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WOUNDED ARMY GUARD AND RESERVE FORCES:

INCREASING THE CAPACITY TO CARE

HEARING

BEFORE THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

FEBRUARY 17, 2005

Serial No. 109–4

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpo.gov/congress/house

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

CHRISTOPHER SHAYS, Connecticut

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

GIL GUTKNECHT, Minnesota

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

CANDICE S. MILLER, Michigan

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

GINNY BROWN-WAITE, Florida

JON C. PORTER, Nevada

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

CHARLES W. DENT, Pennsylvania

VIRGINIA FOXX, North Carolina

——— ———

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

BRIAN HIGGINS, New York

ELEANOR HOLMES NORTON, District of

Columbia

———

BERNARD SANDERS, Vermont

(Independent)

MELISSA WOJCIAK, Staff Director

DAVID MARIN, Deputy Staff Director/Communications Director

ROB BORDEN, Parliamentarian

TERESA AUSTIN, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

(III)

C O N T E N T S

Page

Hearing held on February 17, 2005 ....................................................................... 1

Statement of:

Embrey, Ellen, Deputy Assistant Secretary of Defense for Employment

Health, Department of Defense; Daniel Denning, Acting Assistant Secretary of the Army, Manpower and Reserve Affairs, accompanied by

Lieutenant General Roger Schultz, Director, Army National Guard;

Lieutenant General Franklin L. Hagenbeck, Deputy Chief of Staff,

G–1, U.S. Army; Lieutenant General Kevin C. Kiley, M.D., U.S. Army

Surgeon General; Major General Charles Wilson, Deputy Commander,

U.S. Army Reserve Command; and Philip E. Sakowitz, Jr., Deputy

Director, U.S. Army Installations Management Agency ........................... 144

Denning, Daniel ......................................................................................... 160

Embrey, Ellen ............................................................................................ 144

Hagenbeck, Lieutenant General Franklin L. .......................................... 169

Kiley, Lieutenant General Kevin C., M.D. .............................................. 181

Sakowitz, Philip E., Jr. ............................................................................. 194

Wilson, Major General Charles ................................................................ 187

Kutz, Gregory D., Director, Financial Management and Assurance, U.S.

Government Accountability Office; Brigadier General Raymond C.

Byrne, Jr., Acting State Adjutant General, State of Oregon, accompanied by Colonel Doug Eliason, M.D.; Sergeant First Class John Allen,

B/3/20th Special Forces Group, North Carolina National Guard; Sergeant Joseph Perez, 72nd Military Police Co., Nevada National Guard;

Chief Warrant Officer Rodger L. Shuttleworth, Chief, Reserve Component Personnel Support Services Branch, Army Human Resources

Command, Maryland National Guardsman, accompanied by Chief Warrant Officer Laura Lindle; and Master Sergeant Daniel Forney, Reserve

Component liaison, Medical Hold, Walter Reed Medical Center, U.S.

Army Reservist, Pennsylvania ..................................................................... 35

Allen, Sergeant First Class John ............................................................. 73

Byrne, Brigadier General Raymond C., Jr. ............................................. 54

Forney, Master Sergeant Daniel .............................................................. 123

Kutz, Gregory D. ....................................................................................... 35

Perez, Sergeant Joseph ............................................................................. 98

Shuttleworth, Chief Warrant Officer Rodger L. ..................................... 112

Letters, statements, etc., submitted for the record by:

Allen, Sergeant First Class John, B/3/20th Special Forces Group, North

Carolina National Guard, prepared statement of ...................................... 79

Byrne, Brigadier General Raymond C., Jr., Acting State Adjutant General, State of Oregon, prepared statement of ............................................. 56

Cummings, Hon. Elijah E., a Representative in Congress from the State

of Maryland, prepared statement of ............................................................ 25

Davis, Chairman Tom, a Representative in Congress from the State of

Virginia, prepared statement of ................................................................... 4

Denning, Daniel, Acting Assistant Secretary of the Army, Manpower

and Reserve Affairs, prepared statement of ............................................... 162

Embrey, Ellen, Deputy Assistant Secretary of Defense for Employment

Health, Department of Defense, prepared statement of ............................ 146

Forney, Master Sergeant Daniel, Reserve Component liaison, Medical

Hold, Walter Reed Medical Center, U.S. Army Reservist, Pennsylvania,

prepared statement of ................................................................................... 125

Hagenbeck, Lieutenant General Franklin L., Deputy Chief of Staff, G–

1, U.S. Army, prepared statement of .......................................................... 171

Page

IV

Letters, statements, etc., submitted for the record by—Continued

Higgins, Hon. Brian, a Representative in Congress from the State of

New York, prepared statement of ................................................................ 218

Kiley, Lieutenant General Kevin C., M.D., U.S. Army Surgeon General,

prepared statement of ................................................................................... 182

Kutz, Gregory D., Director, Financial Management and Assurance, U.S.

Government Accountability Office, prepared statement of ....................... 37

Miller, Hon. Candice S., a Representative in Congress from the State

of Michigan, prepared statement of ............................................................. 216

Perez, Sergeant Joseph, 72nd Military Police Co., Nevada National

Guard, prepared statement of ...................................................................... 104

Ruppersberger, Hon. C.A. Dutch, a Representative in Congress from the

State of Maryland, prepared statement of .................................................. 31

Sakowitz, Philip E., Jr., Deputy Director, U.S. Army Installations Management Agency, prepared statement of ..................................................... 196

Shuttleworth, Chief Warrant Officer Rodger L., Chief, Reserve Component Personnel Support Services Branch, Army Human Resources

Command, Maryland National Guardsman, prepared statement of ........ 116

Waxman, Hon. Henry A., a Representative in Congress from the State

of California:

Minority report .......................................................................................... 10

Prepared statement of ............................................................................... 19

Wilson, Major General Charles, Deputy Commander, U.S. Army Reserve

Command, prepared statement of ............................................................... 188

(1)

WOUNDED ARMY GUARD AND RESERVE

FORCES: INCREASING THE CAPACITY TO

CARE

THURSDAY, FEBRUARY 17, 2005

HOUSE OF REPRESENTATIVES,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The committee met, pursuant to notice, at 10:10 a.m., in room

2154, Rayburn House Office Building, Hon. Tom Davis (chairman

of the committee) presiding.

Present: Representatives Tom Davis of Virginia, Shays, Gutknecht, Miller, Porter, Marchant, McHenry, Dent, Foxx, Waxman,

Cummings, Davis of Illinois, Clay, Watson, Lynch, Van Hollen,

Ruppersberger, Higgins, and Norton.

Staff present: Jennifer Safavian, chief counsel for oversight and

investigations; Rob White, press secretary; Drew Crockett, deputy

director of communications; Grace Washbourne and Brien Beattie,

professional staff members; Teresa Austin, chief clerk; Sarah

D’Orsie, deputy clerk; Kristina Sherry, legislative correspondent;

Roody Cole, GAO detailee; Phil Barnett, minority staff director; Andrew Su, minority professional staff member; Earley Green, minority chief clerk; and Jean Gosa, minority assistant clerk.

Chairman TOM DAVIS. Good morning. A quorum being present,

the committee will come to order.

I want to welcome everybody to today’s hearings on the effectiveness and efficiency of Army medical administrative processes that

affect the care of injured Army Guard and Reserve forces.

This hearing is the third in our continuing investigation into the

Department of Defense’s administrative and management challenges created by the largest mobilization of Reserve Component

soldiers since World War II.

For the last year, along with the Government Accountability Office, our committee has been investigating the plight of injured

Army Guard and Reserve soldiers seeking quality care, standardized medical and personnel assistance, and comprehensive service.

We are here today to ask some basic but troubling questions.

How is it that so many injured and Reserve soldiers have been

inappropriately removed from active duty status in the automated

systems that control pay and access to medical care?

Why do soldiers languish for weeks or months in medical holding

companies, not because of medical care but because of lags in efficient administrative processing?

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Why do we all continue to hear from our Reserve Component

constituents and their families still struggling under the convoluted

current system?

Today the GAO will issue a report on their examination of two

Army processes: active duty medical extensions [ADMEs], and medical retention processing [MRPs]. The committee, looking into the

Medical Evaluation Board and Physical Evaluation Board processes, has reached similar findings that are, quite frankly, stunning in scope.

Current Army guidance for processing injured Guard and Reserve does not clearly define organizational responsibilities or performance standards. The Army has not adequately educated Reserve Component soldiers about Army medical and personnel processing or adequately trained Army personnel responsible for helping soldiers.

The Army lacks an integrated medical and personnel system to

provide visibility over injured or ill Reserve Component soldiers,

and as a result sometimes actually loses track of these soldiers and

where they are in the process.

Last, and certainly not least, the Army lacks compassionate, customer friendly service. Frankly, I am appalled that these men and

women not only have had to face the recovery from their war

wounds, but are simultaneously forced to navigate a confusing and

seemingly uncaring system of benefits.

What are the effects of these inadequacies? We will listen today

to the individual experiences of two Guardsmen whose stories will

be hard for us to hear. Sergeant John Allen of the North Carolina

National Guard and Sergeant Joseph Perez of the Nevada National

Guard will illustrate the price of an Army unprepared to handle

their needs.

General Raymond Byrne, the State Adjutant General of Oregon,

is also here on behalf of his injured and ill Guardsmen.

We are also pleased to have with us today two individuals who

are on the front lines of caring for Reserve Component soldiers and

who will explain the difficulties executing Army regulations and

policies. An officer from U.S. Human Resource Command will relate the Army’s growing pains as it attempts to improve its level

of administrative service and care. One will tell about his experience as a Reserve liaison at Walter Reed Medical Center and the

challenges he still faces as he tries to help injured Reserve soldiers.

Both soldiers have been at their posts since the first return of injured Guard and Reserve soldiers from Operation Enduring Freedom, and both will describe urgent needs that are still unmet.

Certainly, the unprecedented number of Army Guard and Reserves mobilized in the war on terrorism has severely taxed the

Army and its resources. We understand the pressures they are

under. To their credit, Army leadership has accepted these challenges and has come a long way this past year in trying to repair

some of the problems we are addressing today.

From our distinguished second panel we will hear of new management initiatives, increased personnel, enhanced training, and a

new interconnectivity between medical and personnel tracking systems. We will hear of the hopes for vast improvement in Reserve

Component administration and service under the community-based

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health care initiative. We hope to hear of a continued commitment

to other major changes that address weaknesses that are still at

hand.

Today when we ask who in the Army or the Department of Defense is ultimately responsible for the oversight of injured Army

Guard and Reserve soldiers and the commands and agencies providing them care and service, I hope to get a clear answer. But the

truth is we are all accountable to the men and the women who

have been injured defending this country. I am sure we will listen

closely to each witness this morning to better understand what we

can do to assist in any way possible, including legislation, resources, and ongoing oversight.

We all look forward to the day when each and every injured

Army Guard and Reserve soldier receives the care that they have

earned and that they deserve. This distressing period where we

have witnessed the equivalent of financial and medical friendly fire

must end.

[The prepared statement of Chairman Tom Davis follows:]

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Chairman TOM DAVIS. I now yield to our ranking member, Mr.

Waxman, for his opening statement.

Mr. WAXMAN. Thank you very much, Mr. Chairman.

I want to thank you for holding this hearing. This is an important hearing, and I especially want to thank our witnesses who

have come today.

What we are going to hear about and what this committee will

shine a light on is the egregious mistreatment—it is inexcusable—

that wounded National Guard and Army Reserve soldiers face. I

want to mention the fact that the soldiers and their families who

are here with us today deserve praise for their bravery, and especially for speaking out on behalf of their fellow soldiers. I thank

you for being here.

Today we are going to hear about the inadequate care that

wounded National Guard and Army Reserve receive. Tens of thousands of these Reservists have been called to duty with little notice. They have left their jobs, they have left their homes, they

have served honorably far away from their family and loved ones,

and, unfortunately for many Army Guard and Army Reserve soldiers wounded in action, the real battle begins when they arrive

home.

Let me be blunt. The way the administration is treating wounded

soldiers and veterans is a disgrace. As my staff has found in a series of reports, veterans across the country are routinely forced to

wait months just to schedule a medical appointment. And when a

veteran is severely injured, he or she has to wait months without

any income before the Veterans Administration will process his or

her disability claim.

While we looked into the complaints that my office was receiving,

we found that there were 10,000 veterans in Los Angeles, alone,

waiting to have their disability claims processed last year. This

was a huge increase from just the year before.

And the problems are only going to get worse. The number of

veterans who will need medical care will increase 5 percent next

year, but the President’s latest budget actually proposes a decrease

in real funding for VA health care. To make up the difference, the

President proposes large increases in copayments and deductibles

that will force hundreds of thousands of veterans to lose their VA

health care.

Over the last year, I have released several reports documenting

these problems. I would like, Mr. Chairman, to have the report

made part of the hearing record.

Chairman TOM DAVIS. Without objection, the report will be put

in the record.

[The information referred to follows:]

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Mr. WAXMAN. Today we are going to learn about the plight that

wounded National Guard and Army Reserve soldiers face when

they return home. Wounded regular duty troops are sent to medical

facilities at their home bases when they leave Iraq or Afghanistan,

but many wounded National Guard soldiers are placed in what is

called medical hold status. As we will learn, these soldiers are sent

to shoddy, dilapidated bunkers far from their home bases where

they face long delays to receive medical appointments and treatment, and they confront a labyrinth of forms to fill out and offices

to visit just to receive the care and benefits due them.

These soldiers have risked their lives for us, and they are returning home with severe and sometimes incapacitating injuries, yet

the administration continues to neglect their health care and delay

their benefits.

Mr. Chairman, I hope this hearing will be a step toward doing

right by our veterans. Guardsmen and Reserve soldiers will be

sorely needed for the foreseeable future. Let’s give them the respect

and care that they all so rightly deserve.

[The prepared statement of Hon. Henry A. Waxman follows:]

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Chairman TOM DAVIS. Mr. Waxman, thank you very much.

Are there any other Members who wish to make statements? The

gentleman from Nevada, Mr. Porter.

Mr. PORTER. Thank you, Mr. Chairman. I appreciate your taking

the time to hold this hearing today. I would also like to thank our

witnesses for coming here to testify. Sergeant Perez is here today,

a constituent of mine, from Logandale, NV. I would like to especially thank him and his wife Elena for traveling this long way to

be with us today.

Our country is at war in a war against terrorism. Throughout

this war, thousands of our brave men and women have volunteered

to wear military uniforms and fight for the freedoms that many of

us take for granted. Unfortunately, this war has had its casualties,

but it is our job as Members of Congress to make sure that our injured and returning soldiers are cared for in the best possible manner.

The purpose of this hearing today is to examine the effectiveness

and the efficiency of Army medical administrative processes and

procedures that govern injured Army Guard and Reserve soldiers.

Although the majority of these men and women are treated appropriately and above and beyond, we are now aware that many returning soldiers are experiencing difficulties associated with active

duty medical extensions, medical retention processing, Medical

Evaluation Boards, and Physical Evaluation Boards. With these

programs, many returning soldiers are finding that they will have

to deal with numerous layers of bureaucratic red tape, significant

paperwork, and in some situations problems associated with their

pay and benefits.

I have two constituents who have submitted their testimony to

the committee regarding this problem. One of my constituents,

Brian Robinson, was not able to be here today. Brian was a specialist in the Nevada Army National Guard. During his time in Nevada Army National Guard he was deployed to Iraq, where a vehicle he was riding in was struck by a hand-detonated land mine. As

a result of this attack, Specialist Robinson suffered damage to both

of his ears, cuts and bruises over his left eye, fractures to his left

elbow and left wrist, a crushed index finger, severe head and back

pain, whiplash, shrapnel damage, as well as swelling and bruising.

After this attack, Specialist Robinson was flown from Iraq to Kuwait, and then from Kuwait to Germany for additional care. But

after about a week in Germany, Specialist Robinson was cleared to

return to the United States. Specialist Robinson was then admitted

for care at Madigan Hospital and was granted 30 days leave for

convalescent care. It was during this time that the U.S. military

contacted his parents to notify them that he had been injured and

that he was in a hospital in Germany.

Finally, while Specialist Robinson was being cared for by the Air

Force physicians at Nellis Air Force Base in Las Vegas while on

convalescent leave, the Army decided that Sergeant Robinson

would have to return to Madigan for care by Army physicians as

opposed to Air Force physicians.

Sadly, Mr. Chairman, Specialist Robinson’s story is not unique.

Another one of my constituents, Sergeant Joseph Perez, who is

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here today, is going to tell a similar story about the difficulties he

encountered after being injured in the line of duty in Iraq.

Sergeant Perez is an exemplary American who served this country both since 1988 in the U.S. Marine Corps and later in Nevada

Army National Guard, and is certainly someone that we should be

proud of, since he received the Naval Commendation Medal, Sergeant of the Year for Western Region, and Recruiter of the Year.

I, of course, will let Sergeant Perez tell his story in person, but

I will point out that both Specialist Robinson and Sergeant Perez

proudly served our country during the global war on terror, and

both have submitted testimony not to bash the Army, but rather

to help find a solution to this longstanding problem.

Mr. Chairman, I am hopeful that our Army witnesses will help

us look toward an effective, long-term solution, and I firmly believe

that our Reserve soldiers who were injured or became ill in the line

of duty should be given the pay and the benefits they deserve in

an accurate and timely manner.

Again, thank you, Mr. Chairman.

Chairman TOM DAVIS. Thank you very much. Any other Members wish to make statements? Ms. Norton.

Ms. NORTON. Mr. Chairman, I think you do a service for members of our military and for Congress, alike, in holding this hearing, and I appreciate that you have done so. I want to thank the

members of the military who have agreed to step forward to help

educate the Congress and to help us better prepare for what we

should be doing for our members of the military, and especially the

Reserve and the National Guard.

Walter Reed Hospital is, of course, located in my District here in

the District of Columbia, and I have visited Walter Reed and seen

world class treatment of the most seriously injured. I have also

seen television reports of state-of-the-art treatment moving people

from the battlefield to where they can be treated. So it looks like

there are some places in the military where people do get first-class

treatment.

Members of Congress are particularly close to the Reserve and

National Guard. They are citizen soldiers and we have been hearing complaints now for years, particularly since the Iraqi war. I am

concerned on two levels: first and foremost, at the health care that

returning soldiers are receiving or not receiving; and, second, with

the future of the volunteer Army, itself. We will hear about that.

I believe there have been some improvements. There are still complaints. We need to know what the status is today and what we

can do about it.

As to the volunteer Army, we are dealing with an unpopular war

at home that has already taken its toll on recruitment for the

Army Reserve and National Guard. We need to do all we can if we

want to have a volunteer Army to make sure that people want to

join that Army, particularly at a time when we are engaged and

they see it every day on television in a guerilla war on the ground.

At the very least they need to know that if they are wounded they

are going to get the best health care that the United States has to

offer. Every member of this panel I am sure is committed to seeing

that happens.

I thank you again, Mr. Chairman.

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Chairman TOM DAVIS. Thank you.

Any other Members wish recognition? Mr. Cummings.

Mr. CUMMINGS. Thank you very much, Mr. Chairman, for holding this hearing on medical treatment of injured Army National

Guard and Army Reserve personnel.

As I stated at the committee’s hearing last year, it is deeply troubling to learn of the pervasive problems associated with pay and

medical treatment of Guard and Reserve personnel. I believe—and

I am sure that many other members of this committee believe, as

well—that this situation is simply unacceptable. While I am comforted to learn of new efforts to help address these important

issues, such as the community-based health care initiative, I am

equally unhappy with the fact that there are soldiers who shed

blood, sweat, and tears in the service of this country experiencing

pay disruptions or medical care that is as much a burden as it is

a blessing.

Insufficient planning and poor management controls by the Army

made it ill equipped to meet the needs of the Guard and Reserve

soldiers recently activated and deployed in Iraq, Afghanistan, and

elsewhere around the world in the war on terror.

A central focus of this hearing is to examine the quandary many

Guard and Reserve soldiers find themselves in when they are classified in a medical hold status while injured or ill. While approximately 5,000 Reservists are in medical hold, too many of our Nation’s bravest have to endure long delays in diagnosis and medical

treatment in austere facilities far away from friends and family.

The consequences of this problem often manifest themselves in pay

disruptions, stress, and undermined morale at a period of time

when injured Guard and Reserve soldiers should be primarily focused on recuperation.

