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THIRD WALTER REED OVERSIGHT HEARING:

KEEPING THE NATION’S PROMISE TO OUR

WOUNDED SOLDIERS

HEARING

BEFORE THE

SUBCOMMITTEE ON NATIONAL SECURITY

AND FOREIGN AFFAIRS

OF THE

COMMITTEE ON OVERSIGHT

AND GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

SEPTEMBER 26, 2007

Serial No. 110–53

Printed for the use of the Committee on Oversight and Government Reform

(

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html

http://www.oversight.house.gov

(II)

COMMITTEE ON OVERSISGHT AND GOVERNMENT REFORM

HENRY A. WAXMAN, California, Chairman

TOM LANTOS, California

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

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

BRIAN HIGGINS, New York

JOHN A. YARMUTH, Kentucky

BRUCE L. BRALEY, Iowa

ELEANOR HOLMES NORTON, District of

Columbia

BETTY MCCOLLUM, Minnesota

JIM COOPER, Tennessee

CHRIS VAN HOLLEN, Maryland

PAUL W. HODES, New Hampshire

CHRISTOPHER S. MURPHY, Connecticut

JOHN P. SARBANES, Maryland

PETER WELCH, Vermont

TOM DAVIS, Virginia

DAN BURTON, Indiana

CHRISTOPHER SHAYS, Connecticut

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

MARK E. SOUDER, Indiana

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

VIRGINIA FOXX, North Carolina

BRIAN P. BILBRAY, California

BILL SALI, Idaho

JIM JORDAN, Ohio

PHIL SCHILIRO, Chief of Staff

PHIL BARNETT, Staff Director

EARLEY GREEN, Chief Clerk

DAVID MARIN, Minority Staff Director

SUBCOMMITTEE ON NATIONAL SECURITY AND FOREIGN AFFAIRS

JOHN F. TIERNEY, Massachusetts, Chairman

CAROLYN B. MALONEY, New York

STEPHEN F. LYNCH, Massachusetts

BRIAN HIGGINS, New York

CHRISTOPHER SHAYS, Connecticut

DAN BURTON, Indiana

JOHN M. MCHUGH, New York

TODD RUSSELL PLATTS, Pennsylvania

DAVE TURK, Staff Director

(III)

C O N T E N T S

Page

Hearing held on September 26, 2007 ..................................................................... 1

Statement of:

Pendleton, John, Acting Director, Health Care, U.S. Government Accountability Office, accompanied by Daniel Bertoni, Director, Education, Workforce, and Income Security, U.S. Government Accountability Office; Major General Eric Schoomaker, Commander, Walter Reed

Army Medical Center; Michael L. Dominguez, Principal Deputy Under

Secretary of Defense, Personnel and Readiness, U.S. Department of

Defense; and Patrick W. Dunne, Rear Admiral, retired, Assistant Secretary for Policy and Planning, U.S. Department of Veterans Affairs ..... 31

Bertoni, Daniel .......................................................................................... 65

Dominguez, Michael L. ............................................................................. 79

Dunne, Patrick W. ..................................................................................... 104

Pendleton, John ......................................................................................... 31

Schoomaker, Major General Eric ............................................................. 66

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

Davis, Hon. Tom, a Representative in Congress from the State of Virginia, prepared statement of ........................................................................ 15

Dominguez, Michael L., Principal Deputy Under Secretary of Defense,

Personnel and Readiness, U.S. Department of Defense:

Followup questions and responses ........................................................... 127

Prepared statement of ............................................................................... 81

Dunne, Patrick W., Rear Admiral, retired, Assistant Secretary for Policy

and Planning, U.S. Department of Veterans Affairs, prepared statement of ........................................................................................................... 107

Pendleton, John, Acting Director, Health Care, U.S. Government Accountability Office, prepared statement of ................................................. 34

Schoomaker, Major General Eric, Commander, Walter Reed Army Medical Center:

Followup questions and responses ........................................................... 141

Prepared statement of ............................................................................... 70

Shays, Hon. Christopher, a Representative in Congress from the State

of Connecticut, prepared statement of ........................................................ 26

Tierney, Hon. John F., a Representative in Congress from the State

of Massachusetts:

Prepared statement of ............................................................................... 10

Prepared statement of Senator Bob Dole and Secretary Donna

Shalala .................................................................................................... 3

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

of California, prepared statement of ........................................................... 22

(1)

THIRD WALTER REED OVERSIGHT HEARING:

KEEPING THE NATION’S PROMISE TO OUR

WOUNDED SOLDIERS

WEDNESDAY, SEPTEMBER 26, 2007

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON NATIONAL SECURITY AND FOREIGN

AFFAIRS,

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM,

Washington, DC.

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

2157, Rayburn House Office Building, Hon. John F. Tierney (chairman of the subcommittee) presiding.

Present: Representatives Tierney, Lynch, Higgins, Yarmuth,

McCollum, Van Hollen, Hodes, Welch, Waxman [ex officio], Shays,

Platts, Turner, Westmoreland, and Davis of Virginia [ex officio].

Also present: Representative Norton.

Staff present: Roger Sherman, deputy chief counsel; Brian

Cohen, senior investigator and policy advisor; Daniel Davis, professional staff member; Teresa Coufal, deputy clerk; Caren Auchman,

press assistant; Dave Turk, staff director; Andrew Su and Andy

Wright, professional staff members; Davis Hake, clerk; Dan Hamilton, fellow; David Marin, minority staff director; A. Brooke Bennett, minority counsel; Grace Washbourne and Janice Spector, minority senior professional staff members; Christopher Bright, minority professional staff member; Nick Palarino, minority senior investigator and policy advisor; Brian McNicoll, minority communications director; and Benjamin Chance, minority clerk.

Mr. TIERNEY. Good morning, everybody. For some reason Mr.

Shays has been unable to extricate himself from his other committee, but I expect him to be over shortly, and Mr. Davis, as well.

We don’t want to hold you gentlemen up. You have been kind

enough to come here and give us your time, and we appreciate

that.

We are going to begin our hearing entitled, ‘‘Third Walter Reed

Oversight Hearing: Keeping the Nation’s Promise to Our Wounded

Soldiers.’’

I am going to ask unanimous consent that only the chairman and

ranking member of the subcommittee and the chairman and ranking member of the full Oversight and Government Reform Committee be allowed to make opening statements. Without objection, that

will be ordered.

I also ask unanimous consent that the written statement of

former Senator Bob Dole and former Secretary Donna Shalala, CoVerDate 11-MAY-2000 14:52 Jun 27, 2008 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 C:\DOCS\42584.TXT KATIE PsN: KATIE
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Chairs of the President’s Commission on Care for America’s Returning Wounded Warriors, be submitted for the record. Without

objection, that also is ordered.

[The prepared statement of Senator Bob Dole and Secretary

Donna Shalala follows:]

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Mr. TIERNEY. I ask unanimous consent that the gentlelady from

the District of Columbia, Representative Eleanor Holmes Norton,

be allowed to participate in this hearing. In accordance with our

rules, she will be allowed to question the witnesses after all official

members of the subcommittee have first had their turn.

I ask unanimous consent that the hearing record be kept open

for 5 business days so that all members of the subcommittee will

be allowed to submit a written statement for the record. Without

objection, that is all ordered.

Good morning. On March 5th, we held a hearing at Walter Reed.

At the medical center, we heard from Specialist Jeremy Duncan,

from Annette and Dell McCloud, and from Staff Sergeant Dan

Shannon about their experiences with military health care—the

mold, the red tape, the frustrations; all of the situations that were

reported that have frustrated all of you, as well as members of this

panel.

In preparation for the hearing today, we reached back out to all

of those witnesses to find out what was going on with them, to ask

if there was anything else they needed for help, to get their take

on how things have improved or not improved, and what our committee needed to focus on, in their opinions, with respect to our

sustained and hopefully vigorous oversight.

Jeremy Duncan is at Fort Campbell fighting to rejoin his unit

overseas in Iraq. Annette and Dell McCloud have noticed some improvements, but they are still navigating through the retirement

compensation process. And Sergeant Shannon’s most recent experiences with military health care were recounted in the Washington

Post less than 2 weeks ago. He is trying to leave Walter Reed, but

he has faced some additional bureaucratic roadblocks, which I

think General Schoomaker can report have been overcome at this

point in time.

Sergeant Shannon did tell us something that I think gets to the

heart of this matter, and he said recommendations mean nothing

until something is done with them. That is exactly what this oversight is all about.

At an April 17th hearing, we heard the recommendations of the

Defense Secretary’s Independent Review Group. Since then, the

President’s Commission, led by former Senator Dole and Secretary

Shalala, issued their own recommendations.

The purpose of today’s hearing will be to ensure that these recommendations and the human faces and stories of our Nation’s

wounded soldiers behind them, aren’t ignored or forgotten, which

unfortunately has too often happened in the past, and also to make

sure that our Government is moving swiftly to address all of the

problems that were identified.

This morning we will hear from top directors with the Government Accountability Office, Congress’ investigatory arm, on where

we are at. Instead of yet another commission or panel issuing recommendations, today we will get the first independent assessment

of the progress we have made and of the challenges and obstacles

that may lie ahead.

We are also going to hear directly from key officials in the Army,

the Department of Defense, and the Department of Veterans AfVerDate 11-MAY-2000 14:52 Jun 27, 2008 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 C:\DOCS\42584.TXT KATIE PsN: KATIE
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fairs who have been tasked with fixing the problems and implementing all of the various recommendations.

We have been told time and time again that things are improving and that, next to the wars in Iraq and Afghanistan, taking care

of our wounded soldiers is the highest priority of our military.

While I believe some progress has been made, especially through

some of the Army’s efforts to throw significant additional resources,

energy, and manpower at the problem, I would like to take a few

moments to highlight some lingering concerns. I do not do this to

focus on the negative. I do this because taking care of our wounded

heroes is too important to not demand that we strive for the highest levels of care and respect, and that we do so with a sense of

real urgency.

A number of us on the subcommittee visited Walter Reed earlier

this week. We had the privilege and honor to meet with our brave

men and women recovering there, and here is what we heard.

First, the disability review process is broken, plain and simple. It

is burdensome, archaic, and adversarial. We also heard stories of

wounded soldiers so frustrated that they would tell us they were

just ‘‘giving up.’’

Second, the challenges we face with traumatic brain injury, TBI,

and post-traumatic stress disorder, PTSD, are immense. We heard

stories about TBI stigma; that is, soldiers afraid to come forward

for help out of fear that they would be kicked out of the military.

Third, quality control and oversight will be absolutely key going

forward. While the Army has thrown significant bodies at the problem, we need systems to identify and reward great performers and

to identify and deal with those treating our wounded soldiers with

anything but respect.

These challenges—and countless others—won’t be easy to overcome. For instance, we have known for a long time that the disability review process is broken, but we haven’t had the will or the sustained focus to fix it in the past. Will the newly created Senior

Oversight Committee, made up of top officials from the Department

of Defense and the Veterans Administration, be up to the task of

urgently and finally fixing and reinventing the disability review

process? Will our military be able to hire additional top nurses and

psychologists, a key challenge that the GAO has highlighted.

Finally, what are we doing now to plan for the future? In my

District in Massachusetts, instead of expanding and enhancing

health services and retaining specialized personnel, the Veterans

Administration officials continue to push for consolidation. They

are limiting options for our veterans when, unfortunately, there

will clearly be a high demand for years and years to come.

As chairman of the National Security Subcommittee, I have

made it a top priority to ensure that there is sustained congressional oversight and accountability so that all of those who risk

their lives for the country receive the care and respect that they

deserve.

And I have been routinely impressed by the seriousness and the

vigor that the other members of this subcommittee have approached when they are dealing with this issue. It is vital that we

continue to have open and public hearings and that we hear from

rank-and-file soldiers, as well as high-ranking generals and departVerDate 11-MAY-2000 14:52 Jun 27, 2008 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 C:\DOCS\42584.TXT KATIE PsN: KATIE
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ment heads. We have already had three hearings, and today’s hearing will certainly not be the last.

We hope that in the months to come we won’t have to hear about

how Sergeant Shannon had yet another bureaucratic roadblock

thrust in his way in his 3-year odyssey to navigate the military

health care system. Rather, we hope to hear about how enormously

difficult problems were finally overcome with dedication, hard

work, and ingenuity.

I want to thank all of these witnesses whose hard work and ingenuity will certainly be put to the test as we meet this task.

[The prepared statement of Hon. John F. Tierney follows:]

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Mr. TIERNEY. I now yield to the ranking member of the committee, Mr. Davis, for his opening remarks.

Mr. DAVIS OF VIRGINIA. Thank you very much, Chairman

Tierney. And I want to thank the chairman of the full committee,

Mr. Waxman, for his leadership, and our ranking member, Chris

Shays.

At the subcommittee’s hearings in March and April, we heard

about ambitious plans for improvements in the medical processing

of wounded soldiers, and we heard promises to pursue these reforms with urgency. Prior to that, the Government Reform Committee heard many similar plans and promises, starting as far back

as 2004, when we first tried to help soldiers caught between systems and policies not designed to handle the types and the numbers of wounds inflicted by this new global war.

After so many promises but so little progress, we need to start

seeing concrete results. I applaud your persistence, Mr. Chairman,

in pursuing these issues.

The report of the President’s Commission on Care for America’s

Returning Wounded Warriors released in July sets forth another

list of findings and recommendations for executive and congressional action. The Commission also urges those reforms to be pursued with a sense of urgency and strong leadership. We agree.

