good morning and welcome to the subcommittee on oversight investigations hearing on transitioning heroes a new era same problems this meeting will come to order january twenty first two thousand and ten i ask unanimous consent that all members have five legislative days to revise and extend their remarks and submit a statement for the record there are no objections so ordered i would like to thank everyone for attending today's oversight and investigation subcommittee hearing in title transitioning heroes new era same problems thank you especially to our witnesses for testifying today we're here today to address what both the department of defense and the department of veterans affairs are doing to assist the men and women of our armed forces to  seamlessly transition back to civilian life time and again we have heard from our returning service members expecting a smooth transition back to the lives they once lived only to find themselves lost in a complex and frustrating  today we will hear from a severely injured veterans shawn johnson who was hit by a mortar round in iraq and is now completely blind although he has received excellent treatment at the rehabilitation center in chicago he was never assisted federal care was never assigned she's me a federal care coordinator after contacting the v a almost a year ago in addition staff sergeant johnson and his family are experiencing the hardships of navigating through both the d system and the v a systems at the same time this is just one example of many staff sergeant johnson joins those veterans and their families who share the same concerns that are veterans service orders voice here today additionally as i  to proactively bring the v a to our veterans as opposed to waiting for the veterans to find the v a this is a critical part of delivering the care they have earned in exchange for their brave service the v a should be a place where veterans can easily and with confidence go for the help they seek but the v a must also be willing to reach out to those veterans affecting outreach will not only ensure better to every service and for veterans but will also increase morale i am hopeful that today both the v a what they are doing to make certain our veterans are receiving the best possible care available they're being provided with the services and resources they have earned and most importantly that the two departments are working together to ensure that these benefits ar seamlessly delivered i believe that all my colleagues join me in being steadfast in our hopes that secretary shinseki as he transformed the v a into a twenty first century organization will help eliminate the stigma that so many of our nation's veterans have placed upon the v a we must ensure that both the v a and deal d are working together in providing veterans the services they rightly deserve again thanks to all of you are witnesses for testifying today and we look forward to hearing your testimony before i recognize ranking members for his remarks i would like to swear in our witnesses i ask that all witnesses stand and raise a right hand country not only their military service but their continued service by appearing here today to share their testimony and help us work towards a better transition for our nation's veterans prior to this hearing my staff provided it with a list of the hearings held by the committee on veterans affairs over the past ten years totaling around thirty three hearings the topics have range from employment transition through the use of public trauma centers pre and post deployment health assessments sharing of electronic health record of our wounded service members transition assistance programs for guard and reserve forces and the list goes on as you can tell helping our service members move from the military to civilian life is of great importance to this committee concern in congress about helping our service administration and department defense health resources sharing and emergency operations act this act created a v a care committee to supervise and manage opportunities opportunities to share medical resources today's hearing will enable the committed to review the various programs that have instituted have been instituted to assist our nation's veterans and wounded warriors in their transition to civilian life we'll be looking forward not only at the medical record exchange between v a and d o d but also at the various other transition services the use of poly trauma centers across the country and programs available to assist our veterans this is not the first hearing to look at these items and i am certain it will not be our last we here in congress must do everything we can to make certain that the transition our military personnel on the go is smooth easy and the programs available are truly helping our nation's veterans in the past it appears that any transition many service members have encountered have not been exactly seamless and certainly not easy or smooth statement to the record but i want to thank both both of you for holding this and for our witnesses for being here there's nothing more important that we do than the care for our veterans and many of you in this room and i know my my colleagues up here heard me talk about seamless transition till they're blue in the face there might be a reason for this i just heard dr ro talk about when we first started talking about this here that's before i started basic training and did a twenty five year career and took some time off and came to congress and here we said today still talking about it it is unacceptable it is not getting the care for our veterans it's costing this country money and it's undermining the faith in what we do for them we have the capability we have the technology i am absolutely convinced that this is the fundamental systemic issue on claims backlogs on on many other issues and so i i want to congratulate chairman the ranking member once again for tackling this issue it's complex and all of you will testify today know that but when we hear from staff sergeant johnson and i think you're going to hear some of the issues no one in this country thinks that's acceptable no one thinks it's acceptable and the problem with that is is that i think tom's empirics out there somewhere in the blinded veterans of america they can predict this every time what's going to happen and they tell us exactly what the pitfalls are exactly where the veterans going to fall through the cracks and then they give us suggestions on how to fix that and i hope now that this is the time it feels like the momentum is there and so i look forward to hearing from our witnesses on on ways we can correct this i yield back thank  you tom i'd like to welcome panel one to the witness table and join in on our first palace staff sergeant shawn johnson an operation iraqi freedom veteran from south dakota joseph wilson deputy director of health care national veterans affairs and rehabilitation commission the american thomas legislative associate for iraq and afghan of america and captain jonathan pruden area outreach coordinator for the wounded warriors project each will have five minutes to make a presentation but i also want them to know their complete statement i will be interested to the record but please keep it to five minutes and i will ask in this order the speakers sergeant johnson mr wilson disclaimer i'm not here in a military capacity and here as a veteran and private citizen my name is shawn johnson i'm thirty eight years old  i'm a three time deployed vet persian gulf bosnia and iraq and i was deployed to iraq on october nineteenth two thousand and five and between october nineteenth two thousand and five and march twenty fifth two thousand and six i was exposed to four mortar blasts within thirty feet and rocket blast also within thirty feet on march twenty fifth two thousand and six i was exposed to a mortar blast ten feet away i remember a bright light and a loud boom and that's it blew me three feet in their back and landed on my shoulders and my neck i was have received damage to my c spine from c one to see seven i got up before i got up i was kind of paralyzed i didn't know what was going on another mortar as i looked through my feet another mortar hit twenty five feet away the other blast i was able to shake it off this blast i couldn't i didn't hear it for almost a day i was dizzy confused i couldn't see eve in the distance i couldn't see at night i had headaches and abdominal pain and then i went into the hospital on  may of two thousand and six and i was there for seven days the trauma surgeon was in charge of my case and they concentrated on the abdominal pain sent me back and forth to germany twice and they couldn't figure it out and they said it's got to be well in between these trips to germany they gave me antibiotics and stopped antibiotics so i ended up with a serious infection