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Care of Seriously Wounded After In-Patient Care.

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MARCH 13, 2008

SERIAL No. 110-76

Printed for the use of the Committee on Veterans' Affairs





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BOB FILNER, California, Chairman


VIC SNYDER, Arkansas
JOHN J. HALL, New York
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
TIMOTHY J. WALZ, Minnesota

STEVE BUYER,  Indiana, Ranking
HENRY E. BROWN, JR., South Carolina
BRIAN P. BILBRAY, California




Malcom A. Shorter, Staff Director

HARRY E. MITCHELL, Arizona, Chairman

TIMOTHY J. WALZ, Minnesota
GINNY BROWN-WAITE, Florida, Ranking
BRIAN P. BILBRAY, California

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined.



March 13, 2008

Care of Seriously Wounded After Inpatient Care


Chairman Harry E. Mitchell
        Prepared statement of Chairman Mitchell
Hon. Ginny Brown-Waite, Ranking Republican Member
Hon. Cliff Stearns
Hon. Nick Lampson
        Prepared statement of Congressman Lampson


U.S. Department of Veterans Affairs,  Mahdulika Agarwal, M.D., MPH, Chief Officer, Patient Care Services, Veterans Health Administration
        Prepared statement of Dr. Agarwal

Iraq and Afghanistan Veterans of America,  Todd Bowers, Director of Government Affairs
        Prepared statement of Mr. Bowers
Owens, Corporal Casey A, USMC (Ret.), Houston, TX
        Prepared statement of Corporal Owens
Wade, Sarah, Chapel Hill, NC, on behalf of Sergeant Edward Wade, USA (Ret.)
        Prepared statement of Ms. Wade
Wounded Warrior Project, Meredith Beck, National Policy Director
        Prepared statement of Ms. Beck


Memorandum entitled, “Acceptance Requirements for VA Volunteers” from the William F. Feeley, MSW, FACHE, Deputy Under Secretary for Operations and Management (10N), dated February 22, 2007

Post Hearing Questions and Responses for the Record:

Hon. Harry E. Mitchell, Chairman, and Hon. Ginny Brown-Waite, Ranking Republican Member, Subcommittee on Oversight and Investigations, Committee on Veterans' Affairs, to Hon. James B. Peake, Secretary, U.S. Department of Veterans Affairs, letter dated April 17, 2008, and VA responses


Thursday, March 13, 2008
U. S. House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:00 a.m., in Room 340, Cannon House Office Building, Hon. Harry E. Mitchell [Chairman of the Subcommittee] presiding.

Present:  Representatives Mitchell, Space, Walz, Brown-Waite, Stearns, Bilbray.


Mr. MITCHELL.  Good morning.  This hearing will come to order.  This is the Subcommittee on Oversight and Investigations and the hearing today is on the care of seriously wounded after inpatient care.

We are here today to hear from veterans, their families, and the U.S. Department of Veterans Affairs (VA) about the long-term care of our most severely wounded Afghanistan and Iraqi veterans.

We do know that the U.S. Department of Defense (DoD) and VA provide excellent inpatient healthcare for these warriors, but many of the most seriously injured require extensive outpatient care, some for the rest of their life.  Their families need care and assistance as well.

Unfortunately, once these veterans leave the hospital, the care they receive does not seem to be on par with what they receive directly following their injury.  And I think we can do better.

Planning for veterans health care was not planned very well at the outset of this war.  The need to provide care and assistance to wounded servicemembers and their families in significant number and for the long term has been largely ignored.

We will hear today what it has been like for some of them.  Their stories are inspiring, but also discouraging.  They are inspiring because even after they suffered terrible injuries, they carry no bitterness, only pride from their service, discouraging because they have been left to fend for themselves for too long.

The DoD and the VA are large organizations with an overwhelming bureaucracy.  Their care and services often overlap in messy, unpredictable ways.  At a time of enormous stress, this bureaucracy only hurts the injured warrior and his family.

When our troops return from theater with serious injuries, they are met with a dozen seemingly unrelated people with different services.  We addressed much of these problems last year with the passage of the Wounded Warrior provisions in the Defense bill, but there is obviously still more to be done.

We need to realize that families are an integral part of treatment and recovery and have their own needs.  Unfortunately, the VA is restricted from providing the many services families need and deserve when their sons and daughters, siblings, and parents return with service-connected injuries.

We have been playing catch-up since the beginning of this war.  It is irresponsible that the only support structure available to a 19-year-old wife of an injured soldier is the wife of a similarly injured soldier.  We are going to hear from people that have been dealing with the difficulties of the system for a long time.

On February 14, 2004, Sergeant Ted Wade lost his right arm and suffered severe traumatic brain injury (TBI), along with many other injuries in an improvised explosive device (IED) explosion in Iraq.  Sergeant Wade is here today with his wife, Sarah. 

Marine Corporal Casey Owens of Houston, Texas, lost both his legs when his unarmored Humvee struck a landmine in Iraq on September 20, 2004. 

Corporal Owens and Ms. Wade will tell us about the frustrations and difficulties they have faced and we look forward to their testimony.

Sarah and Ted Wade have devoted themselves to helping hundreds of other injured servicemembers and their families. 

Just two weeks after he was injured, Casey Owens told his family that he wanted a camcorder so he could document his progress from start to finish.  He could only communicate by writing at the time of his request.  He wanted to show his future children how far he had come and how good he had it.  Today you can find Casey gliding down the slopes at Aspen. 