One of the most important of the Commission’s recommendations

restates the longstanding call to overhaul and standardize the disability rating systems used by the Department of Defense and the

Department of Veterans Affairs. Every week my staff still hears

appalling stories from wounded soldiers caught in DOD medical

evaluation and physical evaluation board processes. They are

trapped in a system they don’t understand and that doesn’t understand them. The process is seldom the same twice in a row, and

often yields two different ratings, one from DOD and the other

from VA. Having to run that double gauntlet causes additional

pain and confusion, literally adding insult to injury. This has to

stop.

The Commission is recommending a single comprehensive standardized medical examination that DOD administrators use to determine medical fitness and that VA uses to establish an initial

disability level. VA would assume all responsibility for establishing

permanent disability ratings and for the administration of all disability compensation and benefits programs.

I look forward to hearing from our DOD and VA witnesses today

about a firm implementation deadline, details on how the integration of these evaluations will occur, and what performance standards will be put in place to make sure the consolidation serves the

near and long-term needs of veterans.

We will also need to hear more about the Army’s medical action

plan, a road map the Army has created to address patient administrative care at Walter Reed and at all Army medical treatment facilities. The plan is comprehensive in scope and includes stabilized

command and control structures, prioritizing patient support with

a focus on family needs, developing training and doctrine, facilitating a continuum of care, and improving transfers to the Department of Veterans Affairs. These are worthy and long-overdue goals,

but at this point they seem frustratingly incremental and risk

14

drawing energy and resources from the broader systematic changes

that I think are clearly needed. And even those goals have to be

viewed with skepticism looking back on more than 3 years of quarterly reports, missing deadlines, and glacial progress that changed

the process but didn’t always improve the product for the Army’s

wounded warriors.

Clearly, the Army has dedicated considerable manpower and resources to the new Warrior Transition Units and patient services,

but better training and clean lines of responsibility and accountability are still needed. Diagnosis and treatment for this war’s signature wounds—traumatic brain injuries and post-traumatic stress

disorder—are still far from adequate. And those looking to find

their way home from war are still hitting dead ends and a looping,

baffling maze of medical and physical disability assessment procedures.

When a truck or plane gets damaged in battle, we fix it. Honor

demands we do everything possible to fix the most precious assets

we send into harm’s way, the men and the women who volunteer

to fight for us.

I look forward to the testimony of all of our witnesses today and

a very frank discussion on how we can accomplish recommended

reforms quickly and make sure all of our wounded warriors receive

the care they deserve.

Thank you.

[The prepared statement of Hon. Tom Davis follows:]

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Mr. TIERNEY. Thank you, Mr. Davis.

Mr. Waxman.

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

This hearing today is in the tradition of our committee’s oversight with regard to military health care problems. Long before the

public ever heard about the problems at Walter Reed, under the

leadership of Congressman Tom Davis we held hearings on the important problems that Guard and Reserve troops were having with

health care and military benefits.

Chairman Tierney, your subcommittee held the first hearing of

the problems at Walter Reed, and you have continued to be a leader on this issue. I want to commend you for that.

In May the full committee had a hearing on the hundreds and

thousands of soldiers who may be returning from Iraq and Afghanistan suffering from PTSD and other mental health problems.

This committee’s efforts have helped uncover both new and longstanding problems with the military health care system. This oversight is some of the most important work that this committee does.

Few causes are more noble than giving our injured soldiers the

care they deserve.

Despite the increased attention, the pace of change at DOD and

VA is intolerably slow. Again and again we see the same thing—

blue ribbon task forces like the West/Marsh Commission on Walter

Reed or the Dole/Shalala Commission on Military Health care provide detailed road maps to better care. DOD and VA representatives come before Congress and insist that things are getting better. Still, the horror stories about problems with the military’s

health care system continue.

Here is just some of the new and disturbing information we have

received over the last several months: We learned from the Washington Post that Staff Sergeant John Daniel Shannon, who testified

about his problems at Walter Reed before our committee in March,

remained stuck in bureaucratic limbo at Walter Reed, unable to obtain his discharge, obtain VA benefits, or return to his family and

pick up his life.

We received deeply troubling reports from Fort Carson, CO, indicating that the leadership there seems to utterly lack understanding, basic understanding, of the problems faced by ill and injured

soldiers. Whistleblowers and investigators and struggling families

have told the committee that soldiers with PTSD and PTI are being

dishonorably discharged under the pretense of having pre-existing

personality disorders. We have heard of one soldier who was ordered back to Iraq, despite a diagnosis of PTSD and TBI. And we

have heard press reports indicating that one commander at the

base recommended discharging mentally ill soldiers simply as a

way to get rid of ‘‘deadwood.’’

We have heard from VA that they have over 1,200 unfilled psychologist, social worker, and psychiatrist positions within their

ranks, and that the VA is unable to provide even the most rudimentary estimates of the number of soldiers who will need mental

health care or the cost for such treatment.

And we have heard reports from the Army that suicide rates

among soldiers are at their highest levels in 26 years, while 20 perVerDate 11-MAY-2000 14:52 Jun 27, 2008 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 C:\DOCS\42584.TXT KATIE PsN: KATIE
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cent of Army psychologist positions are unfilled and morale among

Army mental health care providers continues to sink.

We will hear testimony from GAO and others today pointing to

other persistent or emerging problems at VA and DOD. While I am

looking forward to hearing testimony from all of our witnesses

today—and I am happy that we will have at least some good

news—I continue to be frustrated with the pace of improvement,

and I worry that after 5 years of war our military health care system is over-stretched, with bigger problems coming down the line

as soldiers are forced to serve more and longer deployments in Iraq

and Afghanistan.

In the coming years, hundreds of thousands of soldiers will return home and will need DOD and VA care for injuries or mental

illness. We can’t let these soldiers and their families down.

I want to thank you for holding this hearing today. I am looking

forward to see how we can make things better.

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

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Mr. TIERNEY. Thank you, Mr. Waxman.

Mr. Shays joined us earlier in the week out at Walter Reed and

has been consistently involved with this oversight process, as well.

Do you have an opening statement, Mr. Shays?

Mr. SHAYS. Thank you, Mr. Tierney, for your commitment to our

subcommittee’s ongoing inquiry into the medical care for the men

and women of our armed forces. Previous hearings taught us well

about the challenges facing our wounded warriors under current

Army, Department of Defense, and Department of Veterans Affairs

processes. We heard from many who were failed by the system and

challenged those responsible to address these failings.

We will do that again today when we question the current commander of Walter Reed Army Medical Center about the new Army

medical action plan aimed at addressing shortcomings at Walter

Reed and other Army medical facilities.

In our congressional oversight responsibilities, it is important we

focus on the Department of Defense’s Wounded, Ill, and Injured

Senior Oversight Committee’s efforts to carry out the recommendations contained in the President’s Commission on Care for America’s Returning Wounded Warriors, commonly known as the Dole/

Shalala Consumer.

In July this Commission released findings that are similar to

what we found during our committee’s initial investigations begun

in the spring of 2004, and are comparable to those we heard from

the independent review group this past spring. But the Dole/

Shalala Commission’s recommendations for executive and congressional action are more aggressive than those in the independent review group. Their implementation will require a collaborative commitment from the Department of Defense, the Department of Veterans Affairs, and especially from congressional committees.

Most of the real work still lies before us. As recommended in the

Dole/Shalala report, we must ask some tough questions. Can we

completely restructure the disability and compensation system of

the Army, Air Force, Navy, Marine Corps, the Department of Defense, and the Department of Veterans Affairs in time to help the

number of wounded currently in and entering the systems? Can we

create comprehensive recovery plans for every serious injured service member and create a cadre of well-trained recovery coordinators

for all stages in a wounded serviceman’s life? Who will be responsible for seeing that these plans are carried out between departments? Where will this cadre of coordinators come from? How will

they be trained?

We have learned the wounds of war extend far beyond the physical, with many patients struggling to cope with the devastating

emotional impacts of war. One of the most chronic outpatient

issues for our recovering soldiers has been the diagnosis and treatment of traumatic brain injury [TBI], and the post-traumatic stress

disorder [PTSD]. Central to the military creed is the promise to live

no soldier or Marine on the battlefield, but if we do not appropriately recognize and treat all wounds, including the issues associated with post-traumatic stress disorder and traumatic brain injury, we do precisely that—we leave them behind.

So we ask the question: how will DOD and the VA now aggressively prevent and treat post-traumatic stress disorder and trauVerDate 11-MAY-2000 14:52 Jun 27, 2008 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6633 C:\DOCS\42584.TXT KATIE PsN: KATIE
25

matic brain injury? What standards of diagnosis and treatment will

be created? Who will pay for this treatment? How will DOD and

the VA move quickly to integrate medical information and data between their organizations in order to get clinical data to all essential health, administrative, and benefits professionals that need it?

I look forward to hearing our Government Accountability Office

witness recommendations about what the Federal Government can

do to address the needs of our wounded warriors. We owe the

wounded warrior men and women of our armed services and their

families, as has been pointed out already, more than we have given

them to date.

I am told the President is committed to implementation of the

Dole/Shalala recommendations, and I know this subcommittee is

also committed to ensuring we provide the best possible care to our

brave men and women.

I look forward to hearing the testimony from our distinguished

panel.

I would just close, Mr. Chairman, and again thank you for your

work on this and the work of your staff and our staff. One of my

staff received an e-mail from a soldier in Iraq who, upon hearing

of this hearing this morning, said, ‘‘You, the American people, gave

us a mission to fix Iraq. We are accomplishing that mission. What

we expect from you, the American people, is to help fix us when

we come home broken.’’

Thank you, Mr. Chairman.

[The prepared statement of Hon. Christopher Shays follows:]

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Mr. TIERNEY. Thank you, Mr. Shays.

Now the subcommittee will, in fact, receive testimony from the

witnesses before us today. I would like to begin by introducing the

witnesses on our panel. We have John Pendleton, Acting Director

of the Health Care Department at the U.S. Government Accountability Office. With him is Daniel Bertoni, Director of the Education, Workforce, and Income Security Department at the U.S.

Government Accountability Office; Major General Eric Schoomaker,

M.D., Commanding General of the North Atlantic Regional Medical

Command and Walter Reed Army Medical Center; the Honorable

Michael S. Dominguez, Principal Deputy Under Secretary of Defense for Personnel and Readiness, U.S. Department of Defense;

and Rear Admiral Patrick Dunne, retired, Assistant Secretary for

Policy and Planning at the U.S. Department of Veterans Affairs.

Welcome to all of you and thank you for joining us.

It is the policy of the subcommittee to swear you in before you

testify, so I ask you to stand and raise your right hands. If there

are any other persons who might be assisting you in responding to

questions, would they also please rise and raise their right hands.

[Witnesses sworn.]

Mr. TIERNEY. The record will reflect that all witnesses answered

in the affirmative.

Your full written statements, of course, as most of you know from

previous experience here, will be submitted on the record and accepted, so we will ask that your oral remarks stay as close as you

can to 5 minutes and give us a little synopsis of what you have to

say.

Mr. Pendleton, I know that you and Mr. Bertoni come as a team,

and I understand that you will be presenting remarks and Mr.

Bertoni may not. In that case, we will give you a little leeway on

the 5-minutes, as we will for all the witnesses in any regard. I

thank you and the Government Accountability Office for your fairness in your report and the depth of your work. I would ask you

at this point in time to proceed with your testimony.

STATEMENTS OF JOHN PENDLETON, ACTING DIRECTOR,

HEALTH CARE, U.S. GOVERNMENT ACCOUNTABILITY OFFICE, ACCOMPANIED BY DANIEL BERTONI, DIRECTOR, EDUCATION, WORKFORCE, AND INCOME SECURITY, U.S. GOVERNMENT ACCOUNTABILITY OFFICE; MAJOR GENERAL ERIC

SCHOOMAKER, COMMANDER, WALTER REED ARMY MEDICAL CENTER; MICHAEL L. DOMINGUEZ, PRINCIPAL DEPUTY

UNDER SECRETARY OF DEFENSE, PERSONNEL AND READINESS, U.S. DEPARTMENT OF DEFENSE; AND PATRICK W.

DUNNE, REAR ADMIRAL, RETIRED, ASSISTANT SECRETARY

FOR POLICY AND PLANNING, U.S. DEPARTMENT OF VETERANS AFFAIRS

STATEMENT OF JOHN PENDLETON

Mr. PENDLETON. Thank you, Mr. Chairman.

Mr. Chairman and members of the subcommittee, I am pleased

to be here today as you continue your oversight of DOD and VA

efforts to improve health care and other services. As the situation

in Walter Reed came to light earlier this year, the gravity and imVerDate 11-MAY-2000 14:52 Jun 27, 2008 Jkt 000000 PO 00000 Frm 00035 Fmt 6633 Sfmt 6633 C:\DOCS\42584.TXT KATIE PsN: KATIE
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plications of many longstanding issues became clear. I visited Walter Reed last month, as I know many of you have, and learned

first-hand from many of the soldiers there just how far the system

still has to go.

I am pleased to be joined by my colleague, Dan Bertoni, who

leads our disability work at GAO.

Mr. Chairman, I would like to ask Dan to make a few comments,

because he is our disability expert.

Mr. TIERNEY. That is fine.

Mr. PENDLETON. I will provide an overview first and then turn

it over to Dan to focus on disability.

Mr. TIERNEY. That is fine. Thank you.

Mr. PENDLETON. Please take note that the findings that we are

presenting today are preliminary, based in large part on ongoing

reviews. Much of the information is literally days old, and the situation is evolving rapidly.

Efforts thus far have been on two separate but related tracks.

First I will cover the Army’s service-specific efforts; then I will

cover the collective DOD/VA efforts.

The Army is focused on its issue through its medical action plan.