The GAO has indicated in its report entitled, ‘‘Military Pay: Gaps

in Pay and Benefits, Etc.,’’ that sensible guarantees could not be

given that Guard and Reserve soldiers would receive undisrupted

pay and benefits in the event that they became wounded or sick.

The study also indicated a startling finding that a designation of

‘‘falling off orders’’ lead to 24 of 38 Reservists having their pay disrupted while they were undergoing medical care.

Additionally, the GAO cites numerous obstacles to inefficient

management in the medical treatment of Guard and Reserve soldiers ranging from poor dissemination of information to soldiers

about the active duty medical extension to lack of an integrated

personnel system that is updated at all times.

Mr. Chairman, finally I believe that we honor the service and

sacrifice of those who risk their lives for our Nation in the Armed

Forces by eliminating inefficient, ineffective bureaucracies that undermine their ability to receive the pay that they are entitled to

and the benefits that they are entitled to.

I am eager to hear from the witnesses today about what has been

done and what is being done to address the pay and benefit problems Guard and Reserve soldiers are experiencing, and I hope, in

the words of one of my constituents, that we don’t have motion,

commotion, and emotion and no results.

Thank you very much, Mr. Chairman. I yield back.

[The prepared statement of Hon. Elijah E. Cummings follows:]

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Chairman TOM DAVIS. Mr. Ruppersberger.

Mr. RUPPERSBERGER. Thank you, Mr. Chairman.

First, I would like to begin this opening statement by thanking

our brave soldiers for their courage and bravery, not only on the

battlefield but for being here today on behalf of your comrades. I

was struck to the core when reading your stories. You are quite

right in stating you are sadly not alone in this poor treatment. The

Nation, the Pentagon, and this Congress owes you better.

Sergeant Allen, you spoke of the responsibility leadership carries,

and I commend you for that. Soldiers, particularly disabled soldiers, should not be further burdened by disconnected bureaucracies. As members of this committee and in this legislative body,

we must take responsibility and lead better in this area.

This is not a new issue for me. In August 2004 the problems severely disabled soldiers were facing came to my attention and on

September 1st I introduced H.R. 5057—and this is a bipartisan

bill—with Congressman Jones and Congressman Hoyer to expand

the DS3 program in the Pentagon. That bill envisioned a joint command center with an executive agent to be a one-call-fits-all

helpline for soldiers, Marines, Sailors, Airmen, and Coast Guardsmen.

It was intended to help with all sorts of problems severely disabled servicemen and women face when they return home, including pay, medical appointments, caseworker management, transportation, employment-related issues, and many other problems. Senators Bond and Kennedy introduced companion legislation in their

chamber, and we came very close to passing that legislation before

the close of the 108th Congress.

Now, I know we were onto something when Paul Wolfowitz, Secretary Wolfowitz, held a ribbon-cutting ceremony on February 1st

of this year to launch the Military Severely Injured Joint Support

Operations Center. This center draws heavily from H.R. 5057, and

I congratulate the Pentagon on this effort.

We are working with our colleagues in the House and Senate to

monitor this program and its progress and to see if it is working

and if we can help.

The issue before us today is not just about processing paperwork;

it is about the most basic promise we make to all men and women

who put a uniform on and take the oath to serve our Nation. As

leaders we have the responsibility to take care of these men and

women and to leave no one behind and to not ignore them once we

bring them home.

One great lesson from today’s testimony and the GAO report is

that our Federal Government needs to get much smarter in the

way we do business. We have spent millions and millions of dollars

creating joint weapon systems, open architecture platforms, and

other integrated systems to create a more seamless battlefield between our military branches. Certainly we can do the same for our

payroll and other processing systems for the Army, Navy, Air

Force, and Marines. I fear the stories we hear today are just the

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tip of the iceberg and we should draw from the courage of these

soldiers to fix this system and to help those who will follow.

Thank you, Mr. Chairman.

[The prepared statement of Hon. C.A. Dutch Ruppersberger follows:]

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Chairman TOM DAVIS. Thank you very much.

Any other opening statements?

[No response.]

Chairman TOM DAVIS. Well, if not we will proceed to our first

panel of witnesses. We are very honored and grateful that you are

here today to share your personal experiences with the committee.

I understand that some of you appear with a little apprehension

about how your candor today might affect your future careers in

the military. Let me just say that we appreciate the opportunity to

receive your testimony under oath, and you have our assurances

that you will not pay a professional price for sharing your stories

with us. In fact, Congress is deeply gratified for your willingness

to step forward.

We welcome today Mr. Gregory Kutz, the Director of Financial

Management and Assurance at the U.S. Government Accountability Office; Brigadier General Raymond C. Byrne, the acting State

Adjutant General of Oregon; Sergeant First Class John Allen, B/3/

20th Special Forces Group, North Carolina National Guard.

Sergeant Allen, it is nice to see you again and have the opportunity to publicly thank you for all that you have done to bring the

plight of injured Guard and Reserve soldiers to the attention of this

committee.

We also have with us Sergeant Joseph Perez, the 72nd Military

Police Co., Nevada National Guard; Chief Warrant Officer Rodger

L. Shuttleworth, Chief, Reserve Component Personnel Support

Services Branch, Army Human Services Command, Maryland National Guard. Chief Shuttleworth is accompanied by Chief Warrant

Officer Laura Lindle, who is here to support Chief Shuttleworth’s

testimony—so when we swear everyone in, if you could rise and

raise your right hands—and Master Sergeant Daniel Forney. He is

a Reserve Component liaison, Medical Holding Co., Walter Reed

Medical Center, an Army Reservist from Pennsylvania.

Sergeant Forney, it is also good to see you again and I want to

thank you for your commitment to those soldiers and their families.

Give my best to your fellow Reserve liaison soldiers at Walter

Reed.

Before we begin, I want to recognize and thank a few more people who are here accompanying our first panel. Along with Mr.

Kutz, I want to recognize John Ryan, Gary Bianchi, and Diane

Handley of the GAO Special Investigations Office, who over the

last 2 years have gone beyond the call of duty to assist this committee with its investigation.

I also want to welcome and thank Mrs. John Allen and Mrs. Joseph Perez for coming here today with your husbands. As we salute

your husbands’ service and the sacrifices, we salute yours, as well.

There is another husband and wife team I want to recognize and

thank who have provided separate written statements today about

their experiences: Specialist Brian Robinson of the Nevada National Guard, and his wife, Mrs. Nicole Robinson, whose stories I

encourage everyone to read. I think Mr. Porter referred to it in his

opening remarks.

I want to thank everybody for taking part in this very, very important hearing. It is our policy that all witnesses be sworn before

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their testimony, so if you would rise with me and raise your right

hands.

[Witnesses sworn.]

Chairman TOM DAVIS. Thank you very much.

Your entire written testimony is in the record. Questions will be

based on that. That is in the public record. There is a light in front

of you that will be green when you start. It will turn orange after

4 minutes, and at the end of 5 minutes it turns red. We would appreciate it if you could move to summary after that, but we are not

going to gavel you shut if you feel you just need to add something.

This is an important issue, and we want to give you time to adequately explain to live Members what we are about today in your

experiences.

Mr. Kutz, we will start with you and we will move straight on

down the line. Thanks for being with us and thanks for the work

that you and your team have done on this.

STATEMENTS OF GREGORY D. KUTZ, DIRECTOR, FINANCIAL

MANAGEMENT AND ASSURANCE, U.S. GOVERNMENT ACCOUNTABILITY OFFICE; BRIGADIER GENERAL RAYMOND C.

BYRNE, JR., ACTING STATE ADJUTANT GENERAL, STATE OF

OREGON, ACCOMPANIED BY COLONEL DOUG ELIASON, M.D.;

SERGEANT FIRST CLASS JOHN ALLEN, B/3/20TH SPECIAL

FORCES GROUP, NORTH CAROLINA NATIONAL GUARD; SERGEANT JOSEPH PEREZ, 72ND MILITARY POLICE CO., NEVADA NATIONAL GUARD; CHIEF WARRANT OFFICER

RODGER L. SHUTTLEWORTH, CHIEF, RESERVE COMPONENT

PERSONNEL SUPPORT SERVICES BRANCH, ARMY HUMAN

RESOURCES COMMAND, MARYLAND NATIONAL GUARDSMAN, ACCOMPANIED BY CHIEF WARRANT OFFICER LAURA

LINDLE; AND MASTER SERGEANT DANIEL FORNEY, RESERVE COMPONENT LIAISON, MEDICAL HOLD, WALTER

REED MEDICAL CENTER, U.S. ARMY RESERVIST, PENNSYLVANIA

STATEMENT OF GREGORY D. KUTZ

Mr. KUTZ. Mr. Chairman and members of the committee, thank

you for the opportunity to discuss pay problems for mobilized Army

National Guard and Reserve soldiers. I previously testified that 94

percent of the soldiers that we investigated had pay problems. My

bottom line today is that gaps in pay and benefits cause significant

stress and financial hardship for injured soldiers and their families.

My testimony has two parts. First, pay problems for injured soldiers, and second, Army’s new process for soldiers injured fighting

the global war on terrorism.

First, we found that the Army does not know how many injured

soldiers have experienced pay problems. Injured Reserve Component soldiers can request to have their active duty orders extended

and their pay and benefits continued. When soldiers fall off of orders, pay and benefits generally stop. Based on our analysis of

Army data for 2 months in 2004, 34 percent of the 867 soldiers who

applied for extensions fell off their orders before their requests

were granted.

We found the following examples of the impact of these problems:

soldiers and their families denied medical and dental care, loss of

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access to the post exchange and commissary, negative impact on

credit due to late payment of bills, soldiers borrowing money from

friends and family to pay bills, added stress for soldiers that already had serious medical conditions, and injured soldiers spending

incredible amounts of time to obtain entitled pay and benefits.

Of our 10 case study, 2 soldiers are here today, Sergeant First

Class John Allen and Sergeant Joseph Perez. They will tell you

their own stories.

The key causes of these problems included a weak control environment, a broken process, and non-integrated pay and personnel

systems. For example, one Special Forces soldier who lost his leg

when a roadside bomb destroyed his vehicle in Afghanistan missed

three pay periods totaling $5,000. Why? Because this soldier’s application did not contain adequate information to justify his qualification for an extension.

The financial hardships experienced would be far worse if not for

the heroic efforts of people like Master Sergeant Forney and Chief

Warrant Officer Shuttleworth, who will also tell you their stories.

Second, there is some good news. The Army’s new process for soldiers injured fighting the global war on terrorism appears to have

significantly improved the front-end application process. According

to Army officials at each of the 10 installations that we visited,

they have experienced few delays in obtaining initial orders for injured soldiers. However, several key issues remain, including the

Army’s lack of visibility over injured soldiers. This problem reflects

DOD’s many stovepiped personnel systems. For example, the Army

contacted one soldier’s parents to inform them that their son was

injured in Baghdad and was at a hospital in Germany; however,

this soldier had been back in the States for 20 days.

In conclusion, this pay issue is another example of the ineffective

and wasteful business practices processes that plague virtually

every aspect of DOD’s high-risk business operations. To its credit,

the Army’s new streamlined process has significantly reduced the

initial delays extending orders; however, many problems remain

and must be addressed in a more comprehensive manner with clear

leadership and accountability for results. There should be zero tolerance for the poor treatment of our injured heroes.

Mr. Chairman, I look forward to continuing to work with this

committee to help soldiers. I am also honored to be at the table

with the other witnesses who have each played a significant role

helping injured soldiers, and I look forward to their testimony.

[The prepared statement of Mr. Kutz follows:]

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Chairman TOM DAVIS. Thank you very much.

General Byrne, thank you for being with us today.

STATEMENT OF BRIGADIER GENERAL RAYMOND C. BYRNE,

JR.

General BYRNE. Mr. Chairman, members of the committee, I

would like to thank the Committee on Government Reform for the

opportunity to speak today.

Over 3,000 Oregon soldiers have served their country as part of

the Operation Iraqi Freedom and Operation Enduring Freedom.

These citizen soldiers have served bravely with the expectation of

returning to home, family, and employer. Currently, over 100 of

them have paid a much larger price through injury or illness, and

10 have made the ultimate sacrifice in the service of their Nation.

I am currently serving as the Acting Adjutant General of Oregon

and work directly for the Governor of the State of Oregon, the Honorable Ted Kulongoski. This point is important because it highlights where my loyalty and duty reside: to the Governor and the

soldiers and airmen of the Oregon National Guard.

Additionally, I have been questioned by some individuals as to

my interest in Oregon National Guard soldiers currently in Title

10, active duty status. I have been told they are no concern of

mine. The answer I give is that Oregon National Guard is a force

provider and has a duty to ensure that the soldiers and airmen on

active duty are well taken care of. Their employers, families,

friends at ‘‘Fort Oregon’’ all have an interest in their care and wellbeing. All my soldiers and airmen will come home to Oregon one

way or another.

In visiting my soldiers who have returned wounded or injured,

I have a few observations which I would like to share with this

committee.

First, I applaud the community based health care organizations

[CBHCO], which is the single greatest improvement in care for Reserve Component soldiers I have seen in my military career. For

the first time we have placed the needs of the soldiers and the Reserve Component on par with the active duty soldiers. This program is critical and should be supported, continued, and, in fact,

expanded to allow soldiers to return home, yet receive the care they

need and deserve.

Second, we must look at the administrative processes that hold

up wounded or injured soldiers at power projection platforms. The

soldier whose medical decisionmaking process is complete, a determination has been made, should never have to wait up to 30 days

for an order releasing him or her from active duty.

Third, we must provide advocacy for Reserve Component soldiers

in helping them through a foreign and often frightening process of

determining disability. The Army Medical Department provides

first-class care on par with any health care organization in the Nation, but our Reserve Component soldiers are accustomed to a far

different system, a much more consumer friendly system with

choices, especially when it comes to getting second opinions on procedures that may provide to be life-changing, and the feeling on

their part that your health care provider works for you. We need

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advocates other than the Inspector General for our Reserve Component soldiers who can break down the perceived and real barriers.

The reality many of our soldiers are faced with after a wound or

injury is that they may not be able to return to their civilian occupation, and the financial support that is available through the disability ratings determination may be inadequate to sustain them

and their families while they are in the retraining environment.

Their lives and the lives of their families are forever changed.

Soldiers that go through the MEB process and are discharged with

0 percent disability receive no disability payment, cannot join a Reserve unit, and in some cases may not be able to return to their

previous job.

It is the experience of one VA counselor I talked to in Oregon

that it is not uncommon for VA to double the disability rating received by service members going through the MEB/PEB process.

The stress and turmoil a Reserve Component soldier faces not

knowing if they will be able to support their family or return to

their jobs is a clear impediment to the healing process. We must

do a much better job of bridging the gap from AC to RC or to VA

when our soldiers are injured or wounded.

Finally, we need to help heal the hidden wounds of post traumatic stress disorder [PTSD], and post deployment readjustment.

A recent New England Journal of Medicine study on four battalions

of active duty soldiers and Marines provides a valuable insight into

future problems and issues. Again, this study was done on active

duty personnel, and I would urge a study be conducted on Reserve

Component personnel who face far different circumstances as they

return to their communities and not active duty posts that contain

services and support not found in many remote areas of Oregon.

I have with me today Colonel Doug Eliason, senior medical officer of Oregon and a family practice physician in Salem, OR.

Thank you for your time and your support.

[The prepared statement of Brigadier General Byrne follows:]

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Chairman TOM DAVIS. Thank you very much.

Sergeant Allen, thank you for being with us. I just want to urge

the committee members to listen to his testimony.

This is the equivalent of financial and medical friendly fire from

armed services. We met before over at Walter Reed, and I asked

you to come forward, and I very much appreciate you and Sergeant

Perez being here to share your personal stories, because this puts

a personal face on the problems that our troops face when they

come back from battle.

Thank you very much.

STATEMENT OF SERGEANT FIRST CLASS JOHN ALLEN

Sergeant ALLEN. Yes, sir.

Mr. Chairman, members of the committee, it is a distinct honor

to be here to discuss the important issues affecting National Guard

soldiers.

I would like to start by saying that I am definitely out of my element, so I am a little nervous today, so bear with me.

My name is Sergeant First Class John Allen. I am a National

Guard soldier from Blairstown, NJ. In my civilian occupation, I am

a police officer. In the Army I am a member of Bravo Co. Third

Battalion 20th Special Forces Group. I am a U.S. Army Special

Forces weapon sergeant responsible for weapons, tactics, and security.

I have been a soldier for 14 years, and while in Afghanistan I

was asked to extend my deployment, and I happily did. If medically

able to, I would rejoin my brothers in arms, who did some wonderful things to free an oppressed people from a reign of tyranny. It

was and is well worth every personal sacrifice I have made.

I tell you my story in hope that after you hear my testimony I

will motivate you all to make the necessary changes.

Over a year ago when the GAO investigators first approached

me, I was asked what can we do to make things better. My statement then is exactly the same as it is today: to bring to light a broken, dysfunctional system in order to correct it so not one more of

my comrades will have to go through what I went through.

I am retiring later this month, and nothing I say or anything you

may elect to do as a result of my testimony will personally benefit

me.

In the summer of 2002, while deployed in Afghanistan, I sustained multiple injuries from a helicopter accident and a grenade

blast. I am currently receiving medical treatment at Walter Reed.

After being wounded, I was placed in the Army’s active duty medical extension program [ADME]. I have experienced significant

problems from ADME program, and by Army regulation it is a 90-

day extension. When my orders expire, it creates a multitude of

problems for me and my family—no pay, no access to the base, no

medical coverage for my family, and the cancellation of all my

scheduled medical appointments.

Our wounded soldiers have our share of champions, to include

the President, the Secretary of Defense, the Deputy Secretary, and,

of course, this committee. I want to personally thank all of you. In

regards to what I call the day-to-day survival people who I have

been blessed with meeting, such as Gary Bianchi of the GAO,

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Grace Washbourne of Chairman Davis’ staff, I can never thank you

enough for what you have done for me and my family. Most important of all, I want to thank all the doctors and health care professionals at Walter Reed Medical Center for their excellent health

care.

We have come a long way since I was wounded, and some significant changes have been made. By working together with my champions, we have already made some significant accomplishments.

We brought Walter Reed up to the handicapped access standards,

the Reserve Component pay and finance system is being reworked,

we have done away with the active duty medical extension program

for injured warriors, and we have opened the severely disabled veterans clinic. However, significant problems continue to exist that

will require all of our assistance in completing the task.

The problems as I see them are a combination of the system and

some of the personnel. Commanders at all levels must be the engines for change, and the subordinates must follow that commander’s intent. Unfortunately, there is no overall good guy wearing a

white hat and no overall one bad guy wearing a black hat. I wish

it were that easy.

I have certainly encountered some lazy, non-caring, even prejudicial individuals along the way, but had an adequate system been

in place to take care of Reserve Component disabled veterans, it

would have made my situation almost impossible to occur. As long

as I have been around the Army, I could not have taken care of

my family had I not met some of the prominent people that I have.

I shudder to think what would have happened to me and my family

without all of you that have helped me.

So what happens to the lower enlisted soldier that knows no one

of importance, the young soldiers who don’t have any rank? Who

are their champions? How does that leave a Reserve Component

soldier that gets wounded today? Exactly where I was 2 years

ago—left to figure it out on his own.

In my written testimony I have included a detailed timeline of

the events related to my ADME issues that clearly demonstrate a

broken system. When the people in my life hear my story, they look

at me like I am crazy. Even Gary Bianchi of the GAO, when I first

met him, looked at me like it was an unbelievable story until I provided him the supporting documentation and proof.

As I was writing my testimony on what happened to me over the

last 3 years, I have to agree with them that I must be crazy to put

myself and my family through this. A lot of guys can’t deal with

this, and somewhere along the process they just quit and they go

home. I would like to be able to say the problems are fixed; however, this is not the case.

Currently, I still have problems with my orders, and up to last

month having pay problems. The system is still broken, and the

only way I have been able to get anything done is by knowing the

people that I know. What happens if you don’t know those people?

My first order I would like to address is the commander’s intent

and the willingness of the mid-level command personnel to make

logistical effective changes.

The President of the United States declared war on the terrorists, and the fact is we are at war. I have met many leaders, to

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include the current administration, senior representatives of the

Department of Defense, senior leaders of the Army, and some of

this great Nation’s Congressmen. I personally feel that they all do

genuinely care about me and my family. I have seen them get involved in matters and get them fixed. I believe that the breakdown

is clearly in the mid-level command.