We owe Corporal Owens and Sergeant Wade a great debt.  We cannot repay that debt, but we can make sure that Corporal Owens and Sergeant Wade, their families, and everyone like them get long-term care and services that are also world class.

[The statement of Chairman Mitchell appears in the Appendix.]

Mr. MITCHELL.  Before I recognize Ranking Republican Member for her remarks, I would like to swear in our witnesses.  And I would ask all witnesses if they would please stand, and raise their right hand.

[Witnesses sworn.]

Mr. MITCHELL.  Thank you.

Next I would like to ask unanimous consent that Mr. Lampson be invited to sit at the dais for the Subcommittee hearing today.  Hearing no objection, so ordered.

Mr. Lampson, please join us at the dais.

I would now like to recognize Ms. Brown-Waite for opening remarks. 

[Microphone Technical Difficulties.]


Ms. BROWN-WAITE.  Let us hope this works a little bit better.  I am sorry.

Good morning.  Mr. Chairman, I thank you for holding this hearing and also for yielding.  I am going to keep my comments short because I am looking forward to hearing from our witnesses on how we can make the system better.

Over the past several years, this Committee has watched over the development of the Polytrauma Rehabilitation Care (PRC) units throughout the VA system.  It has seen good work including one in my own neighborhood in Tampa, Florida.

We are happy that we are doing better on inpatient care for our severely wounded servicemembers.  What we have observed during our oversight visits is a dedicated staff and resources that are necessary to make sure that the care given to our veterans is second to none.

However, this Subcommittee is concentrating its focus on what happens after the servicemember or veteran is discharged from the VA.  How are these severely injured veterans and their families actually integrating back into their communities and back with their families?  What kind of post hospitalization care and support services are they receiving?  What avenues do they find opened or closed to them?  Basically, what are the challenges that the veterans are facing?

We are all looking forward to hearing from our first panel as to what they have encountered since their discharges.  Hearing their stories is not only important to the Committee but also to the VA as they develop their Federal Care Coordinator Program to reach out to our severely injured veterans and assist them whenever and however they need it.

Those who are serving on the front lines of battle do not consider where their actions will take them in the future.  Our Nation’s heroes have sacrificed their time, energy, and often physical health to secure freedom and democracy throughout the world.

And I think every American believes that they deserve the best possible care that we can give.  Our obligation to care for severely injured servicemembers does not end when they leave the PRC but continues long after the discharge care process.

Again, Mr. Chairman, thank you for holding this hearing and I yield back my time.  And I apologize for the problematic microphone here and it is not my Blackberry because I handed it over.

Mr. MITCHELL.  Thank you.

Congressman Walz?

Mr. WALZ.  I will reserve my time.

Mr. MITCHELL.  Congressman Stearns?


Mr. STEARNS.  Yeah.  Let us see if this works.  Thank you, Mr. Chairman, for holding this hearing.

Obviously today we are addressing a very critical issue facing our heroic wounded warriors and their families and, of course, their transition back into civilian life.

A recent article in which former U.S. Department of Health and Human Services (HHS) Secretary Shalala commented, she indicated if we are asking people to risk their lives and their future, then we ought to be willing to make this investment.  And that is what we are trying to do here.

Families are the most important factor in the successful transition back to civilian life for our warriors.  Obviously they deserve all the support we can provide for them.

I am very glad that on our first panel of witnesses, we will hear the personal testimonies from two individuals who have experienced these issues firsthand, Corporal Casey Owens, and Ms. Sarah Wade will be speaking on behalf of herself and on behalf of her heroic husband, Sergeant Edward Wade.

And I want to thank both of them for traveling the distance to come here and take the time to testify before us.

My colleagues, since 2003, I have been pleased at some of the initiatives that the VA has established to serve wounded warriors and their families.

In June of 2005, the VA issued a directive expanding the scope of care it would provide to include psychological treatment for family members.  This is very important.  In addition, the VA has expanded their team of caseworkers, but we do need more. 

Intensive clinical and social work case management services have been created for the four regional traumatic brain injury rehabilitation centers now named the polytrauma rehabilitation centers.  VA also established joint programs with the Department of Defense to ease the transfer of injured servicemembers to the VA medical facilities.

In August of 2003, VA and DoD established a program assigning VA social workers to select military treatment facilities to coordinate patient transfers between DoD and the VA medical facilities.  The social workers make appointments for care, ensure continuity of therapy and medications, and follow-up with the patients after their discharge.

But I am concerned, first of all, that caseworkers seem to have too large a caseload which may inhibit the amount of time and focus they are able to spend with each and every family.  Particularly when servicemembers are discharged from the VA polytrauma rehabilitation centers, most, if not all, still require follow-up care at the VA, at DoD, or private-sector facilities.

I want to know if this transition system functions smoothly, whether the patient is going back to the military or is the patient going back to the private sector.

In addition, most of the most severely wounded patients require long-term care and will become veterans eligible for VA care when discharged from active duty.

So I look forward to this hearing, Mr. Chairman. 

I have had the opportunity, as I am sure many members have, to participate in the VA winter sports clinic out at Snow Mass, Colorado and seeing the enormous energy disabled veterans put into that skiing clinic and to see how successful they are and it is inspiration for all of us.  And so I welcome our witnesses today and I look forward to their testimony, Mr. Chairman.

Mr. MITCHELL.  Thank you.

