# Presentation: 563598

**UNCLASSIFIED**

**Department of Veterans Affairs**
*** ******Caring for Those Who Served in Seamless Transition***

** **

**Marianne Mathewson-Chapman PhD, ARNP**
**VA Office of Seamless Transition**

**USDOL-VETS 2007 Competitive**
**Grantees Training Conference **
**August 7-9, 2007**

**National Guard and Reserves Combat Veterans**

**Notes:**
Good morning/afternoon Ladies and Gentlemen and Distinguished Guests

I would like to highlight today the challenges of the new generation of warriors in providing VA healthcare and VA benefits to this new population.

Ladies and Gentlemen—”We are at War” and there is no greater cause than to provide world class healthcare and benefits to this new generation of veterans.

## The Reality of War

- The New Generation of Veterans Returning to Hometown America

**Notes:**
These pictures highlight the reality of war with severe injuries for female and male soldiers.  The legacy of this war is Traumatic Brain Injury due to the IEDs.  Additionally, we have other severe injuries that we have developed programs to ensure timely access to Va servcies/benefits as these war heroes transition from DoD to VA.  These SI conditions include:  
TBI, SCI, Burns, Amputees, Blind, Severe Disfigurement and PTSD

## Outline

**Seamless Transition from DoD to VA to community**
**........................****.Caring for the War Wounded**
**Categories of War Injuries**
_***Severely Injured (TBI, SCI, Blind, Amputee, PTSD, Burn) ***_
_***Medical Holdover and CBHCO:  (Warriors in Transition)***_
_***Hidden/Lingering Wounds***_
**Unique Challenges for National Guard and Reserve**
**Geographical Dispersion, State Coalitions and Role of Transition Assistance Advisors in each state**
**Outreach Programs**
**Recommendations to Enhance Employment **

**Notes:**
This presentation will identify the categories of the wounded , the Seamless Transition Process, Challenges of the National Guard and Reserve Service member, new programs and initiatives that are the result of this conflict, the deployment cycle process and VHA utilization of healthcare services.

## Transitioning from DoD to VA to the Community

**Transitioning from DoD to VA to the Community**

**Battlefield**

**VA at MTF**

** ****VA OIF/OEF**
**Program Managers**

**(2004)**

**2005**

**Recovery and Health Continuum of Care**

- State  Coalitions
- Transition Assistance Advisors
- Family Programs

**Outreach**
**PEB and PDHRA**

**Notes:**
This Collage picture depicts the Seamless Transition Process:  note the left corner is the DoD journey from the battlefield to the MTF and then transitioning to VA for further medical treatment, rehabilitation and disability benefits and then transfer to the community.  The VA is the continuum of care from DoD.

## Categories of War Wounded

**Seamless Transition Process**

**Category 1:**
**Severely Injured**

** ****11 MTF Liaisons at:**** **
**Brooke AMC, Balboa**
**Eisenhower AMC**
**Madigan AMC**
**Bethesda NNMC, WR**
**Ft. Carson, Ft Hood**
**  ****Camp Pendleton**
**   ****Gordon and CFI**

**VA full time VA Social Worker  VBA Benefits Counselor**

**Tampa VAMC**

**Transition**

**Severely Injured****:**
-   TBI
-  SCI
- Amputee
- Severe disfigurement
- Burns
- PTSD

**Category 2:**
**  ****Medical Hold/holdover**
**  ****Community Based **
**Healthcare Organization (CBHCO)**

**Category 3:**
**Hidden Wounds at**
**Post deployment**

**VA Liaisons/POC**
**VHA facilities: 157**
**VBA ROs: 57**
** ****4 Polytrauma Centers**
** ****2 WRIISC, 207 Vet Centers**

- Veterans
- Tracking
- Application

- Active Duty

- Veterans

**DoD**

**VA**

**Notes:**
Since 2003, we have determined that there are 3 categories of injuries:
Category 1:  Severe Injuries (the 5 that I mentioned)
Category 2:  Those service members who sustain an injury and just need time to heal in the recovery phase.  They remain on active duty until they are healed from their injury while being placed in a med hold status.
Category 3:  Those service member who return home with “hidden wounds” may be active duty or Guard/Reserve but symptoms continue to be burdensome and treatment is delayed. VA also has two WRIISCs for evaluating “MUS” medically unexplained symptoms at East Orange NJ and Washington DC VA.  