The hospital administrators are also doctors. What surprises me

is their own motto: cause no further harm. How can you allow Reserve Component soldiers to go months without pay, nowhere to

live, their medical appointments canceled, and not even being paid?

The result is a massive stress and mental pain causing further

harm, violating their own creed.

In the Special Forces we have our own motto: free the oppressed.

In this case, the oppressed are the Reserve Component disabled

veterans that I am here to free today.

I have personally talked to and seen many Marines being treated

at Bethesda Naval Station. I was amazed how their stories and

care treatment are the complete opposite of my own. Examples of

this are contained in my written report and are in detail for your

support.

We are at war and Walter Reed is the receiving center for our

wounded warriors. I would like to invite each one of you to come

to Walter Reed for an unannounced visit and see for yourself. It

would be very easy to correct the situation if the command element

climate supported it. The command staff at Walter Reed needs to

show their care. After what our soldiers have done and sacrificed

for our Nation, don’t they deserve better?

When a Marine is wounded and can no longer support the team,

they are idolized and treated as the heroes they are. When someone asked me about joining the service, I always used to recommend the Army. Now, after what I have lived, if one of my own

sons came to me I think I would tell him to join the Marines. After

thinking about that, I thought of what my father used to tell me—

you were either part of the problem or you are part of the solution.

I was wrong to think that. I am part of and I have felt proud to

be part of the Army, and I should not let a broken system taint

my overall experience. Rather than being part of the problem, I am

here today to be part of the solution. We need to fix our Army, my

Army.

Case worker confusion—the saying ‘‘too many cooks in the kitchen spoils the soup’’ holds entirely true here. There are too many

people involved. Each one thinks that what they do is the most important. The most important thing is what my doctor tells me, not

spending my time chasing my tail for their accountability and their

paperwork. I only need the U.S. Army Special Operation Command

liaisons. These individuals are more than willing and capable of

handling all of my needs. Each branch should have their own people helping their own people. If someone is needed, it should go to

my liaison and he can schedule it. If there is an argument between

my ombudsman and whoever it is, I as the patient can go on about

getting better and not being stressed and harassed.

Reserve Component versus active duty—I do not know of any Reserve Component units that have liaisons. Until the U.S. Army

Special Operations Command commander sent their liaisons on a

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permanent basis to Walter Reed, life was very difficult for me. But

what about the Reserve Component soldier that is in transportation company? Who represents him and who is his ombudsman?

I thank God I joined the Special Forces, because the Special

Forces are taking care of me. But that shouldn’t make me special

in terms of care and representation. In combat, I was considered

a member of the active duty. Once I was wounded, I was considered a Reserve Component soldier. As a Reserve Component soldier, my family is not authorized on my orders to relocate with me.

I am not entitled to use my leave as terminal leave. I am not entitled to have open-ended orders.

My wife and three sons are still living in New Jersey. My oldest

son, who was 10 years old when I was mobilized, is going to be 14

in July. I have missed a large part of his life and I can never get

it back. When I asked to go home, I was told active service members have to go to a medical treatment facility. I am not an active

service member. I am a Reserve Component soldier and my family

is at home, a fact that is causing me significant hardship. However,

when I tried to get any of the active duty entitlements I am told

I am a Reserve Component soldier. I have no problem with either

scenario, but make a command decision on which one I am and

allow me the benefits of that system.

If I need to come back, do so at the Government’s expense, instead of causing me, the soldier, more harm by separating me from

my family and having the soldier assume the financial burden of

paying to go see his family.

The medical hold company I am sure has some kind of function.

To those members of the company that are here today who have

given your all, I thank you and I apologize to you for putting you

in this category with the rest. If they are supposed to keep our accountability, my liaison does that. If it is handling and processing

my orders and ensuring that I am paid, then they are not doing

their job. It is to this end that I boldly state there is no reason for

the existence of the medical hold company. They are simply another cook in the kitchen just spoiling the soup.

They also need to understand they are not dealing with basic

training recruits, but rather our wounded warriors. Requiring amputees to attend formations, demanding you to come any time they

need something, and the general lack of caring they have clearly

demonstrated by allowing Reserve Component soldiers to go off orders is wrong. The overall attitude toward our Nation’s finest is

disgusting, and at best they should be ashamed of themselves. This

goes on with the full knowledge of the mid-level command philosophy.

Point five, confusion about the system: everything in the Army

has some kind of standard. I have not ever seen a standard for

medical treatment for Reserve Component soldiers. The overall

board process is confusing. Add in the Reserve Component factor

and it is even more confusing and complicated. Records for Reserve

Component soldiers are kept at their units and their command are

not readily available.

Once mobilized, I was assigned to Third Group Special Forces.

The day I was ordered to ADME my problems started. From the

first day to the present, there is not one set of standards that I

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have been provided, and I have not ever submitted the same supporting documentation. Had I been provided a manual for injured

National Guard or Reserve soldiers, I could have avoided the majority of the problems that I had.

The Medical Board for Reserve Component versus active duty—

the Medical Board for all soldiers should be the same, but it is not.

Bullets don’t discriminate between Reserve Component and active

duty soldiers, and neither should the Army. Once I was identified

as an injured soldier, I should have stayed on OEF/OIF orders. The

pot of money to run the war should include the price tag for taking

care of the wounded for that war.

I was left on open-ended OEF/OIF orders. There would be only

two amendments to my orders, instead of the eight or nine I think

I have had. My orders would not run out in 90 days or, under the

new system, every 179 days. If my doctor knows that my treatment

is going to take 14 months, then my orders should be for 14

months, plus processing time. Why is the decision left up to some

personnel person to determine how long if my treatment is going

to be shorter than the order? If the treatment is longer, there is

no problem because it is an open-ended order.

The burden should not be on me every 90 days to get all my paperwork done and turned in, keeping following up on the status of

those orders, getting new ID card, a new window sticker for my vehicle, my family have to travel all the way down to get new ID

cards at their expense and re-register for Tri-Care. I should be focusing on my medical treatment, the reason that my orders were

extended in the first place.

The Board is supposed to be the same for active duty and Reserve Component soldiers, but there is one huge difference that I

have contained in my written testimony.

Wounded soldiers are not quitting the team, they are getting out

because their disabilities force them to. There is a big, big difference. They should still be considered part of the team.

While talking to a U.S. Army Special Operations commander recently, he told me of an idea of his of tracking soldiers once they

are out. This is a great idea, and I think the Army should be helping the disabled veterans after they are out with their employment,

getting into the Veterans Affairs system, and their reentry into civilian life.

My conclusion—I believe in utilizing my chain of command. In

my case, my chain of command went through military channels

and made no progress. I did not start this investigation; my chain

of command did on my behalf. I have been cooperative in hopes of

fixing a broken, dysfunctional system, and I have been persecuted

for my actions.

Mr. Chairman, I am retiring this month and I am not afraid to

speak my mind, but for some of the guys still receiving medical

treatment and guys that are going to be at Walter Reed testifying

today, to quote my father one last time, ‘‘Tell the truth and let the

chips fall where they may. That way you can always look at the

man in the mirror in the eye.’’ I know my father would be proud

of me today standing here letting the chips fall by fighting for my

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disabled veterans. I am grateful for the opportunity to tell my

story. I thank you for all your support and effort. God bless you

and the greatest Nation on this planet, the United States of America.

[The prepared statement of Sergeant Allen follows:]

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Chairman TOM DAVIS. Thank you very much, Sergeant Allen.

Thank you.

Sergeant Perez.

STATEMENT OF SERGEANT JOSEPH PEREZ

Sergeant PEREZ. I would like to begin by conveying my sincere

appreciation to all the committee members today for this opportunity to help my fellow soldiers.

It is my belief that everyone here today is ultimately here for the

same reason: for love of country and for the heart of the armed

forces. It is my hope that what is conveyed here today is taken in

a positive force, and the steps to improve the policies and/or administration issues that have been found lacking, which applies to all

U.S. soldiers and their families.

I am a 38-year-old Nevada National Guard. I was on active duty

ever since the Twin Towers fell. I wanted to serve and defend my

country. I was deployed with the 77nd Military Police Co. in September 2001 for Operation Noble Eagle in Monterey, CA. During

this deployment, two Army stop loss orders affected my enlistment.

My second stop loss regarding specific MOS extended my service

again for 12 months, but after revision put my ETS to April 2003.

Shortly after our 13-month deployment ended, I took a position

as a Federal fire fighter at the Department of Air Force, Hill Air

Force Base, Layton, UT. However, I was ordered to come back to

Nevada to redeploy for Operation Enduring Freedom. I was notified

that I was to be placed on a third involuntary stop loss order that

extended me to full length of the deployment plus an additional 3

months. Our deployment orders sent us to Fort Lewis, WA, to prepare, be evaluated, and deploy to Iraq.

In late April I was deployed to serve my country as a 95 Bravo

military police sergeant. My unit provided critical support in theater operations in criminal and security detention missions. We

worked endless hours in weather conditions exceeding 130 degrees

in order to build and establish confinement operations in an area

which is well known as extremely hostile to coalition forces. We endured over 22 days of rocket-propelled grenades, mortar attacks,

and with performing MP missions in Iraq under the most dangerous and hostile conditions such as several vehicle escort missions to various locations in downtown Baghdad and nearby cities.

I was also selected to play a vital role in transporting detainees

to and from the courthouse in downtown Baghdad and was subject

to daily threats of ambush and attacks during these convoys.

On July 13, shortly after returning from the convoy with my

squad releasing detainees in the Baghdad area, we were alerted to

rush to the prison compound area. An uprising within the insurgent detainees led to a prison riot. The insurgents were armed with

sharpened tent poles, tent spikes, and rocks. They had already injured one soldier, and there was another pinned down. We led a

group of soldiers into the compound as a quick reactionary force.

While under fire, we helped the downed soldier and quelled the

prison riot with physical force. During these actions I injured my

left knee while taking down a combative. I also received a strong

hit to my head.

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That night again, just like so many other nights, we continued

to be RPGed and mortar attacked. On occasions, these mortars entered the confined areas, killing and wounding numerous detainees. They also took the lives of two MI soldiers working with us.

I remember the day working on the tower and witnessing part of

our own company of 11 soldiers, many of them being close friends,

load onto a military deuce truck. They were struck by an IUD just

outside the prison walls. It blew them all out of the vehicle, causing many injuries. I still to this day relive these moments and feel

helpless and have rage.

While on a family related emergency leave, I reported to Nellis

Air Force Base to have my knee examined and x-rayed. They found

my knee injury causing me to be unfit for deployment and in need

of medical attention. I notified the Army National Guard. I was informed that because the physical profile was conducted by the U.S.

Air Force, I could not receive care until I returned back to Baghdad, Iraq to be examined by an Army medical doctor. Not wanting

to get into trouble, I returned back to my unit without delay.

On September 2, 2003, I finally had a chance to be seen by the

28th CSH unit—combat support hospital—in Baghdad, Iraq. Because of the injuries to my knee, I was placed on medical evacuation orders to Landstuhl, Germany. After further examination and

x-rays in Germany, they put me on a plane to Fort Lewis, WA, to

be attached to the 2122 GTSB Medical Hold Co. for treatment. I

was put in the Reserve platoon under National Guard sergeant on

orders. He stated his unit was on orders to work with injured soldiers of the National Guard and Reserves. He also stated that they

were overwhelmed with the amount of soldiers and the host of

medical and personal problems they were coming home with. I was

given old sheets and led to an old World War I barrack with insufficient water, heating, limited access for injured soldiers, and with

mold growing on the walls. I was given a bus schedule and told to

find a case manager at Madigan Hospital.

I found and reported to my case manager. I was set up to see

medical staff within a few days. I was told they wanted to start my

medical process with physical therapy, which was set 3 weeks

away. During this time many of the medical hold soldiers felt like

they were lost and thrown away.

When you come back to the States, you figure that flashbacks

and nightmares were a normal stress that you go through when

you come out of a war zone. Soldiers still say, however, that, despite the Army’s efforts, languishing in medical hold compounds

one’s medical and psychological issues. Everything is uncertain.

You are denied care, and you feel that they don’t give a damn

whether you get better or not.

During the month of November 2003, my National Guard unit

was REFRAD and returned home for Thanksgiving. They were

given a hero’s welcome. The ones in medical hold watched it on TV.

On December 8, 2003, I was finally allowed to take convalescent

leave. At this point my wife had to care for me, and I couldn’t see

any hope of getting my position back as a fire fighter at Hill Air

Force Base. My wife was beginning to see signs of change in me

and she was worried about my mental health because of the nightmares and always wanting to be alone. I couldn’t even enjoy the

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time with my children and visit family without putting up a front.

It was my case manager, Captain Boardman at Madigan, who

promised to get me remote care through the VA so I could heal and

start physical therapy near my family.

I reported to the VA in Las Vegas in January 2003. I met with

my primary care provider and began medical treatment. That care

I received at the VA was outstanding. Most of my care and surgery

was contracted through a VA fee base program. I was able to get

x-rays, MRIs, physical therapy, surgeries to my knees and my

neck. My appointments were handled quickly and with the best of

care. I also started a veterans PTSD focus group at the vet center

in Las Vegas. My wife and I do believe that they saved my life. For

the first time I felt that my medical and psychological issues were

finally being handled properly.

During my stay in medical holdover, I received little to no counseling regarding traumatic events I experienced during war. Why

didn’t I or others ask for help? The culture here is that unless your

leg has been torpedoed off or your arm shot off, then it is not a

combat-related injury. Many servicemen here fear to be stigmatized

for being able to deal with their problems on their own. I did the

same thing that everyone else does in the military—you suck it up.

You don’t whine. But I am sure during the course of treatment a

soldier will display signs that will suggest that an individual is in

need of mental health counseling of some kind.

My National Guard unit was demobilized February 10, 2004. Because of this, my family and I fell off the Army records. After many

calls to the National Guard and hearing that, because I was still

on Title 10 orders, it was an active Army problem, I started to call

Fort Lewis. I was told the exact opposite. I was finally told that

there was confusion about how to handle the ADME orders and

line of duty packages. I asked to speak to my case manager, to find

out he was replaced by a new case manager who didn’t have a clue

who I was or what my situation was. My family went 3 months

without military IDs, Tri-Care health, pay, and even denied entrance onto Nellis Air Force Base to shop.

Not being able to work, I had to borrow money from family members to make ends meet. At the same time, I was still receiving

phone calls from the 2122nd medical hold company saying they

couldn’t fix anything unless I came back, or I had to come back or

I would be placed on AWOL. This caused more stress because I had

just had surgery to my cervical spine.

I was low on funds, didn’t have orders, or even a military ID

card. My wife and family members couldn’t believe all the problems, and started to think that maybe I did something wrong and

I was being punished. All this made me feel worthless, and I ended

up on April 22nd in a mental health unit at Mike O’Callaghan Hospital for PTSD and again suicidal thoughts.

After two extension orders and a back-dated ADME to report

back to Fort Lewis to be attached to the Madigan Medical Hold, I

finally was able to get my family updated in DEERS and have military ID again. I was finally able to show proof of employment and

get a rental house for my family. I reported back to Madigan Medical Hold on July 8, 2004. I was glad to see that the troops did not

have to stay in the old barracks any more, but a lot of the same

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problems still remained. Many of the soldiers were still having pay

and order problems. I started to try to help as much as I could.

I have been involuntarily medically separated because of the injuries I accrued for my country in Iraq in combat. I have gone

through a major life change, and within the next month I am having to endure another. I have always had pain in my knees, and

if I walk long distances or lift anything the pain is greater. Pain

in my knees is from the injuries and the past two knee surgeries

for tears, damaged cartilage, micro fractions, and lateral release.

I also had cervical fusion. I have lost some range of motion in

my neck. I sometimes can’t turn my head to the left and if I look

down for a long time, such as reading a newspaper, my neck locks

up. I have chronic neck pain which starts in my neck and ends in

my lower back. I have taken large doses of hydrocodone throughout

the day and the night for relief. This prevents me from performing

tasks that I feel that I need to be sharp mentally. This medication,

along with other medication, keeps me balanced. I have to take the

medication for the rest of my life.

I can’t get to sleep most nights, and I must sleep with a CPAP

machine strapped to my face because of severe obstructive sleep

apnea. I also sleep with a hard mouth brace because of the TMJ

surgeries to my jaw. I still do my therapy with the VA in Las

Vegas.

I continue to take my PTSD group meetings every week at the

Las Vegas Vet Center because it works for me. It helps keep me

strong and centered. I and many of my colleagues say such problems are particularly acute among the National Guard and Reserve

soldiers, who make up 40 percent of the deployed troops. I don’t

think it has been budgeted for the Reserve and Guard components,

and now they want us to suck it up. An injured soldier shouldn’t

be thought of less because he is a Guard member or a Reserve. I

am very displeased how my family has been treated during my

medical holdover. But the issues that are mostly directly affecting

my future is my dispute with the Army over disability ratings.

Most of my conditions are chronic and I can’t perform many of

my functions as a fire fighter nor law enforcement. These were my

chosen fields I have strived to be proficient and professional at. I

am told to look forward to a VE rehab program to help with education and training into a new field starting me over again. My

family and I live in a rural city outside of north Las Vegas. Our

closest health care, hospital, major food shopping, fitness center,

and largest gas station has always been Nellis Air Force Base, Las

Vegas, NV. My first daughter was even born here when I served

with the U.S. Marine Corps. It is very hard knowing that this has

been taken away from us.

As a Nation, we should note the special contributions of our National Guard and Reserves. Since the attacks of September 11th,

and extended into the Iraq conflict, demands placed on citizen soldiers and their families have been extraordinary.

I make this statement today not to complain or look for pity, but

to finally have my chance to tell my story. I don’t believe or want

to presume that I have a well-rounded knowledge of military procedures. I do believe this committee has a vigilant desire to make

provisions to the adjustment and strengthening of these programs.

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I would like to make the following considerations: National

Guard and Reserve forces face challenges that their active duty

avoid. When part-time soldiers do return home, they have little

interaction with other soldiers and sometimes feel that they are the

only ones going through these emotional adjustments. I feel a bit

isolated, like the rest of the world has just gone by me for the past

3 years. For these reasons, I feel that remote care would benefit

and aid the recovery of individual soldiers and their families. I

would recommend the Veteran Association in ways of medical care.

The medical holding companies have full control over the soldiers

to be able to utilize them in tasks that don’t hinder their care as

soldiers. This could help the soldiers progress in the military and

have an active duty component to handle problems that arise.

Many of these soldiers fall through the cracks when it comes to

promotions, educational benefits, and awards.

The wounds of the battle frequently do not require hospital attention. There are severe long-term physical and psychological disabilities that prevent veterans from attaining positions in our Nation’s work force. When a soldier returns, they have to go through

a complex workman’s comp type paperwork to prove that there is

something that they did in war, which is the reason that they are

sick. That can take from 4 to 16 months. They come home injured,

and rather than being integrated into society they are stuck in

medical limbo waiting for their disability ratings and then being diagnosed with pre-existing conditions that imply that they shouldn’t

have been sent overseas in the first place.

For these reasons, I believe there should be a seamless transition

from going from medical hold status to veteran status. I feel that

the veterans service organizations should have more access to

bases to help the injured soldiers deal with the MEB and PEB

issues. Families would be free to focus on physical and emotional

recovery progress in lieu of following up on paperwork, policies,

and medical care on their own financial and emotional expense.

I have found that many of the problems occurred during my medical care because the DOD and the VA create an independent patient record. Records are hand carried to and from agencies. I also

found, unfortunately, that the current VA/DOD process for sharing

information about eligible service members does not facilitate

quickly and there is not a smooth transition into enrollment into

the VA programs.

There seems to be a great deal of difference in the policies regarding the medical care and treatment of soldiers between the

branches of the military. I feel that the treatment to an injured

should be written and maintained as one standard. A medical doctor’s opinion shouldn’t change based off of the uniform that they

wear.

Last, I would like to see more progress and emphasis on mental

health services available in post traumatic stress and depression.

It has made a difference in my life, and I feel that the programs

such as at the vet center will give a great deal of comfort to many

of the returning veterans as they undergo their personal struggles.

It is because I have a great deal of love for my country and family that I write this statement. I have cherished much of my life

in the armed services. I have taken pride in wearing the uniform.

