<DOC>
[110th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:42584.wais]
THIRD WALTER REED OVERSIGHT HEARING: KEEPING THE NATION'S PROMISE TO
OUR WOUNDED SOLDIERS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON NATIONAL SECURITY
AND FOREIGN AFFAIRS
of the
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
SEPTEMBER 26, 2007
__________
Serial No. 110-53
__________
Printed for the use of the Committee on Oversight and Government Reform
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______
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COMMITTEE ON OVERSISGHT AND GOVERNMENT REFORM
HENRY A. WAXMAN, California, Chairman
TOM LANTOS, California TOM DAVIS, Virginia
EDOLPHUS TOWNS, New York DAN BURTON, Indiana
PAUL E. KANJORSKI, Pennsylvania CHRISTOPHER SHAYS, Connecticut
CAROLYN B. MALONEY, New York JOHN M. McHUGH, New York
ELIJAH E. CUMMINGS, Maryland JOHN L. MICA, Florida
DENNIS J. KUCINICH, Ohio MARK E. SOUDER, Indiana
DANNY K. DAVIS, Illinois TODD RUSSELL PLATTS, Pennsylvania
JOHN F. TIERNEY, Massachusetts CHRIS CANNON, Utah
WM. LACY CLAY, Missouri JOHN J. DUNCAN, Jr., Tennessee
DIANE E. WATSON, California MICHAEL R. TURNER, Ohio
STEPHEN F. LYNCH, Massachusetts DARRELL E. ISSA, California
BRIAN HIGGINS, New York KENNY MARCHANT, Texas
JOHN A. YARMUTH, Kentucky LYNN A. WESTMORELAND, Georgia
BRUCE L. BRALEY, Iowa PATRICK T. McHENRY, North Carolina
ELEANOR HOLMES NORTON, District of VIRGINIA FOXX, North Carolina
Columbia BRIAN P. BILBRAY, California
BETTY McCOLLUM, Minnesota BILL SALI, Idaho
JIM COOPER, Tennessee JIM JORDAN, Ohio
CHRIS VAN HOLLEN, Maryland
PAUL W. HODES, New Hampshire
CHRISTOPHER S. MURPHY, Connecticut
JOHN P. SARBANES, Maryland
PETER WELCH, Vermont
Phil Schiliro, Chief of Staff
Phil Barnett, Staff Director
Earley Green, Chief Clerk
David Marin, Minority Staff Director
Subcommittee on National Security and Foreign Affairs
JOHN F. TIERNEY, Massachusetts, Chairman
CAROLYN B. MALONEY, New York CHRISTOPHER SHAYS, Connecticut
STEPHEN F. LYNCH, Massachusetts DAN BURTON, Indiana
BRIAN HIGGINS, New York JOHN M. McHUGH, New York
TODD RUSSELL PLATTS, Pennsylvania
Dave Turk, Staff Director
C O N T E N T S
----------
Page
Hearing held on September 26, 2007............................... 1
Statement of:
Pendleton, John, Acting Director, Health Care, U.S.
Government Accountability Office, accompanied by Daniel
Bertoni, Director, Education, Workforce, and Income
Security, U.S. Government Accountability Office; Major
General Eric Schoomaker, Commander, Walter Reed Army
Medical Center; Michael L. Dominguez, Principal Deputy
Under Secretary of Defense, Personnel and Readiness, U.S.
Department of Defense; and Patrick W. Dunne, Rear Admiral,
retired, Assistant Secretary for Policy and Planning, U.S.
Department of Veterans Affairs............................. 31
Bertoni, Daniel.......................................... 65
Dominguez, Michael L..................................... 79
Dunne, Patrick W......................................... 104
Pendleton, John.......................................... 31
Schoomaker, Major General Eric........................... 66
Letters, statements, etc., submitted for the record by:
Davis, Hon. Tom, a Representative in Congress from the State
of Virginia, prepared statement of......................... 15
Dominguez, Michael L., Principal Deputy Under Secretary of
Defense, Personnel and Readiness, U.S. Department of
Defense:
Followup questions and responses......................... 127
Prepared statement of.................................... 81
Dunne, Patrick W., Rear Admiral, retired, Assistant Secretary
for Policy and Planning, U.S. Department of Veterans
Affairs, prepared statement of............................. 107
Pendleton, John, Acting Director, Health Care, U.S.
Government Accountability Office, prepared statement of.... 34
Schoomaker, Major General Eric, Commander, Walter Reed Army
Medical Center:
Followup questions and responses......................... 141
Prepared statement of.................................... 70
Shays, Hon. Christopher, a Representative in Congress from
the State of Connecticut, prepared statement of............ 26
Tierney, Hon. John F., a Representative in Congress from the
State of Massachusetts:
Prepared statement of.................................... 10
Prepared statement of Senator Bob Dole and Secretary
Donna Shalala.......................................... 3
Waxman, Hon. Henry A., a Representative in Congress from the
State of California, prepared statement of................. 22
THIRD WALTER REED OVERSIGHT HEARING: KEEPING THE NATION'S PROMISE TO
OUR WOUNDED SOLDIERS
----------
WEDNESDAY, SEPTEMBER 26, 2007
House of Representatives,
Subcommittee on National Security and Foreign
Affairs,
Committee on Oversight and Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 10 a.m. in
room 2157, Rayburn House Office Building, Hon. John F. Tierney
(chairman of the subcommittee) presiding.
Present: Representatives Tierney, Lynch, Higgins, Yarmuth,
McCollum, Van Hollen, Hodes, Welch, Waxman [ex officio], Shays,
Platts, Turner, Westmoreland, and Davis of Virginia [ex
officio].
Also present: Representative Norton.
Staff present: Roger Sherman, deputy chief counsel; Brian
Cohen, senior investigator and policy advisor; Daniel Davis,
professional staff member; Teresa Coufal, deputy clerk; Caren
Auchman, press assistant; Dave Turk, staff director; Andrew Su
and Andy Wright, professional staff members; Davis Hake, clerk;
Dan Hamilton, fellow; David Marin, minority staff director; A.
Brooke Bennett, minority counsel; Grace Washbourne and Janice
Spector, minority senior professional staff members;
Christopher Bright, minority professional staff member; Nick
Palarino, minority senior investigator and policy advisor;
Brian McNicoll, minority communications director; and Benjamin
Chance, minority clerk.
Mr. Tierney. Good morning, everybody. For some reason Mr.
Shays has been unable to extricate himself from his other
committee, but I expect him to be over shortly, and Mr. Davis,
as well. We don't want to hold you gentlemen up. You have been
kind enough to come here and give us your time, and we
appreciate that.
We are going to begin our hearing entitled, ``Third Walter
Reed Oversight Hearing: Keeping the Nation's Promise to Our
Wounded Soldiers.''
I am going to ask unanimous consent that only the chairman
and ranking member of the subcommittee and the chairman and
ranking member of the full Oversight and Government Reform
Committee be allowed to make opening statements. Without
objection, that will be ordered.
I also ask unanimous consent that the written statement of
former Senator Bob Dole and former Secretary Donna Shalala, Co-
Chairs of the President's Commission on Care for America's
Returning Wounded Warriors, be submitted for the record.
Without objection, that also is ordered.
[The prepared statement of Senator Bob Dole and Secretary
Donna Shalala follows:]
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Mr. Tierney. I ask unanimous consent that the gentlelady
from the District of Columbia, Representative Eleanor Holmes
Norton, be allowed to participate in this hearing. In
accordance with our rules, she will be allowed to question the
witnesses after all official members of the subcommittee have
first had their turn.
I ask unanimous consent that the hearing record be kept
open for 5 business days so that all members of the
subcommittee will be allowed to submit a written statement for
the record. Without objection, that is all ordered.
Good morning. On March 5th, we held a hearing at Walter
Reed. At the medical center, we heard from Specialist Jeremy
Duncan, from Annette and Dell McCloud, and from Staff Sergeant
Dan Shannon about their experiences with military health care--
the mold, the red tape, the frustrations; all of the situations
that were reported that have frustrated all of you, as well as
members of this panel.
In preparation for the hearing today, we reached back out
to all of those witnesses to find out what was going on with
them, to ask if there was anything else they needed for help,
to get their take on how things have improved or not improved,
and what our committee needed to focus on, in their opinions,
with respect to our sustained and hopefully vigorous oversight.
Jeremy Duncan is at Fort Campbell fighting to rejoin his
unit overseas in Iraq. Annette and Dell McCloud have noticed
some improvements, but they are still navigating through the
retirement compensation process. And Sergeant Shannon's most
recent experiences with military health care were recounted in
the Washington Post less than 2 weeks ago. He is trying to
leave Walter Reed, but he has faced some additional
bureaucratic roadblocks, which I think General Schoomaker can
report have been overcome at this point in time.
Sergeant Shannon did tell us something that I think gets to
the heart of this matter, and he said recommendations mean
nothing until something is done with them. That is exactly what
this oversight is all about.
At an April 17th hearing, we heard the recommendations of
the Defense Secretary's Independent Review Group. Since then,
the President's Commission, led by former Senator Dole and
Secretary Shalala, issued their own recommendations.
The purpose of today's hearing will be to ensure that these
recommendations and the human faces and stories of our Nation's
wounded soldiers behind them, aren't ignored or forgotten,
which unfortunately has too often happened in the past, and
also to make sure that our Government is moving swiftly to
address all of the problems that were identified.
This morning we will hear from top directors with the
Government Accountability Office, Congress' investigatory arm,
on where we are at. Instead of yet another commission or panel
issuing recommendations, today we will get the first
independent assessment of the progress we have made and of the
challenges and obstacles that may lie ahead.
We are also going to hear directly from key officials in
the Army, the Department of Defense, and the Department of
Veterans Affairs who have been tasked with fixing the problems
and implementing all of the various recommendations.
We have been told time and time again that things are
improving and that, next to the wars in Iraq and Afghanistan,
taking care of our wounded soldiers is the highest priority of
our military. While I believe some progress has been made,
especially through some of the Army's efforts to throw
significant additional resources, energy, and manpower at the
problem, I would like to take a few moments to highlight some
lingering concerns. I do not do this to focus on the negative.
I do this because taking care of our wounded heroes is too
important to not demand that we strive for the highest levels
of care and respect, and that we do so with a sense of real
urgency.
A number of us on the subcommittee visited Walter Reed
earlier this week. We had the privilege and honor to meet with
our brave men and women recovering there, and here is what we
heard. First, the disability review process is broken, plain
and simple. It is burdensome, archaic, and adversarial. We also
heard stories of wounded soldiers so frustrated that they would
tell us they were just ``giving up.''
Second, the challenges we face with traumatic brain injury,
TBI, and post-traumatic stress disorder, PTSD, are immense. We
heard stories about TBI stigma; that is, soldiers afraid to
come forward for help out of fear that they would be kicked out
of the military.
Third, quality control and oversight will be absolutely key
going forward. While the Army has thrown significant bodies at
the problem, we need systems to identify and reward great
performers and to identify and deal with those treating our
wounded soldiers with anything but respect.
These challenges--and countless others--won't be easy to
overcome. For instance, we have known for a long time that the
disability review process is broken, but we haven't had the
will or the sustained focus to fix it in the past. Will the
newly created Senior Oversight Committee, made up of top
officials from the Department of Defense and the Veterans
Administration, be up to the task of urgently and finally
fixing and reinventing the disability review process? Will our
military be able to hire additional top nurses and
psychologists, a key challenge that the GAO has highlighted.
Finally, what are we doing now to plan for the future? In
my District in Massachusetts, instead of expanding and
enhancing health services and retaining specialized personnel,
the Veterans Administration officials continue to push for
consolidation. They are limiting options for our veterans when,
unfortunately, there will clearly be a high demand for years
and years to come.
As chairman of the National Security Subcommittee, I have
made it a top priority to ensure that there is sustained
congressional oversight and accountability so that all of those
who risk their lives for the country receive the care and
respect that they deserve.
And I have been routinely impressed by the seriousness and
the vigor that the other members of this subcommittee have
approached when they are dealing with this issue. It is vital
that we continue to have open and public hearings and that we
hear from rank-and-file soldiers, as well as high-ranking
generals and department heads. We have already had three
hearings, and today's hearing will certainly not be the last.
We hope that in the months to come we won't have to hear
about how Sergeant Shannon had yet another bureaucratic
roadblock thrust in his way in his 3-year odyssey to navigate
the military health care system. Rather, we hope to hear about
how enormously difficult problems were finally overcome with
dedication, hard work, and ingenuity.
I want to thank all of these witnesses whose hard work and
ingenuity will certainly be put to the test as we meet this
task.
[The prepared statement of Hon. John F. Tierney follows:]
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Mr. Tierney. I now yield to the ranking member of the
committee, Mr. Davis, for his opening remarks.
Mr. Davis of Virginia. Thank you very much, Chairman
Tierney. And I want to thank the chairman of the full
committee, Mr. Waxman, for his leadership, and our ranking
member, Chris Shays.
At the subcommittee's hearings in March and April, we heard
about ambitious plans for improvements in the medical
processing of wounded soldiers, and we heard promises to pursue
these reforms with urgency. Prior to that, the Government
Reform Committee heard many similar plans and promises,
starting as far back as 2004, when we first tried to help
soldiers caught between systems and policies not designed to
handle the types and the numbers of wounds inflicted by this
new global war.
After so many promises but so little progress, we need to
start seeing concrete results. I applaud your persistence, Mr.
Chairman, in pursuing these issues.
