The Results of the President's Task Force on Returning Global War on Terror Heroes.
THE RESULTS OF THE PRESIDENT’S TASK FORCE ON RETURNING GLOBAL WAR ON TERROR HEROES
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
MAY 9, 2007
Printed for the use of the Committee on Veterans' Affairs
SERIAL No. 110-22
U.S. GOVERNMENT PRINTING OFFICE
For sale by the Superintendent of Documents, U.S. Government Printing Office
CORRINE BROWN, Florida
STEVE BUYER, Indiana, Ranking
Malcom A. Shorter, Staff Director
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.
C O N T E N T S
May 9, 2007
The Results of the President’s Task Force on Returning Global War on Terror Heroes
SUBMISSIONS FOR THE RECORD
Miller, Hon. Jeff, a Representative in Congress from the State of Florida, statement
MATERIAL SUBMITTED FOR THE RECORD
Report of the Task Force on Returning Global War on Terror Heroes, April 19, 2007
THE RESULTS OF THE PRESIDENT’S TASK FORCE ON RETURNING GLOBAL WAR ON TERROR HEROES
Wednesday, May 9, 2007
U. S. House of Representatives,
Committee on Veterans' Affairs,
The Committee met, pursuant to notice, at 2:03 p.m., in Room 334, Cannon House Office Building, Hon. Bob Filner Chairman of the Committee] presiding.
Present: Representatives Filner, Michaud, Herseth Sandlin, Mitchell, Hall, Hare, Berkley, Salazar, Donnelly, McNerney, Space, Walz, Buyer, Stearns, Baker, Brown of South Carolina, Boozman, Brown-Waite, Lamborn, Bilirakis, Buchanan.
The CHAIRMAN. The House Committee on Veterans' Affairs is called to order. We thank the members for their attendance.
Mr. Secretary, we thank you for being here. We thank you for chairing the President's Task Force on the Returning Global War on Terror Heroes and for the Task Force's report to the President.
Mr. Secretary, we will hear from you on the Task Force recommendations. I think that you know, and I know you feel it personally, the frustration amongst us all as to making sure that we clearly and professionally deal with the returning veterans from Iraq and Afghanistan and that while we are doing that keep services up for our older veterans. That is a challenge that you have, and that we all have, in working together to do that. We want it done today or yesterday or last week and I know you do too. So we are looking forward to your report and the implementation of the recommendations. I was disappointed at the charge that you got in that you had to stay within certain constraints, no new programs, no new money.
I hope that you might give our Committee a report that does not have those constraints, that details what we have to do to make sure that we meet the needs, and we meet them urgently.
Every one of us has had the experience, and I know you have because we have done it together, of talking to veterans around the country and looking into the faces of the spouses of troops, returning troops who have brain injury and knowing that they are going to have to spend 24 hours a day with them and lose their jobs. What is their future going to be? We meet people, young people with Post Traumatic Stress Disorder (PTSD) trying to cope with this and trying to deal with a bureaucracy that sometimes seems unresponsive to them.
So we have a job to do as a Committee and as a Congress and your agency is right at the frontiers of that. Everybody is looking to the VA to do its job correctly. So we hope that these recommendations do not sit around like so many other recommendations have done.
There are other reports on the table. I know that there was a President's Task Force to Improve Healthcare Delivery for Our Nation's Veterans in 2003. There was a report from the Congressional Commission on Servicemembers and Veterans Transition Assistance in 1999. And of all those recommendations, not all of them have ever been implemented.
We want a time frame for the implementation of your recommendations, who is going to be responsible for implementation; how will we be informed on the progress because we, as we have talked about, want to have accountability for all of this. So we are interested in time lines and implementation and we want to know what else we can do if we provide more resources.
I think you know that in the first three budget bills that went through the House, only one of them signed by the President so far, that we were able to add close to $13 billion to the budget from last year, the highest increase in history. This is almost a 30-percent increase in healthcare revenues.
So we think we are giving you the resources that you need, but we want to make sure that they are spent the right way and that our returning heroes do, in fact, get the kind of care and love and attention that we all want.
I will say one more thing before I turn to Mr. Buyer for an opening statement, that we are discussing the war and the funding of that now. I just want to assure you, and the American people, that wherever we are on the war, wherever we stand, we are united in saying that every young person that comes back from that war gets all the care and attention, love, honor, and dignity that this Nation can bestow.
I think many of us may have made mistakes in greeting heroes from Vietnam. We, as a country, are not going to make those mistakes again, and we look forward to working with you to make sure that that occurs.
[The statement of Chairman Filner appears in the Appendix.]
The CHAIRMAN. Mr. Buyer, you are recognized for an opening statement.
Mr. BUYER. Thank you very much, Mr. Chairman. I want to thank you for being responsive to my request to have the Secretary come up here today. This is a very good hearing. I appreciate your cooperating to make this happen.
Mr. Secretary, thank you for being here today and for chairing this task force on behalf of the President and the country.
The President has made clear his intent to establish a truly seamless transition for servicemembers between the military and the VA, as well as other agencies providing services to our veterans. You and your colleagues on the task force have produced a thorough review of factors affecting seamless transition and you are to be commended.
I must inform you, though, Mr. Secretary, over the past 15 years, I have seen, whether it is from the reports from the U.S. Government Accountability Office (GAO), the Inspector General (IG), commissions, task force reports, and reports on this issue, from my personal experience with seamless transition on this Committee, I know that at this point, there are few new discoveries.
