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STATUS OF MILITARY AND VA HEALTH CARE COORDINATION, INCLUDING POST-DEPLOYMENT

HEALTH CARE OF RECENTLY DISCHARGED

VETERANS

FIELD HEARING

BEFORE THE

SUBCOMMITTEE ON HEALTH

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

APRIL 13, 2004

HEARING HELD IN SAN ANTONIO, TX

Printed for the use of the Committee on Veterans’ Affairs

Serial No. 108–37

(
COMMITTEE ON VETERANS’ AFFAIRS 

CHRISTOPHER H. SMITH, New Jersey, Chairman 

MICHAEL BILIRAKIS, Florida 

TERRY EVERETT, Alabama 

STEVE BUYER, Indiana 

JACK QUINN, New York 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

ROB SIMMONS, Connecticut 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

TIM MURPHY, Pennsylvania 

LANE EVANS, Illinois 

BOB FILNER, California 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

CIRO D. RODRIGUEZ, Texas 

MICHAEL H. MICHAUD, Maine 

DARLENE HOOLEY, Oregon 

SILVESTRE REYES, Texas 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TOM UDALL, New Mexico 

SUSAN A. DAVIS, California 

TIM RYAN, Ohio

PATRICK E. RYAN, Chief Counsel and Staff Director 

SUBCOMMITTEE ON HEALTH 

ROB SIMMONS, Connecticut, Chairman 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

CLIFF STEARNS, Florida 

TIM MURPHY, Pennsylvania 

CIRO D. RODRIGUEZ, Texas 

BOB FILNER, California 

VIC SNYDER, Arkansas 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TIM RYAN, Ohio 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

DARLENE HOOLEY, Oregon

(II) 
(III)

C O N T E N T S 

April 13, 2004

Page 

Status of Military and VA Health Care Coordination, Including Post-Deployment Health Care of Recently Discharged Veterans ........................................ 1

OPENING STATEMENTS 

Chairman Simmons ................................................................................................. 1

Hon. Ciro D. Rodriguez ........................................................................................... 3

Hon. Jeff Miller ........................................................................................................ 6

WITNESSES 

Aguilar, Raul, M.D., Chief Medical Officer, McAllen Outpatient Clinic, VA 

South Texas Veterans’ Health Care System ...................................................... 28

Prepared statement of Dr. Aguilar ................................................................. 85

Bauer, M.D., Richard, Chief of Staff, VA South Texas Veterans’ Health Care 

System ................................................................................................................... 10

Prepared statement of Dr. Bauer .................................................................... 57

Cancio, M.D., Lt. Col. Lee, Chief, Burn Center, Brooke Army Medical Center . 31

Prepared statement of LTC Cancio ................................................................. 91

Coronado, Jose R., Director Department of Veterans Affairs, South Texas 

Veterans’ Health Care System ............................................................................ 8

Prepared statement of Mr. Coronado .............................................................. 51

DeKoning, Col. Bernard, Commander, Darnall Army Community Hospital, 

Fort Hood, TX ....................................................................................................... 15

Prepared statement of Colonel DeKoning ...................................................... 71

Del Toro, Janeth, NP, VA South Texas Veterans’ Health Care System .............. 25

Prepared statement of Ms. Del Toro ............................................................... 82

Fox, Jr., C. William, Brig. Gen., Commander, Brooke Army Medical Center .... 11

Prepared statement of General Fox ................................................................ 61

Green, Charles B., Brig. Gen., Commander, 59th Medical Wing, Wilford Hall 

Medical Center, Lackland AFB, Texas and Lead Agent, TRICARE Region 

6 ............................................................................................................................. 16

Prepared statement of General Green ............................................................ 76

Herrle, Douglas, Disabled American Veterans accompanied by William Morin 40

Prepared statement of Mr. Herrle .................................................................. 105

Holliday, Ph.D., Stephen L., ABPP, President, Association of VA Psychologist 

Leaders .................................................................................................................. 29

Prepared statement of Dr. Holliday ................................................................ 87

Holloway, Richard, The American Legion ............................................................. 41

Prepared statement of Mr. Holloway .............................................................. 107

Leija, Ignacio, American GI Forum, National Veterans Outreach Program ...... 39

Prepared statement of Mr. Leija ..................................................................... 101

Masterson, M.D., Lt. Col. Brian J., Chief Information Officer, Wilford Hall 

Medical Center, Lackland AFB, Texas ............................................................... 32

Prepared statement of LTC Masterson .......................................................... 96

(1)

STATUS OF MILITARY AND VA HEALTH CARE 

COORDINATION, INCLUDING POST-DEPLOYMENT HEALTH CARE OF RECENTLY DISCHARGED VETERANS 

TUESDAY, APRIL 13, 2004

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC 

The Subcommittee met, pursuant to call, at 8:43 a.m., in the City 

Council Chambers, City Hall Complex, Municipal Plaza Building, 

San Antonio, TX, Hon. Rob Simmons (chairman of the subcommittee) presiding. 

Present: Representatives Simmons, Rodriguez and Miller. 

OPENING STATEMENT OF CHAIRMAN SIMMONS 

Mr. SIMMONS. The Subcommittee on Health will come to order. 

Can you hear me now? 

VOICES. Yes. 

Mr. SIMMONS. Loud and clear. My name is Rob Simmons and I 

am a member of Congress from the State of Connecticut. I am a 

Vietnam veteran, proud of it, and we are here to have a hearing 

of the Subcommittee on Health of the Committee on Veterans’ Affairs. 

For opening remarks, I would like to introduce the Mayor Tempore Ron Segovia, City Councilman, District 3. Mr. Mayor. 

Mr. SEGOVIA. Good morning. 

Mr. SIMMONS. Good morning. 

Mr. SEGOVIA. I apologize for the sunshine. 

Mr. SIMMONS. I am from Connecticut and we love the sunshine. 

We do not have any up there. (Laughter.) 

Mr. SEGOVIA. I am pleased to represent the Mayor and the City 

Council of San Antonio and welcome the Committee for Veterans’ Affairs, the Subcommittee on Health to our city and council chambers. I would like to extend a special welcome to our hometown 

representative, Ciro Rodriguez. Congressman Rodriguez is a champion for our community and it is always good to have him here. 

As you may know, San Antonio is known as Military City, U.S.A. 

San Antonio is home to four active duty military installations, plus 

Guard and Reserve units, representing some 48,000 active duty 

personnel. Even more impressive, San Antonio is home to over 

153,000 veterans. I always say were it not for the veterans we 

would not be here today. 
2

So your discussion related to the transition from Department of 

Defense Health Care Services for active duty personnel to the Department of Veterans Affairs Health Care System for separated 

servicemembers is very important to San Antonio. With the presence of the Audie Murphy Memorial Veterans’ Hospital and the 

Frank M. Tejeda VA Outpatient Clinic, veterans in and around San 

Antonio have access to some of the best care our nation has to 

offer. 

Today over 140,000 members of our armed forces are deployed 

around the world to fight terror. Many of those soldiers are from 

San Antonio and will come back home to transition to civilian careers, while many other may choose to retire and/or visit San Antonio because of our veterans’ healthcare facilities. In any case, if recently separated servicemembers need to access the veterans’ healthcare system, we must remain resolute in our commitment to 

provide for their health care needs in a timely fashion. We must 

continue to work on securing sufficient funding to provide for the 

veterans so justly deserved. 

With assistance from this Committee on healthcare and Congress 

as a whole, San Antonio will continue to provide the best veterans’ healthcare possible. The city looks forward in working with the 

Subcommittee on Health and the Congress to address the health 

infrastructure needs of Texas and the nation as a whole. 

I hope that your stay here will be informative, productive and enjoyable. You are our guests while you are in this facility and in this 

city. Please let me or the city staff know if there is anything we 

can do to assist you. 

Again, welcome on behalf of the Mayor and the City Council. We 

welcome you to San Antonio and hopefully maybe you can stay a 

few days longer and enjoy some of our fiesta. Thank you. (Applause.) 

Mr. SIMMONS. I thank you, Councilman Segovia. We appreciate 

that invitation to stay for the fiesta. I am told that it is a very exciting event. That sounds great. 

I am joined today by the Subcommittee’s ranking Democratic 

member, my friend Ciro Rodriguez and a fellow Republican member from the great State of Florida, my colleague Jeff Miller, who 

represents another area of our country with substantial military 

and veteran populations, the 1st Congressional District of Florida, 

from Pensacola to Okaloosa County in the Florida Panhandle. Welcome to you here today, Jeff. Of course, this is your hometown, Mr. 

Rodriguez, and I am pleased to be here. And I also welcome our 

witnesses and all in attendance today. 

I note that one individual in attendance today is Staff Sergeant 

Canady, a winner of the Silver Star, who has been treated for his 

injuries here over the last 100 days or so. Sergeant, would you 

mind standing and being recognized? Thank you for your service to 

your nation. (Applause.) 

Mr. SIMMONS. The genesis of this hearing occurred in February 

of this year at a meeting between myself and Mr. Rodriguez when 

we were discussing field hearings that we wanted to hold throughout the country. We agreed that San Antonio would be a good site 

for a hearing because of the concentration of military and VA 

health resources in this area. Let me describe briefly some of these 
3

attributes. The Audie L. Murphy Memorial Veterans Hospital, the 

Kerrville VA Medical Center in Kerrville and associated community clinics, a system that employs over 3,000 people with a budget 

of $386 million. And 11 miles from here, the Audie L. Murphy Division, named after the nation’s most highly decorated World War II 

veteran and native son, opened in 1973 with over 500 beds and a 

variety of primary and tertiary care services. The Wilford Hall Air 

Force Hospital at Lackland Air Force Base, about 11 miles from 

here, is the Air Force’s largest and most extensive military treatment facility. The Brooke Army Medical Center, about eight miles 

from here, is the Army’s most advanced tertiary care facility with 

its world renowned burn center serving the entire nation as a specialized source of critical care. 

And speaking personally for myself, when I took my second tour 

in Vietnam back in 1970 to 1972 working for the CIA, a friend of 

mine was very seriously injured due to burns from a white phosphorus grenade. He lingered near death, was evacuated to the Philippines where they sustained him and eventually he was evacuated 

back to the Brooke Army Medical Center where they did an absolutely extraordinary job. They were state of the art for the nation 

and the world 30 years ago, they are state of the art for the nation 

and the world today and we should be proud as Americans that we 

have this wonderful facility right here in San Antonio, TX. 

And then, of course, the Darnall Army Community Hospital at 

Fort Hood which is about 150 miles from here. Coming from Connecticut, 150 miles is a long way away, but I know for you folks 

here in Texas that is just a hop, skip and a jump. It is just going 

around the corner to the 7-Eleven. 

With approximately 50,000 Army and Guard personnel returning 

from Iraq and Afghanistan and their family members, this is truly 

a center of activity for our U.S. military here in the United States 

of America. It is truly a center for our veterans here in San Antonio, what some people refer to as a billion dollar center for military 

and veterans’ healthcare. What a pleasure for me to be here today. 

At this point, I would like to defer to my colleague, my distinguished ranking member, Ciro Rodriguez, somebody who I have 

served with with great pleasure and great honor for the past 3 

years. Somebody who puts partisanship aside when it comes to the 

healthcare and the benefits of our veterans. Somebody whose focus, 

in my observation, is entirely on the wellbeing of those who have 

served their nation and now need some of that service back from 

their nation. Our ranking member of the Health Subcommittee, 

Ciro Rodriguez. 

OPENING STATEMENT OF HON. CIRO D. RODRIGUEZ 

Mr. RODRIGUEZ. Thank you, Mr. Chairman. I want to personally 

thank you for not only your leadership back in Washington, but 

also for deciding to come down to San Antonio. I want to personally 

thank you for a relationship that we have had, as you have indicated, a very bipartisan effort in making sure that we respond to 

the needs of our veterans. 

I also want to take this time to thank Congressman Miller for 

coming down. I know that we are going to be challenged right now 

with the construction work. I know we had some difficulty in get-
4

ting a location, so I do want to thank Mayor Pro Tem Ron Segovia 

for allowing us to utilize the beautiful City Hall facilities we have 

here in San Antonio. 

Mr. Chairman, welcome to San Antonio. I appreciate you and Mr. 

Miller joining me here to hold this important hearing. I hope you 

enjoy our south Texas hospitality and weather. This is a little cooler than usual. This morning it was some 40 degrees, but welcome 

to San Antonio. We wanted to make you feel at home coming from 

Connecticut, so we thought we would have a little cooler weather. 

Mr. SIMMONS. Where is the snow? 

(Laughter.) 

Mr. RODRIGUEZ. You might have to wait a good 10 years to get 

that. 

As you know, the City of San Antonio, as indicated by the Mayor 

Pro Tem is referred to as Military City, U.S.A. and we are proud 

of that. We have a great tradition of supporting and caring for our 

military men and women and I cannot think of a better topic for 

us to explore here today than the healthcare of our veterans. 

We have had several hearings in Washington which have focused 

on the post-deployment health of our servicemembers returning 

from Iraq and Afghanistan. This is clearly a topic that is in all of 

our hearts and minds now with such frequent reports of new casualties, particularly in Iraq, but also in Afghanistan. We want to 

ensure that servicemembers who are returning with their injuries, 

that are far more severe than the past periods of combat, are receiving the best healthcare that they can and that the nation can 

provide from them. We have to make sure that we are there for 

them. 

Our military bears the chief responsibility for ensuring the 

healthcare of our troops, and as the Veterans’ Affairs Subcommittee on Health, we also have an obligation and responsibility. 

While pre-deployment screening may be getting better, we still 

have a long way to go and there is still significant room for improvement. As you well know, Mr. Chairman, we have worked 

hard, and I know you have worked hard in that area in terms of 

reaching out to the Department of Defense in making sure we 

begin to do that a lot better. 

Post-deployment screening also continues to be problematic. 

Physical examinations are often given only upon the request of the 

individual being discharged and then there is a waiting time for 

those who choose to receive them. Imagine returning home from 

war anxious to see loved ones and return to routine life and having 

to wait an amount of time to receive an examination in my view, 

it is highly unlikely many would choose to stay. These examinations need to happen immediately before these individuals return 

from deployment so that more are willing to participate. 

As I stated earlier, we have held various hearings in Washington 

to discuss post-deployment health of our service men and women. 

What we have learned is the transition between the VA and the 

Department of Defense is effective particularly for the active duty 

servicemembers with severe physical wounds. 

The Committee has primarily assessed the working relationship 

in Washington between Walter Reed Army Medical Center, Bethesda Naval Medical Center as well as the Washington VA Med-
5

ical Center. The VA has staff stationed at these major military 

treatment facilities to enroll active-duty servicemembers for VA 

health care and help them obtain benefits. This is also true at some 

of the major medical demobilization sites, such as Brooke Army 

Medical Center and Darnall Army Hospital in Fort Hood, as we 

will no doubt hear later today. 

But it remains unclear how effective this system is away from 

these sites and how well it works if servicemembers’ problems are 

less obvious than severe traumatic injuries—such as those that suffer from post traumatic stress disorders and other less less obvious 

illnesses. We have to make sure that their transition occurs as 

smoothly as possible. For our future veterans who might have some 

readjustment difficulties, we have to ensure that our services will 

be there. We all know full well some illnesses can surface later like 

those veterans that served in Desert Storm who suffer from what 

we now refer to as Gulf War Syndrome. That surfaced later, but 

I know it was not recognized until much later—we have to make 

sure that we are there for those veterans. 

What we have learned thus far is that communication between 

the VA and the Department of Defense must improve drastically to 

ensure that the active-duty members, the reservists and the National Guardsmen are not lost in the system meant to serve their 

healthcare needs. Ideally, there should be a shared medical record 

for each individual discharged showing his or her health status 

prior to and immediately following deployment and any service provided to that individual during that time. 

Unfortunately, we have learned that the VA does not even routinely get access to the post-deployment health assessments the 

military is supposed to collect. This will continue to make continuity of care between the two healthcare systems problematic and 

will not allow the VA to adequately prepare for those it will serve. 

In San Antonio, we are blessed with state-of-the-art VA and military medical treatment facilities and it is clear they are working 

hard to care for our soldiers returning with significant injuries. In 

fact, more than a thousand injured or sick servicemen and women 

from the Global War on Terrorism have been treated in this region 

alone. 

I am looking forward to hearing from all of our panelists today 

to get a better understanding on the role of care that we are providing, and also looking in terms of the needs that we have, especially recommendations we might be getting from you to be able to 

address the needs in the future. As always, I also look forward to 

hearing directly from our service organizations and our veterans. 