The report of the President's Commission on Care for
America's Returning Wounded Warriors released in July sets
forth another list of findings and recommendations for
executive and congressional action. The Commission also urges
those reforms to be pursued with a sense of urgency and strong
leadership. We agree.
One of the most important of the Commission's
recommendations restates the longstanding call to overhaul and
standardize the disability rating systems used by the
Department of Defense and the Department of Veterans Affairs.
Every week my staff still hears appalling stories from wounded
soldiers caught in DOD medical evaluation and physical
evaluation board processes. They are trapped in a system they
don't understand and that doesn't understand them. The process
is seldom the same twice in a row, and often yields two
different ratings, one from DOD and the other from VA. Having
to run that double gauntlet causes additional pain and
confusion, literally adding insult to injury. This has to stop.
The Commission is recommending a single comprehensive
standardized medical examination that DOD administrators use to
determine medical fitness and that VA uses to establish an
initial disability level. VA would assume all responsibility
for establishing permanent disability ratings and for the
administration of all disability compensation and benefits
programs.
I look forward to hearing from our DOD and VA witnesses
today about a firm implementation deadline, details on how the
integration of these evaluations will occur, and what
performance standards will be put in place to make sure the
consolidation serves the near and long-term needs of veterans.
We will also need to hear more about the Army's medical
action plan, a road map the Army has created to address patient
administrative care at Walter Reed and at all Army medical
treatment facilities. The plan is comprehensive in scope and
includes stabilized command and control structures,
prioritizing patient support with a focus on family needs,
developing training and doctrine, facilitating a continuum of
care, and improving transfers to the Department of Veterans
Affairs. These are worthy and long-overdue goals, but at this
point they seem frustratingly incremental and risk drawing
energy and resources from the broader systematic changes that I
think are clearly needed. And even those goals have to be
viewed with skepticism looking back on more than 3 years of
quarterly reports, missing deadlines, and glacial progress that
changed the process but didn't always improve the product for
the Army's wounded warriors.
Clearly, the Army has dedicated considerable manpower and
resources to the new Warrior Transition Units and patient
services, but better training and clean lines of responsibility
and accountability are still needed. Diagnosis and treatment
for this war's signature wounds--traumatic brain injuries and
post-traumatic stress disorder--are still far from adequate.
And those looking to find their way home from war are still
hitting dead ends and a looping, baffling maze of medical and
physical disability assessment procedures.
When a truck or plane gets damaged in battle, we fix it.
Honor demands we do everything possible to fix the most
precious assets we send into harm's way, the men and the women
who volunteer to fight for us.
I look forward to the testimony of all of our witnesses
today and a very frank discussion on how we can accomplish
recommended reforms quickly and make sure all of our wounded
warriors receive the care they deserve.
Thank you.
[The prepared statement of Hon. Tom Davis follows:]
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Mr. Tierney. Thank you, Mr. Davis.
Mr. Waxman.
Mr. Waxman. Thank you very much, Mr. Chairman.
This hearing today is in the tradition of our committee's
oversight with regard to military health care problems. Long
before the public ever heard about the problems at Walter Reed,
under the leadership of Congressman Tom Davis we held hearings
on the important problems that Guard and Reserve troops were
having with health care and military benefits.
Chairman Tierney, your subcommittee held the first hearing
of the problems at Walter Reed, and you have continued to be a
leader on this issue. I want to commend you for that.
In May the full committee had a hearing on the hundreds and
thousands of soldiers who may be returning from Iraq and
Afghanistan suffering from PTSD and other mental health
problems.
This committee's efforts have helped uncover both new and
longstanding problems with the military health care system.
This oversight is some of the most important work that this
committee does. Few causes are more noble than giving our
injured soldiers the care they deserve.
Despite the increased attention, the pace of change at DOD
and VA is intolerably slow. Again and again we see the same
thing--blue ribbon task forces like the West/Marsh Commission
on Walter Reed or the Dole/Shalala Commission on Military
Health care provide detailed road maps to better care. DOD and
VA representatives come before Congress and insist that things
are getting better. Still, the horror stories about problems
with the military's health care system continue.
Here is just some of the new and disturbing information we
have received over the last several months: We learned from the
Washington Post that Staff Sergeant John Daniel Shannon, who
testified about his problems at Walter Reed before our
committee in March, remained stuck in bureaucratic limbo at
Walter Reed, unable to obtain his discharge, obtain VA
benefits, or return to his family and pick up his life.
We received deeply troubling reports from Fort Carson, CO,
indicating that the leadership there seems to utterly lack
understanding, basic understanding, of the problems faced by
ill and injured soldiers. Whistleblowers and investigators and
struggling families have told the committee that soldiers with
PTSD and PTI are being dishonorably discharged under the
pretense of having pre-existing personality disorders. We have
heard of one soldier who was ordered back to Iraq, despite a
diagnosis of PTSD and TBI. And we have heard press reports
indicating that one commander at the base recommended
discharging mentally ill soldiers simply as a way to get rid of
``deadwood.''
We have heard from VA that they have over 1,200 unfilled
psychologist, social worker, and psychiatrist positions within
their ranks, and that the VA is unable to provide even the most
rudimentary estimates of the number of soldiers who will need
mental health care or the cost for such treatment.
And we have heard reports from the Army that suicide rates
among soldiers are at their highest levels in 26 years, while
20 percent of Army psychologist positions are unfilled and
morale among Army mental health care providers continues to
sink.
We will hear testimony from GAO and others today pointing
to other persistent or emerging problems at VA and DOD. While I
am looking forward to hearing testimony from all of our
witnesses today--and I am happy that we will have at least some
good news--I continue to be frustrated with the pace of
improvement, and I worry that after 5 years of war our military
health care system is over-stretched, with bigger problems
coming down the line as soldiers are forced to serve more and
longer deployments in Iraq and Afghanistan.
In the coming years, hundreds of thousands of soldiers will
return home and will need DOD and VA care for injuries or
mental illness. We can't let these soldiers and their families
down.
I want to thank you for holding this hearing today. I am
looking forward to see how we can make things better.
[The prepared statement of Hon. Henry A. Waxman follows:]
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Mr. Tierney. Thank you, Mr. Waxman.
Mr. Shays joined us earlier in the week out at Walter Reed
and has been consistently involved with this oversight process,
as well. Do you have an opening statement, Mr. Shays?
Mr. Shays. Thank you, Mr. Tierney, for your commitment to
our subcommittee's ongoing inquiry into the medical care for
the men and women of our armed forces. Previous hearings taught
us well about the challenges facing our wounded warriors under
current Army, Department of Defense, and Department of Veterans
Affairs processes. We heard from many who were failed by the
system and challenged those responsible to address these
failings.
We will do that again today when we question the current
commander of Walter Reed Army Medical Center about the new Army
medical action plan aimed at addressing shortcomings at Walter
Reed and other Army medical facilities.
In our congressional oversight responsibilities, it is
important we focus on the Department of Defense's Wounded, Ill,
and Injured Senior Oversight Committee's efforts to carry out
the recommendations contained in the President's Commission on
Care for America's Returning Wounded Warriors, commonly known
as the Dole/Shalala Consumer.
In July this Commission released findings that are similar
to what we found during our committee's initial investigations
begun in the spring of 2004, and are comparable to those we
heard from the independent review group this past spring. But
the Dole/Shalala Commission's recommendations for executive and
congressional action are more aggressive than those in the
independent review group. Their implementation will require a
collaborative commitment from the Department of Defense, the
Department of Veterans Affairs, and especially from
congressional committees.
Most of the real work still lies before us. As recommended
in the Dole/Shalala report, we must ask some tough questions.
Can we completely restructure the disability and compensation
system of the Army, Air Force, Navy, Marine Corps, the
Department of Defense, and the Department of Veterans Affairs
in time to help the number of wounded currently in and entering
the systems? Can we create comprehensive recovery plans for
every serious injured service member and create a cadre of
well-trained recovery coordinators for all stages in a wounded
serviceman's life? Who will be responsible for seeing that
these plans are carried out between departments? Where will
this cadre of coordinators come from? How will they be trained?
We have learned the wounds of war extend far beyond the
physical, with many patients struggling to cope with the
devastating emotional impacts of war. One of the most chronic
outpatient issues for our recovering soldiers has been the
diagnosis and treatment of traumatic brain injury [TBI], and
the post-traumatic stress disorder [PTSD]. Central to the
military creed is the promise to live no soldier or Marine on
the battlefield, but if we do not appropriately recognize and
treat all wounds, including the issues associated with post-
traumatic stress disorder and traumatic brain injury, we do
precisely that--we leave them behind.
So we ask the question: how will DOD and the VA now
aggressively prevent and treat post-traumatic stress disorder
and traumatic brain injury? What standards of diagnosis and
treatment will be created? Who will pay for this treatment? How
will DOD and the VA move quickly to integrate medical
information and data between their organizations in order to
get clinical data to all essential health, administrative, and
benefits professionals that need it?
I look forward to hearing our Government Accountability
Office witness recommendations about what the Federal
Government can do to address the needs of our wounded warriors.
We owe the wounded warrior men and women of our armed services
and their families, as has been pointed out already, more than
we have given them to date.
I am told the President is committed to implementation of
the Dole/Shalala recommendations, and I know this subcommittee
is also committed to ensuring we provide the best possible care
to our brave men and women.
I look forward to hearing the testimony from our
distinguished panel.
I would just close, Mr. Chairman, and again thank you for
your work on this and the work of your staff and our staff. One
of my staff received an e-mail from a soldier in Iraq who, upon
hearing of this hearing this morning, said, ``You, the American
people, gave us a mission to fix Iraq. We are accomplishing
that mission. What we expect from you, the American people, is
to help fix us when we come home broken.''
Thank you, Mr. Chairman.
[The prepared statement of Hon. Christopher Shays follows:]
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Mr. Tierney. Thank you, Mr. Shays.
Now the subcommittee will, in fact, receive testimony from
the witnesses before us today. I would like to begin by
introducing the witnesses on our panel. We have John Pendleton,
Acting Director of the Health Care Department at the U.S.
Government Accountability Office. With him is Daniel Bertoni,
Director of the Education, Workforce, and Income Security
Department at the U.S. Government Accountability Office; Major
General Eric Schoomaker, M.D., Commanding General of the North
Atlantic Regional Medical Command and Walter Reed Army Medical
Center; the Honorable Michael S. Dominguez, Principal Deputy
Under Secretary of Defense for Personnel and Readiness, U.S.
Department of Defense; and Rear Admiral Patrick Dunne, retired,
Assistant Secretary for Policy and Planning at the U.S.
Department of Veterans Affairs.
Welcome to all of you and thank you for joining us.
It is the policy of the subcommittee to swear you in before
you testify, so I ask you to stand and raise your right hands.
If there are any other persons who might be assisting you in
responding to questions, would they also please rise and raise
their right hands.
[Witnesses sworn.]
Mr. Tierney. The record will reflect that all witnesses
answered in the affirmative.
Your full written statements, of course, as most of you
know from previous experience here, will be submitted on the
record and accepted, so we will ask that your oral remarks stay
as close as you can to 5 minutes and give us a little synopsis
of what you have to say.
Mr. Pendleton, I know that you and Mr. Bertoni come as a
team, and I understand that you will be presenting remarks and
Mr. Bertoni may not. In that case, we will give you a little
leeway on the 5-minutes, as we will for all the witnesses in
any regard. I thank you and the Government Accountability
Office for your fairness in your report and the depth of your
work. I would ask you at this point in time to proceed with
your testimony.
STATEMENTS OF JOHN PENDLETON, ACTING DIRECTOR, HEALTH CARE,
U.S. GOVERNMENT ACCOUNTABILITY OFFICE, ACCOMPANIED BY DANIEL
BERTONI, DIRECTOR, EDUCATION, WORKFORCE, AND INCOME SECURITY,
U.S. GOVERNMENT ACCOUNTABILITY OFFICE; MAJOR GENERAL ERIC
SCHOOMAKER, COMMANDER, WALTER REED ARMY MEDICAL CENTER; MICHAEL
L. DOMINGUEZ, PRINCIPAL DEPUTY UNDER SECRETARY OF DEFENSE,
PERSONNEL AND READINESS, U.S. DEPARTMENT OF DEFENSE; AND
PATRICK W. DUNNE, REAR ADMIRAL, RETIRED, ASSISTANT SECRETARY
FOR POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF JOHN PENDLETON
Mr. Pendleton. Thank you, Mr. Chairman.
Mr. Chairman and members of the subcommittee, I am pleased
to be here today as you continue your oversight of DOD and VA
efforts to improve health care and other services. As the
situation in Walter Reed came to light earlier this year, the
gravity and implications of many longstanding issues became
clear. I visited Walter Reed last month, as I know many of you
have, and learned first-hand from many of the soldiers there
just how far the system still has to go.
I am pleased to be joined by my colleague, Dan Bertoni, who
leads our disability work at GAO.
Mr. Chairman, I would like to ask Dan to make a few
comments, because he is our disability expert.
Mr. Tierney. That is fine.
Mr. Pendleton. I will provide an overview first and then
turn it over to Dan to focus on disability.
Mr. Tierney. That is fine. Thank you.
Mr. Pendleton. Please take note that the findings that we
are presenting today are preliminary, based in large part on
ongoing reviews. Much of the information is literally days old,
and the situation is evolving rapidly.
Efforts thus far have been on two separate but related
tracks. First I will cover the Army's service-specific efforts;
then I will cover the collective DOD/VA efforts.