What we have regrettably seen and what I believe has compelled the President to directly intervene is a general lack of implementation. So to be fair, I believe the U.S. Department of Veterans Affairs (VA) has made most of the progress. It has, in fact, led the Federal effort, but the VA cannot do it alone. You need to have the cooperation and leadership from your counterparts at the Departments of Defense (DoD), Health and Human Services (HHS), Homeland Security (DHS), Labor (DoL), Education (DoE), and other agencies.
So, Mr. Secretary, with the task force work behind us and this report now before us and the President's intent made clear to you as the leader of this task force, we must now have implementation.
Now, when I ask about implementation, you and I both recognize that there are some other things that are still out there. We still have the Dole-Shalala report that will be due later on in the summer and we have the Claims Commission. So while we have some overlap, we want to avoid duplication and redundancies, but there are things that we can do now.
So in a few short weeks, the President I believe is due to receive a progress report on the implementation of recommendations from the report. We in turn will look to you and other agency heads, in particular Defense Secretary Gates, to work directly with you and your respective departments as you move forward.
So in your statement, I am hopeful that you will touch on these relationships and how you foresee them as you proceed.
So what happens is we want to talk about real progress. This report is nonetheless, I believe, encouraging. And among the task force, 25 recommendations, a handful alone would dramatically improve transition and must become a high priority within the Administration.
These include the development of a system of co-management and case management for returning servicemembers to facilitate transition between the Department of Defense and the VA.
Second, the screening of all Global War on Terror veterans seen in VA healthcare facilities for mild to moderate traumatic brain injury (TBI). Now, it is often said about TBI being the signature injury of this war, yet the actual numbers that are actually being treated for TBI are relatively small. You will have to tell me what the exact number is.
But there are individuals who are survivors of these improvised explosive device (IED) explosions that are excited that they survived, but they, in fact, may have some effects that they are not aware of. And that screening, I think, would be pretty important. And I know it is an issue that the Chairman is also pretty concerned about.
Expanding VA access to DoD records to coordinate improved transfer of servicemembers' medical care through the patient handoff is a need that you and I witnessed as we went through the theater into Germany and saw those medical records taped to their chests. I know that is something vivid in your mind.
Another goal is the Development of the joint DoD, VA process for disability benefit determinations by establishing our cooperative medical and physical evaluation board process within the military service branches and the VA care system. Also among my goals here on the Committee is to ensure that the veterans have every opportunity to live full and healthy lives, that they can take advantage of the economic opportunities their service helped preserve.
Among key recommendations, the task force report would help veterans transition to civilian life. As you mentioned, this would include increasing attendance at transition assistance and disabled transition assistance programs for active-duty Guard and Reserve, requiring the Department of Education in cooperation with the Department of Labor to participate in DoD job fairs for returning servicemembers and their families with awareness of post-secondary education benefits, requiring the Department of Labor through Veterans Employment and Training Service to participate in workforce investment systems in every State, territory, and partnering with private-public sector job fairs to expand the number of employers involved in the active veteran recruitment.
The accomplishment of these recommendations as well as others is critically important. Since 2003, this Committee held more than ten hearings and conducted fifteen site visits focusing on seamless transition. Our experiences collaborate the value offered by these recommendations. And that is why I compliment you.
Mr. Chairman, there are two other things I would like to address, and that is, one, there were statements, Mr. Secretary, made by members of this Committee that have ended up in the press as of late, some of which concerned me and I would thus probably label them as freshman over-exuberance. And so let me address each of them.
The CHAIRMAN. Mr. Buyer, we are here to hear the Secretary. I would prefer if we have time at the end that you go over those.
Mr. BUYER. That would be fine.
The CHAIRMAN. But as a prosecuting attorney once said, once you open that door, anybody else can walk through it. So I would like to get to the Secretary.
Mr. BUYER. I will restrain myself and close with this: Mr. Secretary, we are pleased to have you here. We look forward to your report.
The CHAIRMAN. Wait a minute. Please, Mr. Secretary, you are on.
Mr. BUYER. So you have cut off my statement?
The CHAIRMAN. You told me you finished your statement.
Mr. BUYER. No. I said I will not refer to what I was about to discuss and just let me complete the statement. It is just a minute, Mr. Chairman.
The CHAIRMAN. You have one more minute.
Mr. BUYER. Thank you.
Mr. Secretary, I want to compliment your initiatives out there, not only coupled with this report, but you have doctors in Pittsburgh right now in your efforts to reduce the staph infection rates and you are about to leverage that across the VA system. I extend great compliments to you.
Your diabetes initiative, you know, is doing over 8,000 amputations a year. A lot of people do not realize why you are so good in that business.
And you just announced a new formal Advisory Committee yesterday. So at some point, if you could let us know about what that is about.
And thank you, Mr. Chairman, for your courtesy.
[The statement of Congressman Buyer appears in the Appendix.]
The CHAIRMAN. Thank you, Mr. Buyer.
Mr. Secretary, welcome, and we look forward to your report.
STATEMENT OF HONORABLE R. JAMES NICHOLSON, SECRETARY, U.S. DEPARTMENT OF AFFAIRS; ACCOMPANIED BY HONORABLE PATRICK W. DUNNE, RADM, RET., ASSISTANT SECRETARY FOR POLICY, PLANNING AND PREPAREDNESS, U.S. DEPARTMENT OF VETERANS AFFAIRS
Secretary NICHOLSON. Thank you, Mr. Chairman and members of the Committee. I welcome the opportunity to come here to give a report on the work of the President's Task Force on the Global War on Terror Heroes.
The recent series of articles in the news media highlighted significant problems at the Army's Walter Reed Medical Center. Many people have misconstrued this to relate to the VA healthcare system which is an entirely different entity.