And again, Mr. Chairman, I want to personally thank you for 

coming to San Antonio and for doing what you always do in a gracious manner. And also to Congressman Miller for taking the time. 

I know how difficult it is to leave your district and your families 

during these times. So I want to personally thank both of you for 

being here with us. I look forward to the testimony of the panelists. 

Thank you very much and thank you to everyone present for being 

here with us. 

Mr. SIMMONS. Thank you, Representative Rodriguez. 

We are joined here by another colleague from the great State of 

Florida, representing the First Congressional District which is lo-
6

cated in the Florida panhandle, a district that is rich in military 

and veterans’ facilities—my friend and colleague, Jeff Miller. Congressman Miller, do you have some remarks that you would like to 

make? 

OPENING STATEMENT OF HON. JEFF MILLER 

Mr. MILLER. Thank you very much, Mr. Chairman. Again, I also 

want to echo my colleague’s remarks. I think this is a very timely 

and appropriate place for this hearing to take place. I appreciate 

your service as chairman of this subcommittee. I also want to say 

that my colleague, Congressman Rodriguez, I do not believe anybody could serve the veterans of this district better than he has. 

The commitment that he has made to make sure that the care is 

what it needs to be and if it is not he rings the bell to make sure 

that folks know that it is not what it was designed to do. 

I do look forward, Mr. Chairman, today to hearing the testimony 

from area healthcare providers and organization representatives 

that we see out in the audience. I think it is important that we talk 

about the transition as our military men and women move from active duty to veteran status, the importance of the seamlessness of 

how it should be when the make that transition. We know that 

there are some areas that need improvement without question. We 

also know that there are some areas where there is a lot of good 

work being done, and I think the DOD/VA sharing collaboration 

that we have seen in the south Texas area is an excellent model 

for us to follow. 

My district has the most veterans of any congressional district in 

the United States. We have one community-based outpatient clinic 

and no VA hospital, so we are working outside the box now in 

northwest Florida trying to find ways that we can share. Both the 

Air Force and the Navy have been very helpful in doing memorandums of agreement whereby the co-sharing process can take place 

and the veterans in my district can receive the quality healthcare 

that they deserve. 

I also think that it is important that we talk just for a second 

today—and I know that my colleagues would echo my remarks—

in regards to what is going on around the world. We are in fact engaged in a war on terror. We have all had the opportunity to travel 

around this globe and visit with our troops, wherever they might 

be deployed, and witness first-hand the reconstruction efforts that 

are currently ongoing in Iraq. I just want to remind folks that, you 

know, Saddam Hussein ruled Iraq longer than Adolph Hitler ruled 

Germany, longer than Tojo dominated Japan. His wars scarred 

Iran, Kuwait, Saudi Arabia and Israel and his internal terror decimated the Kurdish minority in the northern portions of Iraq. 

Less than a year after the rebirth of Iraq, our coalition forces are 

coming under heavy fire, literally and figuratively for its inability 

to fix all of the problems and to purge all the evils unleashed between July 1970 and May of 2000. Our service men and women get 

no salute from the media. The whole story is that the mission in 

Iraq is succeeding and all of Iraq is rising to live a new day. This 

Subcommittee and our entire Congress, if the members are reminded back home that it is the cleaning up of wounds, working 

to rehabilitate the injured and securing sustainable post-service 
7

employment is just as important as searching out the hovels and 

the caves to push the terrorists out into the sunlight, if we will remember that, we will all be delivering on the duty that we have 

each been charged with. 

I look forward to the testimony today. I thank the Chairman, and 

again, my good friend Ciro Rodriguez for asking that this field 

hearing be held in San Antonio. 

Mr. SIMMONS. I thank the gentleman for his remarks. 

The focus of today’s field hearing is on coordination between military and VA healthcare systems, and my colleague Mr. Rodriguez 

and my colleague Mr. Miller have both made reference to that fact, 

that a military person who serves on active duty or is activated by 

the Guard and the Reserve is frequently confronted with a situation when—especially in the case of the Guard or the Reserve—

they return back from their activation and they receive a DD 214 

and they have exit health examinations. For those on active duty 

who are wounded, they also will be transferred out of the military. 

What we want to see happen, is we want to see that transition be 

as seamless as possible. We want to see records transferred in a 

seamless fashion. We want to see the physical exams coordinated, 

and some Members of Congress have even talked about having a 

single physical exam, not more than one. We want to make sure 

that our service men and women become veterans of this great nation in as seamless and coordinated way as possible. 

We will have three panels today. The first panel will consist of 

Mr. Jose Coronado, Director of the Department of Veterans Affairs 

for the South Texas Veterans’ Health Care System. Welcome to 

you, sir. He will be accompanied by Richard Bauer, Dr. Bauer who 

is Chief of Staff at the VA South Texas Veterans’ Health Care System. We will also have Brigadier General C. William Fox, Jr., Commander at Brooke Army Medical Center, accompanied by Colonel 

Bernard L. DeKoning, commander, Darnall Army Community Hospital, Fort Hood, TX; Brigadier General Charles B. Green, Commander of the 59th Medical Wing, Wilford Hall Medical Center. 

Gentlemen, before you proceed, for those of you in the audience 

or watching on the television, to my left is John Bradley, the Subcommittee Staff Director and to my far right is Susan Edgerton, 

the Subcommittee Minority Staff Director. I thank them for their 

service and support. 

Gentlemen, you have been announced. Please proceed. 
8

STATEMENTS OF JOSE R. CORONADO, DIRECTOR DEPARTMENT OF VETERANS AFFAIRS, SOUTH TEXAS VETERANS’

HEALTH CARE SYSTEM accompanied by RICHARD BAUER, 

M.D., CHIEF OF STAFF, VA SOUTH TEXAS VETERANS’

HEALTH CARE SYSTEM; BRIG. GEN. CHARLES B. GREEN, 

COMMANDER, 59TH MEDICAL WING, WILFORD HALL MEDICAL CENTER, LACKLAND AFB, TEXAS AND LEAD AGENT, 

TRICARE REGION 6 and BRIG. GEN. C. WILLIAM FOX, JR., 

COMMANDER, BROOKE ARMY MEDICAL CENTER accompanied by COL. BERNARD DEKONING, COMMANDER, 

DARNALL ARMY COMMUNITY HOSPITAL, FORT HOOD, TX 

STATEMENT OF JOSE R. CORONADO 

Mr. CORONADO. Good morning. 

Mr. SIMMONS. Good morning. 

Mr. CORONADO. Mr. Chairman and members of this distinguished Subcommittee, I want to express my appreciation for the 

opportunity to discuss with you the South Texas Veterans’ Health 

Care System’s efforts addressing the seamless transition of returning Operation Iraqi Freedom and Operation Enduring Freedom soldiers from the Department of Defense healthcare system into the 

VA healthcare system. 

As you are aware, the South Texas Veterans’ Health Care System as a part of the Department of Veterans Affairs has four specific missions, which are to improve the health and quality of life 

for our patients; to facilitate graduate medical education; to foster 

medical research activities and lastly to support the Department of 

Defense. We are totally committed to achieving each of these missions, and each is critical to our success as a department. For this 

morning’s discussion, I will concentrate on efforts to support our 

Department of Defense colleagues through our shared platform of 

partnership. In this regard, our commitment includes providing resources in support of local Department of Defense activities, ensuring a seamless transition of our military servicemembers into veterans status. 

Additionally, the South Texas Veterans’ Health Care System currently has 133 employees who are military reservists. Thirty-seven 

of these have been deployed in support of Operation Iraqi Freedom 

and Operation Enduring Freedom. Eight of these 37 VA employees 

have returned safely from active duty while 29 members of our 

staff still remain mobilized. 

This brings me to the focus of my testimony, the South Texas 

Veterans’ Health Care System involvement in the program for a 

seamless transition of active duty military to new veteran status. 

At the South Texas Veterans’ Health Care System we take very seriously our responsibility to our servicemembers to ensure that 

they have timely access to the benefits they have earned through 

their military service. To fulfill this commitment to them we have 

committed resources and focused efforts with the VA’s Veterans’

Benefits Administration, the Texas Veterans’ Commission, The 

Brooke Army Medical Center and Wilford Hall Air Force Medical 

Center. These coordinated linkages assure a smooth transition into 

veteran status by providing immediate enrollment or healthcare 

services, access to benefits information and quick determination of 
9

eligibility for these VA benefits. This guarantees immediate priority service and allows access to all services that the South Texas 

Veterans’ Health Care System and the Veterans’ Benefit Administration have to offer. We have spared no effort to assure that not 

one of our heroes falls through the cracks. 

In response to a VA central office directive I organized and 

launched a new South Texas Veterans’ Health Care System task 

force in September of 2003 for the seamless transition of returning 

servicemembers into veteran status. This multi-disciplinary task 

force includes a full-time social worker, a program manager, a physician clinical liaison and a benefits advisor from the Veterans’

Benefits Administration. The team is centered around the full-time 

VA social worker who is based at Brooke Army Medical Center. 

The social worker conducts discharge planning activities, clinical 

coordination services for each potential VA patient. The social 

worker provides prompt notification of casualty arrivals, delivers 

coordinated benefits briefings to all potential VA candidates and 

assists with the coordination of appropriate transfer to geographically distant VA facilities. Prior to discharge from the Department 

of Defense, our social worker enrolls all patients in the VA system 

to expedite their transition. 

Our local team first provides timely notification and tracking of 

casualties. Secondly, facilitates transfer of active-duty military soldiers into veteran status prior to their separation from the Department of Defense. Thirdly, arranges care close to their homes and 

lastly, assists with claims processing. 

Additionally, our team has identified Iraqi casualty point of contacts in each of our five satellite clinics in the Kerrville Hospital 

Division of the South Texas Veterans’ Health Care System. These 

points of contacts are charged with coordinating care of any returning Iraqi conflict veterans. The team has ensured that as patients 

are identified appropriate measures are put in place to provide a 

seamless transition into veteran status. 

To support communication with all returning Iraqi conflict soldiers in our area, we have initiated substantial outreach initiatives. 

We have produced and distributed specific brochures, scripts, role 

and responsibility guidance and outreach media products designed 

to aid in the transition of returning into veteran status. We have 

taken our mantra, ‘‘Treat now, ask questions later’’ from the words 

of Secretary Anthony Principi and used it as the foundation for our 

outreach initiatives. All guidance pertaining to the treatment of our 

newest veterans instructs employees to quickly facilitate care prior 

to determination of eligibility. Guidance on the processing of Iraqi 

conflict veterans has been forwarded to all front-line employees 

along with scripts detailing how to interact with our new patients. 

Furthermore, to educate our employees regarding Operation Iraqi 

Freedom and Operation Enduring Freedom veterans, the South 

Texas Veterans’ Health Care System required mandatory viewing 

by all employees of the Our Turn to Serve video. This training 

video developed by our central office in Washington and the Employee Education System gives an in-depth view of the conditions 

faced by combat veterans as they continue down their road to recovery. 
10

Other outreach efforts include communicating with veteran service organizations throughout South Texas during regularly scheduled meetings and by distributing flyers, posters and informative 

brochures through their organizations. Finally, South Texas Veterans’ Health Care System publicizes and utilizes the VA Central 

Office website that addresses areas of interest essential to the care 

of this growing population. Information is readily available for employees, active duty personnel, reservists, members of the National 

Guard, veterans and family members. 

To date, the South Texas Veterans’ Health Care System has coordinated the transition of 465 service men and women who have 

supported our nation’s defenses in Operation Iraqi Freedom and 

Operation Enduring Freedom. We currently care for 78 of these 

465 locally and have assisted with the transfer of 128 employees— excuse me, soldiers into a VA facility geographically distant from 

south Texas. 

Thank you for the opportunity to testify before you. I will yield 

to our Chief of Staff Dr. Dick Bauer. 

Mr. SIMMONS. Thank you for those comments, Doctor. We will 

proceed with the other panelists and then save our questions until 

the end. I will also suggest to the panelists that we have a 5-

minute clock on them. We can see a little red light here. We also 

have their written testimony. So if they will be mindful of the 

clock, I will let them know when the 5 minutes is up. 

I will also note for the record that Colonel Robert Gombeski is 

not here accompanying Brigadier General Fox. Apparently it is 

Colonel DeKoning, who is Commander at Darnall Army Community Hospital. Is that correct? 

Colonel DEKONING. Yes sir. 

Mr. SIMMONS. I apologize for the misstatement, Colonel. It is 

good to have you here. Dr. Bauer. 

[The prepared statement of Mr. Coronado appears on p. 51.] 

STATEMENT OF RICHARD BAUER, M.D. 

Dr. BAUER. Mr. Chairman and members of this distinguished 

committee, thank you for the opportunity to be here today and to 

discuss the status of VA healthcare delivery in south Texas. 

The South Texas Veterans’ Health Care System encompasses 63 

counties in south Texas and reaches to Brownsville in the south, 

Victoria in the east, Sanderson in the west and San Angelo in the 

north, a span of 350 miles from east to west and 400 miles from 

north to south. Because of the distribution of population within this 

system, the South Texas Veterans’ Health Care System operates 

eight VA staffed clinic sites. Three of these are in San Antonio, including the Frank Tejeda Outpatient Clinic, the Southeast Bexar 

Clinic and clinics at the Audie Murphy VA Hospital. VA staff clinics are also located in Victoria, Corpus Christi, McAllen, Laredo 

and Kerrville VAMC. 

Additionally South Texas has contracted for primary care services in 11 smaller communities such as Beeville and Uvalde, Alice 

and New Braunfels and also within San Antonio to address long 

waiting times and inability to provide adequate office space for primary care and mental health services within existing infrastructure. 
11

All VA staffed clinic sites provide primary care, mental health 

and podiatry services. A concerted effort has been made to provide 

specialty services locally. In Corpus Christi, for example, an orthopedic surgeon visits the clinic bi-weekly. A sharing agreement with 

the Corpus Christi Naval Hospital provides optometry, audiology 

and general surgery services. The Corpus Christi clinic also has a 

radiology unit, pharmacy and physical therapy programs. 

Services are also provided in local communities through contract. 

In the lower Rio Grande Valley, for example, the VA, through a 

contract with community hospitals, provides outpatient surgery 

such as colonoscopies, hernia repairs and cataract surgery and 

short-stay admissions. 

Staff vacancies in several critical positions remain an ongoing 

problem delivering these services. Forty-eight percent of South 

Texas’ employees are over age 50 and 75 percent of senior executives are eligible for retirement. Hard to fill positions defined as 

few or no qualified applicants after 6 months of recruitment include dentists, police officers, pharmacists, registered nurses, social 

workers, physical and occupational therapists, physicians, diagnostic radiology technicians and medical technologists. 

The medical staff of the two large military treatment facilities, 

Wilford Hall Medical Center and Brooke Army Medical Center, 

have worked closely with the South Texas Veterans’ Health Care 

System to provide services to veterans in some areas where staffing 

shortages exist. After deployment of one general surgeon and the 

resignation of the second general surgeon at the South Texas Veterans’ Health Care Center, Wilford Hall assigned two general surgeons to provide inpatient surgical services at Audie L. Murphy. 

Neurosurgical staff from Wilford Hall has also provided on-call and 

emergency coverage for the neurosurgical programs. A sharing 

agreement has been established with Wilford Hall to improve 

urological care and details are being negotiated for cardiac cath 

and inpatient cardiothoracic services to be provided at Wilford Hall 

while one of our two South Texas Cardiac Cath units is being remodeled. 

Initiatives to perform joint credentialing of medical staff and for 

bi-directional transfer of laboratory data have also been submitted 

and approved for funding through a joint VA/DOD demonstration 

project. Additional clinical initiatives include consolidation of the 

bone marrow treatment facilities of Wilford Hall and South Texas 

to conserve resources, and staffing a vacant ICU at Wilford Hall by 

the South Texas Veterans’ Health Care System in order to decrease 

ER diversions. 

Thank you for the opportunity to testify before this Committee. 

The balance of my comments have been provided to the Committee 

in writing. 

Mr. SIMMONS. Thank you, Dr. Bauer. Right on 5 minutes. We appreciate it very much. 

Next, we will have Brigadier General Fox. 

[The prepared statement of Dr. Bauer appears on p. 57.] 

STATEMENT OF BRIG. GEN. C. WILLIAM FOX, JR. 