and i was sent back to the states to fort riley kansas i was placed on the med hold there  there was all kinds of problems there i had to watch seven congressional complaints and i was told at one time that if i stopped talking to my congressman they would actually treat me  fort riley the doctors there want to take care of their patients they don't want to make referrals they don't want while to read or to evaluate their patients they want to treat in themselves type of an ego problem i believe after the congressional complaints i did receive treatment at walter reed for pain and at that time created they said my case was too complex and they couldn't help me anymore and the reserves their hands are tied i have had a m e b waiting for two years and i just started it now and they told me it would take another two years to get through it and they're making me drill and basically i go to drill and they pay me to sit in a small room to do nothing i had not got the any transition of care i wasn't contacted by a federal court recovery coordinator i wasn't contacted by anybody i had to copy my medical records on paper take them to the v a and at that point they entered him into their system and they started all over again checking the abdominal pain and then some somebody referred me to the poly trauma doctors because of the blast injury and they said well you have a head injury you have severe p t s d and at that point i was treated and then my vision loss came about a year later i was seen by one of thomas tristen a couple and a couple of ophthalmologist they said my eyes are fine panel said that doesn't count and my question is why they spend thousands of dollars to get an expert opinion and they don't use it so you're going through exams unnecessarily over and over again before you get your benefit and that just adds to the backlog not only that but if they keep going back to a lower level of care they won't they won't be able to correct the problem and it really bothers me that it took twenty one months to figure out twenty one months i went through all the treatment i went through part of them and it took them twenty one months to discern that it was a traumatic brain injury and that's really scary because you can't get the treatment that you need timely enough to benefit you the federal coverage coordinators we didn't even know about them nothing was ever said to us and four years later i got a call from one last night  i brought my paperwork they will know what's going on and there's a lot of young soldiers that don't know that don't know to copy the paperwork or are given the opportunity to stand get their disability they're given a severance check and sent off i know what's happened several times i've talked to people in the med holds about it and it's just shameful you know they put the burden on the v instead of taking care of the soldier and then transferring him there's no seamless transition it's just not there and there's a one of the suggestions that i have a vision center of excellence needs to be staffed and needs to be the building needs to be created at bethesda and they need to get that done they were given six million dollars in the last round of of money that was handed out and nothing has been done they need to get that building up they need to get the staff because they're the ones who are going to do the trauma research and the i research which is what the injuries are coming out of iraq and afghanistan the number of injuries is staggering and it's happening two years after the injury so it's not something that happens right away and the scary part is the benefits if you are past seven hundred thirty days they don't pay out the money and that's a legislative thing the d o d put that disclaimer in there well if you're have iron juries and you go blind to it after years later there's no no help for you and that's the money that's supposed to help you get started on getting your house done get your bills paid and the other thing that i would like to see and i think it would help is the care bill and i believe that was brought up and it's in the senate and the house my wife has given me tremendous care and looked out for me and it's really a strain strain on my children a strain on her work and she may end up losing her job because to be gone all the time to take care of me i can't go to doctor's appointments without her because i don't remember what goes on and i suggest that that may be a fix and there needs to be a red flag system there needs to be for t b i and seriously injured soldiers they need to be in pol trauma care and they need to be taken care of and not a year down the road the federal recovery coordinators they need to be there right away to make sure that the patients are getting the care they need because up until now there's hundreds maybe a thousand soldiers like me who get left left behind it's unacceptable you've got people that aren't getting the care they need and they're getting left behind or slip through the cracks and you sit there for four years to get a med board that probably takes three days four years later i was injured on the battlefield four years later give me a purple heart you know things like that we're soldiers are waiting and there's a lot for that the  needs to get the soldiers to the care and the doctors are strained the doctors are strained the nurses are strained because of the overloaded system and i understand they added four four or five recovery coordinators how effective is that i guess the biggest thing i want you to know is people are falling through the cracks and that this needs to be addressed and the federal recovery coordinators they need to have access to get this taken care of the severely injured soldiers can't wait you know if you're blind the v a if you're not permanent and total they won't give you the benefits of a payment of how they give a certain amount of money for your house to be structured they won't they won't give it to you unless you're permanent total all blind soldiers need to have that money so that they can make their houses and their lives better not to wait endlessly through exams and exams and exams to finally get permanent in total that need to be done right away there's five ophthalmologists neuro ophthalmologists in the and i hope that by my testifying today that some of the prob are out there and you can come up with ways to help and i hope that my testimony  helped bring things to light and i speak for myself not for myself today but for all the soldiers that can't be here that are falling through the cracks and not getting the care they need and not getting the they needed timely manner and i want to thank you for the opportunity to be here today and i will answer any questions that i can and i appreciate you giving me a little extra time to give my testimony as it's a little difficult to summarize when you've got a vision problem that's all i have and answer any questions that i can thank you thank you very much mr wilson chairman mr mitchell members of the so committee i thank you for the opportunity to present the american legion's views on seamless transition issues currently there are approximately twenty three point four million veterans in the united states of that total seven point eight million i enrolled in the v a health care system v a treats five point eight million veterans and more than one hundred fifty hospitals and eight hundred plus clinics as we examine the transition process the american legion in its efforts to ensure travis new service members receive continuous life seamless care has determined that veterans a face and various challenges which make your vocal bleed deter any chance of a successful and smooth transition back into their local communities an example of challenges include incomplete post deployment health reassessment questionnaires a p d f or a inability to fully share medical records among the the department of defense and a health care facilities lack of space that we a medical facility and shortage of staff to include nurses emphasis and v a in the odp both play important roles in the transition process as women return from iraq and afghanistan facing uncertainty with injuries and illnesses the american legion contends that closer oversight must be placed on various programs such as the p d h r a and federal coverage of coordination programs or the f r c p that have been implemented to ensure no one fall through the cracks we ask congress to assess those these whorls to ascertain the appropriateness of functional tools required to accommodate the nation's veterans their families and the complex issues they are met with the odeon v a are have created and implemented various programs to support each service member and veteran as they transition from active duty to civilian life to include the ph r m a the ph a program was established to identify and address