Servicemembers maintained on active duty for care were being housed in a former motel at Walter Reed that had not been properly maintained for some time. Conditions in what everyone now knows as Building 18 were deplorable. That our servicemembers would be expected to live in those conditions elicited outrage. This situation was unfortunate on many levels.
My wife, Suzanne, and I have visited Walter Reed Hospital many, many times in the two plus years that I have been the Secretary. We continue to be impressed by the character of our young, injured servicemembers. We are as well impressed with the quality and the compassion of the medical care that they receive there, but that is a focus on the critically injured inpatients, not on those who are in the Army's medical hold status.
Upon learning of the Army's situation in Building 18, I immediately did two things. First, I directed that a survey be conducted at all points of access to the VA healthcare system, our 155 hospitals and nearly 900 outpatient clinics, to ensure that we did not have situations comparable to those encountered in Building 18.
Although the findings in large part were positive, those areas of concern identified were addressed immediately under my orders that the VA non-recurrent maintenance funds be used to rectify them.
I also wrote to every member of the United States Congress and reiterated my own commitment to assure that our veterans receive the very best care possible in an environment of care that is appropriate to that care.
So I also asked them, you, to visit a VA medical center in your State or district at your earliest convenience. And to date, I am pleased to say that 305 members have done so and almost universally they have expressed their high regard for the quality of care being provided, the commitment of the caregivers, and the cleanliness of the environment in which that care as given.
The President also took decisive, aggressive action. By Executive Order, he established two groups, the President's Commission on Care for America's Returning Wounded Warriors and the Task Force on Returning Global War on Terror Heroes, which he asked me to Chair.
The President's Bipartisan Commission is chaired by former Senator Bob Dole and former Secretary of Health and Human Services, Donna Shalala. That Commission is to report to him by the end of July.
Our task force was to develop recommendations and report back to him in 45 days with an assessment of gaps that may exist in services needed by our servicemembers that could be addressed without additional legislative authority or appropriations. Those were the two constraints.
The task force which I chaired included the Secretary of Defense, Robert Gates; Secretary of Labor, Elaine Chao; Secretary of Health and Human Services, Michael Leavitt; Secretary of Housing and Urban Development, Alphonso Jackson; Secretary of Education, Margaret Spellings; the Director of the Office of Management and Budget, Rob Portman; the head of the Small Business Administration, Steven Preston; and the Office of Personnel Management, Linda Springer.
And I am proud of the work of this task force. There is a new era of cooperation and what we can do here can make a substantial difference. The recommendations of the task force focus on ways that we can immediately improve the services for those returning servicemembers from the war and how we can better reach out to them and their families to make them aware of what services exist.
We developed 25 recommendations and I want to note here what I consider some of the most significant.
In the context of healthcare, DoD and VA have agreed to a new system of co-management and case management for these combatants who are seriously injured as they move from one system to another. We have the most advanced polytrauma centers in the world bar none. Our patients' transition from the military medicine arena to ours will be seamless for them and their families.
We are going to work with DoD to develop a joint process for disability determinations which will provide consistency and speed for our veterans.
We are now going to screen every Global War on Terror veteran who comes to us for any form of brain injury looking for the mild or moderate form of brain injury as a result of the environment they are in over there and the concussive blasts that are so prevalent. We want to identify it as early as possible and begin treatment.
We are going to simplify the enrollment process for veterans to enroll for healthcare whether they enroll on-line or in person. And we will continue to develop our world standard of electronic medical records.
The DoD is taking action to increase the attendance at the transition assistance programs known to you probably as the TAP briefings. The more our veterans understand about their benefits, the more successful their transition to civilian life will become.
A few other areas I want to briefly highlight for you today include the VA and HHS collaborating to improve access to care for returning servicemembers in remote or rural areas.
The SBA is expanding eligibility of the Patriot Express Loan Program to provide a full range of lending, business counseling, and procurement programs to veterans, service-disabled veterans, Reservists, and families if the desire for a returning servicemember or family is to obtain self-employment.
The DoD and the Department of Labor are improving civilian workforce credentialing and certification allowing for greater exposure of a servicemember's military experience to civilian job opportunities.
The Department of Housing and Urban Development is expanding access to the national housing locator for servicemembers. By expanding its use, returning servicemembers will have a resource that provides safe, disability accessible, if needed, and affordable housing to ease in potential relocation to a new geographic area.
The Department of Education in cooperation with the Department of Labor will participate in DoD job fairs to provide returning servicemembers and their families with more awareness of the post-secondary education benefits available to them.
The Department of Education will provide education benefits training to the 211 transition assistance programs and those sites would service more than 150,000 transitioning servicemembers every year.
The Office of Personnel Management is expanding their military treatment facility outreach to promote the availability of Federal employment and veterans' preference rights.
So all in all, our focus, I think, really is very simple. It is to make the existing services that are there of the Federal Government the very best they can be for our veterans and for their families and for the survivors of those who paid the ultimate price.
Thank you very much, Mr. Chairman.
[The statement of Secretary Nicholson and the Task Force on Returning Global War on Terror Report appears in the Appendix.]
The CHAIRMAN. Thank you, Mr. Secretary.
I will be calling on colleagues in just a second after one short question I have.
Let me just give you an example of the frustration many of us feel when we see reports like this. You said we will screen every veteran that comes to us for TBI. Now, that is the recommendation of the task force. What I would like to hear you say is only X percent, it is fairly small, of returning veterans come to us. We should be screening them comprehensively and mandatorily for both TBI and PTSD before they are discharged or before they enter the civilian life.
