STATEMENT OF
MAJOR GENERAL MARIANNE MATHEWSON-CHAPMAN, USA (RET) PH. D. ARNP
NATIONAL GUARD AND RESERVE COORDINATOR
OFFICE OF OUTREACH TO GUARD AND RESERVE FAMILIES
VETERANS HEALTH ADMINISTRATION
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE HOUSE VETERANS' AFFAIRS COMMITTEE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

June 24, 2008

Good afternoon, Mr. Chairman and members of the Subcommittee. Thank you for inviting me to speak about the cooperation between the Department of Veterans Affairs (VA), the Department of Defense (DoD), the National Guard, and the Reserves. I am pleased to report VA and DoD are coordinating their efforts more closely than ever to ensure former members of the National Guard and the Reserves are reintegrating into society and are being offered all of the benefits and services to which they are eligible. I am accompanied today by Dr. Edward Huycke, Chief VA/DoD Coordination Officer, VHA, Mr. Charles Flora, Executive Assistant for the Readjustment Counseling Service, VHA, Karen Malebranche, Executive Director of OEF/OIF, VHA, and Mr. Bradley Mayes, Director of the Compensation and Pension Service in the Veterans Benefits Administration (VBA).

From the start of Fiscal Year (FY) 2002 through the first quarter of FY 2008, 837,458 veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have separated from active duty and become eligible for VA health care. Of those, slightly more than half, 422,870 were members of the Reserve or the National Guard. Thirty-nine percent of all separated OEF/OIF veterans have obtained VA health care, while 38 percent of returning veterans from the Reserve or National Guard have chosen to receive care from VA.

VA has a long-standing commitment to serving this important component of our Armed Forces. We are dedicated to providing the highest quality care and services to all who have worn the uniform in any branch of service. We also recognize the importance of timely contact, and that not all separating service members, or members of the National Guard and Reserve, will be interested in immediately enrolling in VA for health care or benefits. Many of them are focused on returning to their family and friends, their community, and their careers, and justifiably so. As a result, VA has developed a multi-faceted strategy to provide both episodic and continuous outreach.

Specifically, VA is focusing on three phases of intervention: first, at 12 Army Reserve Component demobilization sites across the country; second, at post-deployment health reassessments ( PPDHAs) conducted at their military base; and finally, on a continuing basis after separation from military service. VA also works closely with families, communities, counties and state governments to coordinate efforts and ensure we cast as broad a net as possible to inform our nation's veterans of the benefits and health care services they have earned.

DEMOBILIZATION

DoD provides VA with dates, numbers of participants and locations for Reserve Component units in demobilization and reintegration programs. The two Departments are standing up a comprehensive program for VA participation in mandatory demobilization out-processing procedures at Army sites. This pilot program began May 28, 2008, and through the first half of June has already established contact with more than 1,000 separating members of the National Guard and Army Reserves at Ft. Bragg, North Carolina and Camp Shelby, Mississippi. VA has enrolled approximately 80 percent of these veterans.

At these events, Veterans Health Administration ( VHA) staff representatives from the local VA medical center are given 15 to 30 minutes during mandatory demobilization briefings for a presentation. During this time, veterans receive information about recent changes in enrollment and eligibility, including the expansion of the period of enrollment from two to five years for OEF/ OIF veterans following their separation from active duty. They are also educated about the period of eligibility for dental benefits, which was recently extended by the 2008 National Defense Authorization Act from 90 days to 180 days following separation from service.

Veterans are also shown and provided with an Application for Medical Benefits (the 1010EZ, which enrolls them for VA health care). Moreover, they are shown how to complete the form. VHA staff also discuss how to make an appointment for an initial examination for service-related conditions and answer questions about the process. These completed forms are collected at the end of each session. VA staff at the supporting facility match the 1010EZ with a copy of the veteran's DD214, their discharge papers and separation documents, scan them, and email or mail them to the VA medical center where the veteran chooses to receive care. The receiving facility staff will process the paperwork and notify the veteran. Guard and Reserve veterans receive a special form and a toll-free number they can dial if they need to seek medical care before they have received their official enrollment letter in the mail.

