Sen. Levin: Good morning, everybody. The committee meets this morning to review actions taken over the last year to improve living conditions, outpatient care, and processes to help our severely injured and ill service members as they transition to care provided by the Veterans Administration and to civilian life, and to discuss actions in progress or yet to commence. Our nation has a moral obligation to provide quality health care to the men and women who put on our nation's uniform and are injured and wounded fighting our nation's wars.
On February 18, 2007, the headlines of the Washington Post read: "Soldiers face neglect; frustration at Army's top medical facility." A series of articles by Dana Priest and Anne Hull served as a wake-up call regarding the care and treatment of our wounded warriors.
Articles that appeared in the press a year ago described deplorable living conditions for service members living in an outpatient status at the Walter Reed Army Medical Center; a bungled, bureaucratic process for assigning disability ratings that determined -- determine whether a service member would be medically retired with health and other benefits for the member and for his family.
It described a clumsy handoff from the Department of Defense to the Department of Veterans Affairs as these injured soldiers tried to move on with their lives.
We also learned that these problems were not limited to the Army or to Walter Reed. A lot has been accomplished in the wake of these articles, but much more needs to be done.
This committee held a hearing on March 6, 2007, to address the shortfalls in the care of our wounded warriors. At that hearing, we concluded that it would require the coordinated efforts of the VA Committee and the Armed Services Committee to address the issues in a comprehensive manner.
This lead to a rare joint hearing of the Committee on Armed Services and the Committee on Veterans Affairs on April 12. The committees continued to work together to pass the "Dignified Treatment of Wounded Warriors Act," on July 25, 2007.
This comprehensive, bipartisan, legislation that addressed the care and management of our wounded warriors was drafted, marked up, and passed by the Senate in record time.
This Act, enhanced by provisions from the House-passed Wounded Warrior Assistance Act of 2007, is and became the Wounded Warrior Act that was included in the recently enacted National Defense Authorization Act for Fiscal Year 2008.
The Wounded Warrior Act represents major reform and was supported by the Veterans Service Organizations. It advances the care, management and transition of recovering service members, enhances health care and benefits for families, and begins the process of fundamental reform of the disability evaluation systems in the Department of Defense and Department of Veterans Affairs.
We require Department of Defense, in this law, to use VA standards for rating disabilities and to use the VA presumption of sound condition in determining whether a disability is service- connected.
We increased disability severance pay for certain service members; we required the Department of Defense and the Department of Veterans Affairs to jointly develop a comprehensive policy on improvements to care and management of recovering service members; we established centers of excellence for traumatic brain injury, posttraumatic stress disorder, and traumatic eye injuries; and we authorized respite care for seriously injured service members
The Wounded Warrior Act addresses nearly all of the findings of the various commissions that have examined the issues regarding the care and treatment of our wounded warriors. The most significant exception is the recommendation of the Dole/Shalala Commission, to restructure the VA Disability Compensation System. The essence of this recommendation is a restructuring of the VA disability compensation benefit.
It falls, the recommendation, primarily in the jurisdiction of the House and Senate Veterans Affairs Committees, both of whom are examining it. The Department of Veterans Affairs has just recently awarded a contract to develop information regarding changes in the composition of disability payments as recommended by the Dole-Shalala Commission, and some Veterans Service Organizations have expressed some questions about this change.
Working together in an approach that is consistent with the Wounded Warrior Act, the Departments of Defense and Veterans Affairs established a high-level Senior Oversight Committee, co-chaired by the Deputy Secretary of Defense and the Deputy Secretary of Veterans Affairs, to oversee analysis of and changes to the DOD and VA systems to improve the care and treatment of our injured and ill service members. We hope to learn this morning what the Departments have accomplished thus far, what initiatives are in the works, and if any additional legislation is needed to accomplish their goals.
The Army has established the Army Medical Action Plan to develop a sustainable system for the medical treatment and rehabilitation of injured and ill soldiers, to prepare them for successful return to duty or transition to civilian status. And I'm confident that Secretary Geren and General Schoomaker will have more to say about this.
Finally, we are proud of the fact that our military doctors, nurses, and medics have courageously provided outstanding medical care to those who are wounded. This care begins on the battlefield itself, where these providers are at great personal risk as they tend to the wounded.
Many service members who would have died in earlier conflicts are surviving injuries incurred in Iraq and Afghanistan, because of the care and the loving care of it and the advances in battlefield in medical treatment -- of -- that exist now that didn't exist before, but also -- and we want to reiterate this -- because of the skill and bravery of our combat medical teams. Seriously injured troops are rapidly evacuated to world-class medical facilities, where they receive state-of-the-art care, as inpatients.
Today's hearing is about the actions taken by the Departments of Defense and Veterans Affairs, and by the Army, to implement the Wounded Warrior Act and recommendations made by various commissions over the many months.
There is a vote scheduled for 10:30 this morning. I hope that we can complete our opening statements and begin questions, even before the vote.
Sen. John Warner (R-VA): Thank you, Mr. Chairman.
Mr. Chairman, this is a most unique piece of legislation and one of its hallmarks is a strong bipartisan effort that has been put in, both sides of the aisle.
And one of the stalwarts on our side is Senator Sessions, who's been in the forefront of this, and I'm going to invite him now to deliver the remarks for our side of the aisle.
Sen. Jeff Sessions (R-AL): Thank you, Senator Warner. I do care about this deeply as I know you do and thank you for your leadership and that of Senator Levin.
Welcome our panel members. It's a distinguish group, and I think, your appearance here today represents the value of very positions -- the commitment the Department of Defense has to fixing the problems that we've seen.
Images of a mold-infested room at Walter Reed, which was home to a recovering service member, will not and should not be forgotten. We're all accountable for the conditions at Walter Reed and its impact on the families. We are all answerable to the American people for the full and complete resolution of those problems. Now, there's just no doubt that we commit our men and women to harm's way, if they are injured, there is a deep bond we have with them, I think, that cannot be disputed that we will do whatever we can to ensure they have the finest medical care possible.
The independent review group established by Secretary Gates in February of '07 described the situation that overwhelmed Walter Reed as a "perfect storm." It involved the confluence of an increase in operational tempo as a result of the war, the decision of the Commission on BRAC to close Walter Reed, inattention by leaders to processing delays and antiquated disability evaluation process, a breakdown in outpatient care and transition to the Department of Veteran Affairs. In addition, the Department of Defense lacked the tools to accurately identify traumatic brain injury and its overlap with posttraumatic stress disorder.
We now realize that the problems were far broader than just the Walter Reed side, and I believe that progress in addressing shortfalls in care is underway. Congress provided $900 million in supplemental funding to DOD in Fiscal Year '07 for the purpose of aiding wounded and ill service members with traumatic brain injury and posttraumatic stress disorder.
The Army has activated a new Warrior Transition Brigade, focused solely on helping wounded and ill soldiers to heal. As of February 4, '08 -- 9,782 soldiers, both active and Reserve, are assigned -- or attached to a warrior transition unit. The Army now has broken ground on a new and greatly expanded hospital at Fort Belvoir, Virginia, which will be completed ahead of the BRAC schedule and will improve services for our wounded and ill military personnel, especially for orthopedic and mental health concerns, and I know Senator Warner is very proud of that hospital that will be at Fort Belvoir.
And it is evident by our panel today that the Department of Defense and the Department of Veterans Affairs are working together, rather than at odds. Yet according to the DOD's recent survey of wounded and ill service members, one-in-four rate poorly their experience with medical evaluation board process. One-in-five rates poorly their ability to access care and appointments as soon as needed.
Studies conducted in the last year reassure the American people that the men and women who volunteer for our military and are sent to harm's way will receive the best medical care in the world. I quote from the report, the Gates Panel, which said, quote, "Through advances in battlefield medicine, evacuation care, the Department has achieved the lowest mortality rates of wounded in history."
I quote also from the report on the commission appointed by President Bush, co-chaired by Senators Robert Dole and Secretary Donna Shalala, quote, "The medical care at Walter Reed Army Medical Center and other military treatment facilities is compassionate and complete. The specialized services and programs for amputations and burns, in particular, are world-class."
So this hearing will examine the response of our government to the shortfalls for service members who are outpatients during the long-term healing they require. The Wounded Warrior Act is itself a significant contribution toward that goal. I was privileged to be a part of that significant bipartisan effort, along with many members of this committee and the Veterans Committee.
The new law will ensure cooperation between the Department of Defense and Veterans Affairs, open new avenues of treatment for traumatic brain injury and psychological health, and begin the process of reforming the disability evaluation system for our nation's veterans of war, in other words, achieving nearly all the goals of the Shalala-Dole commission.
So, we looked to the Committee on Veterans Affairs for leadership on the important work, which remains modernization of the benefits and compensation for our nation's veterans, and, in particular, eliminating duplication between DOD and VA. Senator Burr, ranking member, has announced his intention to pursue these needed reforms through legislation to create a modern, less confusing, and more equitable system for today's wounded warrior. We shall forget neither the images at the Walter Reed nor the stories of so many wounded veterans and their families who, as a result of lack of care, received lack of fairness, lost trust in the government that they served. Nor shall we ever forget the statement of General George Washington, who said, quote, "The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the veterans of earlier wars were treated and appreciated by that country.
Mr. Chairman, thank you and I look forward to this excellent panel today.
Sen. Levin: Thank you, Senator Sessions.
Let me start with Secretary Mansfield and -- then we'll go to you, Secretary Chu, are you going to be giving the statement for Secretary England?
Mr. Mansfield: Senator, I'll do Secretary England's prepared remarks.
Sen. Levin: Okay, thank you. Secretary Mansfield?
Mr. Mansfield: Thank you, Chairman Levin and members of the committee. I appreciate the opportunity to appear before you today. I'm especially pleased to be accompanied by Admiral Dunne, Secretary Geren, Secretary Chu and General Schoomaker.
The Department of Veterans Affairs and the Department of Defense have a positive, good news report to give you today on our enhanced partnership to ensure today's active duty service members and veterans receive the benefits, care, and services a grateful nation has promised them. They have surely earned that, and I know, Mr. Chairman and members, that you and the committee members are here to make sure that it happens.
I'm especially pleased to have had the opportunity to work with Gordon England, the deputy secretary of Department of Defense. Over the past year Gordon and I have had a unique opportunity to focus the attention of both departments on the needs of those we serve: our service members and veterans. We have concentrated attention on a need for a seamless transition from the Department of Defense to the Department of Veterans Affairs. I want to publicly thank him for his leadership, which has allowed us to accomplish so much. As he has said, the ties between the two organizations have been strengthened and lines of communication are now available across the two departments.
The Senior Oversight Council, the SOC, has been operational since May 8, 2007. But it is important to note that serious high-level cooperative efforts in the areas of health care and benefits delivery predate the SOC. VA and DOD formed a Joint Executive Council in February 2002. You later codified in statute in November of 2003. The JEC responsibility and I quote from its standards -- that standup document is, "The JEC will work to remove barriers and challenges, assert and support mutually beneficial opportunities, recommend to the two secretaries, the strategic directives for the joint coordination and sharing efforts between and within the two departments, and oversee the implementation of those efforts."
I believe it is important to identify some of the positive efforts produced under the auspices of the JEC from its start. Dental care for reserve and national guardsmen was taking care of the North Chicago VA and U.S. Navy cooperative effort to form the first joint federal health care facility, TSGLI, the Traumatic Service Group Life Insurance, which has been effective thanks to the Congress since December 1, 2005. As of January 31, we have paid 4,111 claims for a total of $254.4 million to seriously injured service members.
Benefits delivery at discharge, we now -- we now have more than 95 MoUs covering 153 military sites. VBA counselors inserted at MTS, data sharing efforts the Joint Incentive Fund that Congress authorized to fund 66 projects for $160 million between the two organizations. So in short, the JEC provided at the starting point for the SOC. I want to command and thank Dr. David Chu for his past and continued efforts and cooperation as my DOD partner on the JEC.
The SOC, established by direction of the two secretaries following, as you mentioned, Mr. Chairman, hearings that are on the Hill, established eight lines of actions which general defined the issues needing resolution. They include the disability evaluation system, traumatic brain injury and PTSD, case management, data sharing efforts, facilities, legislation and public affairs, personnel pay and financial support, and what we call "a clean sheet review," or after we look at these issues we were starting over, where would you start and what would you build that would be different from what we have today.