servicemembers health concerns that emerge over did not contain question as for possibly twenty three percent of of the three hundred nineteen thousand of operation enduring freedom operation iraqi freedom service members who returned from theater this means approximately seventy two thousand service members were without question as in the repository the response to the absence of the question has concluded the does not have reasonable assurance that service members to whom the p h y requirement applies were given the opportunity to fill out the questionnaire and identify as well as address health concerns that could emerge over time following deployment the american legion believe the administration of the p t a is essential to the success of the servicemembers transition because the results would disclose telltale signs of the bill taken ill and illnesses such as the disorders that plague many veterans who have gone on diagnosed as separation from active duty next the federal recovery coordination program the american legion would also like to ensure that the f r c p a successfully a system all recovering service members and veterans suffered from suffering from severe wounds illnesses and injuries as well as their families in the system the care service in the benefits provided through specifically da m b a now there are more challenges tr transition into service members and veterans face they have been various reports of critical challenge challenges involving veterans who have recently departed from active duty service these challenges as reported by rand include barriers to mental health care access and community settings more to specify i would discover that military service members and veterans are often reluctant to seek mental health care the mental health workforce has insufficient capacity the american legion recently passed a revolution number twenty nine improvement to implement a famous transition which recognized gaps in services and have consistently advocated improvements be made to the process of service members in their transition from active duty to civilian life to make a leader continues to express their service members and their families are easily overwhelmed when dealing with were accuracy of multiple deployed apartment however a more expeditious process that explicitly focuses on moving service members from point a to point b a b o d to be a respectively would ensure timely and accessible care the american legion believes this extremely vital that the nation this nation service members before their departure should be placed in a comparable full duplex capable of fully compatible deal these last be a database with a partner miles to ensure their transition isn't stifled by the unknown after all the service active duty service members have been conditioned to be directed to all military appointments and event upon separation from service these newly transitioned veterans may heighten most importantly be complete complete shared by complete shared access to medical records of service members and veterans as well as assessment of this relationship let us remember that there is no pause button for veterans every moment is critical  must be treated the such although the world war two veterans population is diminished at approximately one thousand daily of the veterans to include those from the vietnam era to current prison and to v a with old and new issues complacency and communication into the community thank you thank you mr carrington mr chairman ranking member and members of the subcommittee half of iraq and afghanistan veterans of america's hundred eighty thousand members and supporters alike thank you for the opportunity to speak for you today as i know i have veteran was ten years of service in the army i have seen firsthand the difficulties that many veterans face when transitioning from service member to veteran for both the wounded warrior who was torn from service due to their extraordinary sacrifice or the young veteran who spent most of their formative years in uniform the transition can be difficult at a time when most of our civilian peers have begun to hit their professional stride many of us now must start over and this transition is felt by all but none more acutely and the brave men and women who have sacrificed blood and limb for the country in who now must enter a war world that does not fully understand their needs veterans of iraq and afghanistan may regularly receive excellent care in the ever expanding poly trauma system and while these centers can provide excellent care for service members and veterans there is a noticeable drop in the quality of care when transitioning to community based institutions near the veterans home  additionally the quality of services for disabled veterans near their home generally does not match the standards of care that a veteran receives at a poly trauma center and nowhere is this more true for veterans who are in the national guard and reserve component additionally i v  s concerned with the structure of some adaptive services benefits that many veterans use after leaving polly from a care veterans are being forced into debt because of shortcomings in the benefits and services that the v a provides currently benefits for adaptive housing automobiles are stuck at one thousand nine hundred seventy s funding levels and most are just one time deals with about eighty percent of all veterans under the age of thirty a veteran living with permanent disability when more than likely require more than one automobile in his or her life the current rate may have bought a van equipped with the death of modifications back in one thousand nine hundred seventy two today that same amount might get you a mid sized kiya with no adaptive technology these veterans are left to pay the difference and we cannot tolerate a benefits system that requires a veteran to incur debt just perform everyday functions also many veterans wounded in iraq and afghanistan are not homeowners and must return to their family homes to recover their then faced with the choice during the critical time in their recovery to choose between adapting the home that they are recovering in or say that benefits for the home that they will eventually settle the need for these services is obvious and the figures that require upgrading are absolutely kno so there is no excuse for leaving a veteran with substandard benefits be a social workers play an indispensable role in the treatment of veterans recovering from multiple traumatic injuries the v a must rapidly expand their numbers as more and more enter the v a health system their overall needs will continue to inundate the overworked and understaffed cadre of social work professionals within the v a system private sector social workers on average work on a case worker to client ratio of one to ten to one to fifteen in comparison in house v a social workers operate a ratio near one to thirty five the v a must address this issue before ratios expand even further and these caseworkers cannot properly address the needs of our veterans and their families under the current crushing workload for spouses and dependence of veterans who gave the last full measure of devotion to this country the v a provides educational benefits under chapter thirty five the survivors independent educational assistance act in two thousand and eight the v a reported that over eighty thousand family members took advantage of this program more than the number of reservists using chapter sixteen zero six and unlike the generous nine eleven post nine eleven g i bill or the recently increased montgomery g i bill provides a paltry sum of just over nine hundred dollars a month which will cover less than sixty percent of the cost of an education i have you believe the da benefits should be aligned with those of the new g i bill and if we don't what will end up having is a two tiered benefit system one tear our family members were able to attend college because they qualify for the master going to resign or they're going to be sergeant fry scholarship one of the post nine eleven g i bill the second tier of those forced to use the must take out student loans just to pay for community college since two thousand and eight we have seen a noticeable shift in how the v a educates ben veterans about the benefits and services that we are talking about today and i've personally met with representatives from the v a the v a and the v a business office to discuss how they can better reach out to veterans of iraq and afghanistan and there has been a visible improvement with online and television advertising but there is a clear lack of coordination between these departments within the v a i firmly believe that there is talent will and desire to change the passive nature of communication however there are still substantial cultural and structural hurdles that need to be