Our representatives also make a straightforward presentation regarding the advantages of enrolling in care immediately: this is free health care for service-connected conditions, and they retain their choice of providers as their TRICARE benefits will continue for six months after separation. Enrollment serves as a measure of insurance in case at some point in the future, a veteran begins displaying symptoms of a service-connected condition. Essentially, our message reinforces a positive message about enrollment for VA health care, both now and in the future.

The Vet Center program is the VHA arm for community outreach to returning combat veterans. The outreach to provide veterans and family members with educational information about services is one of the legislatively mandated missions of the Vet Center program. In response to the growing numbers of veterans returning from combat in OEF/ OIF, the Vet Centers initiated an aggressive outreach campaign to welcome home and educate returning service members at military demobilization and National Guard and Reserve sites. Through its community outreach and brokering efforts, the Vet Center program also provides many veterans the means of access to other VHA and Veterans Benefits Administration ( VBA) programs. To augment this effort, the Vet Center program recruited and hired 100 OEF/ OIF veterans to provide the bulk of this outreach to their fellow veterans. To improve the quality of its outreach services, in June 2005, the Vet Centers began documenting every OEF/ OIF veteran provided with outreach services. The program's focus on aggressive outreach activities has resulted in the provision of timely Vet Center services to significant numbers of OEF/ OIF veterans and family members. Since the beginnings of hostilities in Afghanistan and Iraq, the Vet Centers have seen over 288,594 OEF/ OIF veterans, of whom over 216,172 were outreach contacts seen primarily at military demobilization and National Guard and Reserve sites and 72,422 were provided readjustment counseling in the Vet Center. The Vet Center Program has also provided outreach services to the United States Marine Corp IRR reservists across the nation.

The approach builds on a prior outreach effort conducted during the first Gulf War, which received the commendation of the President's Advisory Committee on Gulf War Veterans' Illnesses. In its final report of March 1997, the Committee cited the Vet Centers for providing exemplary outreach to contact and inform this veteran cohort about VA services. On October of 2004, the U.S. Medicine Institute of Health Studies and Association of Military Surgeons of the United States reported that " VHA's Vet Centers have proven a "best practice" model in fostering peer-to-peer relationships for those with combat stress disorders."

POST-DEPLOYMENT HEALTH REASSESSMENTS (PPDHA's)

Following demobilization, DoD regularly holds post-deployment health reassessments ( PPDHA's) for returning combat Guard and Reservists between three and six months after separation from active duty. The PPDHA is a health protection process designed to enhance the deployment-related continuum of care. PPDHA's provide education, screening, and a global health assessment to help facilitate care for deployment-related physical and mental health concerns. Completion of the PPDHA is mandatory for all members of the National Guard or Reserve who complete the post-deployment health assessment.

DoD provides VA a list of locations and times where these will take place - often at the Reserve unit's base prior to deployment. VA outreach staff from local medical centers and Vet Centers participate at these events. DoD clinicians screen veterans and VA staff are available to prepare referrals for any veteran interested in seeking care from a VA facility. Vet Center staff are also present to assist veterans with enrollment in VA for health care or counseling at a local Vet Center.

PPDHA's are typically held in person with mandatory attendance for units of 30 or more service members, while smaller units conduct their PPDHA's by phone on a person-by-person basis. Almost 73 percent of all Reserve Component PPDHA referrals were to VA - either a Vet Center or a VA medical facility. VA's PPDHA mission is threefold: enroll eligible service members, including members of the Guard or the Reserves, into VA health care; provide information on VA benefits and services, and; provide assistance in scheduling follow-up appointments. VA medical center and Vet Center representatives provide post-event support for all onsite and Call Center PPDHA events.

VA medical centers and Vet Centers accept direct PPDHA referrals from DoD's 24/7 Contract Call Center. Between November 2005 and May 2008, VA staff supported over 1,050 onsite and 380 Call Center PPDHA events. During that same period, DoD conducted 193,559 Reserve Component PPDHA screenings, resulting in more than 41,100 referrals to VA medical centers and 19,200 to Vet Centers.