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I have made great friends and I have seen and accomplished many

things throughout my deployments. There can be no doubt of the

commitment of those in uniform, whether active, National Guard,

or Reserve. When we speak words of sacrifice, courage, and conviction it touches my heart as a former Marine and a soldier, as they

do for those who are serving in uniform today in the defense of our

safety and liberty.

I thank you again.

[The prepared statement of Sergeant Perez follows:]

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Chairman TOM DAVIS. Sergeant Perez, thank you very much for

sharing that with us. Mr. Shuttleworth, thank you.

STATEMENT OF CHIEF WARRANT OFFICER RODGER L.

SHUTTLEWORTH

CWO SHUTTLEWORTH. Mr. Chairman, members of the committee,

it is a distinct honor to be here to discuss important issues affecting injured Reserve Component soldiers, including those injured as

a result of the global war on terrorism. Our Reserve Component

soldiers have born the brunt of growing pains necessary to change

a system that was not designed to support Reserve Component soldiers.

My name is Chief Warrant Officer Rodger Shuttleworth. My military career began in 1973, where I served in the active Army until

1981. I then joined the Maryland Army National Guard and became a full-time employee of the National Guard Bureau of 1988.

I was assigned to my current position as Chief, Reserve Component

Support Services Branch, Army Human Resources Command, in

February 2003. My responsibilities include all aspects of personnel

for Reserve Component soldiers ordered to active duty under Title

10.

Prior to September 11th, there were only two programs that

dealt with injured Reserve Component soldiers—active duty medical extensions and incapacitation pay. Incapacitation pay and allowances are paid to soldiers without them being on active duty.

There are a lot of soldiers on incapacitation pay. Over $3 million

monthly is spent on their care. Without proper oversight, questions

to the best use of the money remains. If these soldiers were placed

on active duty medical extension, they would be better managed

and the Army would spend less money getting them returned to

duty or placed in the physical disability system.

The numbers of injured soldiers in these programs prior to 2001

was manageable, but due to the largest mobilization of Guard and

Reserve since World War II in the global war on terrorism, the

amount of injured needing assistance grew beyond the capacity to

assist.

For example, I started with a staff of six. At the time, the Adjutant General of the Army gave me a mission: to do all I could to

increase the capacity to care of our injured Reserve Component soldiers. At that time, the only process was active duty medical extension and incapacitation pay. An active duty medical extension prior

to September 11, 2001 was used to order drilling soldiers injured

during training to active duty for medical care. Because we were

not prepared for the disaster of September 11, ADME had to be

used to support GWOT soldiers injured in the line of duty. Because

ADME was not specifically designed for GWOT, soldiers were being

denied eligibility, fell off pay systems, and lost benefits for their

families.

ADME was supposed to be a 179-day program, longer than the

30 days given, but the Army G–1 who was responsible for establishing and interpreting ADME policy also chose to execute it, and

they became a major stumbling block, shortening extensions as we

tried to ensure GWOT soldiers were treated equally to their active

component counterparts.

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These problems continued until the creation of medical retention

process in March 2003. This was an improvement, better because

the application process was easier, the requirements were streamlined, and all extensions were automatic for 179 days. We also directly submit the soldiers’ orders to the Defense Finance and Accounting Service so pay problems and benefits will end.

In January 2004, I established the Medical Services Section of

my branch to facilitate MRP processing, Medical Board process,

and other RC personnel functions for medical reasons. During this

time, we began to realize that we were also responsible to train

and assist Reserve Component and active Army personnel in medical care facilities who had any questions at all on Reserve Component processing.

Some calls are from the medical holdover companies who do not

always know how to process or help Reserve or Guard soldiers

being treated in their facilities, but most of the callers are Guard

and Reserve soldiers who have not gotten any answers from their

chain of command at the facilities and have exhausted all other

avenues in health and service.

One of the major problems is that Army medical personnel do not

interface with Army personnel specialists. This continues to cause

serious misunderstandings, delays, and holdups in personnel services.

Another of the major problems is that we have a medical command telling an injured Guard or Reserve soldier one thing and we

tell him another.

Another continuing source of inter-Army command difficulties for

us involves our relationship with the Army G–1. The Army G–1 is

by definition supposed to be a source of policy decisions, innovation

that the Army Human Resources Command are executors of, but

this is not always the case. This causes the following problems:

great delays in the approval in each soldier’s paperwork, causing

increased days in treatment; pay problems and benefits; and great

family stress. We have spent far too much time debating between

our offices on the most effective way to support injured Reserve

Component soldiers.

In regards to these difficulties, I am happy to report that 2 days

ago the Army G–1 transferred functional responsibility for all types

of Reserve Component personnel management in regards to medical processing to my branch.

I want to bring forward another problem that my staff and I encounter every day. Reserve Component soldiers are remaining on

active duty for long periods of time without being injured into the

physical disability process and remain in a medical board process

for long periods of time. Of the paperwork we review, approximately 80 percent of ADME and MRPE Reserve Component soldiers will end up in a physical disability system. Part of the problem is the shortage of trained manpower, both at medical command

and the U.S. Army Physical Disability Agency. Injured Reserve

Component soldiers have paid the price for this, but we are trying

to improve manning and training.

Guard and Reserve soldiers have so many difficulties because the

active Army tries to treat them like active Army soldiers in all

cases, and in some instances they cannot. An example is when an

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active Army soldier is med-evac’ed from a theater of operation to

a Stateside medical facility and determined to be an outpatient,

they are returned to their home unit for a period of recovery. The

Reserve Component soldier may not have a home station because

his unit has been mobilized and there may be no one left at home

station to assist them. This causes us to lose accountability for

these soldiers. All of them are authorized to receive medical care

and treatment and should be reported through active Army organizations prior to returning to their home of record.

To alleviate this problem, the Army has created the community

based health care initiative. This initiative will allow some Reserve

Component soldiers, after being processed through an active Army

organization, to return to their home of records and their families,

remain on active duty, and receive medical care. Each community

based health care organization is responsible for the care and accountability of the soldiers assigned them. My office assists in

training the staff personnel of these newly created facilities. In addition to that, I have placed over 80 NCOs at Army treatment facilities in the United States and Germany to assist in patient

tracking and Medical Board processing. Because of the placement

of these NCOs, completed Medical Board ratios have now improved. Over 400 are being done annually.

We have also placed personnel at the U.S. Army Physical Disability Agency, the DOD Defense Finance and Accounting Service,

and at the CBHCOs. We were also asked very recently by the

Army Installation Management Agency to provide experienced Reserve Component command and control staff onsites at the installation because there is a shortage of permanent staff at the installation medical readiness processing units and CBHCOs.

There is still a need to sustain this staff currently and at least

2 years after the current contingency operations end. As of last

week, the Director of the Army staff has approved my office to fill

these leadership voids with the Army extended active duty program.

I hope from my testimony you understand how important it is to

me that my staff and the Army continues to resource and improve

policies aimed at supporting injured Guard and Reserve soldiers.

There are four things I want to bring to your attention.

One involves a needed change to Title 10. Under the current law,

Reserve Component soldiers not injured in the line of duty are entitled to a retirement benefit that soldiers that are injured in the

line of duty are not entitled to. That bothers all of us. I respectfully

ask that Congress change this unfair law. Right now, if you are injured prior to entering the armed forces and have 15 years of credible service and are found to be non-retainable, you are eligible to

retire and obtain benefits at age 60. But if you agree to come to

active duty and fight for your country and are injured in the line

of duty, you are not entitled to this benefit.

Second, I have deep concerns about current Army procedures for

injured Reserve Component soldiers at certain Army installations,

including Walter Reed, Fort Bragg, Fort Bliss, Fort Lewis, Fort

Dix, and Fort Drum. These installations do not provide timely and

accurate medical personnel records or line of duty investigations

that are vital to Reserve Component soldiers who are leaving active

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duty and will need future medical care. At these installations there

is no standard for consistency in who is responsible for providing

us timely and accurate records or applications for MRP extensions

so that the soldier is entered into the system. If this doesn’t

change, Army case managers will not have access to the records

they need, orders will be cut too late and pay and benefits will be

affected.

I ask the Army Installation Management Agency to help create

standards for installations so that we will have the same policies

in place to assist these soldiers.

Third, even with the new influx of medical case workers assigned

to assist injured Guard Reserve soldiers, the ratio between patient

and care manager is still too high at at least 50 to 1 at each hospital and now 30 to 1 at the CBHCO. These people are crucial to

making appointments, liaisoning with families, liaisoning with doctors on treatment time tables, and also entering correct information

into the mod system, one of the many data bases tracking medical

data, timely and accurately. If you can, please help us with this.

Last, my office needs more resources. I have space issues, funding issues to visit facilities for training and assistance, and equipment shortages. I have time and again asked my budget office for

the ability to use reimbursable GWOT funds to cover these expenses and am denied. I don’t understand the reluctance to use already dedicated funds. I look to Congress to consider line item appropriations to help us in the Guard and Reserve.

Thank you, Mr. Chairman.

[The prepared statement of CWO Shuttleworth follows:]

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Chairman TOM DAVIS. Thank you very much.

Sergeant Forney, thank you.

STATEMENT OF MASTER SERGEANT DANIEL FORNEY

Sergeant FORNEY. Mr. Chairman and members of the committee,

it is a distinct honor to be here to discuss active duty medical extension, the medical retention process, and life at medical hold at

Walter Reed for injured Guard and Reserve soldiers.

I am Master Sergeant Forney, an Army Reservist from Pennsylvania with almost 25 years of proud service. I arrived at Walter

Reed Army Medical Center in July 2002, after I volunteered and

received orders from Chief Warrant Officer Shuttleworth of the

Human Resources Command. Chief Shuttleworth saw the need for

someone to help the administrative process for Guard and Reserve

soldiers because the active duty medical hold company did not

know how to help these soldiers.

I was the first Reservist liaison to be sent to Walter Reed to help

soldiers. I was the only one there in that capacity for over 1 year.

When I first arrived, there were only about 10 injured Army Reserve and National Guard soldiers on ground. I assessed the situation and determined that the process was broken. Soldiers fell off

orders and had delayed pay and lost medical care. The soldiers’

families also lost Tri-Care benefits.

Then came the task of keeping them on orders. This is where the

real trouble started. Because I had to send their packets to the

Army G–1 at the Pentagon to be signed and approved, sometimes

it would take up to 4 months to get their orders. Although doctors

had requested extensions for soldiers for up to 179 days and we

submitted those requests, G–1 sometimes did not grant this much

time, instead approving 90-day extensions. This caused more workload for us and put the soldiers at risk of falling off orders. This

caused great hardship for the soldiers and their families, not only

monetarily but because medical care for soldiers and their families

stop when soldiers are not on orders.

G–1 requirements for valid support for an extension often

changed, sometimes without notice. For example, at first a form

46–2-R was acceptable for doctors to sign off, and this worked well.

However, after about 6 months this form was no longer taken. Now

a letter from a doctor was needed that included significantly more

information, such as the diagnosis, prognosis, and medical treatment plan. This then slowed down the process even more, because

a soldier would have to get his or her doctor to take time and write

the letter.

In April 2004 the medical retention process was implemented.

This was a great step forward, reducing the process of getting orders down to an average of 7 days.

There are still stipulations for getting MRP orders. They have to

be on 12301 orders. These are the mobilization orders. There are

still some bugs in the system and we are working with the Human

Resources Command to fine tune the process.

In addition to the problem with extending orders for soldiers and

lost pay and benefits, there are other issues I want to bring to the

committee’s attention. For example, during all this we encountered

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even more problems with the active duty, as they did not know how

to deal with the Reserves and National Guard soldiers.

When I first arrived at Walter Reed in 2002 I found a soldier

from California that was living in the hotel on ground. He had

been living there for 3 months paying out of his own pocket. He

had fallen off orders 2 months before. When he went to active duty,

he was told that there was nothing they could do for him because

he was National Guard. I did get him his back pay, and that took

2 months because it took a month to get him back on orders. As

far as I know, he has never been reimbursed the total cost for his

out-of-pocket expenses, approximately $5,000.

Mr. Chairman, my staff and I do whatever it takes to make sure

that soldiers are taken care of. The motto for the medical hold company at Walter Reed is soldiers first. My staff and I have spent approximately $2,000 of our own money in the past 2 years and are

continuing to pay out of our own pockets for a lot of the supplies

we use to uphold the motto. The medical hold company only gets

so much money a year, and my office is at the bottom of the list

for funding. What makes this so bad is the Reserves and Guard are

fighting next to the active duty, and still we treat them like second

class citizens. We do not want to be treated special, just equal.

Thank you, sir.

[The prepared statement of Sergeant Forney follows:]

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Chairman TOM DAVIS. Thank you very much. That was very

compelling testimony. It shows what happens when you don’t get

information sharing between the Guard and the Reserves and military and we are not interconnected and we are just letting regulations drive this whole process and we are forgetting about the people.

I am going to start the questions with Mr. Porter.

Mr. PORTER. Thank you, Mr. Chairman. Again, thank you to the

panelists for pretty compelling testimony.

I have a specific question for Sergeant Allen. You had mentioned

in your testimony and your backup regarding being persecuted for

actions, vindictive medical hold personnel, and have been labeled

as a troublemaker. Can you give me a little more details about

that? How are you being labeled, and what are they doing to cause

you additional pain and suffering right now?

Sergeant ALLEN. At the time, sir, when the original GAO investigation was started with Mary Ellen Tribanic—she is a great

help—my chain of command started the investigation. They came

to me. I was forthcoming, provided the information that was asked

of me.

Shortly thereafter the first GAO report came out. The information that was contained in that report was very specific. It stated

something to the effect, if my memory recalls correctly, ‘‘A Virginia

Special Forces National Guard police officer from New Jersey—’’

something to that effect—‘‘receiving medical treatment at Fort

Bragg,’’ which I was the only one of. When that happened I had

on different occasions be called late at night, 8:30, 9 p.m., be told

that I had a 4:30 or 4 a.m. appointment, medical appointment that

is, sir.

And on more than one occasion I went to the appointment, documented when, where I was told to go. On one occasion at 4:30 a.m.

I was told to have an MRI done. I went there. The NCOIC, the

non-commissioned officer in charge, told me that he had told my

medical administrator that they would not do my appointment at

4:30 a.m. and that I should come back Friday when my original appointment was scheduled.

I had the NCOIC write a letter, memorandum for record, stating

that, turned it over to GAO, and continued to have those type of

problems. I do have them documented. I have filed them all with

the GAO. It is very unfortunate. I consider myself a big boy. I can

take care of myself, and I have taken care of myself. But my concern has been and will be for the lower enlisted guy that can’t take

care of themselves. That is one of the examples.

Mr. PORTER. Thank you.

Mr. Chairman, if I could ask an additional question. Mr. Perez,

again, thank you for being here. I know that you are a long way

from home. I appreciate it very much. Very compelling testimony.

Can you kind of explain the difference between when you were

in the Marines and your most recent service? Was there different

treatment? Was there substantial difference in culture and procedures?

Sergeant PEREZ. Yes, I would go ahead and answer that. I enjoyed both the services, but I did feel that the care and the commitment that I received while in the Marine Corps, even like it was

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stated, your mid-level sergeant positions, a gunnery sergeant or an

E–6 or an E–7 took great pride in taking care of their under-enlistment soldiers. They didn’t try to pass it up the chain of command

for the next level to try to take care of it. I found when I got into

the Army once again that, even though we were serving side by

side with the active, when we got back it was just—there seemed

to be a complete discomfort on how we were treated as National

Guard and Reserves.

Many of our command, when they come back to the States, they

are coming back—when they come back to the States they are getting demobilized. They are going back to their job, going back to

1 weekend out of the month, 2 weeks out of the summer time. So

when you are trying to get in contact with the same command that

you are serving active duty with, a lot of times you can’t get in contact with them, not even e-mails or replies back. That is real discomforting, because this is the command group that you are hoping

would be there for you the same way you were there for them.

Mr. PORTER. Thank you.

Chairman TOM DAVIS. Ms. Norton.

Ms. NORTON. Thank you, Mr. Chairman.

Mr. Kutz, in trying to get our arms around this process, your

own work has been important to us. We recognize that part of what

has happened with the medical hold has to do with the planning

connected with the overall war effort. But when we hear this testimony and we read your report, it has all the appearance of a startup effort. Can I ask you whether or not medical holds have been

used? Is it because we have such a large—in other wars? I mean,

it is as if we haven’t done this before. Does this have to do with

the fact that we are using such a large Reserve and Guard component to fight this war in the first place?

Mr. KUTZ. Yes. Under the old active duty medical extension program that was really not designed for the kind of operational

tempo we have today. The medical retention process that they have

in place now is probably more equipped with what is going on, although that has risks also.

But really what you are talking about here is that they have a

process, not a program that is being managed. There is no one really in charge, no one responsible. There is a lot of organizations, but

there is no one that you can go to and say that you are accountable

for this.

So the kinds of stories that you have heard from the witnesses

here, you can’t go hold anyone accountable at this point, and so I

think someone does need to be put in charge, made responsible.

Put a general in charge of this, an ombudsman, or someone, because this is clearly reflective of not being prepared to handle the

kind of operational tempo that you have today.

Ms. NORTON. In that regard I would like to get a clarification

from Chief Warrant Officer Shuttleworth who said in one section

of his testimony he was happy to report that G–1 transferred functionally ‘‘responsibility for all types of Reserve Component personnel management with regard to medical readiness processing to my

branch.’’ I wonder if you are saying that you are in charge. What

are the specific effects you expect from the transfer you describe in

your testimony?

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CWO SHUTTLEWORTH. The G–1 has transferred all orders processing and for the most part the approval process except for those

cases that may be in question or may have some specific things

that doctors and medical professionals need to look at. But what

that does is what we had before we did this was that we had several different agencies within the Army publishing orders, depending on the kind of active duty that you were going to place that

soldier on.

As of this month, we now own all the orders, ADME, medical

readiness processing both one and two, and all the other processes

that keep these global war on terrorism soldiers on active duty.

Therefore, the soldier now has one place to go and one place to get

those orders from and doesn’t have to go wondering where they are

going to get their next order from.

Ms. NORTON. Do you believe, for example, if you would just take

me through a scenario—you have heard them here—that this

would solve the problems we have heard and the testimony we

have received here this morning?

CWO SHUTTLEWORTH. Yes. ADME was never designed to be a 30

or 60 or 90-day program. ADME was a program that was designed

to be just what MRP is, but for a smaller number of people. It was

designed to be a 179-day program, 6 months for each soldier, but

because the individuals who managed the program chose to decide

for themselves how much care a soldier really needed based on the

number of days they wanted to put them on orders, those soldiers

began to fall off orders, which was the wrong thing to do and that

will be fixed. No order is cut for less than 179 days, and they are

all directly fed to the finance accounting office so they will not drop

off the system.

Ms. NORTON. We are going to really be expecting real improvements here. You talk about debates back and forth over what to

do. It seems a pretty simple remedy that somebody has come up

with. I can’t imagine why it took so long if this is, in fact, centralizing control that was the answer all along.

May I ask, because it looks like some progress was being made

on the front end, that there were additional personnel that many

on the front end were no longer falling off of their orders and pay,

and there were housing standards. As a result of some of the work

of this committee, it looks like some improvements have been

made.

Now, given the improvement you spoke of, it seems to me a signal improvement in your testimony. You nevertheless have a real

mop-up job to do here, and therefore I am really interested in corrective efforts. My question really goes to part of, I guess, Mr. Kutz’

testimony where he says we need advocates. I am sorry, this is

General Byrne’s testimony. He says we need advocates other than

the Inspector General for our RC soldiers who can break down the

perceived and real barriers.

I wish you would explain what you mean. It certainly is true that

you have to go all the way to that high level, a pretty nuclear level

to get problems dealt with. I wonder what you have in mind, what

kind of—are you talking about some kind of ombudsman, some

kind of better troubleshooting? Does what we have heard from Mr.

Shuttleworth take care of it in terms of the support you would need

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other than the advocate general in order to get these problems

dealt with?

General BYRNE. Ms. Norton, I will go ahead and start it, and

then I would like Dr. Eliason. Essentially, what I would be looking

at is some sort of form of an ombudsman, someone who knows the

system, who can take the part of the soldier. For example, in the

process each of the soldiers is given a case worker, but the case

worker doesn’t necessarily work for the soldier, it works for the

system in working through getting the soldiers to the end of the

process, the medical process. So they are not neutral necessarily or

for the soldier, and so as a soldier does go through the process they

are not familiar with the process.

