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39–452 2008

FINDINGS OF THE PRESIDENT’S COMMISSION 

ON CARE FOR AMERICA’S RETURNING 

WOUNDED WARRIORS 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 19, 2007 

Serial No. 110–43 

Printed for the use of the Committee on Veterans’ Affairs 

( 


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COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

GINNY BROWN-WAITE, Florida 

MICHAEL R. TURNER, Ohio 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

Malcom A. Shorter, Staff Director 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


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C O N T E N T S 

September 19, 2007 

Page 

Findings of the President’s Commission on Care for America’s Returning 

Wounded Warriors ............................................................................................... 1 

OPENING STATEMENTS 

Chairman Bob Filner ............................................................................................... 1 

Prepared statement of Chairman Filner ........................................................ 32 

Hon. Steve Buyer, Ranking Republican Member .................................................. 3 

Hon. Harry E. Mitchell, prepared statement of .................................................... 33 

Hon. Jerry Moran, prepared statement of ............................................................. 33 

Hon. Ginny Brown-Waite, prepared statement of ................................................ 34 

WITNESSES 

President’s Commission on Care for America’s Returning Wounded Warriors: 

Hon. Donna E. Shalala, Co-Chair (former Secretary of Health and 

Human Services) ........................................................................................... 4 

Prepared statement of Secretary Shalala ............................................... 34 

Hon. Bob Dole, Co-Chair (former United States Senator from the State 

of Kansas) ...................................................................................................... 8 

Prepared statement of Senator Dole ........................................................ 36 

SUBMISSIONS FOR THE RECORD 

Disabled American Veterans, Joseph A. Violante, National Legislative Director, statement ....................................................................................................... 38 

Miller, Hon. Jeff, a Representative in Congress from the State of Florida, 

statement .............................................................................................................. 40 

MATERIAL SUBMITTED FOR THE RECORD 

Post-Hearing Questions and Responses for the Record: 

Hon. Bob Filner, Chairman, Committee on Veterans’ Affairs, to Hon. 

Donna E. Shalala, Co-Chair, President’s Commission on Care for America’s Returning Wounded Warriors, and President, University of Miami, 

and Hon. Bob Dole, President’s Commission on Care for America’s 

Returning Wounded Warriors, letter dated October 18, 2007, also transmitting additional questions from Hon. Joe Donnelly ............................... 42 

Reports: 

‘‘Serve, Support, Simplify: Report of the President’s Commission on Care 

for America’s Returning Wounded Warriors,’’ July 2007 .......................... 45 

‘‘Serve, Support, Simplify: Report of the President’s Commission on Care 

for America’s Returning Wounded Warriors,’’ Subcommittee Report and 

Survey Findings, July 2007 ......................................................................... 82 


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FINDINGS OF THE PRESIDENT’S COMMISSION 

ON CARE FOR AMERICA’S RETURNING 

WOUNDED WARRIORS 

WEDNESDAY, SEPTEMBER 19, 2007 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 10:02 a.m., in Room 

334, Cannon House Office Building, Hon. Bob Filner [Chairman of 

the Committee] presiding. 

Present: Representatives Filner, Snyder, Herseth Sandlin, Mitchell, Hall, Hare, Berkley, Salazar, Rodriguez, Donnelly, McNerney, 

Space, Walz, Buyer, Moran, Brown of South Carolina, Boozman, 

Brown-Waite, Turner, Bilbray, Lamborn, Bilirakis, Buchanan. 

OPENING STATEMENT OF CHAIRMAN FILNER 

The CHAIRMAN. This meeting of the House Committee on Veterans’ Affairs is called to order and we have a distinguished panel 

to address us this morning. 

As we all know, in March the President signed an Executive 

Order to establish the President’s Commission on Care for America’s Returning Wounded Warriors. That came in the wake of the 

Walter Reed scandal and I must say there were a couple of silver 

linings in that cloud we call Walter Reed. One was the Commission 

that was formed and your report, for which we are grateful. The 

other, of course, was, we were able to add in the various budget 

bills that went by over $13 billion of resources for veterans’ 

healthcare for this year over last year, because all of America understood that we are not caring for the veterans who came back 

from Iraq and Afghanistan the way they thought that we were 

doing and we should be doing. 

The Commission was charged with the task of examining the effectiveness of returning wounded servicemembers’ transition from 

deployment in support of the Global War on Terror to returning to 

productive military service or civilian society, and recommend 

needed improvements. 

That report, of course, was recently released and we will be hearing from the Co-Chairs of that Commission, Secretary Donna 

Shalala and Senator Bob Dole. I look forward to a frank discussion 

of your recommendations. 

Of course, we are all focused on how to serve our troops when 

they transition from the Pentagon to the U.S. Department of Veterans Affairs (VA) for their healthcare. In order for our troops to 


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experience the seamless transition that they deserve, the bureaucratic problems that prevent many from getting the care they need 

must be fixed. And while both VA and the U.S. Department of Defense (DoD) have made adjustments and changes over the last few 

years in an attempt to address these issues, many obstacles, as you 

point out, still remain. 

As Chairman of the Committee on Veterans’ Affairs, I am sensitive to the difficulties involved in coordinating the activities of the 

Department of Defense and the Department of Veterans Affairs. 

They have different missions. But we no longer have the luxury of 

time and we, as a country, must act. 

Right now, while we prepare to discuss this issue, our servicemembers are in harm’s way. Some of these brave men and women 

will be killed or seriously wounded. We have talked about the necessity of providing a seamless transition for a long, long time. But 

now we have a test as a Nation and this is a test that, with your 

help, we will pass. 

I want to welcome our two distinguished panelists. Donna 

Shalala was appointed by President Bill Clinton as Secretary of the 

U.S. Department of Health and Human Services (HHS) in 1993 

where she served for 8 years, becoming the longest serving Secretary of HHS in our Nation’s history. She directed the welfare reform process, made health insurance available to an estimated 

three and a half million children, raised child immunization rates 

to the highest levels in history, led major reforms of the Food and 

Drug Administration’s drug approval process and food safety system, revitalized our National Institutes of Health and directed a 

major management and policy reform of Medicare. 

You have dealt, Secretary Shalala, with large bureaucracies like 

the VA and DoD before this, and so we welcome your experience 

in implementing programs that work for people, not against people. 

Senator Dole, your story is well-known. But every time I read it, 

I am just amazed by your strength and courage. You were twice 

decorated for heroism, receiving two Purple Hearts for injuries and 

the Bronze Star Medal with combat ‘‘V’’ for valor. You joined the 

United States Army’s Enlisted Reserve Corps to fight in World War 

II and became a second lieutenant in the 10th Mountain Division. 