## Category 1:   Severely Injured

**VA Liaison for Healthcare (10 MTFs) and adding 7 more**
**Veterans Integrated Service Network (VISN) POCs (21)**
**VA Medical Center OIF/OEF Program Manager at 157 VA facilities**
**OEF/OIF Case Managers**
**Transition Patient Advocates (TPA)**
**VBA Regional Offices OEF/OIF Coordinators in each state-57**
**Readjustment Counseling Services (Vet Centers 206+) for outpatients**
**VA Inpatient mental health/suicide prevention coordinators**

**New Positions at MTF, VAMC and Regional Office **

**VTA**

**DoD**

**VA**

- VTA

## New DoD/VA Medical Center Positions

- VA Liaison
- Healthcare
- at DoD

**VA and Community**

## Category 2:  WTU/Med Hold/CBHCO

**Continued Care at Military Treatment Facility. Case management in Warrior Transition Unit (WTU) **

**Reserve/Guard may live at Home, receive rehabilitation at VAMC near home. Case management from CBHCO**

**Military Treatment Facility and Warrior**
**in Transition Units (WTU)**

- Active Duty

**Live at Home**

**Treatment at ****local**** VAMC**

**Guard/Reserve with case**
**Management from community based health**
**Care organization (CBHCO)**

**MEB/PEB determination**

## Category 2: Warrior Transition Units                                    

**Community Based Health Care Organizations (CBHCO)**

**PR**

**CBHCO Detachment and **
**Case Manager Locations**

**Arkansas**
**(KS-LA-MO-NE-OK-TX) **

**California****(ID-NV-OR-WA)**

**Florida**
**(GA-SC)**

**Massachusetts**
**(CT-ME-NH-NJ-NY-PA-RI-VT)**

**Wisconsin**
** ****(IA-IL-IN-MI-MN)**

**Utah****(AZ-CO-MT-ND-NM-SD-WY)**

**Virginia****(DC-DE-MD-NC-OH-WV)**

**Alabama****(KY-MS-TN)**

**8 Sites**

**Active Duty Status with Maximum 300 per site**

**Sacramento**

**Riverton UT**

**Camp Robinson, AR**

**Huntsville, AL**

**Orlando, FL**

**Virginia Beach, VA**

**Concord**
**MA**

**Rock Island Arsenal, IL**

- Guard/Army Reserve

## Former Active duty now veterans.............292,289

| Mobilized:  88,084                   Demobilized:  534,965                         Total:  623,049 |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Reserve 
Components | ARNG | USAR | ANG | USAFR | USNR | USMCR | USCGR | Total |
| Currently
Mobilized
 | 49,535 | 27,643 | 945 | 276 | 5,087 | 4,297 | 301 | 88,084 |
| Demobilized 
To Date:   | 240,529 | 147,578 | 35,375 | 32,418 | 33,432 | 36,763 | 8,870 | 534,965 |
| Total 
Mobilized 
To Date: | 290,064 | 175,221 | 36,320 | 32,694 | 38,519 | 41,060 | 9,171 | 623,049 |

**Reserve Components:  Noble Eagle**
**Enduring Freedom and Iraqi Freedom**

- ++Includes Mobilized and Demobilized more than once

_**Mobilized:**_  Involuntary active duty in a Federal Status (10 USC 12302)
-  that authorizes the use of Reserve Forces for up to 24 months

- 18 July 2007  Services Daily Mobilization Report

## Slide 11

**Notes:**
This slide shows the aging force of the reserves.  As you know you can stay in the reserves from age 18 to 60 years.  You will see the % of soldiers, sailors, airmen, marines who are over the age of 40 and the potential for experiencing chronic diseases (hypertension, CAD etc, while continuing to fight in this war.