Mr. Space?

[No response.]

Mr. MITCHELL.  Thank you.

I ask unanimous consent that all Members have five legislative days to submit a statement for the record.  Hearing no objection, so ordered.

At this time, I would like to recognize Congressman Nick Lampson of Texas who is here to introduce his constituent, Corporal Casey Owens.

Congressman Lampson?


Mr. LAMPSON.  Thank you, Mr. Chairman.  Hopefully this one works.

I want to thank Chairman Mitchell and Ranking Member Brown-Waite and Members for allowing me to come and sit in on this hearing with you today.  I am honored to join you on this distinguished Subcommittee and very proud to introduce Corporal Casey Owens of Missouri City, Texas.

Casey is an extremely exemplary young man and I commend him for his willingness to continue to serve his country and his fellow veterans.  We are proud of his service to this Nation in many, many ways.

I was impressed when we met yesterday for the first time by all of his accomplishments.  A graduate of May Creek High School, he went to the University of Texas.  But following the attacks on September 11, he decided to join the Marines. 

He was deployed twice, the first time from February 2003 to October of 2003 and the second time from August of 2004 until September 20, 2004, when he sustained his injuries.  During this time in the Marine Corps, he received several medals in recognition of his distinguished service.

Less than a year after sustaining his injuries, Casey successfully completed the Marine Corps marathon in 2005 using a hand-cranked wheelchair with a time of approximately two and a half hours, probably better than any of us here could do.  I know better than I could do.

He is currently training as a member of the competitive ski team in Colorado that has been recognized by the Paralympics and the VA as an official training center.

Even more impressive than the three accomplishments, than all of these accomplishments in my opinion, is Casey’s advocacy for veterans’ care.  He has worked with Mayor Bill White, Houston Mayor Bill White’s Veterans Task Force which was established last year to address the needs of Houston’s veterans, both young and old, when it comes to housing, health and mental care, job training, and other issues.

And he has come here today to testify before Congress about the challenges new veterans in this country continue to face as they transition from DoD to the VA system and try to navigate it.

The most impressive, though, is the concern for his fellow veterans and those that will come after him.  He is here today to ensure that our Nation’s future wounded warriors will not go through the same frustrations and feelings of neglect that he and his friends have experienced at the DoD and the VA and have struggled to adapt to a new breed of patients as they have struggled to adapt.  So they deserve much more in return for their service.  And I commend Casey for his advocacy on their behalf. 

And, again, I thank the Subcommittee for allowing me to sit in and I yield back my time, Mr. Chairman.

[The statement of Congressman Lampson appears in the Appendix.]

Mr. MITCHELL.  Thank you.

At this time, I would like to recognize our first panel, Corporal Owens, Ms. Wade, and Sergeant Wade.

And I just want to say that last evening, I met with all three in my office and we had a great visit.  And I hope that you convey in a very matter-of-fact way what you told me yesterday because I think it is a very compelling story and everyone should hear it.

So thank you very much.  And we will start with Corporal Owens. 



Corporal OWENS.  Good morning.  Thank you, Chairman Mitchell and Members of the Subcommittee, for coming.

I was injured September 20, 2004.  I was serving with the 1st Battalion, 7th Regiment Weapons Company.  I was in Al Anbar Province out west on the Syrian border.  We were on a reconnaissance mission, dropped off a reconnaissance team.  Minutes later, we got a call to pick them back up for a medivac mission.  A Sergeant from reconnaissance had been shot in the throat who later succumbed to his injuries.

On the way back to base, we were engaged again and ran over two anti-tank mines, which resulted in the loss of both my legs.  I was flown to a field hospital in Iraq, stabilized, treated there, and to Landstuhl, Germany.  I was there for three to four days and then flown to the Bethesda, Maryland Naval Hospital.

I woke up about a month later from a coma to find my legs were missing.  I had suffered two collapsed lungs, a pulmonary embolism, serious head trauma, broken my clavicle and my jaw, which now has a metal plate, and my teeth were knocked out, several shrapnel wounds to my neck and torso.

From there, I had several surgeries over the next two to three months to stabilize me and was transferred to Walter Reed to join the amputee program there and to walk again.

Over this time, I was a patient at Walter Reed and Brooke Army Medical Center and was discharged and retired February 26 of 2006.  And I did not have my right leg completed yet.  I was still experiencing problems.

Upon retiring in February, I needed another surgery, about March, early April.  My right leg, which is my myodesis, which is kind of the muscle flap that goes over the end of your femur, kind of gives you a padding, it had previously, once about a year earlier, had torn completely off my femur and I had my leg amputated again about an inch, and my sciatic nerve cut.  They reattached it.  It looked good.

Over the next year, I still had more surgeries.  I had problems with heterotrophic ossification, which is a bone growth which kind of held me back with my prosthetic care, my prosthetic progress.

So when I was retired, I had a 60-day window that you are still under the Department of Defense care.  So I was able to return to Brooke Army Medical Center to have it repaired.  That is where it had been done the first time.  I went back there.  They repaired it.

Within a month, it had failed again for the third time.  And when I say third time, the myodesis was performed on the initial injury.  Failed the first time, second time, now third, so this would be the fourth time to fix it.

I was now enrolled in the VA as of April 1, 2006.  I went to the VA, said, you know, I think it is failing again.  I know it is failing again.  I can feel the bone coming through the muscle this time and you could see it.