Our excellent joint DOD and VA staff, provided through a special office led by Melinda Darby and Roger Dimsdale, identified these lines of actions from the issues presented in numerous reports, investigations or commissions, which reported last year. As you mentioned, Mr. Chairman, Dole-Shalala, Terry Scott's commission, the Marsh-West commission and the Secretary Nicholson's commission that the president directed that we take part in. All were reviewed completely to come up with a comprehensive plan of action. Currently the SOC has overseen the efforts to apply the decisions made from this line of action recommendations.
For example, the federal recovery coordinators or case managers decisions has resulted in VA federal recovery coordinators standing up at an office, hiring the first eight individuals, training them, placing them in military treatment facilities, and having them start the process of fulfilling that requirement, which you directed for us. In another area we have started a pilot project to have the VA complete one single medical exam, which will allow, first, DOD under their responsibility to make the decision whether this individual is fit or unfit to continue to serve on active duty. And if the individual is not fit to serve on active duty, to allow the VA to use that same information to process a claim for disability benefits when the individual is discharged.
This pilot has gotten one case already through the process. The examinations are taken place in the Washington D.C. area and the cases are going to the VA office in St. Petersburg for decision.
This pilot will run for approximately one year, starting last November it is going to November of this year, and will give us the starting point for more efforts on how to make to sure that this transfer from active duty to veteran status becomes seamless and the information is transferred and used by both at the same time.
We realize we have more work to do, data sharing for example, where we move to the ability to transfer patient data between our two systems. We are doing more than we ever had before, we are sharing data, we are moving towards making it operational, and I think -- I can report to you that more efforts are going forward in that area than ever before. It is a hard area, there is a lot of issues to deal with, and we continue to work on that at a high level. We are also working together on traumatic brain injury and PTSD issues. The care, research, and treatment as we see a greater emphasis on these issues on a new center of excellence is under construction, and will be taken place at the new Bethesda location.
Currently the SOC is prepared to come together whenever required to make decisions required by the dedicated VA and DOD staff which oversee the efforts on each of these lines of action. We continue to address any issues which may arise regarding cooperation between the two departments. Gordon England and I and David Chu and I continue to discuss these issues as needed. The remaining requirements, stemming from the National Defense Authorization Act passed last session, will keep us focused intently on continuing improvements.
The issue of a new disability benefit system is proposed by the president through Dole-Shalala report remains an open item. The VA has contracted for two studies, which will allow us to move forward in this area. Studies are due for completion in approximately six months. They deal with transition payments and then compensation and quality of life issues in a to-be proposed system.
The issue of rehabilitation medicine continues to evolve as we treat and evaluate the patients returning from the battlefield, entering acute care treatment, and initial rehabilitation and military treatment facilities before they transition to VA polytrauma centers and medical centers.
And finally, we are working to ensure better involvement and care of the family members of these individuals.
That concludes my statement and I await your questions.
Sen. Levin: Thank you, Secretary Mansfield.
Dr. Chu: Mr. Chairman, thank you for the opportunity to represent the Department of Defense this morning.
Again, I convey Secretary England's apologies that he could not be here. He very much looked forward to this session. And so I present his planned opening -- opening remarks.
He does have a statement for the record which I hope you will accept.
Sen. Levin: We will.
Dr. Chu: It is indeed a great privilege to join Gordon Mansfield who has been our strong partner in the Senior Oversight Council that he described and in the Joint Executive Council established earlier. The two Departments have worked very closely, as he has outlined and strengthened thereby the ties between the two coveted agencies, so that we can, indeed, provide veterans of the support that they deserve.
Gordon Mansfield has summarized the lines of actions, the eight lines of actions, that are the mechanism through which the Senior Oversight Council exercises its responsibilities. These lines of action are jointly staffed, co-chaired by personnel from DOD and Department of Veterans Affairs, and have created a very strong partnership between the two agencies. They have succeeded in accomplishing great deal in a short period of time.
We have, as Gordon Mansfield reported, appointed the first federal response coordinators. We have the Disability Evaluation System pilot begun and 120 people are in various stages of evaluation in that pilot system. We have established the Center of Excellence for Psychological Health and Traumatic Brain Injury; we are I believe, on track to completing by the end of this year, a set of software changes that will allow existing electronic data to be shared between the two agencies, which I know has long been a subject of great concern to all. And we have the proposed to the Congress and got congressional support and accelerated and enhanced a set of changes at the new Walter Reed campus in Bethesda where the Naval Hospital is currently located.
We have benefited in these decisions from the studies that were done earlier and of course from the actions of the Congress. There are in the earlier studies there are over 400 recommendations offered to the department, over 300 on these subjects of posttraumatic stress disorder and traumatic brain injury alone.
Although, a great deal has been done, we recognize that we are not finished. These lines of action will be adding to their agendas, particularly with the additional instruction of the Congress in the fiscal 2008 National Defense Authorization Act. We meet as necessary to accomplish these goals.
Secretary England asked that I underscore that he and Gordon Mansfield and their respective teams are completely dedicated to resolving all the issues between the two departments, and to putting the long-term care of men or women in uniform where it should be. We view this is the partnership between the two departments and the partnership of the Congress, the caregivers within our departments and with other agencies of the federal governments, as well as the agencies at the state and local level.
Secretary England did ask that I underscore one other issue that you raised, Mr. Chairman, and Secretary Mansfield touched on his opening statement, and that is we do hope the Congress in future legislation will address a central issue raised in the Dole-Shalala proposal, and that is a new and different disability compensation system for our veterans, one that would more sharply delineate the responsibilities of the respective departments: focusing defense on the key military question, fitness to serve, and focusing the veterans affairs department on the question on support for those who cannot.
I'm joined this morning by Secretary Geren and General Schoomaker who will be ready to provide details on the progress the Army has made in its specific efforts to care for the Army's wounded personnel.
Thank you for this opportunity and I look forward to your questions.
Sen. Levin: Thank you, Secretary Chu.
Mr. Geren: Thank you, Mr. Chairman.
Chairman Levin, Senator Warner and members of the committee, thank you for providing General Schoomaker and me the opportunity to come before your committee today, and talk about the progress that has been made over the past year.
I'd also like to thank every one of you for your unwavering support of soldiers and families in our United States Army. Our Congress, and particularly this committee, are full partners in building the Army that we have today. And I also want to thank you for your Wounded Warrior Act and the initiative that you included in last years authorization bill. You included initiatives that will help soldiers, initiatives that will help families, and you also provided the flexibility so that the Army could continue to meet the dynamic challenges in our modern health care world, and we appreciate that. We thank you for that partnership in your legislation and the partnership over this past year.
Twelve months ago, almost to the day, the Washington Post ran their story on the shameful conditions at Walter Reed. The reports sparked outrage across our nation, but nowhere more so than among the ranks of soldiers and veterans, nowhere equal to the outrage, the rage felt by soldiers. Soldiers take care of soldiers, soldiers give their lives and limbs for each other. Strip away everything else, and at its core, that is what the Army is all about: soldiers taking care of soldiers. When soldiers learned that some of their own had violated their duty to our wounded, they demanded action and stepped up and took action.
Today, 12 months later, we are a better Army with good news to report to this committee because of the good work and hard work of soldiers, but with the acknowledgment there that there remains much to do. Mr. Chairman, I would like to ask you if I could introduce four of the soldiers who have been great leaders in this effort over the past year who have joined us today?
Sen. Levin: We would be honored to have you do that.
Mr. Geren: Thank you Mr. Chairman.
Colonel Terry McKenrick, who is brigade commander at Walter Reed.
Terry, could you please stand up?
Command -- his Command Sergeant Major Jeff Hartless, Deputy Commander Major Steve Gventer, and his First Sergeant, Matthew Dewsbury (ph). They've done an outstanding job, and deserve a great deal of credit for their leadership.
Sen. Levin: Thank you, Secretary Geren, for introducing to us these great soldiers. Again, we are honored to be in their presence.
Mr. Geren: Thank you, Mr. Chairman.
The Army, the Department of Defense, and the Department of Veterans Affairs, and the Congress' response, has gone well beyond the problems identified in the Washington Post series of articles. We all realize that we had an opportunity not to just fix the problem highlighted in the articles, but transform our health care and disability system to better meet the needs of those who have borne the battle -- our wounded, ill and injured -- and better support their families. It is an opportunity to do something big, complicated, and important that does not come along very often. And together we've made progress, and we thank you for that partnership.
Today, Lieutenant General Schoomaker and I will discuss the progress the Army has made, and join this panel in discussing the progress the Department of Defense has made, working with the Congress, and particularly with this committee, and identify areas that we must continue to improve.
A year ago, outpatient care in the Army was called "medical hold," for active duty, and "medical holdover," for the Reserve component.
The names themselves, "hold" and "holdover," and the fact that there were two systems, give you a good sense of the problems that underlay the Army system.
A year later, the Army has completely transformed outpatient care. The old system, with fragmented leadership that was not staffed, resourced, nor organized, to meet even the pre-9/11 needs of outpatient soldiers, was overwhelmed by the increase in patients that came with the casualties of war. Pre-existing seams were stretched and snapped by the surge in wounded, ill, and injured. The Guard and Reserve were organized separately from the active force, with a widely held perception, if not the reality, of different standards of care. Mental health issues had not received the attention nor the resources they required, leaving the needs of many soldiers and family members unmet.
Today, no more hold or holdover units. In their place, we have our Wounded Warriors and 35 Warrior Transition Units located at major posts INCONUS and abroad. Active Guard and Reserve together, one army.
The care and support of our soldiers and our WTUs is driven by our mission statement, with leadership, officer and NCO, organized in support of that mission, with a triad of care; the squad leader, the nurse case manager, and the primary care manager, supporting every wounded, injured, and ill soldier.
Our soldiers in the WTUs are being moved into the best barracks on the post. And over the last eight months, nearly 2,500 personnel have been added to medical command to support our wounded warriors. Every WTU today has an ombudsman. And now, 33, and soon, all of our WTUs will have a soldier and family assistance center, bringing dispersed family services together into a one-stop shop for soldiers and families.
In mental health care, the Army, working with our sister services, OSD and the VA, and with strong leadership and support from the Congress, have made investments in personnel, infrastructure, and programs to care for soldiers who suffer from TBI, posttraumatic stress, and other mental and emotional illnesses, and help their families with the challenges of supporting their soldiers suffering from these invisible wounds of war -- with much left to do in this area.
In the Army, we are teaching every one of our 1 million soldiers how to identify symptoms of PTSD and TBI, and how and where to go to get help. Every soldier is required to take that class. So far, 800,000 soldiers have received the training, and the program is available to families.
It is good substantive training, but perhaps more importantly, it is a major step forward in reducing the stigma associated with mental health care. We are seeking to hire over 300 additional mental health professionals to meet the needs of soldiers and families, adults and children. We are short of this goal and face the challenging market for the people we need. The direct hire authority that you provided to us in your authorization bill is a big help, but we are not where we need to be in this area. And we've initiated a comprehensive approach to prevent the tragedy of suicide among our soldiers, recognizing we have far to go to stem this growing challenge among our ranks. Much to learn and much to do.
Cooperation between the Department of Defense, OSD, and our sister services, and the veterans administration is strong, and you'll hear today about much of the progress that's been made.
Senator Levin and Senator Sessions, thank you for acknowledging the extraordinary work of our Army's health care professionals. These selfless men and women are the very best at what they do.
In stark contrast to the shortcomings identified in the Post article are the almost miraculous recent advances in battlefield medicine, trauma care and rehabilitation, much of which is been accomplished by the medical professionals and staff at Walter Reed, and elsewhere in the Army system.
Survival rates for soldiers wounded in combat are an unprecedented 94 percent, the highest in the history of warfare. Soldiers are surviving and recovering from wounds that would have been fatal in any other era, and in any other health care system. Thanks to the service men and women in military medicine, the Army, and our sister services.
Throughout the Army, we have leaders, officers and NCOs, uniform and civilian, committed to taking care of soldiers and families, demanding the best for our wounded, ill, and injured, and their families. Because of that, our report today is one of progress, but it is not, and probably never will be, a report of mission of accomplished.
February 18, 2007, was a day our army will not forget. A painful day, a shameful day for a proud institution, a band of brothers and sisters who look out for each other, who take care of each other, no matter the personal cost.
The Washington Post helped us see something that we had overlooked. And because of that Washington Post story, we are a better army today than we were a year ago. And we remain committed to continuing to improve our care and support of our wounded, our ill, and our injured soldiers, and our families.