We all have heard from experts that the sooner we catch this, as you mentioned, the better off the veteran is. Some symptoms are hidden until months later, so maybe we need a six-month screening and then a twelve-month screening and a twenty-four month screening. That is our obligation. Part of the cost of war is dealing with the cost of caring for of our veterans.
And so we applaud that screening, but it is just a small part of what we really should be doing. And we need you to show—I know you know this—but tell us so we have a context in which we view these recommendations, as I said, on the one hand under the constraint of no new money, but on the other hand, what do you really want to meet the needs of our returning heroes. That is the kind of thing that I hope we can work together to solve.
Mr. Michaud, who is Chairman of our Health Subcommittee will start off the questioning.
Mr. MICHAUD. Thank you very much, Mr. Chairman.
And thank you, Mr. Secretary, for coming here today and for presenting this report to us.
Looking at the report and having had a chance to read it when it first came out, I appreciate the fact that you are assigning a lead agency to look over some of these recommendations along with a target date for implementation so we can see where you are throughout the process.
My concern, however, is, even though the task force did a great job, back at my office I have the Presidential Task Force for a Seamless Transition recommendations that came out in 2003 that currently is sitting there and it is the implementation which is extremely important. I compared those task force recommendations for a seamless transition to these task force recommendations and see how many are the same. These reports are not going to do any good unless we act upon them.
I can tell you that I will definitely be keeping a close eye on the target dates when these recommendations are supposed to be implemented and, if they are not, see why the implementation has not moved forward.
You heard the Chairman talk about how you were directed to do this with existing resources and existing authority. Do you feel you can do all these recommendations without any additional resources for your agency?
Secretary NICHOLSON. Yes, I do, because we abided that constraint of the action items that we are taking pretty carefully. That was our mandate.
Mr. MICHAUD. Okay. Are there any recommendations when you went through looking at the seamless transition and what was needed out there, are there any recommendations that actually might have cost funding that you could not do that are out there that we should look at?
Secretary NICHOLSON. There is a possibility, Congressman Michaud, as some of these things would, you know, as they mature.
For example, I think the very enlightened idea of simplifying and streamlining this discharge procedure. The way it works now is that if a servicemember is injured, the Army makes a determination or the Marine Corps or the services that they are either fit or unfit to be retained on active duty. And if they are fit, in theory they go back to their unit. If they are unfit, they go into a category for determination of that degree of unfitness prior to their separation.
And what we know is that if they are not happy with that, they have appeal rights within the Armed Services, but further they then can come to the VA and make a claim at the VA. And many, many of them do. And that entails months, if not years of time that they are sort of in limbo. In fact, that was the case at Walter Reed. I think some 600 people were in that medical hold category.
What we are talking about is slicing through some of that. If they are fit, put their boots back on and go back to duty. If they are unfit, come in an expedited way to the VA and we then evaluate and process that degree of disability and work it into our compensation system. That could entail additional resources upon its full maturation.
Mr. MICHAUD. It would be helpful if you can provide any other recommendations that came out of the task force or thoughts, but because it did not meet that criteria of within existing resources, it would be helpful if you could provide that to the Committee because I think we are very interested to make sure we do take care of our men and women who wear the uniform and those who become veterans.
My last question is, what will happen, and I think the VA has done an excellent job when you look at medical records and what have you, and I think the Department of Defense has been slack in that area, what happens if there is a disagreement between DoD and the VA? How do you resolve those differences? How do you deal with that issue?
Secretary NICHOLSON. Well, first, let me tell you a very encouraging note that the first meeting was held yesterday in Deputy Secretary England's office over in the Pentagon with my Deputy and all three of the service Secretaries and the Deputy Chiefs of those services to discuss these very issues.
And, further, there is an agreement for such a meeting to take place now every Tuesday afternoon. That is significant movement because there is, I think, a new awareness and there is a new command emphasis that comes from the President, and people are getting it, that we are just going to have to do a better job in getting these two big organizations to talk to each other, particularly with respect to medical records.
Mr. MICHAUD. Thank you very much, Mr. Secretary.
The CHAIRMAN. Thank you very much.
I will yield to Mr. Buyer and also Mr. Stearns for his time.
Mr. BUYER. Mr. Chairman, I will exercise the same courtesy that you did.
But in my opening statement to the Secretary, I had asked him in his opening statement to comment on this reduction of the infectious disease of our hospitals because we are talking about, you know, our soldiers coming home and transitioning to what. And, Mr. Secretary, you are getting out in front of the reduction of the infectious disease rate and it is a good story.
Can you tell us about what happened at Pittsburgh, the reductions, and how you are trying to leverage that?
Secretary NICHOLSON. Yes, I can. I can tell you, and maybe some of you have seen, there is a graphic out there that graphically portrays some of the things you do in life that are on a scale of very dangerous to very safe. And on the very dangerous thing that you can do in the United States today is—
The CHAIRMAN. Being a Cabinet Secretary?
Secretary NICHOLSON. Pardon?
The CHAIRMAN. Cabinet Secretary is right up there, right?
Secretary NICHOLSON. —is to go into a hospital. One of the very safe things you can do today is fly on a commercial airliner. And there are some things in between.
So it is a fact that far more people are being killed today in today's hospitals by mistakes than are dying on the highways. One of the problems are staph infections. There is a technical name for it which is called methicillin staph resistant aureus and the acronym is MRSA. And we at the VA, I think we have established an exemplary record for patient safety and performance measures and so forth, but we have had that problem as well. So we instituted a pilot project at our VA hospital in Pittsburgh to go after the MRSA.
And in one year, we reduced staph infections by 70 percent. And it is not space science how we did it. It is a disciplined approach, sanitation, culturing patients when they come in. It is usually a swab in the nasal passage. It used to take two days to read the culture. We now have a new technology. We can read them in two hours.