The centerpiece of that plan is the new Warrior Transition Units.

The Army formed these to blend active and reserve component soldiers into one unit and to improve overall care for its wounded

warriors.

While these units have been formed on paper, many still have

significant staff shortfalls. As of mid-September, just over half of

the total required personnel were in place in these units; however,

many of those personnel that were in place had been borrowed,

presumably temporarily, from other units. Ultimately, hundreds of

nurses, enlisted and officer leaders, social workers, and other highly sought after specialists, like the mental health professionals that

will help with TBI and PTSD, will be needed.

The Army told us it plans to have all the positions filled by January 2008, and it is planning to draw these personnel from both the

active and reserve component, as well as from the civilian marketplace. Filling all the slots may prove difficult. As I think everyone

knows, the Army is stretched thin due to continuing overseas commitments.

Furthermore, the military must compete in a civilian market

that will pay top dollar for many of these health professionals. This

is an area that we intend to monitor closely as we continue our

work.

Now if I could I am going to briefly describe the broader efforts.

Through the newly created Senior Oversight Committee, DOD

and VA are working together to address the broader systemic problems. One of the key issues being taken on by the Senior Oversight

Committee is improving the continuity of care for returning service

members. In plain English, this is about helping the service members move from inpatient to a less-regimented outpatient status,

and navigate within and across two entirely different departments,

DOD and VA, as well as possibly out to the private sector to obtain

needed care. This can be quite complex.

To improve continuity, the Dole/Shalala Commission recommended that recovery plans be crafted to guide care for seriously

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injured service members and that senior-level recovery coordinators

be put in place to oversee those plans.

DOD and VA intend to adopt this recommendation, but key questions remain unanswered. For example, it is unclear exactly which

service members will be served by this recovery coordinator, and

without an understanding of the proposed population it is impossible to answer other fundamental questions, like how many recovery coordinators will ultimately be needed.

It is also unclear how the Army’s efforts will be synchronized

with the broader efforts. This is important so that service members

do not have too many case managers, potentially resulting in overlaps and confusion.

Mr. Chairman, given the complexity and urgency of these issues,

it is critical for top leaders to ensure the goals are achieved expeditiously; however, careful oversight will be needed to ensure that

any gains made in the near term are not lost over time.

That concludes my part of the statement. With your permission,

Dan will focus on disability.

[The prepared statement of Mr. Pendleton follows:]

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Mr. TIERNEY. Thank you, Mr. Pendleton.

Mr. Bertoni, we would be interested to hear from you.

STATEMENT OF DANIEL BERTONI

Mr. BERTONI. Good morning, Mr. Chairman and members of the

subcommittee. I am pleased to be here to discuss an issue of critical importance: providing timely, accurate, and consistent disability

benefits to returning service members and veterans. Thousands of

Operation Iraqi Freedom and Operation Enduring Freedom service

members have been wounded in action, many of whom are now trying to navigate a complicated labyrinth of disability policies and

often wait many months and even years for a decision.

Various commission reports have noted that overhauling the disability evaluation process is key to improving the cumbersome, inconsistent, and confusing bureaucracy facing injured service members.

My testimony today draws on our ongoing work and focuses on

three areas: current efforts to improve the evaluation process; challenges to reforming the system; and issues to consider as DOD and

VA press ahead on this important matter.

In summary, our prior work has identified longstanding weaknesses in DOD’s and VA’s disability programs, especially in regard

to the timeliness, accuracy, and consistency of decisions. More recently, an Army Inspector General report noted similar problems

with DOD’s system, including a failure to meet timeliness standards, poor training, and service member confusion about disability

ratings.

In response, the Army developed several near-term initiatives to

streamline processes and reduce bottlenecks such as expanding

training, reducing the case loads of staff responsible for helping

service members navigate the system, and conducting outreach to

educate service members about the process and their rights.

To address the more fundamental systemic issues, DOD and VA

area also planning to pilot a joint disability evaluation system. The

agencies are currently vetting multiple pilot options that incorporate variations of: one, a single medical exam; two, a single disability rating performed by VA; and, three, a DOD-level evaluation

board for determining fitness for duty. However, at the time of our

review, several key issues remain in question, such as who will

conduct the medical exam, how the services will use VA’s rating,

and determining the role of the board.

DOD and VA recently completed a tabletop exercise of four pilot

options using actual service member cases. While preliminary results showed that no single option was ideal, officials told us they

were currently analyzing the data to determine which option or

combination thereof would be most effective.

Although the pilot was originally scheduled for roll-out in 2007,

this data slipped as officials continued to consider these important

issues, as well as various commission report findings and pending

legislation which could, in fact, affect the pilot’s final design and

implementation.

Beyond pilot design issues, DOD and VA face other challenges.

Three of the options call for VA to conduct the medical exam as

well as establish the disability rating. This could have substantial

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staffing and training implementations at a time when VA, with

400,000 pending claims already, is struggling to provide current

veterans with timely and quality services.

We are also concerned that, while having a single rating could

improve consistency, VA’s outdated rating schedule does not reflect

changes in the national economy and the capacity of injured service

members to work, thus potentially undermining the re-integration

of returning warriors into productive society.

Going forward, DOD and VA must take aggressive yet deliberate

steps to address this issue. Key program design and policy questions should be fully vetted to ensure that any proposed redesign

has the best chance of success. This will require careful, objective

study of all proposed options and pending legislation, comprehensive assessment of pilot outcome data, proper metrics to gauge

progress of the pilot, and evaluation process to ensure needed adjustments are made along the way.

Failure to properly consider alternatives or address critical policy

details could worsen delays and confusion and jeopardize the system’s successful transformation.

Mr. Chairman, this concludes my statement. I am happy to answer any questions you might have.

Mr. TIERNEY. Thank you very much. Thanks to both of you gentlemen.

General Schoomaker, would you care to make some remarks?

STATEMENT OF MAJOR GENERAL ERIC SCHOOMAKER

General SCHOOMAKER. Mr. Chairman, Congressman Shays, distinguished members of the subcommittee, thanks for this opportunity to update you on the extraordinary and heroic acute care

and rehabilitative and comprehensive support of our warriors and

families being performed every day at Walter Reed Army Medical

Center and throughout our Army. I am very proud to be here with

you today sharing some of the many accomplishments of the clinicians, medics, technicians, nurses, therapists, uniformed and civilian Army, Navy, Air Force, full-time, volunteers—all of those who

care for these most-deserving American warriors and their families.

Words, alone, really can’t do justice to caregivers at Walter Reed

Army Medical Center and their colleagues throughout the Joint

Medical Force for what they do every day in really extremely demanding jobs. You have seen them yourself when you have been

out to visit our hospitals. They are witness to much pain and suffering. The pace is constant and unyielding. But they recognize

that we have the privilege to care for the best patients in the

world, our young men and women who have given of themselves for

our country.

Our patients, as you have seen, are an astounding group of warriors who inspire and amaze us every day. Their incredible spirit

and energy drive our hospitals to the highest level of performance

and invoke in our health care providers and staff a level of commitment and dedication to patients that is unparalleled, in my experience. I am constantly impressed with the quality and caliber of the

health care team at Walter Reed and their unwavering focus on

caring for these deserving warriors and their families.

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I am always careful to point out to all visitors and to members

of the public and to our elected officials that the quality of care,

itself, was never in question at Walter Reed or any military facility.

As you know, my Command Sergeant Major Althea Dixon and I

joined the Walter Reed leadership team in early March. In fact, I

took command shortly before you.

Our focus has been on ensuring that the warriors for whom we

care get the very best medical care, the best administrative processing, and the best support services that are available. With

worldwide support from the Army leadership and of trusted colleague Brigadier General Mike Tucker, a career armor officer, a

former NCO, and a veteran of both Operation Desert Storm and

Iraqi Freedom, who set out to correct identified deficiencies and

provide the very best for our warriors and their families, we have

received extraordinary support from the U.S. Army Medical Command, the entire Army, the senior Department of Defense leadership, and the Department of Veterans Affairs.

During the past 6 months we have identified problems and,

where appropriate, we have taken immediate corrective actions.

Many involved the creation of support services which were present

at larger Army installations but weren’t available at Walter Reed

before the events of mid-February.

The specifics of these changes and the continuing improvements

are outlined in my formal written statement for this hearing. Let

me focus on several recent events and key people to highlight our

progress.

First, I would like to talk about Staff Sergeant John D. Shannon.

Many of you know Staff Sergeant Shannon is one of the first three

soldiers who raised serious concerns about our care and support of

soldiers like him. He lived in building 18. He appeared before this

committee at a hearing held at Walter Reed in March. He has since

met with you and members of your staff updating you on his concerns and progress, and, as you alluded to, Mr. Chairman, he recently was the subject of a newspaper cover story on continuing

problems for our warriors in transition like him.

I regret that he declined to be with us today. He is in the midst

of out-processing, and I trust that he won’t take issue with my

talking about him in an open hearing here to day.

We have endeavored to work closely with wounded warriors like

Staff Sergeant Shannon to improve our system of care and administrative processes at Walter Reed, and, by extension, across the

Army and the joint force, and into long-term care and continued rehabilitation within the Veterans Administration system. We immediately improved the housing conditions for all our warriors in

transition who were in building 18 and any other accommodations

that did not meet the highest standards of the Army.

We created a triad of a squad leader, a physician primary care

manager, and a nurse case manager to ensure the well-being; provide comprehensive medical oversight; and ensure administrative

efficiency, timeliness, and thoroughness in the care and rehabilitation and adjudication of physical disability for these warriors.

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problem toward the end of his very lengthy acute treatment, rehabilitation, and processing of disability which resulted in misinVerDate 11-MAY-2000 14:52 Jun 27, 2008 Jkt 000000 PO 00000 Frm 00071 Fmt 6633 Sfmt 6633 C:\DOCS\42584.TXT KATIE PsN: KATIE
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formation and fear of unnecessary delays in his medical retirement.

But his chain of command and the support systems embodied in

the triad responded promptly to his call for help and he underwent

all steps on schedule in his Physical Evaluation Board process, and

he is now out-processing from Walter Reed and will be medically

retired from the Army.

Ironically, Staff Sergeant Shannon, in conversations with him,

did not realize that because the physical disability system and the

Physical Evaluation Board are separated from our squad leaders,

that he should not have gone to his squad leader to get help. In

fact, that is exactly what we would have asked him to do, and we

have used his example to re-educate people about how to get help

within our system.

We truly appreciated his service and his sacrifice. It is our obligation, it is, frankly, our sworn duty to heal soldiers like Staff Sergeant Shannon.

Every warrior in transition and every family is a unique case

and experiences unique challenges. We won’t perform flawlessly always, but we are hard at work building a team of clinicians, military leaders, and case managers and experts in all aspects of medical benefits and physical ability adjudication to allow us to provide

the very best possible care.

Finally, let me talk briefly about efforts to accelerate the transition at Walter Reed into a new Walter Reed National Military

Medical Center at Bethesda and how our work on warrior care in

the Army is being embraced by the entire joint medical community.

Our transition is proceeding very well. Rear Admiral Promotable

Madison of the Navy, who was recently appointed as the commander of the joint task force to combine medical military operations in the National Capital Region, strongly supports the future

establishment of a warrior transition brigade at the future Walter

Reed National Military Medical Center in Bethesda, and that may

well serve as a model for the development of a joint service approach to caring for warriors in transition.

We are also encouraged by recent directions from the Deputy

Secretary of Defense, Mr. Gordon England, in an August 29, 2007,

memorandum that directs the service Secretaries to use all existing

authorities to recruit and retain military and civilian personnel

necessary for seriously injured warriors and directing the Secretaries to fully fund these authorities to achieve this goal.

In his memorandum, Secretary England directs the Secretary of

the Army to develop and implement ‘‘a robust recruitment plan’’ to

address identified gaps in staffing and sufficiently fund the Walter

Reed budget to pay for these recruitment and retention incentives.

These efforts should help to stabilize the work force at Walter

Reed and to ensure that our warriors will continue to be cared for

by the best health care professionals in the world. I believe that

the actions that we have taken in the last 6 months will ultimately

make Walter Reed and the Army Medical Department stronger organizations, more adept at caring for warriors and their families.

We need to continue to address our shortfalls. We need to continue to focus on serving our warriors and families, and we will

continue to improve.

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Thanks for this opportunity to speak with the committee today

and answer your questions.

[The prepared statement of General Schoomaker follows:]

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Mr. TIERNEY. Thank you, General.

Mr. Dominguez.

STATEMENT OF MICHAEL L. DOMINGUEZ

Mr. DOMINGUEZ. Thank you, Mr. Chairman. Mr. Chairman, Congressman Shays, distinguished members of the committee, thank

you for the opportunity to update you on the progress we have

made improving the systems for support and care of our wounded,

ill, and injured service members and their families.

I apologize for the tardiness of my written testimony, but trust

that you will find within it the specific information you need in

order to fulfill your oversight responsibilities.

I would like to use this opening statement to make four headline

points: First, the issues that emerged at Walter Reed last February

did, indeed, uncover systemic deficiencies in our care and support

for the wounded, ill, and injured. We failed. We acknowledge that

failure, and the senior leadership of the Defense Department is

committed to correcting the system and repairing the damage. Secretary Gates has stated that, outside of the war, itself, he has no

higher priority.

Next, it is absolutely clear to us that fixing this system requires

a partnership with the Congress, with the various advisory committees, with the Nation’s many charitable and service organizations, but first and foremost a partnership with the talented men

and women in the Department of Veterans Affairs. Deputy Secretary Mansfield of the VA and Deputy Secretary England of Defense established the Senior Oversight Committee to forge that

partnership. At my level, I believe I have spent more time over the

last few months with Under Secretary Cooper and Assistant Secretary Dunne than I have spent with members of my own staff. We

are jointly and cooperatively working this challenge.

