My name is Lynn Tucker.  I am here to testify on behalf of my son Private First Class Benjamin Tucker, a lifelong resident of the rural community of Museville in the 5th Congressional District of Virginia.  Ben enlisted in the United States Marine Corps in May 2004.  Ben served for 22 months before tragedy struck in the form of a dirt bike accident leaving him with a traumatic brain injury. Ben is classified by the Veterans Administration as 100-percent disabled. I am here to testify on behalf of Ben’s two brothers, Corporal Jonathan Tucker and Lance Corporal Clayton Tucker, who served two tours as Marines in Iraq. They suffer from the effects of repeated IED and RPG blasts and the deaths of many friends.  I am also here to testify on behalf of all veterans needing care from the VA.  My testimony today is based as a caregiver to Ben, who lives at home in Museville.

Ben’s story reveals what should be our concerns for all veterans, particularly those representing rural areas; the concerns are: access to primary and specialty care, effective and efficient communication within the VA and approval and remittance of payments from the VA for medically related items and services.  Problems in any of these areas affect rural veterans like Ben, Jonathan and Clay by limiting medical choices, causing travel hardships, and contributing to an overall breakdown in the quality of care and life.  What we all need to remember here is that these individuals, and all veterans, made a commitment to serve and to protect our liberties without knowledge of the ultimate outcome.

Access to primary and specialty care is imperative for all veterans and especially difficult for rural veterans.  For Ben who requires frequent specialized care, this is quite a challenge.   Ben lives 45 minutes from the Danville CBOC, 1 hour and 15 minutes from the Salem VA, and 3 hours from the Richmond VA.  Only the Richmond VA can provide all the different types of care Ben needs and is the least accessible.

In October 2006 Ben returned home after almost a year in hospitals and was totally dependent for all his care as he had no voluntary movement and was fed by a gastric tube.  He was eligible for 15 hours weekly with the VA Home Health Aide Program. Due to his rural location, locating and retaining certified nursing assistants with the selected VA vendor was often impossible.  Months would pass with no nursing help and no help from the VA in locating a vendor with nurses willing to drive the extra distance for a rural client. Just this last year we were able to retain a reliable and caring nurse through the VA when a new vendor was selected. With Ben’s monthly VA disability payments another CNA was employed after a period of 4 months with no nursing help.  Overall low payroll compensation with the added expense of additional driving discourages CNA’s from accepting rural clients.

Ben has a Codman shunt in his brain to drain excess fluid and requires care from a neurosurgeon. The Salem VA does not have a neurosurgeon; therefore, Ben has continued to see a Roanoke neurosurgeon practicing with Carilion Hospitals.  Getting approvals for appointments is so time consuming, we have stopped applying for approval of routine visits and use Ben’s Medicare Insurance and pay the balance remaining.   This practice is not an appropriate solution for veterans and conveys that the VA does not have an appropriate system in place to care for their own. Many veterans’ families that our family is associated with express concerns about waiting for approval and appointments with primary care doctors and specialists.  Per two VA clinic staffers in Salem, with the intake of more veterans from Iraq and Afghanistan, this situation is growing worse by the day.  Do VA administrators understand this situation?

Effective communication is a barrier for veterans seeking care and necessary assistive equipment.  Communication between VA staffers within the administration often results in long delays or unnecessary denials.  During the summer of 2006 Ben applied for the grant to help pay for a custom wheelchair van. This request was submitted to the Roanoke Regional VA office.  The form was passed along through the VA from person to person until somewhere a copy was made and the copy was passed along instead of the original.  After several weeks, inquiries were made of the VA on Ben’s behalf with no results.  It was not until the family actually traced the path of the grant form, with the help of Kay Austin of the Paralyzed Veterans of America, that it was determined the form was in fact on the desk of a VA employee where it had laid for two months. The employee stated the original was needed, but had not tried to locate the original or call for a new original.   The Ms. Austin faxed a new form and a second completed copy was delivered personally to the VA employee. 

Veterans often have to wait for needed medications to be refilled. Just this past month, Ben needed renewal on a medication that took over 12 days to resolve.  The CBOC in Danville received my request by fax and the receipt was confirmed by a nurse.  Three of the medications arrived in the mail, but the one in question was not on Ben’s prescription list in My HealththeVet.  I called the CBOC and left a message on the nurse line. No one called. Inquiries confirmed the message was retrieved off the voice mail, but no action was taken.   Finally the nurse called to say we needed to contact Richmond for an approval.  In all it took 12 days for the CBOC to tell me to call Richmond.  Consider this: if you needed medication for your hypertension would you be willing to forgo that for 12 days?  Is that not harmful to your health? Living in a rural area with the nearest pharmacy 30 minutes away and the nearest VA pharmacy an hour and 15 minutes away, this problem is compounded. Simple communication would have alleviated the wasted time, energy, and driving to fill this prescription.