The Army is focused on its issue through its medical action
plan. The centerpiece of that plan is the new Warrior
Transition Units. The Army formed these to blend active and
reserve component soldiers into one unit and to improve overall
care for its wounded warriors.
While these units have been formed on paper, many still
have significant staff shortfalls. As of mid-September, just
over half of the total required personnel were in place in
these units; however, many of those personnel that were in
place had been borrowed, presumably temporarily, from other
units. Ultimately, hundreds of nurses, enlisted and officer
leaders, social workers, and other highly sought after
specialists, like the mental health professionals that will
help with TBI and PTSD, will be needed.
The Army told us it plans to have all the positions filled
by January 2008, and it is planning to draw these personnel
from both the active and reserve component, as well as from the
civilian marketplace. Filling all the slots may prove
difficult. As I think everyone knows, the Army is stretched
thin due to continuing overseas commitments.
Furthermore, the military must compete in a civilian market
that will pay top dollar for many of these health
professionals. This is an area that we intend to monitor
closely as we continue our work.
Now if I could I am going to briefly describe the broader
efforts.
Through the newly created Senior Oversight Committee, DOD
and VA are working together to address the broader systemic
problems. One of the key issues being taken on by the Senior
Oversight Committee is improving the continuity of care for
returning service members. In plain English, this is about
helping the service members move from inpatient to a less-
regimented outpatient status, and navigate within and across
two entirely different departments, DOD and VA, as well as
possibly out to the private sector to obtain needed care. This
can be quite complex.
To improve continuity, the Dole/Shalala Commission
recommended that recovery plans be crafted to guide care for
seriously injured service members and that senior-level
recovery coordinators be put in place to oversee those plans.
DOD and VA intend to adopt this recommendation, but key
questions remain unanswered. For example, it is unclear exactly
which service members will be served by this recovery
coordinator, and without an understanding of the proposed
population it is impossible to answer other fundamental
questions, like how many recovery coordinators will ultimately
be needed.
It is also unclear how the Army's efforts will be
synchronized with the broader efforts. This is important so
that service members do not have too many case managers,
potentially resulting in overlaps and confusion.
Mr. Chairman, given the complexity and urgency of these
issues, it is critical for top leaders to ensure the goals are
achieved expeditiously; however, careful oversight will be
needed to ensure that any gains made in the near term are not
lost over time.
That concludes my part of the statement. With your
permission, Dan will focus on disability.
[The prepared statement of Mr. Pendleton follows:]
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Mr. Tierney. Thank you, Mr. Pendleton.
Mr. Bertoni, we would be interested to hear from you.
STATEMENT OF DANIEL BERTONI
Mr. Bertoni. Good morning, Mr. Chairman and members of the
subcommittee. I am pleased to be here to discuss an issue of
critical importance: providing timely, accurate, and consistent
disability benefits to returning service members and veterans.
Thousands of Operation Iraqi Freedom and Operation Enduring
Freedom service members have been wounded in action, many of
whom are now trying to navigate a complicated labyrinth of
disability policies and often wait many months and even years
for a decision.
Various commission reports have noted that overhauling the
disability evaluation process is key to improving the
cumbersome, inconsistent, and confusing bureaucracy facing
injured service members.
My testimony today draws on our ongoing work and focuses on
three areas: current efforts to improve the evaluation process;
challenges to reforming the system; and issues to consider as
DOD and VA press ahead on this important matter.
In summary, our prior work has identified longstanding
weaknesses in DOD's and VA's disability programs, especially in
regard to the timeliness, accuracy, and consistency of
decisions. More recently, an Army Inspector General report
noted similar problems with DOD's system, including a failure
to meet timeliness standards, poor training, and service member
confusion about disability ratings.
In response, the Army developed several near-term
initiatives to streamline processes and reduce bottlenecks such
as expanding training, reducing the case loads of staff
responsible for helping service members navigate the system,
and conducting outreach to educate service members about the
process and their rights.
To address the more fundamental systemic issues, DOD and VA
area also planning to pilot a joint disability evaluation
system. The agencies are currently vetting multiple pilot
options that incorporate variations of: one, a single medical
exam; two, a single disability rating performed by VA; and,
three, a DOD-level evaluation board for determining fitness for
duty. However, at the time of our review, several key issues
remain in question, such as who will conduct the medical exam,
how the services will use VA's rating, and determining the role
of the board.
DOD and VA recently completed a tabletop exercise of four
pilot options using actual service member cases. While
preliminary results showed that no single option was ideal,
officials told us they were currently analyzing the data to
determine which option or combination thereof would be most
effective.
Although the pilot was originally scheduled for roll-out in
2007, this data slipped as officials continued to consider
these important issues, as well as various commission report
findings and pending legislation which could, in fact, affect
the pilot's final design and implementation.
Beyond pilot design issues, DOD and VA face other
challenges. Three of the options call for VA to conduct the
medical exam as well as establish the disability rating. This
could have substantial staffing and training implementations at
a time when VA, with 400,000 pending claims already, is
struggling to provide current veterans with timely and quality
services.
We are also concerned that, while having a single rating
could improve consistency, VA's outdated rating schedule does
not reflect changes in the national economy and the capacity of
injured service members to work, thus potentially undermining
the re-integration of returning warriors into productive
society.
Going forward, DOD and VA must take aggressive yet
deliberate steps to address this issue. Key program design and
policy questions should be fully vetted to ensure that any
proposed redesign has the best chance of success. This will
require careful, objective study of all proposed options and
pending legislation, comprehensive assessment of pilot outcome
data, proper metrics to gauge progress of the pilot, and
evaluation process to ensure needed adjustments are made along
the way.
Failure to properly consider alternatives or address
critical policy details could worsen delays and confusion and
jeopardize the system's successful transformation.
Mr. Chairman, this concludes my statement. I am happy to
answer any questions you might have.
Mr. Tierney. Thank you very much. Thanks to both of you
gentlemen.
General Schoomaker, would you care to make some remarks?
STATEMENT OF MAJOR GENERAL ERIC SCHOOMAKER
General Schoomaker. Mr. Chairman, Congressman Shays,
distinguished members of the subcommittee, thanks for this
opportunity to update you on the extraordinary and heroic acute
care and rehabilitative and comprehensive support of our
warriors and families being performed every day at Walter Reed
Army Medical Center and throughout our Army. I am very proud to
be here with you today sharing some of the many accomplishments
of the clinicians, medics, technicians, nurses, therapists,
uniformed and civilian Army, Navy, Air Force, full-time,
volunteers--all of those who care for these most-deserving
American warriors and their families.
Words, alone, really can't do justice to caregivers at
Walter Reed Army Medical Center and their colleagues throughout
the Joint Medical Force for what they do every day in really
extremely demanding jobs. You have seen them yourself when you
have been out to visit our hospitals. They are witness to much
pain and suffering. The pace is constant and unyielding. But
they recognize that we have the privilege to care for the best
patients in the world, our young men and women who have given
of themselves for our country.
Our patients, as you have seen, are an astounding group of
warriors who inspire and amaze us every day. Their incredible
spirit and energy drive our hospitals to the highest level of
performance and invoke in our health care providers and staff a
level of commitment and dedication to patients that is
unparalleled, in my experience. I am constantly impressed with
the quality and caliber of the health care team at Walter Reed
and their unwavering focus on caring for these deserving
warriors and their families.
I am always careful to point out to all visitors and to
members of the public and to our elected officials that the
quality of care, itself, was never in question at Walter Reed
or any military facility. As you know, my Command Sergeant
Major Althea Dixon and I joined the Walter Reed leadership team
in early March. In fact, I took command shortly before you.
Our focus has been on ensuring that the warriors for whom
we care get the very best medical care, the best administrative
processing, and the best support services that are available.
With worldwide support from the Army leadership and of trusted
colleague Brigadier General Mike Tucker, a career armor
officer, a former NCO, and a veteran of both Operation Desert
Storm and Iraqi Freedom, who set out to correct identified
deficiencies and provide the very best for our warriors and
their families, we have received extraordinary support from the
U.S. Army Medical Command, the entire Army, the senior
Department of Defense leadership, and the Department of
Veterans Affairs.
During the past 6 months we have identified problems and,
where appropriate, we have taken immediate corrective actions.
Many involved the creation of support services which were
present at larger Army installations but weren't available at
Walter Reed before the events of mid-February.
The specifics of these changes and the continuing
improvements are outlined in my formal written statement for
this hearing. Let me focus on several recent events and key
people to highlight our progress.
First, I would like to talk about Staff Sergeant John D.
Shannon. Many of you know Staff Sergeant Shannon is one of the
first three soldiers who raised serious concerns about our care
and support of soldiers like him. He lived in building 18. He
appeared before this committee at a hearing held at Walter Reed
in March. He has since met with you and members of your staff
updating you on his concerns and progress, and, as you alluded
to, Mr. Chairman, he recently was the subject of a newspaper
cover story on continuing problems for our warriors in
transition like him.
I regret that he declined to be with us today. He is in the
midst of out-processing, and I trust that he won't take issue
with my talking about him in an open hearing here to day.
We have endeavored to work closely with wounded warriors
like Staff Sergeant Shannon to improve our system of care and
administrative processes at Walter Reed, and, by extension,
across the Army and the joint force, and into long-term care
and continued rehabilitation within the Veterans Administration
system. We immediately improved the housing conditions for all
our warriors in transition who were in building 18 and any
other accommodations that did not meet the highest standards of
the Army.
We created a triad of a squad leader, a physician primary
care manager, and a nurse case manager to ensure the well-
being; provide comprehensive medical oversight; and ensure
administrative efficiency, timeliness, and thoroughness in the
care and rehabilitation and adjudication of physical disability
for these warriors.
Regrettably, in Staff Sergeant Shannon's case we
encountered a problem toward the end of his very lengthy acute
treatment, rehabilitation, and processing of disability which
resulted in misinformation and fear of unnecessary delays in
his medical retirement. But his chain of command and the
support systems embodied in the triad responded promptly to his
call for help and he underwent all steps on schedule in his
Physical Evaluation Board process, and he is now out-processing
from Walter Reed and will be medically retired from the Army.
Ironically, Staff Sergeant Shannon, in conversations with
him, did not realize that because the physical disability
system and the Physical Evaluation Board are separated from our
squad leaders, that he should not have gone to his squad leader
to get help. In fact, that is exactly what we would have asked
him to do, and we have used his example to re-educate people
about how to get help within our system.
We truly appreciated his service and his sacrifice. It is
our obligation, it is, frankly, our sworn duty to heal soldiers
like Staff Sergeant Shannon.
Every warrior in transition and every family is a unique
case and experiences unique challenges. We won't perform
flawlessly always, but we are hard at work building a team of
clinicians, military leaders, and case managers and experts in
all aspects of medical benefits and physical ability
adjudication to allow us to provide the very best possible
care.
Finally, let me talk briefly about efforts to accelerate
the transition at Walter Reed into a new Walter Reed National
Military Medical Center at Bethesda and how our work on warrior
care in the Army is being embraced by the entire joint medical
community. Our transition is proceeding very well. Rear Admiral
Promotable Madison of the Navy, who was recently appointed as
the commander of the joint task force to combine medical
military operations in the National Capital Region, strongly
supports the future establishment of a warrior transition
brigade at the future Walter Reed National Military Medical
Center in Bethesda, and that may well serve as a model for the
development of a joint service approach to caring for warriors
in transition.
We are also encouraged by recent directions from the Deputy
Secretary of Defense, Mr. Gordon England, in an August 29,
2007, memorandum that directs the service Secretaries to use
all existing authorities to recruit and retain military and
civilian personnel necessary for seriously injured warriors and
directing the Secretaries to fully fund these authorities to
achieve this goal.
In his memorandum, Secretary England directs the Secretary
of the Army to develop and implement ``a robust recruitment
plan'' to address identified gaps in staffing and sufficiently
fund the Walter Reed budget to pay for these recruitment and
retention incentives.
These efforts should help to stabilize the work force at
Walter Reed and to ensure that our warriors will continue to be
cared for by the best health care professionals in the world. I
believe that the actions that we have taken in the last 6
months will ultimately make Walter Reed and the Army Medical
Department stronger organizations, more adept at caring for
warriors and their families.
We need to continue to address our shortfalls. We need to
continue to focus on serving our warriors and families, and we
will continue to improve.
Thanks for this opportunity to speak with the committee
today and answer your questions.
[The prepared statement of General Schoomaker follows:]
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Mr. Tierney. Thank you, General.
Mr. Dominguez.
STATEMENT OF MICHAEL L. DOMINGUEZ
Mr. Dominguez. Thank you, Mr. Chairman. Mr. Chairman,
Congressman Shays, distinguished members of the committee,
thank you for the opportunity to update you on the progress we
have made improving the systems for support and care of our
wounded, ill, and injured service members and their families.
I apologize for the tardiness of my written testimony, but
trust that you will find within it the specific information you
need in order to fulfill your oversight responsibilities.
I would like to use this opening statement to make four
headline points: First, the issues that emerged at Walter Reed
last February did, indeed, uncover systemic deficiencies in our
care and support for the wounded, ill, and injured. We failed.
We acknowledge that failure, and the senior leadership of the
Defense Department is committed to correcting the system and
repairing the damage. Secretary Gates has stated that, outside
of the war, itself, he has no higher priority.