Third, we have accomplished a great deal. That is documented in

our testimony. We are doing more every day. In fact, only yesterday the two Deputy Secretaries endorsed a plan to pilot a substantive revision of the disability evaluation system which features

a single comprehensive physical exam done to VA standards using

VA templates and a single rating for each disabling condition, with

that rating issued by the world-class professionals at DVA, and

that rating decision being binding on the Department of Defense.

Integrating DVA into DOD’s administrative decisionmaking processes is evidence of the extraordinary level of cooperation we have

achieved.

Four, while we have accomplished a great deal, there is still

more to do. We will do everything we can within the realm of policy

and regulation. Undoubtedly, we will seek legislation, but that legislation would be ground-breaking, changing the foundations of our

current disability systems and changing fundamentally roles and

responsibilities among Government agencies. We do not need from

the Congress prescriptive legislation addressing the minutia of how

we execute our responsibilities within current law. We do need and

welcome your oversight of these areas through hearings such as

this one and visits such as you conducted earlier this week. And

when we have formed our ideas about fundamental changes, we

will bring them to the Congress. In the meantime, we are making

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changes, we are making them fast, and we won’t stop until our

wounded warriors have the support system they deserve.

Thank you. I look forward to your questions.

[The prepared statement of Mr. Dominguez follows:]

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Mr. TIERNEY. Thank you.

I want to break protocol here a little bit because I don’t generally

do this, but I think my colleagues would share this. I hear the

tenor in your voice about not wanting Congress to come in with

prescriptive legislation, but you have to understand what makes it

tempting for Congress to do that is the utter lack of urgency over

a decade that we have sense with the Department of Defense and

other agencies in the Government about getting this job done.

Nobody that I know of on this panel or anywhere else thinks

about doing prescriptive legislation if we don’t have to, but we oftentimes think about giving a foot right where it is needed to get

things moved, and I will get into it further in my questioning and

whatever. I am glad to see that you have a pilot program that you

are finally focused on. We will talk about why it took forever to get

there, relatively speaking, and things of that nature, and what legislation might be needed. But do understand that nobody here

wants to be prescriptive, but the temptation is great when it takes

too long a period of time to move from one point to another.

Mr. Shays, do you want to add a comment to that?

Mr. SHAYS. Just to say that is an opinion shared on both sides

of the aisle.

Mr. DOMINGUEZ. Yes, sir, and, again, I acknowledge we failed,

and fixing the problem is absolutely urgent and absolutely a top

priority of our two departments’ leadership and we commit to it,

sir.

Mr. TIERNEY. Admiral Dunne.

STATEMENT OF ADMIRAL PATRICK W. DUNNE

Admiral DUNNE. Mr. Chairman, distinguished members of the

committee, thank you for the opportunity to discuss the recent activities of the Department of Veterans Affairs to serve our Nation’s

veterans through improved processes and greater collaboration

with the Department of Defense.

Over the past 7 months, I have had the privilege of being engaged in many activities dedicated to ensuring our returning heroes from OEF and OIF receive the best available care and services. I join my colleagues from VA and those from DOD in striving

to provide a lifetime of world-class care and support for our veterans and their families.

On March 6th, the President established the Inter-Agency Task

Force on Returning Global War on Terror Heroes. VA’s Secretary

Nicholson was appointed Chair, and I was proud to support him as

the Executive Secretary. On April 19th the task force issued its report to the President. There were 25 recommendations to improve

health care, benefits, employment, education, housing, and outreach within existing authority and resource levels. The report was

unique in that it also included an ambitious schedule of actions

and target dates. Thanks to outstanding inter-agency cooperation,

56 of 58 action items have been completed or initiated to date.

The results are having a positive impact. The Small Business Administration launched the Patriot Express Loan Initiative. This

program, which has already provided more than $23 million in

loans, provides a full range of lending, business counseling, and

procurement programs to veterans and eligible dependents.

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Other task-force-inspired initiatives will support seamless and

world class health care delivery. VA and DOD drafted a joint policy

document on co-management and case management of severely injured service members. This will enhance individualized, integrated, inter-agency support for the wounded, severely injured, or

ill service member and his or her family throughout the recovery

process.

To assist OEF/OIF wounded service members and their families

with the transition process, VA hired 100 new transition patient

advocates. These men and women, often veterans themselves, work

with case managers and clinicians to ensure patients and families

can focus on recovery.

VA also revised its electronic health care enrollment form to include a selection option for OEF/OIF to ensure proper priority of

care.

Additionally, a contract was recently awarded for an independent

assessment of in-patient electronic health records in VA and DOD.

The contract will provide us recommendations for the scope and

elements of a joint health record.

As you know, many recommendations have been issued lately

which center around the treatment of wounded service members

and veterans. To ensure the recommendations were properly reviewed and implemented, VA and DOD established the Senior

Oversight Committee which has been discussed this morning,

chaired by our two Deputy Secretaries.

In a collaborative effort with DOD, VA made great strides in addressing issues surrounding PTSD and TBI across the full continuum of care. The focus has been to create a comprehensive, effective, and individual program dedicated to all aspects of care for our

patients and their families.

VA and DOD have partnered to develop clinical practice guidelines for PTSD, major depressive disorder, acute psychosis, and

substance abuse disorders.

Our Senior Oversight Committee also approved a National Center of Excellence for PTSD and TBI.

Since 1992, VA has maintained four specialized TBI centers. In

2005, VA established the poly trauma system of care, leveraging

and enhancing the expertise at these TBI centers to meet the needs

of the seriously injured. The Secretary of Veterans Affairs recently

announced the decision to locate a fifth poly trauma center in San

Antonio, TX.

VA and DOD are also working closely to redesign the disability

evaluation system. As Mike mentioned, a pilot program is being finalized to ensure no service member is disadvantaged by this new

system and that the service member receives the high-quality medical care and appropriate compensation and benefits.

This proposed new system will be much more efficient, and I

have provided additional details in my written testimony.

Over the last 4 years, VA has increased outreach and benefits delivery at discharge sites to foster continuity of care between the

military and VBA systems and speed up VA’s processing of applications for compensation. VBA also processes the claims of OEF/OIF

veterans on an expedited basis.

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Collaborating with DOD, we have accomplished a great deal, but

there is still much more to do. We at VA are committed to

strengthening our partnership with DOD to ensure our service

members and veterans receive the care they have earned.

I would be happy to answer your questions.

[The prepared statement of Admiral Dunne follows:]

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Mr. TIERNEY. Thank you.

Typical of this institution, those are messages for votes coming

up, I assume, on that. I will be able to get more information on

that in a moment. What I think we will do is start with the questioning and then make a determination when we find out how

many votes we have whether we will have to interrupt the meeting

or whether we can try to continue on through.

I want to thank all of you for your testimony. Despite my interruption of Mr. Dominguez, I think we are trying to be helpful here

in trying to move forward on this basis. If there was something in

the tone or the comment that you made that struck a chord there

amongst several of us here, but that had to do really with urgency.

One of the things that we constantly have from all of the commissions and from all of the conversations with returning people is a

sense that there has been a lack of urgency over time about dealing

particularly with the rating system, with the evaluation system on

that. When I look at how long it has taken for the Senior Oversight

Committee to stand up and get going on this thing, the frustration

is palpable. I was just making sort of a broad comparison to General Jones’ work. He did the Independent Commission on the Security Forces of Iraq. He started in May 2007. They assembled teams,

20 prominent retired and active officers, police chiefs, Secretaries

of Defense, etc. They have organized and attended syndicates. They

focused on either discrete components or cross-cutting functional

areas. They were all subject to review of the full committee. They

traveled widely throughout Iraq, which for anybody is a seriously

difficult prospect to do in the middle of a war. They interviewed

hundreds of Iraqi officials, U.S. officials, visited sites, and did all

that and filed their report in 4 months.

We are 7 months into this process, that we all admit is one of

the major concerns that we have, and we are just now getting off

the ground. So that is, you know, the lack of urgency that I think

Members coming back from Iraq and Afghanistan sense and the

Members here on this dais sense. Why has it taken so long to get

going on that?

Now, I will let you answer that in the context of the first question I am going to ask. Now we have had the pilot program that

you announced either yesterday or today, which is good. I am glad

that is moving forward. We need to know from you a little bit more

about that pilot program, what it entails, and does it address

GAO’s concerns in terms of personnel. I understand from your brief

comments that it is going to be the Veterans Administration’s

standards and template on that, so that raises the questions, I

think, that Mr. Pendleton or Mr. Bertoni raised about if you choose

that, then you have difficulties with the process, itself, at VA.

The single disability evaluation should make it more consistent

in disability ratings, but does it have enough people involved in the

system? Are we going to have the personnel? Are we going to take

into account the assistive technologies and disabled veteran’s ability to work, have a new system for getting people that can be put

into work out there and do something about the outdated rating

system. Does it address that? And how long is this pilot program

going to go? Why aren’t we moving immediately into a final disposition of this, if you have done your table tops, you have had

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your analysis, you have dealt with the experts, you have looked at

the situation and have examined the data? How long is this pilot

going to go? Why aren’t we going right into just getting this done?

I suspect we will give you an opportunity to answer that.

Mr. DOMINGUEZ. Thank you for the question.

First let me say that if there was anything in my tone that was

critical, I apologize for it. It was not intended to be.

The sense of outrage by the Congress and the American people

is fully justified. Last spring in the demand for urgency, fully justified, 100 percent with it, I felt the boot had been appropriately applied, and I do want to say that we are moving urgently.

The SOC that meets for an hour a week, has been doing that in

a decisionmaking forum.

Now, why it takes us a little longer to get going is that we are

doing more than the report. In crafting our recommendations to the

SOC on what we are going to do, we have to reach down into the

organization and get those people who have an equity stake, who

have a lot of knowledge and experience, and cause them all to try

and work through this and come together, so it is very much managing an alliance as we work through the issues and come to grips

with it.

And then I remind you again of the comments Mr. Bertoni made

about, here is a bunch of the questions that have to be answered,

and you have to have the evaluation plans and how you are going

to do that. Those are the kinds of questions and the due diligence

we have to put in place before we can launch a system.

So it does take some time to develop the details, to build that

consensus, and to work through these issues.

I have to say that each of the military services feel an intense

need to solve this problem themselves, so when I ride in there with

Secretary Dunne saying, OK, stand back, guys, we are going to fix

this, their immediate reaction is, prove it first before we let you

hurt us more. This is justifiable on their part, as well. That is part

of the confidence building process that we have to use.

Now, how this process will work, we will use the VA rating. The

VA rating for the unfitting condition will be determinative, and the

percentage that they put on that will dictate whether a person

found to be unfit is separated or retired and the level of benefits,

just as in the current system.

The pilot we are doing must stay within the context of the current law. That includes how the VA does their thing with the VA

scheduled rating disabilities. The fact that it needs to be updated

has been acknowledged by the Secretary. I will let Pat speak to

that. But what we are going to be moving forward with is within

the current context of law and what we can do by policy changes

and by bringing the VA talent onto our side of the administrative

processes.

Mr. TIERNEY. And how long do you project the pilot is going to

be?

Mr. DOMINGUEZ. Sir, because this affects people, it is an administrative process that actually issues an outcome that affects benefits

in for-real individuals, our first step is we are going to do the next

thing beyond a table top, which is actually proof of concept where

we walk people who have already been through the system and alVerDate 11-MAY-2000 14:52 Jun 27, 2008 Jkt 000000 PO 00000 Frm 00125 Fmt 6633 Sfmt 6633 C:\DOCS\42584.TXT KATIE PsN: KATIE
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ready been issued their benefits and their determinations, we are

going to walk them back through this system and see how those

two things compare. Then, notionally, in January 2008 we will actually start putting new cases through this.

There is also training associated with it in preparation for it. I

don’t, at the present, have a concept for how long that would work.

We are going to do it in the Washington, DC, metro area first,

within a few months, depending on the number of people who go

through it and the outcomes, we could very well begin to scale it

up across the Department shortly thereafter.

When and if fundamentally different legislation such as the ideas

proposed by Secretary Shalala and Senator Dole come, then a lot

of things would change based on that, so we have to re-evaluate

how we do that.

Mr. TIERNEY. We will explore that a little further.

My time has expired.

Mr. Platts, would you care to ask some questions?

Mr. PLATTS. Thank you, Mr. Chairman. I appreciate your and the

ranking member’s leadership on this issue and the various hearings and visits to Walter Reed, and I want to thank all of our witnesses, both those on the front lines of trying to make these systems work, as well as the GAO colleagues and their important

oversight work.

Mr. TIERNEY. Excuse me, Mr. Platts. I hate to do this to you, but

there are only 6 minute left to vote.

Mr. PLATTS. OK.

Mr. TIERNEY. I know you want to record your vote. You have a

choice. You can stay and I will stay with you, or we will both try

to make it, or we could go and do the two quick votes and be back

in 10 minutes.

Mr. PLATTS. Do you want to do that, Mr. Chairman?

Mr. TIERNEY. Fine. We are going to recess. I apologizes to our

witnesses for the schedule around here, but we will take 10 minutes probably maximum and be back here.

Thank you.

[Recess.]

Mr. TIERNEY. The subcommittee will resume.

Mr. Platts, thank you for allowing us to interrupt you. I think

it was a better way to proceed, and hopefully you will get your entire 5 minutes again starting now.

Thank you.

Mr. PLATTS. Thank you, Mr. Chairman.