In April 1945, while engaged in combat in the hills of northern 

Italy, you were hit by German machine gun fire in the upper right 

back and badly injured, waiting 9 hours on the battlefield before 

being taken to the evacuation hospital before you began your recovery at a U.S. Army hospital in Michigan. And then, of course, a distinguished career in politics. 

So thank you both for your service, not only on this Commission, 

but I know your commitment to implementing the recommendations. You are not letting this just become something on people’s 

shelves. I asked both of our panelists what they were going to do 

and they said we are going to get this done. And so we welcome 

your energy, your enthusiasm, and the expertise that you brought 

to this adventure and we look forward to hearing from you. 

I would yield to the Ranking Member, Mr. Buyer. 

[The prepared statement of Chairman Filner appears on p. 32.] 


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OPENING STATEMENT OF HON. STEVE BUYER 

Mr. BUYER. Thank you, Mr. Filner. 

Secretary Shalala and Senator Dole, we thank you for your work. 

Your report is before us and we appreciate your service to our 

country. Our country continues to call upon you, and you always 

step forward willingly to serve others and that is what separates 

you from so many. So on behalf of the country, I extend my appreciation for your contribution. 

We are involved in a long war against terrorism. For this, the 

Nation’s mothers, fathers and spouses trust their sons and daughters and spouses to the Nation’s armed forces. They must be confident that they will be cared for should harm come their way. I 

believe that systems are still dysfunctional. The question is, are the 

bureaucracies, organizationally and culturally, ill-suited to make 

the bold changes necessary for a seamless transition? 

I have my questions, because the bureaucracy will tell us that 

they are on top of it, that they are fixing it. The bureaucracy has 

had 6 years of ground combat to fix this problem. We have developed new combat systems in the last 6 years, perfected new tactics, 

ushered in new governments. It is time our servicemembers and 

veterans have seamless transition. 

I personally have been fighting this battle over seamless transition since I arrived in Washington in 1992. From the year 2004, 

when I was a Subcommittee Chairman and a full Committee 

Chairman, I held 19 hearings on the issue of seamless transition. 

Legislation mandating the cooperation between the Pentagon and 

VA, Senator Dole, dates back to perhaps your memory. Nineteen 

eighty-two is when the mandate came from Congress and the Senate. 

So it is time our servicemembers and veterans have the seamless 

transition. It is why I was equally enthused when I heard that 

President Bush hailed your work product and directed that the 

Administration prepare legislative proposals reflecting your recommendations. I think I can speak for all of us here that we look 

forward to seeing these proposals. We expect to get those proposals 

soon so we can act to improve the care and the seamless transition 

that our Nation’s warriors are entitled. 

We look forward to your testimony and your candor is always 

welcomed. 

I yield back. 

The CHAIRMAN. Thank you, Mr. Buyer. 

You have as much time as you need and we will start with Secretary Shalala. Thank you again for your service. 


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STATEMENTS OF HON. DONNA E. SHALALA, CO-CHAIR, PRESIDENT’S COMMISSION ON CARE FOR AMERICA’S RETURNING 

WOUNDED WARRIORS (FORMER SECRETARY OF THE U.S. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES); AND 

HON. BOB DOLE, CO-CHAIR, PRESIDENT’S COMMISSION ON 

CARE FOR AMERICA’S RETURNING WOUNDED WARRIORS 

(FORMER U.S. SENATOR FROM THE STATE OF KANSAS); ACCOMPANIED BY EDWARD A. ECKENHOFF, MEMBER, PRESIDENT’S COMMISSION ON CARE FOR AMERICA’S RETURNING 

WOUNDED WARRIORS, AND FOUNDER, PRESIDENT, AND 

CHIEF EXECUTIVE OFFICER, NATIONAL REHABILITATION 

HOSPITAL, AND MEMBER, BOARD OF DIRECTORS, DISTRICT 

OF COLUMBIA HOSPITAL ASSOCIATION; MARIE E. 

MICHNICH, DR.PH., EXECUTIVE DIRECTOR, PRESIDENT’S 

COMMISSION ON CARE FOR AMERICA’S RETURNING WOUNDED WARRIORS, AND DIRECTOR, HEALTH POLICY EDUCATION PROGRAMS AND FELLOWSHIPS, INSTITUTE OF MEDICINE/THE NATIONAL ACADEMIES; KAREN GUICE, M.D., MSP, 

DEPUTY DIRECTOR, PRESIDENT’S COMMISSION ON CARE 

FOR AMERICA’S RETURNING WOUNDED WARRIORS, AND 

CLINICAL PROFESSOR OF SURGERY, MEDICAL COLLEGE OF 

WISCONSIN, MILWAUKEE, WI; AND SUSAN D. HOSEK, CO-DIRECTOR, RAND CENTER FOR MILITARY HEALTH POLICY RESEARCH, AND GROUP MANAGER, ECONOMICS AND STATISTICS, RAND CORPORATION 

STATEMENT OF HON. DONNA E. SHALALA 

Secretary SHALALA. Mr. Chairman, Mr. Buyer and sitting Members of the Committee, thank you for giving us the opportunity to 

testify today, and in particular with Senator Bob Dole, about the 

recommendations of our Commission—— 

The CHAIRMAN. Madam Secretary, can you pull the microphone 

closer to you—thank you. 

Secretary SHALALA. Thank you for giving me the opportunity to 

testify today. It is truly a privilege to serve, to have served on the 

President’s Commission on Care for America’s Returning Wounded 

Warriors, especially with Senator Dole, whose shrewdness and distinction as a great public servant and whose knowledge of this subject and dedication was really an inspiration to all of us. 

We worked hard, but we had an awful lot of fun and I learned 

a lot from him in the process. We were joined by a stellar group 

of Commissioners, each of whom gave their full energy and attention to the critical mission we faced. One of them, Ed Eckenhoff, 

who just arrived, of course, is the head of the National Rehabilitation Hospital here in Washington and one of the great experts on 

rehabilitation in this country and we are delighted to see Commissioner Eckenhoff here with us. 

As you know, we had an extremely short timeframe to complete 

our mission, but we were propelled by a sense of urgency that the 

issues before us required. Mr. Chairman and Members of the Committee, we know you share this sense of urgency and that is why 

we are pleased to be with you today to discuss not only our recommendations, but the critical need to implement them. 


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We have been truly heartened by the response to our report that 

we have received from Congress, from the White House and 

throughout the country. This country has rallied behind the need 

to help those who have put their lives on the line in service to our 

country and we are optimistic that the Congress and the Administration will move quickly to respond to this need by enacting all 

of our recommendations. 

We were reminded again in Saturday’s Washington Post the 

problems facing our injured service men and women have not gone 

away. Congress and the Administration have spent a great deal of 

time these past few weeks discussing the future of the war in Iraq. 