Now, what we have done in Oregon is periodically we send our

medical personnel plus our administrative personnel papers now

up to the various places we have soldiers all across the Nation, and

they go through and they assist them in any pay, personnel actions, and in some cases any medical actions that they can assist

in.

Let me turn it over to Colonel Eliason. He can better explain.

Colonel ELIASON. The uncertainty of medicine causes concern for

our soldiers. When I as a private physician am asked by a soldier

for my medical opinion, there is a relationship built on trust that

has happened because they have selected me. They have come to

me to be their doctor. They know that they have choices, that they

can go and get second opinions, they can ask other physicians. Our

soldiers, when they become injured——

Ms. NORTON. You said they can get second opinions, although

that was one of the areas that Mr. Kutz’ testimony said raised

issues for members of the Reserve and Guard.

Colonel ELIASON. Yes, ma’am. I guess what I was trying to highlight is that the uncertainty happens frequently because of the fact

that you will hear two separate stories, not because one system has

better medicine than the other, but because of the fact that there

is uncertainty and that different treatment plans vary based on different physicians.

The problem is our soldiers are looked at. When they arrive at

a medical facility they see a green-suit doctor who is the company

doctor, the Army doctor. They don’t always see this as their physician, a person they can trust and establish that kind of relationship. What advocacy is about is somebody who can help break

down those barriers and explain the uncertainty in medicine, explain and advocate for the soldier, maybe even attend an appointment with them to settle a misunderstanding about their treatment plan.

As General Byrne has said earlier, the Sergeant General has

wonderful indicators of the quality of care that he provides in the

system. The problem is our soldiers often begin with an element of

distrust or at least concern about what health care they can receive, and this is their physician telling them that they need surgery or that it is better not to have surgery and maybe physical

therapy first.

Chairman TOM DAVIS. Thank you very much. I am going to

take——

Ms. NORTON. Mr. Shuttleworth had——

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Chairman TOM DAVIS. Did you want to say anything, Mr.

Shuttleworth, on that?

CWO SHUTTLEWORTH. No, sir.

Chairman TOM DAVIS. OK. I will take my 5 minutes. It looks to

me like what we have, gentlemen, is a breakdown in the chain of

command. I mean, it is very clear here that this is absolutely broken, and when people who are in the system tried to move forward

and tried to be advocates they were ostracized, they were slapped

down. We heard this from Sergeant Forney’s testimony.

Maybe a designated ombudsman whose job it is to get to the bottom of this and that is their job and nobody questions them is

something that you need. We had people who tried to step up to

that role, but the system tended to swallow them.

You have so many different stovepipes in the military right now,

so many chair fights, so we are not getting the information sharing

back and forth. This has taken 30, 40 years to get it this way. Everybody wants to do it their own way. They want their own legacy

system. They want this or that. We come into a war at this point

and we can’t put it together, and these people, these soldiers who

are on the front lines taking fire, some of them killed, some of them

injured coming back, we have a system that has been so turf driven

that it is beyond the power of one or two people to fix.

One of the purposes of this committee is to try to get Government to work as a unit. We don’t have the jurisdiction of a lot of

the other authorizing committees. We try to work across those lines

to make it work. This is just an indication with some very sad consequences, and I think, from the perspective from the Department

of Defense, some very embarrassing consequences of what has happened with years and years and years of these systems that are

jealously guarded, that are stovepipes, that are not communicating

with other systems, and the people that fall through the cracks.

It gets so regulation driven at this point we forget about the mission, which is getting these people back on their feet, getting them

the health care that they have earned, that they deserve, and getting them back out in society. It is embarrassing for all of us.

Yes, I think there will be some appropriate followup action on

this. The Armed Services Committee is also very, very concerned

about this. But if these gentlemen hadn’t taken their initiative to

come forward—and we asked them to come. We asked them to

come here. We begged them to come here. Nobody wants to embarrass anybody, but it wouldn’t get fixed. We have more and more

people in queue. I think people are trying to make it better, but

I am not sure this isn’t so stovepipe driven at this point it becomes

more and more difficult all the time.

General Byrne, can you give me some examples of some specific

problems soldiers encountered during their time at Fort Lewis?

And also you made the statement about these soldiers were of no

concern of yours, which is a typical stovepipe answer that now they

are under Army care and you guys back out. It is the typical turf

fight. Who said that?

General BYRNE. I would rather not say.

Chairman TOM DAVIS. I know you wouldn’t, but I am asking you

who said it at this point. Do you want to get with the committee

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later on? You know, it is not what ought to be happening. You

agree with that, don’t you?

General BYRNE. Yes, sir.

Chairman TOM DAVIS. I mean, somebody has to be accountable

somewhere when they are saying this kind of stuff, so I am not

going to ask you to say anything but we are going to ask you afterwards. Will you help us? Because this should not be allowed to continue, and the person who said that needs an attitude adjustment.

Go ahead, though. Tell me some of the problems.

General BYRNE. What concerned me, just to followup on that, the

conversation I had with the individual, what concerned me most in

the conversation was the fact that nowhere in our conversation did

taking care of soldiers come up. It was the fact that there was a

newspaper article that had been published, the fact that potentially

I was not following procedures as far as how we went and did business. As a result of maybe a news article that came out, my intent

was not to raise major issues, was not to——

Chairman TOM DAVIS. Of course not.

General BYRNE [continuing]. Embarrass anybody, was not to create major problems. My whole purpose in going to Fort Lewis in

this case was to take care of soldiers. The way I run things in Oregon, and I hold my subordinates accountable for this, is I don’t

place blame. What is the problem? Let’s put our effort and energy

into taking care of the problem, the issue. That is the way I do

business. And so I sometimes, when things get sidetracked, I get

real excited and it bothers me.

Chairman TOM DAVIS. I think the statement is less reflective of

the individual, I am afraid, and more reflective of the system.

General BYRNE. I would agree.

Chairman TOM DAVIS. That is why I understand you don’t want

to come forward.

General BYRNE. Yes.

Chairman TOM DAVIS. It probably is reflective of the system.

General BYRNE. I can’t speak to it. I can only speak to individuals.

Chairman TOM DAVIS. Yes.

General BYRNE. Very similar to what the soldiers here today

have talked about, very similar things related: pay issues, promotion issues. I own some of that, and part of the reason why I

went to Fort Lewis was to find out what is—after I finished the

visit I divided up my findings what I had. I divided it up into three

parts: what is it that I owned? What is it that maybe the medical

folks owned? And what is it that maybe the post owned? Then I

sent that off to Fort Lewis, and then I sent my folks the piece that

I had.

I deal with families, so any issues that were related to families

and families not being taken care of I worked at.

Chairman TOM DAVIS. That is fine. I am glad somebody was

looking after them at this point.

General BYRNE. Well, I do.

Chairman TOM DAVIS. Right.

General BYRNE. That is my job.

The second piece that I worked on was there are pay issues.

Again, we need one system, one pay system, and at this point in

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time that is not there, but strides are being made, and so I own

some of the pay issues that the soldiers have. I also own some of

the personnel issues, for example, promotions and things like that,

so I own those, too. But as services and similar instances that

these soldiers have testified toward, those are things that I had

concerns of, and then I turned those back over to Madigan Hospital.

Chairman TOM DAVIS. Right.

General BYRNE. I would like to compliment Dr. Dunn, who is the

commander at Madigan Hospital. When he knows the information,

he works it hard.

Chairman TOM DAVIS. Thank you. My time is up, but let me just

ask for Sergeant Allen and for Sergeant Perez and also to Mr.

Shuttleworth and Forney, I mean, the two individual cases we

heard about are not isolated cases, are they? Is that correct, Sergeant Forney?

Sergeant FORNEY. Right.

Chairman TOM DAVIS. Unfortunately, these are just two people.

One, we had a long talk with Sergeant Allen, but he had a half

dozen other people with him that had similar problems just over

at Walter Reed, and this is just 1 day going through. Unfortunately, we are not taking one or two nit-picky instances. This is a

problem that has been endemic throughout the system. Would you

agree with that, Sergeant Allen?

Sergeant ALLEN. Yes, sir, I would. From the six injured soldiers

from my unit, all six of us had significant pay problems, significant

problems with our orders not being renewed in a timely manner.

And from the other National Guard and Reserve soldiers that are

at Walter Reed with me, they were having significant problems.

One of the caveats that I do want to add is there is a couple really good guys that were trying hard that were getting squashed, like

Sergeant Forney.

Chairman TOM DAVIS. Yes.

Sergeant ALLEN. And Chief Shuttleworth and Chief Laura Lindle

that was in my testimony, last month when I talked to you and I

was having the pay problems and you read my testimony about the

23rd, well, that was due to Chief Shuttleworth and Laura Lindle.

Hopefully now that he has gotten command of that structure, it is

going to make a change for all these guys and we are not going to

have what we have had.

Mr. KUTZ. Mr. Chairman, I would say that we looked at this

overall. We are talking about hundreds, possibly over 1,000 soldiers

that have had this type of problem, based on our overall look.

Chairman TOM DAVIS. Yes. And you don’t think that is going to

help recruiting and retention, do you, Mr. Kutz?

Mr. KUTZ. That is an issue, because the soldiers that aren’t injured are very well aware of what is happening to the injured soldiers.

Chairman TOM DAVIS. And they should be, frankly. I mean, this

is just something that we weren’t ready for.

Mr. Ruppersberger, 5 minutes.

Mr. RUPPERSBERGER. Thank you, Mr. Chairman.

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I have a whole list of questions, Mr. Chairman, I would like to

leave with GAO and have written answers given back, but I have

another hearing I have to go to at 12.

The one issue that I would like to talk about right now with respect to Walter Reed, I had one of my staff people go to a briefing

this past Monday for the care that wounded soldiers currently were

receiving at Walter Reed, and she left with the impression that

even though there are still a lot of issues out there that we have

discussed here today with respect to the Army and DOD and the

problems from pay to care, but she left with the impression that

a lot of the issues that we talked about here today, that Walter

Reed has really resolved some of those problems.

Now, when you go to a briefing sometimes you only hear what

the top people want you to hear. I want to make sure, to hear from

you all whether or not—I guess you, Chief Shuttleworth—are there

problems that still exist at Walter Reed? What are they? We have

heard these problems today. If they are, let’s talk about them.

CWO SHUTTLEWORTH. Obviously I can’t speak for the medical

care. That is a medical professionals’ issue, but from the

administration——

Mr. RUPPERSBERGER. I am talking about paperwork issues, which

is what you testified to.

CWO SHUTTLEWORTH. From a personnel/administrative

standpoint——

Mr. RUPPERSBERGER. Right.

CWO SHUTTLEWORTH [continuing]. As far as soldiers dropping off

orders and dropping out of pay, I believe that we have fixed that

problem. There are still some accountability issues within the system that we are still trying to get our hands wrapped around, but

I believe that we have about a 99 percent accountability of those

Reserve Component soldiers that we didn’t have before. So we are

improving the process. We may not be there yet, but we are about

90 percent there.

Mr. RUPPERSBERGER. OK. Well, in my opening statement I talked

about a bill that we are still attempting to work. I really would like

to meet with you and maybe Sergeant Forney to get further information.

Just one question, though. You say the paperwork system seems

to be doing better. That is why we are here. That is why we want

to move forward. How about the system entirely, not just Walter

Reed? Do you have any knowledge of other problems that are out

there? Since Walter Reed has gone a long way in relation to paperwork, that should be a model for the other areas.

CWO SHUTTLEWORTH. Well, the good news is that when we fixed

the system we didn’t just fix Walter Reed. We looked at everybody.

So when we started fixing the program, we fixed the entire program. When we developed the MRP process, it was for the entire

Army and not because of what was happening at Walter Reed at

the time. So we really have wrapped our arms around the whole

thing, and the whole thing is being fixed at the same time, rather

than one piece at a time.

Mr. RUPPERSBERGER. You feel it is beyond just Walter Reed

then?

CWO SHUTTLEWORTH. It was, yes.

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Mr. RUPPERSBERGER. Mr. Kutz, the questions that I am going to

present to you are questions about solving the problem, I mean, our

whole system, the priority of funding, our technology and how we

are using it. One of the things, it seems to me, the problem is that

it all starts at the top, and upper-level management has to hold

middle-level management accountable for the follow-through and it

just hasn’t happened. That was your testimony all day through. We

have to start at the top, see what the system is, make sure the resources are given, and hold the people accountable so that this will

not happen.

Thank you all for being here to day.

Chairman TOM DAVIS. Thank you.

Mrs. Miller.

Mrs. MILLER. Thank you, Mr. Chairman. First of all, Mr. Chairman, let me thank you for holding this hearing today and all of

these witnesses for coming here. This is an unbelievable issue. I

shouldn’t say unbelievable. I suppose we should be shocked by

some of the testimony, but unfortunately we are not. We do recognize that this is a problem, perhaps a manifestation of the high degree of the amount of people, Guard and Reserve, that we have as

a component of the total force in today’s world and today’s military.

But, you know, at a time when our country is successfully prosecuting the war on terror, at a time I think when our country is

needing to be so focused on recruitment and retention and these

kinds of things, the testimony that we have heard today is certainly distressing. It does call for action by the Congress, by the

DOD, and, as the chairman has said, that is something that our

committee I think can very much be a conduit of as we investigate

some of these different situations.

I have a question for General Byrne. Let me preface the question

by telling you a bit. In my particular Congressional District we

have what is known as Selfridge Air National Guard Base, which

is a unique kind of facility in the inventory of the Guard, as you

know. It is unusual, the exception rather than the rule, that the

Guard would actually own a base, own the real estate. They do.

Normally they are an appendage off of a commercial airport or

something, and of course the armories. We have all of that also.

But we have at this particular base every facet of the military

represented there, not only the Air Guard, but the Air Force Reserve, the Marines, the Navy. It is not only a critical component

in the recruitment in an urban area, of course, but it has been a

major deployment area as we are in theater here for the Guard and

Reserve forces. In fact, my husband, after having served as a fighter pilot in Viet Nam in the Air Force, finished his military career

as a Air Reserve, Michigan Air National Guard Reserve officer. He

was the base commander there.

I will tell you one of my other committee assignments is also

serving on the House Armed Services Committee, and so, as the

chairman has said, our committee also has been looking at some

of these kinds of problems.

To the extent that in our last Defense authorization, reauthorization bill, we actually titled it ‘‘2004, the Year of the Troops.’’ With

all of the tremendous expenditures our country does make on armaments and various systems, there is no second, obviously, for

139

our troops. So we were very pleased to have as a component of the

Defense Reauthorization Act a real emphasis on creating parity for

the Guard and Reserve to the active duty. As one of you mentioned,

the bullet doesn’t know if it is hitting an active duty or a Guard

or Reserve. I think that was you, Sergeant Allen. That is so true.

We have had, I won’t say huge strides, but we made a lot of improvements last year in having parity, I think, between the active

duty and the Guard and Reserve, not only with pay, but with commissary privileges. One of you mentioned about commissary privileges. As you know, previously you could only go once a month,

which is crazy. Actually having parity with all of this is so important, as well.

And, of course, as we mentioned, now if you go and look in theater, in the high 30 percentile is the component you will find of our

Guard and Reserve, whether you are in Iraq, Afghanistan,

Uzbekistan, what have you. Many of the Guard and Reserve, unfortunately perhaps maybe for them, have such a tremendous skill set

that they are called for longer deployments, depending on what the

mission is there. We are finding that those kinds of things are happening with extended tours.

That is a sort of long lead-up to the question, General, but I actually have a unit coming home to our base tomorrow, I believe, that

has had some similar instances that you have articulated a little

bit in your testimony, as well, to some of your Reserve units. It is

a group that actually—there was also a newspaper article about

them. They process through Fort Bliss.

We actually had called the processing personnel from our office

and said we were going to send a person down there to make sure

that these Guard and Reserve, as they were coming back home,

that their needs were being met, etc., and that we weren’t absolutely convinced because they had a bad experience as they began

their deployment, quite frankly, not having—I won’t go into all the

details, but similar to what you have found with some of your

units, perhaps, in Oregon there.

I would ask you, General, do you think that the respective adjutant generals—my adjutant general for Michigan is General Tom

Cutler. Now, he is a blue-suiter. I hope you won’t hold that against

him. But is it possible for the adjutant generals, as we are calling

on all of our Guard and Reserve forces in the universe or in the

Nation to do more, is it possible for the adjutant generals to have

a more forceful role perhaps as a fraternity in making sure that

their units—and I also appreciate the chairman’s comments, which

you said you were told that your troops were no longer a concern

of yours now that they weren’t active duty and how outrageous

that comment actually is.

How can the adjutant generals perhaps be a more effective conduit to making sure that as your units are called up, as they begin

deployment, as they are processed into theater and then all the

way through their deployment and coming home, is there something else that the AGs could do or that Congress could help you

to do?

General BYRNE. I am sure that each of the adjutant generals

takes a very profound interest in deploying and redeploying their

units, whether they are Army or National Guard, Air Force. I know

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that they advocate for their personnel. Also, there is an organization, the Adjutant General Association of the United States, which

also collects commonalities and works through those. I know that

organization works very hard to develop agendas and items related

to deployment and re-deployment. So we do work it.

Mrs. MILLER. I mean, I think you have to. I am sure that every

AG across the Nation shares your consternation, if they are getting

those kinds of answers. My adjutant general has never mentioned

anything quite like that, but there is a different culture, I think,

and so I wondered about that.

Thank you. And thank you, Mr. Chairman.

Chairman TOM DAVIS. Thank you very much.

Mr. Shays.

Mr. SHAYS. General Byrne, you provided a list of 84 of your soldiers that are now in medical hold status. Of the 84, 73 have been

in longer than the current reported Army standard of 67 days, 35

of them have been in longer than 6 months. Is this the standard

you have found?

General BYRNE. I would like to let Dr. Eliason answer the question. This is his area. He follows a lot better.

Mr. SHAYS. Sure. I thought all you were going to say is no.

Colonel ELIASON. Well, sir, I can’t speak to the Army standard.

When soldiers are put in medical holdover, under the MRP processing there is supposed to be a determination made relatively early

whether they can eventually return to theater, which I suspect is

where the 67-day rule is.

Our major concern is getting our soldiers home. What we would

like and what we have asked and, quite frankly, what has improved markedly in the last year is getting them into programs like

community based health care organizations. Their length of treatment is their length of treatment. People heal as they heal. But the

sooner we get them home, we believe they are going to heal better,

and so that is our push—as rapidly as possible getting them returned to their State for care, where they are living in their own

home with their family and their support system around them.

Mr. SHAYS. That is your answer?

Colonel ELIASON. Yes, sir.

Mr. SHAYS. Well, frankly, this is an old story, and it is shocking

except it is an old story, which kind of makes it even more shocking. I am pretty convinced that in Congress we have tried to put

enough focus on this to embarrass a solution, and yet that doesn’t

seem to work. So I am somewhat lost for why this continues to persist, and I am just wondering if any of you could suggest to me why

it continues to persist.

I would like, Mr. Kutz, for you to tell me why you think it persists.

Mr. KUTZ. You are talking about the Medical Board process? I

am not familiar with that, so I can’t really comment on that. I

mean, we heard from the soldiers that we talked to that had the

MRP problems and the medical extension problems that they were

in hold waiting for the Medical Boards for hundreds of days in

some cases, and that is about all the knowledge that I would have

on that.

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Sergeant ALLEN. Sergeant Allen, sir. I think it is a serious lack

of leadership ability in the mid-level command. People aren’t willing to step up to the plate and just do what is necessary. If something is identified that is wrong, then it needs to go away. What

has perplexed me this whole time living this nightmare is how

could something be so wrong and continue to go on and on and on

and just keep perpetuating itself? It is generation after generation.

A perfect example, I just went to get my orders to out-process

and they were wrong and they had me as a specialist in the Army.

I talked to my friend that got out 2 months ago and I said, ‘‘I can’t

believe this. I feel like I am the first guy to go through this.’’ His

name is Ryan Kelly, and he said, ‘‘Well, that is funny, because I

thought I was the first guy 2 months ago to go through it.’’ And

so I think it is a serious lack of people just stepping up to the plate

and coming up with a solution. I think if somebody can come up

with a solution, then it would be implemented and there wouldn’t

be the problem.