Again, just let me reiterate to our witnesses my thanks to each

of you for your efforts on behalf of our wounded warriors.

When we had our hearing earlier this year, the first hearing at

Walter Reed, one of the common messages or two that I want to

try to address in my 5 minutes quickly, one was the care, when

provided, in the overwhelming instances was excellent, but the

challenge was the coordination of that care, either within the DOD

system or the transfer to the VA system, and then the second was

the transfer of information from DOD to VA. I am going to try to

address both of these.

Certainly, that has been the focus of the various studies or commissions that have been done, and specific to the Army with the

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creation of the Warrior Transition Units. Then in the broader sense

the SOC has talked about, I think what you are calling recovery

coordinators to kind of oversee and be that one-stop person for

wounded warriors and their family members.

My concern is, given that is so critical to these individuals, these

soldiers getting to the right entity for their care and not being, as

we had heard with Staff Sergeant Shannon and others, left to find

their own way, the fact that we are now more than half a year

along the path, and according to GAO report about half of these positions are unfilled, and even a good portion of those that are filled

within the Army ranks are temporary, and then with the SOC recommendation it is still just a recommendation. We haven’t even

begun to implement this process.

So I guess if I can start with our two Secretaries first to the

broad issue on the recovery coordinators, where we stand and what

is the greatest challenge to getting this up and running and to

making a difference. Then, General Schoomaker, if I can go to you

on specific to the Army and the fact that we still have so many vacancies in these very critical positions.

Mr. DOMINGUEZ. Sir, I will start.

I think the first headline I have to tell you is that the Army has

changed the situation on the ground in these hospitals. The triad

of care that they are deploying through the Warrior Transition

Units and stuff is changing the situation on the ground. That is the

necessary and immediate response to soldiers in need.

Mr. PLATTS. I know that is the plan, but my understanding and

I think from GAO is that only 13 of the 38 Army facilities actually

have those fully staffed, those triads staffed. Is that incorrect?

Mr. DOMINGUEZ. I can’t dispute the GAO data on it, because this

plan and the triad and the requirement for it emerged in the

Army’s look internally at what they needed to do, and we have

given them at the DOD level every support possible and every encouragement. In fact, the directive that General Schoomaker mentioned about, you know, hire everybody you need to hire, use every

authority you have to do that in terms of this medical unit. So the

situation on the ground has changed where the Army has been able

to respond and been able to staff that. Again, challenges remain.

More needs to be done. We are pouring all the gas on it we can.

That is also true with regards to the VA/DOD collaboration

around information sharing and, in fact, people. There are people

from both departments in each other’s facilities actually coordinating and managing the transfer of patients and information when

patients move back and forth between our systems, another great

example of the partnership stepping up to the challenge and changing the situation on the ground.

At the more global level, at the SOC what we are again trying

to do is trying to figure out, all right, what else needs to be done

globally.

Mr. PLATTS. And specifically with recovery coordinators?

Mr. DOMINGUEZ. Yes, sir. That is one of the things that we are

looking at now is the architecture of roles and responsibilities and

how that all works together, because you don’t want to disrupt this

triad of care. You want to augment it and supplement it.

Mr. PLATTS. Right.

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Mr. DOMINGUEZ. So what needs to be done, how do we do that,

how do we introduce this new phase, what value-added does that

new phase bring, and how do you connect them then with the triad

of care that is going on? So you want to move carefully and deliberately, with urgency absolutely, and I hope to be able to have

something definitive within the next few weeks about how we are

sorting through the care recovery coordinator. In fact, part of that

discussion will be at the SOC on October 2nd.

Mr. PLATTS. OK. Mr. Chairman, could General Schoomaker—if

you could respond in specific to the triad approach and my understanding from the GAO information the number of vacancies, and

your efforts, and what do you need from us, if anything, to help fill

those positions?

General SCHOOMAKER. Yes, sir. I appreciate the question.

First of all, I think Mr. Pendleton made the comment earlier that

the findings at GAO are preliminary and it gives us an opportunity

to clarify and to better explain some of the data that are reported

in this very thorough GAO study that we greatly appreciate.

First of all, warriors in transition, who are these people. It is important that you realize that the former terms of med-holdover

don’t exist any longer within the Army. We have taken all soldiers,

active component soldiers and mobilized reserve component soldiers, National Guardsmen, Reservists, regardless of where they

became injured, ill, whether they are combat casualties or whether

they are, frankly, injured on a training base or develop a serious

illness in the course of their service, we put them all together in

a single unit we call Warrior Transition Units, and they are called

Warriors-in-Transition.

The important thing is not where they got injured or ill; it is simply that they developed an injury or an illness as a consequence

of their service and we want to treat them all the same.

We are at this point on the projected glide path to fully staff all

Warrior Transition Units by the first of January. I hesitate to use

the word incremental here because it has a bad sort of taste in our

mouths now, but we are going as quickly as we can. The Army has

been very, very aggressive about supportings, giving us full staff to

provide the oversight of squad leaders, platoon sergeants, first sergeants, company commanders, battalion commanders for these

units, and we are on a very good glide path to achieve the goal.

What the GAO heard about and does exist are not casualties of

war. Every casualty evacuated out of the theater of operation or

any major illness is immediately assigned to a Warrior Transition

Unit and is given the term or label of a Warrior-in-Transition and

is assigned to a unit that is staffed with a squad leader, platoon

sergeant, company commander, and the like.

What we do have in the Army, however, and have always had,

is about an equivalent sized, almost brigade-sized element distributed throughout our war fighter brigades, divisions, and corps, who

have a medical illness or an injury that renders them at least temporarily unfit or unable to deploy. We now have a case-by-case negotiation with their commanders to bring them into the Warrior

Transition Unit, to call these, to embrace them as Warriors-inTransition and assign them.

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That population is as yet unstaffed for cadre because we haven’t

identified them.

Mr. PLATTS. But you have prioritized those from the combat operations as far as the staffing, and now you are moving through the

ranks?

General SCHOOMAKER. Yes, sir. If you go to every WTU across

the Army right now, we are at over 50 percent cadre supplied. At

Walter Reed, frankly, we are at 95 percent. Across the Army we

are at about 65 percent across all Warrior Transition Units, and we

are on that glide path to be fully staffed.

Mr. PLATTS. OK. Thank you, Mr. Chairman.

General SCHOOMAKER. Does that clarify?

Mr. PLATTS. Perhaps I will have a chance to followup if we have

additional rounds. Thank you.

Mr. TIERNEY. Thank you.

Mr. Waxman.

Mr. WAXMAN. Thank you, Mr. Chairman.

I want to address this question to Under Secretary Dominguez.

There have been reports about soldiers who, despite physical or

mental health problems and against the advice of their doctors,

have been ordered to redeploy to Iraq. We first heard this at our

hearing on May 24th, and since then we have received additional

reports from soldiers at Fort Benning and Fort Carson. These reports are extremely concerning, disturbing.

Do you agree that soldiers who are physically or mentally ill

should not be deployed against the wishes of the doctors who are

treating them?

Mr. DOMINGUEZ. Absolutely, sir.

Mr. WAXMAN. I understand there may be some gray area here.

Some soldiers have illnesses that are not severe enough to prevent

them from combat duty; others have mental illnesses that can be

successfully treated with medication. In some cases, the soldiers

may even want to return to their units. Has DOD put together a

policy that governs these redeployments? How do you balance the

needs of the soldiers, the unit, and the military as a whole?

Mr. DOMINGUEZ. Sir, we have given that a great deal of thought

in these last several months. That is part of some of the work of

the Mental Health Task Force. I would have to get back to you on

the record with the policy that governs this. I do know that you are

screened. People are screened before they redeploy. They are

screened when they come back and then again before they go. People who have conditions that make them unable or unfit to serve

in combat, in a combat theater, we have policies and practices in

place where they should not be deployed.

Mr. WAXMAN. Well, under the policies, as I understand it, there

is supposed to be a unit commander to have to get a waiver from

Central Command before they can redeploy somebody, and we have

one documented case at least from Fort Carson where a unit commander sought a waiver to redeploy a soldier who was on psychiatrically limiting medications and the waiver was denied. And then,

despite this denial, the soldier was ordered to redeploy and subjected to disciplinary action when he could not. This seems to me

like a clear violation of DOD policy. It was bad for the soldier, unquestionably. It couldn’t have been good for the unit, either. The

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soldier is not well enough to be in combat, he could present a real

danger to his comrades.

Can you explain why it appears that DOD policy is not being followed with regard to redeployments of mentally ill soldiers at Fort

Carson?

Mr. DOMINGUEZ. No, sir, I am not familiar with that particular

case.

Mr. WAXMAN. Well, could you tell us what steps DOD is taking

to ensure that the policies are followed? Are unit commanders who

do not follow the policy subject to disciplinary action?

Mr. DOMINGUEZ. Sir, unit commanders who don’t follow DOD

policies, yes, are subject to disciplinary action.

Mr. WAXMAN. I know the military is greatly strained, that we

have people who have been back and redeployments sometimes

three or four times, but if we are going to redeploy people, at least

we ought to make sure that they are well enough to be in a combat

zone.

The other thing I wanted to ask you about is there are also credible reports of systemic problems at Fort Carson with regard to

wrongful discharges of soldiers with psychiatric conditions. The

military comes back and says, well, they have a pre-existing condition, and therefore they are not going to take care of them. They

don’t accept that this is a mental illness problem related to combat.

NPR reported on a memo from the Director of Mental Health at

Evans Army Community Hospital, and, according to reports, this

memo was written to help commanders deal with soldiers with

emotional problems, and NPR stated, ‘‘We can’t fix every soldier,

and neither can you. Everyone in life, beyond babies, the insane,

the demented, mentally retarded have to be held accountable for

what they do in life.’’ And the memo goes on to urge commanders,

‘‘to get rid of the dead wood.’’

Are you familiar with that memo?

Mr. DOMINGUEZ. No, sir, I am not.

Mr. WAXMAN. Well, it appears this memo is advocating giving up

on some of our mentally ill soldiers. That is certainly not a responsible approach. And this business of pre-existing conditions discharge, it means that the soldier is discharged dishonorably and

they can’t get access to mental health care that they require from

the Veterans Administration. That doesn’t make sense to me. It

seems like if a soldier was healthy enough to be accepted into the

Army, disciplinary problems that appear to be related to PTSD

should not be blamed on pre-existing conditions. These soldiers

should receive treatment, not blame.

I would like to get further reports from you on this issue. It is

certainly not appropriate to discharge soldiers with PTSD via this

pre-existing condition discharge. I would like to get from you for

the record, because my time is up but I think we need to get this,

the DOD policies that prevent soldiers from being inappropriately

discharged for pre-existing conditions. If this is going on, it is certainly an outrage.

Mr. DOMINGUEZ. I am happy to provide that.

[The information referred to follows:]

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Mr. DOMINGUEZ. If I might, I do want to call attention to Secretary Garon and Chief of Staff General Casey’s efforts to train the

Army on the challenges of combat stress. If you haven’t seen or

heard about the activity they initiated—and General Schoomaker

can tell you a lot more—a superb effort of leaders to make sure

that leaders throughout the Army understand the challenges of

combat stress and how to deal with them. I think it is a laudable,

commendable, superb effort by those two.

Mr. WAXMAN. Well, it doesn’t seem to be getting through to the

leaders at Fort Carson, so I think we need further reports on

whether the Army is actually getting educated or whether more

paper is just being generated.

Mr. DOMINGUEZ. Happy to do that, sir.

Mr. WAXMAN. Thank you, Mr. Chairman.

Mr. TIERNEY. Thank you.

Mr. Dominguez, we will expect some report back on those particular incidents that Chairman Waxman discussed in a reasonable

time. We would appreciate that.

Mr. DOMINGUEZ. Yes, sir. Happy to do that.

Mr. TIERNEY. Thank you.

Mr. Turner.

Mr. TURNER. Thank you, Mr. Chairman.

I want to thank you again for all the work that you have done

on this issue, both when the original issues came to light about the

care that our soldiers were receiving, and your efforts on this committee have not only made a big difference, but have highlighted

some solutions that we have been hearing today.

I serve on the Armed Services Committee, the VA Committee,

and on this subcommittee, so I get three bites of the apple on this

issue. I was very proud to listen to Senator Dole and Secretary

Shalala deliver their recommendations to the VA Committee and,

like many, are very appreciative of their work. They have looked

to some real solutions and identifying real problems.

I want to echo the comments that others have made about the

Medical Evaluation Board Processes at DOD, the VA, and the recommendations from Secretary Shalala and Senator Dole on the

problems of the time for the process, the inconsistencies, and the

lack of coordination between DOD and VA. I think they have some

great recommendations.

So many times we look at the streamlining processes instead of,

as they have recommended, collapsing processes and making them

thereby more efficient. But in looking at the three different committees that I serve on, and the information that we receive and

how we need to proceed, one of the things that this committee has

continued to hear in this process of great concern is a sense between Reserve components, Guard, and active members that there

is a disparity perhaps for Reserve and Guard members and the

level of their care at the facilities, the resources that are brought

to bear to assist them. They have told the committee that at times

they feel like they are second-class citizens.

I know that each of you have a concern and a dedication to that

issue, and I would like to give you an opportunity to respond to the

feelings of disparity that they have, the issues that you do see

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where there are disparities, and ways in which it might be addressed or ways in which you actively are looking to address it.

We will start with the General.

General SCHOOMAKER. You want to start with me, sir?

Mr. TURNER. Please.

General SCHOOMAKER. Well, sir, I would say right off the bat I

think that their perceptions are real, and they are certainly justified. I think one of the failures that was alluded to by Mr.