Next, it is absolutely clear to us that fixing this system
requires a partnership with the Congress, with the various
advisory committees, with the Nation's many charitable and
service organizations, but first and foremost a partnership
with the talented men and women in the Department of Veterans
Affairs. Deputy Secretary Mansfield of the VA and Deputy
Secretary England of Defense established the Senior Oversight
Committee to forge that partnership. At my level, I believe I
have spent more time over the last few months with Under
Secretary Cooper and Assistant Secretary Dunne than I have
spent with members of my own staff. We are jointly and
cooperatively working this challenge.
Third, we have accomplished a great deal. That is
documented in our testimony. We are doing more every day. In
fact, only yesterday the two Deputy Secretaries endorsed a plan
to pilot a substantive revision of the disability evaluation
system which features a single comprehensive physical exam done
to VA standards using VA templates and a single rating for each
disabling condition, with that rating issued by the world-class
professionals at DVA, and that rating decision being binding on
the Department of Defense. Integrating DVA into DOD's
administrative decisionmaking processes is evidence of the
extraordinary level of cooperation we have achieved.
Four, while we have accomplished a great deal, there is
still more to do. We will do everything we can within the realm
of policy and regulation. Undoubtedly, we will seek
legislation, but that legislation would be ground-breaking,
changing the foundations of our current disability systems and
changing fundamentally roles and responsibilities among
Government agencies. We do not need from the Congress
prescriptive legislation addressing the minutia of how we
execute our responsibilities within current law. We do need and
welcome your oversight of these areas through hearings such as
this one and visits such as you conducted earlier this week.
And when we have formed our ideas about fundamental changes, we
will bring them to the Congress. In the meantime, we are making
changes, we are making them fast, and we won't stop until our
wounded warriors have the support system they deserve.
Thank you. I look forward to your questions.
[The prepared statement of Mr. Dominguez follows:]
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Mr. Tierney. Thank you.
I want to break protocol here a little bit because I don't
generally do this, but I think my colleagues would share this.
I hear the tenor in your voice about not wanting Congress to
come in with prescriptive legislation, but you have to
understand what makes it tempting for Congress to do that is
the utter lack of urgency over a decade that we have sense with
the Department of Defense and other agencies in the Government
about getting this job done.
Nobody that I know of on this panel or anywhere else thinks
about doing prescriptive legislation if we don't have to, but
we oftentimes think about giving a foot right where it is
needed to get things moved, and I will get into it further in
my questioning and whatever. I am glad to see that you have a
pilot program that you are finally focused on. We will talk
about why it took forever to get there, relatively speaking,
and things of that nature, and what legislation might be
needed. But do understand that nobody here wants to be
prescriptive, but the temptation is great when it takes too
long a period of time to move from one point to another.
Mr. Shays, do you want to add a comment to that?
Mr. Shays. Just to say that is an opinion shared on both
sides of the aisle.
Mr. Dominguez. Yes, sir, and, again, I acknowledge we
failed, and fixing the problem is absolutely urgent and
absolutely a top priority of our two departments' leadership
and we commit to it, sir.
Mr. Tierney. Admiral Dunne.
STATEMENT OF ADMIRAL PATRICK W. DUNNE
Admiral Dunne. Mr. Chairman, distinguished members of the
committee, thank you for the opportunity to discuss the recent
activities of the Department of Veterans Affairs to serve our
Nation's veterans through improved processes and greater
collaboration with the Department of Defense.
Over the past 7 months, I have had the privilege of being
engaged in many activities dedicated to ensuring our returning
heroes from OEF and OIF receive the best available care and
services. I join my colleagues from VA and those from DOD in
striving to provide a lifetime of world-class care and support
for our veterans and their families.
On March 6th, the President established the Inter-Agency
Task Force on Returning Global War on Terror Heroes. VA's
Secretary Nicholson was appointed Chair, and I was proud to
support him as the Executive Secretary. On April 19th the task
force issued its report to the President. There were 25
recommendations to improve health care, benefits, employment,
education, housing, and outreach within existing authority and
resource levels. The report was unique in that it also included
an ambitious schedule of actions and target dates. Thanks to
outstanding inter-agency cooperation, 56 of 58 action items
have been completed or initiated to date.
The results are having a positive impact. The Small
Business Administration launched the Patriot Express Loan
Initiative. This program, which has already provided more than
$23 million in loans, provides a full range of lending,
business counseling, and procurement programs to veterans and
eligible dependents.
Other task-force-inspired initiatives will support seamless
and world class health care delivery. VA and DOD drafted a
joint policy document on co-management and case management of
severely injured service members. This will enhance
individualized, integrated, inter-agency support for the
wounded, severely injured, or ill service member and his or her
family throughout the recovery process.
To assist OEF/OIF wounded service members and their
families with the transition process, VA hired 100 new
transition patient advocates. These men and women, often
veterans themselves, work with case managers and clinicians to
ensure patients and families can focus on recovery.
VA also revised its electronic health care enrollment form
to include a selection option for OEF/OIF to ensure proper
priority of care.
Additionally, a contract was recently awarded for an
independent assessment of in-patient electronic health records
in VA and DOD. The contract will provide us recommendations for
the scope and elements of a joint health record.
As you know, many recommendations have been issued lately
which center around the treatment of wounded service members
and veterans. To ensure the recommendations were properly
reviewed and implemented, VA and DOD established the Senior
Oversight Committee which has been discussed this morning,
chaired by our two Deputy Secretaries.
In a collaborative effort with DOD, VA made great strides
in addressing issues surrounding PTSD and TBI across the full
continuum of care. The focus has been to create a
comprehensive, effective, and individual program dedicated to
all aspects of care for our patients and their families.
VA and DOD have partnered to develop clinical practice
guidelines for PTSD, major depressive disorder, acute
psychosis, and substance abuse disorders.
Our Senior Oversight Committee also approved a National
Center of Excellence for PTSD and TBI.
Since 1992, VA has maintained four specialized TBI centers.
In 2005, VA established the poly trauma system of care,
leveraging and enhancing the expertise at these TBI centers to
meet the needs of the seriously injured. The Secretary of
Veterans Affairs recently announced the decision to locate a
fifth poly trauma center in San Antonio, TX.
VA and DOD are also working closely to redesign the
disability evaluation system. As Mike mentioned, a pilot
program is being finalized to ensure no service member is
disadvantaged by this new system and that the service member
receives the high-quality medical care and appropriate
compensation and benefits.
This proposed new system will be much more efficient, and I
have provided additional details in my written testimony.
Over the last 4 years, VA has increased outreach and
benefits delivery at discharge sites to foster continuity of
care between the military and VBA systems and speed up VA's
processing of applications for compensation. VBA also processes
the claims of OEF/OIF veterans on an expedited basis.
Collaborating with DOD, we have accomplished a great deal,
but there is still much more to do. We at VA are committed to
strengthening our partnership with DOD to ensure our service
members and veterans receive the care they have earned.
I would be happy to answer your questions.
[The prepared statement of Admiral Dunne follows:]
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Mr. Tierney. Thank you.
Typical of this institution, those are messages for votes
coming up, I assume, on that. I will be able to get more
information on that in a moment. What I think we will do is
start with the questioning and then make a determination when
we find out how many votes we have whether we will have to
interrupt the meeting or whether we can try to continue on
through.
I want to thank all of you for your testimony. Despite my
interruption of Mr. Dominguez, I think we are trying to be
helpful here in trying to move forward on this basis. If there
was something in the tone or the comment that you made that
struck a chord there amongst several of us here, but that had
to do really with urgency. One of the things that we constantly
have from all of the commissions and from all of the
conversations with returning people is a sense that there has
been a lack of urgency over time about dealing particularly
with the rating system, with the evaluation system on that.
When I look at how long it has taken for the Senior Oversight
Committee to stand up and get going on this thing, the
frustration is palpable. I was just making sort of a broad
comparison to General Jones' work. He did the Independent
Commission on the Security Forces of Iraq. He started in May
2007. They assembled teams, 20 prominent retired and active
officers, police chiefs, Secretaries of Defense, etc. They have
organized and attended syndicates. They focused on either
discrete components or cross-cutting functional areas. They
were all subject to review of the full committee. They traveled
widely throughout Iraq, which for anybody is a seriously
difficult prospect to do in the middle of a war. They
interviewed hundreds of Iraqi officials, U.S. officials,
visited sites, and did all that and filed their report in 4
months.
We are 7 months into this process, that we all admit is one
of the major concerns that we have, and we are just now getting
off the ground. So that is, you know, the lack of urgency that
I think Members coming back from Iraq and Afghanistan sense and
the Members here on this dais sense. Why has it taken so long
to get going on that?
Now, I will let you answer that in the context of the first
question I am going to ask. Now we have had the pilot program
that you announced either yesterday or today, which is good. I
am glad that is moving forward. We need to know from you a
little bit more about that pilot program, what it entails, and
does it address GAO's concerns in terms of personnel. I
understand from your brief comments that it is going to be the
Veterans Administration's standards and template on that, so
that raises the questions, I think, that Mr. Pendleton or Mr.
Bertoni raised about if you choose that, then you have
difficulties with the process, itself, at VA.
The single disability evaluation should make it more
consistent in disability ratings, but does it have enough
people involved in the system? Are we going to have the
personnel? Are we going to take into account the assistive
technologies and disabled veteran's ability to work, have a new
system for getting people that can be put into work out there
and do something about the outdated rating system. Does it
address that? And how long is this pilot program going to go?
Why aren't we moving immediately into a final disposition of
this, if you have done your table tops, you have had your
analysis, you have dealt with the experts, you have looked at
the situation and have examined the data? How long is this
pilot going to go? Why aren't we going right into just getting
this done?
I suspect we will give you an opportunity to answer that.
Mr. Dominguez. Thank you for the question.
First let me say that if there was anything in my tone that
was critical, I apologize for it. It was not intended to be.
The sense of outrage by the Congress and the American
people is fully justified. Last spring in the demand for
urgency, fully justified, 100 percent with it, I felt the boot
had been appropriately applied, and I do want to say that we
are moving urgently.
The SOC that meets for an hour a week, has been doing that
in a decisionmaking forum.
Now, why it takes us a little longer to get going is that
we are doing more than the report. In crafting our
recommendations to the SOC on what we are going to do, we have
to reach down into the organization and get those people who
have an equity stake, who have a lot of knowledge and
experience, and cause them all to try and work through this and
come together, so it is very much managing an alliance as we
work through the issues and come to grips with it.
And then I remind you again of the comments Mr. Bertoni
made about, here is a bunch of the questions that have to be
answered, and you have to have the evaluation plans and how you
are going to do that. Those are the kinds of questions and the
due diligence we have to put in place before we can launch a
system.
So it does take some time to develop the details, to build
that consensus, and to work through these issues.
I have to say that each of the military services feel an
intense need to solve this problem themselves, so when I ride
in there with Secretary Dunne saying, OK, stand back, guys, we
are going to fix this, their immediate reaction is, prove it
first before we let you hurt us more. This is justifiable on
their part, as well. That is part of the confidence building
process that we have to use.
Now, how this process will work, we will use the VA rating.
The VA rating for the unfitting condition will be
determinative, and the percentage that they put on that will
dictate whether a person found to be unfit is separated or
retired and the level of benefits, just as in the current
system.
The pilot we are doing must stay within the context of the
current law. That includes how the VA does their thing with the
VA scheduled rating disabilities. The fact that it needs to be
updated has been acknowledged by the Secretary. I will let Pat
speak to that. But what we are going to be moving forward with
is within the current context of law and what we can do by
policy changes and by bringing the VA talent onto our side of
the administrative processes.
Mr. Tierney. And how long do you project the pilot is going
to be?
Mr. Dominguez. Sir, because this affects people, it is an
administrative process that actually issues an outcome that
affects benefits in for-real individuals, our first step is we
are going to do the next thing beyond a table top, which is
actually proof of concept where we walk people who have already
been through the system and already been issued their benefits
and their determinations, we are going to walk them back
through this system and see how those two things compare. Then,
notionally, in January 2008 we will actually start putting new
cases through this.
There is also training associated with it in preparation
for it. I don't, at the present, have a concept for how long
that would work. We are going to do it in the Washington, DC,
metro area first, within a few months, depending on the number
of people who go through it and the outcomes, we could very
well begin to scale it up across the Department shortly
thereafter.
When and if fundamentally different legislation such as the
ideas proposed by Secretary Shalala and Senator Dole come, then
a lot of things would change based on that, so we have to re-
evaluate how we do that.
Mr. Tierney. We will explore that a little further.
My time has expired.
Mr. Platts, would you care to ask some questions?
Mr. Platts. Thank you, Mr. Chairman. I appreciate your and
the ranking member's leadership on this issue and the various
hearings and visits to Walter Reed, and I want to thank all of
our witnesses, both those on the front lines of trying to make
these systems work, as well as the GAO colleagues and their
important oversight work.
Mr. Tierney. Excuse me, Mr. Platts. I hate to do this to
you, but there are only 6 minute left to vote.
Mr. Platts. OK.
Mr. Tierney. I know you want to record your vote. You have
a choice. You can stay and I will stay with you, or we will
both try to make it, or we could go and do the two quick votes
and be back in 10 minutes.
Mr. Platts. Do you want to do that, Mr. Chairman?
Mr. Tierney. Fine. We are going to recess. I apologizes to
our witnesses for the schedule around here, but we will take 10
minutes probably maximum and be back here.
Thank you.
[Recess.]
Mr. Tierney. The subcommittee will resume.
Mr. Platts, thank you for allowing us to interrupt you. I
think it was a better way to proceed, and hopefully you will
get your entire 5 minutes again starting now.
Thank you.
Mr. Platts. Thank you, Mr. Chairman.