And while this debate is one that our Nation must have, I implore 

you not to forget about those who have already sacrificed so 

much—our injured men and women. They need to be front and center in the congressional debate and within the Administration. The 

story of Staff Sgt. John Daniel Shannon, as told in the Washington 

Post, is a story that we heard throughout our time with the Commission, a story of numerous case managers, none of whom held responsibility for spearheading an integrated care system, a story of 

lost paperwork and frustration, a story of a disability system that 

was in desperate need of repair. 

It is stories like this that sparked the creation of our Commission 

and stories like this that should and must drive immediate congressional and White House action. This past July, it was the Commission’s honor to present to the President, to Congress and the 

public, six groundbreaking patient and family centered recommendations that make sweeping changes in military and veterans’ healthcare and services. The recommendations include the 

first major overhaul of the disability system in more than 50 years. 

It includes the creation of recovery plans with recovery coordinators; a new e-Benefits Web site; and guaranteeing care for posttraumatic stress disorder (PTSD) from the VA for any servicemember deployed to Iraq and Afghanistan. Our report, Serve, Support, Simplify, is a bold blueprint for action that will enable injured 

servicemembers to successfully transition, as quickly as possible, 

back to their military duties or to civilian life. Our report calls for, 

and I quote, ‘‘fundamental changes in care management and the 

disability system.’’ I respectfully request that this report be submitted for the record, Mr. Chairman. 

Specifically, our six recommendations will immediately create 

comprehensive recovery plans to provide the right care at the right 

time and in the right place. We recommend that we completely restructure the disability determination and compensation systems, 

aggressively prevent and treat post-traumatic stress disorder and 

traumatic brain injury (TBI), significantly strengthen support for 

families, rapidly transfer patient information between DoD and 

VA, and strongly support Walter Reed by recruiting and retaining 

first rate professionals through 2011. 

Our 6 recommendations do not require massive new programs or 

a flurry of new legislation. We have identified 34 specific action 

steps that must be taken to implement the 6 recommendations. 

Only 6 of the 34 items require legislation, and that is what we will 

focus on today. A complete list of the action steps for the 6 recommendations is included on the last page of my testimony. 


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Let me summarize the first three actions that require legislation 

and then my colleague, Senator Dole, will cover the remaining 

three. 

The first is to improve access to care for servicemembers with 

post-traumatic stress disorder. We call on Congress to authorize 

the VA to provide lifetime treatment for PTSD for any veteran deployed to Iraq or Afghanistan in need of such services. This presumptive eligibility for the diagnosis and treatment of PTSD 

should occur regardless of the length of time that has transpired 

since the exposure to combat events. 

The current conflicts involve intense urban fighting, often 

against civilian combatants, and many servicemembers witness or 

experience acts of terrorism. Five hundred thousand servicemembers have been deployed multiple times. The longer servicemembers are in the field, they are more likely to experience events 

which can lead to symptoms of PTSD. The consequences of PTSD 

can be devastating. The VA is a recognized leader in the treatment 

of combat-related PTSD, with an extensive network of specialized 

inpatient, outpatient, day hospital, and residential treatment programs. Therefore, we ask that any veteran of the Iraq or Afghanistan conflicts be able to obtain prompt access to the VA’s extensive 

resources for diagnosis and treatment. 

Next, we ask Congress to strengthen the support for our military 

families. In our travels across the country, it has become abundantly clear that we not only need to help the severely injured, we 

need to help their loved ones as well. These loved ones are often 

on the frontlines of care and they are in desperate need of support. 

Therefore, we call upon Congress to make servicemembers with 

combat-related injuries eligible for respite care and aide and personal attendant benefits. These benefits are provided in the current 

Extended Care Health Option program under TRICARE. 

Presently, DoD provides no other benefit for caregiving. Yet we 

know that many families are caring for their injured servicemember at home, and many of these servicemembers have complex 

injuries. These families, forced into stressful new situations, don’t 

need more anxiety and confusion. They need support. Families are 

unprepared to provide 24/7 care. Those that try, wear out quickly. 

By providing help for the caregiver, families can better deal with 

the stress and problems that arise when caring for a loved one with 

complex injuries in their homes. 

We also recommended that Congress amend the Family and 

Medical Leave Act (FMLA) to extend unpaid leave from 12 weeks 

to up to 6 months for a family member of a servicemember who has 

a combat-related injury and meets the other FMLA eligibility requirements. According to initial findings of research conducted by 

the Commission, approximately two-thirds of injured servicemembers reported that their family members or their close friends 

stayed with them for an extended time while they were hospitalized; one in five had to give up their job to do so. That is simply 

unacceptable. 

Getting family members to the bedside of an injured servicemember is not a problem. The services have developed effective 

procedures to make this happen, and the private sector has stepped 

up to provide temporary housing. Because most injured serviceVerDate Aug 31 2005 00:23 Jul 31, 2008 Jkt 039452 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 E:\HR\OC\A452.XXX A452

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members recover quickly and return to duty, a family member’s 

stay may be short. However, for those whose loved one has incurred complex injuries, the stay may last much longer. Extending 

the Family and Medical Leave Act for these families will make a 

tremendous difference in the quality of their lives. Congress enacted the initial Family and Medical Leave Act in 1993, when I 

was Secretary of Health and Human Services. Since then, its provisions have provided over 60 million workers the opportunity to care 

for their family members when they need it most. We have tremendous experience and evidence with that Act. All of these family 

members have been able to care for a family member without losing their jobs. 

We were pleased to see the Senate has already unanimously 

passed the Support for Injured Servicemembers Act which implements this particular recommendation. We hope that the House 

will quickly follow suit. 

Mr. Chairman, having served in government for about half of my 

adult life, I believe that government can work to improve the lives 

of its citizens. But sometimes, people of good will want to solve a 

problem and their idea is to fix a problem by adding a program or 

a new regulation. What we have done in this report and the reason 

why it is short and very focused, is rather than simply coming to 

you and recommending new legislation on top of existing legislation, we have rethought existing programs. 

And one of the things we have done that is never done on commissions is that we have suggested simplifying the program itself 

so it is very clear who is responsible for what. And Senator Dole 

will be speaking to the disability provision that we have recommended. So don’t think of this as adding another piece of legislation that adds a program on top of programs. I spent years, as you 

well know, trying to sort out Medicare. Part of the problem with 

the most complex legislation is that it is almost impossible for an 

ordinary competent government worker to administer the programs, let alone the people that are supposed to get the services 

of that legislation to understand them, not because someone tried 

to create a complex bureaucracy, but because they kept trying to 

fix problems by adding new legislation which added to the complexity of the administration. 

So read this and the word ‘‘simplify’’ as attempting to make clear 

who is responsible for what and making it much easier for the patient and their families, as well as the people that have to administer the programs, to administer those programs in a way that is 

very responsive and very efficient for the programs. 

