Good Morning, Chairman Michaud, Ranking Member Brown, and Members of the Subcommittee.  Thank you for the opportunity to appear to discuss the Department of Veterans Affairs’ (VA) work in caring for severely injured Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans and Servicemembers through our full complement of specialty, rehabilitative services.  VA’s mission includes ensuring we have appropriately staffed facilities that provide timely, accessible, coordinated, high quality specialty care for our severely injured Veterans.  We appreciate Congress’ support in providing VA the resources necessary to meet the needs of our Veterans.

VA is committed to helping Servicemembers transition from active duty to Veteran status as smoothly as possible.  The Veterans Health Administration (VHA) is well-known for its integrated system of health care and its expertise in treating spinal cord injuries and disorders (SCI/D), traumatic brain injury (TBI), and blindness and visual impairment.  Our provision of quality rehabilitation care is supported through a system-wide, long-term collaboration with the Commission on Accreditation of Rehabilitation Facilities (CARF) to achieve and maintain national accreditation for all appropriate VHA rehabilitation programs.  VA continues to increase collaborations with private sector facilities to successfully meet the individualized needs of Veterans and complement VA care and services.  This ensures that quality rehabilitation programs are offered in a timely manner that meet the unique needs of severely injured Veterans and provide a catalyst for improving their quality of life.  

Our severely injured Veterans returning from OEF/OIF rightfully expect us to provide the latest in treatment, technology, and rehabilitation services.  VA has established policies and supports its facilities to ensure that specialty services are structured appropriately, fully staffed, and effectively coordinated.  We understand and appreciate the specialized skills required to deliver the care our Veterans need and deserve, and to that end VA has created numerous education and training opportunities for our clinical providers.

Facility capacity and bed occupancy rates are routinely monitored at the local level and are reported to the national program offices at least monthly to ensure our OEF/OIF Veterans have open access to our care and services.  Any surge in demand for services are addressed with corrective actions such as temporarily increased staffing, use of additional existing authorized beds at the Polytrauma Rehabilitation Centers (PRCs), careful planning of elective admissions, and transfers within the Polytrauma System of Care (PSC) of non-traumatically disabled Veterans to ensure that the first priority for admissions remains allocated to Servicemembers and Veterans with severe injuries.  Flexibility is available to provide additional resources at specific locations, if necessary.

My testimony will begin by explaining how VA supports and facilitates the transition and care management of severely injured OEF/OIF Veterans into specialty rehabilitation programs, then provide a detailed review of four major rehabilitation areas:  VA’s Blind Rehabilitation Service, its Spinal Cord Injury/Disorders program (SCI/D), the Polytrauma and TBI System of Care, and the Amputation System of Care and Prosthetics and Sensory Aids Service. 

Transition and Care Management of OEF/OIF Veterans

VA recognizes that severely injured Servicemembers face a significant transition when returning home and becoming Veterans.  In addition to treating Veterans with blindness, SCI&D, polytrauma/TBI, and amputations, VA and Department of Defense (DoD) have worked together through a Memorandum of Agreement for almost 30 years to deliver rehabilitation services to active duty Veterans and Servicemembers with such injuries.  

As soon as the pre-requisites for medical stability are met, the DoD physician and the VA admitting physician at one of VA’s specialty centers begin discussion on the patient’s medical status and arrange for appropriate transportation and admission to the VA facility closest to the Veteran’s or Servicemember’s home.  Each patient receives a customized rehabilitation plan designed to achieve patient-centered goals and maximal functional independence.  Rehabilitation serves to improve any bodily functions affected by the injury, teach compensatory functions using remaining intact body systems, anticipate and prevent medical complications, alter the environment as needed, and educate the person to promote autonomy and to achieve their full potential and quality of life.

In order to make VA easier to access for those most in need, we have responded by partnering with DoD to create the Federal Recovery Coordination Program, and creating a Care Management and Social Work Service responsible for developing policies and deploying staff to VA and DoD facilities.