Again, just let me reiterate to our witnesses my thanks to
each of you for your efforts on behalf of our wounded warriors.
When we had our hearing earlier this year, the first
hearing at Walter Reed, one of the common messages or two that
I want to try to address in my 5 minutes quickly, one was the
care, when provided, in the overwhelming instances was
excellent, but the challenge was the coordination of that care,
either within the DOD system or the transfer to the VA system,
and then the second was the transfer of information from DOD to
VA. I am going to try to address both of these.
Certainly, that has been the focus of the various studies
or commissions that have been done, and specific to the Army
with the creation of the Warrior Transition Units. Then in the
broader sense the SOC has talked about, I think what you are
calling recovery coordinators to kind of oversee and be that
one-stop person for wounded warriors and their family members.
My concern is, given that is so critical to these
individuals, these soldiers getting to the right entity for
their care and not being, as we had heard with Staff Sergeant
Shannon and others, left to find their own way, the fact that
we are now more than half a year along the path, and according
to GAO report about half of these positions are unfilled, and
even a good portion of those that are filled within the Army
ranks are temporary, and then with the SOC recommendation it is
still just a recommendation. We haven't even begun to implement
this process.
So I guess if I can start with our two Secretaries first to
the broad issue on the recovery coordinators, where we stand
and what is the greatest challenge to getting this up and
running and to making a difference. Then, General Schoomaker,
if I can go to you on specific to the Army and the fact that we
still have so many vacancies in these very critical positions.
Mr. Dominguez. Sir, I will start.
I think the first headline I have to tell you is that the
Army has changed the situation on the ground in these
hospitals. The triad of care that they are deploying through
the Warrior Transition Units and stuff is changing the
situation on the ground. That is the necessary and immediate
response to soldiers in need.
Mr. Platts. I know that is the plan, but my understanding
and I think from GAO is that only 13 of the 38 Army facilities
actually have those fully staffed, those triads staffed. Is
that incorrect?
Mr. Dominguez. I can't dispute the GAO data on it, because
this plan and the triad and the requirement for it emerged in
the Army's look internally at what they needed to do, and we
have given them at the DOD level every support possible and
every encouragement. In fact, the directive that General
Schoomaker mentioned about, you know, hire everybody you need
to hire, use every authority you have to do that in terms of
this medical unit. So the situation on the ground has changed
where the Army has been able to respond and been able to staff
that. Again, challenges remain. More needs to be done. We are
pouring all the gas on it we can.
That is also true with regards to the VA/DOD collaboration
around information sharing and, in fact, people. There are
people from both departments in each other's facilities
actually coordinating and managing the transfer of patients and
information when patients move back and forth between our
systems, another great example of the partnership stepping up
to the challenge and changing the situation on the ground.
At the more global level, at the SOC what we are again
trying to do is trying to figure out, all right, what else
needs to be done globally.
Mr. Platts. And specifically with recovery coordinators?
Mr. Dominguez. Yes, sir. That is one of the things that we
are looking at now is the architecture of roles and
responsibilities and how that all works together, because you
don't want to disrupt this triad of care. You want to augment
it and supplement it.
Mr. Platts. Right.
Mr. Dominguez. So what needs to be done, how do we do that,
how do we introduce this new phase, what value-added does that
new phase bring, and how do you connect them then with the
triad of care that is going on? So you want to move carefully
and deliberately, with urgency absolutely, and I hope to be
able to have something definitive within the next few weeks
about how we are sorting through the care recovery coordinator.
In fact, part of that discussion will be at the SOC on October
2nd.
Mr. Platts. OK. Mr. Chairman, could General Schoomaker--if
you could respond in specific to the triad approach and my
understanding from the GAO information the number of vacancies,
and your efforts, and what do you need from us, if anything, to
help fill those positions?
General Schoomaker. Yes, sir. I appreciate the question.
First of all, I think Mr. Pendleton made the comment
earlier that the findings at GAO are preliminary and it gives
us an opportunity to clarify and to better explain some of the
data that are reported in this very thorough GAO study that we
greatly appreciate.
First of all, warriors in transition, who are these people.
It is important that you realize that the former terms of med-
holdover don't exist any longer within the Army. We have taken
all soldiers, active component soldiers and mobilized reserve
component soldiers, National Guardsmen, Reservists, regardless
of where they became injured, ill, whether they are combat
casualties or whether they are, frankly, injured on a training
base or develop a serious illness in the course of their
service, we put them all together in a single unit we call
Warrior Transition Units, and they are called Warriors-in-
Transition.
The important thing is not where they got injured or ill;
it is simply that they developed an injury or an illness as a
consequence of their service and we want to treat them all the
same.
We are at this point on the projected glide path to fully
staff all Warrior Transition Units by the first of January. I
hesitate to use the word incremental here because it has a bad
sort of taste in our mouths now, but we are going as quickly as
we can. The Army has been very, very aggressive about
supportings, giving us full staff to provide the oversight of
squad leaders, platoon sergeants, first sergeants, company
commanders, battalion commanders for these units, and we are on
a very good glide path to achieve the goal.
What the GAO heard about and does exist are not casualties
of war. Every casualty evacuated out of the theater of
operation or any major illness is immediately assigned to a
Warrior Transition Unit and is given the term or label of a
Warrior-in-Transition and is assigned to a unit that is staffed
with a squad leader, platoon sergeant, company commander, and
the like.
What we do have in the Army, however, and have always had,
is about an equivalent sized, almost brigade-sized element
distributed throughout our war fighter brigades, divisions, and
corps, who have a medical illness or an injury that renders
them at least temporarily unfit or unable to deploy. We now
have a case-by-case negotiation with their commanders to bring
them into the Warrior Transition Unit, to call these, to
embrace them as Warriors-in-Transition and assign them.
That population is as yet unstaffed for cadre because we
haven't identified them.
Mr. Platts. But you have prioritized those from the combat
operations as far as the staffing, and now you are moving
through the ranks?
General Schoomaker. Yes, sir. If you go to every WTU across
the Army right now, we are at over 50 percent cadre supplied.
At Walter Reed, frankly, we are at 95 percent. Across the Army
we are at about 65 percent across all Warrior Transition Units,
and we are on that glide path to be fully staffed.
Mr. Platts. OK. Thank you, Mr. Chairman.
General Schoomaker. Does that clarify?
Mr. Platts. Perhaps I will have a chance to followup if we
have additional rounds. Thank you.
Mr. Tierney. Thank you.
Mr. Waxman.
Mr. Waxman. Thank you, Mr. Chairman.
I want to address this question to Under Secretary
Dominguez. There have been reports about soldiers who, despite
physical or mental health problems and against the advice of
their doctors, have been ordered to redeploy to Iraq. We first
heard this at our hearing on May 24th, and since then we have
received additional reports from soldiers at Fort Benning and
Fort Carson. These reports are extremely concerning,
disturbing.
Do you agree that soldiers who are physically or mentally
ill should not be deployed against the wishes of the doctors
who are treating them?
Mr. Dominguez. Absolutely, sir.
Mr. Waxman. I understand there may be some gray area here.
Some soldiers have illnesses that are not severe enough to
prevent them from combat duty; others have mental illnesses
that can be successfully treated with medication. In some
cases, the soldiers may even want to return to their units. Has
DOD put together a policy that governs these redeployments? How
do you balance the needs of the soldiers, the unit, and the
military as a whole?
Mr. Dominguez. Sir, we have given that a great deal of
thought in these last several months. That is part of some of
the work of the Mental Health Task Force. I would have to get
back to you on the record with the policy that governs this. I
do know that you are screened. People are screened before they
redeploy. They are screened when they come back and then again
before they go. People who have conditions that make them
unable or unfit to serve in combat, in a combat theater, we
have policies and practices in place where they should not be
deployed.
Mr. Waxman. Well, under the policies, as I understand it,
there is supposed to be a unit commander to have to get a
waiver from Central Command before they can redeploy somebody,
and we have one documented case at least from Fort Carson where
a unit commander sought a waiver to redeploy a soldier who was
on psychiatrically limiting medications and the waiver was
denied. And then, despite this denial, the soldier was ordered
to redeploy and subjected to disciplinary action when he could
not. This seems to me like a clear violation of DOD policy. It
was bad for the soldier, unquestionably. It couldn't have been
good for the unit, either. The soldier is not well enough to be
in combat, he could present a real danger to his comrades.
Can you explain why it appears that DOD policy is not being
followed with regard to redeployments of mentally ill soldiers
at Fort Carson?
Mr. Dominguez. No, sir, I am not familiar with that
particular case.
Mr. Waxman. Well, could you tell us what steps DOD is
taking to ensure that the policies are followed? Are unit
commanders who do not follow the policy subject to disciplinary
action?
Mr. Dominguez. Sir, unit commanders who don't follow DOD
policies, yes, are subject to disciplinary action.
Mr. Waxman. I know the military is greatly strained, that
we have people who have been back and redeployments sometimes
three or four times, but if we are going to redeploy people, at
least we ought to make sure that they are well enough to be in
a combat zone.
The other thing I wanted to ask you about is there are also
credible reports of systemic problems at Fort Carson with
regard to wrongful discharges of soldiers with psychiatric
conditions. The military comes back and says, well, they have a
pre-existing condition, and therefore they are not going to
take care of them. They don't accept that this is a mental
illness problem related to combat. NPR reported on a memo from
the Director of Mental Health at Evans Army Community Hospital,
and, according to reports, this memo was written to help
commanders deal with soldiers with emotional problems, and NPR
stated, ``We can't fix every soldier, and neither can you.
Everyone in life, beyond babies, the insane, the demented,
mentally retarded have to be held accountable for what they do
in life.'' And the memo goes on to urge commanders, ``to get
rid of the dead wood.''
Are you familiar with that memo?
Mr. Dominguez. No, sir, I am not.
Mr. Waxman. Well, it appears this memo is advocating giving
up on some of our mentally ill soldiers. That is certainly not
a responsible approach. And this business of pre-existing
conditions discharge, it means that the soldier is discharged
dishonorably and they can't get access to mental health care
that they require from the Veterans Administration. That
doesn't make sense to me. It seems like if a soldier was
healthy enough to be accepted into the Army, disciplinary
problems that appear to be related to PTSD should not be blamed
on pre-existing conditions. These soldiers should receive
treatment, not blame.
I would like to get further reports from you on this issue.
It is certainly not appropriate to discharge soldiers with PTSD
via this pre-existing condition discharge. I would like to get
from you for the record, because my time is up but I think we
need to get this, the DOD policies that prevent soldiers from
being inappropriately discharged for pre-existing conditions.
If this is going on, it is certainly an outrage.
Mr. Dominguez. I am happy to provide that.
[The information referred to follows:]
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Mr. Dominguez. If I might, I do want to call attention to
Secretary Garon and Chief of Staff General Casey's efforts to
train the Army on the challenges of combat stress. If you
haven't seen or heard about the activity they initiated--and
General Schoomaker can tell you a lot more--a superb effort of
leaders to make sure that leaders throughout the Army
understand the challenges of combat stress and how to deal with
them. I think it is a laudable, commendable, superb effort by
those two.
Mr. Waxman. Well, it doesn't seem to be getting through to
the leaders at Fort Carson, so I think we need further reports
on whether the Army is actually getting educated or whether
more paper is just being generated.
Mr. Dominguez. Happy to do that, sir.
Mr. Waxman. Thank you, Mr. Chairman.
Mr. Tierney. Thank you.
Mr. Dominguez, we will expect some report back on those
particular incidents that Chairman Waxman discussed in a
reasonable time. We would appreciate that.
Mr. Dominguez. Yes, sir. Happy to do that.
Mr. Tierney. Thank you.
Mr. Turner.
Mr. Turner. Thank you, Mr. Chairman.
I want to thank you again for all the work that you have
done on this issue, both when the original issues came to light
about the care that our soldiers were receiving, and your
efforts on this committee have not only made a big difference,
but have highlighted some solutions that we have been hearing
today.
I serve on the Armed Services Committee, the VA Committee,
and on this subcommittee, so I get three bites of the apple on
this issue. I was very proud to listen to Senator Dole and
Secretary Shalala deliver their recommendations to the VA
Committee and, like many, are very appreciative of their work.
They have looked to some real solutions and identifying real
problems.
I want to echo the comments that others have made about the
Medical Evaluation Board Processes at DOD, the VA, and the
recommendations from Secretary Shalala and Senator Dole on the
problems of the time for the process, the inconsistencies, and
the lack of coordination between DOD and VA. I think they have
some great recommendations.
So many times we look at the streamlining processes instead
of, as they have recommended, collapsing processes and making
them thereby more efficient. But in looking at the three
different committees that I serve on, and the information that
we receive and how we need to proceed, one of the things that
this committee has continued to hear in this process of great
concern is a sense between Reserve components, Guard, and
active members that there is a disparity perhaps for Reserve
and Guard members and the level of their care at the
facilities, the resources that are brought to bear to assist
them. They have told the committee that at times they feel like
they are second-class citizens.
I know that each of you have a concern and a dedication to
that issue, and I would like to give you an opportunity to
respond to the feelings of disparity that they have, the issues
that you do see where there are disparities, and ways in which
it might be addressed or ways in which you actively are looking
to address it.
We will start with the General.
General Schoomaker. You want to start with me, sir?
Mr. Turner. Please.