If they are a MRSA carrier, they are treated accordingly. The staff will scrub afterwards, regarb if they have close contact with that patient. We cut those infections 70 percent.
So we had a discussion about taking this pilot to ten or fifteen hospitals I said, no, let us take this to 155 hospitals. And I say I am very proud like I am in many ways of the leadership and the medical corps of the VA. They have embraced this and it is underway in our system. And I think we are going to see some just tremendous results from it.
The CHAIRMAN. Mr. Stearns, you have five minutes.
Mr. STEARNS. Thank you, Mr. Chairman, and thank you for having this hearing.
I want to thank the Secretary for the job he is doing and the sacrifice he is making at this critical time. We appreciate your efforts.
Yesterday we had an Oversight Subcommittee hearing in which we had a lot of the DoD and Veterans Affairs up here. And it was clear to us that the whole idea of inter-operability between DoD and Veterans Affairs is a long way off.
And as you know, we have been working on this. There has been legislation. There has been studies and this has been going on for some time unsuccessfully. And we found yesterday that it could be as late as 2012 when they possibly will have inter-operability.
And this goes to your policy directive, your Veterans Health Administration (VHA) directive of April 13th in which you said it will be the policy of the VHA that all Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans receiving medical care within VHA must be screened for possible TBI. Those who on the basis of the screening might have TBI must be offered further evaluation and treatment by clinicians with expertise in the area of TBI.
I guess my question is to you, is it not crucial and important that the Department of Defense provide you the medical information that they have so that the seamless transition when they move from active duty to veteran, that all that information, particularly dealing with traumatic brain injury, is available to the veterans?
And I was just disappointed last night that it is still not being done and I just would like your opinion.
Secretary NICHOLSON. Yes, it is. It is extremely important. It is critically important that we get what is available on the medical history of that servicemember since being injured.
And as Congressman Buyer mentioned earlier, he and I had been in Iraq with other members. Two people were injured where we were one day near Fallujah and we happened to be going into the hospital in Landsthul the same time as they were coming in on gurneys and their medical records were taped to them with duct tape to their bodies—
Mr. STEARNS. Yeah.
Secretary NICHOLSON. —bespeaking, I think, the anomaly that there exists between how highly technical our Armed Services are with the state-of-the-art target acquisition, night vision, optical equipment and, yet, still very rudimentary with paper records which are fraught with being illegible, things getting lost. It is not a lack of bad faith on their part.
Mr. STEARNS. No. I think it is just getting all these departments together.
Secretary NICHOLSON. It is problematic.
Mr. STEARNS. You know, in my congressional district, I have a company called Banyan Biomarker and they are trying to determine through diagnostic blood samplings whether traumatic brain injury is—what category of seriousness it is.
Now, when you say you are going to do this screening, I assume in addition to questions and answers, you are also going to do MRIs and things like that. I am asking you for the technical aspect.
But these scientists have pointed out that you really cannot fully detect traumatic brain injury or, for that matter, posttraumatic stress disorders. You have to do it diagnostically through blood. And we are not at that point, so there is going to be a lot of debate of a person who comes through and you say, no, you do not have TBI and, yet, the person says there is something wrong.
And so I think you and your staff should be aware of that, that there is another state-of-the-art for this testing that through blood diagnostic you can find this.
But I think the thing that I think is extremely important, and you have sort of confirmed it, is this inter-operability in this age of information, we should be able to have that those records are not affixed, attached to a person, but should be electronically transmitted automatically. And I think that part of your whole task force is to continue to push on that effort.
And I thank you, Mr. Chairman.
The CHAIRMAN. Thank you.
Mrs. Herseth Sandlin—
Ms. HERSETH SANDLIN. Takes some getting used to.
The CHAIRMAN. —the Chairperson of our Economic Opportunity Subcommittee.
Ms. HERSETH SANDLIN. Thank you, Mr. Chairman.
The CHAIRMAN. Congratulations on your recent marriage.
Ms. HERSETH SANDLIN. Thank you. Thank you and the Ranking Member for having this hearing today.
Mr. Secretary, thank you for your testimony. I would like to start out with the recommendation that you cited and that is in the materials from the task force work product to expedite adaptive housing and special home adaptation grants claims.
I could not agree with that recommendation more and I am wondering if the task force looks specifically at the change in the law that we made in 2003 where active-duty servicemembers could apply for these specially-adapted homes because I have a constituent that has run into a lot of hurdles and was initially told that you cannot apply for the specially-adapted housing grants until you have a DD-214 and a VA disability rating, but he is still on active duty. And we have more and more active-duty status servicemembers who have suffered serious brain injuries.
If you could elaborate as to whether or not the task force did look into that specifically in terms of implementing that legal change and what recommendations you might have.
Secretary NICHOLSON. I am aware of that issue, Congresswoman. The answer, though, our task force did not look at that because, again, that would require legislation. And within the ground rules that we were operating and this expedited time frame we had, we did not look at those things.
Ms. HERSETH SANDLIN. Okay. Well, I just want to bring it to your attention so that you know that the Subcommittee may very well be interested in looking at what is needed to make sure that the implementation of the change that was made in 2003 for active duty and what VA needs to more quickly process these claims with the authority, I think, was given in 2003.
But I think this is again an area where DoD, when a soldier is still active duty and under the way that the claims processing has always worked, you need to be discharged and have a VA disability rating. And we have got some folks out there that are either in polytrauma centers or they are in private rehabilitation facilities that are trying to apply and getting misinformation.