VA’s Care Management and Social Work Service

In October 2007, VA established the Care Management and Social Work Service to address the needs of wounded and ill Veterans and Servicemembers.  VA’s Military Liaisons for Healthcare are social workers or nurses who serve as essential resources for transitioning injured and ill OEF/OIF Veterans and Servicemembers.  VA now has 33 VA Military Liaisons for Healthcare stationed at 18 military medical treatment facilities (MTFs) to transition ill and injured Servicemembers from DoD to a VA more appropriate for the specialized services their medical condition requires, or closer to home.  

VA Military Liaisons are co-located with DoD Case Managers at MTFs and provide onsite consultation and collaboration regarding VA resources and treatment options.  They educate Servicemembers and their families about VA’s system of care, coordinate the Servicemember’s initial registration with VA, and secure outpatient appointments or inpatient transfer to a VA health care facility as appropriate.  VA Military Liaisons make early connections with Servicemembers and families to begin building a positive relationship with VA.  Our Liaisons coordinated 5,000 referrals for health care and over 20,000 professional consultations in fiscal year (FY) 2010 through June.  

Each VA medical center has an OEF/OIF Care Management team in place to coordinate patient care activities and ensure that Servicemembers and Veterans are receiving patient-centered, integrated care and benefits.  Members of the OEF/OIF Care Management team include:  a Program Manager, Clinical Case Managers, Veterans Benefits Administration (VBA) Service Representatives, and a Transition Patient Advocate.  The Program Manager, a nurse or social worker, has overall administrative and clinical responsibility for the team and ensures that all OEF/OIF Veterans are screened for case management.  Severely injured OEF/OIF Veterans are provided a case manager, and any other OEF/OIF Veteran may be assigned a case manager based upon initial assessment or upon request.  Clinical Case Managers coordinate patient care activities and ensure that all clinicians providing care to the patient are doing so in a cohesive and integrated manner.  

VBA team members assist Veterans by educating them about VA benefits and assisting with the benefit application process.  The Transition Patient Advocate helps the Veteran and family navigate VA’s system by acting as a communicator, facilitator and problem-solver.  Since many returning OEF/OIF Veterans connect to more than one specialty case manager, VA introduced a new concept of a “lead” case manager.  The lead case manager now serves as a central communication point for the patient and his or her family.  Case managers maintain regular contact with Veterans and their families to provide support and assistance to address any health care and psychosocial needs that may arise.  The OEF/OIF Care Management program now serves over 44,000 Servicemembers and Veterans, including 5,800 who are severely injured. 

OEF/OIF Care Management team members actively support outreach events in the community, such as annual ‘Welcome Home’ events.  OEF/OIF team members also participate in the demobilization process, the Yellow Ribbon Reintegration Program, Post-Deployment Health Reassessment events, and Individual Ready Reserve musters.  OEF/OIF staff regularly make presentations to community partners, Veterans Service Organizations, colleges, employment agencies and others to collaborate in providing services and connecting with returning Servicemembers and Veterans.  VHA and VBA officials coordinate on the full range of services and benefits to Veterans and their families to support their transition back to civilian life.

Federal Recovery Coordination Program

The needs of severely injured Servicemembers and Veterans are also met through the services provided by the Federal Recovery Coordination (FRC) Program.  FRCs serve to ensure that severely injured Veterans and Servicemembers receive access to the benefits and care they need to recover.  Since its creation in 2008, the FRC Program has helped Servicemembers and Veterans access Federal, state and local programs, benefits and services, while supporting the families of these heroes through their recovery, rehabilitation, and reintegration into the community.  Currently, 556 clients are enrolled and another 31 individuals are being evaluated for enrollment; an additional 497 have received assistance through FRC.  

Blind Rehabilitation

The VA Blind Rehabilitation Service (BRS) provides world-class comprehensive evaluation, planning, and rehabilitation treatment for OEF/OIF Veterans and Servicemembers with any level of visual impairment.  BRS assesses, recommends and trains Veterans in the use of technology and assistive devices with enlarged print, Braille or speech output such as computers, personal digital assistants and global positioning systems.  BRS, together with VA eye care practitioners, incorporates the latest in optical enhancing devices into rehabilitation care.  This technology serves to enhance independence, social functioning, employment, and education.