General Schoomaker. Well, sir, I would say right off the
bat I think that their perceptions are real, and they are
certainly justified. I think one of the failures that was
alluded to by Mr. Dominguez earlier of the Department of
Defense--and in the Army, we were guilty of the same--is that
we put in place some structural solutions shortly after the
first appointments of our Reserve component colleagues. We
mobilized National Guard and Reserve elements, and when they
returned or when they were injured or showed up at our
deployment platforms with illnesses, we segregated them into
two different populations, med-hold for active component
soldiers and med-holdover units for the Reserve component
soldiers. Now, that was done because there are differences
between the two components when it comes to processing of
disability and outprocessing in the Army and the like, the
things that are more arcane than this General can understand,
quite frankly.
But I think what that did, unfortunately, was create the
impression, on both sides, ironically, both the active
component and the mobilized Reserve component soldiers, that
they were being treated differently.
Certainly we will continue to work on this misperception of
the two groups by creating a Warrior Transition Unit and a
single term to apply to all soldiers, they are all active duty
soldiers. Whether they come out of the Reserve component, or
they are active component soldiers like myself, they are all
active duty soldiers that are serving the Nation, and, frankly,
they are carrying a heavy load, and so we are trying in every
way we can to break down that misconception.
Mr. Turner. General, I appreciate your commitment to that.
It is an important issue, and I know that everyone agrees with
you on the need for your and other's success.
Would anyone else like to comment on the issue of things we
need to look at?
Mr. Dominguez. Sir, if I might, yes, I believe the Army has
changed the situation on the ground in the military treatment
facilities at Army installations. We have a continuing
challenge when we get Reserve and Guardsmen home, as they want
to do fast, and then they may have trauma and challenges,
particularly PTSD and the TBI, which sometimes emerge late
after they have been demobilized back into their civilian
communities. We have challenges trying to devise and deliver
programs to help them with the tough, tough challenge of re-
integration, because they are distributed all over the place.
They are not concentrated at a military facility where we can
get to them.
We are working through those challenges. Several activities
right now are underway in terms of re-integration. Lots of
work, thinking through with the VA how to reach those people in
their communities at home and make sure they get care when they
are back home, and lots of opportunities through TRICARE
delivery organizations to make sure that they get treated. But
it is a challenge when we get them back home, making sure they
get the care and support they need.
Admiral Dunne. Sir, if I might also comment, in Secretary
Nicholson's task force we also discovered that, with the Guard
and Reserve, when they would go home and then try to do the
post-deployment health reassessment, we found that it would be
helpful if the local VA medical center was represented at those
sessions, and so, as a result of the task force, we have taken
that action to get from DOD the schedule of when those
reassessments are taking place, and then we task the closest
medical center to support those events and have VA experts
available at those sessions.
So we are aware of potential problems, Guard and Reserve,
and we are working hard to try to find solutions to the process
to alleviate those.
General Schoomaker. Let me add one additional comment to my
earlier comments.
When we have looked very carefully at one of the critical
steps in adjudication of disability for both Reserve component
and active component soldiers, you need to understand,
Congressman, we have not found any systemic evidence that the
two are treated differently at that level. I think much of what
you are describing is a perception at our facilities. What Mr.
Dominguez said and what the Admiral said is exactly right--when
they get back out to their communities, it is very hard for us
to reach out and touch them, and we are working very actively
to try to find the resources necessary to extend that care.
But certainly at the point of separation and adjudication
of disability, Reserve component soldiers sit on the boards
that adjudicate their disability, and we have found no
evidence, in looking back at those adjudications, that there is
any systemic bias.
Mr. Tierney. Thank you, Mr. Turner.
Mr. Bertoni. Excuse me. Can I offer up just a quick
observation?
Last year we actually did a study for the Armed Services
Committee where we were asked to look at disparities in the
ratings system for Reservists and active duty. We did a very
sophisticated analysis of outcomes, and it is true we couldn't
find a real disparity between the ratings level between Army
active service members and Reservists, but we did find that the
Reservists were less likely to receive disability retirement
benefits as well as lump sum benefits. The data was
insufficient for us to determine the reasons for that. It just
wasn't available.
We think a couple of things were going on. I think one of
the things was the 8-year pre-existing condition rule. A
Reservist entering the service in 1985 fulfilling all the
obligations of his commitment or her commitment going on a 1-
year tour of Iraq and Afghanistan, by 2005 that person would
only have 6.9 years of creditable service and would fall within
the 8-year pre-existing condition rule, so that is certainly a
factor.
Generally, time and service would come into play also. If
they didn't have the 20 years, they certainly wouldn't get the
20 years in that period of time based on based on Reserve
status.
I testified before the Dole/Shalala Commission on this
issue and brought forth a couple of points.
There are 26,000 service members assessed through DOD's
system in 2006 or 2005. One in four of those was a Reservist,
so not only do we have more Reservists making up a larger share
of our military force, but we also have more Reservists coming
in and seeking disability services, so I think we really need
to look at our policies currently and whether they are serving
the Reservists.
Mr. Tierney. Thank you.
Thank you again, Mr. Turner.
Mr. Turner. Thank you, Mr. Chairman.
Mr. Tierney. Ms. McCollum.
Ms. McCollum. Thank you, Mr. Chairman. Thank you for the
followup that you have been doing on this issue, because quite
often it comes to light and then there is a lot of excitement
and people are making plans, and then no one follows up to make
sure the plans actually are implemented, so thank you so much
for this hearing. I thank the gentlemen here today for their
testimony.
I am not a stranger to the VA system. My father was a
disabled vet. I am a regular fixture quite often at our VA
facility in Minneapolis. I would like to commend the work that
I have seen done in the poly trauma units, the lessons learned
from the roll-outs as the units have gone through, the video
linking with the families being present and the doctors
speaking to one another with the patients. So there has been a
lot of work done in there because basically you were starting
from ground zero, so you could kind of invent the platform that
you wanted to work off of using updated technology.
But that is not necessarily the case you see in the other
parts of the VA system. One area, even in the poly trauma unit,
that I am concerned about is the Department of Defense person
that is assigned there to make sure that the flow of the
paperwork goes forward. Most of that time that person is there
for 3 months. It is not a career maker to be assigned to that
unit, and so there even might be people who look at this as
something that, if they can get transferred out of quickly,
that they will. I think that service in that unit has a lot to
offer for families.
The Marines, however, have decided to make this a priority,
and the Marines that I have spoken with at our facility in
Minneapolis are planning on being there for a year.
My comments now shift more to GAO. One of the things that
we heard Mr. Dominguez say is, as we go through with the
disparities rating, DOD is looking at moving forward with the
VA disability rating. I turn my attention to page 17 of the GAO
report, and there are two things on there I would like to have
you comment on. One is the lack of confidence that our service
men and women often have in the disability rating system, both
in DOD and possibly VA. And second is the way in which the VA's
rating system needs to be updated to reflect what is currently
going on in today's labor market. Maybe if you could even
comment, I had many people I case worked with, airline
mechanics receive shoulder injuries, arm injuries, they were
very concerned about their ability to return back to work and
return back to work at a level which would allow them to move
forward.
The other issue I would like to see addressed, and DOD and
VA keeps talking about their plans. You folks did the study. I
haven't seen any budgets on how these plans are going to be
implemented. I mean, we need to know. I serve on the
Appropriations Committee. We need to know what we should be
setting aside to appropriate to make these plans become a
reality, both in the transfer of technology and what this is
going to mean to staffing personnel.
Mr. Chairman, the buzzer is going off, but I would just
also like to bring to the Chair's attention there is concern
that traumatic brain injuries might lead to epilepsy for some
of our service men and women later on in life, and my
understanding is the VA, where they are in working with NIH to
make sure that this is addressed and is not considered a pre-
existing condition, ignoring that.
Thank you, Mr. Chair.
Mr. Tierney. Thank you very much, Ms. McCollum.
Mr. Lynch, do you have any objection? Mr. Hodes apparently
has another meeting to go to and he has asked to ask a question
before he leaves. Does that fit with your schedule, or do you
also have a place to go?
Mr. Lynch. Well, we have votes.
Mr. Tierney. We have two people to question before we go.
Mr. Lynch. I'm sorry?
Mr. Tierney. We have both Mr. Hodes and you, will you be
able to get your questions in before we go.
Mr. Lynch. Yes. I have no problem.
Mr. Tierney. Great.
Mr. Hodes, please proceed.
Mr. Hodes. Thank you, Mr. Chairman, and thank you for
holding these hearings.
As you are all aware, these matters first came to
prominence with articles about substandard care at Walter Reed
that appeared in the Washington Post, and among the results of
the articles and initial hearings was the testimony by Sergeant
Shannon, who had lost an eye, suffered head trauma, and
testified about languishing at Walter Reed for 2 years, and he
talked about the difficulties he had had.
Now here we are in September, with all the attention that
has been paid. We met Sergeant Shannon on Monday. He is back in
the newspapers again. There was an article about his retirement
papers having been lost, and he is now going to have to wait
until December or January before he can retire.
The subcommittee went to Walter Reed on Monday, and we
thank you, General Schoomaker, for briefing us and for telling
us about your efforts. We had the opportunity to meet with a
large group of soldiers in a room without brass, and we heard
horror stories from them. They told of case managers who are
unqualified, not doing their job, not up to the task. They told
us of delays in pay or not receiving the awards due to them for
their service to the country. They told about continuing to
languish at Walter Reed for months or years. They told about
continuing problems with scheduling medical appointments so
that they were basically jerked back and forth about their
scheduling. One soldier said to us sarcastically, ``Walter Reed
was the best place I have ever been incarcerated.''
When we asked them whether they prefer to go back to Iraq
or be in Walter Reed, nearly all of them said they wanted to go
back to Iraq.
I have a constituent who turned to me to help him because
he has been experiencing the same kind of thing on an ongoing
basis, and I have been advocating for him within the system. He
had to turn to his Congressman to advocate for him within this
system.
The Army apparently will agree that Walter Reed's problems
are a microcosm of those found throughout the Army. I would
like to know first why are these horror stories still
continuing as of our visit on Monday, No. 1?
No. 2, I would like to move on to questions about the case
management system. But why are we still hearing this?
General Schoomaker. Well, I think that is a difficult
question. You met with 31 or 34 soldiers, I believe, on Monday
when you went a self-selected group of soldiers, in large
measure, who wanted to talk to you. We have 680 soldiers in
that category right now at Walter Reed, and so you have seen a
subset of the whole population.
I would venture to say that every one of the soldiers that
you saw has an individual case with an individual set of family
or personal problems and we have to work through each and every
one of. This is a difficult time in the lives of all of these
soldiers. We acknowledge the fact that we start off in a
difficult position with them trying to establish trust and a
relationship. They have gone into the Army, or in some cases
they have gone overseas, and have come back not the same people
that they went. We start at a disadvantage. We try to rebuild
that relationship, but we aren't always successful in
overcoming all of the problems these soldiers face.
All I can tell you, Congressman, is if you give me details
about each and every one of them, we can address them through
the devices that we have, acknowledging that we continue to
seek solutions to this single adjudication process that has
already been alluded to by our leaders within the DOD and the
VA. That still represents and represented for Sergeant Shannon
one of his hot button points, as they approach the final
adjudication of their disability, it elicits enormous anxiety
and resentment about their service and how we are treating them
and how we as a Nation see their service.
If you give me details about any of those horror stories,
sir, I will personally take them on.
Mr. Hodes. Is it your testimony that the soldiers who we
visited with on Monday are not representative of the active
duty outpatient population at Walter Reed now?
General Schoomaker. Yes, sir. I would have to say that is
true. I was placed in that position to solve the problems of
Walter Reed, and if at the end of this period of time, with all
the efforts that we have put into it, if all of the soldiers at
Walter Reed are characterized by what you just described, I
would say that I have been a failure as a commander and I
should be held accountable.
This is not the general rule. I can't say that every
soldier is happy with what is going on in their lives. As I
explained before, they start at a disadvantage. They have come
back ill or injured. They are going back into communities, some
of them unable to resume their employment. But no, sir, I would
not say that this characterizes the rule for our soldiers.
Mr. Hodes. I see my time is up.
The only comment I would make, General, is I appreciate the
task that you have undertaken in trying to reform the way
things are done, but I suggest to you that if there is one
horror story at Walter Reed, then there is room for
accountability, and it should not be up to Congress to tell you
who is having problems, but for you and your staff and the case
managers to find out who is having problems and address them as
quickly and completely as possible.
Thank you, General.
Mr. Tierney. Thank you, Mr. Hodes.
Mr. Lynch.
Mr. Lynch. Thank you, Mr. Chairman.
I want to thank the panelists for attending, as well,
helping the committee with its work.
I have a couple of questions, and they are related.
As previously noted by the GAO in its March 31, 2006,
report, the Department of Defense grants each of the branches
of the service considerable discretion in how it evaluates
disability. That is with, one, respect to a determination of
whether the service member is fit to duty, and second, with
respect to the assignment of disability ratings. Specifically,
each branch of the armed services manages its own physical
disability evaluation system, which includes the MEB, the
Medical Evaluation Board, and the PEB, the Physical Evaluation
Board.
I asked the Department of Defense to send me the numbers on
how each branch of the service handles these evaluations for
disability. I was surprised. Well, maybe I shouldn't have been,
but I was. When you take the Navy's numbers, and those include
the Marines, they basically had determination rate of about 35
percent, either totally or temporarily disabled, 35 percent for
the Navy. The Air Force has about 24 percent. The figure that
really stood out to me was the Army. The Army has about 50
percent of all of the disability claims before it, and it
approves only 4 percent. That is 4 percent compared to the
other branches for permanent and then 15 percent for temporary
disability.