The other area I wanted to explore was the specific recommendations in the health area for traumatic brain injured servicemembers. I know that you mentioned at the outset that one of the most significant recommendations in your opinion is developing that system of co-management and case management more broadly, but then specifically the polytrauma identifier as well as the traumatic brain injury database to track patients.
And I am wondering, well, I would just make the comment that as you move forward in implementing these, a recommendation, suggestion again by the mother of one of my constituents in talking with the mother of another brain injured soldier is that the case management, managers could be trained specifically for TBI patients because untrained people may not be fully aware of what seriously injured, brain injured servicemembers may require. If we had this subset of trained case managers, it might help these families substantially.
One last question. Did the task force specifically evaluate the suitability of existing programs and the restrictions on those programs in the Vocational Rehabilitation Employment Service for brain injured soldiers?
Secretary NICHOLSON. I am sorry. Of the what programs?
Ms. HERSETH SANDLIN. The existing programs under vocational rehabilitation and the restrictions on the participation of those programs and their suitability for brain injured servicemembers.
Secretary NICHOLSON. Yes, we did. Looked at that quite carefully and have stepped up the efforts for awareness of those programs.
Ms. HERSETH SANDLIN. I understand. I appreciate that and I appreciate the recommendation of extending the period of time because over two years or more we see cognitive functions continuing to come back and develop for these servicemembers.
And so, again, the Subcommittee will work more closely with you and those that work with you to more closely evaluate the suitability and the need to maybe modify these programs to work best for these servicemembers and their families. Thank you, Mr. Secretary.
And thank you, Mr. Chairman.
The CHAIRMAN. Thank you.
Mr. Baker, you have five minutes.
Mr. BAKER. Thank you, Mr. Chairman. I appreciate your courtesy.
Mr. Secretary, I commend you and the task force for identifying promptly the problems at Walter Reed and taking prompt corrective action. It is highly commendable.
My observation today is we have a similar problem in Louisiana as a result of Katrina. Due to the destruction of the VA hospital there, veterans now may travel as much as eight hours to receive appropriate healthcare.
It was February 23rd, 2006, that is for the Committee 15 months ago, when the VA and the State entered into an MOU to explore the feasibility of VA-State partnership for delivery of innovative care in the New Orleans area.
Only recently, as in the last couple of weeks, has the State forwarded its proposal which I thought was rather unexpected in that its $1.2 billion scope and bed count was above earlier anticipated numbers.
In the interim, since that report has initially been issued, there have been two statements for the record, one by Governor Blanco, one by the Chairman of the LRA, the Recovery Authority, indicating several points of consideration, the need of economic recovery, the need of an economic engine, financial necessity. It went on and on in the letter. I found it of interest in the three pages of correspondence the word veteran was not mentioned once.
On April 10th, the Chairman and myself, the Ranking Member, Mr. Jefferson of New Orleans forwarded correspondence to your office requesting establishment of a date certain. We are not trying to tell anybody how to do it. We are only requesting that it get done. I am awaiting that determination. The problem is clear in Louisiana just like it was at Walter Reed. You see it, you decide what to do, and you went and fixed it.
My reason for being here today is after 15 months is to say it is time for us to do something. We do not have to describe a plan. We do not have to tell the State what to do. We merely should say by a date certain. Whatever that date is, you are certainly free to make that determination. As I understand the MOU, either party can unilaterally withdraw for any cause whatsoever.
But the plan now under consideration will require the acquisition of considerable private property interest. In one plan as few as 200 parcels. In another plan as much as 37 acres, some of which is in downtown Orleans which has generated considerable discussion among those homeowners.
The original plan contemplated to have begun planning and feasibility studies for the structure itself would have been engaged already, would not have allowed a ribbon cutting and service of veterans until 2012.
With the added curve of the acquisition of new private property in order to facilitate a 60-acre site above the initial 37 proposed by the State, it would seem logical to me that control of the site for development may take not months but years.
If I were to tell veterans they were to wait until 2012, which was plan A, they were not happy. To be honest, I cannot represent that to them anymore because I cannot tell them when it will be.
My question, Mr. Secretary, is not how long I am going to have to wait. I am not important. But it is extremely important for me to be able to tell the veterans how long are they going to wait. When are we going to set a date, Mr. Secretary?
Secretary NICHOLSON. Well, you do not have any more frustration there than I, Congressman. We did enter into the memorandum of agreement, making a lot of good sense to collaborate and share facilities such as parking, laundry facilities, certain other infrastructure, utilities, and did it in good faith with high expectations.
And while we do not have all of the money that we need to build the hospital, you need to give us about another $300 million of authorization, we do have $300 million appropriated and authorized, plenty to start all the design work, engineering, site planning. But we have not been able to count on a site.
So as you know, about two months ago, I said we cannot wait any longer for LSU. And I put out an RFP for alternative sites which we are now looking at with a view towards possibly having to build this hospital independent of a collocation with LSU. And we are going to be vetting out those sites soon.
But as I sit here today, I could not give you a date certain. I just could not be honest about it if I did because we do not yet have enough—
Mr. BAKER. Will we likely wait another year, another two years? I mean, is there an outside limit? There has got to be. I mean, at this point, we have no plan. The State does not have the money. There are alternative private interests who are willing to make their facilities available within the region.
I am just asking for a business decision and I am not going to ask for it today, but I think it highly inappropriate to have such uncertainty over something that is so important to the region. There is not any reason in the world to have someone have to drive to Houston or Biloxi.
These are Louisiana veterans coming home and they have every right to expect care in their community because it used to be there. And all I am suggesting is a decision. I will be happy with a bad one, just we need a decision.