overcome i believe that in order for the v a to conduct a fat affective outreach to let these veterans know what is available to them it must centralize its efforts and speak as one department of veteran affairs the average veteran doesn't understand the difference between the average american certainly doesn't understand why wait entire semester for my g i bill check the comm i'm not upset at the v a i'm upset the v a when i wait two months to get a medical appointment i'm not upset at the v a i'm upset at the v a if the v a ever wants to effectively improve its communications it must speak to the veteran population the american people clearly and avoid government jargon thank you once again for the chance to communicate our opinions on several of the issues facing veterans of iraq and afghanistan we look forward to continuing to work with the committee and i appreciate your time and attention thank you thank you mr president mr chairman members of the freedom i've made the transition myself now after twenty operations of seven different hospitals including their potations of my right leg work as an area outreach coordinator for the wounded warrior project i work with hundreds of warriors around the southeast covered florida georgia alabama south carolina or the past six years i witnessed d o d and v a making significant strides in coordination and information sharing this subcommittee study focus on these issues has helped to achieve greater seamlessness for our wounded warriors but even the most well coordinated seamless handoff from d o d to v a will not change the fact that for many wounded warriors this transition feels like they've been thrown off a the two departments can take pride in certain areas of real progress when two wars leaving the service continue to face programatic cultural and structural barriers at the v a it is critical in our view that these very serious be toppled and that key v a programs and service delivery mechanisms be reengineered with the goal of having wounded warriors thrive physically psychologically and economically currently v a does not provide wounded war anger depression unemployment lack of employment opportunity and lack of permanent housing in some cases these issues and behavioral health problems have resulted in run ins with the law  programs targeted as specific problems but little in the way of a holistic coordinated approach to turn these lives around it must move in the direction of providing wraparound services to integrate the work of v a s health and benefits administration much work also needs to be done within those administrations to make existing programs more veteran centric let me cite a few examples too many veterans under v a care for p t s d or other mental health conditions are still simply being given pills to manage their symptoms despite a policy that emphasizes the goal of recovery and rehabilitation rather than just some to management this needs to change oh yeah veterans who are struggling with p t s d need good clinical care but they also need support and mentoring from peers who have made strides in battling the same demons we urge the v a employees that are in at every medical center to provide such peer support as well as to do outreach to the many who have been reluctant to seek treatment to offer another example our own work with wounded warriors has highlighted the difficulties facing those who have p t s d and need inpatient treatment the as inpatient programs don't have a uniform admission criteria facility seems to set its own criteria too often warriors circumstances don't fit those inflexible criteria for specialized p t s d care and they're  denied admission to these programs that are so vitally needed and short rather than veteran centered care the seems to be more like barrier centered care of veteran centric for system would not as some facilities do impose rigid requirements that a veteran must have had success in outpatient therapy for three to six months to qualify for admission must have had no suicidal tents or suicidal ideation even for the past six months must first complete outpatient anger management before they can receive treatment must first be substance abuse free for a certain amount of time and must first be interviewed and if accepted may be a admitted at a later date tragically many oh yeah federal who are suffering with severe p t s d are hanging on by a fingernail and they don't have months to wait to receive in patient care warrior project field staff has considerable experience in helping veterans get needed mental health care from v a facilities but we have encountered great difficulty with placements when veterans conditions pose a relatively urgent need for specialized inpatient treatment the most pronounced of these cases that involve veterans who have been jailed because of behaviors linked p t s d and substance abuse and whose cases have become before a judge who is willing to have the veterans undergo treatment rather than incarceration in several cases however v a medical center personnel who've attempted to facilitate such placements have been stymied by long waiting lists at specialized inpatient facilities inside their visits on numerous occasions our staff have inquired on behalf of our warriors about inpatient p t s d placement options beyond the confines of a particular visit only to learn the v a staff have no central positive or of information or clearinghouse to turn to to find out about programs that exist outside of their visit or their immediate area i'm aware of one case where tuscaloosa alabama there are one hundred twenty five individuals veterans on a waiting list for dual diagnosis  d program one hundred eighty miles away in jackson mississippi was an analogous program with empty beds next week the two programs didn't know the other one exist because there was a vision line between them this is unacceptable we've urged the department of veteran affairs established a clear clearinghouse on these programs to provide relatively real time patient and placement information to date however this recommendation is elicited no response to cite another area employment is certainly key to successful reintegration programs targeted at helping veterans gain federal employment wounded warriors encounter troubling obstacles even at the v a the one agency you'd expect to go the extra mile in employing veterans as you know mr chairman service connected disabled veterans are entitled to ten point preference in federal hiring but those extra points seem to give our warriors little or no practical help instead the complex hurdles of the k s sales and demonstrating on adjusted generation of veterans ever thank you it concludes my testimony thank you very much as a couple question i want to ask you first to staff sergeant johnson did i understand you correctly that you are still going to reserve yes i was told i was put in a holding cell and they told me that until my m e b is over and they give me a disability rating that i have to go to monthly drills and like i said i go into a room i sit there that's it now how long after he returned home did you  optic nerves are already started to die and the t b i had affected my brain can't comprehend what my eyes are seeing so calling to what they told me it could have been prevented but i services would have helped tremendously in that time period of could have been some transition to knowing what was going to happen and said nothing up until after i actually became blind yes and i hear you say that you have not even received your purple heart yet correct and how many years at th or years four years thank you let me ask mr wilson something what are the top two concerns for veterans that that you hear from in your organization a trance transitioning from d you know i had actually heard those issues yesterday i just returned from a site visit at one of the four level one poly trauma centers in tampa last night i returned to testimony today transitioning screen extensive extensively so screening and pretty much ignorance of the be a program or even the transition itself so even if the v a comes and they testify i'm sure that they have all these programs the problem is the veterans don't know about ok this i can pretty much put them if you evaluate the v a looking at their programs we have a system we're saving of sideways we're conducting those the problem is is the transition of the communication between the two which began also medical records yesterday there was a doctor speaking on speaking on really good programs and so i asked him about us what is the challenge and he said the challenge comes from getting records from from d o d and he said so i said well how do you do it do you do it the conventional way he says exactly the conventional way and that takes lots of time and being an old computer guy i know there's the program that will allow