Mr. SHAYS. See, usually what happens in something like this,

when Congress decides that we are going to conduct a hearing on

it, it is such a shameful thing that people start to take action.

Sometimes the problem is resolved before we even have a hearing.

In this case, this is not the first hearing and the problem continues. That is what I find, frankly, a bit discouraging. It clearly has

to be the stovepipe nature of it, and no one taking responsibility.

Sergeant ALLEN. To add to that, sir, some very senior high people in DOD and the Army have been trying to help us, the guys

that aren’t getting paid, aren’t getting orders. I mean, the one-star,

two-star, three-star generals, people over at DOD, and you would

think that would encourage things to be changed, but there again,

you know, it is got to be in the mid-command level of the philosophy, command philosophy as a whole, which is what I put in my

testimony, that people, they don’t take the time to care.

Mr. SHAYS. My conclusion is it is just not a priority of DOD. That

is the only conclusion I can get.

If I told my Dad when I was young, ‘‘Well, I forgot,’’ he would say to me, ‘‘If I gave you $100, you wouldn’t have forgotten.’’ It was

a clear message to me. In other words, if it had been a priority,

I wouldn’t have forgotten. And in the case of DOD, this has been

a longstanding problem. We have too many of our Reservists and

National Guard risking their lives, and they get treated like dirt.

That is the bottom line.

Thank you, Mr. Chairman.

Chairman TOM DAVIS. Yes. Thank you very much.

Ms. Norton.

Ms. NORTON. I just have two short questions. My colleague from

Connecticut is pressing toward a remedy when he says why has

this gone on so long, and I just want to understand what the testimony here has been with respect to remedy. Do I understand—and

perhaps it was General Byrne—that you endorse the notion of

some form of ombudsman attached to these companies that would

perhaps do some of what, or at least bring to earlier attention some

of what we have heard about in these work-around procedures I

think that GAO reported where people are in an ad hoc business

running around trying to straighten these out.

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I am asking would an ombudsman help that. And I am also asking Officer Shuttleworth whether he would endorse the notion,

whether it would help his work now that he says this has been centralized with him, to have an ombudsman connected to these holding companies.

First General Byrne.

General BYRNE. Ms. Norton, yes, a neutral party, someone who

is educated in the process that can, one, explain and, two, be an

advocate for the individual as they go through the process.

Ms. NORTON. Do you endorse that notion, Officer Shuttleworth?

CWO SHUTTLEWORTH. We can use all the help we can get. I will

tell you that as far as the comment on the Medical Board process

a while ago, understand that prior to September 11th the amount

of Medical Boards that were pushed through for Reserve Component soldiers in a year was very low, sometimes not even 100. If

you look at the statistics from prior to that, what happened—and

the liaison offices for those medical facilities are staffed with civilian employees, and not very many of them, I will tell you, to work

with the active Army soldiers that get hurt.

So after September 11th trying to push 400 and 500 boards

through every 3 months or 4 months on a Guard or Reserve soldier

is just overburdening the system. That is why there are in my testimony 80 NCOs out there at treatment facilities who have Guard

and Reserve experience to help these soldiers with that.

So to have someone else out there helping us? Absolutely. We can

use anything that we can get in order to get these soldiers through

the system timely and fairly.

Ms. NORTON. Mr. Chairman, I wouldn’t want it to go unnoticed,

because I think this comes out of the hearings you have held, the

GAO report you ordered, not only the notion this notion of ombudsman is endorsed here, but also I would not want to go unnoticed

what, again, Officer Shuttleworth said here today. I believe that

has come out of your work in this hearing, where he announced

that 2 days ago they centralized these concerns for processing in

his branch, and therefore we are going to look to that person in

charge now for improvements on the theory that it will help the

process.

One final question. It was very compelling testimony about what

we in civilian life call post traumatic problems or syndrome, very,

very disturbing. I wonder whether somebody could tell me whether

or not in this war and other wars that qualifies for disability or if

it should qualify for disability.

CWO SHUTTLEWORTH. I believe that on the next panel there is

a colonel from the Physical Disability Agency.

Ms. NORTON. Thank you. I will ask them.

Chairman TOM DAVIS. Can I just say thank you to all of you.

Sergeant Allen and Sergeant Perez, very, very compelling testimony. I think the Members were very moved by it. Let me thank

your wives, who have had to stick through this thing. This has

been a family issue for a long time, and we appreciate your loyalty.

You are all heroes and heroines in my book.

To Mr. Shuttleworth and Sergeant Forney, you tried to be ombudsmen, but we have a system right now that just really doesn’t

embrace that concept. Maybe we ought to formalize it a little bit.

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General Byrne, thank you for your continued concern for your

troops there. I think what you have shown is that it is a systematic

problem, just in terms of the troops go from you to the Federal system, the Federal system says, ‘‘It is not your concern, it is ours,’’

and then they don’t take care of them. I mean, what are you supposed to do?

And Mr. Kutz, you laid the groundwork in your report, you and

your team. We want to thank you for that. Hopefully we can limit

the damage in the future because of what people have been able

to come forward with today and testify to, so this is not in vain.

It is important, and we appreciate it.

I will dismiss this panel and move on. We will take a 1-minute

recess and move on to the next panel. Thank you very much.

[Recess.]

Chairman TOM DAVIS. We welcome our second panel. I want to

thank them for taking the time from their schedules to come today.

We have Ms. Ellen Embrey, the Deputy Assistant Secretary of

Defense for Employment Health from the U.S. Department of Defense; Daniel Denning, Principal Deputy Assistant Secretary of the

Army for Manpower and Reserve; Lieutenant General Franklin

Hagenbeck, the Deputy Chief of Staff, G–1, U.S. Army; Lieutenant

General Kevin Kiley, M.D., U.S. Army Surgeon General; Major

General Charles Wilson, Deputy Commander, U.S. Army Reserve

Command; and Mr. Philip Sakowitz, who is the Deputy Director,

U.S. Army Installation Management Agency.

It is our policy that all witnesses be sworn, so please rise with

me and raise your right hands.

[Witnesses sworn.]

Chairman TOM DAVIS. Thank you very much for being with us

today. I think you have heard the first panel and I think we agreed

you wanted to go after the first panel, give them an opportunity

to air some of the problems that we have encountered.

We have a 5-minute rule. We were a little lax on it in the first

panel. We wanted to give some of the people just an opportunity

to tell the whole story. We will try to ask you to be a little more

accommodating of it.

We have votes that could come up at any time, and it is my intention, if votes come up, to move straight through the panel, and

I will stay as long as I can and then let Ms. Norton finish with

votes, give her questions, and then close the panel at that point

and recess, if your time permits, until after votes, and then we

would come back and the rest of us ask questions. Ms. Norton

would be able to go ahead with her questions. We have done that

before. Unfortunately, we are allowed to do this because Ms. Norton doesn’t get a vote on the House floor, something that Mr. Shays

and myself are trying to rectify. I just wanted to add that.

Ms. Embrey, we will start with you. Thank you for being with

us.

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STATEMENTS OF ELLEN EMBREY, DEPUTY ASSISTANT SECRETARY OF DEFENSE FOR EMPLOYMENT HEALTH, DEPARTMENT OF DEFENSE; DANIEL DENNING, ACTING ASSISTANT

SECRETARY OF THE ARMY, MANPOWER AND RESERVE AFFAIRS, ACCOMPANIED BY LIEUTENANT GENERAL ROGER

SCHULTZ, DIRECTOR, ARMY NATIONAL GUARD; LIEUTENANT GENERAL FRANKLIN L. HAGENBECK, DEPUTY CHIEF OF

STAFF, G–1, U.S. ARMY; LIEUTENANT GENERAL KEVIN C.

KILEY, M.D., U.S. ARMY SURGEON GENERAL; MAJOR GENERAL CHARLES WILSON, DEPUTY COMMANDER, U.S. ARMY

RESERVE COMMAND; AND PHILIP E. SAKOWITZ, JR., DEPUTY

DIRECTOR, U.S. ARMY INSTALLATIONS MANAGEMENT AGENCY

STATEMENT OF ELLEN EMBREY

Ms. EMBREY. Thank you, Mr. Chairman and distinguished members of this committee. I appreciate the opportunity to talk today

about the force health protection programs in the Department and

how they impact the care that we provide to wounded service members. I want to reiterate that the Department is firmly committed

to protecting the health of our active and Reserve Component

members before deployment, while they are deployed, and, of

course, upon their return.

I am pleased to join my colleagues today on this panel to address

your specific concerns regarding the care for soldiers injured in Operations Enduring Freedom and Iraqi Freedom. Today I will outline the Department’s current management practices, technological

advances, and initiatives underway to address this very important

issue, with a particular focus on the Army Reserve components.

With your permission, Mr. Chairman, I would like to submit my

written testimony for the record and then just discuss——

Chairman TOM DAVIS. Let me note, everyone’s entire written testimony is in the record and is a part of it, and questions will be

based on the entire, so it will allow you 5 minutes to kind of accent

what you want.

Thank you.

Ms. EMBREY. Terrific. Thank you.

As you know, the global war on terrorism is the largest ongoing

mobilization of the Reserve Component since World War II. In fact,

since September 11, 2001, approximately 475,000 Reserve Component members have been mobilized to support the global war on

terrorism. Of those mobilized, 376,000, or roughly 79 percent, of

the Army Reserve Component were mobilized.

Virtually all operations yield lessons learned, and our OIF and

OEF experience has been no different. Early on we recognized that

many rules and procedures that worked well for smaller mobilizations of shorter durations are very well unsuited for a large and

prolonged mobilization that we are currently experiencing in OIF

and OEF.

The Department and the services recognized these shortfalls and

undertook several initiatives over the last 2 years to improve the

medical readiness of the force overall and the Reserve Components

in particular. These include: establishing a deployment health

quality assurance program, establishing individual medical readiVerDate 11-MAY-2000 11:22 Apr 27, 2005 Jkt 000000 PO 00000 Frm 00148 Fmt 6633 Sfmt 6633 D:\DOCS\20085.TXT HGOVREF1 PsN: HGOVREF1
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ness standards for the total force, refining and expanding the postdeployment health assessment screening processes, establishing

ability to capture electronically the pre- and post-deployment assessment information so that it could be used by medical professionals later on. And finally, since November 2003 we have routinely monitored and reported to the Secretary of Defense and the

Under-Secretary for personnel and readiness the status of service

members in a medical hold status.

The Army, with the majority of the total mobilized force, has

taken very seriously its responsibility to provide world class care

to the Army’s sick and injured combat veterans. They recently have

taken several initiatives to enable the Reserve Component soldiers

in the medical hold status to receive treatment and recuperate at

or near their homes when appropriate care is available locally.

These ongoing efforts have resulted in significant improvements,

but we recognize that there is still much work to do. We are exploring new initiatives to further enhance medical readiness and to ensure timely and effective care of deployment-related illnesses and

injuries. These include: establishing a standard annual periodic

health assessment program applicable to the total force; working

with the VA to identify better ways to leverage specialty care capabilities that they have to support our service members’ needs, especially for Reservists; investigating options to enhance awareness of

the health status of Reserve Component members over time. We do

not have access to their health records as civilians, only when they

are under our care. And, last, we are also working with VA to access medical records of the Reserve Component members, help VA

get access to those records while they are continuing their service

to us.

I would like to also add that we are working to streamline the

cumbersome line of duty determination process that the Reserve

Component members have to go through in order to access care for

illnesses and injury, so we will be working on that.

Mr. Chairman and members of the committee, I thank you for

the opportunity to be here, and I defer to the other members of my

panel to address their particular issues.

[The prepared statement of Ms. Embrey follows:]

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Chairman TOM DAVIS. Thank you very much.

Dr. Denning.

STATEMENT OF DANIEL DENNING

Mr. DENNING. Mr. Chairman, members of the committee, I am

Dan Denning, Acting Assistant Secretary of the Army for Manpower and Reserve Affairs. To my left with me today are Lieutenant General Franklin Hagenbeck, Deputy Chief of Staff G–1; Lieutenant General Kevin Kiley, the Surgeon General of the U.S. Army;

Major General Charles Wilson, Deputy Commander of the U.S.

Army Reserve Command; and Mr. Philip Sakowitz, Deputy Director of the Installation Management Agency. Also with us today is

Lieutenant General Roger Schultz, the Director of the Army National Guard.

Thank you for inviting us to discuss the medical holdover program. I would also like to thank panel one for their candor and for

their obvious desire to improve the U.S. Army.

I would like to take a moment to introduce to the committee two

more fine soldiers currently in the medical holdover program: Staff

Sergeant Salvatore Cerniglia, who is an Army Reserve soldier from

Florida who was wounded during a rocket propelled grenade attack

in Iraq. He is assigned to the community based health care organization in Plant City, FL. This program allows him to reside at

home and receive his medical care locally.

Sergeant Jamie Brown is an Indiana National Guard soldier—

my home State—who has spent the past 15 months at Walter Reed

Army Medical Center recovering from wounds he received from

rocket fire during an ambush. In addition to his status as a medical holdover soldier receiving treatment, Sergeant Brown has actively assisted the medical holdover company by serving as an assistant platoon sergeant.

Could those soldiers just stand for a moment? You can see them

in the back.

Chairman TOM DAVIS. Thank you very much for being with us.

Mr. DENNING. As you know, the Army continues to face many

challenges, including the global war on terrorism and the continuing operations in Iraq and Afghanistan. In all of this, the Army is

absolutely committed to taking care of its soldiers and families and

providing them the best possible health care. This is true regardless of whether a soldier is a member of the active Army or Reserve

Components, and regardless of the nature of the soldier’s injury or

illness, whether it occurred in combat or in training.

The Army continues to intensively manage the health care and

disposition of Reserve Component soldiers in a medical holdover

status. My office provides oversight over the medical holdover operations and, along with forces command, the executive agent for this

program, is engaged in monitoring effectiveness.

A system analysis and review team comprised of personnel from

my office, from FORCECOM, from the Office of the Surgeon General, from Human Resources Command, and from the Installation

Management Agency, has visited and assessed the operations at

every installation managing medical holdover soldiers, and we plan

to continue to actively monitor our performance in support of soldiers.

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In late 2003, the large number of medical holdover soldiers at

Fort Stewart and Fort Knox exceeded the capacity of the military

infrastructure to adequately house and provide expeditious medical

care management to soldiers assigned to these installations. Upon

review, we realized this problem was not confined to just these installations and immediately embarked on a series of actions to address this unacceptable situation. In the interest of time today I am

not going to cover those here. My colleagues will cover it in much

more detail later.

Rotation of forces for Operation Iraqi Freedom and Operation

Enduring Freedom is expected to significantly increase the total

medical holdover population in the coming months. We have taken

precautionary actions to ensure this surge will not exceed medical

command’s medical support capacity during the third quarter of

2005.

One of the key initiatives we are currently executing will increase our medical support capacity and expand the Army’s commitment to taking care of soldiers. This is the community based

health care initiative. It began as a way of providing high quality

care to Army Guard and Reserve soldiers near their homes while

maintaining administrative control and relieving pressure on Army

medical facilities at power projection platforms.

It has also proved itself as a means of providing a way for the

Army to meet its obligation to provide quality health care for Reserve soldiers who require protracted treatment to achieve full recovery from their injuries and illnesses and to allow Reserve soldiers who are medically able to live at or near their homes and

families, and finally to leverage sister services, VA and civilian

health care assets.

I can state without reservation that the community health care

initiative has been an unqualified success for soldiers, their families, and for the Army. It has evolved into an innovative program

designed to manage the prolonged health care treatment needed by

some Reserve Component soldiers in order for them to fully recover.

The community health care initiative ensures that the same high

standard of care we require for all soldiers is met while effectively

managing their health care and recovery. It helps alleviate stress

caused by the separation of soldiers from their families by allowing

many to reside at home during treatment and recovery.

The original five community based health care organization sites

managing health care delivery to soldiers in some 23 States is expanding this month with the addition of Alabama, Virginia, and

Utah, and with three satellite operations in Hawaii, Puerto Rico,

and Alaska. These additions, plus increases in capacity at our existing five sites, will provide for 50-State coverage.

We will continue to work closely with FORCECOM, the Installation Management Agency, Office of the Surgeon General, and the

Army G–1 to assist in the prompt return to duty or release from

active duty of our dedicated soldiers who serve our country.

Thank you.

[The prepared statement of Mr. Denning follows:]

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Chairman TOM DAVIS. Thank you very much.

General Hagenbeck.

STATEMENT OF LIEUTENANT GENERAL FRANKLIN L.

HAGENBECK

General HAGENBECK. Mr. Chairman and members of the committee, it is a great opportunity and I appreciate being invited here

this afternoon to talk about this very important topic. It is essential for the Army in both maintaining the morale and the welfare

of our soldiers who serve this grateful Nation.

As you know, the Army will continue to be deployed worldwide.

We currently have 640,000 soldiers serving on active duty, and of

those, 315,000 soldiers are deployed for overseas in over 120 different countries. These soldiers are from all the components, active

duty, 155,000, our Army National Guard, 113,000, our Army Reserve, 47,000. Even with this expansive rotation of troops, the soldier remains the centerpiece of the Army formations, and as such

it is the Army’s pledge to remain dedicated to the well-being of the

soldiers and their families.

Since the beginning of the global war on terrorism, we have witnessed the largest mobilization of the Reserve Component since

World War II. The exemplary performance of the Guard and Reserve soldiers alongside that of the active component is testimony

that we are, indeed, one Army, an Army whose components explicitly link and complement each other. I know our Nation is very

proud of the performance of our Guard and Reserve folks, and you

have seen them firsthand both at home and on these contingency

missions, and I know that you are as equally proud of them.

These soldiers deserve our continued commitment to training

them to do their jobs and taking care of them and their families

throughout their association with the Army. This includes providing the best care available to soldiers who become injured or ill in

the line of duty while serving our country.

Though this effort has not been without challenge, we continue

to improve our processes and strive to deliver compassionate and

timely care to the medical holdover soldier. The soldiers reporting

to mobilization stations and returning from the theater to the evacuation chain or demobilizing, the medical holdover population grew

quickly. In the midst of supporting the war fight, we realized that

existing MHO policy and infrastructure were inadequate, and we

immediately embarked on a series of corrective actions.

As the G–1, I am the proponent for the active duty medical extension program and am responsible for its implementation, policy

execution, and program management. The medical retention processing program is an Assistant Secretary of the Army Manpower

and Reserves policy, but I am responsible for its implementation of

guidance and the execution of the policy. And the medical retention

processing two program is also Acting Secretary Denning’s program. It is still being staffed for approval, but upon that process

being concluded I will be responsible for its implementation, guidance, and execution of the policy once the program, as I mentioned,

is finally approved.

Today we are processing large numbers of soldiers with disabilities, the likes of which we haven’t experienced in over 30 years.

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In 2004 we processed approximately 15,000 disability cases, nearly

a 50 percent increase from the number of cases processed during

the years before G–1. We are witnessing an even higher percent increase in the number of mobilized Army Guard and Reservists entering into the disability system, 134 percent increase during fiscal

year 2004.

Now, to meet this caseload we have added additional members

to the three physical evaluation boards, we have increased the

number of JAG officers assigned, we have created a mobile PEB,

a three-member board that travels to each of the fixed PEB sites

to augment their efforts there, and we placed liaison NCOs at each

of the medical treatment facilities and at the Physical Disability

Agency headquarters to assist in processing Reserve and National

Guard cases.

These efforts have paid off. In June 2004 there were 900 mobilized Reserve and National Guard cases pending PDA, and today

that number has been reduced to 344. PDA still receives about 159

new mobilized Reserve and National Guard cases each month.

While much has been accomplished, more needs to be done. Acting

in concert with the U.S. Army Medical Command and the Installation Management Agency under the direction of the Assistant Secretary of the Army for Manpower and Reserve Affairs, the following initiatives are underway: Structuring a comprehensive reporting system that tracks the soldier as he or she is medically evacuated from the area of operations until returned to duty or separated or retired from the U.S. Army. A high priority, this task force

will present its initial recommendations to the Director of the Army

staff within the next 2 weeks.

Second, as part of the information gathering and sharing enterprise, we are working closely with the Department of Veterans Affairs and the Defense Finance Accounting Services to better coordinate the termination of military pay and the initiative of Veterans

Administration payments. An important linkage to this process is

access to the Reserve Component soldiers’ personnel documents for

the calculations of retired and severance pay, and efforts are ongoing to bring automation solutions to this process.

