Mr. Ken Fisher
Chairman Runyon, Members of the Committee:
On behalf of co-chairs Dole and Shalala who could not be with us today, the members of the commission, and my fellow commissioner Gail Wilensky, I appreciate the opportunity to appear before you today. Both as a commissioner and a Chairman of the Fisher House Foundation, I have devoted the last 12 years of my life towards improving both the care and the quality of life of our military, those wounded, veterans and their families. Today’s hearing on the DES and the seamless transition are critical to this nations security and I am proud to discuss my work on the commission, its recommendations and action steps, and how this system must be made simple, easily understandable and easier to navigate. But I must admit to being a bit confused. We are the greatest nation on earth, with the best equipped and the best trained military in the history of the world. What puzzles me is the fact that it has been five years since the findings of Dole Shalala and we are still having hearings on the same issues as 2007.
Before I begin, I feel compelled to preface my statement by explaining our mission. We were charged by President Bush to examine, evaluate, and analyze the care and process related to our returning wounded global war on terror servicemen and women. We looked at the system through the eyes of the wounded service people. We were solution driven, and held numerous field hearings, interviewed wounded, base commanders, doctors and family members as well as others who played a role in the recovery process. We not only examined the problems and inadequacies but also looked for best practices that might help improve their care. Our goal was to simplify and help eliminate the log jam, which was the result of the fighting lengthy two front wars with a VA that was already challenged by the weight of an intolerable beaurocratic system. By doing this, we sought to eliminate the back log and claims that had reached approximately 800,000 -900,000.
While the living conditions at Walter Reed were indeed horrendous, this was only the tip of a massive iceberg. We found hundreds of troops waiting months for follow up appointments or awaiting the rating process. This gap in benefits caused massive problems known to but a few.
The commission was given six months to evaluate the entire disability evaluation system and our findings were thoughtful, inclusive, and easily implementable. It was not our intention to put forth hundreds of recommendations that would have been difficult to implement or too expensive as a whole.
And as a side bar, I would like to compliment our nation’s world class military healthcare professionals whose work and use of the latest technologies resulted in a 95% battlefield survivor rate.
Today, five years after our report was made public, there has been progress, to be sure, but, and with all due respect, not nearly fast enough, and the appearance that there is no real sense of urgency. Tracking the results of the commission has been difficult, as admittedly I would not expect the process to be transparent. But again, we were given the task of OEF/OIF, with the hope that its adoption would have moved the system along faster.
Our recommendations were short and to the point.
Our first recommendation called for a recovery care coordination program – a plan to smoothly guide and support service members from start to finish. This would apply to both the VA and the DoD. I believe this has been implemented, although I cannot speak to its success. On this I would have to differ to our VA and DoD representatives. In the interest of time I thought we would focus on the four issues that I think are crucial.
Our second recommendation called for an overhaul of disability. Our plan called for one physical administered by DoD who then determines fitness to serve. If separation is required, they are compensated on rank and length of service, and then they are moved to the VA who determines their rating and benefits along with a series of payments. The joint DoD VA plan that is currently in use is the Integrated Disability Evaluation System which is now out of the pilot program and is in use system wide as they phase out the legacy program over the next two years. It calls for one physical administered by the VA. The DoD component is done simultaneously - they determine fitness to serve through the MEB and PEB. The VA rating systems apply, and the entire process is designed to eliminate the benefit gap. Pilot programs were able to take the legacy process of 500 days down to 300, but as the system was expanded – the waiting time climbed back to 500 days.
According to the GAO, there are some glaring weaknesses – chief among them staffing issues. In addition, VA doctors are having integration issues at DoD facilities, which come as no surprise to me. There were disagreements in diagnosis, which is not uncommon – but it does add more time to the process. And I must admit to being a bit confused as to why VA doctors are performing the DoD physical. I believe an Army doctor, for example, is better suited to determining whether a soldier is fit to serve. This also frees up VA doctors not only to treat the younger veterans as they enter the VA but also an older set of veterans who are reentering the VA system. But I cannot emphasize enough - in the private sector the best possible plans are just words on paper if there isn’t enough qualified people to implement said plan. This is an over simplified written in the interest of time constraints. This includes recovery care people as well PEBLO’s and other crucial personnel.
Another important recommendation highlighted is the incompatibility of the DoD and VA IT systems and as our report put it, this alone is not the silver bullet. However, if information could be transmitted this way, the veterans would have less paper work, and find out what is available to them much faster at the push of a button. We believed that information sharing was critical to the help of the system.
We recommended life time treatment for PTSD. These men and women have endured multiple deployments; have been in intense urban fighting, often against civilian insurgents who too often hide behind innocent women and children. They have seen horrific injuries caused by IED’s. And the stigma associated with coming forward and asking for help leaves too many to suffer in silence and if they are home their families do suffer as well. We believed this was a major problem when our report was made public, and it has been for any service member who fought in battle be it World War II, Korea, Vietnam or today.
Today it is evident why this was a major recommendation. Five years after our report was made public, there have been well over 1000 suicides - out pacing the civilian population, domestic violence, and divorce, drug and alcohol abuse, homelessness, joblessness, are all at unacceptable levels. Just the other day in USA Today, an article appeared discussing alcohol within the ranks of the Army, and the fact that they have delayed for three years a confidential counsel program for treatment. They had begun a pilot program in 2009, but it was ended after high dropout rates. According to the article, 25% have a drinking problem.
The issue’s importance is self explanatory because of the collateral damage it causes. Here again, staffing shortages are at the heart of the issue, as with disability. We need to consider engaging the private sector to help with has become the signature wound of this war. The stigma has not completely vanished, and this wound is the worst kind because it cannot be seen until after it manifests itself.
Perhaps we need to reexamine screening before and after deployment, and I believe a spousal educational program is vital. They are the first line of defense, and if they know what to do after seeing their loved one’s behavior change.
I believe that progress has been made in our family support recommendation, as the family medical leave act has been extended to six months, and the VA now offers a caregiver stipend to the caregiver.
Military families bear burdens that the average American has no concept of. And for too long, military families bear their stress either alone or with other military families. When one gets wounded, that stress can be unbearable. The private sector has stepped up and numerous foundations are in action and I would encourage Congress, the DoD and the VA to find the ones that work and embellish them, not impede them by making them part of the intolerable beaurcracy that exists system wide. They have the infrastructure, boots on the ground, and the overwhelming desire to help. There will always be unmet needs, but public private partnerships can bridge that gap, and paint the way to the future.
Mr. Chairman, This concludes my statement. In the interest of time, I tried to keep the nuts and bolts of our report to a minimum, and the fact that most people are already familiar with our report, judging by the criticism it generated. It was always our intention to have Congress and the Veterans Service Organizations weigh in and while they objected to certain parts of our report, it must be emphasized that the needs of today’s young veterans are immediate and this new generation of veterans are coming into the system by the thousands. Times are different, their wounds are different, but I assure you had we had the time we would have examined all veterans because anyone who has worn this nation’s uniform deserves the best we have to offer. A thank you for your service is not enough anymore. I am now ready to answer any questions you may have.