Another essential piece of VA's outreach during PPDHA's and other events at or just after separation from active duty are the 100 Global War on Terror ( GWOT) counselors employed by VA's Readjustment Counseling Service. Vet Center GWOT Veteran Outreach Specialists conduct a focused campaign to inform their fellow GWOT veterans about VA benefits and services. These GWOT Counselors attend demobilization, PPDHA and other activities, including "welcome home" events. These Counselors are performing a vital service, and their personal connection and dedication to the task at hand has helped countless veterans and their families throughout the reintegration process.

POST-SEPARATION

While VA's participation at demobilization sites and in PPDHA events represents critical elements of our outreach strategy, we are well aware that not all veterans will enroll during this time. As a result, through a number of outreach initiatives, VA continues its efforts once veterans, especially members of the National Guard and Reserves, have returned to their community. These measures range from nationwide to neighborhoods and leverage VA's relationships with state and local partners, including a wide variety of organizations.

In May 2005, VA and the National Guard entered into a partnership and signed a Memorandum of Understanding to enhance access to VA health care for members of the National Guard. In 2006, the National Guard hired 54 Transition Assistance Advocates ( TAAs), one for each state and territory with a National Guard presence (Puerto Rico, Guam, the U.S. Virgin Islands, and the District of Columbia). The National Guard continues to fund this robust program. They are presently expanding it with a goal of 2 TAAs for each state with a large number of deployed troops. In early 2006, the National Guard hired and funded the first 54 TAAs, while VA provided specialized training for them at the VBA Academy in Baltimore about VA benefits and health care services. In 2008, an additional six TAAs were hired to provide further support in states with large pools of National Guard members: Texas, Pennsylvania, Georgia, Florida, California, and Minnesota. VA continues working closely with TAAs while they are in the field and serving OEF/ OIF veterans, through regularly scheduled conference calls, newsletters, and annual training conferences that identify and disseminate best practices in each state. TAAs serve two critical missions: first, they perform local problem-solving for any specific issues facing veterans; second, TAAs bring together key leaders and organizations, such as State Directors of Veterans Affairs, Adjutants General, and VA leadership at the Network and facility level. The VHA OEF/ OIF Office of Outreach also has strong ties with the Adjutants General of the National Guard, TAAs, and with State Directors of VA, all of whom can and do keep VA informed of any challenges in accessing VA health care or other issues.

TAAs have been the critical link in facilitating access to VA by National Guard and Reserve members by providing VA with critical information on numbers of returning troops, locations, and home coming and reintegration events. TAAs also facilitate enrollment into VHA care for returning troops. Many Adjutants General have mandated National Guard members to enroll in VA health care in their state during the post-deployment period.

Moreover, VA has signed a Memorandum of Understanding with 47 states that define the roles and responsibilities of VA and the state Departments of Veterans Affairs. A few states prefer to operate under the agreement reached between the National Guard and VA in 2005. These state partnerships are the foundation for the development of state coalitions with participation by VA, State Adjutants General, State Directors of VA, and community and state organizations to address the coming home needs of the Guard and the Reserve members.

VA works with state governments to further our mutual goal of enhanced benefits and care for veterans in multiple ways. Some examples include:

• In Connecticut, the State has signed a Memorandum of Understanding with VA allowing severely injured veterans to volunteer to have their medical information shared with the state, and VA has an active campaign to encourage wounded veterans in the state to contact VA for enrolment and benefits.
• In Delaware, the State signed a Memorandum of Understanding in September 2007 with the Delaware National Guard, the Delaware Department of Labor, VA, and other support agencies to establish clarity of communication and synchronization of efforts between each agency to provide veterans with transition assistance and guidance.
• In Florida, a pilot program was established to allow for ease of transfer of information from VA to the state government for wounded service members who volunteer to have their information shared.
• In Ohio, the National Guard and the regional VA office are negotiating a Memorandum of Understanding to provide comprehensive informational sessions for members of the Guard and their families during different stages of deployment.
• In South Carolina, the State has partnered with VA to offer job and health fairs for returning service members.
• In South Dakota, the State has established a seven step Reunion and Reintegration plan, a portion of which includes providing information on Vet Centers and PPDHAs.
• In Minnesota, during the "Beyond the Yellow Ribbon Reintegration Program", VA participated in briefings to returning troops and families, enrolled members of the National Guard in VA health care, and supported family members in the Family Academy classes, which provided information about VA benefits and health care services for which the spouse or family of a veteran may be eligible.