both of those guys to communicate thank you mr tarantino what complaints do you hear most from veterans who are in the process of transitioning well i think what we're hearing is definitely there is a lack of communication and this is not just for service members leaving activity this is particularly for service members in the national guard the reserve i know myself i would have never gone to see if an old s major who was going through the army alumni program with me hadn't grabbed me and said you know sir right now you're young you're macho and you're stupid when you get to be my age going to be old be less macho and you'll probably still be stupid but you've got to be in pain you're going to need to know what's available to you and the v a does not make itself known to active duty or to the reserve component and what we're seeing especially in the national guard in the reserve component is that soldiers get these individual invisible injuries they get discharged forty eight to seventy two hours after they leave baghdad and now they're home they're drilling and they need care and they have to go to the but there is no mechanism to bring them back into the fold of the d say ok you're injured you need a medical retirement or we need to take care of you in many cases we're seeing members or afghanistan veterans that are seventy to eighty percent disabled that are getting called up out of the i r r back on active duty because and the transition policy is on the right track and what improvements could be made but from what i know i think they are on the right track i think they've made some very substantial improvements over the past  several years here and the addition of more federal coverage coordinators is certainly a step in the right direction but i would like to see again a more seamless handoff to the v increase funding h r eleven sixty nine from small housing grants of twelve thousand to thirty six thousand and a larger housing grants from sixty to one hundred eighty thousand the bail out also increase on mobile grants up to thirty three thousand so i understand that there are some paygo issues with this obviously got to be worked through but i think all the members on this committee be favorable toward that so i just wanted to pass that law you know you know and  chairman has been here one term and you know you have been here a lot of terms when when you're codell goes to great lakes illinois and january which is what we did when other people go into why we went to great lakes and what i keep hearing and i've been to afghanistan how been to have been in the infantry been to afghanistan and spent a week there been to the walter reed and now the great lakes and we have a v a in my hometown so i have a pretty good idea but i'm still having a problem getting my arms around this and after thirty three hearings we're still hearing the same thing and i think it's time to sit down and i agree with you all at home trying to do the right thing i go to wal where the left hand in the right hand knows what she's not because people are not trying to absolutely believe that but i'm going to ask anyone of you take this pass and just tell us is it is it beginning when the war  and i'll give you an example was that they had nursing home care facilities and now they are called community living centers and visited i've visited many over fifty in this nation and  as i said it did the name was changed to a continuum of care and i think we shot away from from from that that that level that we interrupted just a second ago so i don't have much time left but i know when i got out the army i think that having released all physical is vital as part of this but i will tell you that the service members are coming off active duty currently because of enhanced oversight and programs have been implemented in the past six years do have a whole array of briefings about benefits that are available to them as they leave the service oftentimes there's a bit of information overload they don't remember most of what's told them they have one hundred forms that the sign and so they leave the service having heard one time this thing that goes in one ear out the other they don't recognize that they'll need that in the future so i think again it's critical the v a be there doing outreach as these guys are coming into the v a system and you know are sort of the gatekeepers to all of their specialty care and will be the primary folks interacting with our wounded warriors and our veterans and if nurse case managers  capabilities but wounded warriors and veterans with appropriate primary care managers instead of sort of left overs after all the older veterans talk and they know who the best doctors at the v a are not only veterans but but they they know who the best doctors are at the v a and so there's a waiting list to get on with that primary care manager newest nurse case managers and least experience and perhaps maybe the not the best are the ones that open slots typically and oftentimes these wars are assigned to folks who don't know about it or tropical vacation they don't know about as an added back about money a lot of the conditions that these guys are coming back from iraq and afghanistan when you need a primary care manager who's familiar with these things is competent to serve as the gatekeeper to push them out to the appropriate services thank you mr chairman thank you mr hall thank you mr chairman and ranking member and other members to committee for allowing me to to go out of order i have a meeting like most of us double booked on but i'm proud to say we have a member of the winter warrior project who's just joined our staff in the more than nine years after we first entered afghanistan transitioning our troops is still such a challenge and that we have to do better for all of our men and women in uniform and our heroes like st sergeant johnson deserve better i have visited the wounded warrior transition units west point which is in my district and i commend the men and women who are working there but even the success illustrates the  there's also a limited v a presence at west point and these are among the reasons that i plan to introduce legislation to improve the seamless transition by mandating that the v a have a permanent presence on presence on all active duty military facilities and require one on one consultations with active troops as they begin the transition process should be no improperly filled out relevant forms this should cut down on were told if you stop contacting your senators you would be given medical treatment can you tell us who told you that the reserve case manager at fort riley kansas shortly after that i was transferred to another case manager because i stood up to him and said this is not right it's ridiculous and i'm not going to stand for it and i was transferred to another care manager but like it was said before the care managers are stretched thin so instead of one on one or one of five it's one ontarian or fifteen so you get left behind what's good for you for standing up like that and not surprised but many veterans get their problem solved or of help least help getting the problem solved in pa by coming to members of congress or senators just shameful that somebody should tell you to stop contacting your elected representatives as if you gave up your rights as a citizen by being a soldier this is very satisfied for the full v a committee about it and the public comment period caused before christmas that was in november and they're evaluating thousands of pages of testimony before making the final announcement of what the real change will be enemy so as to remove the need for a particular incident being proven i think it's appropriate i think that p t s d obviously is not necessarily caused by a certain focal instance where your own life is threatened but it can be caused by a generalized fear of mortar attack or seen dead bodies seen civilian casualties so i think that's an appropriate st would help facilitate more appropriate care for these guys as they're coming back and unfortunately it's oftentimes when you know the burden of proof heaped on these guys these warriors as their attorney it's a real chairman and thank you very much for holding this hearing perhaps going along with what mr hall said and the opening statement as to when they talked about we had thirty three hearings i think mr rove mentioned totaling about thirty three hearings on this topic  the last ten years i have staff to get me going back to two thousand one hundred six congress the subcommittee on health had a hearing on health care sharing between d o d and the veterans administration two thousand and two there was a hearing on the subcommittee on benefits on the transition assistance program and disabled transition assistance program you can even go through this list and you can just see two thousand and five we