They instructed me to work with prosthetics, and that is use their standard procedure is prosthetics, you know, adjusting your prosthetics before, you know, surgery.  I told them that, you know, this is the third time.  I have been down this road.  I know what I need.

They did not agree with me.  The first day, they did not agree with me.  I said, I will be back in about four to five weeks.  The condition is going to be worse.  Sure enough, about five weeks later, over the weekend, the muscle started retracting, pulling back, leg, you know, was very painful.

It was the weekend, so my choices were to go to the emergency room, which I knew would be come back Monday, see an orthopedic doctor.  So I drove to Brooke Army Medical Center about three hours away, found one of my orthopedic surgeons that had performed the surgery the first two times.  He looked at it right away and said, yes, failed myodesis.  And I said, well, what are you going to do and what procedure.  And he said, we will do what is called a Goshock procedure named after the doctor who invented it.

He said, well, this has failed four times now or failed three times.  This will be the fourth time to do the procedure.  I said, you know, I do not have any more of my leg to give, so he pretty much said, well, that is what we can do.

So I went home disappointed.  I spoke to a prosthetist who told me about a new procedure, the Ertle procedure.  Because he was prosthetics, he said, you know, this advice did not come from me and because in the past, he had been reprimanded for giving advice from an orthopedic because for some reason, that is not his field, even though prosthetics, orthopedics go hand in hand.

So I found it.  On the internet, I found Dr. Ertle.  I went to my doctors at the VA and said I would like to get this Ertle procedure done.  They did not agree with me.

So over the next six months, I debated with the VA until I finally got my surgery done, which the previous two times had taken me less than 72 hours to get it done.

So during this time, I cannot move forward.  I cannot go to work, school.  I am in pain.  I got back on my pain meds which I had already gotten off of.  And also my insurance, my TRICARE insurance supposedly through a clerical error, was canceled.  So that was another deal to deal with.

I did not have a social worker for the first three months, so I sought the advocacy of a friend with Marine for Life who kind of took over my case and Marine for Life, Wounded Warrior Project and other people who just stepped up to the plate and helped me out that were not even government agencies or people from the VA.

I had the surgery done in Oklahoma.  The doctor, well, he has VA benefits, so, you know, I was not really going outside the box.  So, you know, I cannot understand what took so long for the approval.  I never really got an answer other than sorry, we made a mistake.

And I have had the surgery done.  It has performed.  It is doing well.  But they had to amputate two more inches of my leg and cut another three inches of my sciatic nerve which now I suffer from chronic phantom pain.

And I returned home.  I went out to Aspen.  I had to recover.  I had several months before I could work with prosthetics, so I went out to Aspen.  And I was invited out there to train for the Paralympics skiing, mono skiing.

I returned home early summer.  I went to the VA and said I am home.  I am here to work solely on my prosthetics.  This is my number one goal.  I am not working.  I am not in school.  I had appointments about once a week, you know, for an hour which was not sufficient to me, so I said, you know, I need to get this done, you know.  I am technically retired from the military, but, you know, I am ready to go back to school and move on, you know, with a job and career.  And I cannot do it until I have this done because it is going to take several months of rehab.

So they outsourced me because they said they had too many patients and not enough staff to meet my needs.  So they outsourced me to a prosthetist in Houston, which there is only one prosthetist there.  And he did not have a technician at the time either, which even slowed the process more.

I spent the following summer, the next eight months up until about December.  And I had prior engagements with my race team starting early November and, you know, prior commitments to my sponsors for my racing.

I put it off for two months until January, still trying to work on my prosthetics which finally resulted in him telling me I cannot fit you.  You should look elsewhere.

So I returned back to Colorado and finished my skiing.  And next week I go to Oklahoma to a company, some specialists that other guys I know go to.  But I am going there on the bill of the Wounded Warrior Project because it is too much of a hassle to deal with the VA and which it should be their responsibility.  They are the ones who have failed to fit me.

But, like I say, at times, it gets, you know, it is not even worth dealing with the VA because it so much of a hassle and that is how it has been. 

You know, I suffer from post traumatic stress disorder (PTSD) and the VA and all the problems I have dealt with have, you know, furthered it even more.  And in that six months that I dealt with, you know, wondering why no one is helping me, why the government is not stepping up to the plate, and it just feels like I was abandoned.

And, you know, I did my duty and those that are in place are not doing theirs.  And it is a very frustrating feeling to go through.  And for me, it has been a harder battle coming back to the States and dealing with everything I have dealt with than it was going to the war both times.  That was a cake walk compared to this.

And so here I am now and my struggles, I have gone through and done on my own or a lot of my own through the help of, you know, advocates, but I do not want others to go through it either.  So here I am.

[The statement of Corporal Owens appears in the Appendix.]

Mr. MITCHELL.  Thank you.  Thank you very much.

Sarah, are you or Ted going to talk?


Sergeant WADE.  Chairman Mitchell, Members of the Subcommittee, thank you for the opportunity to speak to you today regarding our experiences following my injury in Iraq.

My name is Edward Wade, or Ted, as I prefer to be called.  And this my wife, Sarah Wade.

Ms. WADE.  Hello.  I am not as brave as Casey.  I am going to actually read my comments because I am worried I will get off course.

Ted sustained a very severe traumatic brain injury or TBI and his right arm was completely severed above the elbow.  He suffered a fractured leg, broken right foot, shrapnel injuries, visual impairment, complications due to acute anemia, hyperglycemia, infections, and was later diagnosed with post traumatic stress disorder.