General FOX. Mr. Chairman and members of the Subcommittee, 

as the Commanding General of the Great Plains Regional Medical 
12

Command and Brooke Army Medical Center, I truly appreciate the 

opportunity to speak with you this morning on the relationship between the 10 Army hospitals that comprise the Great Plains Regional Medical Command and in particular Brooke Army Medical 

Center with the Veterans’ Health Services Administration as it relates to the healthcare and delivery process to our beneficiaries and 

in particular to the service men and women that have been injured 

while serving this nation in the global war on terrorism. I do believe that my testimony will help this Committee to understand the 

various ways and means in which we are working to provide a 

medical process that seamlessly serves our soldiers, sailors, airmen 

and marines. We are ensuring that their physical and psychological 

needs are met with dignity and respect. 

Later today Colonel Ben DeKoning, Commander of Darnall Community Hospital at Fort Hood, TX, and one of the Great Plains Regional Medical Command’s subordinate commanders, will provide 

testimony that provides further examples of this improved coordination. He oversees the healthcare delivery at one of our Army’s 

largest power projection platforms and he will provide to you some 

understanding of the extensive pre- and post-health deployment assessments that are provided and documented for each soldier as 

they deploy and redeploy from theater. Pre- and post-deployment 

health assessments, interventions, scrutiny and documentation are 

a critical component of our soldier and force health readiness today. 

This information is essential to the quality care delivery to soldiers 

and it is an essential historical documentation of healthcare for 

both immediate and long-term reference when the soldier must access the VA healthcare system. 

You will also hear from Lieutenant Colonel Doctor Lee Cancio, 

our Chief of the Burn Center, which is a part of the Institute of 

Surgical Research embedded and located within Brooke Army Medical Center. Our burn center is internationally renowned and is the 

only DOD burn center and by agreement cares for VA patients as 

well. 

Brooke Army Medical Center has a longstanding and productive 

relationship with the Veterans’ Health Services Administration 

here in San Antonio. Prior to the conflicts in Iraq and Afghanistan, 

we established several joint sharing initiatives which Mr. Coronado 

outlined for you, and I have included in my written statements 

submitted to you for the record. These initiatives have resulted in 

more efficient use of federal resources, lowered overall healthcare 

costs and consistently improved our ability to deliver a more integrated healthcare benefit. 

With the incentives from the Congress, DOD and VA to further 

increase our sharing efforts, the leadership of both Department of 

Defense facilities here in San Antonio and the VA have participated in a new formal collaborative effort in San Antonio called the 

Federal Health Care Consortium which meets monthly. Collaboration from this body has resulted in further efforts which have included invasive cardiology and cardiothoracic surgery services, 

working out joint credentialing processes for our nurses and doctors, laboratory data sharing, a joint Northside San Antonio clinic, 

a joint pager system, intensive care optimization, rehabilitation 

and end-of-service VA physical examination coordination. 
13

Most importantly for the global war on terrorism effort we coordinated replacing two VA medical staff members into the Brooke 

Army Medical Center team. It is important to detail somewhat the 

missions and focus of Brooke Army Medical Center before further 

explaining the successes that we have had with these collaborative 

efforts. First, Brooke is the Army’s only level one trauma center 

and plays an absolutely vital role in the United States Army readiness and a vital role to the trauma care here in south Texas in collaboration with Wilford Hall Air Force Medical Center and the University of Texas Health Center and University Hospital. 

As only one of seven medical centers in the Army—that the 

Army possesses, we focus on graduate and continuing medical education for Army doctors, nurses and medics and we provide the 

credentialed and safe platform for critical medical research. We deliver state of the art healthcare to our beneficiaries and our primary referral center for soldiers care within the Great Plains Region. These missions have proven to be essential to the Army’s success in the global war on terrorism. We are inextricably linked to 

the healthcare delivery that occurs on the battlefield today via telemedicine, e-mail collaboration, as well as education and collaboration with providers and teams we have deployed. Many of the doctors, nurses and medics that are now assigned to deployable 

healthcare units on the battlefield have trained at Brooke Army 

Medical Center and are providing life saving care to our forces in 

Iraq and Afghanistan. 

Since the war began Brooke Army Medical Center has continued 

to care for the casualties that have returned from the forward care 

through medical evacuation back to our Army medical center. 

Among the many professional accolades that our preeminent institution possesses, the most powerful credential remains the testimony of the soldiers and beneficiaries that we receive and care for 

in our medical system. Since January 2003, we have received 1,321 

soldiers evacuated from forward theaters of operations around the 

world for both medical and surgical issues. Over 60 percent of 

these soldiers have been from the Reserve and National Guard 

components. Two-thirds of these soldiers have been treated and released back to active duty status or have been released from active 

duty or—released from active duty back to their Reserve or National Guard units. Thirty-four percent of the soldiers have progressed to needing a medical evaluation board and the majority 

will need to receive follow-up care in the VA system. 

Within Brooke Army Medical Center there are two VA 

healthcare employees from the Health Benefits and Services Division who work on our Medical Center to ensure that we have a coordinated and seamless care transition. One is a clinical social 

worker who has consulted on more than 270 cases from OIF and 

OEF patients. He provides in-depth briefings on the VA benefits 

and he works critical coordination for referrals of intensive care patient care management with VA medical centers. Through our coordinated efforts our experience has been that the medically 

boarded patients receive specialty clinic care follow-up within 10 

days at their receiving VA hospital or clinic through the coordinated efforts of the embedded VA staff. 
14

Brooke Army Medical Center also has a Department of Veterans 

Affairs Benefits Administration liaison representative who has 

been at the hospital since the spring of 2003 and continues to articulate the benefits to our soldiers, more than 800 so far that have 

served in OIF and OEF. 

Mr. SIMMONS. If you will begin to summarize, General. 

General FOX. Yes, sir. 

Mr. Chairman and members of the Subcommittee, I know that 

you have introduced Staff Sergeant Canady. I would like to just 

briefly cover his service because I think it is a personal testimony 

to the services that have been rendered to our soldiers. 

Mr. SIMMONS. You do not have to be brief on that point. 

General FOX. Thank you. 

He is a noncommissioned officer who was severely injured in Operation Iraqi Freedom in April of 2003. He was deployed from Fort 

Stewart, Georgia, as part of the 3rd Infantry Division and suffered 

a traumatic amputation of his right arm below the elbow and 

shrapnel injuries to his face and right eye during the assault into 

Baghdad in April of last year. The battlefield heroism that he displayed that day, despite his injuries, earned him the Silver Star. 

Staff Sergeant Canady would be the first to tell you that he was 

also cared for by medics and medivac teams that were equally heroic and more importantly to his life were professional and competent in their skills, skills many of them received here at Brooke 

Army Medical Center. 

Staff Sergeant Canady received quality immediate care followed 

by extensive surgical, psychological and physical therapy over this 

past year. Through no less than continued heroic efforts on his part 

to face the extent and discomfort of these injuries, coupled with our 

professional healthcare he has now received and can utilize a stateof-the-art right arm and hand prosthesis. Throughout his long recovery, he has continued his education towards his bachelor’s degree and with our VA staff we have coordinated for medical care 

at the VA hospital in Wilmington, North Carolina. He plans to attend school there in Wilmington and pursue a career in public service. Staff Sergeant Canady is married and has a 6-year old daughter. 

From the moment he arrived at Brooke Army Medical Center we 

have coordinated every step of his care in a multi-disciplinary way. 

Between this center and the VA, he remains assigned to the Medical Center but now is only awaiting the Physical Evaluation 

Board’s final disposition and results from the Physical Disabilities 

Agency for his orders to be released from active service. 

In conclusion, Mr. Chairman, in my testimony today I have 

shared with you some of the ways and means that Brooke Army 

Medical Center has cared for injured soldiers and transitioned 

them to the Veterans’ Administration Health Care System and 

some of the increasing collaborations we are implementing to further improve our services to all of our beneficiaries. As partners in 

this most important process, we are committed to providing state 

of the art healthcare for America’s sons and daughters injured on 

the battlefield. 

I want to thank you again for your time and I am available for 

further questions. 
15

Mr. RODRIGUEZ. Mr. Chairman, I just want to give the young 

man a standing ovation. (Applause.) 

Mr. SIMMONS. Our next panelist is Colonel DeKoning. Welcome, 

Colonel. Again, we have your statement, so if you would like to 

summarize we would appreciate that. Thank you. 

[The prepared statement of General Fox appears on p. 61.] 

STATEMENT OF COL. BERNARD DEKONING 

Colonel DEKONING. Thank you, Mr. Chairman. 

Mr. Chairman, members of the Subcommittee and distinguished 

guests, as the Commander of Darnall Army Community Hospital, 

thank you for providing me the opportunity to discuss how we provide outstanding care to our injured soldiers and seamlessly transition them to the Veterans’ Administration Health Care System 

when required. 

Darnall is one of 10 medical treatment facilities within Great 

Plains Regional Medical Command. We are the largest and busiest 

community hospital in the Army supporting the largest power projection platform in the Army. Earlier you heard from Brigadier 

General Fox who is both Commanding General of Great Plains Regional Medical Command and Brooke Army Medical Center, which 

is our primary referral hospital. 

Our current operational environment has led to soldiers being 

medically evacuated to Army regional and community hospitals 

like Darnall to provide all the necessary care these soldiers need 

and deserve. Since the summer of 2003, Darnall has received over 

500 soldiers medically evacuated from both Operation Enduring 

Freedom and Iraqi Freedom. 

In 2003, the Army developed the Deployment Cycle Support Program to support the successful reintegration of deployed soldiers 

back into their homes. One of the new programs developed to support the Deployment Cycle Support Program has been the Care 

Manager Program. Care Managers ensure that soldiers coping with 

the injuries or stress associated with combat experiences are reconnected back into a noncombat environment. 

In providing these services to Darnall it became apparent to our 

care managers that a solid link to the VA was needed for those soldiers being medically separated from the Army. In addition, Fort 

Hood has Reserve Corps and National Guard soldiers who are in 

a medical holdover status who will transition to the VA healthcare 

system for which that solid link is also needed. 

In response to this need, a social worker from the VA medical facility in Temple, TX began working with the Department of Social 

Work Service at Darnall in February of 2004 to ensure that seamless transition from Darnall to the VA. This has worked extremely 

well, for prior to the agreement soldiers medically separated from 

the Army might have known which VA facility to go to, but they 

had no point of contact for which they could get their medical appointments at that facility. This resulted in extreme frustration on 

the part of the veteran. With the VA social worker at Darnall, this 

process has greatly improved. 

Mr. Chairman and members of the Committee, I am committed 

to taking care of our soldiers and providing them world class 

healthcare. I am also committed to ensuring a smooth transition 
16

from the DOD healthcare system to the Veterans’ Administration 

healthcare system for our patients. 

Thank you for the opportunity to appear before you and thank 

you for your support of our nation’s veterans. I am available for 

your questions. 

Mr. SIMMONS. Thank you, Colonel. 

Our next panelist will be Brigadier General Charles Green, Commander of the 59th Medical Wing. Welcome, General. 

[The prepared statement of Colonel DeKoning appears on p. 71.] 

STATEMENT OF BRIG. GEN. CHARLES B. GREEN 

General GREEN. Good morning, Mr. Chairman. I am Brigadier 

General Charles Green, Commander of the 59th Medical Wing of 

Wilford Hall. I also serve as the Lead Agent of TRICARE Southwest, Region 6, which encompasses the states of Texas, Oklahoma, 

Louisiana and Arkansas. My comments today are taken from my 

written testimony to be submitted to the Subcommittee. 

Mr. Chairman and members of the House Committee on Veterans’ Affairs, Subcommittee on Health, thank you for allowing me 

to appear before you today and offer my thoughts on DOD/VA collaboration in the greater San Antonio area and how this collaboration is meeting the needs of our sailors, airmen, marines and soldiers returning from contingency operations. As Commander of 

Wilford Hall Medical Center, I am keenly aware of how important 

San Antonio is to the war fighter. During calendar year 2003 and 

to date in 2004, the 59th Medical Wing has provided air evacuation 

reception for 609 Enduring Freedom and Operation Iraqi Freedom 

patients. Wilford Hall Medical Center has treated 127 of those patients and arranged care for 482 with other branches of the armed 

services. I want to assure the Subcommittee we in San Antonio 

take very seriously the need to provide pre- and post-deployment 

surveillance for our returning military personnel. 

In the Air Force, all personnel deploying and returning from deployment are required to process through their local Public Health 

office. Public Health ensures that post-deployment health screening 

was accomplished in theater prior to the airmen beginning rest and 

reconstitution leave. If it was not accomplished, it is accomplished 

here before they are allowed to take that leave. All of this is done 

within the first 48 hours of their return. Eight hundred and thirtyseven members processed through Wilford Hall’s Public Health in 

2003 and we are very proud to have 100 percent compliance with 

the pre- and post-deployment screening. This documentation helps 

Mr. Coronado and the VA ensure military members receive seamless medical care when they leave active duty. 

Soon after my arrival at Wilford Hall in July of 2003 I contacted 

General Fox and Mr. Coronado to talk about DOD/VA cooperation 

and to explore ways to make it better. The San Antonio Federal 

Health Consortium was created with the formal charter signed by 

each of us in February of this year to promote sharing among the 

member medical facilities and monitor progress toward mutual 

goals and projects and we are very pleased to report many great 

successes. 

VA and military command authorities recently notified us that 

three San Antonio proposals were selected to progress to the second 
17

level of review for funding under the DOD/VA Health Care Sharing 

Incentive Fund. We anticipate we will receive funding for a joint 

DOD/VA leased clinic in north central San Antonio, that there will 

be additional ICU nurses at Wilford Hall to help the VA avoid expensive healthcare costs downtown and to consolidate our two bone 

marrow transplant units. Mr. Chairman, I am very optimistic San 

Antonio is leading and will continue to lead the nation in DOD/VA 

sharing efforts. The Air Force, Army and VA are currently building 

on a long history of cooperation. The projects we have proposed will 

strengthen our system for providing medical services and ensure 

our service men and women receive the very best care in the entire 

spectrum of the federal healthcare system. 

Thank you for allowing me to speak this morning. I stand ready 

for your questions. 

[The prepared statement of General Green appears on p. 76.] 

Mr. SIMMONS. That concludes the statements by the members of 

the first panel, I believe. I have a couple of questions that I would 

like to ask. First, for any of the panelists, I think each of you in 

your testimony at least once mentioned the word seamless. This 

appears to be a term of art that we all speak. But then the question is, do we in fact have a seamless system, particularly in the 

case of those military personnel who are transitioning out of the active component. My question goes to the issue of does the Department of Defense and do their facilities do an exit exam, and then 

is that exit exam replicated by the VA or do you coordinate or cooperate in that fashion, having essentially a single exam? Feel free 

to stand and use the microphone if you wish. 

Colonel DEKONING. Mr. Chairman, the answer is that we are 

constantly improving on the seamless nature. The fact that we 

have a social worker from the Veterans’ Administration embedded 

within our Department of Social Work Service has greatly enhanced the seamless nature of transition to the Veterans’ Administration. 

Sir, to answer your second question, is there an exit exam for 

those that are transitioned to VA, absolutely. In fact, there are 

probably several exit exams all through what we call our medical 

evaluation board process. That is a series of very, very extensive 

exams, and all of those results are passed to the social worker from 

the Veterans’ Administration to enhance that transfer to the VA 

healthcare system. 

Mr. SIMMONS. Now as I understand it, those exit exams done by 

the active component are systematically and carefully done and, of 

course, that will affect some of the benefits that that veteran may 

receive and some of the services that that veteran may expect to 

receive. So that is—you know, those exit exams are extremely important. 

You mentioned that there is a social worker from the VA. Is 

there a physician from the VA who sits in in those medical evaluation boards in any sense? 

Dr. BAUER. We do have a physician—is this microphone on? 

Mr. SIMMONS. Yes. 

Dr. BAUER. We do have a physician who is identified as the team 

physician coordinator. He does not sit in on the exit physical exam 

that the military does, but coordinates all of the care transfer when 
18

there needs to be a physician-to-physician communication and also 

supervises the team that actually provides ongoing primary care to 

those veterans who are choosing to enter the VA system. I should 

mention that not all people who are leaving the military—some 

who are not injured are choosing to—are choosing VA services. 

Mr. SIMMONS. I appreciate that. So what I have heard 

anecdotally is that there are times when somebody participates in 

the exit exam from the active component and then sooner or later 

applies for VA services but then has to go through a separate 

exam. And so the question I would have is, is it truly seamless or 

is there a gap there? Are the military records transferred in hard 

copy or are they transferred electronically to VA? How does that 

occur? 