## VA and NG State Coalition

- Meeting the Needs of the Guard/Reserve

**VA and NG State Coalition**

- MOU between VA and NG (May 2005)

**Access to Troops and Families of National Guard**

**Notes:**
How are we ensuring that outreach efforts and the delivery of services are “attuned to the Guard and Reserve” ?.  We have been actively engaged in outreach initiatives to identify Guard/Reserve personnel who do not take advantage of the scheduled Transition Assistance Program (TAP) at the mobilization station:
Outreach efforts since 2003:
 Briefings to the senior leadership (Guard/Army Reserve) and field commanders and senior NCO’s
 Letters , brochures and toolkits from the Secretary to all Adjutants General (NG) and Reserve Chiefs in the Army, Navy, AF, Marines, Coast Guard about VA services
 Briefings to the VA senior leadership to understand the impact of serving in this war and the special needs of the Guard/Reserve
 Briefings and handouts to Family readiness groups in the Guard/Reserve
 Formation of the Joint Working Group:  to ensure integrated service delivery strategies are provided and the formation of a VA and NG partnership.
 Locating returning troops who live in remote areas which are at a distance from VA services and VHA/VBA facilities as well as IMAs who return to their community with limited information on VA benefits.
 Viewing of the “We are by Your side” video to Guard/Reserve units and family readiness conferences as well as distribution of brochures and wallet cards.

## Why High Risks for Guard/Reserve

- Guard/Reserve Units are dispersed to remote areas
- Limited family support programs in community
- First deployment and multiple deployments
- Leave civilian jobs for 1 1⁄2 years and frequent mobilizations
- Post-Deployment readjustment issues and the
-                             stigma of mental health
- Demobilization station is not near hometown/community
- Hometown is not near NG/Reserve armory or VA (rural)
- Service related disabilities:  delay in tx or claims
_**Returning Home:  High divorce rate, jobless**_,
- Homeless and delay seeking medical/mental health
- Lack understanding family/employer of challenges
- Limited knowledge of VA healthcare/benefits
- Display high risk behaviors and alcohol/drug abuse

**Notes:**
There are many challenges for the Guard and Reserve Service members:
First deployment
Lack of family support in their community
Leave civilian jobs for 1 1⁄2 years
Older population chronic diseases  (26-28% of the Guard/Army Reserve are over age 40)
Living in remote areas of the state and not near their unit
Potential social issues:  homeless, divorce, jobless, alcoholism, mental health, domestic violence and high risk behavior.