had an oversight hearing on the transition assistance and disabled transition assistance program so this has not been without hearings i think now mr chairman what we need to do is as a result of this hearing come up with a bill one perhaps that mr hall mentioned one that i think both mr row and i can work on to amend perhaps because i have several ideas and kept imprudent is in my congressional district from gainesville i know the second panel is going to mention the veterans and the veterans administration some of their personnel up here but it appears to me two problems one is when the veteran leaves when he leaves the military active service the coordination with the veterans administration has not been successful perhaps even we should have some veterans at the point of demobilization that is there when he leaves whether that is at the military base or at the country where he is so that he gets it the second thing is i think we have to have enforced by the veterans administration medical checks staff sergeant johnson when you left the military did you actually have a medical screening including an eye exam i wasn't clear on that yes when i was the mobilized  because the hospital can no longer do anything for me i was given an exit physical including an eye exam yes for i went to back home to for a little bit to see if they have the p t s d issues they are in and out in three days and nobody wants to stay at the moment they want to go home and see their family i understand they're going to say whatever they want to say get out whatever they need to do you have mental health screening yes and you had a dental examination yes i think with all your injuries everything obviously had a medical screening did you also testimony what kind of changes if you could wave a wand today based upon your experience communication between the v a central office and the caseworkers working in the different  and what would you do today to veterans ministration to help those who are suffering from traumatic brain injuries p t s d or other serious mental issues  and what we as members could follow up and do based on your recommendation you know as i mentioned the testimony i would recommend that there be a central clearinghouse of information that pulls in information about specialized p t they have a window about this big and when they get a warrior in front of them a veteran in front of them needs help they're going to send them to the place down the street because it's a place down the street it's a place they know not because it has available beds not because it's necessarily the best facility for them they send them to the facility because they don't know any better and there's no information coming in and the visit become small fiefdoms and so having a central clearing house for information would i think be a tangible way to make a have a central point of communications i think they'll say they do what we would ask is for them to put in writing system why they might have a different geographic locations but i think the cap and saying is we need something that is system wide so that everybody can go that one person not to the geographic central or if the i talked to over two  avoid caseworkers across the nation about these programs not a single one of them could tell me about programs outside their visit except the cable anecdotal things so if the information exists it is not getting to the folks who need it working on laterally but i think that the best shot the v a has taken was creating the transition patient advocate positions were supposed be filled by a level of personnel and unfortunately when that has been the case i know  and do good and make sure the guys were taken care of as they came from d o d to the v a and unfortunately that wasn't the way it worked out oftentimes well let me just conclude by saying i think we have some very constructive ideas that peer to peer mentoring available for them in a consistent way so that almost before they sign up on the sheets that peer to peer tell them what they're signing off and what it means so if a fellow marine a fellow army  air force personnel said to me cliff before you sign off let me tell you what the situation is i've had post traumatic them and i signed off and i should know this is serious so this idea of being young macho and stupid would be then get their attention rather than just say i just want to get back to dayton ohio want to get back to west virginia this is really serious and you have you're looking in the eyes of guys who are wounded and who have suffered and they can tell me about the experience at their spouses have also suffered so that would make them less stupid so i appreciate all of your testimony and thank you for your time this waltz well thank you mr chairman and thank  service and mr turned to you know i am that old sergeant major you talked to and and i've sat through far too many of these i think i'm at a breaking point on this along with many of you mr johnson especially mrs johnson who i'll be talking to most of the time because that's a key here that we've missed and it hurts this nation it's wrong thing to do but to you mr johnson on behalf of the people of southern minnesota i think it's fair to say that people this country apologize you for what you've been through but i also realize that a yellow ribbon magnet don't even get you a cup of coffee and i have had it with that type of rhetoric i've had it with that type of support if you would call it and you want to hear  real sad story in that very chair you're setting in last year a young man doing travis few gates in that same chair and went to the same thing and and we were warned about it we were told about it we laghman about it we rang our hands we gave and you're going to hear mr gonna come up we'll rail it for not talking to when those people are absolutely committed to our veterans and we're simply still not finding a fix i find it absolutely appalling a caregiver bill and mr john you'll attest this week here what you've gone through your life has changed paths this house passed a sentence that's there now took a week to pass a damn tarp money sure move quick to wall street took three days to pass the money to rebuild the bridge in minneapolis after it fell while your bridge is falling every day armed services committee why the hell aren't they in here why can't we as a congress talk together to figure out we keep talking about that oh no we got our silo we got to protect overtalk who's on representative davis committee if we can't name them shame on us  paper shuffling job at the fire department they work very well with him but within a year he had to take a medical retirement he could not meet the demands of that job and the thinking and decision making things that he needed to do  we started with when he got home we did all of the all of the legwork for that every one of his medical records from the military at times we had to get records we had to search for things that didn't happen or didn't exist we had i think we all need to be very very clear this chain of events for this family was put in place because someone raised their hand and chose to defend this nation and do what they were asked that is the only thing that put them in this position and these people are not victims and the idea god another mr dobbs and another down the road unless we determine at some point to stop it so i appreciate all the advice it's getting you're all exactly right on but i am convinced more than just logistical have an opportunity for counseling or some kind of support group yourself because in effect you are becoming not only regular wives and mother to the children and while if you would please keep your comments to five minutes and your total testimony will be put in the record mr cook excuses for where we are and why we are where we are but let me say before i before i proceed too far into this that what we are attempting to do is novel we've never done it before in history  and we go back fifteen years we were reducing the size of our armed forces we were cutting talent anybody that wanted to leave got to leave and suddenly we find ourselves in a war in wars in which we are being presented with the kind of problems that we're being presented with today some of these problems are as old as history post traumatic stress goes back to the greeks we still haven't figured it out and it's the biggest problem that we have when people look at our wounded veterans they look at traumatic amputation and their heart goes out to that and all of ours do but these people deal with these things very easily people have difficulties of those who suffer from post traumatic stress and so that's one of the things we're rushing with now it has been noted that  we have a lot of effort behind this and we have a lot of programs and our biggest problem is a lack of ability to put this before the