Ted remained in a coma for over two and a half months and withdrawal of life support was considered.  But thankfully he pulled through.

As an above-elbow amputee with severe TBI, Ted was one of the first major explosive blast polytrauma cases from Operation Iraqi Freedom that Walter Reed or the Department of Veterans Affairs had to rehabilitate.

Much of his treatment was by trial and error and there was no model system of care for a patient like Ted.  And there still does not appear to be a long-term model today.

His situation was an enormous challenge as Walter Reed was only able to rehabilitate an amputee, not a TBI.  The VA was able to nominally treat a TBI but not an above-elbow amputee and neither were staffed to provide appropriate behavioral healthcare for a patient with a severe TBI.

Because Ted could not access the necessary services where and when he needed them, he suffered a significant setback in 2005 that put him in the hospital for two weeks and would later take him probably a year to rebound from.

Ted has made a remarkable recovery, by any standards, because we strayed from standardized treatment and developed our own patient-centered path.  I had to educate myself about and coordinate additional outside care.  Often access to the necessary services required intervention from the highest levels of government or pressed to personally finance them ourselves.

But despite our best efforts, Ted is still unable to easily receive comprehensive care for all of his major healthcare issues due to shortcomings in the current system.  And because of the time his needs demand of me, I have been unable to return to regular work or school.

We have been blessed to have family with the means to see us through these difficult times and to help with the expenses.  I was fortunate to have the education of growing up in Washington, DC, and learning about the workings of the various Federal agencies, but our situation is not typical.

We do have a few ideas to provide better long-term care for people like Ted that we would respectfully like to share.

The first one is about special monthly compensation, particularly for reasons of integration, quality of life, dependent’s educational assistance, and respite care.

Individuals like Ted who required someone to be available for assistance at all times are not compensated appropriately.  These veterans would require residential care otherwise, but are not granted the higher level of aid and attendance because they do not require daily healthcare services provided in the home by a person licensed to perform these services or someone under regular supervision of a licensed healthcare professional.

I would be more than willing to be supervised if that is what it took.  But we feel the criteria should be clearly outlined so appropriate compensation may be granted in the case of an individual whose needs of assistance are managing their care and personal affairs or they require support outside of the home to rehabilitate and integrate into their community or to achieve a better quality of life.

Both in the past and at present, we have paid someone to assist Ted outside of the home.  This allows him the flexibility to hire a peer of his choice to provide community support and accompany him on sightseeing outings he has researched and planned with his therapist as part of his community reintegration, to provide transportation to the store to purchase books for homework assignments, go to the community center to swim laps, or help him balance his checkbook at the end of a day.

Not only has this enabled Ted to come closer to achieving independence, but it has greatly improved symptoms of depression by restoring hope and self-confidence, allowed him to attain fitness goals and control his blood sugar without insulin injections, all while providing much needed respite care for me.

Unfortunately, the current VA respite programs are not appropriate for a veteran like Ted.  My option for that is to put him in an extended care facility for 30 days a year or, as my husband says, I could kennel him and the dogs and go on vacation.  And that is not really something that I am interested in doing.  I would rather go on vacation with him, or I could also have someone come provide care in the home, but they cannot take him to the places he needs to go and do the things he needs to do.

And with better resources, I might be able to access the dependent’s educational assistance for which I qualify, but under the circumstances, I cannot use.  And I think one of my great concerns is that these benefits do expire and I am, you know, already probably four years into the expiration time. 

I would like to see a change maybe in that, but also someone provide the assistance we need for me to go to school because not only would it give me the education that I have available to me, but I think it would also help increase the standard of living for Ted by increasing my earning capacity.

Another suggestion we have is about the Compensated Work Therapy Program in the VA system.  Largely due to the success of the program we have created for Ted, the next phase of his recovery will probably include some sort of vocational rehabilitation.  He has already had the opportunity to participate in volunteer work through counseling and job coaching provided by a private practice near our home where he attends a day treatment program for behavioral health and TBI.

But now he is ready for the next stepping stone to employment.  The current Department of Veterans Affairs’ vocational rehabilitation and employment service is more of a challenge than is healthy for someone like Ted, with significant cognitive deficits and significant emotional needs.

VA work therapy programs, while developing work tolerances and promoting effective social skills for more seriously impaired patients, are set in insulated environments.  A work therapy program expanded to other community settings to accommodate patients like Ted who are better served outside of a sheltered atmosphere would be more effective.

Volunteer internship positions or later a part-time job that sparks his interest would be more therapeutic.  Not only would this help him acquire the confidence and independence he needs to some day become gainfully employed, but it would also aid in his reintegration by providing constructive, meaningful activities for him to participate in outside of the home.

I think my last comment will be about counseling and life skills for patients like Ted with TBI and really patient-specific case management.

Although many basic therapies are offered, rarely do they include teaching socially appropriate behaviors which are commonly an issue after TBI.  This task often falls on the veteran’s family member or spouse, increasing the responsibility of the caregiver, and causing conflict with the veteran who feels like they are being treated like a child.

Ted has had the advantage of a community support peer, but also a counselor at the private practice I previously mentioned to help him redevelop age-appropriate social skills and allow me to be his spouse while maintaining his dignity.

She has also worked with Ted to develop healthy coping skills, to manage cognitive deficits, improve mental health, and develop patient-centered treatment plans, which focus specifically on his unique challenges.

