Chairman Hall, Ranking Member Lamborn, and members of the Subcommittee:

On behalf of the National Association for Uniformed Services (NAUS), I am pleased to be here today as you examine the effectiveness of VBA outreach efforts. 

The National Association for Uniformed Services celebrates its 40th year in representing all ranks, branches and components of uniformed services personnel, their spouses and survivors.  NAUS membership includes all personnel of the active, retired, Reserve and National Guard, disabled veterans, veterans community and their families.  We also serve as the main contact for the Society of Military Widows.  We support our troops, honor their service, and remember our veterans, their families and their survivors..

While much publicity is directed at VA outreach to health care, the question at hand for today’s hearing is whether similar attention is being delivered to addressing the problems associated with VBA. 

Clearly, the benefit programs under the jurisdiction of VBA, including the provision of disability compensation payments, fulfill a primary obligation to make up for the economic and quality of life losses veterans suffer as a result of service-connected diseases and injuries.  While we can never fully repay those who have stood in harm’s way, a grateful nation has a duty and obligation to provide benefits and health care to its veterans as a measure of its share of the costs of war and national defense.

Understanding the benefits side of the Department, it must also be clearly understood that VBA is closely linked to the Health side of the VA.  Both focus on securing appropriate attention to the relief of eligible veterans and serve in coordinating a veteran’s earned benefits and services.

As the National Association for Uniformed Services assesses the effectiveness of VBA outreach, we believe it is important that we first have an understanding on the number of OEF/OIF troops using the Department’s health care system.

At present, approximately 1.6 million troops have served in the two theatres of operation since the beginning of the conflicts in Iraq and Afghanistan.  More than 837,000 Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans have left active duty and become eligible for VA health care since fiscal year 2002.  According to the Department of Veterans Affairs, approximately half these veterans are former active duty troops (414,588) and half are Reserve and National Guard members (422,870).

As is well known, advancement in battlefield medicine has improved the chances of survival in warfare.  However, many of our present day wartime casualties suffer from multiple severe injuries such as amputation, traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).  Care for these individuals requires an intense management of treatment for their injuries and special consideration of their families who stand by these returning heroes.

Reports from VA indicate that from fiscal year 2002 through the current date 39 percent (325,000) of the total separated OIF/OEF veterans have obtained VA health care.  Among this group, 96 percent were evaluated and been seen as outpatients only, not hospitalized.  The remaining 4 percent (13,000) OIF/OEF patients have been hospitalized at least once in a VA health care facility. 

VA informs the National Association for Uniformed Services that of the OIF/OEF veterans who have sought VA health care approximately 166,000 were former active duty troops and 159,000 were Reserve and National Guard members.  Again, the population seeking care is nearly half active duty and half Reserve Component troops.

In total, over the last six years VA reports that 6 percent of the 5.5 million veterans in the VA medical care system are veterans of the most recent military conflict, OEF/OIF veterans. 

The Department attributes the rate of VA health care used by recent veterans to two major factors.  First, the department says that recent combat veterans have ready access to the VA system, which is free of charge for five years following separation.  In addition, the Department attributes a high rate of veteran-participation is due to an extensive outreach effort developed by VA to inform veterans of their benefits, including “a personal letter from the VA secretary to war veterans identified by DoD when they separate from active duty and become eligible for VA benefits.”

The National Association for Uniformed Services applauds the recent, May 1, Department announcement of a dedicated outreach program directed at nearly 570,000 Afghanistan and Iraq combat veterans.  The effort, according to VA, is to make sure these veterans are aware of “VA’s medical services and other benefits for which they are entitled.”  In making the announcement, James B. Peake, Secretary of Veterans Affairs, said, “VA is committed to getting these veterans the help they need and deserve.”

The newly initiated VA Outreach program is set out in two phases.  Phase one will contact “the estimated 17,000” who are sick or injured in Iraq and Afghanistan.  VA assures the public that each of these veterans will have “the opportunity” to have a care manager appointed to their case.  It is not clear to NAUS how this choice will be presented, but we understand the faith with which it is being presented. 

The second phase of VA’s outreach program will target 550,000 OIF/OEF veterans who have been separated from military service but have not sought VA care or services.  We are encouraged to hear Dr. Edward Huycke, chief of the VA-DoD coordination office, say, “We will leave no stone unturned to reach these veterans.”

In examining the effectiveness of the outreach effort, it is important to recognize the stark difference in today’s VA’s language over that used in the recent past several years.  We commend this change in expression and tone. 

However, we remain attentive to see that the most recent effort and the improved tone it reflects does not fail.  Clearly there are concerns.  Residue from a previous attitude remains within the system. 

We are seriously concerned, for instance, about reports at the Temple, Texas, VA Medical Center, which suggest that time and money could be saved if diagnosis of PTSD were stopped or deeply discounted.

A PTSD program coordinator and psychologist at the Olin E. Teague Veterans Center sent an email with the subject line “Suggestion” to several VA staffers working with PTSD cases.  The email suggested that VA doctors and clinicians give altered diagnosis to patents exhibiting symptoms of PTSD in order to save time and money.  In the email, the staffer said, “We really don’t … have time to do the extensive testing that should be done to determine PTSD.”