I believe our recommendations are doable, whether it is requiring 

congressional legislation or implementation by DoD or VA. We 

made sure what we were recommending could actually be acted on 

quickly. The advantage of having Senator Dole and me up here is 

that in many ways we are the old warriors. We know—— 

[Laughter.] 

Me too. We have a pretty good feel for what the bureaucracy can 

administer and what can be implemented, because we have been 

through this. And I hope that you, I know that you agree with us 

that our seriously injured servicemembers must not be made to 


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wait. They deserve a healthcare system that serves, supports and 

simplifies. 

So I would like to thank the Committee again on behalf of the 

Commission for the opportunity to discuss our recommendations. 

And because those of you who know me know I don’t mince words, 

I leave the Committee and the Administration with three simple 

words. Just do it. Thank you very much. 

Senator Dole. 

[The prepared statement of Secretary Shalala appears on p. 34, 

and the Commission reports appear on p. 45 and p. 82.] 

Senator DOLE. Oh, thank you. 

STATEMENT OF HON. BOB DOLE 

Senator DOLE. Well, first let me thank the Chairman, Steve and 

others for being here. I want to thank Congressman Moran, Congressman Salazar, Congresswoman Berkley and others who have 

already introduced a draft of the legislation which may not be totally accurate, because we drafted it as we were going through. I 

know the Administration is working on a draft, and I know there 

are others on the Committee who have joined this bipartisan effort, 

which leads me to the second point. 

I know which political party my Co-Chair is in and she knows 

which party I am in. But frankly, I don’t know the political affiliation of any of the other seven members. We never discussed politics. It was totally nonpartisan. We never discussed costs. My view 

was, if we spend billions and billions and billions of dollars of getting young women and men in harm’s way, we will have to spend 

what it takes to get them back in as normal a life as possible, 

whatever it takes. And I think that is where we are coming from. 

So it is going to cost a little money. And Bob, we may use some 

of that which you have authorized. So—— 

The CHAIRMAN. Are you sure you are not a Democrat? 

[Laughter.] 

Senator DOLE. Pardon? 

The CHAIRMAN. Are you sure you are not a Democrat? 

Senator DOLE. Yeah. But, you know we—— 

[Laughter.] 

No. We went way back to the Commission headed by Omar Bradley in 1956. Now, most of you weren’t around then, but I was. And 

there have been a lot of Commissions. This problem just didn’t happen with Building 18 at Walter Reed Hospital. It has been out 

there for years and years and years. We have 25 million, probably 

26 million, veterans now. As they get older, especially the World 

War II generation, more and more need hospital care and VA care. 

One thing we found, and we had visits all over the country, I don’t 

remember a single complaint—there may have been one—about the 

acute care the soldiers received from the battlefield until the end 

of their acute care. 

That is not the problem, as my Co-Chair Secretary Shalala pointed out, it is what happens after that. It is the bureaucracy, which 

is true in many civilian hospitals, too. And that is why we are so 

honored to have Ed Eckenhoff, Chairman of the National Rehabilitation Hospital, on our Commission. He understands the private 

sector. One thing we also underscored in our report is that we want 


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the soldier to get the best possible care. If it is not available in a 

DoD or a VA facility, then they are authorized to go to the best private facility that they can find. We can do no less. And Ed was 

very helpful, not only in that area, but many others. 

We had a young man named Jose Ramos on the Commission, 

and he would have been here today but he has a test. He is back 

in school. He lost an arm in Iraq. Another young man from our 

Commission, Marc Giammatteo, is attending Harvard, which I 

won’t hold against him, but—well, my wife attended Harvard. Marc 

has a very badly damaged leg. We had a young woman on the 

Commission, Tammy Edwards, whose husband had burns on 70 

percent of his body. So we had a good representative Commission. 

We had people who really understood the problem. 

And I must say, I had a Co-Chairman who must have invented 

the Energizer Bunny, because all we did was work, work, work and 

she would tell us what to do and we would all try to do it. We 

learned a lot from each other and we really think we have some 

commonsense ideas. Some have said, ‘‘Why didn’t you go way back 

and overhaul the whole system?’’ Well, our charter was limited to 

Iraq and Afghanistan and people who may follow. Now, we hope 

that war ends quickly. We don’t want any more injuries. One is too 

many. One death is too many. 

But one thing we discovered in trying to get down to the brass 

tacks was the group, the seriously injured group, those were severe 

TBI or spinal cord injuries or amputees or whatever. There are 

about 3,000. Now, if we can’t manage the care of that group in the 

United States of America, with all the VA facilities and all the DoD 

facilities we have, we are in pretty bad shape. And we can. We just 

need to work out some of the wrinkles and that is where we believe 

our Commission can be helpful. 

We can’t dictate anything to this Committee. I spent 351⁄2 years 

in Congress and I know how the system functions. And we know 

it takes time. We have been pushing the Executive Branch. I was 

at the White House last week and I can say very honestly, I am 

really not surprised, but I am very pleased with the effort they are 

making on the executive side and they will have their legislation 

ready in what, another 10 days? 

Secretary SHALALA. Ten days. 

Senator DOLE. So the veteran groups can look at it, and certainly 

Members of this Committee. We also had some outstanding staff, 

and I would just introduce our Director, Marie Michnich, who is 

here and Karen Guice who worked with the Veterans Service Organizations (VSOs) and Sue Hosek of RAND Corporation who has 

had about 30 years experience working with these same problems. 

So I think we have some credibility. At my age, I don’t need this 

job. And you know, I told that to the President. Well, I guess I 

didn’t see him. I saw him later. But I told that to the people at the 

White House and we told it to Bob Gates. Donna—excuse me, Secretary Shalala, she has a lot to do. She is busy. 

The University of Miami football team, they got off to kind of a 

bad start, but they will recover. 

[Laughter.] 

So, you know, we wanted to do something that might mean 

something to somebody. I talked to a young man from Kansas 2 


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days ago. I was at Fort Sam Houston. He is a triple amputee. I 

think there are about 10 or 11 of those. His name is Sergeant Matt 

Lammers and I just was in disbelief of his attitude and his spirit 

and what an inspiration he is. He said he can get down with one 

arm. He has two legs gone above the knee and one arm above the 

elbow missing. He has two children, one 6 and a baby about 1 year 

old. And how he can get down on the floor and play with his children and get back in a chair by himself without any assistance. 

Now, if that doesn’t inspire us to do what we need to do to make 

certain that young man and his family and his children are taken 

care of. If you would just write him a blank check, it would be all 

right with us. But are those young people going to be able to go 

to college? Is he going to be able to earn enough money? He won’t 

be able to do it with the pension he gets. So these are some of the 

things you may want to look at and I know some of the things have 

been looked at elsewhere. 