Dominguez earlier of the Department of Defense—and in the Army,

we were guilty of the same—is that we put in place some structural solutions shortly after the first appointments of our Reserve

component colleagues. We mobilized National Guard and Reserve

elements, and when they returned or when they were injured or

showed up at our deployment platforms with illnesses, we segregated them into two different populations, med-hold for active

component soldiers and med-holdover units for the Reserve component soldiers. Now, that was done because there are differences between the two components when it comes to processing of disability

and outprocessing in the Army and the like, the things that are

more arcane than this General can understand, quite frankly.

But I think what that did, unfortunately, was create the impression, on both sides, ironically, both the active component and the

mobilized Reserve component soldiers, that they were being treated

differently.

Certainly we will continue to work on this misperception of the

two groups by creating a Warrior Transition Unit and a single

term to apply to all soldiers, they are all active duty soldiers.

Whether they come out of the Reserve component, or they are active component soldiers like myself, they are all active duty soldiers that are serving the Nation, and, frankly, they are carrying

a heavy load, and so we are trying in every way we can to break

down that misconception.

Mr. TURNER. General, I appreciate your commitment to that. It

is an important issue, and I know that everyone agrees with you

on the need for your and other’s success.

Would anyone else like to comment on the issue of things we

need to look at?

Mr. DOMINGUEZ. Sir, if I might, yes, I believe the Army has

changed the situation on the ground in the military treatment facilities at Army installations. We have a continuing challenge when

we get Reserve and Guardsmen home, as they want to do fast, and

then they may have trauma and challenges, particularly PTSD and

the TBI, which sometimes emerge late after they have been demobilized back into their civilian communities. We have challenges

trying to devise and deliver programs to help them with the tough,

tough challenge of re-integration, because they are distributed all

over the place. They are not concentrated at a military facility

where we can get to them.

We are working through those challenges. Several activities right

now are underway in terms of re-integration. Lots of work, thinking through with the VA how to reach those people in their communities at home and make sure they get care when they are back

home, and lots of opportunities through TRICARE delivery organizations to make sure that they get treated. But it is a challenge

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when we get them back home, making sure they get the care and

support they need.

Admiral DUNNE. Sir, if I might also comment, in Secretary Nicholson’s task force we also discovered that, with the Guard and Reserve, when they would go home and then try to do the post-deployment health reassessment, we found that it would be helpful

if the local VA medical center was represented at those sessions,

and so, as a result of the task force, we have taken that action to

get from DOD the schedule of when those reassessments are taking

place, and then we task the closest medical center to support those

events and have VA experts available at those sessions.

So we are aware of potential problems, Guard and Reserve, and

we are working hard to try to find solutions to the process to alleviate those.

General SCHOOMAKER. Let me add one additional comment to my

earlier comments.

When we have looked very carefully at one of the critical steps

in adjudication of disability for both Reserve component and active

component soldiers, you need to understand, Congressman, we

have not found any systemic evidence that the two are treated differently at that level. I think much of what you are describing is

a perception at our facilities. What Mr. Dominguez said and what

the Admiral said is exactly right—when they get back out to their

communities, it is very hard for us to reach out and touch them,

and we are working very actively to try to find the resources necessary to extend that care.

But certainly at the point of separation and adjudication of disability, Reserve component soldiers sit on the boards that adjudicate their disability, and we have found no evidence, in looking

back at those adjudications, that there is any systemic bias.

Mr. TIERNEY. Thank you, Mr. Turner.

Mr. BERTONI. Excuse me. Can I offer up just a quick observation?

Last year we actually did a study for the Armed Services Committee where we were asked to look at disparities in the ratings

system for Reservists and active duty. We did a very sophisticated

analysis of outcomes, and it is true we couldn’t find a real disparity

between the ratings level between Army active service members

and Reservists, but we did find that the Reservists were less likely

to receive disability retirement benefits as well as lump sum benefits. The data was insufficient for us to determine the reasons for

that. It just wasn’t available.

We think a couple of things were going on. I think one of the

things was the 8-year pre-existing condition rule. A Reservist entering the service in 1985 fulfilling all the obligations of his commitment or her commitment going on a 1-year tour of Iraq and Afghanistan, by 2005 that person would only have 6.9 years of creditable service and would fall within the 8-year pre-existing condition rule, so that is certainly a factor.

Generally, time and service would come into play also. If they

didn’t have the 20 years, they certainly wouldn’t get the 20 years

in that period of time based on based on Reserve status.

I testified before the Dole/Shalala Commission on this issue and

brought forth a couple of points.

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There are 26,000 service members assessed through DOD’s system in 2006 or 2005. One in four of those was a Reservist, so not

only do we have more Reservists making up a larger share of our

military force, but we also have more Reservists coming in and

seeking disability services, so I think we really need to look at our

policies currently and whether they are serving the Reservists.

Mr. TIERNEY. Thank you.

Thank you again, Mr. Turner.

Mr. TURNER. Thank you, Mr. Chairman.

Mr. TIERNEY. Ms. McCollum.

Ms. MCCOLLUM. Thank you, Mr. Chairman. Thank you for the

followup that you have been doing on this issue, because quite

often it comes to light and then there is a lot of excitement and

people are making plans, and then no one follows up to make sure

the plans actually are implemented, so thank you so much for this

hearing. I thank the gentlemen here today for their testimony.

I am not a stranger to the VA system. My father was a disabled

vet. I am a regular fixture quite often at our VA facility in Minneapolis. I would like to commend the work that I have seen done

in the poly trauma units, the lessons learned from the roll-outs as

the units have gone through, the video linking with the families

being present and the doctors speaking to one another with the patients. So there has been a lot of work done in there because basically you were starting from ground zero, so you could kind of invent the platform that you wanted to work off of using updated

technology.

But that is not necessarily the case you see in the other parts

of the VA system. One area, even in the poly trauma unit, that I

am concerned about is the Department of Defense person that is

assigned there to make sure that the flow of the paperwork goes

forward. Most of that time that person is there for 3 months. It is

not a career maker to be assigned to that unit, and so there even

might be people who look at this as something that, if they can get

transferred out of quickly, that they will. I think that service in

that unit has a lot to offer for families.

The Marines, however, have decided to make this a priority, and

the Marines that I have spoken with at our facility in Minneapolis

are planning on being there for a year.

My comments now shift more to GAO. One of the things that we

heard Mr. Dominguez say is, as we go through with the disparities

rating, DOD is looking at moving forward with the VA disability

rating. I turn my attention to page 17 of the GAO report, and there

are two things on there I would like to have you comment on. One

is the lack of confidence that our service men and women often

have in the disability rating system, both in DOD and possibly VA.

And second is the way in which the VA’s rating system needs to

be updated to reflect what is currently going on in today’s labor

market. Maybe if you could even comment, I had many people I

case worked with, airline mechanics receive shoulder injuries, arm

injuries, they were very concerned about their ability to return

back to work and return back to work at a level which would allow

them to move forward.

The other issue I would like to see addressed, and DOD and VA

keeps talking about their plans. You folks did the study. I haven’t

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seen any budgets on how these plans are going to be implemented.

I mean, we need to know. I serve on the Appropriations Committee.

We need to know what we should be setting aside to appropriate

to make these plans become a reality, both in the transfer of technology and what this is going to mean to staffing personnel.

Mr. Chairman, the buzzer is going off, but I would just also like

to bring to the Chair’s attention there is concern that traumatic

brain injuries might lead to epilepsy for some of our service men

and women later on in life, and my understanding is the VA, where

they are in working with NIH to make sure that this is addressed

and is not considered a pre-existing condition, ignoring that.

Thank you, Mr. Chair.

Mr. TIERNEY. Thank you very much, Ms. McCollum.

Mr. Lynch, do you have any objection? Mr. Hodes apparently has

another meeting to go to and he has asked to ask a question before

he leaves. Does that fit with your schedule, or do you also have a

place to go?

Mr. LYNCH. Well, we have votes.

Mr. TIERNEY. We have two people to question before we go.

Mr. LYNCH. I’m sorry?

Mr. TIERNEY. We have both Mr. Hodes and you, will you be able

to get your questions in before we go.

Mr. LYNCH. Yes. I have no problem.

Mr. TIERNEY. Great.

Mr. Hodes, please proceed.

Mr. HODES. Thank you, Mr. Chairman, and thank you for holding these hearings.

As you are all aware, these matters first came to prominence

with articles about substandard care at Walter Reed that appeared

in the Washington Post, and among the results of the articles and

initial hearings was the testimony by Sergeant Shannon, who had

lost an eye, suffered head trauma, and testified about languishing

at Walter Reed for 2 years, and he talked about the difficulties he

had had.

Now here we are in September, with all the attention that has

been paid. We met Sergeant Shannon on Monday. He is back in the

newspapers again. There was an article about his retirement papers having been lost, and he is now going to have to wait until

December or January before he can retire.

The subcommittee went to Walter Reed on Monday, and we

thank you, General Schoomaker, for briefing us and for telling us

about your efforts. We had the opportunity to meet with a large

group of soldiers in a room without brass, and we heard horror stories from them. They told of case managers who are unqualified,

not doing their job, not up to the task. They told us of delays in

pay or not receiving the awards due to them for their service to the

country. They told about continuing to languish at Walter Reed for

months or years. They told about continuing problems with scheduling medical appointments so that they were basically jerked back

and forth about their scheduling. One soldier said to us sarcastically, ‘‘Walter Reed was the best place I have ever been incarcerated.’’

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When we asked them whether they prefer to go back to Iraq or

be in Walter Reed, nearly all of them said they wanted to go back

to Iraq.

I have a constituent who turned to me to help him because he

has been experiencing the same kind of thing on an ongoing basis,

and I have been advocating for him within the system. He had to

turn to his Congressman to advocate for him within this system.

The Army apparently will agree that Walter Reed’s problems are

a microcosm of those found throughout the Army. I would like to

know first why are these horror stories still continuing as of our

visit on Monday, No. 1?

No. 2, I would like to move on to questions about the case management system. But why are we still hearing this?

General SCHOOMAKER. Well, I think that is a difficult question.

You met with 31 or 34 soldiers, I believe, on Monday when you

went a self-selected group of soldiers, in large measure, who wanted to talk to you. We have 680 soldiers in that category right now

at Walter Reed, and so you have seen a subset of the whole population.

I would venture to say that every one of the soldiers that you

saw has an individual case with an individual set of family or personal problems and we have to work through each and every one

of. This is a difficult time in the lives of all of these soldiers. We

acknowledge the fact that we start off in a difficult position with

them trying to establish trust and a relationship. They have gone

into the Army, or in some cases they have gone overseas, and have

come back not the same people that they went. We start at a disadvantage. We try to rebuild that relationship, but we aren’t always successful in overcoming all of the problems these soldiers

face.

All I can tell you, Congressman, is if you give me details about

each and every one of them, we can address them through the devices that we have, acknowledging that we continue to seek solutions to this single adjudication process that has already been alluded to by our leaders within the DOD and the VA. That still represents and represented for Sergeant Shannon one of his hot button points, as they approach the final adjudication of their disability, it elicits enormous anxiety and resentment about their service

and how we are treating them and how we as a Nation see their

service.

If you give me details about any of those horror stories, sir, I will

personally take them on.

Mr. HODES. Is it your testimony that the soldiers who we visited

with on Monday are not representative of the active duty outpatient population at Walter Reed now?

General SCHOOMAKER. Yes, sir. I would have to say that is true.

I was placed in that position to solve the problems of Walter Reed,

and if at the end of this period of time, with all the efforts that

we have put into it, if all of the soldiers at Walter Reed are characterized by what you just described, I would say that I have been

a failure as a commander and I should be held accountable.

This is not the general rule. I can’t say that every soldier is

happy with what is going on in their lives. As I explained before,

they start at a disadvantage. They have come back ill or injured.

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They are going back into communities, some of them unable to resume their employment. But no, sir, I would not say that this characterizes the rule for our soldiers.

Mr. HODES. I see my time is up.

The only comment I would make, General, is I appreciate the

task that you have undertaken in trying to reform the way things

are done, but I suggest to you that if there is one horror story at

Walter Reed, then there is room for accountability, and it should

not be up to Congress to tell you who is having problems, but for

you and your staff and the case managers to find out who is having

problems and address them as quickly and completely as possible.

Thank you, General.

Mr. TIERNEY. Thank you, Mr. Hodes.

Mr. Lynch.

Mr. LYNCH. Thank you, Mr. Chairman.

I want to thank the panelists for attending, as well, helping the

committee with its work.

I have a couple of questions, and they are related.

As previously noted by the GAO in its March 31, 2006, report,

the Department of Defense grants each of the branches of the service considerable discretion in how it evaluates disability. That is

with, one, respect to a determination of whether the service member is fit to duty, and second, with respect to the assignment of disability ratings. Specifically, each branch of the armed services manages its own physical disability evaluation system, which includes

the MEB, the Medical Evaluation Board, and the PEB, the Physical Evaluation Board.

I asked the Department of Defense to send me the numbers on

how each branch of the service handles these evaluations for disability. I was surprised. Well, maybe I shouldn’t have been, but I

was. When you take the Navy’s numbers, and those include the

Marines, they basically had determination rate of about 35 percent,

either totally or temporarily disabled, 35 percent for the Navy. The

Air Force has about 24 percent. The figure that really stood out to

me was the Army. The Army has about 50 percent of all of the disability claims before it, and it approves only 4 percent. That is 4

percent compared to the other branches for permanent and then 15

percent for temporary disability.