For wounded warriors returning home, forty-three states currently participate in the State Benefits Seamless Transition Program. To date, 350 severely injured veterans have signed the consent form authorizing VA to notify their local State Department of Veterans Affairs of their contact information when they return to their home state. The initiative involves VA health care liaison staff located at the following Department of Defense medical facilities:

• Walter Reed Army Medical Center, Washington D.C.
• National Naval Medical Center, Bethesda
• Brooke Army Medical Center, San Antonio, TX
• Darnall Army Medical Center, Ft. Hood, TX
• Madigan Army Medical Center, Puget Sounds, WA
• Eisenhower Army Medical Center, Augusta, GA
• Evans Army Community Hospital, Ft. Carson, CO
• Naval Medical Center, San Diego, CA
• Womack Army Medical Center, Ft. Bragg, NC
• Naval Hospital, Camp Pendleton, CA
• Naval Hospital, Camp Lejeune, NC

Under the program, wounded veterans returning to their home states can elect to be contacted by their local State Department of Veterans Affairs about state benefits available to them and their families. VHA Liaisons for Health Care identify injured military members who will be transferred to VA facilities, inform them about the program, and obtain a signed consent form from veterans electing to participate. These forms are faxed directly to an identified point of contact in the state's Department of Veterans Affairs. The state offices, in turn, contact the veterans to inform them of available state benefits.

In order to participate in the program, State Departments of Veterans Affairs must provide a point of contact and dedicate a fax machine in a private, locked office to receive the release of information forms. VA asked states to participate in the program in February 2007 when it was expanded beyond the Florida pilot program.

VA also conducts direct outreach by telephone through several initiatives, including the Secretary's recently announced call center campaign to contact every OEF/ OIF veteran and service member, including members of the National Guard and Reserve, who have separated from service but who have not yet enrolled in VA health care. On May 2, 2008, VA began contacting over 500,000 combat OEF/ OIF veterans to ensure they know about VA medical services and other benefits. The Department will reach out and touch all veterans of the war to let them know VA is here for them. The first of those calls went to an estimated 17,000 veterans who were sick or injured while serving in Iraq or Afghanistan. If any of these 17,000 veterans do not already have a care manager to work with them, VA will offer to appoint one for them. The second phase of call initiative is to those discharged from the military but not yet receiving VA health care. Local VA facilities and network representatives are provided referrals in their area to provide follow-up contact should the veteran want additional information or have unmet needs.

The Veterans Assistance at Discharge System process mails a "Welcome Home Package," including a letter from the Secretary, "A Summary of VA Benefits" ( VA Pamphlet 21-00-1), and "Veterans Benefits Timetable" ( VA Form 21-0501), to veterans recently separated or retired from active duty (including Guard/Reserve members). We re-send this information six-months later to these veterans.

The Secretary of Veterans Affairs sends a letter to newly separated OEF/ OIF veterans. The letters thank veterans for their service, welcome them home, and provide basic information about health care and other benefits provided by VA. Through the first quarter of FY 2008, VA mailed more than 766,000 initial letters and 150,000 follow-up letters to veterans.

Families are a vital force in guaranteeing veterans have access to the care and services they need; they are often the first to notice a change in behavior or any symptoms. VA works with National Guard family programs and provides literature on readjustment counseling and health care services to family program directors at annual training conferences. Many VA facilities attend "welcome home" events and Vet Centers identify other resources in the community where families and veterans can establish contact to meet their specific needs. VA is continuing its work with the Army's Warrior Transition Units at active duty Army bases and the nine community based health care organizations to ensure the leadership of these units is linked to case managers at VA medical centers. VA also supports the Family Assistance Centers at Army bases with VBA counselors and vocational rehabilitation specialists who can support and extend VA's outreach efforts to help service members with enrollment for health care, applications for disability, or other VA benefits prior to separation from active duty.

VETERANS BENEFITS ADMINISTRATION
VA currently conducts a comprehensive outreach program, designed to provide information to all military personnel separating from active duty. Separating servicemembers are advised about all of the services and benefits available from VA. Since the beginning of fiscal year 2003 through April of 2008, VA has conducted more than 8,300 briefings and provided information to approximately 510,000 National Guard and Reserve attendees.