Mr. CORONADO. I believe we are pulling together two separate activities that we have in VA/DOD. We have a physical exam that 

we give to determine whether a veteran is eligible for benefits—

pension or compensation benefits—that they might be eligible for. 

The VA has a pre-discharge exam that we provide for active duty 

military who are on the way out. Not necessarily having anything 

to do with the Iraqi Freedom operation. But this is to smoothen 

their coming into the system and that there are no delays in arriving at the decision as to whether they are eligible for certain benefits, pension or compensation. Now what we are working at now is 

the fact that the military has their automated—their computerized 

medical record and the VA has a computerized medical record. The 

two systems are not connecting at this time. But some of the initiatives that we have launched is to try to get our computer systems 

to communicate with one another. If you would study the three 

projects that we have submitted for trying to get the VA and DOD 

to work more closely together is trying to get that communicating 

between the two systems so that we can move much faster in providing services to that returning veteran. 

Mr. SIMMONS. Thank you for that response. I see that I have a 

red light, so I will now yield to my colleague, Mr. Rodriguez. 

Mr. RODRIGUEZ. Thank you very much, Mr. Chairman. I noted 

during the testimony Mr. Coronado and also Doctor, you talked 

about—at least in the written document regarding the number of 

vacancies and retirements. Do we have any system in place or do 

you have any recommendations as to how deal with that? Because 

I know nationally, not only the Department of Defense but the VA 

and other federal agencies, almost 50 percent of our staff is scheduled to retire in the next 2 or 3 years. So what are you personally 

doing or would you recommend that we need to do in terms of 

keeping up on staff training or staff recruitment? 

Mr. CORONADO. We have various initiatives depending on which 

career or profession you’re dealing with. With nurses, for instance, 

we have scholarship programs that we are working with the nursing schools here in San Antonio where we will assist the nursing 

student pay for their tuition if they will join the VA in turn. We 

also have employment programs while they are in school to have 

them come work at the VA during the holidays or during the summer. This is again to outreach to them. The big problem that we 

have in the VA is that the leadership roles are thinning very fast. 
19

You take me for instance, I have been in the VA 44 years. I have 

been retirement eligible for some time now. 

Mr. RODRIGUEZ. I thought you were just 40 years old. (Laughter.) 

Mr. CORONADO. Not quite. Thank you for that compliment, Congressman. 

The thing is to try to find ways of attracting new people to come 

into the VA. We have many programs by which we will assist individuals. The Congress gave us the ability to pay—help an individual pay for their student loans if they join the VA and work for 

the VA for several years. The VA, if they fall into certain categories, will pay for their loans. And we have other mechanisms in 

place to try to soften that break that we are going to—that we are 

beginning to experience where people are beginning to leave. They 

are approaching retirement, they are taking advantage of retirement and we do not have the staff behind them to fill in. It is usually the management, the supervisory level people, and we are 

working very hard at that. The VA did sort of stop its succession 

program, if you will, that we had for many years and we are now 

reinstalling that program and trying to get all sorts of new things 

going to make sure that we bring in new people into the system. 

Mr. RODRIGUEZ. I also wanted to ask the General, but maybe you 

can react. When we provide services and access to healthcare to 

our military personnel and the needs of the families to what extent 

does the VA—do we need additional authority for the VA to provide 

services for families? I know we are restricted in terms of the 

amount of service we provide for families, but I wanted some feedback from you from that perspective. And also get, if possible, the 

General, to make comments in terms of the services we provide to 

our families. 

Mr. CORONADO. The VA has limited authority to take care of 

families. Now the widows and orphans of veterans who died of 

service-connected conditions do have what we call the CHAMP VA 

Program. We sort of ride behind the CHAMPUS Program that the 

military has. This provides healthcare services for the widows of individuals who died in the military service or for 100 percent service-connected can also have their families benefit and their minor 

children have VA benefits. This is generally done by contract. We 

pay for it in the private sector. But others—the system is not like 

the military where we take care of the beneficiaries or the dependents of the active duty military individuals as they do in the Department of Defense. 

Mr. RODRIGUEZ. Thank you. 

Mr. SIMMONS. Congressman Miller. 

Mr. RODRIGUEZ. General Fox is getting ready to speak. 

Mr. SIMMONS. Oh, excuse me. 

General FOX. Did my red light come on again? 

(Laughter.) 

Mr. SIMMONS. Please proceed. 

General FOX. I wanted to answer Congressman Rodriguez’s question about how are we caring for families. Thanks to your efforts 

really in Congress we have been able to support families as soldiers 

have exited at our Reserve component and National Guard component. Their families and those soldiers are entitled to TRICARE 

benefits for the first 180 days from the point that they exit. So in 
20

addition to being able to access the VA system for the soldier, the 

family has benefits for 180 days, which most of our soldiers are 

electing to utilize. That is a great benefit and it is one that I think 

thanks to you all we have been able to provide to those families. 

Mr. SIMMONS. Thank you, General. 

Anybody else want to respond to the ranking member’s questions? 

[No response.] 

Mr. SIMMONS. Hearing none, Congressman Miller. 

Mr. MILLER. Thank you, Mr. Chairman. Now that General Fox 

has taken a seat, I will ask you to step back up, if you would, sir. 

General Green, you might want to respond too. I want to shift the 

questioning a little bit to the VA/DOD co-sharing issue. Talk a little bit, if you would, about the federal consortium. Where does that 

concept come from, who serves on it? We all know the potential 

positives, but can you explain a little bit from DOD’s side any of 

the negatives that may be out there that would impact the retirees 

and the active duty that are currently receiving care in your facilities. 

General FOX. Well thank you for the question. The Federal 

Health Care Consortium that we designed here in San Antonio is 

really just a title of a collaborative effort that we had begun and 

sustained for a number of years. But we realized in the September/

October time frame that we really had the opportunity now to leverage in a big way further efforts that could enhance our collaborative business horsepower, if you will, to get at sort of using our 

logistics needs, our pager system needs, our need for laundry services, a variety, a myriad of support issues that help each one of us 

deliver this kind of quality healthcare, but do it in a marketplace 

that we could go to one market vendor and lower the cost to all 

three services. Those efforts bind our services together better. It 

leaves us with an opportunity on a monthly basis to look for the 

ways and means to increase and improve the ability to move patients between the capabilities that we have. Vast capabilities here 

in these three institutions really can provide some additional intensive care nursing staff. That is one of the efforts that is being 

looked at seriously now for funding from this DOD/VA collaborative 

sharing agreement. 

Another one is our work with cardiothoracic surgery patients. Instead of sending those patients from the VA system perhaps into 

the civilian purchase care sector, bringing them to our military 

healthcare centers where we have the capacity to deliver the quality care, it sustains the training and education and skills of our 

wartime surgeons and at the same time is a good use of the taxpayers support that they have provided us in these systems. 

Mr. MILLER. Thank you. 

General GREEN. Sir, if I may, the Consortium is a very simple 

operation. Essentially there are three voting members. We are sitting here in front of you today. We work by consensus, we do not 

overrule one another. It is not a voting organization. We simply 

look at the finances and leverage the federal health sector dollar. 

There are a lot of things that are making money for us today. General Fox alluded to several of those. We also are looking at equipment standardization, of buying that way. We have not joined 
21

forces really in the pharmacy arena which may be another large 

dollar potential. We are looking very closely at what materials we 

buy and if we buy them together can we get a better price. I think 

most of it is driven by trying to save dollars and leverage our buying power, if that gives you some idea how it is working. 

Mr. MILLER. If I could just ask you, if you would very quickly, 

to elaborate—and I am a very strong supporter of VA/DOD co-sharing. But what are some of the negatives that you may have come 

upon in this process that prevents you from doing your original intended mission? 

General GREEN. There really have been none. Because it is a consensual agreement we have not run into any problems wherein we 

are put upon to do one thing or another. Even if we agreed to pursue the initiatives for instance that we put forward into the DOD/

VA sharing initiative funds, as we go down the charter if we find 

that something interferes with the training program or interferes 

with other operations within the hospital to where it might jeopardize our mission, we come back to the table and simply talk that 

through to see if there is a way to make it happen. I do not believe 

we have run into anything—in fact, in several cases it has been 

very successful over many, many years. I think the most successful 

may be the cooperation of the VA and Wilford Hall on the blood 

bank operation. We provide nearly 70 percent of the Air Force’s 

blood through the volunteerism really of our basic military trainees. We do that in cooperation with the VA who gets their blood 

from our center by providing about nine FTEs who have much 

higher skill levels than we can put into our technicians. It gives us 

a very extended capability that provides as much as 40 percent of 

the blood going to Iraq today. 

Mr. MILLER. Thank you, General. 

Mr. SIMMONS. Thank you. I will go to a second round of questions 

and I will try to keep them brief. First of all, I did have a comment 

to make about the testimony of General Green. I was intrigued at 

the cooperation that exists between you General Fox and Mr. Coronado, and in particular with regard to the shortage of ICU nurses. 

On the one hand, I am excited by the idea that there is cooperation 

and coordination, there is a protocol. You know, these resources are 

all federal resources, and the only different between an active component service personnel and a veteran is the difference of the DD 

214. It is the same person, the same people. So we honor them 

equally. So I am excited that you are working together. 

I am a little concerned about the lack of ICU nurses but I will 

not belabor the point because I actually wanted to ask if any of our 

members of panel one wish to comment on the Prime Time television show that aired last Thursday featuring Diane Sawyer. I believe the program focused on the Kansas City VA Medical Center, 

the Brecksville and Wade Park, various other parts of the country. 

But there was some discussion of the Temple, Texas VA Medical 

Center. I just wondered if our VA panelists wished to comment on 

that Prime Time show at this time? 

General GREEN. I would like to comment. One of the things that 

we found was that in many cases the VA has much more in-depth 

contracting mechanisms than we do. And so in cooperation with the 

VA, we use one of their contracting mechanisms to bring nurses 
22

back into my facility, as we deploy nurses to the war in Iraqi Freedom. Because of that and gaining an understanding, we found that 

we could work much closer together using some of their mechanisms and when they started looking at their diversion rate for 

ICU patients—we are spending nearly a million dollars in town for 

veterans who are going to local intensive care units—it made good 

sense then for them to look at how can we bring some of that nursing into our ICUs where I can advocate the building, not the staff 

and then recapture that care, which is what that whole initiative 

is about. 

Mr. SIMMONS. And am I to understand that the in-town services 

are contracted by VA but are privately provided? 

General GREEN. That is correct, sir. 

Mr. SIMMONS. So in other words, what we are saying here is that 

as military doctors are deployed overseas, and nurses and there is 

a shortage, you can use VA contracted resources to provide those 

services yourself to save them the cost of doing it downtown. Which 

is a good idea, I think it is fiscally responsible. 

What do the downtown hospitals say? 

General GREEN. Well, at this point in time, it will depend on 

whether or not we take the entire volume or not, and of course that 

remains to be seen. Some of these patients will present to a local 

hospital and make it to their intensive care unit, but it is the diversion that we are trying to stop. If they are seen at the Veterans’

Hospital or at one of our hospitals and we then have to send them 

to a local hospital because we do not have that care, it makes only 

good sense to have the care and not have to divert it. So it will be 

interesting to see if there is any backlash. But honestly, we do not 

expect one. I think that we will recapture that care without too 

many problems in the community. 

Mr. SIMMONS. Thank you. 

And to my question, does anyone here from VA wish to respond 

to the Prime Time program of last week? 

Mr. CORONADO. Before I address that, I just wanted to touch on 

the nursing issue with the DOD. One of the good things that has 

happened to us in VA is that we have been given the Title 38 authority for hiring physicians, dentists and nurses. This gives us the 

ability to hire nurses on a different pay scale than we would were 

we to stick with the Civil Service System, and therefore, we are 

able to recruit and retain nurses because once a year we do nurse 

salary surveys to make sure that the VA is not trailing too far behind, and we can adjust the salaries according to what the prevailing wage rates are. And this gives us a tremendous boost forward, if you will, in being able to attract nurses into the field. 

The military still—they have the active duty military nurses 

which can be deployed, as they have been to Iraq and, therefore, 

they are left with not being able to recruit unless they hire nurses 

using the Civil Service System, which does not put them in a very 

competitive position. 

So General Green and General Fox and I have talked about the 

fact that we could use Title 38 authority and we would be better 

able to recruit these nurses. 

But switching over to your second question, and that has to do 

with the Diane Sawyer program that took place last Thursday. And 
23

at the risk of sounding defensive, I would like to tell you that I did 

watch the program. I noted at the beginning of the program, Ms. 

Sawyer said that she did not want the audience to feel that what 

was being presented was the usual thing that happened in the VA 

because they had met a lot of dedicated people and that excellent 

care was being provided and it was about a one or two minute 

statement that she made. 

Being an old timer in the healthcare business, it would seem to 

me that presenting a balanced picture would be a little bit more 

convincing in presenting such a show, in that I think equal time 

should have been given to presenting someone that is doing an outstanding job, and we have many outstanding staff in the VA system who are delivering excellent care. And I think it is a discredit 

to the system and also probably worries our veterans greatly to 

hear that their system is flawed majorly, as it was presented in 

this program. 

I personally do not feel that is true. I think things do happen in 

healthcare. As someone has pointed out, we are human, mistakes 

are being made. One thing that I have always found to be amazing 

in the healthcare system in general is that people are very honest. 

When a mistake is made, they admit that a mistake has been made 

and we work with the patient and the family to try to correct the 

situation. The VA has now adopted a system by which we track all 

errors and mistakes, misadventures if you will, that have happened 

and we do root cause analyses to see what caused these problems, 

because we want to avoid them happening again. So we need to 

learn from mistakes. 

The things that were pointed out about the system in Temple, 

because that is our neighbor, were things of neglect, probably the 

building needed attention, the staff probably lacked direction. 

These things were taken care of even before the program was 

aired, corrective action was initiated by the VA. 

There were five different review teams that went through Temple. I know because South Texas lent a lot of our staff to that effort, as well as providing as much support as we could to make 

sure that they got their system back together. 

I can assure you, from having talked to the staff at Temple and 

to my boss, Mr. Stranovo, that the healthcare delivery system in 

Temple is now well up to the task that is being asked of them. It 

is a quality program and it is moving very aggressively and I can 

assure you that knowing people as I do that those mistakes will not 

happen again. 

Mr. SIMMONS. I thank you for that response. I would ask if my 

colleague, Mr. Rodriguez or Mr. Miller have additional questions 

for panel one? 

Mr. RODRIGUEZ. Just on the same issue, Mr. Coronado—and let 

me just qualify my statement by saying that I know from the Congress, and I want to congratulate our Chairman because I know 

the Committee is pushing forward to try to get additional resources 

and I know that part of the problem is the fact that we just do not 

have sufficient resources that are needed. 

But back to the Primetime program, based on one of the responses that we got was that they sent a team immediately down 

there, but I was concerned with one of the recommendations that 
24

they had. It says action taken since then includes revising facility 

care protocol, reorganizing the supervision structure and it goes on 

and on. But it also says suspending admissions while recruitment 

for additional staff is taking place. So if we stop additional recruitment of veterans that are in need of service, I was just wanting you 

to react to that. Do you know what the situation is down there? To 

what extent that has occurred and if we are back providing the 

services. And I just got this piece of paper here. I know we have 

got some Vietnam veterans in America here that are concerned 

about us not going out there and educating our veterans about the 

types of services that we have. And so I hope that because of the 

program, that we do not do that because I know instead of telling 

them you cannot come in because we do not have the staff, you 

cannot come in because we cannot provide the service, yet they are 

entitled to that. 

So I was wondering—— Mr. CORONADO. I have not actually seen that document, but I 

think that refers to their extended care unit. 

Mr. RODRIGUEZ. A little louder, please? 

Mr. CORONADO. I believe that that document refers to their extended care unit. They do have capability——

Mr. RODRIGUEZ. You are right, by the way. 

Mr. CORONADO. They do have capabilities for extended care services beyond that actual in-patient unit. They have another facility 

that has extended care services and they are also under contract 

for extended care services in the community. 

So while I cannot speak to actually how they manage individual 

cases, they do have alternative sites for providing those services. 

Mr. SIMMONS. Mr. Miller. 

Mr. MILLER. Thank you, Mr. Chairman. 

Since you brought it up, I just want to make a statement and I 

think everybody on the full Committee would say that those issues 

that were highlighted in the Prime Time program, none of those 

are acceptable. So that I think should go without saying. 