Mr. Chairman, members of the committee, thank you all for the opportunity to appear today. I look forward to answering your questions.
Sen. Levin: Thank you, Secretary Geren. It's a very important statement, and a very moving statement. Thank you for the preparation of it, and for delivering it the way you did.
Lt. Gen. Schoomaker: Chairman Levin, distinguished members of the committee, thank you for the opportunity to discuss the total transformation that the army is undergoing in the way we care for soldiers and their families.
We are committed to getting this right, and providing a level of care and support to our warriors and their families that is equal to the quality of their service. Secretary Geren has eloquently expressed this transformation in his testimony
The Secretary, the Chief of Staff of the Army, the rest of the Army leadership are all actively involved with every stage of the Army Medical Action Plan, which you, sir, alluded to in your opening comments, and to the transformation it embodies.
In less than one year, the Army has funded, staffed, and written doctrine for a fundamental change in warrior care. It's truly a remarkable achievement. For example, as Secretary Geren mentioned, we now have more than 2,500 soldier leaders assigned as cadre to 35 Warrior Transition Units that did not exist this time last February. Now this contrasts with fewer than 400 cadres for the same group of patients that were last February. The most significant feature of these Warrior Transition Units is this triad of care that had been alluded to, consisting of a primary care physician, a nurse case manager, and a squad leader working together to care for the needs of each individual.
The regular meetings and the coordination between each leg of this triad serves to create a web of overlapping responsibility and accountability which embraces each warrior for the duration of their treatment and recovery.
Our squad leaders, many of them combat -- soldiers and former patients. Two of the officers and NCOs that you were introduced to earlier have been patients at Walter Reed -- and have been combat injuries -- are trained and responsible for the well-being of a small group of warriors in transition, just as any army unit.
These soldiers that you've met just a minute ago are four combat- tested leaders, and they spend their days at Walter Reed looking out for the best interest of the wounded, ill, and injured soldiers. They really are the backbone of the Army Medical Action Plan.
Sir, with your permission, I'd like to introduce two of my battle buddies in putting together this plan. I'd ask Brigadier General Mike Tucker and Colonel Jimmie Keenan just to stand up. These are two of the principle architects of the Army Medical Action Plan. Mike is a career armor officer.
We took him out of the armor school at Fort Knox. Jimmie Keenan is a career nurse corps officer, and they truly are the architects and executors of the Army Medical Action Plan. We couldn't have done it without them. So --
Sen. Levin: Thank you for introducing them, and thank you for your service.
Lt. Gen. Schoomaker: Another example of the difference between today and last year, one year ago, our wounded, ill and injured soldiers believed that their complaints were falling on deaf ears within the Army. Now we've established a MEDCOM-wide ombudsman program with ombudsmen at 26 of our installations, and we are hiring more each week.
Everyone at our medical treatment facilities knows who the ombudsman is and how to find him or her. Many are retired NCOs and officers with experience in medical care. They work outside of the local chain of command, but they have direct line to the hospital commander, to the installation commander, the garrison commander, to get problems fixed.
We've also established 1-800 wounded soldier and family hotline that is outlined in this card that every soldier and family carries, in order to offer wounded, ill and injured soldiers and their family members a way to share concerns on any aspect of their care or administrative support. We respond to these enquiries within 24 hours of the call. So far we've received in excess of 7,000 calls.
Another improvement in the care of soldiers over the last year is the development of multiple feedback mechanisms so that we can see ourselves from a variety of perspectives. I think this is the lesson that we learned last year. We monitor and evaluate our performance through 18 internal and external means, including the ombudsman and the hotline that I addressed earlier, but we've also got a contracted industry leader and patient surveys that we look at very carefully.
In addition, we host numerous visits from members of Congress and your staffs. In January alone, we opened our WTU doors to more than a dozen congressional visits. These visits gave us a valued external perspective and allow us to -- the opportunity to be as open and transparent in our operations as possible. Your feedback and the feedback of your staffs on these visits has been instrumental in our success.
As you well noticed, by these successes there is much progress to be made. We still need more research on psychological health and traumatic brain injury. Congress jumpstarted us last week -- last year with supplemental funding, for which we are very grateful, but research must be a continuing priority effort. We need to continue to look at the disability -- the physical disability evaluation system in ways to make it more less antagonistic, more user-friendly, and more understandable to our soldiers and their families.
I believe the pilot program that started in the National Capital region is a good start. But as each one of the members of the panel have mentioned, we'd like to see changes made in the physical disability and evaluation system made legislatively as aggressively as possible.
We need your continued support so that we can move it forward together in 2008 much as we did in 2007. This year's National Defense Authorization Act was very consistent with how the Army is approaching wounded warrior matters. I truly appreciate the flexibility you provided us to develop policies and achieve solutions. Your bill not only helps warriors, it helps families, it helps the health care providers caring for them. Thank you for taking the time to listen to us and to work with us.
The Army's unwavering commitment and a key element of the warrior ethos is that we never leave a soldier behind on a battlefield, or lost in a bureaucracy here at home. We are doing a better job of honoring that commitment today than we were at this date last year. In February of 2009, I want to report back to you that we've achieved a similar level of progress we did over the last year. I'm proud of the Army -- of Army medicine's efforts over the past 232 years, and especially over the last 12 months. I'm convinced that in coordination with the Department of Defense, Department of Veterans Affairs, and the Congress, we have turned the corner.
Thank you for holding this hearing, and thank you for your continued support of the warriors that we are so honored to serve. I truly look forward to your questions.
Sen. Levin: Thank you, General. Thank you and all the witnesses for your testimony this morning.
Let's try an eight-minute first round. We will try to work through that role call that's coming up in 10 or 15 minutes, which some of us can just go and vote and come back, so we can try to keep it seamless. As you folks are working on seamlessness, we'll try to do the same thing here this morning.
The studies conducted by the Veterans Disability Benefits Commission concluded that the VA standard for assigning disability rating for PTSD is inadequate. These studies showed a significant discrepancy between the disability ratings assigned by the Department of Defense and the Department of Veterans Affairs for service members with PTSD.
The commission found that of 1,400 service members who were rated by both the Department of Defense and the VA for PTSD, the Department of Defense assigned disability ratings of 30 percent or higher to only 18 percent of that group of 1,400 service members, while the VA assigned ratings of 30 percent or higher to 90 percent of that same group of individuals.
Now that is stunning difference. That's not a few percentage points. Same people, same 1,400, not a -- like 1,400 people over here and 1,400 people over there. These 1,400 people were the same. The DOD gave disability ratings of 30 percent or higher to 18 percent of that group, and the VA gives ratings of 30 percent or higher to 90 percent of those same individuals.
Now ever before we passed the Wounded Warrior Act, the law required the Department of Defense to use VA standards for rating disabilities. But in practice, the service has deviated from those standards, in many cases resulting in lower disability ratings than assigned by the VA for the same disability, for the same person. The Wounded Warrior Act specifically requires the Department of Defense to use the VA standard. It authorizes deviation only when the deviation will result in a higher disability rating for the service member.
Now you've described this pilot project where we are going to have a single exam, followed by a -- hopefully, a single rating, and we very much welcome that. There's -- you said, I think, a 120 people in that pilot project.
But in the mean time, while that project is going to take a year, we have a legal requirement now for the Department of Defense to implement the requirement now in law that restricts deviation from the VA standard to those circumstances where it benefits the service member.
And I think -- let me ask you, Secretary Chu, how are you going to implement this requirement?
Dr. Chu: Of course, Mr. Chairman, as you have pointed out, there has been long-standing -- the policies in the department we are supposed to use, the VA rating schedule.
There are differences in outcomes. We are aware of that. That's why we are so excited about this pilot program, which the secretary has asked that we proliferate across the department as soon as it's practical to absorb its lessons about the administrative issues that do need to be addressed.
The ultimate safeguard because these are basically judgments, clinical judgments, reaching different conclusions. The ultimate safeguard is just to have one agency come to the conclusion. And that is the central feature of the pilot program, which is, we'll use VA's disability ratings.
Now, there will still be an issue here. And this is where the Dole-Shalala report, I think, is important, because fitness of service decision will be on those conditions that speak to that issue. It will not necessarily be all the conditions the individual has, as we've seen already in the pilot. Average person in the group that have received -- come into the program so far has 10 conditions, not all of which are necessarily unfitting for service.
So there is still going to be a tension there that that I think we need to --
Sen. Levin: My question is you got a pilot --
Dr. Chu: But in the mean time --
Sen. Levin: -- program over there, you say, ultimate answer is to have one rating, and you are right, and that's why we put it in the law. But in the mean time, we can't accept that kind of a deviation --
Dr. Chu: I agree, sir.
Sen. Levin: -- to the same people.
Dr. Chu: I agree, sir, and we are trying to reinforce that. It is one schedule, but you will still have -- I do think that the solution, as we all agree, is a single examination system. And we are moving that way.
Sen. Levin: Well, we are going to need to know what are you doing in the meantime until that system is put in place to reduce that deviation. If this were a difference between 5 percent deviation or 10 percent deviation, that'd be one thing. But this is 90 percent versus 18 percent. That is totally unacceptable, even as an interim differential.
Dr. Chu: I would agree, sir. I do think I should emphasize for the record that an earlier study looked at a wider range of conditions, the average difference between the two agencies with 8 percentage points.
Sen. Levin: All right. And PTSD --
Dr. Chu: But PTSD is a particular issue, although it's also true that VA has recently revised PTSD ratings for many of the veterans involved in older conflicts, and that may be partly explaining the larger differences that are reported.
DOD does the rating at the time of discharge. VA may adjust that rating across the veteran's longer life history.
Sen. Levin: Secretary, these are the same 1,400 people. This is not --
Dr. Chu: But that's not necessarily --
Sen. Levin: It doesn't cover veterans, you know, from older conflicts. These are the same 1,400 people. We are going to need to have a much stronger effort for this interim period until there's a single --
Dr. Chu: We understand that, sir.
Sen. Levin: And then we are going to need you to tell us. We are going to give you 30 days on this one to tell us what action is going to be taken to reduce that differential because of the reasons I gave.
Now there is another provision in the law that requires the establishment of a board to review the DOD disability ratings of 20 percent or less. And I'm wondering if -- is that board -- your plan is not to appoint that board?
Dr. Chu: We do intend to appoint that board, sir. It's not yet appointed. But we fully understand the requirement of the statute, which is to review all the older cases since the beginning of this conflict.
Sen. Levin: And where there is 20 percent or less.
Dr. Chu: Where there's 20 percent or less, yes, sir.
Sen. Levin: Because that's a critical issue in terms of benefits and family coverage for medical care. When will that board give us an estimate -- 30 days, you think?
Dr. Chu: I think one to two months to get it established -- (inaudible).
Sen. Levin: All right.
Secretary Mansfield, has the VA updated the VA schedule for rating disabilities for PTSD?
Mr. Mansfield: That's currently underway, sir, and has to go through the federal review process, I believe it is.
Sen. Levin: What's the timetable on that?
Mr. Mansfield: The process itself requires 30 days, and a follow-up of 30 days, and then we would act after that. So I would imagine 60 to 90 days. It has been a highlighted issue within the department and within VBA, our benefits administration.
Sen. Levin: There was a recent series of Denver Post articles that reported 79 soldiers were determined to be medical no-goes had been knowingly deployed to Iraq. General Schoomaker, this question is for you. The most recent article describes a soldier being taken from a hospital where he's been treated for bipolar disorder and alcohol abuse so he could be deployed to Kuwait. Thirty-one days later he was returned to Fort Carson because health care professionals in Kuwait determined that he should not have been sent there in the first place because of his medical condition. These articles quoted e-mail from Fort Carson's third brigade combat team that says, quote, "We have been having issues reaching deployable strength, and thus have been taking along some borderline soldiers who would otherwise have been left behind for continued treatment."
Are these reports accurate? What's the Army doing to address them?
Maybe Secretary Geren and General Schoomaker. Let me start with you, Secretary, and then I'll go to the general.
Mr. Geren: Yes, sir. We are looking into those issues, sir. Before a soldier deploys, they are evaluated. And it's a subjective process to determine whether or not they are fit for deployment, and judgment is exercised.
We've had this issue come up a number of -- deployment platforms around the country, and in fact, one, this time last year that was raised down at Fort Stewart. I guess the essential point is that the judgment is exercised at the point of deployment. And sometimes the judgment turns out to be wrong. But the Post article --
Sen. Levin: Is it the shortage of deployable strength what is now causing some of these decisions to be made that otherwise would not be made?