I have been interested in veteran affairs—I will confess. I didn’t 

know much about disabilities until I had one, and then you suddenly become interested. I served as a service officer of the American Legion and VFW when I was County Attorney 100 years ago 

in Russell, Kansas. And I worked with veterans all my life and all 

my years in Congress and now I am working with World War II 

veterans. They have what they call an Honor Flight where they 

bring in World War II veterans from your districts, without any 

cost to them. They charter them in. They go out and visit the memorials—spending most of their time at the World War II Memorial. They have a box lunch and they go back home and this makes 

their whole life. There will be a group in from Cleveland this afternoon. I will be down to say hello. 

But the point I make is that we hope we have credibility. This 

is not perfect and there are changes you will want to make. And 

Secretary Shalala, I can’t think of anybody with more experience 

in working with Congress than she has had and anybody more effective. So I just want to touch on three other points. 

As Secretary Shalala said, there are six areas where we believe 

Congress needs to act, and you may think of others. And what we 

would like to do, but it may not be possible, is somehow get some 

of our suggestions into a conference report that you may be holding 

later this year on the Senate passed bill and your bill because 

these veterans can’t wait much longer. And when we talk about the 

wait they have to get their claim settled and we know that if it 

doesn’t make it in this year’s bill, it will be next year, and that is 

a long time. 

We think Saturday’s story in the Washington Post would not 

have been there had Secretary Shalala’s idea been adopted with 

the care coordinator. When you get out of the battlefield, and you 

walk or are carried into Walter Reed, you are assigned a recovery 

coordinator who stays with you throughout your treatment. Jose 

Ramos, who is on our Commission, had so many caseworkers that 

he couldn’t remember their names. And that is what happened to 

this Sergeant Shannon. 

So Secretary Shalala had a great idea. It is the first recommendation. And we are not talking about adding thousands or 

another bureaucracy. We are talking about 20, 30, 40, 50 people 


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who have followed the seriously injured from day one until the 

time they leave the hospital or go back home or back to work. Secretary Shalala has already touched on that. She outlined three 

major recommendations. Let me just touch on the others. 

We want to get the DoD out of the disability business and we 

think they wouldn’t mind doing that themselves. Veterans tell us 

that they get better ratings from the Veterans Administration, so 

we are trying to figure out some way—how do we work this so it 

is fair and we don’t penalize anybody and still have the DoD with 

some. First they would have to get together with the VA and work 

out what kind of a physical it would be. And after the physical, 

when you are determined to be unfit for duty, then you go to the 

VA and they make your disability rating—not the DoD, but the 

Veterans Administration. 

We have also added what will be called transition payment. I 

know from personal experience, when you first get out of the service, whether you are in the hospital or not—it doesn’t make any 

difference—you are sort of at sea for 2 or 3 months. And so we 

have these transition payments. It would be your base pay for 3 

months, or whatever Congress decides, while you are getting home, 

getting settled, getting your kids in school, getting a job, whatever. 

There is another payment. It will all be in the same check—but 

something that has never really been considered separately and 

that is called quality of life. I think when you get your rating, I 

am certain if you are an amputee or you lost your sight, it is a consideration. But if you have lost your sight or if you are Sergeant 

Lammers who has lost three limbs, your quality of life has gone 

from a 10 to what, 1, 2 or 3? We think that should be compensable 

and that should be added to any other payment, whatever your rating may be, because you have lost that qualify of life forever. 

It has never been specifically identified. I guess some who examine soldiers would probably say, well, they will include something. 

But we want to make certain that happens. Then, of course, there 

is the earnings loss payment which you would receive based on 

your disability, what your earnings loss might have been in your 

lifetime. 

So we think, and we know there is another commission working 

on the disability program. I think it is fair to say that they have 

endorsed what we have done with two, is it two exceptions, Karen 

or Sue? 

Ms. GUICE. They are still working on their recommendations. 

Senator DOLE. In other words, we are pretty much in agreement 

and their report is due out, I think, sometime in the next 30 days 

or 45 days. But in other words, we don’t want to wait and I know 

you don’t want to wait. I think they would tell you now what they 

are going to do. So now there are differences in ratings depending 

on which military service or which regional office determines the 

rating. In our national survey of injured servicemembers, fewer 

than half understood the DoD’s disability evaluation system and 

only 42 percent of retired or separated servicemembers who had 

filed a VA claim understood the process. That is about one out of 

two that even understood what was happening. 

So, as I said, we recommend that DoD do one thing. They retain 

the authority to determine the fitness to serve. Out of the 28,000 


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wounded, 60, 70 percent are back to duty in 30 days and then there 

is another 10 or 12 percent that aren’t hospitalized very long. But 

there is a group, say around 3,000, 3,200 that are very seriously 

injured and are going to need very special care for a long time. We 

believe that there should be only one physical exam, done by the 

DoD, and then the VA should resume all responsibility for establishing the disability and the rating. 

This new structure, I think, makes it reliable and transparent 

and accountable. Under this action item, DoD and VA can focus on 

what they do best. The DoD determines fitness and the VA can determine your earnings loss and what your rating should be and the 

other things that my colleague has mentioned. The VA can do what 

they should do and I think it is a much simpler system that better 

supports the needs of those who transition between active duty and 

veteran status. 

In our fifth action step, we recommend healthcare coverage for 

servicemembers who are found unfit because of conditions that 

were acquired in combat, supporting combat or preparing for combat. That includes about everybody, because once you sign up you 

are getting ready for combat the next day. So we think Congress 

should authorize comprehensive lifetime healthcare coverage and 

pharmacy benefits for those servicemembers and their families 

through DoD’s TRICARE program. 

Is it fair to say what the White House maybe—— 

Secretary SHALALA. Well—— 

Senator DOLE. We think the White House is going even further 

on this. 

Secretary SHALALA. We think the White House is considering 

going even further to recommend that everyone who is declared 

unfit for service for health reasons, they will cover the individual 

and their family’s healthcare forever. The advantage of that is, obviously, it is easier to get a job if you are disabled, even if you can 

work 20 hours a week, if you don’t have to worry about working 

for benefits for your family members. I think it will help keep families together and will allow people to go to work and not have to 

worry about getting their healthcare covered. It is a tremendous 

step forward. We have limited jurisdiction and the White House 

may recommend going further in that regard. 

Senator DOLE. So we have given a short summary here and we 

know there are questions and other members may want to make 

statements. We know everybody on this Committee wants to do 

what we want to do, and that is to make it work, and particularly 

for those who are really going to be jammed up the rest of their 

life. We want outcomes. We put in more money, as the Secretary 

indicated, for education. To keep people in the program, we raised 

the benefit 10 percent a year if they stayed. There is also a stipend 

to keep them in school. When these veterans finally leave the hospital and go to school, they are going to be better equipped to move 

into the mainstream of American life and have a better quality of 

life and a life of dignity for themselves and their family. 