 Blind Rehabilitation Services are delivered at every VA medical center, with 157 Visual Impairment Service Team Coordinators who provide care management, and 77 Blind Rehabilitation Outpatient Specialists who provide in-home and in-community service.  Additionally, VA has 55 outpatient blind and vision rehabilitation clinics, and 10 inpatient Blind Rehabilitation Centers; three additional inpatient centers will open in FY 2011 in Cleveland, OH, Biloxi, MS, and Long Beach, CA.   VA blind rehabilitation services are structured and geographically located for visually impaired Veterans and Servicemembers to access the care they need.  

The BRS database tracks OEF/OIF Veterans with visual impairment to ensure ongoing coordination of care for these patients.  As of June 2010, Blind Rehabilitation Service is tracking 1,098 OEF/OIF Veterans and Servicemembers who have received blind and vision rehabilitation care, or who have been referred for screening to rule out possible visual consequences associated with TBI.  Of this total, 126 active duty Servicemembers have attended inpatient blind rehabilitation centers due to severely disabling visual impairment.  VA has also held several national training conferences on the visual consequences of TBI to educate our providers, and has added specific medical codes to document the visual consequences of TBI in VA’s clinical patient record system.  We have placed Blind Rehabilitation Outpatient Specialists at Walter Reed Army and National Naval Medical Centers, as well as at locations in VA’s Polytrauma System of Care.  Results indicate  that patients completing VA’s inpatient blind rehabilitation programs have better functional outcomes than patients from blind rehabilitation programs in the private sector.  

Spinal Cord Injury

VA’s Spinal Cord Injury Program is the largest single network of care and rehabilitation in the Nation for the treatment of persons with spinal cord injury (SCI).  VA facilities nationwide in 2009 provided a full range of services to 27,067 Veterans with SCI/D; 13,398 of these Veterans received specialized care within the 24 Spinal Cord Injury Centers or SCI Support Clinics.  For Veterans with SCI, VA provides health care and rehabilitation services, maintains medical equipment and supplies, and offers education and preventive health services.  Since 2003, 503 Servicemembers have been treated in VA SCI units, and of those Servicemembers, 162 incurred a spinal cord injury in an OEF/OIF theater of operations.

VA’s SCI system of care is internationally regarded for its comprehensive and coordinated services for rehabilitation, surgical, medical, preventive, ambulatory, long term, and home-based care.  Interdisciplinary teams of professionals with highly specialized knowledge and experience deliver rehabilitation care, SCI specialty care, and broadly based medical services.  VA is a world leader in best practices providing outstanding clinical care, customized wheelchairs, adaptive equipment, technological interventions, therapies, teaching, and training so Veterans with SCI can be as healthy and independent as possible in their homes and communities. 

VA promotes activity-based therapies at its SCI Centers to improve mobility, recovery of walking and hand function.  Recently, VA enhanced the rehabilitation and training environments to offer the latest and most effective interventions to fully utilize sensory patterned feedback, re-training of central pattern generators, use of body weight support, and electrical stimulation for newly injured Servicemembers and Veterans in all VA Spinal Cord Injury Centers.  These services include: early standing and weight-bearing; body weight support and treadmill training; over ground training for walking; and electrical stimulation for weak and paralyzed muscles in the lower limbs for ambulation and upper limbs for hand function.  There is currently a growing and integrated system of telehealth services for Veterans with SCI, and recent funding has provided telehealth systems in every SCI Center and to more than 90 percent of the SCI support and primary care teams.

VA’s SCI System of Care prevents and treats co-morbid problems related to the original spinal cord injury.  For example, pressure ulcers (bed sores) are a common and costly complication resulting in high rates of illness and death.  Data from FY 2008-2010 demonstrate that our new prevention efforts are successful and have reduced the rate of developing a new hospital-acquired pressure ulcer to an extremely low level.  The data reflects that 95 percent of patients with SCI were screened for pressure ulcer risk within twenty four hours of admission, 96 percent of at-risk patients had a documented plan of skin care within 48 hours of admission, and only 1.3 percent of patients with SCI who were hospitalized in FY 2009 developed pressure ulcers.