people who need it we don't communicate well i spend most of the time out of my office i spend time at places like for riley in fort drum in fort benning in fort bragg and balboa and bam sheehan and polly trauma centers and all these places that you're familiar with and i spend hundreds of hours with these wounded warriors and you know an injured warriors have a pretty good chance of what it is that we're trying to do for them what they feel that we need one of the things i want to say to you is that we are you are we've heard here a lot of these problems are legacy issues and we are moving ahead and i think we are doing a better job at addressing the kinds of problems that were brought up here today now having said that to the question of outreach my office the wounded warrior care and transition policy office has a number of programs to try to deal with this one that i think most members are familiar with as a transition assistance program this was started back during the gulf war twenty years old has never been updated never been addressed never been reformed in that period from the time that was back when we fought a war with most of  component now we're fighting two wars and chewing up our reserve and it's one of those changes in the realities they were confronting were not addressed in the transition assistance program so in november we spent a week look at it it's not it's not the things that attracted emotionally such a wounded soldier and his family it's simpler things just like financial management and when you're young you know you think the money just continues to flow if you don't understand how to handle it by the time you get to be my age and you haven't learned to handle it you're going to be in an awful lot of trouble and so we have these we have youngsters coming back from down range they've had no place warm to spend money down there they've got they've got their base pay they got trigger time hazardous duty pay all these things they come home with a hundred hundred fifty thousand two hundred thousand dollars and what they do with it well they're home they're happy they want to buy mama something one of my favorite stories is the young marine who came home and bought himself a porsche which might have been reasonable enough except that the young man is blind in the car sitting in his living room so we need to teach him how to handle the money is just one of the things that we need to deal with but i but i agree with the congress and we need to start at the beginning and that's part of the counseling which is mandatory for all these people but the v a provides extensive briefing at least four hours on what's going to be when they get out now the point is at what point does that occur and is  useful and you've heard previous witnesses talk about what happens when people come home they don't want to come home and listen to a lot of lectures they want to come home and go home it becomes even more difficult with our reserve components when  these people are not coming back to a base where we've got got our hands on them because they're going to disperse to all the places that we brought them in from the reserves and national guard tend to be not centered around major bases where of people getting in trouble with the law we're looking at veterans courts we'd like to nationalize it separately like that your help doing it it's obviously these courts are not federal courts to deal with these problems but if there was a message that came out from the congress from this  m this committee saying that we need to treat people or we least need to take into account the fact that when they come back with difficulties these difficulties may manifest themselves and gone down  chairman and members of the subcommittee thank you for giving me the opportunity to be here today and to update you on various ways in which is improving the transition for returning service members and veterans i would our building a state of the art post combat care service for our returning service members and veterans we are continuing to refine these services identify additional areas and conduct wider research to improve d in mid february second we have expanded the federal recovery cord nation program this is a joint be a program which helps coordinate and access federal state and local programs benefits and services for the actively involved in assisting in our injured veterans with reintegration into their home communities forth our polly trauma system of care provides coordinated inpatient transitional and outpatient rehab services each of our four poly trauma centers and the twenty one network sites offer unique and highly specialized rehab services which help service members and veterans optimal function and independence in their communities this would be a has greatly enhanced its mental health services we have hired more than four thousand new about health professionals in the last three years six we continue to emphasize interdisciplinary care which is better and centered and requires the treating disciplines to coordinate b i that addresses the corcoran conditions such as p t s d pain and sleep disorders another example of integrated care is the post deployment integrated care clinic these are primary care based clinics where specialists are integrated  into disciplinary teams who address the special needs a combat veteran we are also supporting more research for new treatments and increasing the use of tele help those who live at great distances from our facilities and in rural areas finally does recognize and deeply appreciate the critical role of caregivers and family in supporting veterans offers and respite and home services to supplement the care that's provided by family members to improve the quality of life of veterans and their caregivers however much needs to be done in this arena and we are grateful to congress for its support of secretary shinseki is committed to transforming into a twenty first century result it is a privilege to care for those who have borne the battle in iraq and afghanistan and previous nations conflicts and it is our solemn responsibility to do all we can to restore them to their highest and best level of functioning and support them in their know mr cook you are you have especially the wounded warrior care and transition policy or the defense department but you are the defense department kid you do something about getting discharge in a purple heart for years i think that's an example and i'm just wondering asking around here he's required to go to a reserve meeting he didn't go to reserve meeting would he be classified as a wall i just don't understand  how these and you don't parole mention thirty three hearings we could have a hearing every week on the same issue and we would hear the same things and i know hunter have all been here before you you hear these things i don't leave these meetings very uplifted it's a downer for a long time and we have these continually because i know the people who spoke in the first panel they are just the tip of the iceberg there represent a lot of other people and i just feel horrible that we have to have all this and we hear the same thing over and over different kinds of cases but i think  factor now we're talking about pay go and so on let me tell you we ought to pay for this the same way we paid for the war the same way we got these people over there to be the same way we pay for i'm really kind of a paul also that the no one has come forth and committee members i think we all share the frustration and i know that i've spent a career when i see a problem i fix it and work on fixing and if it takes more people than one we try to get together this is a huge problem when you're doing with hundreds of thousands and millions of veterans as mr wilson pointed out here's a bit of frustration when you we spend a soldier to afghanistan to war it takes a million dollars a year of support to keep that one soldier in theater so this thirty thousand troops are going to send afghanistan the next several it's going to cost thirty billion dollars and yet we have a system here we bring soldiers back that we nickel and dime on what we're doing to take care of that i think i share that frustration with everybody here we spend a million dollars per year keep you in combat keep you in harm's way we get you home we don't have that same commitment to you and i believe being a vietnam era veteran that we owe you i live time's worth of service and though mr cooke is a vietnam veteran and you know we had a group of veterans that were left off the charge for about twenty years we dropped the ball big time and i think i agree with the chairman mitchell i've talked to him before the meeting i'm meeting with general shinseki this afternoon and i'm going to share what we had what we've said  this particular hearing today and i think we just need to sit down there