So you all know the figures. In Vietnam, five out of eight seriously injured survived. Now it is seven out of eight and we owe a 

debt to the people on the battlefield, the medics, the doctors, the 

nurses, therapists and all the people that take care of these men 


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and women who come back. Many who come back are not injured 

or wounded. Their illnesses, the things that happened to them are 

not their fault. But they are entitled to the same care. You don’t 

have to be shot to receive benefits under our program. If it is combat-related which, as I said, covers about everybody, and if you are 

on the way to combat or whatever you are doing and you have an 

injury that is, that should be covered. 

So I just say, Congressman Filner and Congressman Buyer and 

others, we are grateful for this opportunity. We did tell the other 

Commissioners that we would continue to try to help get this done. 

We are going to be around, Secretary Shalala will be around, for 

a long time. I will be around for a while at least and we are going 

to keep working on this. Hopefully, we are going to have your help. 

So thank you very much. 

[The prepared statement of Senator Dole appears on p. 36.] 

The CHAIRMAN. Thank you so much. 

[Applause.] 

Your common sense and your sense of urgency come through and 

provide a standard through which we have to meet. The Executive 

Branch will speak for itself. But we, in Congress here, have to act 

and act quickly. And we thank you for giving us that impetus and 

that charge and the background that you have here. 

Secretary Shalala, you have had quite an effect on the Senator. 

If you had talked to him, or if he had talked like this—— 

Secretary SHALALA. We assure you, though, he did not become a 

Democrat in the process. 

The CHAIRMAN. If he had learned this 10 years ago, you might 

not have had your last 4 years in the Cabinet, so—— 

Senator DOLE. I think the key, Mr. Chairman, is that I don’t 

think we had any disagreements—I mean we may have—it doesn’t 

mean everything was just whatever somebody wanted. But a lot of 

our Commission members had the ideas. On electronic transfer of 

records, we had this outstanding doctor from the Cleveland Clinic. 

He was a tremendous help to us because it is one of the problems 

out there. The VA has a great system. The DoD is trying to catch 

up. When you leave Walter Reed, you leave with a stack of paper. 

When you leave a VA hospital, you don’t have anything. They can 

just punch a button and they can get your record. And there is a 

recommendation on information technology (IT), which we think 

makes a lot of sense and doesn’t cost a big, big bundle of money. 

The CHAIRMAN. Again, thank you so much. Your charge was the 

current war, but when I read your recommendations and I think 

about our Vietnam vets, it seems we could easily substitute Vietnam for what you said and do the same things. I think we did not 

treat our returning Vietnam vets with the honor, respect and care 

that they needed and we are paying a heavy price for it. And we 

still can correct some of that, but we also see what we have to do 

to get it right. Otherwise, we are going to be left with the kinds 

of homelessness and suicide rates that we saw—— 

Senator DOLE. I don’t want to—this is the last time I will interrupt but—— 

The CHAIRMAN. I doubt it. 

Senator DOLE. We are in the Senate. We never interrupt. But 

what we discussed is that it is a new kind of warfare. There are 


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new kinds of injuries. There is new technology. There are new opportunities. We tried to update—and I know the Chairman would 

have rather gone way back and kind of overhauled the whole system—but we did what our charter said. We tried to update and 

make some recommendations that are forward-looking. 

Now, some people may resist change. I assume in the Bradley 

Commission report there were some who resisted change. But we 

have to bring the benefits and everything else up to date and we 

tried to do that in our report. 

The CHAIRMAN. Did you at all, as we looked at the disability system and recommended a major transition, we do have a problem 

that exists right now, 600,000 or more backlogged claims. Some of 

us want to just cut through that bureaucracy right now, for example, and if a claim has been well documented and had advice of a 

veteran service officer, for example, to accept in the same way the 

Internal Revenue Service accepts your tax return and sends you a 

check for a refund, subject to audit, and just move out those 

600,000, you know, as rapidly as we can. Did you at all think about 

that or take that up at all? 

Secretary SHALALA. No. We actually didn’t look at the backlog. 

As you know, this country has had considerable experience. The 

backlogs in Social Security were cleaned up. That requires a systems approach. That was not within our jurisdiction. We do believe, 

though, that our recommendations will actually help to make sure 

we don’t create new backlogs because it will be much more 

straightforward as to who is responsible for what, what you are 

going to get and the combination of benefits, including, I should 

point out, an annuity even if you haven’t spent 20 years in the 

military. All those found medically unfit to serve and leave before 

20 years, will get an annuity. 

I got an annuity after 14 years in the Federal service. If you are 

injured, you ought to be able to take that annuity with you from 

the DoD. So that is added to the pieces and that is pretty straightforward. I think that the combination of transition and some of 

these different ways of simplifying the system will help eliminate 

the backlog. So we didn’t speak to it directly, but we just need a 

more modernized, straightforward system that is easier for everybody to understand. 

Senator DOLE. Another thing is, I remember way back when I 

was at the retirement board and I had some pretty serious injuries. 

I couldn’t use my hands and I couldn’t walk at the time. But I got 

a disability based on the fact that I was a captain. If I were a colonel, I would have gotten a lot more money, even with lesser disabilities. That didn’t make any sense to me then, and it doesn’t make 

any sense to me now. So we think we have devised a system where 

you get this annuity payment, but then you also get a rating, 

whether you are a colonel or a private first class. We think we 

ought to make certain that you are being compensated for the disability. 

And your rank—if you have been in the service 10 or 20 years, 

and many people dedicate their life to the service and we want to 

reward that, you will get the payment that the Secretary just 

pointed out, this so-called annuity, whether you have been in the 

service 6 years or have been in the service 25 years. 


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The CHAIRMAN. You all mentioned, on the basis of a medical discharge, that TRICARE should be given for life. This Committee has 

been concerned about the practice of using a personality disorder 

discharge which we think is almost a purposeful misdiagnosis of a 

preexisting condition, and therefore, would not obligate our government from compensating these servicemembers in the future. We 

think that is a big mistake and I don’t know if you took that up 

in your report or not. But I mean we think we might have to put 

a temporary stop to these diagnoses because they are doing great 

disservice to these young men and women who are serving so faithfully. Did you look at that issue at all? 

Senator DOLE. I think the Secretary is looking for the—we have 

the facts on it. I think the number discharged for personality disorder since 2000 has been about 6,000. I think there are some misleading figures out there; am I correct, or did you find that? 

Secretary SHALALA. Right. I think—that is right. Eighty percent 

were never in combat. 

Senator DOLE. We did check on that because you had raised the 

question when you testified. 

Secretary SHALALA. On page 47 of our supplemental report, it is 

6,000. And if I remember correctly, most of them were not in combat specifically. That obviously could use some study. But one of 

the things that we recommend is that the standard of care for 

PTSD, and a lot of the appeals are about that, must be widely disseminated. We need more research on that subject. But everyone 

who comes for care ought to be treated and everybody ought to be 

eligible to be treated, no matter when they served in combat. 