In a statement, however, VA Secretary Peake repudiated the email and said, “a single staff member, out of VA’s 230,000 employees, in a single medical facility sent a single e-mail with suggestions that are inappropriate and have been repudiated at the highest level of our health care organization.”

The National Association for Uniformed Services appreciates the Secretary’s promise to see that VA gives “absolute accuracy in a diagnosis.”  His immediate response and public commitment to veterans is welcome and well received.  Nevertheless, the incident is deeply troubling because veterans not only need to hear about the services they earned and deserve; they need to know that once they come to VA their exams are completed and their services are delivered.

Mr. Chairman, as we head into Memorial Day next week, your Subcommittee takes a good, well-traveled road.  In sending young men and women to defend our nation, it is important that we let them know what our great and generous country provides them following their service.  Indeed, we have a strong moral obligation to do so because without American patriots in uniform freedom itself might well be extinguished. 

It is clear to NAUS that veterans are generally more aware about the availability of benefits and services than they were four to six years ago.  Not everything is perfect and we can do better.  But things are improved. 

Six years ago, for instance, the administration was deeply opposed to spending resources aimed at making veterans aware of the benefits and services available at the Veterans Department.   And facilities were in decline.

At one point in that past period, a former Secretary of Veterans Affairs told the nation that the Department budget was adequate.  This announcement, made in April of that year, told Congress that VA did not need one-penny more.  However,  only a month later the Secretary reversed his statement to tell the nation that his Department would fall $1.5 billion short of the resources needed to carry veterans services through the remainder of the year. 

Prior to this revelation, NAUS and other associations had presented ample witness to deficiencies throughout the system.  We pleaded with Congress and the Administration that funding levels were totally inadequate and, if not addressed, would lead to cuts in veterans health care services, reductions in veterans education benefits, and logjams in veterans disability claims for service connected injury or illness.

During that period, things were so bad that a memorandum sent out by the Deputy Under-Secretary for Operations and Management (July 19, 2002) actually directed all of its healthcare providers to stop marketing VA programs to veterans. 

In basic, the July 2002 memo said too many veterans were coming in for services and VA was spending too much money.  It directed VA officials across the country to “Stop Outreach to Veterans.”  VA employees were directed to stop participating in VA health fairs, Stand Downs and related outreach events that informed veterans about programs available to them.  Medical facilities were prohibited even from putting out newsletters informing veterans about the services they were legally entitled to receive.

We are thankful that we no longer face that deeply troubling period.  If such heartless, shameful incompetence were in place today, many of OEF/OIF would struggle alone.  

Studies conducted by The Army surgeon general’s Mental Health Advisory Team clearly show that our troops and their families face incredible stress today.  According to the Department of Defense (DoD), 27 percent of noncommissioned officers on their third or fourth tour exhibited symptoms commonly referred to as post-traumatic stress disorder.  That figure is far higher than the roughly 12 percent who show those symptoms after one tour and the 18.5 percent who demonstrate these disorders after a second tour. 

And among the approximately half-million active-duty soldiers who have served in Iraq, more than 197,000 have deployed more than once, and more that 53,000 have deployed three or more times. 

A recent Rand Corporation study suggests that almost half of these returning troops will not seek treatment.  Many of these veterans do not believe they are at risk or they fear that admitting to a mental health problem will mean being stigmatized.  Yet if these brave individuals and their families are made aware of access to VA facilities, to which they are entitled, they are likely to find a treatment therapy that leads to health.

If not addressed, stress symptoms can compound and lead to more serious health consequences in the future.

Secretary Peake’s recent announcement presents an opportunity for veterans to become more aware of VA’s accessibility and readiness to meet their healthcare needs.  The Secretary’s effort is commendable.   In some cases, a successful outreach can be a matter life and death.  Veterans need to hear that VA is part of our nation’s commitment to them.  They need to hear that with appropriate care, our veterans can tackle stress and get themselves back on track. 

NAUS believes that Secretary Peake’s announcement marks a turning point in outreach efforts.  We are guardedly optimistic.  But it is clear that more needs to be done, including follow-through throughout the VA system. 

Of course, there is a financial cost to improved outreach.  But as important is the fact that if we do not make veterans aware of the benefits and services available to them, there is a hidden cost in lives lost, families disrupted and long suffering in homelessness and related problems for decades to come.

We urge the Subcommittee to continue its excellent work with other champions in this Congress to ensure resources are ready not only for the provision of a veteran’s earned benefits but for the veteran’s awareness of these services as well.  It is important that we do so.  After all, these brave men and women shouldered a rifle and risked everything to accomplish their mission, to protect another people’s freedom and our own country from harm. 

As a nation, we need to understand that the value of their service is far greater than the price we pay for their benefits and services.

Appreciation for Opportunity to Testify

As a staunch advocate for veterans, the National Association for Uniformed Services recognizes that these brave men and women did not fail us in their service to country.  They did all our country asked and more.  Our responsibility is clear.  We must uphold our promises and provide the benefits they earned through honorable military service. 

Mr. Chairman, you and the members of your Subcommittee are making progress.  We thank you for your efforts and look forward to working with you to ensure that we continue to protect, strengthen, and improve veterans benefits and services.

Again, the National Association for Uniformed Services deeply appreciates the opportunity to examine with you outreach efforts to veterans, families and survivors on the benefits available to them.