Now I hear today from Mr. Dominguez that we are going to
merge the standards of the DOD with that of the VA, and I think
it was Mr. Bertoni who said earlier today the VA has a 400,000
case backlog. I know from my own personal experience dealing
with my veterans back home in the Ninth Congressional District
of Massachusetts that I have typically an 8-month waiting
period before one of my vets can go see a doctor, a VA doctor.
I am afraid of that, you merge two systems.
I associate myself with the remarks of Mr. Hodes earlier.
We met with 30 to 35 soldiers at Walter Reed on Monday who were
very, very unhappy, and the chief complaint, if I could
generalize, was the mind-numbing bureaucracy that they have to
deal with in getting treated with dignity and respect and
having their cases resolved.
It varied. Some felt they shouldn't be there, they were
fine, and they wanted to go back with their units. They wanted
to go back as war-fighters. Others were being held for more-
extensive injuries. There were some amputees who certainly
needed to be there, but also needed to have their cases dealt
with in a more expeditious manner.
Given the different standards here, you have a military DOD
system that evaluates a soldier based on their fitness for
duty, given their rank and their responsibility. That is the
DOD standard. The VA system is looking at their employability
as a civilian and they are basing their disability evaluation
on that standard.
When you merge these two, I am afraid you are going to
discount the first, Defense Department disability based on
their actual injuries, and you are going to moderate that
because you are going to find some type of employability on the
other end. I am just very concerned about the merger of these
standards. I want our war-fighters to be treated with the
dignity and the respect that they deserve, but I have to raise
a fair amount of caution here because of the two standards.
Let me throw it out to all of you. How do we basically, No.
1, eliminate the disparity between the Navy, the Marines, the
Air Force, and the Army, and then at the same time reconcile
the differences between the two standards, one a civilian
standard and one a military standard in evaluating these
disabilities?
Mr. Tierney. Mr. Lynch, if I can interrupt for a second, I
am going to give you the option to pick one and ask them to
answer in 30 seconds. You have 3 minutes to vote. We will come
back and you will be the first to address them when we come
back.
Mr. Lynch. OK. I pick the first one.
Mr. Tierney. What is that?
Mr. Lynch. We are going to come back?
Mr. Tierney. We are going to come back.
Mr. Lynch. Why don't we come back?
Mr. Tierney. All right. Thank you all very much. Another
10-minute interruption for votes, and we will see if we can get
there in 3 minutes or not. Thank you.
[Recess.]
Mr. Tierney. The subcommittee will resume.
Mr. Dominguez.
Mr. Lynch. Would you like me to restate the question, Mr.
Chairman?
Mr. Tierney. No, thank you, Mr. Lynch. It was a 5-minute
question.
Mr. Dominguez, go right ahead.
Mr. Dominguez. Sir, let me first address how this process
will work. The first is that there will be a single,
comprehensive medical exam, and it will be done to standards
using a template that the VA provides so that we can make sure
we document the medical condition, each and every medical
condition in it, so it is documented. So if there is an issue
with a joint, then the circumstances around it and the degree
of flexion of the joint, and those kind of things, are all
documented so that the down-stream actions can all be taken and
formed by that.
That exam will go to a PAB--Personnel Evaluation Board--
which is military members who will use that information and
look at the medical conditions, and bump that against the
standards for performance of a job within a unique individual's
service and within a skill and within a grade and specialty. So
the decisions then are being made based on a medical
description against a service specified standards for this
individual to do his or her job.
Once that evaluation board determines that the individual
is unfit and will likely have to leave the service, that case
file is then forwarded to the DVA rating examiners. It is only
at that point that a rating is associated with the condition.
That comes back to DOD for one decision only, which is, ``Are
you separated or retired?'' That is how we would use it in our
process. And, of course, the current law provides the degree of
retirement pay you are entitled to. This is also a function of
the degree of the disability above 30 percent. At 30 percent
you are retired. Above that, it affects how much you are paid
in your DOD retirement annuity.
Of course, you have all the appeal rights, etc., but that
is how we would use it. So we are using medical information to
make this military determination, and that determination is
different by each service, because each service standard for
what is required to do the job is different and unique.
You can be an airman with an injured back but not an
infantryman, because you wouldn't be able to carry the
rucksack, for example.
I hope that answers your question sir.
Mr. Tierney. Ms. McCollum, did you want to ask Mr. Lynch to
yield?
Ms. McCollum. Yes. Mr. Lynch, would you yield?
Mr. Lynch. I would. Yes.
Ms. McCollum. Explain to me how the National Guard gets
figured into that, which was part of my questions that I had
asked earlier. I am a highly trained airplane mechanic. I am
called up, active duty. Let's say my shoulder is destroyed. I
can't go back to work as an airline mechanic any more. What do
you do for that individual?
Mr. Dominguez. Ma'am, there were two parts to the question.
Assuming you were a National Guardsman airplane mechanic in the
Guard and we found your condition unfitting and determined that
you needed to be retired, just like any member of the armed
forces, you would then be retired by the Disability Board. You
would be given a retirement annuity based on the level of
disability--in the pilot, again, assigned by a DVA rating
panel. Then, by that time the VA will already have your
records. They will have already determined the degree of
disability. You would be then compensated----
Ms. McCollum. Excuse me, Mr. Chairman. I am not talking
about somebody who was an airline mechanic and that was part of
their job in the National Guard. We have people who are DOD
employees who do an excellent job of maintaining aircraft to
St. Paul/Minneapolis and Homeland Field in St. Paul. I am not
talking about those. I am talking about the gentleman who was
called up for active duty who works for Northwest Airlines and
can't go back to work. What do you do for that individual?
Mr. Dominguez. Once they are retired from the DOD they then
go to the DVA, and it is Admiral Dunne's challenge at that
point.
Mr. Tierney. Nice hand-off, Mr. Dominguez. I have to hand
it to you, that was good.
Admiral Dunne. When the claim is filed and the medical
condition is evaluated in accordance with the VA templates, not
only the shoulder, but any other condition which the veteran
identifies and we have a medical evaluation of is taken to the
ratings schedule, and based on the ratings schedule the
disability percentages are applied for that veteran for every
item that they claim.
Mr. Tierney. Thank you.
Mr. Shays.
Mr. Shays. I thank you, Mr. Chairman, again for doing this
hearing.
I am somewhat conflicted by the challenge that you have to
face, General, and the others. When we came and met on Monday I
felt that I was meeting with a representative group of
traumatic brain injury soldiers, and others, dealing with some
very real, as they said, mental issues. I didn't feel we were
dealing with some of the other physical challenges. So to that
extent I do agree it is not representative, but it is
representative, it seems to me, of those who are dealing with
brain injuries and so on.
On one side we had a group that was complaining that they
weren't being discharged, and on the other side we had people
who were afraid that someone might say something was wrong with
them and they couldn't go back into the service.
I tried to put myself in the position of a doctor. If you
believe that some are there because they are soldiers and
Marines and others and they want to go back, but they may not
be well enough to go back, I am struck with the fact that as a
physician you have a difficult task. You have to try to see who
is not qualified to go back and who need to be discharged, and
neither side may like your outcome.
Now, the one thing that I was struck with, though, there
was one physician in particular. One doctor that almost
everyone there, anyone who came in contact with him--no one
defended him--that he was disrespectful, biased against Guards
and Reservists, and some said incompetent. We have heard
complaints about this doctor by others, because our staff does
extensive work. Evidently he seems to be a key player, and I
have a feeling, General, that you may know which one this is
because there is one who clearly gets a lot of complaints.
Without discussing the individual, what is the argument
that he still is there?
General Schoomaker. Well, first of all, let me just make it
very clear, the two points you have made I think are very good
ones. Virtually every soldier I have ever met in a military
hospital, even our amputees under the most desperate
circumstances, wants to go back to war, wants to go back where
their colleagues are. It is heartbreaking to have to tell
people that they cannot serve in the capacity that they came
into the service, especially when they are leaving an active
theater war.
It is very difficult to work with patients who have a
variety of disabilities and problems that are going to keep
them out of that. Frankly, that doesn't fall to the physician
or to the medical community. In general it falls to the line
commander who is part of that equation.
Mr. Shays. It is difficult. I just want to interject
myself. When you hear of people being there for a year, 18
months, you begin to think there clearly are some breakdowns
there, I just want to say parenthetically.
General Schoomaker. I mean, again, I am very careful about
not making generalizations, because as I have said in many
forums, every patient and every family is different.
One of our heroes is Retired General Freddy Franks, who
came back from Vietnam and ultimately lost a portion of his
leg. He was 21 months in an Army convalescent hospital at
Valley Forge and returned to duty. He ended his service as a
four-star general. He was the Corps Commander that took the
Seventh Corps in the first Gulf war into Iraq. So every time I
am given a timeline to hold a soldier to, I am always pointing
out that is not fair.
Mr. Shays. What about this doctor?
General Schoomaker. The doctor in question, his care has
been looked at very carefully by other physicians in his
practice, and his care objectively has always been determined
to be appropriate. What I was led to believe was that he was
taken out of the front line of caring for these patients.
I will have to go back, sir, and just confirm whether they
are talking about prior events and encounters with him. What we
have moved toward very, very firmly at Walter Reed and across
the Army are dedicated, in a sense, institutionalized MEB
doctors--Medical Evaluation Board doctors--whose specialty, in
a sense, is to take care of the Medical Evaluation Board. But I
will take that question and get back to you for the record.
[The information referred to follows:]
[GRAPHIC] [TIFF OMITTED] T2584.099
[GRAPHIC] [TIFF OMITTED] T2584.100
Mr. Shays. I see a yellow light, but let me ask this: In
regards to the Board, there seemed to be tremendous fear on the
Board. Is that simply because the Board basically plays God on
what happens to these individuals?
General Schoomaker. You are talking about the Physical
Evaluation Board, sir?
Mr. Shays. Yes.
General Schoomaker. Yes, sir. I think for the average
soldier this is especially true. Ms. McCollum I think hit a
very important point. I mean, soldiers come in. They are
declared unfitting for the service and for the role that they
play in the service, but they go back into other civilian
roles. They can't go back. Maybe they come in and serve as an
infantryman, but they are going to go back and walk a beat as a
policeman or woman. What they face is what is going to be life
for them now and their family.
They know that there is a threshold of 30 percent
disability. The 30 percent disability renders them eligible for
TRICARE healthcare benefits for themselves and for their
family. Everybody knows within my hospital, and everybody
within the Medical Evaluation Board system knows, about the 30
percent, but if the unfitting condition that renders you unfit
to serve in whatever capacity you are that only gives you 10 or
20 percent, and by policy and by law, as I understand it, we
are limited to that even if the VA later adjudicates all of the
associated injuries or illnesses as giving them more than 30
percent. We are held to the unfitting condition, and so they
may be separated with a single lump payment, and no healthcare
benefits for their entire family that they would get if they
reached the 30 percent disability rating.
I think that is going to remain a hot button item under any
disability evaluation system that we have, and that has to be
resolved.
Mr. Shays. Just an ending comment. Thank you, Mr. Chairman.
That did come up continually about their health benefits. Their
health benefits almost seemed more important than any financial
benefit they get, and it may behoove us to look at that issue
and see what kind of flexibility could take place.
Mr. Tierney. Thank you, Mr. Shays. And it was a point that
came up again and again, and that adversarial nature is what
results from that. I mean, I think that we are going to look at
that as part of that, look and see whether or not on the other
end coming out, whether something can't be done with
healthcare, work on that.
Is there any member of the panel that would like to ask
another question, that feels some business has gone unfinished
from their perspective?
Ms. McCollum. Are they going to answer the questions that I
asked before you started collectively gathering the questions?
Mr. Tierney. If you have another question you want to ask,
or you don't feel was responded to, you could ask it here if
you like.
Ms. McCollum. They didn't have an opportunity.
Mr. Tierney. Well go ahead and ask.
Ms. McCollum. I had asked about refreshing the VA's
disability standards. The distrust that kind of exists between
the servicemen and women with the Disability Rating Board, and
I think that came forward because most people get turned down
the first time. That has been my experience quite often, and
they are going through an appellate process and it is long and
it is cumbersome. So you would need some suggestions on that.
And then the other question I had to kind of capsulate, so
we can wrap up is: all of these plans and programs that have
been put in place at the hospitals for the poly trauma unit,
for having the case worker be there--and I am probably using
the wrong term now--the Department of Defense person there, to
help with the paperwork and to move things forward being there
longer than 3 months. The budget being built in for all these
new people that are being added as case workers, the money that
is going to be needed to update these systems so that they are
workable for transferrable records and make it seamless for the
soldier, their families, and the doctors involved. I haven't
seen a budget for that.
I have seen plans, lots of ideas, things being painfully
implemented, in a slow process. But this Congress needs to have
a budget so that we do it right, because I am assuming that the
Department of Defense or the VA can't take this ``all out of
hide.'' These are big price-tag items, and I am on the
Appropriations Committee, and to the best of my knowledge I
haven't seen a budget for them. So I was asking for the
gentleman here who conducted the review to let me know what
they thought about that.
Mr. Pendleton. We haven't seen the budget figures either.
Our understanding is that the costs, the incremental costs,
will be included as part of the President's budget. That is one
of the initiatives of the Senior Oversight Committee, and you
have representatives here. We have outstanding requests for
that, but we honestly at this point don't know.
Ms. McCollum. Mr. Chair, could I ask DOD and VA? It has
been ongoing. It has been 10 years since you have been going to
integrate your records. Certainly you have a budget some place
that we can look at, and look at today. Do you not?
