Chairman Mitchell, Ranking Member Congressman Roe, and Subcommittee Members, I appreciate the invitation to testify today from my perspective as a severely injured soldier returning from Iraq.  I want to speak for those veterans who cannot be here today.

I am a Staff Sergeant with the 452nd Ordnance Company of the United States Army Reserves.  I am currently awaiting a medical review board so I can be medically retired from the military.  Following a 15 year career as a Paramedic/Firefighter in my civilian life, I had to take a medical retirement in June 2008 due to my TBI, PTSD, and chronic health issues.

I entered the military on June 22, 1988, and completed basic training at Ft. Leonardwood, MO.  I attended the lab technician program in San Antonio, TX, in 1989.  I was deployed to UAE during the Persian Gulf War from December 1990-March 1991 with the 311th EVAC Hospital from Minot, ND.  I transferred to the 452nd ORD CO in Aberdeen, SD in 1995.  From March-November 1997 my unit was deployed to Taszar, Hungary in support of Operation Joint Guard during the Bosnian War.  I was called to serve under Operation Iraqi Freedom from June 2005-August 2006 in Balad, Iraq. 

Between October 2005 and March 2006, I was in close proximity to one rocket and five mortar attacks where I was within 30 feet of the impact.  On March 25th, 2006, around 6:40 AM four mortars were marched in from the outer perimeter into our location with the third landing in the middle of our group and approximately ten feet from me.  The blast knocked me through the air and about seven feet back.  I landed on my neck and shoulders and was unconscious for three to four minutes.  When I awoke I could not hear and was in shock.  I looked up through my feet and another mortar hit about 25 feet away.  My hearing wasn’t right for several hours and I had a severe headache, dizziness, difficulty seeing distance, and light sensitivity throughout the next several days.  I was seen in sick call on April 12, 2006, for abdominal pain, dizziness, and headache.

I was hospitalized in 332 EDMGTH on May 11, 2006, for seven days with extreme abdominal pain, nausea, vomiting, diarrhea, headache, neck pain, and dizziness.  There was an initial diagnosis of salmonella poisoning and I was given high doses of antibiotics.  During the next month the symptoms persisted and I lost almost 40 pounds.  From June 21-July 10, 2006, I was evaluated at Landstuhl Hospital in Germany.  The doctors were unable to find the cause of the abdominal problems and I was returned to Iraq for regular duty.  I was transported to Germany again on August 7, 2006, and this time was diagnosed with clostridium dificile (c-diff) infection.  On August 25, 2006, I was sent back to the states with orders from my doctor that I be sent to Walter Reed Army Medical Center for further evaluation and treatment.  Instead, the Army sent me to Ft. Riley, KS, where I was placed in the medical holdover barracks and was told by the physician that I would be treated for irritable bowel syndrome (IBS) as my records did not indicate c-diff infection or other health concerns. 

In October 2006, after much insistence on my part, I was seen by a GI doctor in Topeka, KS.  After extensive testing he determined the c-diff infection had cleared and that my persistent abdominal pain, nausea, diarrhea, dizziness, and headaches were not caused by anything related to my digestive system. 

I remained at Ft. Riley from August 2006 to May 2007 on medical holdover.  During this time I had to file several Congressional complaints in order to be evaluated at WRAMC.  My symptoms were not improving and the doctors were offering no explanations.  I was told, “Just take your pain meds and you’ll be fine.”  On several occasions I was told that if I stopped contacting my state Senators, I would be given medical treatment.  The doctors admitted they didn’t know exactly what was wrong with me, but were not willing to make the referral to WRAMC or BAMC where specialists might evaluate my case.

In December 2006, I was sent to WRAMC for an evaluation at Deployment Health Clinical Center (DHCC).  During this time I was diagnosed with Medically Unexplained Physical Symptoms (MUPS) and was scheduled for the three-week Specialized Care Program for pain management in February 2007.

