to contact the family and make travel arrangements for them, and to assist with accommodations at a Fisher House.

I worked with an OEF/OIF/OND VBA case manager to resolve issues related to a client’s VBA compensation and pension rating process. Prior to this, I had worked with VBA to get this client’s rating file moved to the seriously injured list to expedite the case. The client is at a VA spinal cord injury/disability center. The case manager will work with the family and the VBA rating official to ensure that the client’s claim moves forward.

I received a call from a Veteran’s family regarding their visit to a private neurological residential center that I had located for them as a possible site for the Veteran’s next phase of community re-integration. This young Veteran is a candidate for VA’s TBI Assisted Living pilot program. The family was very pleased with the site, which was in the location of their choice. I provided the TBI-Assisted Living pilot program administrator and the local VA with an update on the family’s visit, and they initiated the required contracting process.

I spoke to a case manager at a military treatment facility about a new referral.  The Veteran had not used VA for heath care since a stroke. In addition, the Veteran’s VBA Monthly Special Compensation had recently been decreased, which resulted in the Veteran having to relocate across the country. I reviewed the Veteran’s rating letter and found that the rating decrease was possibly due to inadequate documentation provided to the rater. I began gathering information to help educate the individual and the family about FRCP and to assist the Veteran with collecting the necessary documentation to support the claim. I called the Marine DISC in that area and asked him to contact this former Marine as an additional support to the family. I connected the Veteran with the local OEF/OIF/OND care management team, who then contacted the family to provide assistance.

I assisted an OEF/OIF team in finding a private substance abuse rehabilitation program for a client who required a more controlled environment than VA could provide.

I contacted a VBA regional OEF/OIF officer and asked for his assistance in helping a client whose adapted car recently caught fire and was inoperable. This family had been told that they were not eligible for another auto grant. The VBA representative contacted the family and worked on the issue with them.

I coordinated with multiple levels of leadership to expedite the transfer of one of my clients from one VA community living center to another.

These are just a few examples of what I do every day to assist my clients. Most of my time is spent in making multiple phone calls, writing and responding to e-mails and following-up to ensure that things are progressing as they should. All of my activities are documented in the FRCP data management system. I spend a lot of time providing medical education to families and clients, as they are sometimes reluctant to take up the health provider’s time during a clinic appointment time just to ask questions. I spend a lot of time on the National Resource Directory looking for resources and opportunities for my clients and their families.

Conclusion

In conclusion, in the 3 years I have worked as a Federal Recovery Coordinator, I have established rapport with most of the stakeholders involved in moving these catastrophically ill and injured Servicemembers and Veterans into more stable and satisfactory life situations. I have found that what appears to be a “simple to resolve” situation can take multiple phone calls and e-mails to keep the process moving forward towards resolution. It takes effective communication with a variety of people to address my clients’ complex issues.

I assist my clients in navigating the intricate VA and military health care systems. I have been able to assist many of my families in connecting to the right resources at the right time, assist them with getting their Social Security and VA claims completed, and connect them with private charitable organizations that can meet some of their financial needs. I provide support as relationships are established with VA teams, increasing the Veteran and family’s trust and willingness to choose VA as their health care provider. I am proud to have served our country’s Veterans and Servicemembers that have sacrificed so much for our country.

Thank you for having me here today to share with you my experiences, and I look forward to your questions.