## NG/VA TAA’s Network 

**NGB/VA**
**Liaison**
**NG Joint Staff**** **** **

**National Guard**
**STATE JOINT FORCE HEADQUARTERS**

**VA/NG Transition Assistance  Advisor**

**State Directors**
**Of VA**

**Adjutant**
**General**

**Governor’s**
**Office **

**VA Services**

**NCA**

**VBA**

**NG/VA TAA’s Network**** **
**Services  and Benefits **

**POC**
**VISN/RO**

** ****State VSO**

**County  Service Officer**

**OSD **
**MSIC **
** **

**TRICARE**

- Family Readiness
- Volunteers

- Army
-  Community
-  Svce

- WFPC

** **

- ESGR

- Financial
- Services

- FACs

**NG **
**Chaplains**

**Civilian **
**Medical Community**

- SFPD

**AW2:  **
**Marine4Life**
**Safe Harbor**
**Palace HART**

**National**
**Guard **
**Services**

**DoD**
**Services**

**Returning to the State:  All Service Members and Family**
**and the Safety Net**

- Child and
- Youth Svce

**Training**

**Support**

**Information**

**Services**

**VHA**

**Fed, State, Local **
**& Private Orgs.**

**Legal**
**Services**

**Military Medical**
**Community**
**Medical Hold**
**(CBHCO) **

**VISN**** **

** ****National**
** ****VSO**

**Community Services**

**State Mental**
**Health and **
**Substance **
**Abuse Svce**

**Community**
**Mental**
**Health Svce**

**Military**
**One **
**Source**

**VA/NGB**
** ****Liaison**
**VA Office of Seamless **
**Transition**

**206**
**Vet**
**Center**

**VISN**
**Mental **
**Health**

**VBA RO**

**VAMC**

**MTFs**

- Education

- Loan G

- Insurance

- VRE

- C&P

- OIF/OEF
- PMs

- TPAs

- Case Managers

- DOL

- Women
- Health

- Women
- Benefits

- Family
- Programs

**Notes:**
To further emphasize the critical role of the State Benefits Advisors (SBAs) and the state coalition, the bubbles highlight the role of the NG in each state using the Joint Force Headquarters.  The SBA is instrumental in facilitating the development of a state MOU and a state coalition or network to integrate  community and VA services and benefits into a coordinated effort to assess, refer and evaluate the effectiveness of meeting the needs with a variety of services and benefits at the local level

## Support for Members/Families the State Level

**Support for Members/Families**** the State ****Level**

***Education***

***Monitor***
***Homeless***
***Employment***

***Rehabilitation***

**Transition Assistance **
** ****Advisors (TAA)**

***Disability***
***Benefits***

**State Veterans Affairs Directors**

**Family Programs**

**Coordination**
**With**
**Family Programs**

***Counseling***

***Health Care***

**Coordination**
**With CBHCO**

**57**

## Brochures:
Summary of Guard/Reserve VA Benefits
VA Benefits Wallet Cards
VHA summary of Healthcare
OIF/OEF Newsletter on healthcare
Vet Center and Women’s Health Program
MOU with National Guard and Initiatives with other Reserves
Training tools: 
Veterans Health Initiatives(VHI series)
My HealtheVet, Webpage, Displays, videos 
Training conferences:
VA/Transition Assistance Advisors (Feb 2007)
Evolving Paradigms National Conference (2007)
Letter from Secretary VA, USH,USB to:
Service Member 
Adjutants General
RO/VISN and VAMC Directors

- Summary of Guard/Reserve VA Benefits
- VA Benefits Wallet Cards
- VHA summary of Healthcare
- OIF/OEF Newsletter on healthcare
- Vet Center and Women’s Health Program
- MOU with National Guard and Initiatives with other Reserves
- Training tools:
- Veterans Health Initiatives(VHI series)
- My HealtheVet, Webpage, Displays, videos
- Training conferences:
- VA/Transition Assistance Advisors (Feb 2007)
- Evolving Paradigms National Conference (2007)
- Letter from Secretary VA, USH,USB to:
- Service Member
- Adjutants General
- RO/VISN and VAMC Directors

**Toolkit**
**Office of **
**Seamless**
**Transition**

**      ****Outreach Toolkits for VA Education and Awareness         ****	****Campaign to Veterans, Families and VA Staff**
**                        **

**Video**
**Broadcasts**

**Brochures**

**VHI**

**WEB**
**PAGE**

**Training**
**Programs**

**2 years if free**
**VA healthcare**
**for service**
**related illness/injury**

**90 days **
**For **
**Dental treatment**

- _[http://www.va.gov](http://www.va.gov/)_

**    **Education/Awareness Campaign
-  Plan and Communication/Distribution Plan
-  for Outreach to Guard/Reserve and family
-   **New Technology:  Webcasts, Podcasts**, **Multi-Media Technology for electronic toolkits**

**Notes:**
  We recognized early in the war that returning service members had limited knowledge of VA benefits and services that they were eligible to receive.  
  We began a robust outreach program with both VHA and VBA staff, Vet Center Staff and working with family programs.  Letters were sent to Adjutant Generals in each state and Reserve Commanders.  Brochures and wallet cards were developed to distribute to troops as well as a video called “WE are By Your Side” This video highlights that .it just takes time to readjust and there are many DoD and VA services that can help during this readjustment period.
  Battlemind Training:  Vet Center staff use this model in outreach efforts to assist Warfighters transition from the battlefront to the homefront.