That being said, I do not think the veterans were well-served at 

all. In fact, I am rather appalled by the way that the program was 

put together. My degree happens to be in journalism, but I do not 

think ambush journalism serves anybody well. The fact of the matter remains if in fact ABC’s intention was to assist in any way with 

improving the healthcare of veterans in this country, they would 

not have gone in, shot video and waited 5 months before that video 

was exposed. They would not have done a program 14 years ago 

and then waited for 14 years to go back and check and see how 

things had changed. 

You know, we have a lot of political issues that we deal with in 

Congress back and forth. But one of the committees that very 

few—when you get down to the discussions, there are very few differences and that happens to be the Committee on Veterans’ Affairs, because there are no Democrats, Republicans, Independents 

when it comes to taking care of the veterans of this country. And 

I think that, you know, unfortunately during this year, this campaign season, we are going to be seeing more and more issues like 

this arise and I am not casting aspersion on either party because 

both sides are going to be trying to make their point. 
25

I think the most important thing for the veterans of this country 

to know is that the members that serve on this Committee and the 

vast majority of members in Congress understand the plight that 

the veterans are faced with today. They know that the veterans understand the plight that the VA is under today. There are, in certain instances, limited resources and that is why VA/DOD sharing 

is so important, to be able to take the limited dollars that are out 

there today and make the best use and achieve the best outcome. 

But I cannot let the opportunity pass without saying that, you 

know, what we all witnessed—and I watched it too last week—was 

really a disservice to the veteran community in the way that it was 

portrayed and I would hope that any media outlet that chooses to 

do something to highlight potential negatives to veteran healthcare 

would bring it to attention as quickly as possible so that a solution 

can be found and a problem can be fixed, so that the veterans will 

not continue to be under-served. 

Mr. SIMMONS. I thank the gentleman for his comments. We have 

taken a good long piece of time this morning on panel one and I 

thank them for their testimony. They have really helped us get 

kicked off in this process very nicely. 

Now I would like to welcome the members of panel two to come 

forward. We have Dr. Stephen L. Holliday, President of the Association of VA Psychologist Leaders; we have Lieutenant Colonel 

Brian Masterson of the Wilford Hall Medical Center; we have got 

Lieutenant Colonel Lee Cancio, Chief of the Burn Center, Brooke 

Army Medical Center; we have got Ms. Janeth Del Toro, a nurse 

practitioner from the VA South Texas Veterans’ Health Care System; and we have Raul Aguilar, M.D., Chief Medical Officer of 

McAllen Outpatient Clinic, VA South Texas Veterans’ Health Care 

System. 

Having read them off in sequence, I will now read them off again 

in the sequence that this note says that they are going to speak. 

We will begin with Ms. Del Toro and then we will do Dr. Aguilar 

and then we will do Dr. Holliday, then we will do Lieutenant Colonel Cancio and we will conclude with Lieutenant Colonel 

Masterson. 

We do have you statements which we read as you speak. So feel 

free to highlight your statement in a form that will fit within 5 

minutes. Ms. Del Toro, thank you and please proceed. 

STATEMENTS OF JANETH DEL TORO, NP, VA SOUTH TEXAS 

VETERANS’ HEALTH CARE SYSTEM; RAUL AGUILAR, M.D., 

CHIEF MEDICAL OFFICER, MCALLEN OUTPATIENT CLINIC, 

VA SOUTH TEXAS VETERANS’ HEALTH CARE SYSTEM; STEPHEN L. HOLLIDAY, PH.D., ABPP, PRESIDENT, ASSOCIATION 

OF VA PSYCHOLOGIST LEADERS; LT. COL. LEE CANCIO, M.D., 

CHIEF, BURN CENTER, BROOKE ARMY MEDICAL CENTER 

and LT. COL. BRIAN J. MASTERSON, M.D., CHIEF INFORMATION OFFICER, WILFORD HALL MEDICAL CENTER, 

LACKLAND AFB, TEXAS 

STATEMENT OF JANETH DEL TORO 

Ms. DEL TORO. I wanted to let you know I am not a physician, 

I am a nurse practitioner. 
26

Texas, with 84,000 women veterans, has the third largest population of women veterans. In the South Texas Veterans’ Health 

Care System, we have approximately 10,000 women enrolled. 

Throughout the system, there are women health programs at each 

facility. Women are eligible to receive women’s healthcare through 

their primary care clinic or through a specialty women’s clinic. At 

the Frank Tejeda Outpatient Clinic, we have the Women’s Place 

and at the Kerrville Division we have the Women’s Health Clinic. 

At each hospital, there are nurse practitioners employed as Women 

Veteran Program Managers, who are responsible administratively 

and clinically for the provision of comprehensive women’s 

healthcare. I am the Women Veterans’ Program Manager from the 

Kerrville Division. Each of the five satellite clinics also provide 

women’s healthcare. At each outpatient clinic, there is a Woman 

Veteran Liaison to ensure that to women veterans’ needs are met. 

The women veteran population has unique issues. Among the 

issues that the VA is faced with in the women veteran population 

includes screening and treatment for military sexual trauma and 

clear access to women’s healthcare. Women in the military have 

not seen the VA as a system willing and able to care for women 

veterans. In talking with women veterans, I have been surprised 

to hear that in many cases, women do not consider themselves veterans, and in those cases they certainly do not consider themselves 

eligible for healthcare at the VA. They are surprised and pleased 

to find that the VA has services that equal or surpass women’s 

healthcare offered in the private sector. 

Another priority issue in the women veteran population is the 

screening and treatment of women with military sexual trauma. As 

you know, victims of sexual abuse often do not report this crime. 

Women delay disclosure of sexual abuse until after departure from 

active duty, perhaps in fear of retaliation or rejection or the fear 

of the negative consequences the accusation will have on her career. 

Non-randomized surveys of women veterans indicate rape or attempted rape while in the service are at rates of 23 to 43 percent. 

This represents a challenge to us in the delivery of care and availability of services. Many victims of sexual trauma are not eligible 

for services other than sexual trauma counseling. In this system, 

we have been able to coordinate and collaborate military sexual 

trauma services within the VA and the Vet Center. For many 

years, this system has worked collaboratively with the Vet Center 

to provide counseling. For those veterans who live in remote areas, 

we work with private counselors to provide this. 

Women veterans are seen in our Mental Health Clinic, the PTSD 

Care Team, within the Women’s Clinic and through the Vet Center 

for military sexual trauma counseling. For the past 9 years, the 

Kerrville Division has collaborated with the San Antonio Vet Center to bring these services locally. We have also collaborated to 

offer a retreat to women veterans involved in military sexual trauma group therapy. This has been a tremendous success with 

women veterans expressing that this has been the most successful 

therapeutic experience that they have received. 

The VA is eager and able to provide women’s healthcare; however, getting that information to them has been a challenge. We 
27

have met this challenge in a number of ways. For the past 13 

years, we have offered the Salute to Women Veterans in Kerrville. 

The purpose of this program has been to honor the role of women 

veterans and to increase community awareness of the role of 

women in the military. The Salute has reached women throughout 

the entire system and has heightened awareness of women veteran 

issues and healthcare services. 

The Women’s Place has held women’s health fairs at a local San 

Antonio community college and a representative from the Women’s 

Health Program presents weekly at the local military base’s TAPS 

briefing to apprise military women of services that they are entitled to. 

In November 2002, we collaborated with a local theater group to 

produce the play A Piece of My Heart to women throughout the 

system. This play is a moving depiction of women veterans in the 

Vietnam War. Regularly, the Women Veterans’ Program Managers 

meet with the media in television, radio and newspaper regarding 

women veterans’ issues and stories of interest. 

At the Frank Tejeda Outpatient Clinic, we have two primary 

care physicians, two nurse practitioners and a gynecologist and at 

the Kerrville Division, we have one nurse practitioner providing 

women’s healthcare. At the Audie L. Murphy Division, women can 

choose to receive their healthcare in the primary care team or be 

referred to the Women’s Place. At the satellite clinics, patients receive women’s healthcare with either a nurse practitioner or a physician. Throughout the system, for complex women’s healthcare 

issues, patients are referred to the Women’s Place to be seen by the 

gynecologist. We have a collaborative relationship with University 

Health Systems for gynecological surgical procedures and these are 

done at University Hospital. For obstetrical care, we have contracted with local private providers as well as with Wilford Hall 

Air Force Medical Center. These collaborative program have been 

well received. Since the VA began providing obstetrical care, we 

have delivered 63 babies for women veterans and we anticipate 16 

additional babies this year. 

I was also asked to discuss the role of the nurse practitioner in 

this system. Nurse practitioners have been instrumental in providing care to all veterans but have been especially effective with 

women veterans. Women veterans generally expect holistic care, including meeting not only their physical needs, but evaluating their 

emotional, spiritual and psychological needs. Women in America 

tend to be the primary person in the family responsible for 

healthcare. Women expect detailed information prior to making 

healthcare decisions and nurse practitioners are uniquely able to 

meet this with training in both medical and nursing science. There 

are 24 nurse practitioners in our system where they are utilized in 

the hospitals and within the outpatient clinics. Nurse practitioners 

can be found in long term care, primary care, in triage and in specialty clinics. 

As a nurse practitioner who has worked in both the private sector and within the VA, I am in a unique position to evaluate the 

best of both private and public healthcare. And I feel that our system has met the challenges of women veterans well. In this environment, the women receive care that surpasses the services that 
28

I am able to receive in the private sector as a non-veteran. In 2002, 

we received the Clinical Program of Excellence in Women’s Health 

award, one of six VA facilities to receive this award. I am honored 

to serve in the capacity of the Women Veterans’ Program Manager 

and I feel that I have learned as much from my patients as I have 

imparted to them. 

And I thank you for this opportunity. 

Mr. SIMMONS. Thank you. The next person to testify will be Dr. 

Raul Aguilar, VA South Texas Veterans Health Care System. 

Thank you for being here and feel free to summarize. 

[The prepared statement of Ms. Del Toro appears on p. 82.] 

STATEMENT OF RAUL AGUILAR, M.D. 

Dr. AGUILAR. Good morning. I am honored to be requested to testify before this U.S. House of Representatives Veterans’ Affairs 

Health Subcommittee on veteran healthcare in the Rio Grande Valley. I have been associated with the Veterans’ Administration as a 

healthcare provider since 1981 and it has been my goal to provide 

veterans with the best healthcare that the system can deliver. We 

also have a team of VA healthcare professionals in the Valley that 

are providing daily healthcare delivery to a veteran population that 

has proudly served their country in the Armed Forces. 

The VA Clinic in McAllen, TX was established in 1972 as an outpatient facility and housed in a trailer located near the now demolished and relocated McAllen Methodist Hospital. Originally, the 

clinic was under the auspices of the director of the San Antonio 

Outpatient Clinic. In June 1977, however, the outpatient clinics 

were merged and became satellite facilities of the Audie L. Murphy 

Memorial Veterans’ Hospital under the auspices of the hospital director. In 1978, the clinic relocated from the trailer to a structure 

of 5,000 square feet. And in August 1991, the clinic relocated to its 

present facility of 27,000 square feet. This facility is located 250 

miles south of the parent facility here in San Antonio, TX. The 

catchment area that we have is comprised of approximately 47,000 

veterans, of which we have a market share of 23 percent of the veteran population. This figure does not include the large number of 

winter visitors that significantly swells the veteran population in 

the Valley. 

Services provided in our clinic include medical and psychiatric 

treatment, mental hygiene classes, Aid and Attendance and Housebound exams. We have special clinics for flexible sigmoidoscopy, 

geriatric assessment, gynecology, minor ambulatory surgery, endocrinology and podiatry. Other services in the clinic are psychological evaluation and testing, pharmacy, physical therapy, laboratory, radiology, social service, smoking cessation, marital counseling and dietary therapy. Furthermore, the clinic participates 

with the South Texas Family Practice Residency in McAllen in 

teaching 20 family practice residents in geriatric medicine and internal medicine, flexible sigmoidoscopy and minor surgery. We 

have four Board certified family practice physicians, of which one 

is certified in geriatric medicine, three board certified internal medicine physicians which have specialties in pulmonology, endocrinology and geriatric medicine and we have a psychiatrist and a 

psychologist assigned to the mental health unit. Five of these seven 
29

physicians have faculty appointments as clinical assistant professors in the University of Texas Health Science Center here in San 

Antonio. The clinic recently received accreditation from the Joint 

Commission for Accreditation of Healthcare Organizations from 

2002 to 2005. There are six primary care teams delivering primary 

care and one mental health team composed of a psychiatrist, psychologist, mental health nurse and social worker. The Lower Rio 

Grande Valley Surgical Contract that has been mentioned before 

has provided day surgery on a local basis for Valley veterans for 

the past 5 years or so. 

There are 24 Iraqi-Afghanistan war veterans that have enrolled 

in the McAllen VA Outpatient Clinic, of which four were female 

veterans. Ten of these veterans declined treatment but wanted 

their enrollment documented in the system. Initial screening for 

post traumatic stress disorder, infectious diseases, depression and 

alcohol abuse are conducted on all these veterans as well. 

We anticipate that we will have a Harlingen VA Outpatient Clinic that will be operational as early as July 2004. We will start initially with two primary care teams that will eventually expand to 

eight teams by the year 2006. This expansion of primary care delivery to the veteran population will decompress the McAllen VA Outpatient Clinic, which is operating at full capacity, and accommodate the continued growth of the veteran demand for medical services in the Rio Grande Valley. The Harlingen Outpatient Clinic will 

be situated in the Regional Academic Health Center affiliated with 

the University of Texas Health Science Center in San Antonio and 

will have approximately 30,000 square feet of clinic space. The facility will mirror the clinic in McAllen with the exception of providing additional services in optometry and dental care. 

I would just like to say that my family has proudly served in the 

United States Armed Forces. My father Eulalio Aguilar, Sr. served 

in the Army during World War II, my brother Eulalio Aguilar, Jr. 

served two tours in Vietnam as a Marine receiving a bronze star 

and two purple hearts; and my older brother Alfredo Aguilar also 

served in the Air Force as a medic. I have been associated with the 

United States Air Force Reserve for 15 years and it has been a 

privilege serving with the other men and women serving in the 

Armed Forces. 

Thank you for your attention. 

Mr. SIMMONS. Thank you for your testimony and thank you for 

your family’s service. 

Next we will hear from Dr. Holliday, President of the Association 

of VA Psychologist Leaders. 

[The prepared statement of Dr. Aguilar appears on p. 85.] 

STATEMENT OF STEPHEN L. HOLLIDAY 

Dr. HOLLIDAY. Mr. Chairman, I apologize that you did not get my 

statement in advance. I will see that you get a copy. 

Mr. SIMMONS. Thank you, I appreciate it. 

Dr. HOLLIDAY. My name is Stephen Holliday and I am a clinical 

psychologist and Board certified in clinical neuropsychology. For 

more than 18 years, I have been actively involved in providing psychological services for veterans in the South Texas Health Care 

System. I have also served as a psychology training director for the 
30

past 10 years and this past January was named Chief of the Psychology Service. As such, I have administrative and clinical responsibility for all psychological services provided at South Texas, including our outpatient clinics. 

In addition, as you noted, I am President of the Association of 

VA Psychologist Leaders, representing 200 VA psychology, chief 

psychologists and program leaders throughout the country. I will 

preside at our annual meeting in Washington later this month and 

I am pleased to say your senior staffers will be participating at 

that meeting. A major focus of our meeting in Washington will be 

on preparations for veterans returning from Iraq and Afghanistan. 

We at South Texas have a long and fruitful history of collaboration with DOD in psychology training. Many of our trainees serve 

at BAMC and do training in neuropsychology there. In addition, we 

collaborated on research projects and educational seminars with 

our colleagues at both Wilford Hall and BAMC for the past 15 

years. 

Our staff members at South Texas, both in triage, medical administration service and primary care as well as mental health 

have been trained to expedite services for returning veterans from 

Iraq and Afghanistan. Mental health program leaders have specifically been instructed to ensure that these priority veterans receive 

all needed services in a timely fashion. 

Recent military actions in Afghanistan and Iraq have already increased our caseload of PTSD patients, not so much from returning 

veterans themselves, but from veterans of former wars whose 

PTSD symptoms have been exacerbated by the news coverage of 

the current conflicts. 

Our PTSD program recently received authority to expand their 

staff to accommodate PTSD treatment. They have expanded a half 

time social worker position to full time and we have been authorized to recruit for an additional psychologist and psychiatrist to 

help with this caseload. The new psychiatrist has already been selected and the new psychologist should be selected within a few 

weeks. 

