Mr. Chairman, Ranking Member Brown-Waite, distinguished Members of the Subcommittee, thank you for the opportunity to testify before you regarding post-acute care for the seriously injured. My name is Meredith Beck, and I am the National Policy Director for the Wounded Warrior Project (WWP), a non-profit, non-partisan organization dedicated to assisting the men and women of the United States Armed Forces who have been injured during the current conflicts around the world.
During the recent conflicts in Iraq and Afghanistan, there have been approximately 30,000 soldiers, sailors, airmen, and Marines wounded in action. Fortunately, due to advances in medical technology, the number of those killed in action is far lower. However, in many cases, as the wounded have suffered devastating injuries and require long-term outpatient care and rehabilitation, WWP is pleased that the subcommittee has chosen to focus on this aspect.
As a result of our direct, daily contact with these wounded warriors, we have a unique perspective on their needs and the obstacles they face as they attempt to transition, reintegrate, and live in their communities. As such, WWP has identified the following areas of concern:
Options for Care: Specifically with respect to Traumatic Brain Injury, those suffering from TBI require individualized, comprehensive care, and while the VA has made progress in this area, the agency is still in the process of establishing an extensive, consistent, long-term continuum of care available throughout the nation. As such, and due to the need for ongoing therapy and rehabilitation, many seriously injured veterans and families have indicated that their number one request is increased access to options for care, including access to private facilities previously available to them while on active duty.
Discrepancies in Benefits: On a related topic, many veterans and families of the seriously injured have indicated confusion, frustration, and disappointment upon learning that they are not eligible for the same benefits and care as veterans as they were on active duty and vice versa. For example, consider that an active duty patient can be seen at a VA Polytrauma Center to treat his Traumatic Brain Injury. However, while at the VA facility, the servicemember, due to his duty status, cannot enjoy VA benefits such as Vocational Rehabilitation or Independent Living Services that can be helpful in his recovery. Alternately, as mentioned previously and unbeknownst to most families, a medically retired servicemember cannot use his/her TRICARE benefits to access private care as TRICARE does not cover cognitive therapy once retired. While there is an obvious need for an advantage to active duty service, those who are severely injured as a result of their service in an all-volunteer force deserve special consideration.
The recently passed National Defense Authorization Act for FY2008 contained a provision intended to address these discrepancies. Specifically, section 1631 authorizes for a limited period of time the Secretary of Defense to provide any veteran with a serious injury or illness the same medical care and benefits as a member on active duty and entitles the severely injured still on active duty to receive veterans' benefits, excluding compensation, to facilitate their long-term recovery and rehabilitation. While this provision recognizes the strengths of each agency and the necessity of basing an individual’s care and benefits on his/her medical condition rather than on military status, it is subject to regulation and will require significant oversight to ensure its success.
Respite Care: For those who are seriously injured, one cannot discuss their care without discussing their caregiver. While the VA currently offers some respite care, the available options are often not entirely appropriate given the average age and types of injuries of those serving in Iraq and Afghanistan. For example, retired Army Sergeant Eric Edmundson suffered a severe brain injury in Iraq several years ago, but he is aware and responsive. In fact, he enjoys spending time with his family and recently went fishing with his 3 year old daughter Gracie. Eric’s family is unwilling to place him in a respite facility for fear that it could cause a regression in his rehabilitation and cause Eric distress.
However, WWP has noted that similar to others, Eric’s family has used their personal funds to pay for an innovative type of individualized therapy that also provides a unique form of respite for the caregiver. In Eric’s case, rather than staying indoors all day, his family pays an individual to take him to the park to watch his daughter play. Eric thrives each time, and his progress and enjoyment are noticeable.
As a result of Eric’s success as well as others in similar situations, WWP proposes that the Department of Veterans Affairs (VA) initiate a pilot program partnering with local universities to provide such a care/respite initiative for those with brain injury. As part of the veteran’s ongoing therapy, the program would draw graduate students from appropriate fields( i.e. social work, nursing, psychology, etc.), train them to interact with the veterans, and match them with eligible veterans in their local area so that an individualized program can be developed. In return for making the requisite reports to the veteran’s physician on his/her status, the graduate student would receive course credit.
The creation of such a program would have several positive effects including:
In recognition of the individual nature of Traumatic Brain Injury (TBI), the program would encourage an innovative means of providing age-appropriate maintenance therapy to those suffering from TBI.
While the veteran is benefiting from the therapy aspects of the program, the family caregiver would be offered much needed respite.
Interaction with the graduate students would increase general community awareness of the sacrifices of our nation’s veterans and the needs of those suffering from TBI.
Caregiver Compensation: Traumatic Brain Injury (TBI) has been widely identified as the “signature wound” of the Global War on Terror. While many organizations appropriately focus on the needs of the affected servicemember, the Wounded Warrior Project (WWP) has also identified the family caregiver as an individual in need of assistance. For example, in many circumstances, the spouse or parent is forced to leave his/her job to provide the necessary care for their loved one, leaving the entire family to suffer from an adverse economic situation. In these cases, the VA relies on the family member to assist in the servicemember’s care, but has been denied financial compensation for such labor.
In recognition of this reality, WWP developed and endorsed legislation introduced by Representatives Salazaar and Pascrell requiring the VA to train, certify, and make eligible for compensation the personal care attendants of severely injured TBI patients. This program would expand on one already in existence at the San Diego VA Medical Center for Spinal Cord Injury patients and would help alleviate some of the financial burden incurred by these families. WWP encourages the subcommittee to review the program and help to ensure its implementation.
Oversight: Finally, consistent with the recommendation of the Veterans Disability Benefits Commission and to ensure the best care and benefits for those who have sacrificed so much for our nation, it is imperative that a joint, permanent structure be in place to evaluate changes, monitor systems, and make further recommendations for process improvement. This office must be structured to minimize bureaucracy and must have a clearly defined mission with the appropriate authority to make necessary changes or recommendations as warranted. With the passage of time, as veterans issues fade from the national spotlight, it will be necessary to have such a joint structure in place to ensure future inter and intra-agency coordination.
Mr. Chairman, thank you again for the opportunity to testify today, and I look forward to answering any questions you may have.