In March 2007, with no definitive diagnosis or treatment plan, I began to push for a means to leave med hold and return home to my family.  I applied for Community Based Health Care Organization (CBHCO) so I could go home and work at my local reserve center until my health improved or stabilized.  My request was denied due to the severity of my symptoms.  I was told that my condition was likely to be long-term or not improve and CBHCO is a short-term program for soldiers with less severe health problems.  Ft. Riley decided to send me home as they had done all they could for me.  I asked to be reconsidered for CBHCO as I would not be able to meet the physical demands of my civilian job at this time, and was told that my civilian job was not the concern of the Army.  I was released from med hold and came home to return to my position as a Lieutenant at the Aberdeen Fire Department.  I was placed on light duty within a month of my return home due to my weakened physical state and inability to make decisions and think quickly.  I had to accept a medical retirement in June of 2008 after being diagnosed with a TBI. 

When I returned home, I contacted my local VA CBOC and began medical treatment in Aberdeen, SD.  There was no contact between Ft. Riley and the VA regarding my case.  I had to initiate all care and provide the VA with a complete “paper copy” of my military medical files.  My wife and I spent many appointments going over my symptoms and the growing problems I was having with memory, concentration, decision making, confusion, dizziness, and episodes of staring/non-responsiveness and now ask “why were these not picked up” as warning signs of a probable TBI?  Also, I was still having daily headaches, persistent nausea, intermittent diarrhea with abdominal pain, and wonder if those were all related to the initial blast forces sustained from the injury in Iraq.  The VA continued to search for a GI answer to the problems, despite the previous determination that it was not a digestive track problem.  Finally, in December 2007, I was asked a series of questions at the VA concerning falls and blasts that I had encountered in Iraq.  My profile was flagged for head injury, and I was referred to Dr. Hof at the Polytrauma Unit at the Sioux Falls, SD VA Hospital.  This was the first time since my injury in March 2006 that I had been asked ANY questions about blast injuries.  Dr. Hof and Dr. Muntz did a battery of tests and determined I had a mild TBI due to multiple blast exposures in Iraq. 

In June of 2008, my eye exam noted double vision in multiple fields and loss of peripheral vision at 60 degrees.  I also had nystagmus and recurrent eye pain.  By December of 2008 my double vision was in all visual fields and I had pain behind my eyes daily.  On December 17, 2008, I suffered stabbing eye pain and my vision was reduced to colors and shapes.  I was treated for optic neuritis with IV steroids which brought some pain relief, but no change in vision loss.  My vision was noted at 20/800.  I was referred to the Visual Impairment Service Team (VIST) who provided me with some tools to help me magnify reading materials and protect my eyes from bright light.  My VIST also made arrangements for me to be a patient at the Central Blind Rehabilitation Center at the Hines VA in Chicago, IL.  I was at Hines from February 27, 2009, to May 16, 2009.  I learned to do things independently despite my vision loss, and how to use the vision I have left to the fullest. The Hines Blind Center did an excellent job of keeping my wife informed of my progress, and we both appreciated the family program at the end of my stay where my wife was able to experience my program, my blind training was reviewed, and skills learned were demonstrated.

Most recently, I was an inpatient in the PTSD program at the St. Cloud, MN VA as my nightmares of my combat have grown worse.  It saddens me that I had to wait 3 years for some of this treatment after hearing the doctor tell me I have an extreme case of PTSD.  Think of all the time that I have wasted with my family and not being my best due to the combination of PTSD and TBI, and difficulties encountered in sorting this out since the time of my injury.  I feel the program was very beneficial for my well-being, however, there was absolutely no contact between my family and staff members.  I was told that if my wife wanted to read through my records (375 pages) she could do so and call with any questions.  They did not ask for any input from my family regarding my behaviors at home, nor did they provide any feedback on my progress or treatment plan.  At this time, there is a suggested treatment plan, but no programs available in my rural area, even if I am willing to travel 3 hours to the nearest VA Hospital.  I am receiving 1:1 counseling once per month. 

The impact on my family has been overwhelming.  We have three teenage children receiving private counseling and all on anti-depressant and/or anxiety medication.  They struggle with the “weird” things dad does, the changes in my personality, the difficulty of helping take care of a blind dad when I should be taking care of them, driving me to and from appointments, helping me shop, explaining how to do things I used to know how to do, and the physical changes.  My appointments take my wife and myself away from home, sometimes for days at a time.  I have been at Hines and St. Cloud for a total of 5 months this year, which adds to the separation and reintegration problems similar to my deployment.  My wife uses most of her sick leave to take me to appointments and like many wounded warriors families is worried about loss of her job and meeting our financial needs.  Although there is a DAV van available in our area that helps me with travel, my memory problems make it difficult to see the doctor on my own effectively.  She is a full-time mother, care-giver to me, and works full-time as a teacher.  My wife has spent countless hours researching my conditions, treatments, searching for strategies to help me or to help cope, and looking for information for our children and families. 