Again, our situation is not typical, though.  This is something difficult to provide in an institutional care environment like the Veterans Health Administration without greater flexibility and more resources to provide increased face time with the patients and better injury-specific expertise.

The challenges we have faced are the same as countless other veterans, many of whom have not had the resources Ted has had available to him or an advocate capable of negotiating the system.

A veteran I often think about who had a young wife with a newborn baby and nothing more than a high school education should have received the same world-class care as my husband but sadly did not nor will not.  Despite my best efforts to be a support to his spouse, who is overwhelmed by motherhood while trying to negotiate a seemingly impossible system, she eventually left him because it was more than she could handle.  I think it is a lot to ask any mother to neglect their child.

A veteran’s care should not depend on what family they were born into, who they married, or whether or not family obligations allow their loved one to advocate for them, but sadly it does. 

Though we will never be able to fully compensate seriously wounded veterans for the sacrifice they have made on our behalf, we can certainly do a better job of managing their care, rehabilitating them to the fullest potential in a timely manner, and providing the necessary resources to maximize their quality of life.

I am very pleased to see that the Subcommittee is taking a look back to explore ways to learn from the past and address the needs of the veterans injured yesterday.  I think this will make a tremendous change for the people who are being injured today.

And I want to thank you all again for having us here and look forward to answering any questions.

[The statement of Ms. Wade appears in the Appendix.]

Mr. MITCHELL.  Thank you very much.

And let me just ask a question of all of you very quickly because we know that Congressman Walz has to leave.  But yesterday in talking to all of you, you all have some individual needs.  You are saying that the VA, in a way, has a number of things set up, but nothing to deal individually.

And I would just like, Corporal Owens, for you to tell the story that you told us yesterday about when you went to the methadone clinic, when they sent you out there because they did not know what else to do with you or something like that.  But would you tell that story?

Corporal OWENS.  During the time, I was, you know, that six months, waiting for my surgery, got too much to deal with anymore, so I started taking my pain meds again, still suffering from phantom pains and just the muscle tearing and just grinding against the bone and whatnot.

So I was back on them.  I had my surgery done, so I was still recovering.  About two, three months later, went to the VA, went to my doctor, primary care doctor, said I think it is time I want to get off these, but they are very, very strong narcotic medications.  So, you know, your blood pressure elevates, you know, your body goes through a lot, you know, lack of sleep, sweating, shakes.

So I said I would just like to be monitored, you know, I am ready to get off it.  He said okay.  So gives me an appointment.  So a couple days later, I go up to see a doctor, to the floor, to the substance abuse program.  First, they say, well, what are you here for.  I said I do not know.  I said I just want to get off my meds.  I thought I was coming to see a doctor to monitor me.

So he says, no, you must have been flagged.  Do you have a problem?  I said no.  I said call my doctor, put him on speaker phone.  He calls him, asks my doctor.  My doctor is saying, no, he does not have a problem, I just do not have the time, you know, big patient load.  He said he just wants to be monitored and, you know, helped and, you know, blood pressure medicine, whatnot.

So he gets off the phone.  The guy says, well, we want to put you in the methadone clinic where you will come in every six days and you will get six days worth of methadone.  I said I do not want any more drugs.  I want to get off of them.

So I left there and, again, went to an outside nonprofit veteran group and they sent me to a doctor and to a detox center and I got off of them, have not been on them since. 

But, you know, it amazed me that just a simple week-long monitoring could have taken care of it, but instead just led to more problem, more frustration, and giving me more of an attitude to not deal with the VA which I really do not do.  And most of all my care since I have gotten retired has been from outside doctors and outside sources.  I rarely use the VA.

Mr. MITCHELL.  Thank you. 

I just wanted you to kind of finish that and then we will get into our regular questions.

Mr. Walz?

Mr. WALZ.  I thank the Chairman.  I thank the Ranking Member for her courtesy.

I do have another appointment, but I can tell you with absolute certainty there is no place more important in this country right now than being right in this room.  And I am humbled to hear your testimony.  I am also ashamed that this would happen to our warriors. 

We have talked about it time and time again that dealing with our wounded warriors is a zero sum proposition, that if one is not treated with all the care and all the dignity and their issues are addressed with the utmost concern, then we have failed.  And that has been obvious in these cases, especially with Corporal Owens.  I am not even sure what to say. 

And to make matters worse even, coming to this hearing today, we just came from over in the Rotunda where we had an Iraq and Afghanistan war remembrance where a lot of people spoke and talked about a lot of nice things and you are sitting over here telling us this story. 

And I think Senator Dole summed it up best when he came in and testified.  He said you spent billions putting them in harm’s way, do whatever is necessary to get them out of harm’s way.  And obviously we failed you.

And Sergeant Wade, Ms. Wade, you brought up some very good points.  I just have a couple of quick questions on this.

Corporal Owens, you talked about how your TRICARE was canceled.  And what is so troubling to me about this whole thing is that you have come to expect that we are going to fail you.  I mean, that is obvious that your experience has showed that we are going to fail you.  That means we failed.  Our job is to provide that oversight.  It does not matter.

Last year, we talked about how much we were able to do in the VA.  It obviously did not help you and that is a concern, this Committee’s primary concern.

So what happened with that, with TRICARE?