Polytrauma/Traumatic Brain Injury

VA also offers rehabilitation services for returning OEF/OIF Veterans and Servicemembers with polytrauma and traumatic brain injuries.  “Polytrauma” is a new word in the medical lexicon that was termed by VA to describe the injuries to multiple body parts and organs occurring as a result of exposure to explosive devices or blasts to those serving in OEF/OIF.  Polytrauma is defined as two or more injuries to physical regions or organ systems, one of which may be life threatening, resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability.  Traumatic brain injury (TBI) frequently occurs in polytrauma in combination with other disabling conditions such as amputation, auditory and visual impairments, spinal cord injury, post-traumatic stress disorder (PTSD), and other medical problems.  Due to the severity and complexity of their injuries, Servicemembers and Veterans with polytrauma require an extraordinary level of coordination and integration of clinical and other support services.

VA has developed and implemented numerous programs that ensure the provision of world-class rehabilitation services for Veterans and active duty Servicemembers with TBI.  Since 1992, VA has had four lead TBI Centers designated as part of the Defense and Veterans Brain Injury Center (DVBIC) collaboration to provide comprehensive rehabilitation for Veterans and active duty Servicemembers.  In 1997, VA designated a TBI Network of Care to support care coordination and access to services across VA’s system.  

Beginning in 2005, VA expanded the scope of services at existing VA TBI Centers to implement an integrated nationwide Polytrauma System of Care (PSC) that provides world-class rehabilitation services, and ensures that Veterans and Servicemembers with TBI and polytrauma transition seamlessly from DoD and VA and back into their home communities.  Today, the VA Polytrauma System of Care is an integrated, tiered system that provides specialized, interdisciplinary care for polytrauma injuries and TBI across four levels of facilities, including: 4 Polytrauma Rehabilitation Centers, 22 Polytrauma Network Sites, 82 Polytrauma Support Clinic Teams, and 48 Polytrauma Points of Contact.  The System offers comprehensive clinical rehabilitative services including:  treatment by interdisciplinary teams of rehabilitation specialists; specialty care management; patient and family education and training; psychosocial support; and advanced rehabilitation and prosthetic technologies.

Polytrauma Rehabilitation Centers (PRCs) serve as regional referral centers for the most intensive specialized care and comprehensive rehabilitation care for Veterans and Servicemembers with complex and severe polytrauma.  PRCs maintain a full staff of dedicated rehabilitation professionals and consultants from other specialties to support these patients.  Each PRC is accredited for Brain Injury Rehabilitation by the Commission on Accreditation of Rehabilitation Facilities (CARF), and each serves as a resource to develop educational programs and best practice models for other facilities across the system.  The four regional Centers are located in Richmond, VA; Tampa, FL; Minneapolis, MN; and Palo Alto, CA.  A fifth Center is currently under construction in San Antonio, TX, and is expected to open in 2011.

The next three levels of the Polytrauma System of Care provide specialized rehabilitation services and coordinate care at locations closer to the Veterans’ home communities.  Polytrauma Network Sites (PNS) provide inpatient and outpatient rehabilitation care and coordinate TBI and polytrauma services throughout the Veterans Integrated Service Network (VISN).  The inpatient rehabilitation units at the PNS maintain CARF accreditation for Comprehensive Inpatient Medical Rehabilitation.  Polytrauma Support Clinic Teams conduct comprehensive evaluations of patients with positive TBI screens and develop and implement rehabilitation and community reintegration plans for Veterans and Servicemembers in their catchment areas.  Polytrauma Points of Contact ensure that Veterans and Servicemembers needing specialized rehabilitation services are referred to the appropriate level of care within or outside of VA, if necessary.  VA appreciates Congress’ work in passing the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111-163), which will allow VA to provide specialized residential care for TBI patients and rehabilitation services for Veterans with TBI at non-Department facilities.