Mr. Geren: That should not be happening. I can't tell you that it's not, but it certainly should not be happening, that every soldier must be considered, whether or not he or she is fit for duty, and if not, they should not be sent, and everyone understands that. And I don't believe we found any evidence that pressure has caused people to be sent that shouldn't have. Maybe cases where something was overlooked or whether a mistake was made. But the commanders who evaluate these soldiers understand what the requirements are, and should never send anybody that's unfit. But we look into every one of these cases.
Sen. Levin: Are you familiar with that e-mail, that article?
Mr. Geren: Yes, sir, I am familiar with the article.
Sen. Levin: Have you checked the person who wrote that e-mail to say that that is not an acceptable reason for deploying somebody? Could you do that?
Mr. Geren: Yes, sir, certainly can.
Sen. Levin: Do you want to add anything to that, General?
Lt. Gen. Schoomaker: Well, sir, I've not seen the case myself. I am familiar with the story. My understanding at this point because of the profile -- the soldiers who possess those profiles who were deployed to include the soldier who is the center piece of the article, their profiles and the decision to deploy have been looked at carefully. And all the cases in which soldiers were deployed with profiles, they were placed in positions and in conditions which could be supported by their profile. The profile itself does not limit deployment.
My understanding of the indexed soldier was that he was not hospitalized, and the opinion of outside consultants was that his condition should not limit his ability to be deployed. But I think it's still being looked at.
Sen. Levin: Well, the e-mail itself, however, says, that we've been having issues reaching deployable strength. I mean, that's a contemporaneous e-mail. And that should not be a factor. Would you both agree with that?
Lt. Gen. Schoomaker: Oh yes, sir.
Mr. Geren: Yes.
Sen. Levin: So whoever thought that was a factor has got to be corrected, and that message has got to be made clear across the board, would you agree with that?
Lt. Gen. Schoomaker: I agree with that.
Sen. Levin: Thank you.
Sen. Warner: Thank you, Mr. Chairman. Mr. Chairman, those of us in the Senate who've had the opportunity to work on these issues have received a great deal of information, and indeed, support and learning from the families of these various soldiers, sailors, airmen, and marines that have suffered these injuries. And I've been particularly fortunate to had access to and brought to my attention the wives of a number of these individuals who have, on their own initiative, fought a very courageous battle.
And I'm pleased to say that in our audience this morning is Sarah Wade, whose husband in 2004, Sergeant Ted Wade, was severely injured. He's still in the process of rehabilitation. And she's accompanied by Meredith Beck, who is a very active member of an organization called Wounded Warrior Project. It's a non-profit organization. I wonder, Mr. Chairman, if we'd invite those two to stand and be recognized here, and they are the examples of the families that stand by their men.
Sen. Warner: Secretary Geren, you visited with me the other day, and it's interesting how forthright you are with sharing the information -- good news, and not so good news, with our colleagues.
I feel that in discharging your responsibilities have certainly with this member in Congress, you've been absolutely forthcoming, factual. And you showed me a series of charts about the things that were concerning you, and among them was the very alarming rate of suicide. And it's particularly high in the Reserve and Guard categories. I'd like to ask you to leadoff what steps under your leadership the department and the Army is taking, and then may be we'll go to the other witness who have a broader responsibility for the other departments -- to the extent that the Navy and the Air Force and the Marines are suffering some of this problem.
Mr. Geren: I'll be glad to leadoff, but I'd also like to ask General Schoomaker to add as well, because this is an area where leadership of the Army has focused a great deal of attention, and not just over the last few months. We've recognized over the last few years an alarming growth in the rate of suicides. We, last year, experienced the highest level of suicides we've had since we started tracking suicides in 1980.
Over a year ago --
Sen. Warner: So that's a period of 28 years.
Mr. Geren: Yes, sir. That's when we began tracking it. And we can't tell how it compares to prior years, but we've seen a steady increase over the last five years, and it's something that everybody in Army leadership understands their part of the solution to that -- that effort.
Every week we have a balcony brief. We bring all the senior leadership in the Army together in the Pentagon Wednesday morning, and one of the slides we look at is the suicide incidents over the preceding week. We want to make sure every leader in the Army recognizes it. It's part of his or her responsibility to help address this.
We have a very comprehensive effort underway right now. And General Schoomaker can provide you greater details. But we are looking at innovative ways to approach it through different types of training for soldiers, for leaders, working with the chaplains, working with families.
I think one of the most important things we can do is overcome the stigma over getting help for mental health issues. We've got soldiers that don't come forward and ask to be helped. And until we break down that stigma, until we breakdown that barrier, we are going to have soldiers that are in desperate need that they don't get the help they need.
And this PTSD training that we are doing, it's not just PTSD and TBI, but I think it's going to break down the stigma across the whole range of mental health issues, and help soldiers and family members recognize this soldier has got a problem, come forward and do something with it.
But we are looking at trying to understand the trends. We have seen some of these deaths associated with misuse of narcotics and other drugs that were lawfully prescribed, and perhaps misused. Mix of alcohol and drugs. Most of them result from a failed relationship or some other type of traumatic event in their life, exacerbated by the stress that they are under, and the pressures that they are under. And also leaders in the Army, because the system is stressed, aren't able to put their arm around the soldier and understand what's going on with his life.
But from the lowest ranks to the most senior ranks, this is a problem that we are working to address, and I would like to ask Dr. Schoomaker -- he's done a great deal of work in this area -- and I think that he has much to share with the committee.
Lt. Gen. Schoomaker: Thank you, sir, and thanks for the question. You're right, this is a -- there are two trends right now that we are watching very carefully that the secretary has alluded to.
The first is suicides within the Army at large. And I think Secretary Geren has really outlined the multidisciplinary approach that we have to take. It starts with small unit leaders and their ability to recognize -- and fellow soldiers -- their ability to recognize a soldier who may be in trouble, that may have problems with coping with a lost relationship, which includes, in some cases, loss of a relationship with the Army itself, because of misconduct and the like.
It's compounded by drug or alcohol use. And certainly, the families play a very critical role. So we are looking at this in a multidisciplinary way. We have looked carefully across the major -- the principle staff who are responsible, from the chaplains, through the personnel community, through those that represent leadership at large, and then the medical community. And we are prepared to come in front of the secretary with some recommendations about how we will be approaching suicide prevention and -- in the near future.
The other trend that we are looking at very carefully is a trend in accidental deaths, especially within our Warrior Transition Units. Now that we have, in a sense, concentrated approximately 95, 100, almost two brigades worth of soldiers who have illnesses or injuries, some combat related, some other, within these Warrior Transition Units, under the care of a cadre with a primary care provider and nurse case managers.
We recognize now that a number of them have a constellation of drugs -- drugs for anxiety, drugs for sleep, drugs for pain, which in combination, especially if used with alcohol, can be a lethal cocktail. And we have unfortunately lost, over the last few months, several soldiers. We brought together a team. The secretary and the chief of staff of the Army charged with me, about ten days ago, with expeditiously bringing together a team of experts to look at the factors that lead to these accidental deaths.
I contrast these with suicide. I don't believe these are suicides. We've looked very carefully to separate those that are suicides from those that are truly accidental. And those that we are seeing are accidental deaths. And we've looked at the major factors, and are trying to eliminate those factors.
Sen. Warner: Secretary Chu, to the broader aspects of it.
Dr. Chu: Yes, sir.
Sen. Warner: Fortunately, I don't think the other military departments are --
Dr. Chu: Yes, sir.
The Marine Corps is already beginning to emulate the Army's practice of the chain teaching of mental health indicators, responsibilities at every level of command.
The secretary of defense, to deal with the stigma issue, is small but important step, has advocated, and the administration, I believe, will soon decide to revise the instructions of security questionnaire, so that we set aside a positive answer on have you sought mental health assistance, if it has to do with PTSD or the various issues that relate to combat service.
I do think there are two issues here. One is the trend where we are all concerned with the Army's increase -- also the level. The department, even with this adverse trend, is approximately where civilian rates are. That doesn't mean that's where we want to be. And within the department, we do have a service with much lower levels, absolute levels of suicide, in the Air Force. And so, one of the things we are doing is asking all the departments to look at, well, what success about these Air Force programs that might be translatable to their circumstances.
We are very excited with the Center for Psychological Health and Traumatic Brain Injury that the Congress has so generously funded. It stood up and is originally being led by an Army psychiatrist, colonel, soon general, I guess, Dr. Loree Sutton. I've asked her to focus not just on prevention after the fact, but what can we do before the fact. How can we help the resiliency of our people to deal with the stresses that military life does bring to them?
Should we, for example, be asking questions all the way back at the enlistment point that we don't ask -- or having screens that we don't use today? We do, of course, use one broad screen already. That is a predictor of can you stick with a military group? That's the high school diploma, that's why it's so important in our recruiting standards.
So we are trying to take a broad-based approach ranging from the specific question -- (inaudible) -- to the strategic, how should we be recruiting people from American society so they can successfully serve in a very difficult environment.
Sen. Warner: Lastly, I say to this distinguished panel, we've got to have the infrastructure to carry forward all of these various initiatives, literally the bricks and the mortars and the roofs and the ceilings and so forth. Where are we with regard to, a) maintaining Walter Reed's physical plan, such that it can continue to deliver that level of health care that these honorable wonderful people are entitled?
And secondly, the projections of a new facility at Fort Belvoir and the modifications to the infrastructure at the Bethesda center to take on the additional load. Are we on schedule? Is the budget adequate for these two construction projects?
Dr. Chu: Yes, sir.
Sen. Warner: Is there anything that Congress needs to do to facilitate --
Dr. Chu: Our most important request will, of course, be to support the fiscal '09 request in this regard, which does ask for a substantial transfer of money to support a more ambitious plan for the new Walter Reed campus than we had before, and a faster plan. And that includes Walter Reed thought about in the large, not just Bethesda campus but also importantly the Dewitt Army Hospital modernization and refurbishment at Fort Belvoir.
In terms of the personnel at Walter Reed, and that is, I think it's always a challenging issue to close a base, how you keep everything up at the top-level all the way up to the last day. We have sought and gotten from the Office of Personnel Management additional direct-hire authority to make sure we can staff Walter Reed correctly, and including ability to pay special retention bonuses to personnel there. But I would defer it to Secretary Geren on additional specifics.
Mr. Geren: General Schoomaker just recently left the post as commander at Walter Reed. I'd like to ask General Schoomaker to respond.
Lt. Gen. Schoomaker: Yes, sir. I think the Congress and leadership of the Department of Defense and the Army sent me and my command, when I commanded Walter Reed last year, a very, very clear message that we were to restore Walter Reed to a world-class facility despite the impending fusion of Walter Reed with the National Naval Medical Center, Bethesda and the formation of the new Walter Reed National Naval Medical Center that the secretary alluded to.
And we've done just exactly that. We have given very clear orders and have had very robust support from the department to fix all those things that need to be fixed and to maintain both the manpower as well as clinical practices in the physical plan of the Walter Reed campus.
Sen. Warner: All right, very much.
Lt. Gen. Schoomaker: Yes, sir.
Sen. Levin: Thank you, Senator Warner. Senator Ben Nelson.
Sen. E. Benjamin Nelson (D-NE): Thank you, Mr. Chairman.
And I want to thank our military men and women, those who, on the civilian side, who do such an outstanding job to protect our country. And, of course, nothing is more important in dealing with their needs than to make sure that the health system we provide for them is the best possible health care system. So we're all chagrined and saddened with the revelations of a year ago.
In terms of what we're working with toward public-private partnering, Secretary Mansfield and Secretary Chu, last year I met with a Sergeant in Nebraska from the National Guard who suffered a traumatic brain injury as a result of his service in Iraq in 2006. And when I met with him, he indicated the many challenges he had in getting the care that he required. He was lost in the system on, at least, two occasions. And he was finally able to care in Nebraska through a private facility; Madonna Rehabilitation Hospital.
Receiving quality health care in rural states is obviously a challenge in many areas due to resources and geography alone. And that's why I believe it's critical that we find partnership opportunities for our public institutions and private institutions to be able to make sure that we get quality care and we integrate it.
How do you provide for that integrated care for veterans as they transition back into their communities so that we ensure their long- term care, not simply a short-term situation, but their long-term follow-up care, across a wide geographic area? And I've been told that local VA hospitals have authority to contract with civilian partners. But in many instances, they're just very reluctant to do so. And we have to continue to press to get them to be able to forge a collaboration.