Corporal OWENS.  Supposedly it was when I got my medical ID, it was supposed to be if you are discharged with a hundred percent from the military, you only get care at—this is how it was explained to me—that you can only get care at the VA.  So they discharged me with 90 percent and the VA found me a hundred percent disabled.  And that way, with TRICARE, I can go to outside the VA.

And when I got my ID, they gave me a hundred, the military, or I do not know who it was, gave me a hundred percent and so it canceled it.  But it took several, I do not know how long, month, two months or longer to reestablish it.

Mr. WALZ.  What happened during that time, I mean, as far as your care and bills and things like that?

Corporal OWENS.  I was going to the VA, so I was not billed anything, but it was just one more hassle, setting up appointments, calling people, and having to deal with it.

Mr. WALZ.  You mentioned a couple of times, too, about this resource issue and people are telling you we are just overburdened, we just cannot do it.

Would it surprise you that members of the VA have sat in front of us and we have asked them if they needed more resources and they said no?

Corporal OWENS.  That is a good point.  You know, I hear all the time about reports that 100, 200 new people have been added to the system to Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) patients.  It looks good on paper, but in reality, that is just an extra nurse or something to the hospital, you know, a new doctor, delegate of the hospital that can treat OIF patients, not to OIF patients, you know. 

I mean, it is for us, but, you know, it is good for reports and good for Committees because it sounds like you are making progress.  But the reality is, I do not see any results.  I do not see any changes.  You know, there are now OIF/OEF coordinators at all the VAs and whatnot, but the problem is, and this is a solution that I find, they need to have an OIF/OEF center. 

You know, they have psychologists, this and that set aside for us, but they are in all different parts, different wings of the building.  There is no correlation or communication among each other. 

And, like I wrote in my testimony, a good example would be Johnny is not going to, say, his prosthetic appointments or other appointments and so he gets reprimanded, written up.  They are like why are you not going, you are not doing anything to further your care.  And the reality is he may be suffering from severe PTSD or his own emotional problems and so he just sits in his room. 

And what they need is they need to come together like they do at Walter Reed and Brooke where all, social worker, prosthetist, orthopedic, vocational worker, they all meet every week and discuss their cases and the patients.  And it helps give insight into some of the people’s problems and the avenues of care they could give them.

Mr. WALZ.  Thank you.

And then a final question as my time expires here.  Ms. Wade, I think you have given a really powerful testimony and a really strong insight into an area that I think we are not addressing.  And it is the issue of respite care and what happens with the family and the caregivers, what happens to their career, what happens to their well-being.  And there has been talk about that. 

And this country means well and all of my constituents want to do whatever they can to help, but I know what happens to you as you see people and they will say, oh, it is good to see you, you are looking good.  It looks like Ted is doing well and all that.  And then they see you another four or five months later and they say, gee, how are you doing, are things going well.  They do not realize every hour of every day of the intensity that goes into that and this is all part of the care.  It is all part of taking care of that veteran. 

So I appreciate your testimony.  And I can tell you there are Members up here that definitely share this concern and believe this is the area, maybe the next big area where we should be focusing as quickly as possible to address that.

So I thank the Chairman and Ranking Member.  I do thank you again for your kindness to let me speak. 

And, of course, I am not sure what to say to you.  Sorry is not good enough in this case.  And everybody is going to stand in front of you and tell you that.  You said you have heard it many a time. 

The only thing we can say to you is that we are going to give every ounce of effort that we can to address this and make sure that you do not go through this.  And I know we may never gain your trust back in that system, but we owe it to those that follow you to do that.

So thank you for being here.

Mr. MITCHELL.  Thank you.

Ms. Brown-Waite?

Ms. BROWN-WAITE.  I will try this one again.

[Microphone technical difficulties.]

Ms. BROWN-WAITE.   I guess I will not.

All three of you, your statements certainly were riveting and sad, very sad.  I visit the various hospitals as many other Members do and I have to ask a basic question. 

When you were going through this, did you ever contact your Member of Congress’ office for help?  Because I know that many Members of Congress take the care of the veteran to be very, very personal.

As a matter of fact, I have the VA hopping in giving me a report every two weeks on a veteran in my district that I know kind of slipped through the cracks.  And I think it is very important that we know about it because I do not think there is a Member of Congress who, if he or she knew that this was going on would have not immediately jumped into action.

So did any of you contact your Member of Congress about the problems you were having with care?

Corporal OWENS.  Well, for me, did I contact my Member of Congress, no.  I do not know if other people on my behalf did.  I know one incident, I had written the President and wrote a letter and gave it to Colin Powell to give to him, but it was returned the following week.  But, no, I cannot say I did.

Ms. BROWN-WAITE.  Sergeant or Ms. Wade?

Ms. WADE.  I guess I have worked some with Senator Byrd’s office, one of our Senators from North Carolina.  He came to me and offered to help.  I had tried to contact Senator Dole’s office and there was just too many hoops to jump through and too much red tape. 

And honestly I think this is one of the problems with people with severe brain injuries or someone that requires a lot of intensive long-term care.  I do not have time.  There is a lot of people that I need to ask for help in a lot of different areas.  And I just gave up. 

I had contacted Senator Dole’s office about a military-related issue since she is on the Armed Services Committee and I was sent a VA waiver.  And I just did not have time to explain that it was not a VA issue. 