In September 2008, a bath sling was requested for Ben by the Richmond VA physical therapy department to the Richmond VA prosthetics department.  A picture and an internet link were provided to the employee.  After months, many calls, and emails with the link again, three improper slings were delivered.  Calls were made to the Guldmann vender in Texas for the sling attempting to provide Ben with the needed equipment.  After calling the Guldmann headquarters and being given information for Guldmann MidAtlantic, on March 4, 2009 the correct bath sling was delivered overnight for free by Guldmann MidAtlantic after hearing the difficulty of trying to procure the sling for Ben. A veteran in a rural location cannot easily travel to a VA center and resolve issues in person.  VA employees must respond to emails and calls and act appropriately to resolve the issue at hand. Veterans should not spend days, weeks, or months waiting by the phone.

During 2008 a recumbent stepper was requested to the Salem VA by a physical therapist for Ben. Ben was taken to the Salem VA and evaluated by a doctor who approved the request.  After months, calls were made about the equipment and found the request had never reached the prosthetics department. Shortly the Salem VA called explaining Ben needed the evaluation he had already completed. The doctor never entered the evaluation into the computer and never forwarded the request to the prosthetics department. Once this issue was resolved and several months passed, calls were made checking the progress of the request again and discovered it was denied. The Danville CBOC was notified but no one notified us. Efforts were made to begin tracking the documentation to determine why the request was denied. The VA employee who denied the request was very exasperated and actually said, “Why am I in the middle of this?” The employee could not grasp why he had to defend his decision nor could he present procedural or policy issues relating to the denial. After a lengthy discussion debating the need for the equipment due to Ben’s rural location and physical condition, the request was approved and the equipment delivered.

Payments from the VA for medical services or equipment outside the VA system are slow to nonexistent, and this situation traps the veteran between the VA and the outside vendor. After Ben’s van was delivered November 13, 2006, the VA owed a payment to the dealer it had already approved.  After several weeks the dealer contacted Ben’s family asking for help in obtaining the payment from the VA.  Phone calls were made seeking this payment to no avail.  Several weeks later the dealer requested the payment from Ben.  The payment for the van finally reached the dealer on February 20, 2007, three months after delivery of the van to Ben.

The van is not the only example of poor payment practices, Ben currently has collections against him for medical bills the VA agreed to pay.  At first we paid some of the bills ourselves until realizing this wasn’t an exception, but the norm. A great deal of time has been spent tracking many payments with the hospital and the VA not willing to communicate with each other. Currently all collection calls are referred to the VA

Ben was referred for physical therapy at the Carilion Clinic in Rocky Mount. During one of his appointments I was called to the front desk because the center did not have the authorization number to pay for his therapy. It was necessary to contact the VA from the front desk of the facility in order that Ben could complete his appointment.  Otherwise, Ben or his family would have had to agree to pay for the therapy.  

Ben spent almost 5 months in 2006 at Craig Hospital in Colorado after we paid over $14,000.00 to have him flown medically.  On his return trip home, the VA agreed to pay for the flight because it was necessary for him to be evaluated by the Salem VA before returning home. On the day before the flight, the air ambulance company asked for a credit card number because the VA could not locate who approved payment for the flight.  Once again, many phone calls were made adding to an already tense situation.

In May 2006, my husband and I sat in a meeting with the Richmond VA after Ben was discharged by the Marines in April.  Ben was an active duty Marine for 22 months, two months short of eligibility for VA coverage, with no TRICARE insurance, and his VA claim not processed.  The VA employee wanted to know how the bill of approximately $40,000.00 per month was to be paid if Ben continued to stay in the polytrauma unit.  With no help from the VA, we investigated and obtained cobra insurance with TRICARE for Ben and the VA was paid.

As a taxpayer and citizen of the United States of America it is striking how we take for granted the lives of those who voluntarily put theirs on the line. Ben, Jonathan, Clay, and all veterans enlisted without knowledge of the outcome.  They made a commitment to their country.  Where is their country now?  Where will our country be when all the veterans return from Iraq and Afghanistan?  Will they too be burdened with forms, phone calls, red tape, and delays? Will they too be turned away and not cared for? We cared to send them.