## Recommendations

- Education and Awareness of  Service Members, Family Members, clinicians, federal and state employers
- Longitudinal Study on employment challenges
- Closer links of Employment Specialists with ESGR Coordinators at VAMC with OIF/OEF Program Managers
- Participating with the state coalitions and MOU
- Employment Coordinators participate in PDHRA events, family programs, job fairs, reunions, and unit events
- Support legislation for home station reintegration
- Closer ties with VA VRE programs
- Robust Reintegration Programs at home station

## QUESTIONS ?

**VA Office of Seamless Transition**
**202-273-7822**

- Caring for Guard/Reserve Through ...................Seamless Transition ** **

**Notes:**
John and I :  Thank you all for having us here today and to share the many new initiatives that have been developed as part of the seamless transition process.  We continue to learn each day better ways to assist in the healthcare and benefits needs of our true heroes in this GWOT.  Thank you

## 2007 Task Force, GAO and Commission Reports to the President

- Togo West’s Commission on Care of War Wounded at Walter Reed
- VA Secretary Nicholson’s:  Returning GWOT Heroes:
-         25 Recommendations
- Bob Dole Commission Final Report
- GAO reports

## Resources

**Basic VA Benefits Questions:  **
- _[www.va.gov](http://www.va.gov/)__  or 1-877-222-VETS (8387)_
**VA Office Seamless Transition- ****(202-273-7822)**
**DoD VA Program Coordination Office ****(703-681-0039)**** **
**Military Severely Injured Center (****1-888-774-1361)**
**         **_[severelyinjured@militaryonesource.com](mailto:severelyinjured@militaryonesource.com)_
**Army Wounded Warrior Program ****(1-800-833-6622)  **_[www.armyds3.org](http://www.armyds3.org/)_
**Marine for Life ****(1-866-645-8762) **_[injuredsupport@M4L.usmc.mil](mailto:injuredsupport@M4L.usmc.mil)_
**Air Force Palace HART ****(1-888-774-1361) **_[severelyinjured@militaryonesource.com](mailto:severelyinjured@militaryonesource.com)_
**Navy Safe Harbor ****(1-888-774-1361)  **_[severelyinjured@militaryonesource.com](mailto:severelyinjured@militaryonesource.com)_
**Military One Source ( 1-800-342-9647)    (24/7)  **_[www.militaryonesource.com](http://www.militaryonesource.com/)__   _

**Notes:**

The following are a list of important numbers and resources for DoD support as well as the main number to call concerning VA Benefits.

You are all aware of the militaryone source.com---again another great resource for counseling and support for returning service members and family.

## VA OIF/OEF Healthcare Utilization Summary

-         **SW Asia Veterans Who Separated From Active duty:**
- 	  **631****, 174 OEF/OIF veterans** and are eligible for VA care 				       since FY 2002-2006
-           _Totals                     Use VHA                  Component_
-      292,289):          (101, 259)        Former Active duty
-      147,020):          (41,090)           Reserves
**     **_191,865)           (62,739)           National Guard_
-       631,174                    205, 097
**  ****	****32% or 205,097 evaluated by VA from 2002-2006**
***  ******	******represents 4% of 5.3 million veterans in any one year ***
**	****	****     ****	**
** ****Total Female Veterans:  ....   65,231**
**% Combat Women Veterans**
**            ****enrolled in VHA care.........36.2% (****3rd quarter 2006)**

**Notes:**
Quarterly we monitor healthcare utilization of the OEF/OIF veterans accessing services at VA.  The following numbers document those OEF/OIF veterans who have separated from active duty:

44%  Former active duty
56%  Guard and Reserve

31% (184,524) of the above eligible veterans are accessing VA for their healthcare needs