I yield back.
The CHAIRMAN. Thank you.
Mr. Buyer and I have joined you and Mr. Jefferson in trying to do this and we share the frustration of Mr. Baker.
The Chairman of our Investigations and Oversight Committee, Mr. Mitchell.
Mr. MITCHELL. Thank you, Mr. Chairman.
And thank you, Mr. Secretary, for being here today to report on the findings of the task force.
You know, the Global War on Terror has been the reality for our Nation since 2001 and I am glad the President created this task force. But I have to admit I am disappointed that it took until 2007 to do it. It seems to me that the Department of Veterans Affairs should have been prepared many years ago.
Mr. Secretary, I visited the Carl T. Hayden Medical Center. That is the VA medical center in Phoenix. I have tremendous respect for the staff, but what they told me is that they are strained, that they are under-staffed and in some cases do not have the equipment they need.
Aside from the Administration's delay in addressing this issue, I am concerned that the VA may not have the resources it needs to get the job done.
Veterans tell me and VA officials tell me that the VA is under-staffed and lacking the equipment it needs. Do you believe that the VA is under-resourced and do you regret your decision not to ask for funds to allow the VA to handle the strain of the new veterans' population?
Secretary NICHOLSON. I think, Congressman Mitchell, the VA is adequately staffed to take care of this mission that we have. It is a dynamic and the VA is a very large organization with facilities from Maine to Manila. And overall, it is adequately staffed.
The President, since he has been in office, has requested increases in spending for the VA that now are nearly 80 percent from when he came into office.
And I think that while there may be exceptions because it is dynamic and patient demand is not static and sometimes it will cue up in certain places and we have an obligation to adjust to that. The VA healthcare system is, I think, doing an extraordinary job. And that is not just me, a proud Secretary, proud of the people out there doing it, but that is what others say about us.
I was just sent a copy of a book here. It is written by a guy named Phillip Longman, whom I have never met, but I noted his credentials, said VA is the best healthcare anywhere. And it says why VA healthcare is better than yours.
Mr. MITCHELL. Mr. Secretary, I understand that. And it sounds like what you are saying is you have all the resources and all the staffing you need. And I am not too surprised that you are saying that because it almost sounds like you have plenty of money.
And as a result, I think, last week, the Associated Press reported that your top officials were paid the most lucrative bonuses in Government.
Now, it kind of begs the question, but I think it is appropriate. I am going to ask you, do you think it is appropriate with all these political appointees receiving bonuses of $30,000 plus, and these are not salaries, these are bonuses, while veterans are waiting an average of 90 days for PTSD follow-up appointments, the backlog for claims range from 400,000 to more than 600,000 with delays averaging 177 days, and while the Phoenix VA facilities does not even have an MRI device? It seems to me that they are under-equipped and they are under-staffed.
Secretary NICHOLSON. I will respond to that, Congressman. I want to adjust your paraphrasal of my statement when I said I think the VA is adequately staffed and then you said, or it sounds like, you think the VA has all the money it needs.
I would say given the size of the VA and the expanse of our capital system and its age, we can probably always make good use of more money at the VA. So I wanted to clarify that.
Mr. MITCHELL. Okay. So let me ask this then. You say it is adequately staffed, but, yet, we find claims for PTSD to be an average of 90 days, the backlog of claims for disabilities are over 177 days, and you think you have enough people to handle all of these claims and all these appointments that are necessary, and you think this 90 days for a follow-up appointment is adequate, and you think that the average of 177 days is also adequate? And that does not take equipment. That takes manpower. And you say that you are adequately staffed; is that right?
Secretary NICHOLSON. I would say I cannot respond to your 90-day assertion about PTSD. I will have to look at that and get back to you. I am not aware that it is taking that long. If it is in Phoenix, I am not aware of that. It is not system-wide, I am sure.
You are correct about the claims and that is exactly right. It is taking about 177 days and that is too long in my opinion. We have in the 2008 budget a request and so when I say we are adequately staffed, I incorporate our request for personnel in that budget request for 450 additional claims evaluators which we project will be able to bring that time down by at least 18 percent.
Mr. MITCHELL. I yield my time. My time is up.
The CHAIRMAN. Thank you, Mr. Mitchell.
Mr. Buchanan, you are recognized for five minutes if you—
Mr. BUCHANAN. No.
The CHAIRMAN. Mr. Lamborn?
Mr. LAMBORN. Thank you, Mr. Chairman, but I have no statement or questions at this point.
The CHAIRMAN. Mr. Hall, who is Chairman of our Disability Assistance and Memorial Affairs Subcommittee.
Mr. HALL. Thank you, Mr. Chairman.
Mr. Secretary, first of all, thank you for your service in the service and since then in your continuing work for our country.
And congratulations on your progress on the methicillin resistant staph infections. I know firsthand how difficult they can be and have family members who have suffered from drug-resistant bacterial infections and that is a really dangerous thing that is happening in our hospitals. And you are to be commended to be spreading your program to all 155 hospitals.
I want to say that I share Congressman Baker's frustration and I do not know if I was the freshman who was overly exuberant or not, but, what I reflect, I believe, is what I hear from the veterans in my district.
And I am also one of the 305, I think you said, members of Congress who have visited VA facilities in my district and I do find them, the nurses, the doctors, the therapists, the caregivers in the hospitals, to be doing their very best as far as I can tell. And there are many things that our veterans are happy about with the VA system.
However, our job, as you know, is not just to, and since we only have five minutes, it is not even mainly to pat you on the back for the things that are going well.