BENEFITS INFORMATION AT TIME OF INDUCTION INTO SERVICE
VA initiates outreach to National Guard and Reserve members at the beginning of their military career. Since November 2004, everyone inducted into the five military branches receives a VA benefits pamphlet at the military entrance processing station. This pamphlet provides inductees with basic information on VA benefits and services at the start of their military active service. We want to be sure they know that VA will be there for them in the future.

TRANSITION ASSISTANCE PROGRAM (TAP)
One of the formal pre-discharge outreach programs that VA participates in is the Transition Assistance Program ( TAP), which is a program operated in conjunction with the Department of Labor. TAP is conducted nationwide and in Europe to prepare retiring or separating military personnel for return to civilian life, and VA provides benefits briefings as a part of the program. At these briefings, servicemembers are informed of the array of VA benefits and services available, instructed on how to complete VA application forms, and advised on what evidence is needed to support their claims. Following the general instruction segment, personal interviews are conducted with those servicemembers who would like assistance in preparing and submitting their applications for compensation and/or vocational rehabilitation and employment benefits.

DISABLED TRANSITION ASSISTANCE PROGRAM (DTAP)
Also as a part of TAP, servicemembers leaving the military with a service-connected disability are offered the Disabled Transition Assistance Program ( DTAP). DTAP is an integral component of transition assistance for servicemembers who may be released because of disability. Through VA's DTAP briefings, VA advises transitioning servicemembers about the benefits available through the Vocational Rehabilitation and Employment ( VR&E) program. The goal of DTAP is to encourage and assist potentially eligible servicemembers in making informed decisions about the VR&E program and to expedite delivery of these services to eligible servicemembers and veterans.

OTHER OUTREACH EFFORTS
Along with face-to-face outreach efforts, VA is seeking to ensure that a "Welcome Home Package" is sent to all returning National Guard and Reserve members. DoD provides the names and addresses of these returnees based on active duty separation records. The Veterans Assistance at Discharge System ( VADS) then generates a "Welcome Home Package" for recently separated veterans, including Reserve and National Guard members. The mailing itself contains a letter from VA and a summary and timetable of VA benefits. In addition to the VADS mailings, a separate personal letter from the Secretary, along with benefits information, is sent to each returning OEF/ OIF veteran. VADS also sends separate packages that explain education, loan guaranty, and insurance benefits. A six-month follow-up letter with the same general benefits information is also sent to each returning member. VA is currently working with DoD to update the electronic transfer of this information.

PARTNERSHIPS
n peacetime, outreach to Reserve and National Guard members is generally accomplished on an "on call" or "as requested" basis. With the onset of Operations Enduring Freedom and Iraqi Freedom ( OEF/ OIF) and the activation and deployment of large numbers of Reserve and National Guard members, VA's outreach to this group has greatly expanded. VA has made arrangements with Reserve and Guard officials to schedule briefings for members who are being mobilized and demobilized.

VA Regional Offices assist and support seriously injured OEF/OlF service members and veterans by case managing their claims, to include outreach, coordinating services, and expedited claims processing procedures. In collaboration with DoD, VA published and distributed one million copies of a new brochure called, "A Summary of VA Benefits for National Guard and Reservists Personnel." The new brochure summarizes health care and other benefits available to this special population of combat veterans upon their return to civilian life.

VA Regional Offices assist and support seriously injured OEF/OlF service members and veterans by conducting case management activities, including outreach, coordinating services, and streamlining claims processing procedures. In collaboration with DoD, VA published and distributed one million copies of a new brochure called, "A Summary of VA Benefits for National Guard and Reservists Personnel." The new brochure summarizes health care and other benefits available to this special population of combat veterans upon their return to civilian life.

CONCLUSION
VA's mission is to care for those who have borne the battle, and it is a mission we take seriously. Every day our clinicians and staff are developing new methods for providing information to those in need and for improving the quality of care and benefits we offer. We thank the Subcommittee for their interest in this matter and we thank DoD for their cooperative efforts in supporting our veterans.