And so I mean, honestly, the people that have helped me also, Senator Hagel, I had met by accident.  It is an interesting story.  I was quarantined with him during an anthrax scare, but, you know, there is a couple of Senators that I met that offered me help.  And those are the people that I have gone to because there are just people that are trying mightily to get by every day and we do not have the time to get these things done. 

Ms. BROWN-WAITE.  The reason I ask that is because every Member of Congress has staff that work on these kinds of issues and get the elected Member involved to make sure that things happen.

I am sorry that you did not have a positive reaction and that you did not have action by the Congressional staff and the Members of Congress, the Senators that you mention.

You know, maybe the House Members are so much closer and our districts are so much smaller that maybe we have the luxury that the Senators do not.  I honestly do not know.  But I know that every Member of Congress, every Member in this House on both sides of the aisle deeply care about veterans and follow-up on veterans’ care.

Absolutely.  Mr. Bilbray, Representative Bilbray from California just said, “that is what we are here for.”

Let me ask each of you if you had any outreach from either the Department of Defense or the Department of Veterans Affairs after your discharge from inpatient care and what kind of support or care was offered to you or your family.

Corporal, would you like to go first?

Corporal OWENS.  Nothing really stands out.  I cannot say that they did not.  But nothing stands out because when I was discharged, you know, this all happened within a month.  You know, with my leg tearing, the muscle failing again all happened within a month and six months it took to get this done. 

So I cannot really think if they had, you know, I do not see what it would have taken this long.  I went to them, to the VA, and told them, so they were aware of everything.  It was obvious what was wrong with me.  No, not that I can think of.

Ms. BROWN-WAITE.  Sergeant or Ms. Wade?

Sergeant WADE.  I do not—

Ms. WADE.  Do you want me to start from the beginning since you were asleep?  Okay.

For Ted, he had a social worker initially at Walter Reed and Ted was retired from the military before he regained consciousness.  So he quickly was not their responsibility.  We did have a social worker at Walter Reed, who even though he was not her jurisdiction, she still kept in touch with me and tried to help me out.

I will say the person, the group that has been in touch with us from start until now is the amputee service at Walter Reed.  That is the only group of people that have been with us through the whole ride.  The amputee case manager there, I am convinced knows everything in the world.  But Steve Springer, the amputee case manager, and the physician who ran the amputee program at Walter Reed who is now the Chief of Rehabilitation, Colonel Paul Paswena, they are the ones that have been with us throughout this whole ride.

Ted’s care was very fragmented.  We had a social worker when he was in Richmond where one of the level one polytrauma sites is now.  But, you know, once we left there, there was not any contact with them anymore.

When we got home, there is an OEF/OIF case manager at our VA hospital.  She is there when I go to her for issues, but she is not really there for any kind of really injury-specific case management.  It is out of her realm of expertise.  So she was there when we were at Durham the first time and she was there when we were at Durham the second time.  We have been through seven facilities.

And really, I guess the last three years, our continuity has been the civilian place where Ted goes, the civilian practice he goes to.  They have a brain injury case manager who from the first day we went there until just Monday was the last time I talked to her.

Even when Ted is at a different facility for treatment, like right now he is at Walter Reed getting a new prosthesis and doing prosthetic training and rehabbing from some surgery, she still talks to Ted for an hour once a week regardless of where he is in the United States.

So the amputee case manager at Walter Reed and the case manager at our civilian facility for TBI have been our most continuity.

And what we are very hopeful about is the Federal Recovery Coordinator Program.  Ted was recently assigned someone in the Federal Recovery Coordinator Program.  And that has been maybe two, two and a half weeks.  She has already passed her first couple of tests which is a big thing with me.

But we are hopeful that that will maybe create some better continuity.  My concern, though, with that, is there are good reasons why they are starting off slowly with this program, because it is hard to get a hundred people out there, training them when you do not even know what you need to train them for yet and what kind of services people need.

But one of my concerns is in starting off slowly and where a lot of the case management focus has been after the Walter Reed articles in the Washington Post, a lot of the focus has been on the military treatment facilities and the polytrauma sites.  Polytrauma network sites, only a small handful, a few hundred people have been through those.  It is a relatively small number compared to the large group of people being wounded.

And needless to say, the military treatment facilities are short lived.

My concern with the changes in case management, I know that I hear patients at Walter Reed are currently complaining that they have to check in with five different case managers in one day and doctors complaining that the case managers are getting underfoot and they do not have time.

Ms. BROWN-WAITE.  Excuse me.  Is that currently—

Ms. WADE.  Yes, ma’am.

Ms. BROWN-WAITE.  —they are complaining about that?

Ms. WADE.  And so what I feel like is that it would be smart to have some sort of visibility of all the case managers that exist from all these different programs.  I mean, Ted theoretically has five or six, because there are a lot of people who left the military treatment facilities like my husband who just dropped off a cliff. 

I really think that if some of these groups of case managers could be restructured and reassigned that someone needs to have the job of reaching back and finding the people that have been lost for the last few years and finding out if they ever got the treatment they needed.  And if they did not, make it happen now.

Ms. BROWN-WAITE.  Thank you very much.

Did you get a copy of the case plan for your husband when he was leaving the hospital, a case management plan, what they were going to do?

Ms. WADE.  No, ma’am.  I do not think they were doing that.

Ms. BROWN-WAITE.  So there was no case management plan with follow-up care?

Ms. WADE.  I will say our Federal Recovery Coordinator, the first day I met with her, that was our first conversation was what were our immediate goals for the next six months and what were our goals for the next five years.