House Committee on Veterans' Affairs

On Tuesday, March 17, 2009, the House Veterans’ Affairs Oversight and Investigations Subcommittee, led by Chairman Harry Mitchell (D-AZ), conducted a hearing to evaluate the progress the Department of Defense (DOD) and Department of Veterans Affairs (VA) have made on the Vision Center of Excellence (VCE) and how it has affected veterans in need of vision care.  The Subcommittee assessed the efforts of the agencies as they work to ensure a seamless continuum of care for service members and veterans who have suffered eye injuries. 

The Vision Center of Excellence was created through the National Defense Authorization Act of 2008 (NDAA).  The NDAA mandated that “[t]he Secretary of Defense shall establish within the [DOD] a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of military eye injuries…”  The VCE is still in the planning phase and minimal execution has occurred.  Today, thirteen months after the enactment of the NDAA, there is no physical structure identified, no computer hardware, and no support staff.  The two individuals identified to coordinate this center, Colonel Donald Gagliano and Dr. Claude Cowan, are the only employees.  DOD states that $3 million has been allocated to create this center, however minimal money has been spent to create the VCE.

“Today, we will hear from a number of veterans and their families about the difficulties they have experienced receiving vision care after suffering eye injuries on the battlefield,” said Chairman Mitchell.  “While I am confident that the VCE will ultimately provide care for our veterans, I am disappointed to learn that delays leave veterans feeling as if they have been left in a void and they do not know where to turn for treatment.  It took almost seven years for veteran Gil Magallanes to be introduced to his Vision Impairment Services Team Coordinator.  It is unacceptable that veterans are made to wait.”

The injuries of Operations Enduring and Iraqi Freedom are shaped by the widespread use of improvised explosive devices (IED).  IEDs increase the likelihood that active duty service members will be exposed to incidents such as blasts that can cause traumatic brain injuries (TBI) and other debilitating injuries.  Visual problems from TBI are often overlooked during initial treatment of injury.  Frequently these problems are hidden or neglected, lengthening and impairing rehabilitation.   Because there is a close relationship between vision and the brain, TBI can disrupt the visual process, interfering with the flow and processing of information.  The result can be a TBI related vision problem.

The numbers of vision injuries coupled with TBI related complications vary depending on which agency is providing the reports, and there is not a consistent number reporting TBI vision issues amongst the VA and DoD.  In November 2008, the Military Surveillance Monthly Report contained an article from DOD on eye injuries among members of active components (U.S. Armed Forces, 1998-2008) that reported 4,970 perforating and penetrating eye trauma cases, 4,294 chemical or thermal burns, and 686 damaged optic nerves, most of which were from among OIF and OEF injured.  Early reports from Operation Iraqi Freedom showed that 13% of all wounded service members that required air medical evacuation had sustained combat penetrating eye trauma.  As of September 2008, Veterans Health Administration reported 8,747 diagnoses of TBI with approximately 7,500 in diagnostic testing for possible TBI.

“Transmission of electronic medical records between the Pentagon and VA is critical for the continuum of care of our wounded warriors,” commented Bob Filner (D-CA), Chairman of the House Committee on Veterans’ Affairs.  “The Vision Center of Excellence is intended to ensure that veterans receive state-of-the-art treatment without having to deal with the overly bureaucratic process during rehabilitation.  Already, VA Secretary Shinseki and Defense Secretary Robert Gates have begun working together to implement new cooperative approaches to better care for injured veterans.  I am confident they understand the sense of urgency that is felt by our veterans.  We cannot wait any longer to put this plan into action.” 

Witnesses:

Panel 1

• David William Kinney III, Deland, FL, Operation Enduring Freedom Veteran
• Gil and Sherry Magallanes, Clarksville, TN, Veteran and Spouse
• Specialist Travis Fugate, USA (Ret.), Hindman, KY, Operation Iraqi Freedom Veteran)
• Thomas Zampieri, Ph.D., Director of Government Relations, Blinded Veterans Association

Panel 2

• James Orcutt, M.D., Ph.D., Chief of Ophthalmology, Veterans Health Administration, U.S. Department of Veterans Affairs
• Madhulika Agarwal, M.D., MPH, Chief Officer, Patient Care Services Officer, Veterans Health Administration, U.S. Department of Veterans Affairs
  Accompanied by:
        Claude Cowan, M.D., Deputy Director, Military Eye Trauma Vision Center of        Excellence, U.S. Department of Veterans Affairs
• Colonel Donald A. Gagliano, USA, M.D., Director, Military Eye Trauma Vision Center of Excellence, U.S. Department of Defense
• Jack Smith, M.D., Deputy Assistant Secretary of Defense for Clinical Policy and Programs, U.S. Department of Defense

Prepared testimony for the hearing and a link to the webcast from the hearing is available on the internet at this link: http://veterans.house.gov/hearings/hearing.aspx?newsid=361.   

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