Dr. Abney, our PTSD clinical director, is currently planning for 

new groups, especially for these new PTSD cases. Indeed, Dr. 

Abney has already treated several active troops who were disturbed by nightmares from their service in Iraq. I might add that 

these were adult children of Vietnam veterans that Dr. Abney has 

treated over the years. 

In conjunction with our education service, we are also planning 

for an extensive workshop at South Texas on the treatment of 

acute stress disorder by staff from the VA’s PTSD Center of Excellence. 

In addition, other mental health resources have been increased 

this year and we are currently recruiting additional psychiatrists, 

two mental health nurses, an additional psychologist for our outpatients clinics in both San Antonio and Kerrville. 

Although it is difficult to accurately predict the number of returning veterans who will require mental health services, we suspect that it will be substantial. Unlike the relatively brief and low 

casualty first Gulf War, the current conflict in Iraq and Afghanistan are likely to be more protracted and difficult. The mental 
31

health toll taken by extended tours in such stressful conditions is 

well known to us. The question is not if many returning veterans 

will need VA mental health services, but only when they will seek 

it. We know how to effectively treat acute stress disorder and to 

prevent it from becoming severe chronic PTSD. However, we will 

need the resources to do this. Our budgets are cutting currently. 

As the first of the returning veterans begin to enter the system 

over the next several months and seek mental health care, we 

should have a better estimate of the number needing additional 

mental health services and resources. We know that the Committee 

will closely monitor this need and adequate fund the VA services 

accordingly. 

Thank you for your time. 

Mr. SIMMONS. Thank you very much, Doctor. 

Next, we will hear from Lieutenant Colonel Lee Cancio, Medical 

Doctor, Chief of the Burn Center, Brooke Army Medical Center and 

we do have your testimony. We look forward to hearing your summary. 

[The prepared statement of Dr. Holliday appears on p. 87.] 

STATEMENT OF LTC LEOPOLDO C. CANCIO, M.D. 

LTC CANCIO. Good morning. 

Since 1949, we have been the burn center for the Department of 

Defense for VA cases from across the nation and for civilians from 

south Texas. 

Burn care is time, manpower and resource intensive and requires 

a multi-disciplinary team effort at specialized centers. I will give 

you an overview of our experience during the war and of our care 

for the servicemen as they return to duty or civilian life. 

This Burn Center’s mission in this war has been to receive all 

burn casualties up to our maximum capacity and not to close to civilian burns here in south Texas unless absolutely necessary. 

As we prepared for the war, we developed plans for expanding 

our burn center up to a 60-bed capacity, we created a national response for burn care in the event of a mass casualty situation. We 

conducted burn training for hundreds of military medical personnel 

and we put into place a rapid response aeromedical evacuation 

plan. 

With respect to the national response for burn care, our worstcase-scenario prediction was that this conflict could generate approximately 1,000 burn patients, clearly no one burn center could 

provide intensive care for this many patients. Therefore, we collaborated with the American Burn Association, the U.S. Air Force 

and the National Disaster Medical System. 

We e-mailed a daily request for open bed status to 60 participating burn centers across the country and collated the responses 

and sent a report to our Liaison Officer in Germany. In the event 

of a mass casualty situation, this would have allowed him to regulate burn patients coming out of Iraq to available beds in the U.S. 

This unprecedented nationwide system was in continuous operation 

between March and May of 2003. 

We also spoke with the National Disaster Medical System concerning the possibility of activating the Burn Disaster Medical As-
32

sistance Teams to support the Army Burn Center, but this was not 

required. 

With respect to training, most military providers have little 

hands-on burn experience, so we trained approximately 1,100 personnel on site at the Army Burn Center, on the ground in Kuwait 

and aboard the Hospital Ship Comfort. 

With respect to aeromedical evacuation, this center’s burn flight 

teams have pioneered the aeromedical transport of seriously ill 

burn patients since 1951. Today, they are the only Army teams 

whose members are also trained and certified by the U.S. Air Force 

as Critical Care Aeromedical Transport Teams. 

During this conflict, the Army Burn Flight Teams have performed 18 flights to Germany in order to transport burn patients 

without complications. Fortunately, we have been able to care for 

all of the burn casualties from this conflict at our burn center. 

Between March of 2003 and April of 2004, our burn center has 

admitted a total of 91 combat casualties with burns and after discharge, we have followed these patients in our outpatient clinic for 

up to one year. 

These burned servicemen have been supported by a variety of 

services that are unique to this burn center, to include family lodging at the Fisher House, close liaison with the servicemen’s units, 

Purple Heart ceremonies and visits by General Officers, Members 

of Congress and the Secretary of Defense. 

Having these soldiers at one burn center versus scattered across 

the nation has facilitated this type of support and has allowed us 

to collect data on long-term outcome after injury. 

About 25 percent of our combat casualties with burns have ongoing psychological problems and have been referred to mental health 

services for long-term follow-up. About 25 percent have deep burns 

of the hands or of the face, requiring the services of specialized 

hand therapists and reconstructive surgeons. Fifteen have not been 

capable of returning to duty and have undergone a medical evaluation board or are undergoing one now. 

All of the burn patients at Brooke Army Medical Center have received assistance from two VA employees, one a clinical social 

worker and the other a benefits expert, and their hard work has 

been absolutely essential. 

In conclusion, it has been a real honor to care for the burned 

servicemen who have been injured in this conflict. We look forward 

to working with the Veterans’ Administration system to facilitate 

the long-term care they will need. And thank you for the opportunity to testify. 

Mr. SIMMONS. Thank you, Colonel. 

The last panelist for panel two will be Lieutenant Colonel Brian 

J. Masterson, Chief Information Officer, Staff Position Psychiatry 

and Internal Medicine at Lackland Air Force Base, Texas. Colonel, 

welcome. 

[The prepared statement of LTC Cancio appears on p. 91.] 

STATEMENT OF LTC BRIAN J. MASTERSON, M.D. 

LTC MASTERSON. Good morning. I am Brian J. Masterson, I 

practice internal medicine and psychiatry at Wilford Hall. I previously served as Commander for the Critical Care Squadron which 
33

has all the ICUs at Wilford Hall Medical Center. Mr. Chairman 

and members of this House Committee on Veterans’ Affairs Subcommittee on Health, thank you for allowing me to present before 

you today and offer you my thoughts on the medical military 

healthcare in the Department of Defense and the Veterans’ Affairs 

cooperation and initiatives in San Antonio. 

Prior to coming to San Antonio, I spent 5 years at the VA Medical Center in Iowa City, Iowa and worked extensively with post 

traumatic stress victims from both World War II and Vietnam. For 

the last 11 years, I have served as staff psychiatrist and physician 

here in San Antonio and have come to appreciate the unique and 

ideal community that we have here practicing and teaching medicine while delivering health care in a cost-effective and efficient 

manner. 

These world class facilities and research here allow us the opportunity to share resources and to improve the quality of care for our 

military and civilian community. In addition to the unparalleled 

opportunity to share resources, San Antonio Veterans’ Affairs Hospital and the military medical facility play a key role in preparing 

our troops as well as treating the casualties when they return 

home. 

Prior to deployment, our readiness squadron prepares personnel 

that are deployed to all contingencies, whether they be Operation 

Enduring Freedom or Operation Iraqi Freedom. Requirements for 

deployment are validated by the squadron and matched against the 

personnel available with their unit type codes and their skills. The 

individuals are screened against 43 indicators for deployment on 

administrative requirements, training, medical and dental fitness. 

To date, there have been no errors and no need to remove Lackland 

personnel from the theaters of operation. The lowest disease, nonbattle injury in history is four percent in Operation Iraqi Freedom, 

which is much lower than the six percent that was seen in Operation Desert Storm, clearly demonstrating the success of screening 

and aggressive public health and safety initiatives within the theater. 

Personnel returning from deployment are required to process 

through the Air Force Public Health before they can have their rest 

and reconstitution leave. Approximately 840 personnel returned in 

2003. To ensure that this screening is conducted, all tasks must be 

completed before they present to the finance department to receive 

their TDY pay. This has ensured compliance and 100 percent completion of these requirements. Additionally, the medical members 

have medical records screening to ensure that the post-deployment 

health assessment survey is done. That is the DD Form 2796, 

which must be completed in theater. However, there have been a 

few cases that have not. During their processing, they have made 

arrangements with their primary care manager at Lackland. This 

accounts for the 100 percent capture rate that we have had with 

getting the information. 

As I said, the survey is completed and they are seen face-to-face 

with a healthcare provider. If follow-up with the individual is needed, that is addressed and the member is scheduled for appointments. The PCM also schedules any follow-up appointments needed 

after they have reviewed the screening. 
34

This survey analyzes the location, psycho-social health, special 

medications and occupational exposures that they have had during 

deployment. A post-deployment blood sample is also drawn and forwarded to the DOD serum repository. 

Post-deployment care regarding reserve personnel is coordinated 

through their unit and the VA facilities close by. The members that 

require immediate and extensive evaluation are received on active 

duty until they have a disposition. During calendar year 2003 and 

2004, the 59th Medical Wing had received over 609 OEF and OIF 

patients, Wilford Hall treated 127 and 482 were sent to other facilities. 

We work closely with our VA points of contact to ensure that the 

patients are fully aware of their VA benefits. For those patients 

who may be transitioning from DOD healthcare to the VA 

healthcare, we are committed to ensuring their access to the VA. 

One example is a U.S. Marine Corps corporal who basically came 

in having had a cervical spine fracture. He was treated at Wilford 

Hall and is now receiving pain management and coordinated care 

with the Dallas VA system which was facilitated by our VA here 

in San Antonio. In 3 months, he will be re-evaluated and hopefully 

will be returned back to duty. 

The second unfortunate case is a senior airman who jumped off 

a tracked vehicle in Afghanistan and received a foot injury that led 

to reflex sympathetic dystrophy, which is a chronic pain syndrome. 

This is a debilitating issue and we are waiting to do the medical 

board after we get input from the local community. Here again, 

this was facilitated by the DOD/VA. 

In summary, I have been involved with post-Desert Storm surveillance as program director of primary care at Wilford Hall Medical Center and later provided oversight as the Chief of Clinical 

Medicine for Headquarter Air Education and Training Command. 

I can attest to the lessons learned from the comprehensive clinical 

evaluation program, a retrospective analysis of post-Gulf War syndrome, that we have successfully implemented lessons learned. 

This is demonstrated by the effectiveness of both pre-and post-deployment survey completions as well as aggressive public health 

and safety initiatives, both before they go to theater and in theater. 

Mr. Chairman, I am convinced that continued asset sharing between the U.S. Air Force, Army and VA will strengthen our system 

and provide medical services and ensure our service men and 

women will receive the best care in the entire spectrum of the federal health system. 

Thank you for allowing me to testify today. 

[The prepared statement of LTC Masterson appears on p. 96.] 

Mr. SIMMONS. Thank you, Colonel Masterson. 

We have completed the testimony of panel two. I have a question 

for Dr. Cancio, LTC Cancio, representing the burn center. 

In your testimony, you made a statement on page 3 that with regard to the aeromedical evacuation of burned servicemen and the 

Army burn flight teams that were prepositioned in Saudi Arabia, 

your experience was that they were under-utilized. At the same 

time, on page 1 of your testimony, we have a worst-case-scenario 

prediction that the conflict and the global war on terrorism could 

generate approximately 1,000 burn patients. 
35

I just want to share with you an anecdote. On September 11— and you know I am from Connecticut—the State of Connecticut mobilized all of its doctors to deal with what we anticipated to be the 

injured, the burned, the broken and the injured. And in the southwestern part of our state, all surgeries were canceled and all doctors were called in to deal with the injuries. But in fact, there were 

very few. When the World Trade Center collapsed, most people 

were killed. Those who suffered burns died of their injuries or were 

crushed in the building. 

And so the point I am getting at here is that it is very hard I 

think to anticipate what your caseload is going to be in a particular 

situation. As you say, you anticipated certain types of burns in the 

war in the Gulf and that did not occur. You say that a lot of the 

burns are due to accidents, not actually through combat. Maybe 

that is because flame throwers are not used any more, napalm is 

not used. I am not sure. 

How do we, as a nation, anticipate what those burns may be? I 

mean if there is a nuclear explosion of some sort delivered by a terrorist group, I would expect those burns would be very substantial. 

How do we do that? What confidence do you have that you are 

maintaining the right capacity for the nation at this point in time? 

LTC CANCIO. The question of burn bed capacity I think is an important one when you examine, for example, a scenario in which 

the World Trade Towers would not have collapsed. Under those circumstances, we do not know the answer, but it is possible that 

there may have been hundreds of seriously injured casualties that 

would have had to be transferred out of New York City across the 

United States. 

What we found from our experience during Operation Iraqi Freedom was that the daily burn bed capacity was approximately 400 

beds, of about which were intensive care beds and half were ward 

beds in the 60 participating burn centers. 400 burn beds on any 

one day, an average of nine and a half beds per burn center, is not 

a large excess capacity and thus, what we learned from that experience was that the burn capacity is not unlimited. 

When one considers certain more severe scenarios, as you mentioned a nuclear terrorist attack in which we would anticipate 

many thousands of burn casualties, then those casualties would 

certainly potentially overwhelm the burn bed capacity and we 

would have to fall back on non-burn bed to take up the slack. 

Mr. SIMMONS. So the bottom line is we have to maintain the capacity in anticipation of an incident that could occur, but to date 

we have not actually experienced that. 

LTC CANCIO. I absolutely agree. 

Mr. SIMMONS. Thank you, Colonel. Mr. Rodriguez. 

Mr. RODRIGUEZ. Thank you very much. I have three questions, 

if it is okay, Mr. Chairman. 

Ms. Del Toro, let me ask you, I just introduced legislation to permanently extend the military sexual trauma counseling and treatment and I wanted to know how we are doing there and how we 

are progressing and some feedback in terms of are we making any 

gains into the future in that area. 

Ms. DEL TORO. That is one of our priority programs in the women’s healthcare program, to provide for military sexual trauma. 
36

1Patients are also seen for counseling in the mental health clinics in San Antonio, at the 

Kerrville Division and in the satellite clinics. 

And it is a significant need. I would say more than 50 percent of 

my patients have a history of sexual trauma. 

Mr. RODRIGUEZ. What percentage? I am sorry. 

Ms. DEL TORO. It is a guesstimate, I would say at least half of 

my patients that I care for have a history of sexual trauma. Very 

few request counseling services. 

We collaborate with the Vet Center to provide counseling services 

throughout our whole system. 1

I feel like we have good collaborative programs, but I think we 

need more. We need more counselors available. 

Mr. RODRIGUEZ. Thank you. And Dr. Aguilar, I know that we 

had, through the last legislation we also included some language 

in there with the help of Congressman Ortiz to look at the Valley, 

both from Corpus all the way to Brownsville as well as the McAllen 

area that are represented by Congressman Ortiz, Congressman 

Hinojosa, myself and now of course Congressman Doggett and I 

know that there is a great deal of disparity there. There were some 

plans—I know the McAllen Clinic, there is a plan there to expand. 

Where are we at on that expansion and any other comments you 

want to make as it relates to, especially Brownsville and that area 

down there where we do not have sufficient services for our veterans. 

Dr. AGUILAR. Well, first of all, the vast majority of our patient 

population is made up of two counties and that is Cameron County 

and Hildago County. Right now in McAllen, TX, we are serving 

both counties, so we are having to take on almost essentially 

40,000 veterans, potential veterans, of which we serve about maybe 

23 percent of them right now. 

What is going to happen is that that the Harlingen Outpatient 

Clinic will decompress to McAllen VA Outpatient Clinic. In anticipation of that, we are going to move over two physicians from our 

clinic in McAllen over to Harlingen. In the meantime, we have 

been granted over-hire authority to go ahead and bring in two new 

physicians to replace those. 

As that happens, we are going to be transferring the care of the 

patients that are coming in from Cameron County, the adjoining 

county, all the way to McAllen. Those veterans will be asked to see 

if they want to transfer over to the Harlingen Clinic and I think 

most of them probably will accept moving closer to that facility. In 

the case of those that want to stay, of course they will be allowed 

to stay in McAllen. 

So that decompression right now, which is slated to occur as 

early as July 2004, will tremendously help McAllen right now, with 

further plans for expansion in the future. Of course, this is going 

to go on and expand into 2006 with that 30,000 square foot facility, 

with the Regional Academic Health Center that will certainly mirror what we have in McAllen, and I think that both of those facilities will probably be able to handle that patient load. 