And I wish I could say that the private sector had great centers 

of excellence. The experts in the world are in our military and in 

our VA, in particular. And while there are some private sector 

rehab hospitals that have some capabilities, most of this is inhouse. We need to disseminate the standard of care. There are a 

number of centers and we need to make that available to everyone. 

The CHAIRMAN. And thank you, Senator Dole, for praising the 

whole system of care, not only in the VA, but on the battlefield 

today. The Secretary, the VA and I and Congressman Boozman just 

returned from Iraq and Afghanistan and what we did was, we followed that trail of the wounded warrior from when they are 

wounded, to their medical evacuation, to a forward base hospital, 

to a regional hospital, to Landstuhl, Germany, and we followed 

that for very specific individuals and the incredible professionalism, 

expertise, dedication, morale. I mean, and these kids, I mean they 

are 19, 20, 21, who are doing all of this and we were just amazed 

at their professionalism and leading to this, you know, this incredible survival rate once you, if you survive a battlefield injury. So 

thank you for praising them, because they are a tremendous, tremendous asset to this Nation. 

Senator DOLE. I think in our report there is a segment that 

tracks a veteran from injury through medical treatment. 

Secretary SHALALA. We did. 

Senator DOLE. We have a little chart in there. 

Secretary SHALALA. We did. And the University of Miami actually trains those trauma teams. The soldiers and military personnel fly in from different parts of the country. We turn them into 


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a team before they go off to Iraq and Afghanistan. And the medicine today is unbelievable. The disability system is based on a 30- 

year-old medical system. That is the whole point here. If you saw 

the schedules on orthopedics in the disability system that we have 

in VA, it is unbelievable. It doesn’t reflect modern medicine. This 

has to be brought up to date. It is just unacceptable the way it is 

currently set. And in this case, we know what to do. 

Senator DOLE. The one place we need help, and Steve may have 

pointed this out in his hearings, is in the mental health field. 

There are not enough professionals available in the private sector 

or in VA and military hospitals. I don’t know where they are going 

to come from, but—— 

The CHAIRMAN. Thank you. Thank you again. And that teamwork, by the way, was so vital, as we watched it in Iraq and Afghanistan. 

Mr. Buyer, you are recognized for 5 minutes. 

Mr. BUYER. Thank you. 

You know, it is great to see your enthusiasm. As you know, that 

can move mountains. And so not only is it your credibility, but your 

enthusiasm that has me excited. And Mr. Dole, they kind of poked 

you here a little bit when you talked about spending as much 

money as necessary. I think you espoused exactly how you felt all 

the years that I have known you on these issues. When I came here 

in 1992, we had a VA system that was depicted in the movie ‘‘Born 

on the Fourth of July.’’ And as a country we didn’t do well. 

And Ms. Shalala, Dr. Ken Kaiser, your good friend who was then 

the Under Secretary of Health during the Clinton Administration, 

had his ideas of moving to outpatient care and we embraced that. 

And we have invested well—when you look at 1995 as a benchmark, we have invested probably in excess of $300 billion. 

So I embrace exactly what you said, Senator Dole, and—— 

Senator DOLE. Thank you. 

Mr. BUYER [continuing]. A couple of things I wanted to touch on 

and I thank you, Secretary Shalala, for your comments. You made 

yourself narrow and then you went deep and that is why you have 

a good product. We have the Disability Commission that was out 

there, so you were respectful of them. Yet you touched on a few 

areas. So we are with great anticipation waiting on their testimony 

to us. 

I have some questions regarding the TRICARE for Life. I created 

the TRICARE for Life for the military retirees when I was Chairman of the Personnel Subcommittee in our Armed Services Committee. So when you say, Senator Dole, that you would like to get 

DoD out of the disability business, there are a couple of things that 

I need to ask. In order to get DoD out of this business, we still 

have the medical retirees, or as your recommendation, to even do 

away with medical retirees. That is one question. 

The other is, if we are going to say that TRICARE for Life is 

available to those who are found unfit because of conditions acquired in combat, supporting combat or preparing for combat, then 

DoD pays for the TRICARE for Life. So they are not going to be 

totally out of that. We are not going to be able to stovepipe that. 

So there are still going to be payors. And so I will be a good lisVerDate Aug 31 2005 00:23 Jul 31, 2008 Jkt 039452 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 E:\HR\OC\A452.XXX A452

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tener when the Disability Commission comes over and I will embrace your recommendations. 

My question to you is about implementation. So if we are going 

to take the TRICARE for Life program and we are now going to 

implement that, the eligibility, are we going to restrict that eligibility to a core constituency, meaning those, as you defined here, 

and what is the effective date? 

Senator DOLE. Why don’t you go first? 

Secretary SHALALA. The effective date is going to be determined 

by Congress and there will be legislation that will be coming up. 

I think—— 

Mr. BUYER. Do you have a recommendation? 

Secretary SHALALA [continuing]. We are talking about, that will 

be part of, back to 2001. And you will see legislation. That, obviously, is something that can be discussed with Congress in terms 

of setting that, as well as who is to be covered. We are simply talking about DoD making only the fit/unfit decision and if one is not 

fit for health reasons and you get a medical discharge, then you 

ought to have the opportunity—and then you go over and get your 

disability out of VA. You ought to have the opportunity to have 

your healthcare covered. 

The addition here is to cover your family as well, to encourage 

you to go on and get education, as well as to get ready to go to 

work, if you can. If you can’t, obviously, there are all sorts of services that would be available for you. 

Mr. BUYER. All right. With regard to the issue on VA contract 

care, if DoD, what you are trying to do is move these to be patientcentric, thank you very much. I wanted to jump up and hug you 

when I heard you talk about patient-centric. 

Secretary SHALALA. Oh, that would be fun. 

[Laughter.] 

The CHAIRMAN. Trust me, it is not. 

[Laughter.] 

Mr. BUYER. Well, I am hetero, Mr. Filner. 

Senator DOLE. Steve, could I ask—— 

Mr. BUYER. I am not sure. 

[Laughter.] 

Sure, Senator Dole. 

Senator DOLE. You raised a point that I don’t have an answer 

to on medical retirees. 

Sue, would you, or Karen, address that? Let’s say you have 

served 25 years and you—— 

Secretary SHALALA. This is Sue Hosek from the RAND Corporation. 

Senator DOLE. RAND Corporation. She has had 30 years working 

with these issues. 

How do you treat the medical retiree—I should know, but I don’t. 