Through weekly reports, inspections, and personal visits, the

Army is keeping a close watch on the processing of the soldiers

through the PDE system. Though we have challenges ahead, I am

confident that we are taking the right path, the right direction to

do this.

I will tell you that I am personally committed. Sergeant Allen,

who was on panel one, was serving with me in Afghanistan when

he was injured. I have a son who is a Reserve officer in the U.S.

Army Reserves who was deployed once to the Gulf and is alerted

to do again. So beyond my professional interest in this I have a

personal interest and responsibility, as well.

Thank you, ma’am.

[The prepared statement of Lieutenant General Hagenbeck follows:]

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Ms. NORTON [presiding]. Thank you, General.

Lieutenant General Kiley, 5 minutes.

STATEMENT OF LIEUTENANT GENERAL KEVIN C. KILEY, M.D.

General KILEY. Thank you, Mr. Chairman and distinguished

members of the committee. I appreciate the opportunity to make a

couple of opening comments.

I would like to start by echoing the comments of the rest of the

panel in thanking the soldiers that sat on panel one for their courage, their honesty, and for helping us in the U.S. Army Medical

Command and the rest of the Army to make this process better and

more effective. We are very proud of those soldiers. Every one of

them has put a uniform on and reported to the deployment station,

and we feel that pride when we care for those soldiers upon their

return from combat, either as injuries or as illnesses.

In that context, I think it is important to remember that, as has

been stated, this is a medical support to a global war on terrorism

that is not just about medical holdover soldiers but about casualty

receiving and the deploying and re-deploying and demobilizing of

large numbers of Reserve and National Guard.

I am very proud of the members of the U.S. Army Medical Command, of the larger AMED, active and Reserve, that have participated in and cared for these great soldiers in their time of need.

We have processed over 16,000 soldiers through the medical holdover process, 9,000 of which we have returned to the Army fit and

healthy, another 5,000 of which have successfully negotiated the

MEB/PEB process. And in doing that we have learned a great

amount about the PEB process, Reserve and National Guard policies, and our own operations at our installations and MTFs.

I am happy to answer any more of your questions either from

these comments or from my written statement.

Thank you.

[The prepared statement of Lieutenant General Kiley follows:]

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Ms. NORTON. Thank you very much, General Kiley.

Major General Wilson.

STATEMENT OF MAJOR GENERAL CHARLES WILSON

General WILSON. Chairman Davis, members of the committee, I

am Major General Charles E. Wilson, Deputy Commanding General for the U.S. Army Reserve. Thank you for inviting me to appear before your committee to discuss the effectiveness of Army

medical administrative and support processes and procedures that

govern injured Army Reserve soldiers.

During the past months, the U.S. Army Reserve Command and

its leadership has listened to the concerns of all of its soldiers, especially injured Army Reserve soldiers and their families. This

command has explored ways to provide the best health care possible, to improve administrative processes for the soldiers and their

family, before, during, and after mobilization.

Since we know the combat and commander need a force that is

medically fit, ready, and responsive, the Army Reserve has placed

greater stress and scrutiny on management of medical readiness.

We have worked hard to update our policies and procedures to create efficiencies, to develop compassionate and effective strategies

for supporting our soldiers and their families as they prepare for

war, as they wage war, as they endure the separation and the

worry and stress that accomplish this as a family unit.

We work hard on the return home to address the challenges and

stress of family and community reintegration. Our solutions are

still being realized and perfected. They remain very much a work

in progress. You, as a committee, have been concerned and supportive during this very trying period. With your help, we will succeed in meeting our mission and also providing our Army family

with all it needs and deserves as we serve our Nation at war.

Again, thank you for this opportunity to discuss the health care

and well-being of our soldiers and their families. I will be happy

to answer any questions that you may have.

Thank you.

[The prepared statement of Major General Wilson follows:]

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Ms. NORTON. Thank you very much, General Wilson.

Mr. Sakowitz.

STATEMENT OF PHILIP E. SAKOWITZ, JR.

Mr. SAKOWITZ. Mr. Chairman and members of the committee, I

am Phil Sakowitz, the Deputy Director of the U.S. Army Installation Management Agency. I thank you for the opportunity to discuss our contribution to the medical holdover program.

On a daily basis we are responsible for the equitable, efficient,

and effective management of installations worldwide, but we are

particularly honored by our role in support of injured soldiers and

their families. Our headquarters and region staffs, in close cooperation with Forces Command and the 1st and 5th Armies, as well as

the staffs of my fellow panel members, oversee our medical holdover effort. Together we monitor the current and projected medical

holdover populations assigned to each installation to determine if

current capacity levels for command and control and billeting are

sufficient, and, if not, what steps we need to consider to mitigate

the situation.

The Installation Management Agency has supported over 3,000

injured Guard and Reserve soldiers in the medical holdover program at any one time at 36 installations in the continental United

States, Alaska, Hawaii, and Puerto Rico. Our specific roles and responsibilities fall into three areas: command and control of medical

holdover soldiers, billeting, and transition processings. Let me very

quickly review these three areas of support.

Each installation with a significant medical holdover population

now has a dedicated command and control unit called a medical retention processing unit. This unit is under the oversight of our garrison commander, who is ultimately responsible for the installation

medical holdover program. These units are commanded by a commissioned officer and provide soldiers with leadership and basic administrative and logistical support. From the time the soldier is inprocessed to the time the soldier is out-processed we ensure we address the soldier’s needs. This ranges from daily requirements for

food and shelter to assisting with legal assistance, religious support, and transportation to and from medical appointments.

The units work closely with the medical team to monitor the

well-being of the soldier and track progress through the medical retention process. The bottom line: the basic responsibility of this

unit is no different than any other—accomplishing their mission

while caring for soldiers and families.

We also take our responsibility for billeting soldiers very seriously and continually improving their status. Today all medical

holdover soldiers are provided with a safe, secure, climate controlled room with inside latrines and accommodations for their

medical conditions as needed. This is the standard. To meet these

standards, we house soldiers in on-post barracks. When that type

of accommodation is not available, we use temporary relocatable

buildings designated for medical holdover soldiers, or Army on-post

transient lodging, or off-post hotels. Billeting medical soldiers is

and continues to be a high priority.

Our last area of support is in transition processing, which is performed at each installation transition center. These centers process

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soldiers for retirement, return to Guard or Reserve status, or return to civilian life. The Army standard is to out-process these soldiers not later than 30 days after receipt of orders. To get there we

added 24 support personnel across 13 key installations. However,

we have not only met these standards but today our Installation

Management Agency transition centers are out-processing soldiers

in 16 days. This is a good news story and we are continuing to

work to improve these times.

I want to assure the committee that the Installation Management Agency remains fully committed to support the medical holdover program.

Once again, thank you for the opportunity to address you, and

I will answer any questions at this time.

[The prepared statement of Mr. Sakowitz follows:]

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Chairman TOM DAVIS [presiding]. Let me start. You heard the

testimony in the previous panel. I read an article in the ‘‘Orlando

Sentinel’’ on Sunday that tells of 15 wounded or injured Guardsmen who arrived at Fort Stewart, and they have been blocked from

seeking medical treatment at home under the community based

health care initiative that we have just heard touted here. An

Army colonel in Army Forces Command in Atlanta states that the

reason is a very complex budget and statutory problem all wrapped

up in legalese.

I want to refer you to these three charts over here that display

the offices involved, the medical administration process involved in

the Guard and Reserve and the processes, themselves. I mean, it

looks—I think I am pretty competent, guys, a lawyer, and I spent

8 years in the Guard, but it looks pretty complicated.

I mean, who is getting these people through these mazes? It is

no wonder people are falling through right and left. I know everybody is trying, but we end up, instead of a mission driven Government here, just wrapped up in rules and regulations, and the result

is what we see. In wartime, it has just almost been embarrassing.

I think you all would agree to that. I think we are all trying to fix

it.

I guess my first question is: what do we do for these 15 people

in Florida? And how did this all happen?

Dr. Denning, let me start with you.

Mr. DENNING. Sir, my university would be happily surprised, I

suppose, if I was really a doctor, but I am not.

Chairman TOM DAVIS. That is what it says on there.

Mr. DENNING. I know. My Mom would appreciate it.

Chairman TOM DAVIS. Well, congratulations. We held a hearing

on diploma mills a couple weeks ago. I can get you up there pretty

quick for $15.

Mr. DENNING. I may need to take you up on that.

Sir, I will give you an alibi, I guess, or plead guilty. No. 1, we

have a medical system in my judgment and a set of processes that

were sized for a peacetime Army and we are fighting a two-front

war right now, indeed, a worldwide war, and it is loading our systems like they haven’t been loaded since World War II.

Chairman TOM DAVIS. Correct.

Mr. DENNING. No. 2, some of our processes were simply not designed to handle large numbers of mobilized soldiers. The ADME

process you have heard about, for example, was designed to take

care of soldiers injured during their 2 weeks of active duty a year.

It took us, frankly, some time to realize the system was under

strain and breaking, and it took those stories in late 2003 from

Fort Stewart. But the Army really swung into motion there.

Are there the stories you heard this morning? Every one of them

I am absolutely certain is true, and your heart goes out to those

soldiers and their families. I think we have addressed these. That

is why you heard about medical readiness processing. Those charts

you have over there, it is a complex process. Caring for soldiers,

managing their care, taking care of their finances, shifting them

between the kinds of orders that the statutes require us to work

under is a complex process. I think we have it about to the point

now that it will work very well in the future.

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Will there be problems? I am sure there will be some——

Chairman TOM DAVIS. I was in the Guard. I understand a little

bit how it works. You call these soldiers up. They go into basically

Federal service by going abroad, and at that point why don’t they

just stay on that payroll until they are discharged and sent back

to their units? Once they come back and they are injured, you

ought to just keep them and give them all the Federal benefits.

What is so complicated about that? What am I missing here?

Mr. DENNING. Well, first of all, sir, the soldiers are mobilized

under partial mobilization authority, involuntarily mobilized, 12–

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Chairman TOM DAVIS. I understand. I mean, we can make this—

I was a lawyer. I understand how this stuff gets written. But once

they are over there, they are fighting side by side in many

cases——

Mr. DENNING. Yes, sir.

Chairman TOM DAVIS [continuing]. With regular military personnel. I have been over to Iraq several times. I understand that you

can’t tell the difference, and certainly the enemy can’t tell the difference when they are shooting at them or putting something on

the side of the road. So why not, before they come back, if they are

ready to go back to their unit that is easy; otherwise, just keep

them under some kind of Federal purview where they get the commissary and they get the PX and they get the medical and everything else? Why is it so complicated?

Mr. DENNING. Many soldiers, sir, when they are Med-Evac’ed,

they stay on their mobilization orders. Their pay systems aren’t affected. Their benefits aren’t affected. Nothing changes. When we

hit that 24-month brick wall—well, it could be up to 24 months.

Many soldiers are called up for 18 months. It varies by unit. But

once that soldier hits the extent of his original set of orders, he was

placed then on ADME orders, and that is what we have resolved

now. They are going to go on to——

Chairman TOM DAVIS. But some of the people in charge of the

ADME orders were telling people 30 and 60 days. They just took

it on themselves, even though the law allows them to do longer.

That was the testimony.

Mr. DENNING. That is right, sir. That is what we have corrected.

Soldiers will be put on for longer periods.

Chairman TOM DAVIS. Well, why would they do that? I mean,

what is the rationale?

Mr. DENNING. Well, sir, the ADME process, as I mentioned, was

designed as a peacetime system for the Reserve Components, for

soldiers injured during that 2 weeks of active duty every year. It

was never envisioned as a system to take care of soldiers who required long-term medical care.

Chairman TOM DAVIS. What do you think about the idea—and

I am asking all of you—about an ombudsman or case worker or

somebody who that soldier can call and is the soldier’s advocate instead of an advocate for ‘‘the system?’’

Mr. DENNING. I am open to that. I think we have done a lot

though with Installation Management Agency——

Chairman TOM DAVIS. Well, we have, but I hear—not according

to the ‘‘Orlando Sentinel.’’ There are still people falling through the

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cracks as late as last Sunday. Everything is fine, but I am just saying at the end of the day it doesn’t help that soldier to know that

everybody is up there trying and that we are getting more people.

Just having someone that they can call as their advocate, they

shouldn’t have to call my office or Ms. Norton’s office, which is

what they are doing and that is why we are here.

Mr. DENNING. I understand, sir. We are open——

Chairman TOM DAVIS. How does everybody feel about an ombudsman in a case like that? Are we open to that when there is

somebody in a situation like that? Assign them an advocate, somebody that can walk them through the maze and look out for them.

These people have taken time away from their families, away from

their jobs. They have interrupted their careers. Some of them come

back in body bags.

Mr. DENNING. Yes, sir.

Chairman TOM DAVIS. Some of them come back missing limbs.

The least we could do is, when they come back, have somebody

there that is going to advocate for them and get them the maximum the system allows. We owe them that.

Mr. DENNING. We agree completely, sir. I thought—and I will let

the other generals speak for themselves—when we set up the medical readiness processing units, that is what we expected of those

platoon sergeants and those leaders in there, to assist those soldiers, if they encounter difficulties, to help them work through the

maze.

Chairman TOM DAVIS. Well, let me ask another question while

I have the brass up here. This is just a yes or no. Can we be assured there will be no retaliation against the people who testify

here today?

Mr. DENNING. Yes, sir.

General HAGENBECK. Absolutely.

Chairman TOM DAVIS. OK. Is that right?

General KILEY. Yes, sir.

General WILSON. Yes, sir.

Mr. SAKOWITZ. Yes, sir.

Chairman TOM DAVIS. They were very nervous. They did not

want to come forward. They are very respectful of everything everybody is doing. If you heard, there is a frustration there. We really asked them to, because there is nothing like having the victim

sit up there and tell the story. We are not trying to embarrass, but

this is an ongoing problem and I think we all agree they deserve

better, and I think it helps you act better when you see something

like that and you are trying to move something through. You have

to go through lawyers to get stuff done, too. You just can’t wave

a wand and make it happen.

I think hopefully we are helping you get this job done, as well.

Ms. Norton.

Mr. SAKOWITZ. Mr. Denning, did you want me to talk about——

Chairman TOM DAVIS. Sure. Go ahead.

Mr. SAKOWITZ. Sir, what Mr. Denning was referring to is the

medical retention processing unit, which is fairly new in the Army.

When the soldiers first came back a couple of years ago we didn’t

even have an Installation Management Agency. Each installation

decided how to handle their medical holdovers. Now we have a

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standard process with these units that is to do pretty much what

you just said from an ombudsman standpoint. Now, sir, it is not

one-to-one. We have established——

Chairman TOM DAVIS. Of course not.

Mr. SAKOWITZ. We have established a basic military structure,

company structure. We have a commissioned officer with NCOs

that we have now especially assigned, which we never had before,

to handle those particular needs. Sir, there are going to be areas

where we might miss one or something happens.

Chairman TOM DAVIS. Sure.

Mr. SAKOWITZ. But in general I would say at those sites with the

significant medical holdover populations, these units who only do

that job and are assigned for them and are, in fact, Reservists

themselves, sir, who we have called up to handle this, could answer, I would say, most of the questions that you talk about from

an ombudsman standpoint and are doing that.

Chairman TOM DAVIS. Let me ask General Wilson, General

Helming has expressed deep concerns about the retention rate of

Army Reservists, and recent reports confirm unmet recruitment

goals. Do you think that the current administrative problems that

we are seeing for the injured has contributed to this decline?

General WILSON. I can’t directly attribute that specifically.

Chairman TOM DAVIS. It doesn’t help though, obviously.

General WILSON. It doesn’t help, and soldiers have, sir, as you

are well aware, very strong, informal communication network that

works very strongly on their behalf. But I think the continued force

of our leadership to rectify these problems and to deal with these

issues, more importantly than soldiers, the families and the wives

have become a strong advocate and a very stringent questioning

body and query body. So anything we can do to deal with the issues

that the soldier faces will always help us in the area of recruitment

and retention.

Chairman TOM DAVIS. I think the one thing in the first panel

that caught me, in a couple of instances where you had—in one

case you had the adjutant general from Oregon, in another case

you had one of the sergeants that were assigned to Walter Reed

trying to do things. Someone upstairs—and this didn’t come from

you. I don’t think it is in the regulations, you know, ‘‘Why are you

rocking the boat,’’ you know, basically saying, ‘‘It is not your problem. Why are you rocking the boat? Why are you doing this?’’ I understand how that occurs. But at the end of the day those kind of

advocates really help make things go, and we need to get that word

to you as quickly as possible. The faster the word that something

has gone wrong gets to you, the better able you are to correct it.

I think it was in that vein that we called them forward today.

Do you understand what I am saying? Nobody likes blowing a

whistle. These guys would go back again if they were able to do it.

They believe in the mission. They weren’t here denouncing the administration or the President or anybody else. So I think we just

need to work together on this, but we are going to continue to overlook it, because when you look up there and see a chart like this,

I can just tell you things fall through. Maybe what we need to do

is establish and work with you to make sure those advocates are

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in place and working and trained to get the right answers for these

soldiers who deserve that.

Ms. Norton.

Ms. NORTON. Thank you very much, Mr. Chairman.

I was very pleased to hear your response to the chairman’s question about ombudsmen. Let me be clear what the word means, and

then ask you about two examples. An ombudsman has his allegiance to the person, not to the system. One of the problems with

the caseworker system is those people are, of course, caught between their obligation to the system, that is to the service, and to

the service person, as well.

Do I understand you to say that an ombudsman—and, by the

way, we don’t mean one-to-one in the sense that it would be one

person for every member of the service, but an ombudsman who

would have a collection, a set of members. Do I understand your

answer to the chairman’s question to be that you endorse the notion of an ombudsman whose allegiance would be to the soldier,

alone, who would be an advocate for the soldier, who might be,

therefore, advocating to people within the system and not feel that

he had responsibility for the system or could be penalized for pressing the case of the soldier?

And, of course, everybody who presses a case has common sense

on when he has gone as far as he can. Can I understand whether

you mean a soldier’s advocate by the word ‘‘ombudsman,’’ which is

the general meaning of the term, not some caseworker type person

within the system? Did everybody have that same understanding?

Mr. DENNING. Ms. Norton, I indicated I am open to that idea. I

think I would first like to investigate the limitations of the medical

readiness processing units. As I indicated we have NCOs there who

this is their job already.

Chairman TOM DAVIS. Would the gentlelady yield for just a second?

Ms. NORTON. I would be glad to yield.

Chairman TOM DAVIS. I think the idea of an ombudsman—you

can call them whatever you want, but for a soldier, particularly one

who has been having trouble, whether it is getting paid, whether

it is medical, there is still a whole series of problems. There ought

to be a number they can call and a person that is assigned to look

after them.

I am not talking about a gripe session. I am not talking about

they didn’t like their orders or they got KP too much. I am talking

about something related specifically to organized benefits—pay,

medicine. There ought to be a number and a person assigned, and

sometimes that person may say, you are all wet on this. It is just

not going to work.

But right now they go up through the chain of command, and

that has just not seemed to work, simply because people in the

chain have other activities as they see their mission, not that they

are against the soldier, but they are trained to do other things,

somebody who’s trained to know all the ins and outs of the benefit

structure, of the pay structure, of the problems that can occur, the

orders not being cut in time, those kinds of things. That is all we

are asking.

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Obviously, we are not asking you to sign off on a blanket. The

concept of that seems to me—I am talking about an injured soldier

coming back from the war. There is a person that they can call on

the ground if they have a problem.

One of the biggest problems we had here was they couldn’t get

orders cut. They didn’t know where they were going to live. They

didn’t know what their families were going to do. They couldn’t get

leave. Do you understand what I am saying? That is what we are

talking about.

General HAGENBECK. Sir, if I could, we have established that inside what we call our ‘‘disabled soldier support system.’’ It only involves right now about 260 soldiers, and those are most seriously

wounded soldiers, those that have lost limbs, eyesight, have been

paralyzed. We have set up an office—we have funded it last fiscal

year with $4 million. I believe it is $7 million for this fiscal year—

to be exactly what you described.

So I think we have taken the first step, and I think conceptually

we are supportive of that, understanding that we never want to

take away that responsibility that chain of command has, that first

sergeant company commander that needs to work in concert. But

we do agree that there has to be someone that soldier can go to

to cut across the bureaucratic lines at some of these stovepipe organizations when he can’t get resolution.