Mr. RODRIGUEZ. And hopefully we can move on that as quickly 

as possible. But let me also indicate that one of the arguments that 

I get in Washington is that I get told that the demographics show 
37

a large number of veterans in the Valley, both in Cameron, Hildago 

and Nueces and all those areas, yet the numbers are not reflective 

of what the VA has and usually there are serious discussions and 

arguments and they have those specific numbers. And I was wondering, you know, what we might be doing to try to correct that, 

because we actually need help. I know the veterans are there, but 

the demographics does not show that, for some reason or other and 

they are not registered. And there are a lot of veterans that do not 

even have—I guess they are not reporting or not coming forward. 

Are you guys involved at all in that in terms of trying to get that 

corrected? 

Dr. AGUILAR. I know that the veteran population that they have 

given I think will pretty much mirror I think what we have anticipated is the population down there, which is about 47,000 veterans. 

That does not include, of course, the winter visitor population that 

will visit every winter down in the Valley area. But I feel that 

number is about as accurate I think as I can anticipate. 

Mr. RODRIGUEZ. Thank you very much. And Mr. Chairman, last 

question, if I can ask, I wanted to get on the post-traumatic stress 

disorder, this is a real serious dilemma in the military especially 

in people that serve in combat. I just have been going to Wilford 

Hall and Walter Reed, we visited several months ago and we 

talked to the soldiers and of course, they are still gung hearing officer, they are real proud and I understand that. But I also understand how post-traumatic stress disorder operates and they go 

through this process and I know they go through a process of personal guilt that they could have done something to prevent whatever, and then they go to displacement and then blame until they 

are re-assessed. 

Is there something that we could be doing now? Because the typical person in active duty will come back and tell you oh, there is 

nothing wrong with me, I am okay. It does not happen until later, 

sometimes it can be 20, 30 years later. So I was wondering if we 

have come up with some kind of response that we could really address some of these needs on the long-term and I wanted to get 

some feedback from you. 

LTC MASTERSON. Yes, sir. Actually there are a number of studies 

that are ongoing right now to include the use of virtual reality to 

treat patients. A recent article published Science date April 2, 

2004, beta blockers to treat individuals exposed to a traumatic incident. 

One of the things that we have been doing at Wilford Hall is individual and teams receive a briefing before they go and after they 

return. Before, so they understand what they might expect to see, 

so we tailor it to their area of operation for the pre-brief. When 

they come back, they get a post-brief to say these are some of the 

things that you may experience. We also have a number of pamphlets and booklets that we give to the family members as well as 

the deploying member on how do you deal with these type of 

things. And then we have some cards and pamphlets—I actually 

have them with me—that actually give them a number to call, because a lot of times the person has to be ready to talk about it. 

But here again, one of the initiatives that we started back in 

1996–1997 was basically a commander community effort on looking 
38

at suicide in particular. It also applies to post-traumatic stress. 

Looking for signs and symptoms and therefore letting people know, 

you know, what kind of questions do you need to ask of your coworkers, of your husband, of your wife. And then knowing what resources are available in the integrated delivery system we have in 

place which are chaplains, social workers, psychiatrists, psychologists and the family support centers that are all on line. And that 

is new since the Persian Gulf War. 

Mr. RODRIGUEZ. Let me just share one thing with you that—most 

people do not agree with me on this issue, but we have a large 

number of people in our prison system and 80 percent of our prison 

system has to do with drug-related, and a lot of it might be selfmedication because of the problems. We have got a large number 

of our veterans that are in our prison system for self-medication 

and involving illegal activities regarding drugs. But a lot of it is the 

issue of trying to self-medicate. 

Somehow, I would hope that at some point, and I am just throwing this out, that we do something about those veterans, not only 

our veterans but especially our veterans that are in our prison systems that are there for non-violent crimes because of use of drugs 

and in some case might be a result of self-medication trying to cope 

with the situation. 

So I just thought I would throw that out there. And I am wondering if anyone is doing anything in that area. 

LTC MASTERSON. Yes, sir, there are ongoing efforts in those 

areas and there are probably many people out there that would 

agree with you. 

Dr. HOLLIDAY. If I could just respond, Congressman, with two 

points. One is, as you know, the computerized medical record in VA 

has something called clinical reminders where certain healthcare 

information, clinical information, comes up periodically and 

prompts the provider to ask key questions, to make key diagnoses 

that further care. We are already asking about substance abuse 

and depression on an annual basis with every veteran who is seen 

in our clinics. Shortly we will be adding screening questions for 

PTSD. So every veteran who comes into our system will be queried 

annually by their providers, are you having these symptoms, are 

you having these problems. And if you are, then we can help you 

get some care for that. 

In addition, through the use of social workers in almost all of the 

primary care clinics and now increasingly psychologists and psychiatrists assigned to some of these clinics, we are trying to move 

some of our mental health resources into the primary care setting 

with less stigma against approaching a mental health provider, because we are part of the regular healthcare team. 

So those two initiatives are ways we are trying to be ready and 

proactive in identifying these folks that need help. 

Mr. SIMMONS. Mr. Miller. 

Mr. MILLER. Mr. Chairman, if I might, in view of time since we 

have another panel, I will waive my questions. 

Mr. SIMMONS. Most certainly. Mr. Rodriguez, do you have additional questions? 

[No response.] 
39

Mr. SIMMONS. Hearing none, I want to thank panel two very 

much for their testimony. We appreciate their being here and we 

appreciate what they do every day of their lives. Thank you very 

much. 

Panel three is made up of Ignacio Leija of the American GI 

Forum, National Veterans Outreach Program; Jose Diaz, former 

District 20 Commander, Post 20, Veterans of Foreign Wars; Douglas Herrle of the Disabled American Veterans and Richard Holloway of The American Legion. 

Gentlemen, welcome, thank you for being here today, and we 

look forward to hearing your testimony. We are limiting our testimony to 5 minutes for sake of time. So if you want to summarize 

your comments, we do have your written statements in our package to review. First, Mr. Leija of the American GI Forum. Welcome, sir. 

STATEMENTS OF IGNACIO LEIJA, AMERICAN GI FORUM, NATIONAL VETERANS OUTREACH PROGRAM; DOUGLAS 

HERRLE, DISABLED AMERICAN VETERANS accompanied by 

WILLIAM MORIN; RICHARD HOLLOWAY, THE AMERICAN LEGION 

STATEMENT OF IGNACIO LEIJA 

Mr. LEIJA. Thank you, Mr. Chairman and members of this Committee. Good morning, and thank you for inviting me before this 

Committee and for allowing me to participate in this important 

hearing. My name is Ignacio Leija and I am the Vice President of 

Service Operations for the American GI Forum, National Veterans 

Outreach Program based in San Antonio, TX. 

It is my understanding that today’s session focuses on transition 

and access between the Department of Defense and the VA medical 

facilities. This is truly a timely subject due to the thousands of 

troops that are returning within 90 days. Obviously due to the current situation within Iraq, things may change. Eventually however, 

this transition will occur. 

The American GI Forum constituency is made up of many Hispanic veterans. Many of our veterans reside in areas without reasonable access to VA medical centers. For that reason, I would like 

to take the opportunity to voice our support for the continuing addition of VA community based outpatient clinics in areas lacking 

VA medical centers. 

Our nation is faced with the homecoming of many more new veterans who will be returning soon, some of which may require longterm medical care for illnesses or injuries suffered during this Iraqi 

war. For this reason, we support the recent introduction of collaboration between the Department of Defense and Department of Veterans Affairs. The result is that military medical evaluation findings can be accepted by the VA for ratings of medical conditions of 

newly discharged veterans without burdening them with further 

duplicating evaluations. 

The American GI Forum also supports the initiative by the Department of Defense’s personnel evaluation boards that will consider the cases of disabled veterans who want to continue their 

military career. We encourage the continued sensitivity on the part 
40

of the Department of Defense to expand that opportunity for those 

veterans to cross-train to other fields and remain productive in the 

military in spite of a disability. 

A great concern that the American GI Forum constituency has 

is that of releasing veterans immediately after returning state side. 

The participation in a war zone can have a long-term detrimental 

effect. It is our understanding that the Department of Defense 

plans to rotate reservists back from Iraq and discharge them within 48 to 72 hours. The Vietnam experience, as supported by vet 

centers, should have taught us that combat veterans must have 

time to defuse and adjust among their peers with similar experiences. We encourage the Department of Defense to further investigate and possibly consider a 30 to 45 day adjustment period before discharge during which time the Department of Defense and 

the vet centers could collaborate and offer appropriate counseling 

and other supportive services. If not, we fear that another cycle of 

post traumatic stress disorders will follow this new generation of 

veterans. 

Our organization and other VSOs are prepared to assist our returning veterans by joining transition teams that will facilitate the 

return and re-entry of new veterans into civilian life. 

The American GI Forum is proud to serve the needs of all veterans through its National Veterans Outreach Program. With offices in six of the largest cities in Texas, we currently provide services in employment and training for recently separated veterans, 

disabled veterans and veterans that served in theaters of war. The 

staff assigned to these offices are prepared to assist veterans by 

providing them with job search skills and other skills that they 

need for job search placement. 

In closing, I would like to thank Congressman Ciro Rodriguez for 

his continued effort in helping us. We are very fortunate to have 

him in this state. Thank you very much. 

Mr. SIMMONS. I thank you very much for that testimony. 

Next is Douglas Herrle, Chapter 61 Commander of the DAV. I 

understand he is accompanied by William Morin. 

[The prepared statement of Mr. Leija appears on p. 101.] 

STATEMENT OF DOUGLAS HERRLE 

Mr. HERRLE. My name is Douglas Herrle. Mr. Chairman and 

members of the Subcommittee, we thank you for the opportunity 

to present the views of Disabled American Veterans, DAV, Department of Texas, an organization of more than 73,000 wartime disabled veterans, on the status of military and Department of Veterans Affairs healthcare coordination, including post-deployment 

healthcare of recently discharged veterans. 

I have primarily two issues, Mr. Chairman. One of them is the 

funding for the VA healthcare. As we know, at this time VA 

healthcare is underfunded. The numerous veterans’ organizations 

have put out an independent budget and we have seen that budget 

be cut by our Congressmen and Senators because they do not feel 

that VA healthcare is important. Now that may not be the message 

you want to send, but I will guarantee you that is the message that 

the people out here in the world are getting. You do not care about 

the veterans. 
41

The other thing is the time it takes to get an appointment at the 

VA. I am 100 percent service-connected disabled. Actually numerically a little over 300 percent. For me to get an appointment at the 

VA—to call and get a scheduled appointment will take me anywhere from three to 6 months, period. There is no—they will send 

me to triage. I can go sit in triage and I can sit there anywhere 

from three to 18 hours before being seen. It makes no difference 

what I come in for, whether it is heart, chest pains, whatever. I am 

having a bad day because I do have PTSD and they are going to 

send me to triage and let me sit there for 3 or 4 hours. When a 

veteran has PTSD and he is reaching out for help, the last thing 

you want to do is put him in a crowd and tell him he has got to 

sit until he is called which may be 3 or 4 hours. I am lucky. If I 

had not have been retired, I would probably be dead if I had to rely 

on the VA, because when my episodes hit, a lot of times I may 

come home, sit down in the easy chair to watch television and suddenly I am hitting on the nitroglycerin and trying to get my air 

which I cannot do. To go to the VA and sit in triage with chest 

pains, we have had disabled veterans ask department commanders 

for the DAV that have gone there with chest pains and sat for over 

8 hours waiting to see a doctor. 

Our doctors, most of them are limited in their English language 

or they are a part-time doctor available one day a week and then 

maybe only for half a day. 

I see I just got the red light, so I want to thank the Chairman. 

In closing, the DAV of Texas sincerely appreciates the Subcommittee for holding this hearing and for its interest in approving 

benefits and services for our nation’s veterans. The DAV deeply 

values the advocacy this Subcommittee has always demonstrated 

on behalf of America’s service-connected disabled veterans and 

their families. 

Thank you for the opportunity to present our views on these important measures. Again, I would like to extend my very much 

thankful that we have Congressman Rodriguez there to help the 

veterans. Thank you. 

Mr. SIMMONS. Thank you very much. 

The third panelist is Richard Holloway, Vice Chairman of the 

Americanism Commission of the American Legion. Welcome, and 

we look forward to your statement, sir. 

[The prepared statement of Mr. Herrle appears on p. 105.] 

STATEMENT OF RICHARD HOLLOWAY 

Mr. HOLLOWAY. Thank you, sir. 

Good morning, Mr. Chairman and members of the Subcommittee. 

I appreciate the opportunity to present views of the 2.8 million 

members of the American Legion worldwide and those here in San 

Antonio on the status of military and VA healthcare coordination, 

including post-deployment healthcare of recently discharged veterans. The American Legion commends the Subcommittee for the 

holding of this hearing on this timely and important subject. 

With the global war on terrorism and the ongoing military action 

in Iraq and Afghanistan it is clear that DOD and VA must coordinate healthcare delivery to our veterans of this conflict. The young 

men and women returning to Fort Sam Houston, Lackland and 
42

Randolph cannot and should not slip through the cracks between 

these massive agencies due to the lack of information sharing or 

outreach coordination. Our knowledge of the efforts of war on both 

the mind and body has uniformly increased with each succeeding 

military conflict involving our nation. This knowledge obligates our 

government to follow the health status of our veterans who return 

from war. 

The most recent analysis of VA healthcare utilization show that 

127,970 veterans have returned from Operation Iraqi Freedom. 

Fourteen percent, 17,800, have sought healthcare from VA. Other 

than dental or unspecified musculoskeletal conditions the most frequent diagnosis were deafness, 1,212 veterans; infectious and parasitic diseases, 1,103; essential hypertension, 996; and adjustment 

reaction, 970, including 626 diagnoses of PTSD. So far, coordination between the DOD and VA systems with regard to OIF and Operation Enduring Freedom, OEF, appears to be working well at the 

operational level. Pre- and post-deployment health screening has 

improved since the initial programs noted in various reports by 

GAO. 

The American Legion is heartened by the Army’s new Disabled 

Soldier Support System, DS3, an initiative to deliver services to the 

veterans with a minimum of delay and red tape. In previous conflicts, veterans presented themselves to the VA and were required 

to prove their own eligibility. DS3 now facilitates referral to VA 

and provides disabled soldiers with a system of advocacy, including 

representation by VSOs such as the American Legion. The American Legion appreciates DOD’s inclusion of VSOs in this process. 

Hopefully this will evolve into the same relationship that VSOs 

now enjoy with the VA. 

In March of last year VA announced that any veteran returning 

from a combat zone is entitled to 2 years of free VA healthcare. 

This applies to active duty, Reserve and National Guard personnel. 

In the announcement, VA noted the progress made in partnership 

with Department of Defense, notably standardized post-deployment 

physical examinations and clinical practice guidelines. Two joint 

post-deployment VA/DOD clinical practice guidelines address general post-development issues and unexplained fatigue and pain 

have been released and a new CPG is soon to be released on the 

management of traumatic stress with the aim of preventing PTSD. 

In an unusual move the Surgeon Generals of the Army, Navy 

and Air Force have approved the detailing of VA benefits counselors and clinical social workers to MTFs receiving casualties from 

OIF and OEF. 

Mr. Chairman, these efforts by VA and DOD to avert the problems encountered after Operation Desert Shield and Desert Storm 

have been innovative and laudable. Never before have the VA, 

DOD and the VSO community come together so effectively to ensure that those who shall have borne the battle receive the care 

and benefits they have earned and deserve because of their service. 

More challenges lie ahead in institutionalizing these reforms for 

the future. Described as seamless transition, attempts to bring together the DOD and VA healthcare are nothing new. The DOD/VA 

Health Resource Sharing Operation Act of 1982 paved the way for 

cooperation in the sharing of resources during national emer-
43

gencies. Since then a plethora of legislation has mandated and encouraged further VA/DOD cooperation. The most recent and significant of these laws is the National Defense Authorization Act of 

2003, Subtitle C. DOD/VA Health Resource Sharing required VA 

and DOD to develop and publish a joint vision statement and a 

joint strategic plan on sharing efforts among two departments. 

Major resources are being applied by both departments to comply 

with this law. A few current projects include the Joint VA/DOD 

Electronic Health Records Plan will result in a virtual health 

record accessible by authorized users within the DOD and VA. The 

VA and DOD Health Executive Council is providing oversights of 

these activities. 