But is this a centralized or a decentralized process from the standpoint of the VA? What are your thoughts about how we can make this system work? We talk about it being seamless. You'll have to pardon me if I find the word seamless between the VA and the Department of Defense an oxymoron. Perhaps "nearly seamless" might be something more that would be more likely achievable. Seamless, I think, is beyond anyone's expectations given a bureaucracy that is full of what I consider we-be's; we'll be here when you come, we'll be here when you go. And we're going to constantly find that very difficult to merge and converge those systems. But from the standpoint of the VA first, and then the DOD, second.
Mr. Mansfield: Thank you for that question, Senator.
And first let me apologize to that individual that the idea that somebody gets lost in the system is something that we do not want. And we're doing everything we can to ensure that we take care of that. So I would apologize to that individual and --
Sen. Ben Nelson: Sergeant Mack Richards.
Mr. Mansfield: I'll get with you later and we'll follow-up on that. The idea of traumatic brain injury care, serious traumatic brain injury care started with the fact that the VA, since 1992, had four brain injury treatment centers that were doing treatment, care, research, and efforts. And those centers in Palo Alto, Minneapolis, Richmond, and Tampa became our polytrauma centers. Each one of those brain treatment centers was also co-located with a spinal cord injury clinic. So we had a robust rehabilitation capacity in those hospitals. There's a fifth one on the way hopefully in the next budget.
What we've done since then for the effort to have more geographic representation is had each one of our VISNs or 17 more VA medical centers come online as level II polytrauma treatment centers so that we can attempt to get the treatment more dispersed geographically around the country.
The issue of the private treatment is one that we've dealt with in the past, and sharing agreements in various locations to get specialty care that we needed that we didn't have on staff or just couldn't provide. I would --
Sen. Ben Nelson: Excuse me, can that be geography-related as well? Not close by, so that they don't have to drive 250-500 miles --
Mr. Mansfield: Senator, I was going to say, I think that what we're learning and dealing with and attempting to do is deal with the individuals in an effort to bring all the conditions that would apply to bear to make the decision to go forward.
I know that Dr. Kussman, the head of our Veterans Health Administration, has made the point that if the people that we're treating don't feel that they're getting the cure that they need, then we need to work with them in an effort. And I know that we've done that in many instances where folks are getting treatment that either VA is paying for, in some cases TRICARE, I think, is also taken care of the individual. But again, it's an effort that has started, is moving forward, needs to -- the continued emphasis of the leadership, has that continued emphasis and we will do more of it.
Sen. Ben Nelson: Dr. Chu.
Dr. Chu: Sir, if I could address the two issues raised. One is seamless transition; the other is the question of how we provide quality care to those on a geographically dispersed basis.
On the seamless transition front, we are very excited by the appointment of these first federal integrated recovery coordinators. Their ultimate responsibility is to make sure there is a plan for that person that is really lifelong in character and that the steps are in place, mechanism in place to make sure that plan is being followed. And I think that's a key ingredient in getting us, at least, a nearly seamless condition that you set as an immediate goal.
On the question of the geographically dispersed delivery of care, I do think this is where the central proposition of Dole-Shalala is so important. It, as you know, recommends in the president's budget proposal, propose to carry out that if you're medically retired from the Department of Defense, you would get -- we would end DOD deciding whether you've got TRICARE coverage based on the percentage of disability. If you're medically retired, you would get TRICARE coverage for you and your family.
And I think that's important, not only for the families, but also for the issue that you described because that does give you the right to go to any place you want, essentially, in the United States. And that would end a good deal of this problem because it's always been a problem for the VA. In many states, there may be only two or three VA hospitals, it is going to be the distance for patients to come to the hospital for care, even though, their quality reviews across the medical profession of the United States give VA extraordinarily high marks for the quality of the medical care that it delivers. It really is first-class.
Sen. Ben Nelson: Well, I don't think, very often, that the question is about the quality of care. Even recognizing that with a TBI situation, all the research that's going into that, I think, there's a general perception that we're improving the quality of care. It's availability and the seamless nature of it.
General Schoomaker, this has probably happened to others as well. But I know last week, you were interviewed by NPR, and you were given the example that somebody allegedly -- that government officials told workers at the Department of VA to stop helping injured soldiers fill out forms and so forth. So much for the idea, as I said, of seamless care and seamless relationships.
That's probably not the first example of embarrassment and probably not the last, but it does point to how important it is, from the top-down and from the bottom-up, to get it right so that there isn't stovepiping or resistance to this effort to make sure that those who have done it their own way for so long don't frustrate this process by wanting to continue to do it their own way or they -- they know best what way it ought to be done. I wish you might comment on that. I know you did last week.
Lt. Gen. Schoomaker: Yes, sir. And I remain personally chagrined that an effort to really reach out and ensure that the best practices that we are observing, frankly, at Fort Drum were proliferated throughout the system. Ironically, we found a system that was working extremely well and yet it was interpreted wrongly.
I will say, first of all, it's very hard for me to say anything ill about the VA. I'm a product, I'm a physician, a product of the VA system, I was trained there into VA hospitals associated with major universities. This is a great system of care, this is a national treasure. They've set the standard on good objective outcomes-based care within the country. And I think we're better positioned than we ever have with leaders like Undersecretary Mansfield and the new secretary of defense, former boss, General Peake and General Kussman and others throughout that VA system.
Our response to what we saw at Fort Drum -- sure was that Secretary Peake and Secretary Geren promptly sat down, we hammered out an agreement, a memorandum of understanding with the Virginia. And that we've put that aside, we now have a formal memorandum that empowers VBA counselors at each one of our Army MTFs to fully counsel any soldier or family and make it very clear that they're part of this solution and that we welcome that.
Sen. Ben Nelson: But it does point out that it's an ongoing process.
Lt. Gen. Schoomaker: Yes, sir.
Sen. Ben Nelson: That you can't measure it simply in terms of time. It's a marathon, not a sprint.
Lt. Gen. Schoomaker: Yes, sir. And I think your comments earlier about the seamlessness and Secretary Chu's comments; I think the fact is there are seams in the system. And I think the earlier comment from the chairman about disability adjudication, which for the military is based upon fitness-for-duty and within the VA system, is based upon the whole person concept, means that you can apply in the earlier study to virtually any individual problem and you'll find the same issue there.
We adjudicate disability in the military based upon that one major unfitting condition and then we turn to the VA and allow the VA to take all of those conditions that we all jointly recognize are present and adjudicate disability on the basis of the whole person. That's a seam that has to be closed.
Sen. Ben Nelson: Thank you, Mr. Chairman.
Sen. Levin: Thank you, Senator -- thank you, Senator Nelson.
Sen. James M. Inhofe (R-OK): Thank you, Mr. Chairman.
Sen. Levin: And Senator Inhofe, I think the vote has either started or about to start.
And if I --
Sen. Inhofe: I'll go ahead and start -- run through my time.
Sen. Levin: And would you turn that over to the next person.
Sen. Inhofe: Okay, and I would be happy --
Sen. Levin: And if there's nobody here when you're here, just recess until I --
Sen. Inhofe: I'll take care of it.
Sen. Levin: Thank you.
Sen. Inhofe: Yes, first of all, General Schoomaker, I appreciate what you said and let me just drive it home. Because as long I can remember, even back when I was in the United States Army, there is complaints about the kind of treatment in the VA centers. And then when I was elected to here about 21 -- 22 years ago, we had just some real crises. Now may be it's unique in our state of Oklahoma that the treatment was not good.
I can't tell you how that's changed. I had a group in my office yesterday, the veterans, and they just raved about it. And I have gone to all the centers, and I -- including some of the retirement centers and others. I don't know what's accounted for, but whatever you're doing, keep doing it that way, it's been great.
I had -- may be because I'm the only veteran in the Oklahoma delegation, I seem to get more calls and complaints than any of the rest of them do. And there are -- in three areas that have been addressed somewhat in this meeting and by your committee.
One is in the disparity between the disability evaluation systems that we've had. Senator Levin talked about that, you've responded to that. One is -- and two are -- the other two are in transition areas that we've been talking about with Senator Nelson, that is transition into civilian life or into another service of our country. Many of these people who are -- become disabled, they want to continue serving in this transition and in that transition, of course, that we've talked about from DOD to VA.
Now I understand, from whoever wants to respond to this, that this disparity between the evaluations has been pretty -- well, you, Dr. Schoomaker might be the right one -- that this disparity has been corrected now or is in the process of being corrected, in terms of disability evaluations between the various levels.
Lt. Gen. Schoomaker: Sir, I think that's a recommendation of the Dole-Shalala commission that's going to require legislative changes. We can smooth over the bureaucratic steps required between the military system of adjudication and finding of fitness-for-duty and the VA system of adjudication and disability. But we currently are not empowered to make this a single system without further legislation.
Sen. Inhofe: And are you going to be helping us in --
Lt. Gen. Schoomaker: Well, absolutely. I think both departments are --
Sen. Inhofe: -- legislations or big recommendations?
Lt. Gen. Schoomaker: Yes, sir. I don't want to speak for the Department. But --
Dr. Chu: Oh, yes, sir. We'd be delighted to -- General Schoomaker is absolutely correct. Until there's a change in the fundamental statute, you are all -- even if we each rate each condition with the same percentage which is the first issue, which we can deal with and we're dealing with.
Sen. Inhofe: Okay.
Dr. Chu: The department only rules on fitness terms based on those conditions that affect your military career. You may have other conditions. So --
Sen. Inhofe: Well, in terms of evaluations, if any of the -- you don't believe that's a problem, just call our office so that we can provide you with some cases.
Now, in terms of the transition into civilian life or other government services, any further comments you want to -- any of you want to make about that because this has been another source of complaints.
Dr. Chu: Sir, one of the things we've done particularly with this conflict is organize a series of job fairs, particularly at medical centers, where we especially emphasize the importance of federal agencies stepping forward, including our own.
Sen. Inhofe: When did -- when did they start? When did you start?
Dr. Chu: About two years ago, we started these. And we've done about a dozen of these altogether. And they are intended to both bring civil employers as well as government agencies together to the community, not restricted to those who've been recently wounded necessarily. But that's the focus.
And we have worked very hard in a proactive way through the Military Severely Injured Center to help the newly injured think about the possibilities for them. What would make sense from their perspective and how do we link them up with these agencies so they can be successful.
Sen. Inhofe: Secretary Mansfield, you testify to me on this, the transition between the DOD and VA. And could you just address this electronic transfer of data to see -- and are we making progress there?
Mr. Mansfield: We're definitely making progress, sir. We've come further than the JEC had. We're in the process now, where we can actually exchange information. The issue, though, is that we're working in an effort to make it interoperational. Right now, you can read the information, but you can't, you know, deal with it. So we are exchanging information from imaging, from clinics, from pharmacy, and from testing.
So we're further along the line, but we still have a long way to go. And of course, a part of the issue, too, is that when you look at where we're starting, you have an Army record, an Navy record, and an Air Force record that needs to be consolidated. And then we get access to that through a single data access point. We're working on that and we have it --
Sen. Inhofe: Secretary Geren, this is even more Army-sensitive than anything else. The chairman talked about the -- some of them who were deployed, who perhaps should not be deployed. But on the other end of that, there are a lot of them who want to be deployed who are not. It seems like there's a greater problem in the Army.
You know, we just sent our 45th out of Oklahoma, and that's over 2,600, they're over there in Iraq right now. I went down to Camp Gruber when they were preparing for it. And while the National Guard members, they receive TRICARE, they don't have the dental benefits. And this seems to be where the problem is. And I was surprised to see this, that the Department of Defense has set a service-wide goal of greater than 75 percent for fully ready-to-deploy service members and greater than 90 percent for fully-to-partially-ready service members.
Currently, five of seven reserve components are below the 75 percent. And I have, from your report on page 194, those seven. And the two that have the great problem are the Army National Guard and the Army Reserves. Everybody else, frankly, is over in the 75 percent.
But these are not, these are in the case of the Army National Guard, 45 percent; and the Air Guard, 51 percent. Now of those, that's just dental only, problems. That seems to be the greatest problem in terms of having these people not ready for deployment for medical purposes.
It would seem to me that -- and I talked to some of them down there at Camp Gruber before they were going. You can't put a bridge in or do a root canal. There's no time during this transition period. And once they get over into the field of combat, they're not going to be able to do those things.