The most frustrating feeling is having a meeting with a doctor, caregiver, or social worker and being left with confusion and questions not receiving any information from the VA regarding my total care plan, both physical and the PTSD emotional injuries.  Verbal descriptions are given, some theories, possible treatment plans, but I feel, probably like many others, that care managers are needed for more complex cases. When a service member is diagnosed with TBI or PTSD, the VA should immediately provide something tangible for the family to read and review.  It is not right that we are names and case numbers, when we leave the office, the doctor goes on to the next case, but we live with this all day, everyday.  A wait and see approach does not feel very reassuring on the 3-hour drive home.  We need tools we can use now for daily care.  We need someone to check in and see how things are going.  We need to know we are not in this alone.

Again, in conclusion, I am concerned with the lack of continuity or “seamless transition” between active duty, the return home, the VA healthcare system, and the family.  It is unreasonable that an injured soldier who is not able to be rehabilitated for deployment must wait more than two years for his medical review board to be completed. As I look back, I find it shocking that it took 21 months for any medical personnel, be it military or VA, to diagnose my exposure to blasts with a TBI head injury while in Iraq then discern the PTSD.  I am disheartened that soldiers are brushed aside in medical holding units or at home waiting for repeated exams and claims decisions. After years of work on electronic exchange of medical computer records, it doesn’t seem to be any closer than before.

Veterans should be introduced to one Primary Case Manager, then they should consult with one Primary Federal Recovery Coordinator (FRC), so difficult cases are jointly managed at the local level, and for special care programs like the VIST and Blind Rehabilitative Outpatient Specialists (BROS). While every injured service member might not need an FRC Coordinator immediately to enable them to make connections with those in charge of their case, there should be a red flag system for polytrauma cases.  These people in turn must work with individuals, not numbers or files.  Veterans need to be treated with dignity and respect.  Many veterans do not know what to ask, what is available, and who can help them. 

The VA benefits system should use the experts’ written records to make rating decisions permanent, instead of making veterans go through numerous evaluations and exams, as if to make the veteran prove his or her disability again.  Providing veterans with certification of all benefits, like adaptive housing and other vehicle grants, would prevent repeated claims from being filed for the same case.  These soldiers have paid the price in battle to serve their country selflessly, and they don’t deserve the runaround when trying to get the benefits to which they are entitled.  As of today, I still do not have my Purple Heart, and can only wonder how many others are “pending reviews” for theirs?

Defense and VA Vision Center of Excellence need adequate funding, staffing today, and operational registry systems.  The comprehensive system must include those with hearing, vision, and orthopedic problems along with the new TBI and Mental Health Defense Center of Excellence to ensure the care of the severely injured.  More funding is necessary for adequate TBI and vision trauma research.  The number of soldiers returning from battle with these combined injuries is staggering, and our country should not rest until we have provided for the needs of every one of them.

The Veterans’ Caregiver Bill, S. 1963, would be greatly advantageous to those families who are primarily responsible for the veterans’ care, many finding it difficult to work while providing daily care for the veteran.  Many have families to raise in addition to providing care, transporting to appointments (increasingly difficult in rural areas with fewer services), and trying to find their way around the VA system.

I speak today not for myself, but for the thousands of veterans who do not have a voice, who are struggling in a faulty system where their concerns go unnoticed, where their specialized medical needs are sometimes delayed, where they are left waiting often months or years for a VA claims review.  Timely and accurate diagnosis and treatment of conditions help the claims system.  The burden of proof is put back on the veteran and should not be, it should be on the VA.  I speak for families struggling with the changes and uncertainty of a future they never imagined when they proudly stood beside their soldier and professed their pride in America.  I am but one example of thousands.  I hope my story helps as you work on this committee to find solutions and make the necessary changes. This concludes my testimony and I will try to answer any questions that you have for me.

“To care for him who shall have borne the battle.”
Abraham Lincoln