I just want to ask, following up on Congressman Michaud's question, with the revelation that the Army and the Marines appear to be providing ratings under 30 percent in an effort to prevent wounded members of the military from receiving benefits from the DoD, I am concerned about efforts to develop a joint process for disability benefit determinations.
How will the VA ensure that ratings reflect the nature of a servicemember's disability and not a bureaucratic need to minimize payments to the veteran?
Secretary NICHOLSON. The VA makes its evaluation totally independent of the military's. And, in fact, the military, they have a different set of criteria and they are guided by the specific disabling condition that would make one unfit for continuing military service.
To illustrate, if they had a very seriously injured arthritic knee or they were immobilized, that would be the central claim because that is the question of whether they can remain in active duty. And if they had a hearing loss or other problems, that would not be considered as I understand it.
At the VA, when they come to us, we consider all of those disablements that are service connected. And part of that process is to authenticate whether or not they are service-connected and we do that independent of what has gone on at DoD.
Mr. HALL. Thank you. And on another topic regarding Congressman Mitchell's question, what would you consider to be a reasonable time period for veterans to wait for a claim to be heard? If not 177 days, what would be reasonable to you?
Secretary NICHOLSON. There is a marker out there that was there when I came in. Just less than four years ago, it was taking about 220 days for these claims. But there is a marker that says it ought to be 125 days.
I have asked Chairman Filner and he has consented that sometime, if we can ever all find the time, to just have a working session or round table and give us the opportunity to come over here and brief you on what is involved in making these claim evaluations because there is both law and case law. And I will just use one point to illustrate.
If we must go back to a veteran for an additional piece of information to authenticate that he made a parachute jump in 1988 at Fort Bragg and was in the 82nd, he or she, the claimant, has 60 days from the time we request that within which to respond to us. And those are linear, so that—
Mr. HALL. I understand.
Secretary NICHOLSON. —it is difficult. There are other things about it too. But my goal is to get it soon down to 145 days.
Mr. HALL. Thank you, Mr. Secretary. Excuse me for interrupting you, but I am about to run out of time. And I just wanted to ask you lastly, what is the evaluation process for determining the level of bonuses for officers in the VA or the Veterans Benefits Administration (VBA)?
Secretary NICHOLSON. First of all, I want to clarify something that Congressman Mitchell also raised. These bonuses were not given to any political employees. They are all given to career SES, Senior Executive Service, professional Government employees.
And there is a very detailed prescribed set of criteria that we get from the Office of Personnel Management of the Federal Government to use in determining who should be considered for these bonuses. And they are based on their performance in our organization and in the Government, including our organization.
Mr. HALL. Thank you. Maybe you can supply that to the Committee, if you will, or we will write and ask for it.
Secretary NICHOLSON. I would be happy to.
Mr. HALL. Thank you very much.
Thank you, Mr. Chairman.
The CHAIRMAN. Thank you.
We have scheduled that round table on claims for May 23rd and your staff, Admiral Cooper and Mr. Aument, are scheduled to join us for that. So thank you.
Mr. Brown, you are recognized.
Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chairman.
Mr. Secretary, I understand yesterday that you formed a new Advisory Committee consisting of OIF and OEF combatants and it was led by Lieutenant General Barno.
Could you kind of give us a little bit about the mission of this task force?
Secretary NICHOLSON. Yes, sir. Since coming into this job and moving around and meeting with wounded servicemembers and their families, it is no secret to me that they have suffered frustrations, anxiety. I mean, it is a tough state, first of all, when they get seriously injured.
And both DoD and VA have incorporated the families very much into the holistic effort of recovery and rehabilitation. And that is a positive thing.
But there have been cases I have known of. So I started going around and gathering when possible servicemembers and family members and just having discussion sessions with them. And I got a lot of good and I got some that was not very good.
Things like I remember one young mother telling me the time it took to get a new pad for her son's wheelchair and that just should not happen. And that showed a need for better case management.
And so what I decided to do is within the framework that I have of having advisory committees to formalize an Advisory Committee for OIF/OEF returnees, why family members, spouses, VSOs, certain Veteran Service Organizations are very involved with some of these, and survivors, of those who have been killed. They are not only to be a source of information to me, but for them to be out there meeting with other members that are similarly situated so that we know, what is going on. They report directly to me, not through a bureaucratic screen, of what it is like, because then we can cut through and take better action.
Mr. BROWN OF SOUTH CAROLINA. Thank you. I just applaud you for putting that Committee together.
And I have no further questions, Mr. Chairman.
The CHAIRMAN. Thank you, Mr. Brown.
Ms. BERKLEY. Thank you very much for your courtesy. I have been called down to the floor and I was very anxious to ask you a couple of questions. And it is lovely to see you again. I have three issues very, very quickly.
There was a person from the State of Nevada, Lance Corporal Justin Bailey. His parents have testified in front of the Senate VA Committee. He returned from Iraq a few years ago. He sustained some injuries, but his primary problem was PTSD. He developed a serious drug problem. His parents encouraged him to get help and he eventually decided to seek help with the VA. And he was admitted into the West LA VA facility.
He had a serious drug problem going in, but apparently nobody read his records closely enough. He was over-medicated by the VA when he died while he was at the VA facility trying to get clean. The VA gave him five different drugs at the same time, antidepressants, including Methadone, and he ultimately died of an overdose in our care.
And I was hoping that you could look into this. His parents are absolutely beside themselves because they encouraged him to seek help with the VA and it seems as though we did not do our job.
Now, I know that we cannot save everybody and mistakes happen, but this seemed to have been a tragedy that could have been avoided.
The other thing that his parents were heartbroken about is it seemed that they felt they were treated with a tremendous disregard and apathy. When they went to collect his re