Now I hear today from Mr. Dominguez that we are going to

merge the standards of the DOD with that of the VA, and I think

it was Mr. Bertoni who said earlier today the VA has a 400,000

case backlog. I know from my own personal experience dealing with

my veterans back home in the Ninth Congressional District of Massachusetts that I have typically an 8-month waiting period before

one of my vets can go see a doctor, a VA doctor. I am afraid of that,

you merge two systems.

I associate myself with the remarks of Mr. Hodes earlier. We met

with 30 to 35 soldiers at Walter Reed on Monday who were very,

very unhappy, and the chief complaint, if I could generalize, was

the mind-numbing bureaucracy that they have to deal with in getting treated with dignity and respect and having their cases resolved.

It varied. Some felt they shouldn’t be there, they were fine, and

they wanted to go back with their units. They wanted to go back

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as war-fighters. Others were being held for more-extensive injuries.

There were some amputees who certainly needed to be there, but

also needed to have their cases dealt with in a more expeditious

manner.

Given the different standards here, you have a military DOD system that evaluates a soldier based on their fitness for duty, given

their rank and their responsibility. That is the DOD standard. The

VA system is looking at their employability as a civilian and they

are basing their disability evaluation on that standard.

When you merge these two, I am afraid you are going to discount

the first, Defense Department disability based on their actual injuries, and you are going to moderate that because you are going to

find some type of employability on the other end. I am just very

concerned about the merger of these standards. I want our warfighters to be treated with the dignity and the respect that they deserve, but I have to raise a fair amount of caution here because of

the two standards.

Let me throw it out to all of you. How do we basically, No. 1,

eliminate the disparity between the Navy, the Marines, the Air

Force, and the Army, and then at the same time reconcile the differences between the two standards, one a civilian standard and

one a military standard in evaluating these disabilities?

Mr. TIERNEY. Mr. Lynch, if I can interrupt for a second, I am

going to give you the option to pick one and ask them to answer

in 30 seconds. You have 3 minutes to vote. We will come back and

you will be the first to address them when we come back.

Mr. LYNCH. OK. I pick the first one.

Mr. TIERNEY. What is that?

Mr. LYNCH. We are going to come back?

Mr. TIERNEY. We are going to come back.

Mr. LYNCH. Why don’t we come back?

Mr. TIERNEY. All right. Thank you all very much. Another 10-

minute interruption for votes, and we will see if we can get there

in 3 minutes or not. Thank you.

[Recess.]

Mr. TIERNEY. The subcommittee will resume.

Mr. Dominguez.

Mr. LYNCH. Would you like me to restate the question, Mr.

Chairman?

Mr. TIERNEY. No, thank you, Mr. Lynch. It was a 5-minute question.

Mr. Dominguez, go right ahead.

Mr. DOMINGUEZ. Sir, let me first address how this process will

work. The first is that there will be a single, comprehensive medical exam, and it will be done to standards using a template that

the VA provides so that we can make sure we document the medical condition, each and every medical condition in it, so it is documented. So if there is an issue with a joint, then the circumstances

around it and the degree of flexion of the joint, and those kind of

things, are all documented so that the down-stream actions can all

be taken and formed by that.

That exam will go to a PAB—Personnel Evaluation Board—

which is military members who will use that information and look

at the medical conditions, and bump that against the standards for

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performance of a job within a unique individual’s service and within a skill and within a grade and specialty. So the decisions then

are being made based on a medical description against a service

specified standards for this individual to do his or her job.

Once that evaluation board determines that the individual is

unfit and will likely have to leave the service, that case file is then

forwarded to the DVA rating examiners. It is only at that point

that a rating is associated with the condition. That comes back to

DOD for one decision only, which is, ‘‘Are you separated or retired?’’ That is how we would use it in our process. And, of course,

the current law provides the degree of retirement pay you are entitled to. This is also a function of the degree of the disability above

30 percent. At 30 percent you are retired. Above that, it affects how

much you are paid in your DOD retirement annuity.

Of course, you have all the appeal rights, etc., but that is how

we would use it. So we are using medical information to make this

military determination, and that determination is different by each

service, because each service standard for what is required to do

the job is different and unique.

You can be an airman with an injured back but not an infantryman, because you wouldn’t be able to carry the rucksack, for example.

I hope that answers your question sir.

Mr. TIERNEY. Ms. McCollum, did you want to ask Mr. Lynch to

yield?

Ms. MCCOLLUM. Yes. Mr. Lynch, would you yield?

Mr. LYNCH. I would. Yes.

Ms. MCCOLLUM. Explain to me how the National Guard gets figured into that, which was part of my questions that I had asked

earlier. I am a highly trained airplane mechanic. I am called up,

active duty. Let’s say my shoulder is destroyed. I can’t go back to

work as an airline mechanic any more. What do you do for that individual?

Mr. DOMINGUEZ. Ma’am, there were two parts to the question.

Assuming you were a National Guardsman airplane mechanic in

the Guard and we found your condition unfitting and determined

that you needed to be retired, just like any member of the armed

forces, you would then be retired by the Disability Board. You

would be given a retirement annuity based on the level of disability—in the pilot, again, assigned by a DVA rating panel. Then, by

that time the VA will already have your records. They will have

already determined the degree of disability. You would be then

compensated——

Ms. MCCOLLUM. Excuse me, Mr. Chairman. I am not talking

about somebody who was an airline mechanic and that was part of

their job in the National Guard. We have people who are DOD employees who do an excellent job of maintaining aircraft to St. Paul/

Minneapolis and Homeland Field in St. Paul. I am not talking

about those. I am talking about the gentleman who was called up

for active duty who works for Northwest Airlines and can’t go back

to work. What do you do for that individual?

Mr. DOMINGUEZ. Once they are retired from the DOD they then

go to the DVA, and it is Admiral Dunne’s challenge at that point.

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Mr. TIERNEY. Nice hand-off, Mr. Dominguez. I have to hand it to

you, that was good.

Admiral DUNNE. When the claim is filed and the medical condition is evaluated in accordance with the VA templates, not only the

shoulder, but any other condition which the veteran identifies and

we have a medical evaluation of is taken to the ratings schedule,

and based on the ratings schedule the disability percentages are

applied for that veteran for every item that they claim.

Mr. TIERNEY. Thank you.

Mr. Shays.

Mr. SHAYS. I thank you, Mr. Chairman, again for doing this

hearing.

I am somewhat conflicted by the challenge that you have to face,

General, and the others. When we came and met on Monday I felt

that I was meeting with a representative group of traumatic brain

injury soldiers, and others, dealing with some very real, as they

said, mental issues. I didn’t feel we were dealing with some of the

other physical challenges. So to that extent I do agree it is not representative, but it is representative, it seems to me, of those who

are dealing with brain injuries and so on.

On one side we had a group that was complaining that they

weren’t being discharged, and on the other side we had people who

were afraid that someone might say something was wrong with

them and they couldn’t go back into the service.

I tried to put myself in the position of a doctor. If you believe

that some are there because they are soldiers and Marines and others and they want to go back, but they may not be well enough to

go back, I am struck with the fact that as a physician you have a

difficult task. You have to try to see who is not qualified to go back

and who need to be discharged, and neither side may like your outcome.

Now, the one thing that I was struck with, though, there was one

physician in particular. One doctor that almost everyone there,

anyone who came in contact with him—no one defended him—that

he was disrespectful, biased against Guards and Reservists, and

some said incompetent. We have heard complaints about this doctor by others, because our staff does extensive work. Evidently he

seems to be a key player, and I have a feeling, General, that you

may know which one this is because there is one who clearly gets

a lot of complaints.

Without discussing the individual, what is the argument that he

still is there?

General SCHOOMAKER. Well, first of all, let me just make it very

clear, the two points you have made I think are very good ones.

Virtually every soldier I have ever met in a military hospital, even

our amputees under the most desperate circumstances, wants to go

back to war, wants to go back where their colleagues are. It is

heartbreaking to have to tell people that they cannot serve in the

capacity that they came into the service, especially when they are

leaving an active theater war.

It is very difficult to work with patients who have a variety of

disabilities and problems that are going to keep them out of that.

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nity. In general it falls to the line commander who is part of that

equation.

Mr. SHAYS. It is difficult. I just want to interject myself. When

you hear of people being there for a year, 18 months, you begin to

think there clearly are some breakdowns there, I just want to say

parenthetically.

General SCHOOMAKER. I mean, again, I am very careful about not

making generalizations, because as I have said in many forums,

every patient and every family is different.

One of our heroes is Retired General Freddy Franks, who came

back from Vietnam and ultimately lost a portion of his leg. He was

21 months in an Army convalescent hospital at Valley Forge and

returned to duty. He ended his service as a four-star general. He

was the Corps Commander that took the Seventh Corps in the first

Gulf war into Iraq. So every time I am given a timeline to hold a

soldier to, I am always pointing out that is not fair.

Mr. SHAYS. What about this doctor?

General SCHOOMAKER. The doctor in question, his care has been

looked at very carefully by other physicians in his practice, and his

care objectively has always been determined to be appropriate.

What I was led to believe was that he was taken out of the front

line of caring for these patients.

I will have to go back, sir, and just confirm whether they are

talking about prior events and encounters with him. What we have

moved toward very, very firmly at Walter Reed and across the

Army are dedicated, in a sense, institutionalized MEB doctors—

Medical Evaluation Board doctors—whose specialty, in a sense, is

to take care of the Medical Evaluation Board. But I will take that

question and get back to you for the record.

[The information referred to follows:]

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142

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Mr. SHAYS. I see a yellow light, but let me ask this: In regards

to the Board, there seemed to be tremendous fear on the Board. Is

that simply because the Board basically plays God on what happens to these individuals?

General SCHOOMAKER. You are talking about the Physical Evaluation Board, sir?

Mr. SHAYS. Yes.

General SCHOOMAKER. Yes, sir. I think for the average soldier

this is especially true. Ms. McCollum I think hit a very important

point. I mean, soldiers come in. They are declared unfitting for the

service and for the role that they play in the service, but they go

back into other civilian roles. They can’t go back. Maybe they come

in and serve as an infantryman, but they are going to go back and

walk a beat as a policeman or woman. What they face is what is

going to be life for them now and their family.

They know that there is a threshold of 30 percent disability. The

30 percent disability renders them eligible for TRICARE healthcare

benefits for themselves and for their family. Everybody knows

within my hospital, and everybody within the Medical Evaluation

Board system knows, about the 30 percent, but if the unfitting condition that renders you unfit to serve in whatever capacity you are

that only gives you 10 or 20 percent, and by policy and by law, as

I understand it, we are limited to that even if the VA later adjudicates all of the associated injuries or illnesses as giving them

more than 30 percent. We are held to the unfitting condition, and

so they may be separated with a single lump payment, and no

healthcare benefits for their entire family that they would get if

they reached the 30 percent disability rating.

I think that is going to remain a hot button item under any disability evaluation system that we have, and that has to be resolved.

Mr. SHAYS. Just an ending comment. Thank you, Mr. Chairman.

That did come up continually about their health benefits. Their

health benefits almost seemed more important than any financial

benefit they get, and it may behoove us to look at that issue and

see what kind of flexibility could take place.

Mr. TIERNEY. Thank you, Mr. Shays. And it was a point that

came up again and again, and that adversarial nature is what results from that. I mean, I think that we are going to look at that

as part of that, look and see whether or not on the other end coming out, whether something can’t be done with healthcare, work on

that.

Is there any member of the panel that would like to ask another

question, that feels some business has gone unfinished from their

perspective?

Ms. MCCOLLUM. Are they going to answer the questions that I

asked before you started collectively gathering the questions?

Mr. TIERNEY. If you have another question you want to ask, or

you don’t feel was responded to, you could ask it here if you like.

Ms. MCCOLLUM. They didn’t have an opportunity.

Mr. TIERNEY. Well go ahead and ask.

Ms. MCCOLLUM. I had asked about refreshing the VA’s disability

standards. The distrust that kind of exists between the servicemen

and women with the Disability Rating Board, and I think that

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came forward because most people get turned down the first time.

That has been my experience quite often, and they are going

through an appellate process and it is long and it is cumbersome.

So you would need some suggestions on that.

And then the other question I had to kind of capsulate, so we can

wrap up is: all of these plans and programs that have been put in

place at the hospitals for the poly trauma unit, for having the case

worker be there—and I am probably using the wrong term now—

the Department of Defense person there, to help with the paperwork and to move things forward being there longer than 3

months. The budget being built in for all these new people that are

being added as case workers, the money that is going to be needed

to update these systems so that they are workable for transferrable

records and make it seamless for the soldier, their families, and the

doctors involved. I haven’t seen a budget for that.

I have seen plans, lots of ideas, things being painfully implemented, in a slow process. But this Congress needs to have a budget so that we do it right, because I am assuming that the Department of Defense or the VA can’t take this ‘‘all out of hide.’’ These

are big price-tag items, and I am on the Appropriations Committee,

and to the best of my knowledge I haven’t seen a budget for them.

So I was asking for the gentleman here who conducted the review

to let me know what they thought about that.

Mr. PENDLETON. We haven’t seen the budget figures either. Our

understanding is that the costs, the incremental costs, will be included as part of the President’s budget. That is one of the initiatives of the Senior Oversight Committee, and you have representatives here. We have outstanding requests for that, but we honestly

at this point don’t know.

Ms. MCCOLLUM. Mr. Chair, could I ask DOD and VA? It has

been ongoing. It has been 10 years since you have been going to

integrate your records. Certainly you have a budget some place

that we can look at, and look at today. Do you not?

Mr. DOMINGUEZ. The budget that supports the integration and

the sharing of information in the medical organizations is funded.

It is part of the budget that was submitted in 2008. It is in the

TRICARE piece of the budget. I will get back to Dr. Fissells. We

can try to pull that out for you for the record.