Now wouldn't one of this -- one solution that perhaps you might want to consider or you are considering is to somehow have dental benefits.
There was a time when the Guard and Reserve really didn't have these overseas deployments and maybe it wasn't necessary then. But it is now and it seems to be of the medical -- and again, I repeat that, the 38 percent is -- 45 percent is dental only. And so that seems to be biggest problem. What do you think, Pete?
Mr. Geren: Well, the expansion of Oklahoma is not unique. The dental issue is something that we're looking at very carefully. And one of the initiatives that the chief and I are working on is how to do a better job of fully operationalizing the Guard and Reserve. And the medical preparedness for deployment is one of the issues and the dental is always at the top of the list. So I don't have an answer for you today, but it's something that we are looking at.
Sen. Inhofe: Well, if your goal is to reach 75 percent from the figures I have here, and this is not just Oklahoma, this is out of your report, if you pull the dental problem out of that, you're at 75 percent. And it just seems to me like that's something that would be fairly easy to address. Although, it might be expensive to address because it means you'd have to get to do that dental. Yes.
Mr. Mansfield: Senator, I do know that some -- (inaudible) -- in Oklahoma have a doctor, the best practice we'd like to see morally used which is to use O&M funds during periods of pre-mobilization drill to bring mobile dental vans to the unit.
Sen. Inhofe: You mean, prior to --
Mr. Mansfield: Prior to mobilization. So -- and the standards that you've described are what we want all units to be at all the time, not -- so that we don't have to deal with these medical issues post-mobilization and the --
Sen. Inhofe: Well, I appreciate that because I think and -- Mr. Chairman, during your absence I made comments that you talked about how there are some who didn't want to be deployed, but were found deployable. But there's probably more who want to be deployed and for some reason or other, can't. Or else, maybe, that's unique to Oklahoma. But I sure have heard from a lot of --
Mr. Mansfield: No, it's true elsewhere.
Sen. Inhofe: Yeah.
Mr. Mansfield: And again, I want to praise those who have used this practice. It is a great solution, it is reasonable in terms of its cost.
Sen. Inhofe: Yeah, thank you.
Witness: Real quickly, Senator, we have a group of Guardsmen and reservists that advise the chief and the Army leadership on Guard and Reserve issues, they meet with us regularly. And that has been one of the issues that they've been examining and been putting together recommendations in that area. We recognize that challenge. It is expensive and there's also just some logistical issues associated with it. But it's -- we recognize the importance of it and are working through it now.
Sen. Inhofe: Thank you.
Sen. Levin: Thank you, Senator Inhofe.
Senator, Bill Nelson.
Sen. Bill Nelson (D-FL): Gentlemen, thank you for trying to correct this problem and make it right.
Secretary Chu, has Secretary Gates designated a lead agent to implement the TBI-PTSD mental health plan?
Dr. Chu: Yes, we have our Center for Psychological Health and Traumatic Brain Injury. It is the agency that will be executing the very generous addition to budget that Congress provided last year.
Sen. Bill Nelson: The question was has he designated a person to implement it in --
Dr. Chu: The commander is now colonel, soon general, Dr. Loree Sutton, Army psychiatrist.
Sen. Bill Nelson: Okay. You will know the problem here. And thank you for trying to correct this problem. We have excellent care, for example, for TBI. One we can get them into the centers, and one of those centers is in my state, in Tampa. The problem has been getting them identified and getting them in those centers. And as the other Senator Nelson pointed out in a case in his state of Nebraska, I can point out to you many cases in my state of Florida where the military person gets lost between being released from DOD and coming into the VA health care system. And so thank you for working on that.
Mr. Secretary Geren, I want to go over with you, what I had talked to you on the telephone about. And I think it needs to come to the attention of the committee. A World War II veteran who was wrongly accused and incarcerated, African-American, during a POW camp revolt in Italy in World War II, and in the hysteria is swept up and incarcerated for a year. Years later, in fact, just this year, so that's some 60 years later, a review of the records, the Department of Defense realizes that it made a mistake, they reversed his dishonorable discharge, they made it a honorable discharge, acknowledged that the U.S. Army was wrong, and 60 years later, returns to him the back pay that he would have earned during the one year of incarceration, $720.
Now, that's just plain wrong that someone is denied that and is given 1944 dollars without compensation for at least the cost of living adjustments, which would only be $8,000 in today's dollars.
Sen. Levin: Senator Nelson, I'm going to -- excuse me for interrupting. I'm going to run and vote and come back. If no one's here, when you need to go, just a recess --
Sen. Bill Nelson: I'll recess, I will.
Sen. Levin: But thank you for raising this issue, however.
Sen. Bill Nelson: Yes, sir.
Sen. Levin: -- its importance to the committee.
Sen. Bill Nelson: Now, of course I appealed to you as secretary of the Army and then you said you did not have the legal authority. I appealed to the secretary of Defense, and he said he did not have the legal authority. As a result of that, I filed a bill to correct it.
But it seems to me that under equity and fairness, an issue that we're addressing here about health care for wounded warriors. That under equity and fairness, a warrior has been wounded by taking away his most prized possession, which is his honor and his liberty. And 60 years later, that the U.S. Army and the Department of Defense is saying that they don't have, somewhere in the bowels of the Pentagon, the ability through equity and fairness to adjust $720 back pay. Can you share with me, Mr. Secretary, what you think we ought to do to right this wrong?
Mr. Geren: Yes, sir, I'm glad to -- I reacted exactly the same way you did when I learned of this. I'd go so far to say it's a travesty of justice. $720 today is nothing compared to what -- what that soldier when through and what he suffered. And certainly, what $720 would buy you in 1944, and what it would buy you today, it's no comparison at all.
When I learned of this, I asked our lawyers to figure out someway to fix this, someway to address this. And they kept coming back and saying there's no way to do it. We looked at a couple of different ways and unfortunately they kept coming to the same conclusion. And the OSD lawyers agreed with the Army lawyers that under the current statutory framework, we're prohibited from deviating from that schedule.
So I'm glad that you've introduced a bill and I would like to hope there is speedy consideration of it so that we can right this wrong and try to do what we can to compensate this soldier for what he suffered.
Mr. Mansfield: Senator, if I could raise an issue.
If he was dishonorably discharged, he would not have been eligible for VA benefits back then. So while we check in and see if there is some way that we can look at that situation, now that been corrected and the VA -- may be able to assist him.
Sen. Bill Nelson: Okay, Mr. Secretary Mansfield, we'll do that and thank you for that suggestion. Samuel Snow, naturally is getting on up there in years and he lives in Leesburg, Florida.
Here's what, you know, I would pursue this with great vigor because this is somebody who has been wronged. But the reason I'm bringing it up to you all is that again it's another indicator of the cold, hard, impersonal rules and regulation on something that is obviously wrong. We've seen this in Samuel Snow's case, we've seen it in how some of these veterans have been handled.
We've seen it, for example, in that veteran from Winter Haven, Florida, that was lost in the system, the military discharged him, had no indication that he had TBI because they didn't ask, they didn't poke, they didn't probe. And so he's out there on this own. And he knows something is wrong and he goes and gets an appointment after waiting over at one of the VA hospitals at Bay Pines. And then he finally gets there after waiting a couple of months. And then they say, "Well, we can't handle this, you have to go to the Tampa Haley hospital, and of course, that's another waiting period. And somehow this veteran knew to call me. And of course the minute we found out what happened, he had appointments in the Haley Hospital in the TBI center the next day.
There's something cold and hard and impersonal that we have to break through, not only in the subject of this hearing on wounded warriors, but on the treatment of people like Samuel Snow 60 years ago, that his country didn't treat him right. And 60 years later, has given him a check and say, go away. It's wrong, it ought to be corrected.
Dr. Chu: Senator, I would tell you that we are working hard to correct that. I would agree with you that's wrong. We, as I stated in my opening statement, need to ensure that each one of these individuals that steps up, raise their right hand, puts themselves in a position to defend this country and put themselves at risk, deserves timely access to every benefit that this nation has promised them. And we're working together as hard as we can to make that happen.
And I would make the point in regard to the person you mentioned, you know, with that situation and others, we have changed the rules and regulations to make sure that people with these issues get taken in quicker and sooner and are seen. And I would tell you also that everybody that comes to us is trained for TBI and PTSD. And we're working with DOD on follow-up issues to do that.
But I would agree with you, sir. You've got two of the biggest bureaucracies in the world that need a little shaking to make sure that they know that we're dealing with people.
Dr. Chu: Sir, let me also emphasize, as you and Secretary Geren agreed, ultimately the issue with Mr. Snow is statutory. If the Congress is willing to give Secretary of Defense discretion in cases like this, as it has given him discretion in waiving repayments, which we have used extensively, we would be able to avoid the situation. But it's ultimately not a rule or regulation in the Snow's case, it is the law, and we are stuck.
Sen. Bill Nelson: Well, if it is the law we will change it.
Dr. Chu: My point, sir, is for broad discretion as opposed to the rifle shot, because then you can deal with the unanticipated situation just as you have advocated. And we would like to be in that position.
Sen. Bill Nelson: Now, it's hard for me to believe that the Department of Defense, in the enormity of its resources, and rules, and regulations that there is not discretion somewhere to correct this wrong.
Secretary Mansfield has said already there is another avenue that we might explore with regard to, maybe he hasn't been advised of veterans' benefits that would be available to him since he had been wrongly dishonorably discharged, and we will pursue that.
I wonder why we had to come to United States Senate hearing to get to that. But in the meantime, since I have to recess this hearing so that I can go vote, I wish you all in the recess would confer with your assistants and see if there might be any other little angle that we haven't figured out.
Mr. Geren: Sir, I can assure you we have pushed this within our legal system as hard as we can. And I know if you get two lawyers together you get two opinions. But, unfortunately, we continue to run into the same statutory interpretation. If someone could help us see it differently we'd be glad to. I can assure you we all feel the same about that case and want to help him, and appreciate your advocacy, and in your interest in addressing it statutorily we believe that's where we are. And we've sent it back, and sent it back, and sent it back and kept getting the same answer. And we want to see it fixed as well.
Sen. Bill Nelson: The committee will stand in recess subject to the call of the chair.
Sen. Levin: Okay, well, committee will be -- come back to order, yes?
Mr. Mansfield: Sir, could I have the privilege of speaking, please?
Sen. Levin: Sure, Secretary Mansfield, let me just wait till everybody -- I don't know -- before Secretary Mansfield, I call on you -- was Nelson the last one?
Yes. Secretary Mansfield.
Mr. Mansfield: Sir, with reference to the last discussion about the individual wronged and the ability to deal with that, and the need for a legislation I would refer you to Title 38, U.S. Code 503, Administrative error; equitable relief: "If the Secretary determines that benefits administered by the Department have not been provided by reason of administrative error on the part of the Federal Government or any of its employees, the Secretary may provide such relief on account of such error as the Secretary determines equitable, including the payment of monies to any person whom the Secretary determines is equitably entitled to such monies." That's what DOD needs, that's the VA section, and I think that's what DOD needs.
And it would allow us to go back and look at the situation by the -- by virtue of the fact that with that dishonorable discharge he was not eligible for a lot of VA benefits, and we could make an adjustment based on that.
Sen. Levin: Does the mistake have to have been made under that law by the Veterans Administration?
Mr. Mansfield: No, sir. It says on the part of the federal government or any of its employees, the federal government.
Sen. Levin: So there was a mistake made, which there seems to have been, by the DOD, the VA can act now under existing law.
Mr. Mansfield: Yes, sir.
Dr. Chu: For VA benefits --
Mr. Mansfield: For VA benefits --
Sen. Levin: For VA benefits.
Well, that's part of the deal as I understand it --
Mr. Mansfield: That would be one way to make him whole, to look at what he would have been eligible; home loan, or education, or compensation, or --
Sen. Levin: Well, I'm sure Senator Nelson will pursue that. But what you're doing is opening up the avenue that the -- even though you don't think the DOD has that power -- we'll check that in a second -- that the VA has power if there is a mistake made by any governmental agency that affected the benefits of the VA that you can make that. You may not be able to make that soldier whole, but you will be able to at least take care of the VA part of doing it under that law. So I --
Mr. Mansfield: I bet you we can make them pretty damn near whole.
Sen. Levin: Okay, well, that's better, yet. And I'm sure Senator Nelson, I assume he is aware of that, we will pursue that, but if not, thank you for bringing that to our attention.