Mr. Dominguez. The budget that supports the integration and
the sharing of information in the medical organizations is
funded. It is part of the budget that was submitted in 2008. It
is in the TRICARE piece of the budget. I will get back to Dr.
Fissells. We can try to pull that out for you for the record.
They will be certainly in the 2009 President's budget
submission changes to that, because we will be accelerating
those activities.
In the case of the standing up to Warrior Transition Units
and those kind of staffing and those issues, because that
happened in 2008 the DOD and the services took that ``out of
hide'' in terms of reprogramming in 2008. There may have been
something in the supplemental that helped us. In fact, the
Congress appropriated a huge amount for TBI and PTSD--for which
we are deeply grateful--which really did accelerate a lot of
the thinking and the activity and our ability to respond to
those crises.
But in the 2009 submission of the President's budget, we
will make sure that these activities are called out to your
attention when the President submits that budget to you.
Ms. McCollum. Mr. Chair, could I ask GAO then why weren't
you able to get the budget numbers?
Mr. Dominguez. I was referring to future estimates for the
new initiatives. I don't know that they have been created yet.
Mr. Tierney. Thank you.
Mr. Shays, do you have a couple of final questions?
Mr. Shays. First off, the GAO has really pointed out that
DOD and the VA have been trying to work for 10 years to
integrate and to share information, and there has to be a point
where there is going to be some success here. The only thing I
can conclude is it is just simply not a high priority.
I would like to ask GAO two questions: what do you believe
are the greatest challenges to the implementation of each of
the recommendations of the Dole/Shalala Report, and by each of
them just give me some of the highlights, because we have been
here very long? So what do you think are the greatest
challenges to the implementation of these recommendations?
Mr. Bertoni. Of the Dole/Shalala Report?
Mr. Shays. Yes.
Mr. Bertoni. In hearing the VA testimony, I took down some
notes. It looks as though they have gone with a single
comprehensive exam done to VA standards using VA templates. So
we call that the Dole/Shalala light option of the four that we
looked at. All the other options had the VA doing the exam as
well as the rating. So it looks like they are moving toward the
Dole/Shalala portions that don't have to be addressed in
legislation, which is a single exam and a single rating.
I think folks on both sides agree that is probably the way
to go. They had the single exam, and had the single rating.
In terms of the two bureaucracies, I think there might be
some push-back or concern as to who should actually have it in
the end. I mean, changing management is going to be difficult.
I think you need management support at the top. You need a
plan. You need change agents within the agency to sort of
convey to the troops and the bureaucrats that we are moving in
this direction, and you need some early wins. If they go in
this direction and implement the pilot, if they could show that
they have substantially decreased timeframes, that is some
early wins that can gain momentum. So that can help.
I am concerned that they may not be paying enough attention
to accuracy and consistency, sort of the three-pronged issues
that we have identified. If the system is not viewed as being
accurate and consistent, we are back to service member
distrust, congressional oversight, all these things that
brought us here today. So that is certainly an issue.
Generally, getting in front of the implementation before
considering all of the unanswered questions is of concern to
us. We would be interested in seeing how they arrived at this
decision--the data that drove that decision. In our view it
should be a data-driven decision outside of the politics and
other contexts.
I think, in general, again, large agency transformation is
going to be difficult. This is larger than just re-engineering.
Mr. Tierney. Would you yield for 1 second, Mr. Shays?
Mr. Shays. Absolutely.
Mr. Tierney. Mr. Dominguez, would you have any objection to
your department and Admiral Dunne sharing that information with
the Government Accountability Office so that they could do
analysis, look at the data upon which you based your
determination to go to this particular pilot program so that
we, as a panel, could then in turn ask the Government
Accountability Office to give us their assessment of that?
Mr. Dominguez. Yes, sir. We are happy to share with the
GAO.
Mr. Tierney. We will ask the Government Accountability
Office to take a look at then, and give us some idea then of
what your views are toward that data.
Mr. Bertoni. Sure. And to date the information exchange has
been very good. I must say that we have had a lot of
cooperation. We have been riding herd as these things move
forward and asking for information as it is being produced.
Mr. Tierney. Which is what we want.
Mr. Bertoni. And we intend to ask.
Mr. Tierney. And hopefully what this will continue to do is
give us better insight as well.
Do you have any other questions, Mr. Shays?
Mr. Shays. I think Mr. Pendleton wanted to respond.
Mr. Pendleton. Yes. We laid out in our statement the
challenge of placing these recovery coordinators. Dole/Shalala
recommended that these recovery coordinators come from the
Public Health Service. The idea was that they be significantly
high ranking and able to sort of break down bureaucracies, and
I think not necessarily in either of the departments.
The decisions that DOD and VA have made, I think, are these
are going to be placed in VA. That can work, but I think that
is going to require careful lines of accountability and other
things as it goes forward.
In terms of the information sharing, which you touched on,
there has been some progress made. I think the most important
thing that I saw in our review is there is a mark on the wall
now. October 31, 2008, DOD and VA have committed to have all
information viewable, administrative and health information. So
there is now a mark on the wall for that.
I am not necessarily familiar with the history. There may
have been previous marks on the wall, but there is one here.
In general, I think follow-through after the limelight
fades, the spotlight fades, is what is going to be more
important. These plans, many of them are quite solid, are well
thought through. I think the continued accountability,
oversight, and keeping track of how well these things are being
implemented, is going to be key over the long haul.
Mr. Shays. I thank the gentleman.
Thank you, Mr. Chairman.
Mr. Tierney. Thank you.
We have no intention of letting down the oversight from
this end of it, and I know each of the departments feels a
responsibility to do their own oversight. So I hope we are
going to err on the side of too much oversight as opposed to
too little on that much to the chagrin of some out there maybe,
but I think it behooves us all to do that.
Can either Admiral Dunne or Mr. Dominguez give me the
answer as to why the decision was made to not use Public Health
Service Commission Corps, or similar people, instead of VA
people as these recovery coordinators?
Admiral Dunne. Sir, I think we are going to work with the
Public Health Service as we put this recovery coordinator
system together. Our two lead change agents, the two Deputy
Secretaries of VA and Department of Defense, have signed out a
memo which says that we are going to put together a program
that will recognize that Public Health Service has a consulting
role with this, be part of the evaluation, etc.
Mr. Tierney. But, it will not be the actual recovery
coordinators. Is what you are saying?
Admiral Dunne. The plan as put together now would have VA
employees, new VA employees, being the recovery coordinators.
Mr. Tierney. What do you propose to be the chain of command
in that? This recovery coordinator, as I understand it, is
going to be above the triad of individuals that General
Schoomaker has on bases.
Admiral Dunne. Correct.
Mr. Tierney. And who are they going to report to, or does
the buck stop with them? Are they the patient's advocate, or
are they the department's advocate?
Admiral Dunne. They are the patient's advocate, sir.
Mr. Tierney. And they get to make the final shot, or do
they have to report up to somebody else?
Admiral Dunne. They will be of a position description such
that they have the seniority and the presence of mind to be
able to understand the system and know when it is time to say,
based on common sense, somebody needs to do something here and
fix this problem. They will be coordinators.
Mr. Tierney. And they will have sufficient rank so that
when they say, somebody will jump?
Admiral Dunne. That is the intent. Yes, sir.
Mr. Tierney. OK. Thank you.
Admiral and Mr. Dominguez, the SOC is set to expire in May
2008. Are you going to be done by then?
Admiral Dunne. Sir, we hope to have made significant
progress by May 2008, but that date was picked back in May of
this year as a goal. We are going to work toward that goal, but
we still have the Joint Executive Council, which is a joint VA
and DOD organization that will pick up the mantle and continue
to follow through on anything that the SOC puts in place.
Mr. Tierney. Thank you.
Mr. Dominguez. Sir, if I might just add?
Mr. Tierney. Sure.
Mr. Dominguez. The SOC was envisioned and created as a
crisis response organization to drive change fast. The changes
that get implemented then will transition to the day-to-day
oversight of this Joint Executive Council. That is where these
changes will be institutionalized, implemented, and sustained
for all time.
Mr. Tierney. Thank you.
We are going to have additional oversight hearings. It
would be helpful for us to determine, and ask for your
cooperation with our staff on this, on whether we ought to have
individual hearings on specific aspects of the concerns raised
by the Government Accountability Office--in other words, a
hearing on disability evaluation and that process, a hearing on
TBI and PTSD and that situation, one on data sharing, and one
on the Warrior Transition Units and their staffing on those
matters, or whether we will have another one in the aggregate.
Could each of you just, in a couple of words or less as we
go down the line here, tell me when do you think would be an
appropriate time for us to check back when we should be able to
have answers to those, as to how we are proceeding, and a good
idea that we are getting well along in our progress?
Mr. Pendleton. On the issues relating to continuity of
care, that is pretty much new work at GAO, and we haven't done
a lot of tire kicking yet. We want to get out to some units and
see what the impacts are of some of these staffing shortfalls.
It would take us a couple of months probably to be able to give
you much new on that.
Mr. Tierney. OK. And everything else?
Mr. Pendleton. On the information and technology we have
experts at GAO that have been working on that for a long time.
I think they could come and have a hearing. They are following
that actually quite closely, and we cribbed some of their work
for this.
On the TBI/PTSD, we have a team following that as well.
There was a mandate for us to look at that in the National
Defense Authorization Act last year. That team is starting up,
but much like the continuity of care work that we are doing, it
is relatively new. Dan leads our disability specialty.
Mr. Bertoni. Out of 14 or 15 engagements I have had, I
probably have eight right now that are VA or DOD looking at the
benefits delivery, discharge system, vocational rehab for
returning warriors, overlaps, and inefficiencies in the system.
We are about to kick a job off on looking at the temporary
disability retirement list for TBI patients and just a range of
work that is relevant to what is going on here now. We have
been doing it for a couple of months, and, of course, in 2, 3,
4 months if we were asked to come up and give you an interim
report on any of those issues. We would be able to do that.
Mr. Tierney. Thank you.
Mr. Bertoni. And certainly a final report in 8 or 9, 10
months.
Mr. Tierney. Thank you.
So when should we next look at what is happening at Walter
Reed and the other 29 facilities in terms of all of these
overriding issues?
General Schoomaker. Well, sir, one of our milestone events
is going to be January 2008 when we say we will be fully
operational and capable for the Army medical action plan. I
would say any time after that we should be accountable for how
we are doing.
Mr. Tierney. Thank you.
Mr. Dominguez.
Mr. Dominguez. Sir, my suggestion would be that we are
ready now on the IT interoperability plans, what is going on,
where we need to go. I think we are ready now on the PBI/PTSD.
Again, ready now means to talk to you about where we are in
this process. Lots of work in both of those in front of us, but
we are ready now to explain them to you.
In terms of the disability evaluation system, we are not
going to actually walk people through that until November. I
would say in January is probably the right time again for you
to take a deep dive into that and how it is working, because
that is when we are actually going to startup the new system if
all goes well.
Admiral Dunne. Sir, I agree with my partner on the time
lines.
Mr. Tierney. What a surprise. Thank you.
Let me just end. I want to make one last note with respect
to General Schoomaker. We heard some comments earlier about a
number of the soldiers with whom we met and their particular
cases on that. I think in fairness we ought to note that they
were just introduced to a new ombudsman's process as of last
Friday, and you were kind enough to discuss it with us on the
ride out to Walter Reed the other day. Maybe spend 1 minute at
least telling us that there were three, I think, that you
designated for Walter Reed, and what you would anticipate their
role being, and whether they will be replicated, and when
throughout the rest of the system?
General Schoomaker. Thanks for giving me the opportunity to
talk about that.
It distresses me, no question, to know that we have a
single case within the hospital of a warrior in transition who
is not pleased with his or her care and administrative
oversight. We have tried to offer as many options for giving us
candid feedback anonymously or directly with attribution from
these soldiers. One of which is the ombudsman program. I think,
sir, you had a great deal to do with this, and that is
patterned after ombudsmen in other realms besides health care,
a truly objective arbiter that looks at the system for the
patient, looks at the system as a system and tries to figure
out where are the points of weakness, where are the points of
solution for that particular patient.
We are bringing those folks on. We are making them
available to our patients in Walter Reed and across the Army.
Every soldier is also issued a 1-800 24/7 line that they
can call and seek help for themselves or their families. We are
very, very sensitive, especially in our Reserve component,
about colleagues, their access to answers as symptoms may
emerge, or as realizations about their disability, or potential
disability emerge, access to information. That is available,
too.
Mr. Tierney. Thank you very much.
I want to thank you. In fact, it was a previous member of
my staff that brought up the ombudsman situation, and you were
kind enough to accept the concept and work with him on that. He
happened to be a veteran, himself. It is amazing to me the
number of veterans that are following what is going on with the
progress on this and feel very committed to it.
I thank each of you, gentlemen, for the commitment that you
have made to helping us make sure that something is done. I
think we are all disturbed. Everybody here is well intended.
Everybody here is working hard at it. We may have some
disagreements about whether it is fast enough, whether it might
be done in a different way, or how we can improve it; but,
nobody should doubt the commitment that has been made to get
this resolved. I look forward to your cooperation, and we hope
that together we will get this expedited. We will put to it the
sense of urgency that is needed, and we will get the kind of
treatment that our veterans deserve.
Thank you all very, very much and for suffering through the
interruptions that we have had today, as well. Thank you.
[Whereupon, at 1:18 p.m., the subcommittee was adjourned.]
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