with a group people around the table not in a formal setting and get this problem fixed i mean we will have thirty three more hearings  ago exactly when travis was here and sergeant major you're absolutely right i mean exactly the sitting right over there sergeant johnson was one of the comics were having a meeting in johnson city tennessee for r health there's a sizable sum of money two hundred fifty million dollars in rural health and that's where i live in a rural areas where sergeant johnson lives in a rural area and i'm going to talk to the secretary this afternoon and hopefully he'll visit mountain home v a in johnson city tennessee and i'm hopefully he'll be there for this meeting but it's a way how we provide support for these veterans who are a long way away and i think developing these outpatient clinics is vital and right now what happens in outpatient clinic a particular v a like ours at home it's a certain amount of money but it comes out of their budget to put an outpatient center near where the v a veteran i think that's essential to  more i think about this the more essential i believe it is is it to get the care out that the better needs to the veteran instead of having to travel not three hours six hours you've got to go and get back home once you start and so and i also agree with ms johnson i insurance policy and that was it that's that's what we left him with nothing we can do we we not only can do better we are going to do better and if i seem a bit frustrated i am i don't have any questions either mr chairman i just i just want to now not sit here next year with our saying group here and i can assure you that one of the things that i have been most impressed with in this committee is that this committee is not republican or democrat it's about veterans and about doing the right thing thank  thank you mr wallace well thank you mr chairman and thank each of you for your service your commitment to our veterans is never in question we understand that and mr cook your your service to this nation and as a veteran and c e o i very much appreciate that i just had a question for for maybe for each of you to just take up is how does a situation like sergeant steps are johnson's happen way in heck with a three year old at home i was going to do that so they showed me the horse whisperer and told me to be nice to my wife and son at home and that was it and i understand we're all learning that but how does it still happen how did the johnsons end up in this situation if you the first place we have the we have the benefit of coming here and listen to the frustrations of other panels and we have the benefit of listening to your frustrations but there's a separation of powers and there are certain political in that vein but you can hear from general corelli's and others who i'm sure you've talked to behind closed doors i would say i think first of all that the sergeant johnson's situation is an and correct the problems and make sure the more things are done right i don't know why he doesn't have as his purple heart i know a number of other people who have suffered wounds many things take time and sometimes you don't discover problems unless you actually go out and look for them so i happen to be a one military treatment facility and there were it was a naval facility but i was talking pilot and they will be disadvantaged because they're in a different service in the m t f i guess what i would ask mr cook is two thousand and seven i was in iraq and i witnessed as they had seven databases open on medical records not even including best in the transition to that and i made a comment in a hearing here now going on three years ago that wouldn't make sense to record serial concussive blast because we were starting to date at that point that those were going to the long term issues because mark my word on to be to attach it to a soldier and we would know that they've been in in these record them have that data one for the care two to make sure they don't come back and that was three years ago as this virtual lifetime record we're talking about all of us agree with it again to happen is this an i t issue i don't know how many platforms we operate somebody say people are frustrated with windows seven but you guys are using windows one or whatever how do we get beyond that because they don't have as much to work with and so while the rest of us are looking at helmets with sensors on them and things like this which sounds wonderful but you're always looking for a technological solution and the marines just that's not the marine way so what they do is if you're in a blast situation and they bring you back and i ask some simple questions you get your bell rung yes ok how long do you know what do you think thirty seconds forty seconds ok so you go through that three times three strikes you're out of theater and there's a record of it and it works and it's smart with regard to that to what comes under the broader umbrella of information to look at medical records and people who don't understand including myself i don't understand much about information technology it's a kind of magical things we're going to do the medical records as long as we're going to there over how many years twenty plus twenty plus years and how long have you been in your present position five years five years how many times have you had to testify before this committee subcommittee full committee or any one of the subcommittees i would say at least three times my staff thinks it's between five and ten your staff is likely correct also it appears to us that you've had to apologize in this area multiple times do you recollect that does it occur to you that your apology over these number of years you've been in this position for five years is at the point where it should be action rather than apologies mean oh sure indeed you know we continually strive to improve our system but then be make mistakes we do apologize for it and in this instance and in the past all so you're saying in the future you'll have to apologize again i mean you have any confidence low you can come up here and testify and not have to apologize so i would love to be here and never have to apologize and you're saying the reason you have to apologize because you don't have the resources or you don't have the manpower or you don't have the job is too much for you i mean it what point can we get the assurance you come up here and you won't have to apologize what do we have to do to help you sir as i said previously you know we are a system that continually looks to improve the quality of care that we deliver across the board we are a large system and by and large we do about we have created a great network in this instance  for how to take care of service members who are returning to us and the instances when we do not step up and do what we think we should be achieving i feel that it is my  make sure that we take it back and then we course correct well if i were in your position i would come to this committee in a proactive and say doggone it i don't want to come up you know apologizing or here's what i want to do this solve the problem you're on the clinical side examinations for the army air force and not being implemented is that true i'm not sure that is true but we have a factor that the army air force are not implementing separation physicals it's done on a has been examined in the last twelve months then that may be waived and that's one of the things that may be occurring here that gives the gives the american legion concern and that is done with the consent of the of the member but let's say the person is injured and he doesn't want to do it i think you've got to have some kind of i think sorry or let's say comes as the injury doesn't appear to later it an incident which is likely to produce an in an injury then he is going to be examined for it so i don't know that we can give you a categorical case or you can give us a categorical right across the board these examinations are not being did was do oversight of the legislation that we've passed in previous years now this field and go anywhere but it's some point you're exactly right this committee any committee energy and commerce ways and means they pass we vote a thousand times a year and there's no oversight on any of these bills and we sit here and wonder why someone doesn't work well you need oversight you need support so i think you're right about oversight being a big big important part of our thing i know mr cook said it takes time and i understand that but in the meantime people have house payments they have bills and it may be in the long run but you've heard that phrase before in the long run we're all dead  today do we live there's one other thing we may end up having another hearing on which i think may be under your control somebody the vision center of excellence where is what's the status of it