Mr. Mansfield: We'll notify him of -- but DOD needs legislation for that --
Sen. Levin: Let me follow that up now. Do you know Secretary Chu if DOD has that same power?
Dr. Chu: I don't believe so, sir. But obviously, I'd want to double check.
Sen. Levin: Okay. Well, we'll raise that in the authorization bill this year then. There is no reason why DOD should not have the same power that VA has to correct mistakes.
Dr. Chu: Sure.
Sen. Levin: So my staff, I know, is following this, and we will pursue that.
Secretary Geren, do you know whether the DOD has that power?
Mr. Geren: We looked as hard as we could to figure out a way to address this situation. In Army, we looked at it, looked at everything that we had that was discretionary. We could not find a way for it to fit. We went to OSD's lawyers to see if there would be a way to do it at OSD level. They could not find a way. We kept coming to the same conclusion. There was a statutory block that kept us from doing it, and I certainly would support an effort to provide the flexibility --
Sen. Levin: Well, Secretary Mansfield, thank you for bringing that to our attention and --
Mr. Mansfield: Thank my excellent staff here, sir.
Sen. Levin: We thank your excellent staff. We appreciate that. We all rely on our staff more than we like to admit, but --
Mr. Mansfield: I'll admit it today, sir.
Sen. Levin: Well, every other day we admit it too, so -- but anyway, thank you, and that will be pursued.
Let me -- there is nobody here who hasn't had a first round, so let me start a second round here.
The Senior Oversight Committee has been working diligently on a number of the issues as we've heard here this morning, and we're aware of even before this morning. But the question is whether or not the issues that we are discussing will have a -- remain a priority over time when talking about transitions and seamless transitions.
Since there will be a change of administration in January, what steps are you taking to ensure that these issues will remain a priority during the transition period from this administration to the next?
Secretary Chu, why don't I ask you first, and then Secretary Mansfield.
Dr. Chu: We are planning to use -- and Secretary Mansfield and I have already begun discussing that issue. The statute -- now statutorily charted Joint Executive Council, which is a similar partnership between DOD and VA, to make sure that that there is no backsliding, no ground loss, no lessening of commitment to these initiatives. And we are determined to see them through -- pass the transition using that already existing mechanism.
I think it's already produced, as Secretary Mansfield indicated, important success in other areas. I point to North Chicago as a prime example of that agenda succeeding, and I'm confident it can carry forward into the next administration.
Sen. Levin: Secretary Mansfield.
Mr. Mansfield: Sir, one point I would make is that everything that we've discussed that we're putting into action are becoming VA directives that will be on the books as we leave. But the other point I would make is, in the course of a transition there is normally a discussion with the incoming, and the outgoing, and the highlights of what the outgoing administration looks at and wants to put in the -- in their -- give their attention to the folks coming in would be -- I'm sure would be a part of this effort.
Sen. Levin: Is there a permanent structure, a joint structure that's now in place to evaluate these changes that we've talked about, and to monitor systems, and to make further recommendations for process improvement, is there that structure, and if so what is it?
Mr. Mansfield: Sir, I would say that -- again the statutory mandated JEC with its benefits subgroup, and its health care subgroup, have been working for four years now --
Dr. Chu: Five years.
Mr. Mansfield: Five years now in an effort to put processes in place that we can measure what is required and be able to make a decision at the end of each year what we've done, what we need to do.
Sen. Levin: Now, who are the members of the JEC?
Mr. Mansfield: Currently, its myself and Dr. Chu, and Secretary Chao from Labor has asked us to include a member from there, the Veterans Employment and Training Service which is responsible for veterans employment, and we've agreed to bring somebody from there onboard. And then you have in the -- in the benefits arena you have the undersecretary for benefits from the VA and the equivalent OSD and DOD folks. In the health arena you have the undersecretary for veterans health and the equivalent folk from the services in DOD.
Sen. Levin: Now, you two are political appointees?
Mr. Mansfield: Yes, sir.
Sen. Levin: And the ones that you -- those undersecretaries are political appointees, are they?
Dr. Chu: They are political appointees.
Mr. Mansfield: Yes.
Dr. Chu: But the council -- Joint Executive Council is, thanks to your efforts, a statutory body. So whoever succeeds, either acting for or confirmed by the Senate, will succeed to that responsibility. And the career staff understands that this agenda has to go forward using this mechanism.
Sen. Levin: Well --
Mr. Mansfield: The undersecretaries in the VA are political appointees, but they are in four-year terms which would overlap this administration.
Sen. Levin: Can -- would you make sure that the career staff not just tells your successors, assuming you're not reappointed, about this, but that somehow rather can they be acting during a period that there is a gap?
Mr. Mansfield: Sir, the career staff -- the leading senior career staff in each agency are heavily involved in this and understand very well the need for them to be --
Sen. Levin: Are they authorized to meet during a transition period without you?
Mr. Mansfield: As part of the JEC?
Sen. Levin: Yeah. Can the JEC --
Dr. Chu: I see no reason they could not. I don't want to get in the general council's way here on the Vacancies Act issue. But I see no reason that those performing the duties of these officials, which would be the last resort could not in fact -- can be in a meeting and have --
Sen. Levin: Will you let us know whether that can happen?
Dr. Chu: I would do that, sir.
Sen. Levin: And if it can't happen let us know what would be required to make that happen legislatively.
Mr. Mansfield: We will provide that information, sir.
Sen. Levin: All right, that would be great. Thank you.
Secretary Geren, last week you announced a program called the Wounded Warrior Education Initiative, could you tell us what that's about?
Mr. Geren: Yes, sir. We announced it in -- at Leavenworth, Kansas. In September the chancellor of University of Kansas came to meet with me and with Dr. Gates to propose an initiative where Leavenworth partner with Kansas University in developing a graduate degree program for wounded warriors, physically wounded warriors.
It's a program where the wounded warriors would be -- either stay on active duty, or if the have left active duty be supported in some type of an internship role, attend a two-years masters program at Kansas University and then return to the military and serve in either teaching capacity or support capacity at our colleges at Leavenworth. A very innovative program, and we were able to, working with Kansas over just a period of several months, pull it together. And last week we announced that we have eight soldiers accepted into the program, hope to build on it. I think it's a model that could be used elsewhere.
Sen. Levin: Right. Would you -- yeah, if it works I assume you will expand it.
Mr. Geren: Yes, sir.
Sen. Levin: Now, some have proposed giving veterans plastic card that they could take to any health care provider to pay for their health care. Is -- can you give us your view on that proposal, Secretary Mansfield?
Mr. Mansfield: I don't think it's a good idea.
Sen. Levin: Why is that?
Mr. Mansfield: The VA is set up -- we'd have to go in. The VA is set up to be able to be the primary care provider of the individuals in the system, and keep track of what their needs are, and follow them throughout the system.
Part of what you're looking at is taking us away from that where we wouldn't know what's going on with the care, what the quality is, what they need, what they don't need. The other part of it is, it would make us in effect an insurer, the Medicare type payor -- for the system, and I don't know what kind of, you know, requirement we would have for the back office. We have the replicate the -- you know, the Medicare system to get the bills, figure out what the bills, you know, whether they were reasonable or not, whether the treatment was reasonable, and then make a payment.
Sen. Levin: Our veterans groups generally favor this kind of approach, do you know, or not? Service organizations?
Mr. Mansfield: I don't think they do favor it, sir. I think they would look at it as unraveling, starting to unravel the VA, and this was mentioned a year earlier. We now have reached the point where we are regarded as providing pretty good care and taking pretty good care of these individuals that are in our system.
Sen. Levin: One of you mentioned the electronic health record system which we're trying to develop between the two entities. When -- I forgot, who is it? Dr. Chu, were you doing it? You made that reference. What's the timetable for that?
Dr. Chu: Sir, we anticipate by the end of this year having all existing electronic information interchangeable between -- viewable, I see -- as I understand the computer community would phrase it between the two institutions. So if you are a VA doctor you can see the DOD record and vice versa.
We already have the pharmacy data at that stage. We have the laboratory data of that stage. The first discharge summaries of that stage, et cetera, et cetera. Very significant project, it's been ongoing for a number of years. The recent Senior Oversight Committee effort has given extra energy to it. I think we'll get to that goal under -- end of this year.
It doesn't necessarily make the data as the computer community would phrase it "computable," or we can't manipulate it inside the program. I can look at it. For that eventually what we need to do is have a common electronic health record between the two cabinet agencies. And we are committed to doing it. That is a multi-year project, that's not going to be overnight. It allows us to replace our aging, existing inpatient electronic records. We do have in DOD a world-wide, essentially web-based, although it's not actually the vehicle used, it's on the servers that we control, outpatient electronic record now, which is part of -- of course, we're making available to the VA physicians for outpatient treatments.
But we need to modernize our inpatient software, replace it basically. VA eventually will have the same needs. So we are committed jointly. The first exploratory effort has begun to getting to that common, essentially identical, electronic health record for the future. But that is a multiyear project.
Sen. Levin: If it's an identical record, then each agency would be able to add to that record and manipulate the information.
Dr. Chu: Exactly. And manipulate the information. And part of DOD's ambition is to mirror for that what we can now already for ourselves do for outpatients, which is wherever you are, at least in theory, I can call up what's been done to you on an outpatient basis. That's important because our people, as you know well, move around the world so much. So we don't want something that's site-specific in character. So this data -- these data are now on servers -- putting back on servers that allow world wide access.
Sen. Levin: Did we require that by law?
Dr. Chu: We required in the statute that we make it interoperable.
Sen. Levin: But not the second step?
Dr. Chu: Not -- the second stage, it's a multi-year project.
We will be coming to you in -- this in future budgets --
Sen. Levin: But we haven't already mandated it?
Dr. Chu: I don't believe so, sir --
Sen. Levin: You got to come up -- you and I both used the word "manipulate," and I think that we got to find a different verb.
Dr. Chu: Yes, sir. They like to say "computable" as a --
Sen. Levin: Yeah, that's -- I shouldn't use that word, because some people would understand that to be a pejorative word, that we are somehow rather manipulating data for some nefarious purpose rather than --
Dr. Chu: No nefarious purpose intended.
Sen. Levin: No, no, but I use the word too. I don't know what the new verb is. "Computable," is that what it is?
Dr. Chu: "Computable," that's my understanding.
Sen. Levin: Make it "computable."
Okay. I think Senator Chambliss -- yes, Senator Chambliss, you are next.
Sen. Saxby Chambliss (R-GA): Thank you very much, Mr. Chairman.
And gentleman thank you, first of all for being here, your excellent testimony this morning, but thanks for what you do -- thanks for being concerned about our brave men and women who wear the uniform, and please convey our thoughts and prayers to the secretary. Gee, what did you all do to him over there, rough morning at the Pentagon, huh? Well, actually it was pretty slippery in my neighborhood, too. But tell him we're thinking about him.
Let me thank all of you for your efforts over the last year to improve our health care and transition programs for our wounded warriors. I've personally seen how the warrior transition units and our health care professionals have made great strides in caring for and treating our wounded service members. I've been to both Fort Gordon, I've been to Fort Benning where I've seen firsthand what's happening with respect to our men and women who are coming back with injuries. We're doing a great job of helping them reintegrate into the military and the community, and I appreciate the hard work each of you have done to get us to this point.
I note in Secretary England's statement that he focuses on the recovery coordination program. This program is designed to identify and integrate care and service for wounded service members, veterans and their families, obviously, establishing recovery coordinators to serve as the patient's and family's single point of contact during their recovery and transition period was discussed in the number one recommendation of the Dole-Shalala commission, and I'm pleased to see that the department is taking steps to implement this very important recommendation.
Training for the recovery coordinators is obviously very important if they're going to perform their jobs effectively. Augusta, Georgia has developed a very unique collaboration in the area of wounded warrior care. The city of Augusta is home to the Eisenhower Medical Center at Fort Gordon. Formerly operated on the great leadership of General Schoomaker, and -- we miss you there.
Your successor, General Bradshaw is certainly doing a great job. But part of what I'm going to talk about here, and ask you about, is something that began under your leadership, and we thank you for your continued attention to the care for our wounded warriors.
It's home to the, also the Charlie Norwood VA Medical Center and the Medical College of Georgia, particularly the School of Nursing, these three institutions are already collaborating in the treatment of wounded warriors and the Charlie Norwood VA hosts the only active duty rehab facility for military personnel in a VA medical center.