VA continually enhances the scope of specialized rehabilitation services available through the Polytrauma System of Care. New programs and initiatives include:

• In 2007, VA developed and implemented Transitional Rehabilitation Programs at each PRC.  These 10-bed residential units provide rehabilitation in a home-like environment to facilitate community reintegration for Veterans and their families. Through December 2009, 188 Veterans and Servicemembers have participated in this program spending, on average, about 3 months in transitional rehabilitation.  Almost 90 percent of these individuals return to active duty or transition to independent living.
• Beginning in 2007, VA implemented a specialized Emerging Consciousness care path at the four PRCs to serve those Veterans with severe TBI who are slow to recover consciousness.  To meet the challenges of caring for these individuals, VA collaboratively developed this care path with subject matter experts from Defense and Veterans Brain Injury Center (DVBIC) and the private sector.    From January 2007 through December 2009, 87 Veterans and Servicemembers have been admitted into VA’s Emerging Consciousness program.  Approximately 70 percent of these patients emerge to consciousness before leaving inpatient rehabilitation.
• In April 2009, VA began an advanced technology initiative to establish Assistive Technology laboratories at the four PRCs to provide the most advanced technologies related to cognitive-communication, sensory and motor impairments.  This initiative allowed VA to enter into a contractual agreement with the University of Pittsburgh to develop state-of-the-art Assistive Technology (AT) labs.  The goal of this initiative is to develop extensive banks of AT devices for equipment trials, a method for evaluating new AT technology, standardized evaluation procedures, and an outcomes data collection tool.  AT can contribute to enhancing an individual’s ability to function in their environment and achieve the highest level of independence possible for persons with disabilities.

Since March 2003, an average of 130 Servicemembers with severe polytraumatic injuries have been referred annually for acute medical, surgical, and rehabilitative care at the four PRCs, ranging from 99 (FY 2003) to 330 (FY 2008), for a total of 907 Servicemembers.  Of the total 907 Servicemembers served, 754 were injured in OEF/OIF areas of operations.  Thus far in FY 2010, a total of 110 Servicemembers have been treated at the PRCs.  Additionally, a total of 885 Veterans with severe injuries have been admitted to the PRCs since 2003.  In FY 2009, 49,207 patients were seen across VA for inpatient or outpatient services related to TBI; 46,990 patients were treated in outpatient clinics for a total of 83,794 visits.  This represents a 30 percent increase over FY 2008.

VA has developed and implemented the TBI Screening and Evaluation Program for all OEF/OIF Veterans who receive care within VA.  From April 2007 through April 2010, VA has screened 418,109 OEF/OIF Veterans for possible TBI; of these, 57,569 Veterans who screened positive have been evaluated and have received follow-up care and services appropriate for their diagnosis and their symptoms.  A total of 31,480 Veterans have been confirmed with a diagnosis of having incurred a mild TBI.  Over 90 percent of all Veterans who are screened are determined not to have TBI, but the 10 percent who screen positive and complete the comprehensive evaluation are referred for appropriate treatment.  Completion of the TBI screening and evaluation for each OEF/OIF Veteran allows VA to continually assess resources and access to care.

VA has sufficient resources to meet the needs of Veterans with TBI, and TBI is a Select Program in VA budget submissions.  In FY 2010, $231.9 million has been programmed for TBI care for all Veterans and $58.2 million is programmed for OEF/OIF Veterans.  

Amputation/Prosthetics and Sensory Aid Programs

 A closely related Program is the Amputation System of Care and VA’s Prosthetics and Sensory Aid Services.  These two efforts complement each other in providing quality, accessible care to Veterans across the country.

Amputation System of Care

VA has an extensive program for amputation rehabilitation.  In 2007, VA’s Offices of Rehabilitation and the Prosthetics and Sensory Aids Service collaborated to develop an Amputation System of Care (ASC) designed to standardize care delivery, reduce variance, and increase access to state-of-the-science rehabilitation techniques and prosthetic technology.  VA began deploying this System in 2009, enhancing structures within VA to create tiered levels of expertise and accessibility across four distinct components of care.  Today there are 7 Regional Amputation Centers, 15 Polytrauma/Amputation Network Sites, 101 Amputation Clinic Teams, and 31 Amputation Points of Contact across the ASC.  Collectively, this system delivers specialized expertise in amputation rehabilitation incorporating the latest practice in medical rehabilitation management, rehabilitation therapies, and technological advances in prosthetic components.