The Clinical Resource Repository/Health Data Repository seeks 

to develop the software components to ensure the interoperability 

of the DOD and VA Clinical Data Repository. 

The Lab Data Sharing and Interoperability projects facilitate 

electronic order entry and results retrieval between DOD, VA and 

commercial medical labs to maximize resources and reduce costs. 

In closing, U.S. field commanders are aware that their responsibilities include Force Health Protection and this has become a 

major theme in military operations. Congress had widely seen to it 

that these themes extend to the highest reaches of the Pentagon 

and the VA. The American Legion is cognizant that DOD and VA 

face many challenges to achieve these goals. The administrative 

and management cultures are unique in both agencies and information sharing in the past has been slow in coming. The American 

Legion however is confident that the goal of seamless transition 

will be achieved as the requisite technologies are developed and implemented. 

Mr. Chairman, I again thank the Subcommittee for the opportunity to present the views of the American Legion on this subject 

of today’s hearing. I will be happy to answer your questions if you 

have any. Thank you. 

[The prepared statement of Mr. Holloway appears on p. 107.] 

Mr. SIMMONS. Thank you, Mr. Holloway, for that testimony. 

I have a question for the record. 

Mr. Leija, I was very interested in your testimony. I am from 

New England and we do not have a chapter of the GI Forum in 

New England or in Connecticut that I am aware of. I am very interested in the fact that you have stated on page 3 of your testimony that you focus on vet centers and outreach centers. I am assuming you are a Vietnam veteran or members of your organization are Vietnam veterans? 

Mr. LEIJA. Vietnam era veterans. 

Mr. SIMMONS. Vietnam era veterans. How do you find—20 years 

ago when I returned back from Vietnam, I worked very hard with 

Senator Chafee of Rhode Island to extend the vet centers. That 

would be in the late 1970s or early 1980s. I gather that you find 

that this is still a very useful program for our returning veterans. 

How do you cooperate or intersect with the more traditional VSOs 

and with the VA and the other healthcare providers? Do you have 

protocols for that? Is it an informal relationship? How does that 

work? 
44

Mr. LEIJA. Congressman, a lot of those are informal relationships 

that we have established. The American GI Forum is a membership organization and as such has established a services organization, the National Veterans Outreach Program. The National Veterans Outreach Program in turn has been able to establish relationships with other VSOs and with vet centers and with the VA 

as we collaborate and try to assist veterans that are getting out of 

the military or have been out of the military for quite some time 

and are in need of employment. That is basically the area that we 

are specializing in, employment and training. Consequently we get 

a lot of the VSOs that refer individuals to us in addition to vet centers. Once veterans have gone through their treatment services 

they are then referred to our organization in order to obtain employment or training to further enhance their skills so that they 

can lead productive lives. 

Mr. SIMMONS. Thank you very much for that response. That was 

very informative to me. 

Mr. Rodriguez. 

Mr. RODRIGUEZ. Thank you, Mr. Chairman. 

I also want to take this opportunity to thank the American Legion, the GI Forum, the DAV and all the other organizations that 

have come forward. I know that the service that you personally 

provide and extend to our veterans, you are the ones that reach out 

to a large number of our veterans, to help us in educating them 

in terms of what the needs are. So I want to personally thank you 

for what you do, not only here but also throughout, and let you 

know that I know the Chairman recognizes the national organizations also provide testimony on an annual basis to us. We want to 

thank you for what you do in that area. 

I want to specifically kind of talk a little bit about where we are 

at right now, especially as it deals with job training and development. I know that GI Forum—do any of you want to react to that 

in terms of resources that you get and where we are at in terms 

of employment situations for our veterans, especially since we have 

been—you know, here in Bexar County we have done I think pretty 

well economically. We have picked up. I know nationwide we have 

had some difficulty with the unemployment rate increasing and see 

how that impacts the veterans directly. 

Mr. LEIJA. That is a good question, especially right now with, as 

you say, the economy, although it is picking up. We have experienced a considerable amount of unemployment across the board 

and obviously this does affect veterans. Many of the veterans that 

are coming out right now especially are in a situation where they 

have been specialized in their field in the military, but the crossover to the civilian sector sometimes is difficult. And one of the 

things that we have looked at, and the Department of Labor I 

think has also reviewed, and that is utilizing or being able to utilize some of the certifications and licensures that the military get 

in the—or that the veterans get in the military are not 

transferrable to civilian life; therefore, they are required to take 

tests. They are required to go through a recertification process, et 

cetera. One of the things that we would like to see is maybe a situation that will allow that transition a little bit more easily. 
45

The idea also of working with the VA as far as allowing individuals to—that come out and continue to be in the military, if in fact 

there is a disability, I think is something that I mentioned in my 

testimony, because some of them do not want to come out. Some 

of them would like to stay in the military. Consequently that is 

something that maybe the Committee should investigate a little 

further. 

Mr. RODRIGUEZ. Thank you very much. 

Mr. SIMMONS. Mr. Miller. Oh, excuse me. Yes, please, go ahead. 

Mr. Herrle. Congressman, I would like to address the question 

regarding employment. Having been a Texas veterans’ representative, employment, local employment representative for almost 10 

years, there are several avenues that a veteran can take when he 

is coming out of the service, especially here in Texas. He can go to 

the Texas Work Force, contact the local veterans’ representative 

there, get job referrals, get assistance with planning, training, with 

the work—the WIA program here in Texas which helps fund a lot 

of their programs. Also he can go on monster.com and find jobs in 

his local area. He can contact a DAV service officer and they can 

help him. Our DAV NSOs here in San Antonio, Houston are all 

willing to step up and help the department service officers the 

same way. 

There is such a thing here in Texas called the Hazlewood Act. 

I call it the best kept secret in the world. It went into effect in January of 1947 and it allows a veteran 150 semester hours of tuitionfree school at any state-supported school. That is after he runs out 

of his VA benefits, GI bill, vocational rehab. He can still continue 

in school under Hazlewood for 150 additional hours. Thank you. 

Mr. RODRIGUEZ. Thank you, Mr. Herrle. 

Mr. SIMMONS. Mr. Miller. 

Mr. MILLER. Thank you, Mr. Chairman. 

I just wanted to talk a little bit—ask a question about the Veterans’ Outreach Program, if I could. Then you talk about staff 

being assigned to assist vets in providing them with job search 

skills, resume writing, enrollment, short-term vocational class 

training, on-the-job training. How do you coordinate with VA? How 

does your organization coordinate? 

Mr. LEIJA. Well as far as not only San Antonio but in those areas 

that I have mentioned, many of the veterans that we work with are 

not only recently discharged veterans but also some of the veterans 

that have been out for a while and are experiencing problems let 

us say in the area of substance abuse. So consequently what we do 

is we coordinate our efforts so that an individual can go through 

the substance abuse program and receive treatment from the VA. 

We attend their staffings so that we are in touch with the veteran 

that we have referred over there. Once the veteran is released, we 

know about it and they are ready to come back to our office where 

we can continue the development as far as any skills training that 

they may need, coordinate that with vocational schools in the area 

or on-the-job training. If a school is not available, we will work 

with employers that are willing to train the individual in a particular skill and thus become employed once the training has been 

concluded. But the relevancy as far as the coordination takes place 

as individuals go through their system. There has to be coordina-
46

tion and communication between our organization and VA representatives. 

Mr. MILLER. Is part of that duplication of services? 

Mr. LEIJA. Is it duplication of services? I do not believe so. In 

what manner, Congressman? I am sorry. 

Mr. MILLER. Well vocational training that the VA provides. 

Mr. LEIJA. Oh, I see, that the VA provides. I do not see that because we are actually looking at individuals that heretofore have 

not been able to access the VA system maybe and either had difficulty or did not want to, and through coaxing from our staff then 

went into the system and were ready to come back out to us. 

Mr. MILLER. Thank you. 

A final question, Commander Herrle. You can do it from right 

there if you want, sir. Has DAV had any success with being able 

to visit with those returning military men and women who are disabled and will be discharged as such in the hospital? Have you 

been able to get in to them to be able to tell them about the services or are you being prevented from doing that? 

Mr. HERRLE. I will defer to Mr. Morin on that one. 

Mr. MILLER. If you would, identify——

Mr. SIMMONS. Mr. William Morin. 

Mr. MORIN. Yes, I am DAV National Service Officer for this area, 

south Texas. We do have an active transition assistance program 

that is alive and healthy. I might add, in conjunction with the veterans’ benefits program the VA has provided a full staff of VA contact facilitators. In conjunction with that, I have a single person 

that works a transition assistance program at BAMC, at Wilford 

Hall, and Randolph Air Force Base. So it is alive and well. The 

DAV specifically—we are working about 100 to 125 claims per 

month transitioning servicemembers that are also provided a medical and physical evaluation representation. So yes, the program is 

there and it is alive and well, and in my professional opinion is 

really providing excellent service to those veterans that are coming 

off of active military duty and making that transition into civilian 

life. 

Mr. MILLER. We had received some testimony in Washington 

that DAV was having some trouble accessing some of the patients. 

Has that been corrected? 

Mr. MORIN. Yes, it has been corrected. I believe a lot of it was 

the media. I think a lot of it was protecting the privacy of the individuals, especially those that were catastrophically disabled. But 

from the standpoint of us being able to go in and make the transition, the contacts we expect to serve as members that were injured, 

that has improved, at least in the San Antonio area. We are not 

having any problems at the present time getting onto the base and 

seeing those veterans that are making the transition. 

In the DAV system, we provide counsel on the physical evaluation boards and that is when a servicemember is being found physically unfit for active military duty. At that point, he will need, 

from a medical evaluation board side, he will go over to the administrative side, the physical evaluation board side which determines 

whether or not he is reasonably capable of performing his duties 

within limitations of his disability. At that point, we are very successful in that. We are conducting approximately 30 to 35 formal 
47

hearings before the physical evaluation board in both the Army 

and the Air Force system here in San Antonio. 

Mr. MILLER. Thank you. 

Mr. SIMMONS. Thank you. As we bring this hearing to a conclusion, I would like to thank all of the panelists who appeared here 

today and I will remark that something very unusual happened, 

something that does not happen that frequently in Washington, 

DC, but all of the panelists arrived at the beginning of the hearing 

and then they all stayed. You know, that is really exciting for me, 

because so often in Washington, DC, if it’s panel two or three, they 

will come in halfway through the hearing, boom, testify, gone and 

show no interest in what others have to say. And this conveys to 

me an important message, a message that this community of military officers and NCOs, this community of Veterans’ Administration healthcare providers, this community of VSOs actually care 

about each other, they know about each other, they care about 

each, they care about what they have to say and that leads me to 

believe that they probably care very much about the active component soldiers and the veterans that they serve. I am really excited 

to see that. 

Let me make a couple of housekeeping announcements and then 

I will ask Mr. Miller and Mr. Rodriguez if they have closing statements that they would like to make, and I have a short closing 

statement that I would like to make. 

First of all, I understand that personal circumstances prevented 

Mr. Diaz from appearing today. If he provides a statement within 

5 days, we will include it as part of the official record of this hearing. 

Secondly, all members at the dias and all panelists have the opportunity to revise and extend remarks that they have made if they 

have additional revisions or extension of remarks that they would 

like to put into the record, I ask unanimous consent that they be 

allowed to do that. 

Thirdly, I would like to note for the record the presence of Thomas Strenovo, Director of the Veterans’ Integrated Service Network 

or VISN, for this region. I appreciate his attendance and his attention to these issues. Mr. Strenovo, would you stand please? 

[Mr. Strenovo rises.] 

Mr. SIMMONS. Thank you very much for being here, we appreciate that very much. 

I would like to thank the City Council of San Antonio, Mayor Ed 

Garza and his staff and Chief of Police Albert Ortiz, who I hope 

allowed us to park on the street and did not tow our car. (Laughter.) 

Mr. SIMMONS. For their courtesies in arranging our use of this 

facility, and I also am very pleased with the hospitality of the City 

of San Antonio today. 

I want to thank Councilman Segovia for doing the introductions 

this morning. That was extremely helpful to have that assistance. 

And I also want to thank my friend and my colleague Mr. 

Rodriguez and his excellent staff for their help and support in setting up this hearing. I am told by my own staff that they did a 

great job and we really appreciate that very much. 
48

At this point, I would ask Mr. Miller if he has any closing statement he would like to make. 

Mr. MILLER. Again, thank you, Mr. Chairman and my colleague 

Ciro Rodriguez for holding this hearing. I think the testimony that 

was taken for the record was good, our colleagues will be able to 

peruse it and review it as staff will as well. 

A couple of things if I can add, we talked about veterans’ funding 

and I think it is important for the record that we do talk about it. 

We all know that more can be done, the fact remains that in the 

last 3 years, Congress has added over $3 billion above the administration request for veterans’ issues and in 5 years, in the past 5 

years, there has been a 47 percent increase in benefits and services. And I would say that right here in San Antonio, it is my understanding that in the last 6 years, there has been about $100 

million more that has been put into the medical center in San Antonio. 

Is it all we can do? Probably not. Are we trying hard? Yes, we 

are. We owe it to those men and women who have served this country, we appreciate and honor them every day and more will be joining your ranks in the future. 

But thank you for allowing us to serve in Congress and be able 

to represent you on this subject. 

Mr. SIMMONS. Thank you, Representative Miller, for your presence, for making the trip here from Florida, for our insightful questions and for your comments. 

Mr. Rodriguez. 

Mr. RODRIGUEZ. Thank you, Mr. Chairman. I want to personally 

thank you for coming to San Antonio. I know you are also going 

to have an opportunity to visit some of the sites here in both the 

VA and other sites and I know the staff is going to have an opportunity to visit. I know that you will be going to visit our nursing 

home in Wilson County, one of the few veterans’ nursing homes 

that we have in Texas, I am very proud to say that that was in 

my original district, then was changed, and now it is back in my 

district, so we will see what happens. 

But I do want to thank you for being here. And also Congressman Miller, thank you. I know how difficult it is once again to 

come across the country to go to another member’s district, but I 

want to personally thank you for coming over. 

And Mr. Chairman, like always, you have been real gracious and 

I do want to thank the staff. We get a lot of credit but our staff 

does a lot of work. On my staff we have Patricia, Janet, Hector, 

Rudy, J.M.—can you all raise your hands? 

(Applause.) 

Mr. RODRIGUEZ. Thank you very much. And to all the presenters 

and the panelists, thank you for also coming forward. You know, 

in hearing the testimony, it is always good and we have got to continue to dialogue about how do we make that match between the 

Department of Defense as our soldiers get released and the VA, 

and how do we continue to improve in making sure that those soldiers do not fall through the cracks. So I want to personally thank 

you for being here and for especially the organizations, veterans’ organizations that are here, thank you for being here and thank 

you for what you do. 
49

And once again, Sergeant Canady, thank you for your service 

and thank you for joining us. 

Mr. SIMMONS. Thank you, Mr. Rodriguez. 

I would like to conclude a little bit on a personal note. As some 

of my colleagues know, I retired from the U.S. Army after 4 years 

of active duty and over 30 years of Reserve duty, a total of 37 

years, 7 months and 24 days of service and I am a Vietnam veteran, I served for 20 months in the military and 2 years in Vietnam as a civilian with the CIA. 

One of the things that has affected my life and motivated my life 

in many respects is the fact that when I returned back from Vietnam, I did not feel that America appreciated the veterans, I did not 

feel that the nation was grateful for the service and sacrifice of 

Vietnam veterans. And whenever I go to the mall and I see the 

names, the 58,229 men and women, on the wall, I get choked up 

because I think of what they gave to this great country of ours. 

Never in my life did I ever expect to be a member of Congress 

or to chair the Veterans’ Health Subcommittee in Congress, and it 

is a great honor for me to do that. But it is also exciting for me 

to work with my colleagues on both sides of the aisle to try to bring 

about better funding, better coordination, better cooperation, better 

services to our veterans. And at a time when my colleague, Mr. 

Rodriguez, who has done so much for his state and so much for the 

nation and so much for the veterans that he serves in Congress 

every day, at a time when he could probably be focusing on other 

issues, it also makes me feel very good to know that he is taking 

this day off for his constituents and for America’s veterans. That 

to me again is a testament of what this community is all about and 

so I thank you, Ciro, for your service, for your dedication to our veterans, not just here in Texas, but throughout the nation, and I look 

forward to working with you in the future. 

Thank you very much. 

Thank you, Jeff, for your service and for coming all the way from 

Florida. And at this point, this hearing is adjourned. 

[Whereupon, at 11:36 a.m., the Subcommittee was adjourned.] 

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