The Medical College of Georgia School of Nursing has an existing program for training and certifying clinical nurse leaders. These clinical nurse leaders are basically the civilian equivalent of DOD's wounded warrior recovery coordinators and perform many of the same task.
As a means of extending the collaboration and treatment of wounded warriors in the Augusta area, the Medical College of Georgia School of Nursing has proposed a short certificate program which would take advantage of classes and faculty already resident in their clinical nurse leader program to help train and certify DOD's recovery coordinators.
I understand from statements from several of you that DOD is conducting some training, including web-based training, for your recovery coordinators. But I'm wondering if you had considered taking advantage of this proposal that the Medical College of Georgia is offering to determine if it could be an effective means of helping to train your recovery coordinators, and if it would provide a value- added addition to the Department's establishment of a wounded warrior recovery program.
And I'll direct that to whoever wants to respond first. But Dr. Chu --
Dr. Chu: We always value new ideas. We'd be delighted to look at this one.
Sen. Chambliss: Mr. Mansfield.
Mr. Mansfield: Sir, I would add that it's interesting you mentioned Fort Gordon because we have at the present time a program with VA and DOD that goes back, I think, to 2004 where the VA is actually doing rehab for active-duty soldiers down there. So that cooperative effort is already in place down there and we can look at going forward, and as Dr. Chu mentioned, doing something new and better.
Sen. Chambliss: Anyone else have a comment?
Well, I know that the personnel at the Medical College of Georgia School of Nursing would be willing to modify their proposal in order to meet any specific training requirements as well as the necessary timeframe the DOD might require for training their recovery coordinators, and whatever will be helpful to the department and the college. From a discussion standpoint these folks are ready, willing to offer any services necessary. And General Schoomaker, you know firsthand the great job that Dr. Rahm (ph) and the folks over at the medical college do, as well as the folks at the VA medical center.
I've had the pleasure of visiting any number of our patients there at the VA center over the last several years, and the work that we're doing particularly with our severely injured folks is truly amazing there. And thanks again, General Schoomaker, for your leadership in that role at Eisenhower in establishing it. It's certainly the premier, in my opinion, recovery unit for our wounded warriors out there.
Lt. Gen. Schoomaker: Thank you, sir. And, frankly, I get the credit for the terrific work of the team at the Augusta VA Medical Center and at Eisenhower. We had a very farsighted group in both the communities who recognized very early in the war that the nature of the injuries our soldiers, and sailors, airmen, marines were suffering, the long experience that the Augusta VA Medical Center and many VAs throughout the system have in rehabilitative medicine, especially with blind, and deaf, and traumatic brain injury, and posttraumatic stress disorder, which Secretary Mansfield has talked about already, I think that was resident within those communities. And they reached out to us just as we reached to them, and we have a very -- we continue to have a very, very collegial and cooperative relationship.
It's important to note that this was built on a relationship and corporative agreements that go back in neurosurgery, that go back in cardiothoracic surgery between the two organizations which set the framework for what we have there today. And we really truly support -- appreciate the support that you have given to this, that Senator Isakson has given us, the Congressman Norwood -- the late Charlie Norwood gave to it, and now Congressman Brown give to that.
Senator Inhofe said something earlier that I think is very important. And that is that his own -- the revelation, the epiphany that he has experienced in going back into the VA system and saying that this is such a high-quality system, that insight, frankly, is one that all of our soldiers and their families needs to recognize.
And relationships such as what we have at the Augusta VA Medical Center, but all are polytrauma units, if you've been to see them, tell us everyday as well. It allows our soldiers and families, even if they come back into uniform, fully recovered and rehabilitated, it gives them an insight into what the VA medical system provides for them and much greater confidence through working knowledge with the VA. So these kinds of relationships are just absolutely fundamental. Thank you, sir.
Sen. Chambliss: Thank you, Mr. Chairman.
Sen. Levin: Senator Chambliss, thank you.
Sen. Warner: Thank you, Mr. Chairman.
The Army really has on its own initiative established this Warrior Transition Brigade, as I understand this fine officer was introduced as the brigade commander, is that correct?
Lt. Gen. Schoomaker: Yes, sir, right here.
Sen. Warner: Fine. Thank you.
Lt. Gen. Schoomaker: He is the 1st brigade commander, sir, for the warrior transition unit. Colonel McKendrick is the commander of the only brigade within the WTUs. We have 34 other warrior transition units at the battalion and company level.
Sen. Warner: And they're staffed accordingly to the need in that geographic jurisdiction?
Lt. Gen. Schoomaker: Exactly, sir. On a standard Army document that provides staff in accordance with the number of patients and the severity of the patients.
Sen. Warner: Then, General, do you find it desirable if Congress were to recognize this legislation at all, or do you -- or just leave it as it is right now?
Lt. Gen. Schoomaker: I guess, sir, I need a little clarification as to how Congress wants to recognize --
Sen. Warner: Well, now wait a minute. I'm not -- Congress move in -- you've done a -- this is an Army initiative.
Lt. Gen. Schoomaker: Yes, sir.
Sen. Warner: And it's working. May not need anything in there from Congress, but every now and then organizations need a little structural recognition in the law to stay alive after passage of time, and other priorities begin to encroach on Army needs and so forth.
Lt. Gen. Schoomaker: Yes, sir. I believe in the NDAA '08 you gave us the right structure and the right imperative without giving us, without giving us such directive ratios of soldiers and patients that we have the latitude to really make the judgments that we needed to have, sir.
Sen. Warner: Now, what about your staffing? Are there individuals, are you looking for volunteers to take this on, or is it a career-enhancing? You well know that's got to be somewhere in the residual recesses of every Army mind, is if he or she is moving up. Is this assignment going to help me move on to my next goal in the Army?
Lt. Gen. Schoomaker: Yes, sir, what we have done is, first of all, we have codified the units in Army doctrine so that they have all of the necessary administrative tools to have an enduring presence within the Army. We have funded them. The Army has stepped forward very aggressively and put manpower against on them despite a war and the challenges of deploying soldiers they have placed 25,000 soldiers against that. And these are not traditional medics, many of them.
What we see happening is that these positions represent for the cadre that fill those roles and opportunity for them to take a knee from constant deployment, or recruiting duties, or training duties and other things. We've also put special pays in for the NCO leadership. These are all signs that these are important jobs for the Army, and I think the visibility it's given for the senior army leadership and the emphasis that the chief of staff and secretary have given to this I think are all signs of the importance of --
Sen. Warner: And what about Reserve and Guard members, they will be an integral part for you?
Lt. Gen. Schoomaker: They are, sir. They are the --
Sen. Warner: Do you have a quota for so many regular Army and so many Guard and reservists and so forth?
Lt. Gen. Schoomaker: Absolutely sir. In -- to mirror the composition of the warrior transition units, so Guardsmen and reservists are also present there, especially because of the special needs of the Guard and Reserve with respect to administrative, and pay, and travel issues and alike.
Sen. Warner: Let's go back to the family support, the parents, the spouses and so forth. Do they have access to this organization to help get support?
Lt. Gen. Schoomaker: Oh, yes, sir. The -- of course the Army family is one of the cornerstones of the Army. And you may be familiar with the Army covenant that the secretary of the Army, and --
Sen. Warner: Secretary Geren has read that before this committee in years past.
Lt. Gen. Schoomaker: So we feel very strongly about the need to support our families. We have created soldier and family assistance centers at every one of our sites to --
Sen. Warner: I mean, is this brigade also a part of that infrastructure that the families can access?
Lt. Gen. Schoomaker: Oh, absolutely, sir.
Sen. Warner: The wife or the parent can walk right in and say, look, my soldier husband, or son is just not able to get here today, I want to try and get this for him and so forth?
Lt. Gen. Schoomaker: Yes, sir. And the nurse case managers that are providing administrative oversight of the needs of that soldier, I think, that also provide ingress for that, and have I depicted that correctly there.
Sen. Warner: All right. And you're satisfied that the budget -- everything else is adequate to help the family members as they try to continue their roles for the support for their spouses or sons or the case may be?
Lt. Gen. Schoomaker: Yes, sir. We have identified challenges to these families, to travel, for example, or to be there to present and provide support for their wounded son, or daughter, or husband, and wife, even non-marriage, non-medical attendants we have reached out to them and found the necessary funds to support their travel and presence.
Sen. Warner: To our distinguished secretary of the Veterans Affairs, indeed, I look back over your personnel record of achievements. You've certainly served this nation well. Thank you for continuing, Secretary Mansfield, in your role today.
Mr. Mansfield: Thank you.
Sen. Warner: Have we covered here this morning -- some of us of course during the course of votes missed some testimony -- the disability rating for service members, the pilot program. Have you testified about that this morning?
Mr. Mansfield: We talked about it about it generally, sir. The pilot has started, it's up and running. We've had the first case run through the system. They will be running until November, and we'll be taking periodic looks at it to make --
Sen. Warner: So the record this morning has adequate testimony with regard to that very important program.
Mr. Mansfield: I believe so, sir.
Dr. Chu: Yes, sir, I believe so.
Sen. Warner: All right. Thank you very much.
How about the improvements in the DOD disability evaluation system, have we covered that adequately this morning?
Dr. Chu: Yes, that's part and parcel of the same effort.
Sen. Warner: All right. Well, Mr. Chairman, I think you've conducted a very good hearing this morning. I'm glad to be part of it.
Mr. Geren: Mr. Chairman, could I just make one point in response to Senator Warner?
Sen. Levin: Please, Mr. Geren.
Mr. Geren: When the legislation was being developed for the Wounded Warrior Act, there were those -- many of them were in the other body -- that did advocate a fairly prescriptive approach to setting ratios and going -- using statutes to setup these warrior transition units or systems to meet the needs of wounded warriors.
We worked with this committee, and you all gave us the kind of flexibility that we felt was very important for us to be able to shape these units so that they were able to adjust to the dynamic situation that they are asked to work in. And we appreciate very much how this committee worked with us and provided us that kind of flexibility. We think that's one of the success stories in the legislation that you all passed. It does give these army leaders the opportunity to be somewhat entrepreneurial. They did create this in a very short time out of whole cloth, totally different approach, and it's -- they continue to adjust it. They continue to make improvements.
General Schoomaker talked about this task force that he is heading to look at -- now, how do we start accommodating the needs of some of these soldiers who are particularly vulnerable that have all been brought together in these warrior transition units, and he will continue to fine-tune this, as well as General Tucker and other others that are working in the area.
So the flexibility that you all gave us I think is very important as we shape this over the coming years, and we appreciate very much how you've given these great Army leaders the opportunity to be entrepreneurial, do something that has not been done before, and it's a work in progress today, great progress, but a work in progress.
Sen. Warner: The group of Army veterans -- well, actually they're active duty -- is almost 10,000, is that correct?
Mr. Geren: Yes, sir. In the warrior transition unit?
Sen. Warner: Yes.
Mr. Geren: Now, that's active Guard and Reserve, but they're all currently on active duty, it's about 9,600 right now.
Sen. Warner: And these, they go all the way from where they are still getting treatment to this transition group trying to integrate them back into the U.S. Army and find a MOS and responsibility that they can fulfill in the Army commensurate with such limitations as they might have as a consequence of their wounds, is that correct?
Mr. Geren: Yes. Both to give them the opportunity and prepare them to return to duty, or if they're going to transition to civilian life to make sure that they are well-equipped to be productive citizens and everything we can do to prepare them for that.
Sen. Warner: And a number of these are accessing health care both within the regular army and accessing it within the veterans organization, is that correct?
Dr. Chu: That's correct, sir.
Sen. Warner: You've worked out a system how that can be done?
Dr. Chu: Right.
Sen. Warner: These are really dramatic changes, Mr. Chairman, in the small period, a year's time. You are to be commended, each and every one of you.
Dr. Chu, you know, in the old Navy we used to get a red hash mark for every couple of years service. How many years of service have you been coming before this committee?
Dr. Chu: If you include my prior service, my break in service -- (inaudible) -- it's getting close to 20 years.
Sen. Warner: Twenty years. How many Purple Hearts have you been awarded for --
Sen. Warner: -- by wounds inflicted by Congress?
Well, that's quite a record, Dr. Chu.
Dr. Chu: Thank you, sir.
Sen. Warner: That's quite a record. Well, give us -- give your secretary our best. Tell him you stood in very well for both the deputy and Secretary Gates, and -- I don't know, all of us went home on that ice last night, and I -- same experience could have happened to anybody.