They will be certainly in the 2009 President’s budget submission

changes to that, because we will be accelerating those activities.

In the case of the standing up to Warrior Transition Units and

those kind of staffing and those issues, because that happened in

2008 the DOD and the services took that ‘‘out of hide’’ in terms of

reprogramming in 2008. There may have been something in the

supplemental that helped us. In fact, the Congress appropriated a

huge amount for TBI and PTSD—for which we are deeply grateful—which really did accelerate a lot of the thinking and the activity and our ability to respond to those crises.

But in the 2009 submission of the President’s budget, we will

make sure that these activities are called out to your attention

when the President submits that budget to you.

Ms. MCCOLLUM. Mr. Chair, could I ask GAO then why weren’t

you able to get the budget numbers?

145

Mr. DOMINGUEZ. I was referring to future estimates for the new

initiatives. I don’t know that they have been created yet.

Mr. TIERNEY. Thank you.

Mr. Shays, do you have a couple of final questions?

Mr. SHAYS. First off, the GAO has really pointed out that DOD

and the VA have been trying to work for 10 years to integrate and

to share information, and there has to be a point where there is

going to be some success here. The only thing I can conclude is it

is just simply not a high priority.

I would like to ask GAO two questions: what do you believe are

the greatest challenges to the implementation of each of the recommendations of the Dole/Shalala Report, and by each of them just

give me some of the highlights, because we have been here very

long? So what do you think are the greatest challenges to the implementation of these recommendations?

Mr. BERTONI. Of the Dole/Shalala Report?

Mr. SHAYS. Yes.

Mr. BERTONI. In hearing the VA testimony, I took down some

notes. It looks as though they have gone with a single comprehensive exam done to VA standards using VA templates. So we call

that the Dole/Shalala light option of the four that we looked at. All

the other options had the VA doing the exam as well as the rating.

So it looks like they are moving toward the Dole/Shalala portions

that don’t have to be addressed in legislation, which is a single

exam and a single rating.

I think folks on both sides agree that is probably the way to go.

They had the single exam, and had the single rating.

In terms of the two bureaucracies, I think there might be some

push-back or concern as to who should actually have it in the end.

I mean, changing management is going to be difficult. I think you

need management support at the top. You need a plan. You need

change agents within the agency to sort of convey to the troops and

the bureaucrats that we are moving in this direction, and you need

some early wins. If they go in this direction and implement the

pilot, if they could show that they have substantially decreased

timeframes, that is some early wins that can gain momentum. So

that can help.

I am concerned that they may not be paying enough attention to

accuracy and consistency, sort of the three-pronged issues that we

have identified. If the system is not viewed as being accurate and

consistent, we are back to service member distrust, congressional

oversight, all these things that brought us here today. So that is

certainly an issue.

Generally, getting in front of the implementation before considering all of the unanswered questions is of concern to us. We would

be interested in seeing how they arrived at this decision—the data

that drove that decision. In our view it should be a data-driven decision outside of the politics and other contexts.

I think, in general, again, large agency transformation is going

to be difficult. This is larger than just re-engineering.

Mr. TIERNEY. Would you yield for 1 second, Mr. Shays?

Mr. SHAYS. Absolutely.

Mr. TIERNEY. Mr. Dominguez, would you have any objection to

your department and Admiral Dunne sharing that information

146

with the Government Accountability Office so that they could do

analysis, look at the data upon which you based your determination to go to this particular pilot program so that we, as a panel,

could then in turn ask the Government Accountability Office to

give us their assessment of that?

Mr. DOMINGUEZ. Yes, sir. We are happy to share with the GAO.

Mr. TIERNEY. We will ask the Government Accountability Office

to take a look at then, and give us some idea then of what your

views are toward that data.

Mr. BERTONI. Sure. And to date the information exchange has

been very good. I must say that we have had a lot of cooperation.

We have been riding herd as these things move forward and asking

for information as it is being produced.

Mr. TIERNEY. Which is what we want.

Mr. BERTONI. And we intend to ask.

Mr. TIERNEY. And hopefully what this will continue to do is give

us better insight as well.

Do you have any other questions, Mr. Shays?

Mr. SHAYS. I think Mr. Pendleton wanted to respond.

Mr. PENDLETON. Yes. We laid out in our statement the challenge

of placing these recovery coordinators. Dole/Shalala recommended

that these recovery coordinators come from the Public Health Service. The idea was that they be significantly high ranking and able

to sort of break down bureaucracies, and I think not necessarily in

either of the departments.

The decisions that DOD and VA have made, I think, are these

are going to be placed in VA. That can work, but I think that is

going to require careful lines of accountability and other things as

it goes forward.

In terms of the information sharing, which you touched on, there

has been some progress made. I think the most important thing

that I saw in our review is there is a mark on the wall now. October 31, 2008, DOD and VA have committed to have all information

viewable, administrative and health information. So there is now

a mark on the wall for that.

I am not necessarily familiar with the history. There may have

been previous marks on the wall, but there is one here.

In general, I think follow-through after the limelight fades, the

spotlight fades, is what is going to be more important. These plans,

many of them are quite solid, are well thought through. I think the

continued accountability, oversight, and keeping track of how well

these things are being implemented, is going to be key over the

long haul.

Mr. SHAYS. I thank the gentleman.

Thank you, Mr. Chairman.

Mr. TIERNEY. Thank you.

We have no intention of letting down the oversight from this end

of it, and I know each of the departments feels a responsibility to

do their own oversight. So I hope we are going to err on the side

of too much oversight as opposed to too little on that much to the

chagrin of some out there maybe, but I think it behooves us all to

do that.

Can either Admiral Dunne or Mr. Dominguez give me the answer as to why the decision was made to not use Public Health

147

Service Commission Corps, or similar people, instead of VA people

as these recovery coordinators?

Admiral DUNNE. Sir, I think we are going to work with the Public Health Service as we put this recovery coordinator system together. Our two lead change agents, the two Deputy Secretaries of

VA and Department of Defense, have signed out a memo which

says that we are going to put together a program that will recognize that Public Health Service has a consulting role with this, be

part of the evaluation, etc.

Mr. TIERNEY. But, it will not be the actual recovery coordinators.

Is what you are saying?

Admiral DUNNE. The plan as put together now would have VA

employees, new VA employees, being the recovery coordinators.

Mr. TIERNEY. What do you propose to be the chain of command

in that? This recovery coordinator, as I understand it, is going to

be above the triad of individuals that General Schoomaker has on

bases.

Admiral DUNNE. Correct.

Mr. TIERNEY. And who are they going to report to, or does the

buck stop with them? Are they the patient’s advocate, or are they

the department’s advocate?

Admiral DUNNE. They are the patient’s advocate, sir.

Mr. TIERNEY. And they get to make the final shot, or do they

have to report up to somebody else?

Admiral DUNNE. They will be of a position description such that

they have the seniority and the presence of mind to be able to understand the system and know when it is time to say, based on

common sense, somebody needs to do something here and fix this

problem. They will be coordinators.

Mr. TIERNEY. And they will have sufficient rank so that when

they say, somebody will jump?

Admiral DUNNE. That is the intent. Yes, sir.

Mr. TIERNEY. OK. Thank you.

Admiral and Mr. Dominguez, the SOC is set to expire in May

2008. Are you going to be done by then?

Admiral DUNNE. Sir, we hope to have made significant progress

by May 2008, but that date was picked back in May of this year

as a goal. We are going to work toward that goal, but we still have

the Joint Executive Council, which is a joint VA and DOD organization that will pick up the mantle and continue to follow through

on anything that the SOC puts in place.

Mr. TIERNEY. Thank you.

Mr. DOMINGUEZ. Sir, if I might just add?

Mr. TIERNEY. Sure.

Mr. DOMINGUEZ. The SOC was envisioned and created as a crisis

response organization to drive change fast. The changes that get

implemented then will transition to the day-to-day oversight of this

Joint Executive Council. That is where these changes will be institutionalized, implemented, and sustained for all time.

Mr. TIERNEY. Thank you.

We are going to have additional oversight hearings. It would be

helpful for us to determine, and ask for your cooperation with our

staff on this, on whether we ought to have individual hearings on

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ability Office—in other words, a hearing on disability evaluation

and that process, a hearing on TBI and PTSD and that situation,

one on data sharing, and one on the Warrior Transition Units and

their staffing on those matters, or whether we will have another

one in the aggregate.

Could each of you just, in a couple of words or less as we go down

the line here, tell me when do you think would be an appropriate

time for us to check back when we should be able to have answers

to those, as to how we are proceeding, and a good idea that we are

getting well along in our progress?

Mr. PENDLETON. On the issues relating to continuity of care, that

is pretty much new work at GAO, and we haven’t done a lot of tire

kicking yet. We want to get out to some units and see what the

impacts are of some of these staffing shortfalls. It would take us

a couple of months probably to be able to give you much new on

that.

Mr. TIERNEY. OK. And everything else?

Mr. PENDLETON. On the information and technology we have experts at GAO that have been working on that for a long time. I

think they could come and have a hearing. They are following that

actually quite closely, and we cribbed some of their work for this.

On the TBI/PTSD, we have a team following that as well. There

was a mandate for us to look at that in the National Defense Authorization Act last year. That team is starting up, but much like

the continuity of care work that we are doing, it is relatively new.

Dan leads our disability specialty.

Mr. BERTONI. Out of 14 or 15 engagements I have had, I probably have eight right now that are VA or DOD looking at the benefits delivery, discharge system, vocational rehab for returning warriors, overlaps, and inefficiencies in the system. We are about to

kick a job off on looking at the temporary disability retirement list

for TBI patients and just a range of work that is relevant to what

is going on here now. We have been doing it for a couple of months,

and, of course, in 2, 3, 4 months if we were asked to come up and

give you an interim report on any of those issues. We would be able

to do that.

Mr. TIERNEY. Thank you.

Mr. BERTONI. And certainly a final report in 8 or 9, 10 months.

Mr. TIERNEY. Thank you.

So when should we next look at what is happening at Walter

Reed and the other 29 facilities in terms of all of these overriding

issues?

General SCHOOMAKER. Well, sir, one of our milestone events is

going to be January 2008 when we say we will be fully operational

and capable for the Army medical action plan. I would say any

time after that we should be accountable for how we are doing.

Mr. TIERNEY. Thank you.

Mr. Dominguez.

Mr. DOMINGUEZ. Sir, my suggestion would be that we are ready

now on the IT interoperability plans, what is going on, where we

need to go. I think we are ready now on the PBI/PTSD. Again,

ready now means to talk to you about where we are in this process.

Lots of work in both of those in front of us, but we are ready now

to explain them to you.

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In terms of the disability evaluation system, we are not going to

actually walk people through that until November. I would say in

January is probably the right time again for you to take a deep

dive into that and how it is working, because that is when we are

actually going to startup the new system if all goes well.

Admiral DUNNE. Sir, I agree with my partner on the time lines.

Mr. TIERNEY. What a surprise. Thank you.

Let me just end. I want to make one last note with respect to

General Schoomaker. We heard some comments earlier about a

number of the soldiers with whom we met and their particular

cases on that. I think in fairness we ought to note that they were

just introduced to a new ombudsman’s process as of last Friday,

and you were kind enough to discuss it with us on the ride out to

Walter Reed the other day. Maybe spend 1 minute at least telling

us that there were three, I think, that you designated for Walter

Reed, and what you would anticipate their role being, and whether

they will be replicated, and when throughout the rest of the system?

General SCHOOMAKER. Thanks for giving me the opportunity to

talk about that.

It distresses me, no question, to know that we have a single case

within the hospital of a warrior in transition who is not pleased

with his or her care and administrative oversight. We have tried

to offer as many options for giving us candid feedback anonymously

or directly with attribution from these soldiers. One of which is the

ombudsman program. I think, sir, you had a great deal to do with

this, and that is patterned after ombudsmen in other realms besides health care, a truly objective arbiter that looks at the system

for the patient, looks at the system as a system and tries to figure

out where are the points of weakness, where are the points of solution for that particular patient.

We are bringing those folks on. We are making them available

to our patients in Walter Reed and across the Army.

Every soldier is also issued a 1–800 24/7 line that they can call

and seek help for themselves or their families. We are very, very

sensitive, especially in our Reserve component, about colleagues,

their access to answers as symptoms may emerge, or as realizations about their disability, or potential disability emerge, access to

information. That is available, too.

Mr. TIERNEY. Thank you very much.

I want to thank you. In fact, it was a previous member of my

staff that brought up the ombudsman situation, and you were kind

enough to accept the concept and work with him on that. He happened to be a veteran, himself. It is amazing to me the number of

veterans that are following what is going on with the progress on

this and feel very committed to it.

I thank each of you, gentlemen, for the commitment that you

have made to helping us make sure that something is done. I think

we are all disturbed. Everybody here is well intended. Everybody

here is working hard at it. We may have some disagreements about

whether it is fast enough, whether it might be done in a different

way, or how we can improve it; but, nobody should doubt the commitment that has been made to get this resolved. I look forward

to your cooperation, and we hope that together we will get this exVerDate 11-MAY-2000 14:52 Jun 27, 2008 Jkt 000000 PO 00000 Frm 00153 Fmt 6633 Sfmt 6633 C:\DOCS\42584.TXT KATIE PsN: KATIE
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pedited. We will put to it the sense of urgency that is needed, and

we will get the kind of treatment that our veterans deserve.

Thank you all very, very much and for suffering through the

interruptions that we have had today, as well. Thank you.

[Whereupon, at 1:18 p.m., the subcommittee was adjourned.]

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