Regional Amputation Centers provide the highest level of specialized expertise in clinical care, technology, and rehabilitation for Veterans with the most severe extremity injuries and amputations.  These Centers have clinical expertise in state-of-the-science medical and rehabilitation techniques and prosthetic components and design.  These Centers provide comprehensive, holistic rehabilitation care through an interdisciplinary team that includes physiatrists, physical therapists, occupational therapists, prosthetists, social workers, case managers, nurses, psychologists and recreation therapists.  These Centers also serve as a resource for other facilities in the System through the development of tele-rehabilitation for consultation, models of care, best practices, educational programs, and the evaluation of new technology.

Polytrauma/Amputation Network Sites also provide inpatient and outpatient amputation rehabilitation as well as prosthetic labs closer to the Veteran’s home.  These Sites provide care to Veterans with multiple impairments, including amputation, and addressing the long-term care needs and coordinating access to specialized services either directly or via consultation.  These Sites also provide interdisciplinary care, with the clinical teams at these facilities well-trained in evaluation techniques, rehabilitation methods, and prescription of prostheses.  In addition to providing the full range of clinical and ancillary services, the Sites serve as a resource and consultant for complex management issues to other facilities within their network.  

Amputation Clinic Teams are designated at facilities with limited resources that may not provide a full scope of services, but still offer an interdisciplinary amputation care team.  Facilities at this level may or may not have an in-house Prosthetic/Orthotic Laboratory or an inpatient rehabilitation bed program.  Any sites without such services are augmented as necessary either through a contract, referral to a Polytrauma/Amputation Network Site, or through fee-based referral to an accredited facility in the private sector community.  Finally, Amputation Points of Contact are located at smaller VA facilities and ensure that Veterans and Servicemembers needing specialized rehabilitation and prosthetic services are referred to appropriate level of care or to other non-VA services.

VA provides care to more than 43,000 amputees, many of whom are older Veterans who require amputations as a result of medical problems such as dysvascular disease or diabetes.  A growing number of OEF/OIF Veterans with traumatic amputations also come to VA for services.  As of June 1, 2010 there were 1,011 OEF/OIF Veterans or Servicemembers with major amputations, of which 657 (or 65 percent) have sought care in VA.  Much of this care has been in the area of prosthetics where new prosthetic limbs and limb repair is provided.  All Veterans with amputation seen within VA, including OEF/OIF Veterans who account for 1.67 percent of these patients, require specialty care for the rest of their lifetime.  VA’s Amputation System of Care will ensure that VA is able to meet their needs.

 The VA Amputation System of Care works collaboratively with the Department of Defense’s Amputation Centers at Walter Reed Army Medical Center, the Center for the Intrepid in San Antonio at Brooke Army Medical Center, and the Amputation Center at the Balboa Navy Medical Center to coordinate transition services, train interdisciplinary amputee teams, and develop best practices.

VA and the Amputee Coalition of America (ACA) have partnered to establish a Peer Visitation Program within VA.  The ACA has trained 20 VA instructors across the Nation who can now train Veterans to be peer visitors.  VA currently has over 30 Veterans certified as peer visitors, and expects to double this number in 2011.  This program has been extremely successful at Walter Reed Army Medical Center and was identified by Servicemembers as the most important factor supporting their rehabilitation, second only to physical therapy with amputations.  VA and ACA are currently exploring establishing a peer visitation program for caregivers of amputees.

VA and DoD partnered to develop the Amputation Rehabilitation Clinical Practice Guideline, which represents the first attempt to provide an evidence-based structure for rehabilitation in lower limb amputation.  This will further assist in identifying priorities for new research efforts and allocation of resources to incorporate new technology as rehabilitation practices emerge.  VA and DoD also partnered to develop the Amputation Patient Education Handbook “The Next Step.”  This publication has received extensive positive feedback from Veterans, Servicemembers, and clinicians in its pre-release, and will be available for distribution across VA and DoD by the end of July 2010.