Chairman TOM DAVIS. And you agree that today, the couple of

situations we heard, that would have helped a lot?

General HAGENBECK. Absolutely would have helped. Yes, sir.

Chairman TOM DAVIS. Yes.

Ms. NORTON. And, of course, the command structure needs all

the help it can get. I am sure they would be the last people to say

that they wanted to handle these everyday, run-of-the-mill complaints rather than have it go to somebody whose job it was to followup.

I want to just test to see how this would work, because let’s say

that we have countless examples of relatives—wives, parents,

members of the military who are not able to maneuver for themselves, call their Congressman. You really do not want Chairman

Davis and I to be the advocate. I am sure that is the last advocate

you need. But that is what happens.

Chairman TOM DAVIS. I am not sure they want to answer to you.

Ms. NORTON. Exactly. So all we are saying about ombudsman is

it is in your best interest, as well. But we are very worried about

what happens to the relatives, because we are getting the same

kind of terrible, horrific complaints from them, being on the phone

for hours, being passed from one part of the Army to the next part

of the Army.

I wonder if there is a, let’s say even for these 200 or so, or for

any others, if there is a central location or phone number where

someone who is a relative of the Reserve or National Guard can

call and get answers to the question about the treatment and the

Army or about some of the issues that have been raised here so

that this would not be passed on to the already anxious relatives

of these members of the service to whom they turn when they are

not able to get any answer themselves.

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General HAGENBECK. If I could answer that initial question, we

have established an 800 number for what we call ‘‘DS3,’’ disabled

soldier support system. So I think conceptually we know how to do

that, I mean not just conceptually but in concrete terms. But, again

we would need to——

Ms. NORTON. That 800 number directs them to where?

General HAGENBECK. They have a case manager, exactly that, an

ombudsman who then takes——

Ms. NORTON. Don’t call the case manager the ombudsman. We

have had all kinds of problems with case managers.

General HAGENBECK. I am perhaps defining it differently than

you, but the point is that is their go-to person by name and who

they are. They keep a complete file on them and they are responsible for that soldier, and they are responsible for being their advocate, whether it is entry into the VA system, they are having problems medically, financially, or whatever it happens to be.

Ms. NORTON. General Wilson, you had a response?

General WILSON. Yes. Given much like the Guard, most of our

soldiers, the overwhelming majority comes from the community,

itself. Between the Guard and the Reserve there are over 3,000

local locations that soldiers are mobilized from. In our case, we

have the Army one source, which is a 24-hour, 7-days-a-week, 365-

day telephonic or web-based source for dealing with the full range

of issues, from medical and dental benefits, training and support

to help readjustment and reintegration into civilian life and their

jobs, reunion and marital reintegration with spouse, children, and

personal social adjustment. The beauty of this program, it is one

source. We publicize it in all of our family support and our rear detachment operation sites. With this program they have a benefit of

receiving up to seven in-person consultations relevant to issues.

So the Army Reserve and I believe the Army National Guard,

but I can’t answer for sure with that, have the Army one source

where they can go out and find this type of information or be referred to a specific source for support.

Ms. NORTON. Thank you very much.

Ms. EMBREY. Excuse me?

Ms. NORTON. Yes, Secretary Embrey.

Ms. EMBREY. I would like to also add that just 2 weeks ago we

had a ribbon-cutting ceremony announcing a DOD-wide program

for the severely injured joint support operations center, and the objective of that center is to provide 24/7 access to anyone who is unaware of the service specific program so they can get information

about how to access and resolve their problems in navigating. It

specifically is designed for the injured service member and their

families.

We recognize this is an important emerging issue that sometimes

information about what is available is not known to individuals at

the ground level. This is a way in which to have DOD-wide access

to get that information and to refer to the programs that are viable

and active in each of the services.

Ms. NORTON. You have to believe these soldiers have e-mail and

voice mail. They know how to phone home when in trouble.

I have a very specific question, a concern I have about Walter

Reed here in the District, where I am told that as of January of

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this year, just this past month, that soldiers being held there on

medical hold are being compelled to pay for their own meals. I need

to know if this is true. Enlisted soldiers apparently—again, according to the information I have been able to get hold of—get $267 in

allowances per month to pay for meals.

At Walter Reed, after a soldier has returned from the battlefield,

the cost would be $450 a month. I would like to know is it true

that these soldiers on medical hold have to pay for their own meals

that other soldiers receive free of charge? That is a pretty specific

question and I need to know yes or no if that is the way it works.

General KILEY. Those medical hold soldiers that are in an outpatient status during basic allowance subsistence allowance are required, when they use the dining facility at Walter Reed, like all

the other soldiers assigned to Walter Reed, both active duty and

Reserve, are required to pay for their meals as they go through the

food line. They have an option to go on separate rations, as I understand it, and give up that $280 a month of subsistence allowance, at which time their meals in the dining facility are free.

That is no different than any other hospital——

Ms. NORTON. Wait a minute. Let me understand this. I thought

that the $267 was for enlisted soldiers to pay for their meals, but

that at Walter Reed that is not what you got. You had to pay for

all three meals. Is that not the case?

General KILEY. If you are an outpatient. If you are an inpatient,

you are not paying for your meals.

Ms. NORTON. Of course.

General KILEY. But because if you are——

Ms. NORTON. But you are in a hold company. You are trapped

there.

General KILEY. If you are assigned to Walter Reed or if you are

assigned to the medical holdover unit at Walter Reed in an outpatient status, then you are authorized to pay and privileges for a

soldier that is not living in the barracks and having a mess hall

to go to, a dining facility to go to. So under those circumstances,

the Army gives those soldiers money to buy their meals at the dining facility, or to buy meals——

Ms. NORTON. So they receive——

General KILEY [continuing]. Or Burger King or McDonald’s.

Ms. NORTON. So this soldier in medical hold receives how much

money to buy his——

General KILEY. As far as I understand it, just like every other

soldier on active duty who is not sick in hospital and not on a meal

card, which is the Army’s way to give them free meals—you either

get a meal card and you don’t get any monthly allotment and then

you either eat at the mess hall with this meal card free, or you

have to go find——

Ms. NORTON. So they can get this meal card?

General KILEY. Yes, ma’am, that is my understanding. That is

my understanding.

Ms. NORTON. And then they could have three meals a day——

General KILEY. Free.

Ms. NORTON. Free?

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General KILEY. Yes, ma’am. But when they get the meal card

they give up the monthly what is called subsistence allowance,

the——

Ms. NORTON. Wait a minute. The monthly subsistence allowance,

that is not just for food?

General KILEY. Yes, ma’am. For food.

Ms. NORTON. So they give up the whole thing then?

General KILEY. Well, they are getting three meals a day, 30 days

out of the month.

Ms. NORTON. And they are living free of charge on the base, is

that it?

General KILEY. Yes, ma’am. They are in the barracks or in the

hotels.

Ms. NORTON. I see. OK.

Could I ask you about the—we are interested particularly in

equal treatment between the Guard, Reserve, and the enlisted

members. As I understand it, for some of the active duty medical

extension soldiers prior to this war, for example, in Bosnia, the way

it works apparently is that some of the injured Army Reserve Component soldiers in prior wars like Bosnia used the active duty medical expense process, whereas for these soldiers you have to apply

through the medical retention process. Why were they not allowed

to use the active duty medical expense process, especially since

some of the soldiers in Bosnia were allowed to do so?

General KILEY. If I understand——

Ms. NORTON. Why isn’t there a single system, in other words, no

matter what theater of war you are in, you use the same process?

General KILEY. I think the key—and I could be corrected if I am

wrong, but I think the key in this process, which is where the

ADME process evolved from, started with soldiers that were injured during training. A medical assessment was made of the nature and extent of their injury, depending on the circumstances

under which they were activated, and then a decision was made as

to how long they would remain on ADME.

Even during Bosnia, the numbers of soldiers that flowed back to

continental United States, Reserve and National Guard soldiers,

was small enough that the administration of the ADME process, to

include consultation with physicians repetitively, was robust

enough to handle those relatively small numbers. I think what we

experienced—and as you know I was at Walter Reed from 2002 to

2004 as a commander—the numbers just exploded on us.

And so, in attempting to follow the regulations and attempting

to be good keepers of the faith, as it relates to the law and the regulations, we had to work through this very burdensome system,

and hence we discovered, frankly, pretty early on that soldiers

were dropping off. We were hearing this, frankly, at morning report

at the hospital, and that hold knew about it. It was a function of

coming to the realization that we needed to change the way we

were doing business.

It took us a little while to do it, and I believe by the first of

March we will have just about everybody off ADME. But that is

just an older system that served us well when the numbers were

real small under the circumstances we were operating under.

Ms. NORTON. Mr. Denning.

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Mr. DENNING. Yes, ma’am. Since the fall of 2003 and the Fort

Stewart incidents, we all at this table, particularly the Surgeon

General, have worked—I think ‘‘tirelessly’’ may be too strong a

word, but really hard to ensure that the AC soldiers and the RC

soldiers were treated absolutely the same, that there was no discrimination. In fact, I can sit here before you today and tell you

that the RC soldiers are treated at least as well if not better than

their AC counterparts in terms of access to the medical care system.

The Surgeon General has established very specific guidelines in

terms of waiting time for appointments, priority order, to ensure

that RC soldiers get the best quality health care available.

Ms. NORTON. Ms. Embrey, I just have to ask, the total failure of

the planning process, so that after troops were in there you all

began to somehow understand that you would have people back

here that would be held in companies like the company at Walter

Reed. What was the flaw in the planning process? Did you expect

simply to get into, let us say, Iraq and get out with almost nobody

injured and that would be it?

You had a long time to plan for this. The discussion on whether

or not we would go to war had to have gone on for at least a year.

You had to go back and forth to the United Nations. It was very

controversial. There was lots of things. I mean, why wasn’t the

planning done there? What was the flaw in the planning?

Was it that you anticipated not having or having almost no injuries and therefore didn’t plan on having this number of Guard and

Reserves there? And if so, if that was your thinking, on what basis

did you believe that you did not have to plan for so many injured

members of the Guard and Reserve?

Ms. EMBREY. I think I will answer this in a couple of different

ways. The first is there are a number of factors that have contributed to the situation we are in. The first is that we organize as

units and there are various specializations in a unit, and one of the

specializations in those units is to understand how to navigate the

process in your command and control structure.

When we mobilize, especially Guard and Reserve, they go and

there is a pre-deployment process screening where we try to identify those who are not physically or medically ready to deploy.

There is a certain percentage of those folks that stay back, but the

rest of the unit goes, along with the expertise to help them navigate the process.

Then, while they are there, those who get injured are, if they are

severely injured, are medically transported back to the States

through various points of care, returned to a place where their special requirement can best be provided, and again their expert that

helps them navigate the system from their unit is not with them.

When they return, through a post-deployment process individuals identify their concerns, their physical problems. They are referred and then taken care of, and some of them end up in medical

hold. Again, the rest of their unit and the expertise to help them

navigate the system has gone home.

That is part of the problem, and I believe that——

Ms. NORTON. Yes, we understand the problem. My question was:

what was the flaw in the—was this all unforeseeable?

212

Ms. EMBREY. I don’t think it was unforeseeable. I cannot speak

for the Department on failure to plan. I think there was a very

good understanding that we were trying to screen individuals who

would not deploy with medical problems. I think we thought that

our peacetime structure would be able to handle the anticipated

casualties. We realized going in that this is a marathon, not a

sprint, and we are now having to make adjustments based on what

we are learning.

Ms. NORTON. That is precisely my question. The President

warned everybody from the beginning of September 11 don’t expect

this to be over soon. I only dated back to when we began to discuss

going in Iraq.

Ms. EMBREY. Would Congress have agreed to a surge in the force

structure in order to accommodate these requirements?

Ms. NORTON. Do you for a moment believe that if you had come

to this committee or to the Armed Services Committee and said, we

expect real problems to develop because of the number of injured

soldiers who may be coming home for a system that is not equipped

to handle them on base, and so they will be held in medical hold,

do you for a moment believe that Congress would have said, go

away?

I mean, you are returning your question to me? We expect you

to do the planning, come to us, and say, this is a warning, everybody. We are not equipped to handle this. It is a question of resources. You need to alert us. Are you saying you alerted us and

we did not respond?

Ms. EMBREY. No.

Ms. NORTON. Well then don’t come and tell me, would we have

responded. The question is why did you not alert not only this committee but a number of other committees who first and foremost

think of the men and women on the ground and then think about

everybody else? So I can only take yours to be a rhetorical question.

Now, let me finally say—and the reason we ask it, very frankly,

is that the committee, you know, is really looking for remedies. The

message we are sending is that we very much respect the way the

military fights wars. We have not respected the way the military

has cared for these injured soldiers coming home. We don’t think

that the people on the ground or what happens on the ground is

broken. I think you will agree that this was broken, is being fixed.

We have noted the way it is being fixed, are appreciative, but because we are involved in a longtime conflict the message is plan,

plan, plan, just like you plan to go to war in some respects and not

other respects.

It is absolutely inexcusable not to do the proper planning that

will help us take care of people who have been injured in war. It

has been heartbreaking to hear the testimony of these soldiers here

today, and we just want to make sure the planning is done to make

sure it doesn’t happen again.

I have only two more questions. We heard testimony from one of

the prior witnesses, Sergeant Forney, again over a situation at

Walter Reed where he had to use his own funds to buy supplies

and equipment. I need to know whether that has been entirely

cured, why it was that anybody would have been responsible for

213

having to do that, why a soldier had to put out his own funds. I

am not even sure whether he was repaid.

General KILEY. I have no idea either, Congresswoman.

Ms. NORTON. Well, would you followup on his testimony——

General KILEY. I certainly will.

Ms. NORTON [continuing]. And report back to this committee

what you were able to find?

Final question: I asked the prior panel and was told by that

panel that you would be the appropriate panel to ask for answers

to some of the most disturbing testimony about post traumatic

stress disorder. We are told that it may arise some time after, some

months, for example, after the soldier is back, may linger for some

time.

We wonder whether or not, under your current system and regulations, whether or not somebody who suffers from post traumatic

stress disorder can ever be considered to have a disability as described under Army regulations, or, if not, how such a person who

now must come back to civilian life is expected to navigate through

the rest of his problem.

General KILEY. I would be happy to try to answer that question.

I think it is a very good one, frankly, and the Army Medical Department and the Army and, frankly, the Department of Defense

has taken a great interest in this process. As you know, there was

an article published recently in the New England Journal by one

of our medical health care screening teams that documented a not

insignificant number of soldiers who, on a survey, answered that

they were having problems, be it nightmares, anger, alcohol, or

family disturbance issues. We recognize that, recognized it in terms

of the pre- and post-deployment screening that we do for every single soldier who comes back, both active and Reserve, National

Guard. They get a face-to-face screen during the demobilization

process.

We have also recognized that process, alone, may not be

enough—specifically, that soldiers won’t admit that they have

issues, or they think that once they are back at home, they demobilize, they are looking forward to getting back with their family,

that some of the issues they may or may not have been worried

about are now going to be resolved.

There is no question that every soldier that mobilizes and deploys goes through a traumatic experience just in the mobilization

and deployment, and then with combat operations it can be a significant shock to the system, so to speak. Like everything else in

human nature, there is a bell-shaped curve of resiliency associated

with that.

But we have gotten more sensitive and more aggressive in seeking out soldiers and asking them how they are doing. We have actually done some followup on soldiers who went through the original screening and found that over time they actually start to admit

and recognize that some of the problems they have been struggling

with haven’t gone away. So we are in the process of identifying

that systemically and clearly offering opportunities for soldiers to

come back and see us.

Just recently, as you probably know, the Secretary directed the

services to begin a formalized process at the 90- to 180-day mark

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to bring soldiers back and screen them, and we are in the process

of working our way through the policies and the resources required

to execute that.

The second part of that is once we have identified soldiers that

may need counseling or help, it is collating the resources to provide

that. The mental health communities in general are already very

busy—psychiatrists, psychologists, social workers, and other counselors—and we want to make sure we have some place to refer our

soldiers, Sailors, Airmen, Marines when they do recognize that

they have some problems.

Our experience is that most of those soldiers, almost all of them

will resolve these issues, particularly with some assistance, but

PTSD is recognized and I am understood to believe that in its most

severe forms it is recognized as a disability with sort of the PEB

system and soldiers do get recognition of that, depending on the

nature and the extent of their symptoms.

It is often a temporary position that does heal itself over time,

and so in some cases those soldiers will go into a TDRL status and

come back in 18 months, and we will sit down with them again and

see how they are doing.

We are very sensitive to this. Some of this is an outgrowth of the

first Gulf war and our work in dealing with and the development

of the diagnosis of post traumatic stress syndrome.

I hope that answers your question.

Ms. NORTON. I appreciate your answer, because I could not agree

more when somebody comes back from war the notion of stress,

waiting to see whether or not or at least following the soldier to

see if that stress will develop into some long-term problem, that is

a close call. As long as you are following the soldier, I think we

would be satisfied.

Let me tell you what leads me to ask about disability. When you

see the number of soldiers—I mean, appalling number—from the

Viet Nam war that are on the streets homeless, you recognize that

you never want to see that happen again. I realize that was a

draft. There may have been many there who are very unlikely volunteer soldiers.

But it has seared itself into the consciousness of Members of

Congress, because those are people who will call our offices, whose

families will call our offices, the notion that, as difficult as it is to

decide whether or not we are dealing with something that can truly

be called a disability and, hey, that is your job as well, as long as

that is something that is not off the table or impossible to get in

appropriate places, that would certainly satisfy me.

I am particularly concerned in the volunteer Army about that because one’s heart goes out as one hears interviews on television

members of the service who are asked, well, would you go back, or

who volunteer that they want to go back. These are people who

have lost limbs or worse. These are folks who have imbibed the notion that they have done a service for their country, who say, I

have somehow or feel often I have abandoned my fellow soldiers,

and what I need to do in order to feel right about myself is to go

right back there and serve as long as they serve. That is the psychology one hears over and again.

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I have to tell you I believe the press goes around trying to find

somebody who will say the opposite, and they just can’t find people.

They all seem to say, I want to go back, or, I would go back if I

could. That leads me to believe that what you just said, General

Kiley, is the case. Hey, that is not the right thing to say if you are

a soldier, that you are feeling any pain, that you don’t want to go

back. Therefore, the possibility that these volunteer soldiers who

have absorbed the notion that they are first and foremost a soldier

need to be followed very, very carefully, because their reluctance to

admit is perfectly understandable.

Finally, in closing this hearing, I want to thank all of our witnesses, and I especially thank you. This has been an accountability

hearing. You can imagine that we feel a very special obligation

when we continue to hear in our own offices about these problems.

We know that you have responded to some of the problems that

have been brought to your attention through the GAO and through

hearings of this committee, and I want you to know that, despite

our questioning, we appreciate the fact that the Army has been responsive to the committee, and we will press you further until we

think the system has been entirely fixed. That is our obligation. We

think you believe it is yours.

Before we adjourn, the chairman has asked me to say that he

has a request of the Army. As you have done for this committee

on the issues of the Guard and Reserve pay, he requests quarterly

briefings to be provided to the committee on the state of the medical administrative treatment of Guard and Reserve forces. It appears that you have some distance to go to improve the oversight,

infrastructure, patient service, and efficiency of your policies.

Also, to better address the questions of Reserve Component members, their families, and congressional case workers, he also asks

that the Army takes steps to provide a one-call ombudsman office,

and, if I may add, described the way we described it, differently

from the case worker who is torn between the system and the soldier—a one call ombudsman office where staff trained in all Reserve Component administrative issues can answer questions in a

timely and comprehensive manner.

We would also like to add that the record will be kept open for

2 weeks to allow witnesses to include additional information into

the record. That includes witnesses from the service, witnesses who

may be family members, or members of the service.

Again, we thank you for coming.

The hearing is now adjourned.

[NOTE.—The GAO report entitled, ‘‘Military Pay, Gaps in Pay

and Benefits Create Financial Hardships for Injured Army National Guard and Reserve Soldiers,’’ is on file with the committee.]

[Whereupon, at 1:40 p.m., the committee was adjourned.]

[The prepared statements of Hon. Candice S. Miller and Hon.

Brian Higgins, and additional information submitted for the hearing record follow:]

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