Lastly, VA is developing a Telehealth Amputation Program to improve access to specialty amputation care closer to the Veteran’s home.  Telehealth will be used to connect all four levels of the ASC, and amputation specialty care to community based outpatient clinics.

Prosthetics and Sensory Aids

VA’s Prosthetic and Sensory Aids Service (PSAS) provides Veterans with the prescribed equipment they require to maximize their independence and health.  PSAS exceeds other health care organizations in providing the variety and array of equipment and services.  PSAS provides everything from state-of-the-science bionic limbs, to custom wheeled mobility and seating solutions, to home and vehicle adaptations.  PSAS has a national evaluation process for reviewing and approving the purchase of new or experimental technology and services that are medically prescribed by the Veterans VA health care provider.  This process allows for the provision of devices that are not typically provided by DoD, Medicare, or any private health care provider.  

Female Veterans particularly find the personal attention required for their specific needs through PSAS.  Prosthetic devices such as breast prostheses or breast pumps, or a prosthetic style designed for women instead of men, are provided by PSAS to meet the unique needs of this Veteran population.  In FY 2009, PSAS provided items and services to 116,000 female Veterans at a cost of over $61 million.  Over 40,000 female Veterans received eyeglasses through VA with timely, accurate service, and an eyeglass style with which they are comfortable.  Our interdisciplinary Prosthetic Women’s Workgroup provides guidance regarding new items that are available to this special population, and is assisting with developing a brochure that targets female Veterans to inform them about PSAS services.  PSAS provides the personal service to ensure that every female Veteran receives the equipment and services—in the preferred style unique to women—to maximize her independence and quality of life.

Although not exclusive to the OEF/OIF Veteran, this population has helped bring to the forefront a wide range of technologies to keep this population active and engaged in their community.  VA provides computers for blind as well as physically disabled Veterans to assist them in managing their lives and retaining their independence.  VA also provides global positioning systems (GPS), smartphones, and the most advanced wheeled-mobility and seating solutions available.  VA was the first in the US to provide a microprocessor knee over ten years ago, and we have remained at the cutting edge of technology in the realm of prosthetic limbs.  We are currently optimizing the DEKA arm in hopes of getting it to the market place soon so that all Americans with upper extremity amputations might benefit.  VA is also receiving several of the new X-2 knees developed through a public-private endeavor  to build a knee that can navigate stairs, water, and even enable the user to walk backwards.

PSAS is a pioneer in the area of standardizing care through its Prosthetic Clinical Management Program.  PSAS developed national contracts that not only saved VA $400 million over the past few years, but also elevated the level of care for all Veterans by awarding national contracts to companies that provide only the highest quality products.  Interdisciplinary teams of clinical, patient safety and engineering experts rigorously review each offer to ensure only the best products are procured for our Veterans.  This Program has also led the development of more than 35 clinical practice recommendations that provide guidance to clinicians for prescribing prosthetic devices.  The result has been the successful elevation of the quality of devices and evaluations for Veterans.

Care to Women Veterans

The conflicts in Iraq and Afghanistan have introduced a new generation of Veterans into VA with specialized needs.  One segment of this new generation is Women Veterans.  Of the 1.1 million OEF/OIF Veterans, 128,397 are women Veterans; approximately 50 percent of these women Veterans utilized VA health care between FY 2002 and the first quarter of FY 2010.  Our women Veterans have unique health care needs compared with the larger male Veteran population.  On average, women Veterans are younger than male Veterans with over two-thirds of OEF/OIF women Veterans being in reproductive age groups.  VA again thanks Congress for its work on Public Law 111-163, which has given VA the authority to provide newborn care for women Veterans.  VA has enhanced its current system to transition from a disease model to a wellness model of care that assures equal access for all Veterans, and continues to deliver world-class health care for our Veterans who have served.  

Conclusion

Thank you again for this opportunity to speak about VA’s role in providing timely, coordinated care to our severely injured OEF/OIF servicemembers and veterans.  I am prepared to answer any questions the subcommittee might have.