Ms. HOSEK. If you are declared unfit, you get your discharge for 

medical reasons. And, obviously, if you have served 20 years, you 

are still going to get your retirement. What our proposal does is to 

provide essentially a partial retirement benefit in the form of an 

annuity payment for those who don’t reach the 20 years. Right now 

they walk away with nothing. And so we don’t want the person 


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who has, you know, say, 15 years of military service to walk off 

without that. And so that is an important change that we—— 

Senator DOLE. But then you get your earnings loss from the VA. 

Ms. HOSEK. Yes. Then the VA takes care of the disability benefits that you would be entitled to, yeah. 

Mr. BUYER. Thank you. 

Senator DOLE. Well, they are a little different, Steve. I wanted 

to say just one word about Walter Reed. I think the initial Washington Post story was kind of a wake up call for all of us and everybody began to focus on a lot of things that should have been focused on before. But, again, having been treated there for a lot of— 

I had several operations there. It is a great hospital. 

Our last recommendation is that until the other place is totally 

ready, we have to keep Walter Reed in A–1 condition before they 

turn off the lights, because we hope this conflict is going to end 

soon. For about 26 percent of the patients, their first stop is Walter 

Reed Hospital. So we have to keep that, if we have to, and we suggest providing incentives, because a lot of people don’t want to stay 

in a place that is about to sink. You know, you want to get overboard, get in a life raft or something or find another job. 

So we would recommend some incentives for the civilians who 

may be contracting there or even the military personnel—some 

kind of a bonus for staying on the job at Walter Reed, because this 

is where at least one-fourth of our casualties go. So we don’t want 

anything but first-rate service there until somebody finally says, 

okay, we can turn off the lights. 

Mr. BUYER. Thank you for your contribution and viewing this 

through the eyes of a soldier. 

The CHAIRMAN. Thank you. Dr. Snyder is next. I just want to 

thank him for focusing on an issue that I know may be not as part 

of your charge, but, you know, half of our fighting forces are the 

Guard and Reserve units who we think have got to have access to 

the same benefits. And Dr. Snyder has led the way and we thank 

him. You are recognized. 

Dr. SNYDER. Thank you, Mr. Chairman. Thank you all for being 

here today. We held a hearing yesterday on the Subcommittee on 

Oversight and Investigations on the Armed Services Committee on 

Military—— 

Senator DOLE. I have a little, I have a little trouble—— 

Dr. SNYDER. I am sorry. We held a hearing yesterday on our Subcommittee on Oversight on the Armed Services Committee on DoD 

civilian personnel and their medical care and benefits and incentives serving in a war zone. And I will tell you what, I presented 

a scenario to the Department of Labor guy. If I was a DoD civilian 

that worked 18 hours a day at the Baghdad airport and had 6 

hours off and was playing basketball on the court for my recreation 

time and a mortar came in and I got injured, would I be covered 

by worker’s comp? 

And we could not get a definitive answer, that for sure, even 

though it was a clear-cut combat-related injury, that a DoD civilian 

would be covered by worker’s comp. My guess is they will come 

back and say well, yeah, we thought about it and we think we can 

definitely say that. But I will tell you what, if you were a civilian 


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government worker working in Iraq right now, that kind of answer 

would create some uncertainty for you. 

The Disability Commission, I am told, report will be briefed to 

the Armed Services Committee staff on October 2nd and that their 

report will be made public October 3rd, which should be out in 

plenty of time, I think, to inform these decisions as we go forward 

in conference and hopefully there will be things that we can react 

to this year. 

I wanted to ask a couple of specific questions. In your report, you 

mention—well, I will just read the two sentences. ‘‘To make the 

system work, recovery coordinators need considerable authority 

and to be paid accordingly. Recruitment, training and oversight by 

a new unit of the U.S. Public Health Service serves as commission 

corps and the Department of Health and Human Services should 

be strongly considered.’’ That makes some of us apprehensive when 

we consider the years that we have tried to bring the VA system 

and the DoD system together and we are going to throw up our 

hands and say well, the way to get it is bring in a third huge system that everybody in this room has had problems with also in 

other areas. 

Is that really something we need to do in terms of bringing in 

HHS, or is there not another way to get at that? 

Secretary SHALALA. There are other ways, obviously. And our 

feeling was that the Commission corps ought to be involved certainly in the training and that is being considered by the White 

House in the legislation they are going to send forward. The most 

important thing is a degree of independence, that this recovery coordinator has to be able to cut across whatever benefits are available and have some authority and be there for the full period of 

time when the soldier, from the time they are injured until they 

either go back to civilian life or complete their disability and rehab 

period. 

If a police officer goes down in my community of Miami, an officer is assigned to that person from the time they are injured, right 

through their hospital stay, right through their rehabilitation. The 

problem now, as the Senator pointed out, is that there are so many 

care coordinators. These soldiers and their families can’t remember 

all their names. So that for the most severely injured people, we 

need a highly trained professional. And we are not talking about 

that many people. But a number of agencies have to participate in 

the outline in that training. Where they are located, who pays their 

salary, we were, we strongly recommended that it be independent 

of the VA and the DoD. But the most important thing to us is the 

level of their training, the fact that they are going to stick with 

that soldier and their family right through the process and that 

they don’t change, for particularly these very complex cases. 

Dr. SNYDER. I agree with all—— 

Secretary SHALALA. We are not talking about a large number of 

people. Does that answer your question well enough? 

Dr. SNYDER. It does. I think it is the function that is key. 

Senator DOLE. I would just add that there has been some concern 

with that provision by the veterans groups, another layer of bureaucracy. Well, we are not trying to do that. We are talking about 

a very small number of people. And if it is not the Public Health 


smartinez on PROD1PC70 with HEARING
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Service, the Secretary has had a lot of experience with them because HHS is sort of the umbrella group. 

But she stated it very clearly. We want somebody with authority 

to get an appointment. 

Dr. SNYDER. No. I want to ask one—— 

Senator DOLE. It might speed up the process and—— 

Dr. SNYDER. I want to ask one final question before my time runs 

out. And you talked about it, Senator Dole, when you talked about 

the combat-related injury related to training hazardous duty. I 

think we have always had a pretty strong feeling in the Congress 

that we want to treat all our veterans, military people, in similar 

situations the same. And so, I can come up with scenarios, you 

know, Little Rock Air Force Base is in my district. A guy is working on a water tower in the military, falls off the tower or gets 

blown off by the wind or crosses the street and gets hit by a car, 

has a terrible spinal cord injury, that we would, I would think that 

would not fit under the language of Ms. Berkley’s bill or the kind 

of language that you outline there and we are going to treat that 

person differently and their family medical leave qualification differently than a person who may have landed on a carrier in the 

Gulf and had a similar kind of injury. 

I understand the importance of focusing on combat-related, but 

on the other hand, we are going to have two classes of people in 

our military. I am not sure that we want to go down that road. 

What do you think? 

Senator DOLE. Right. We had a lot of discussion. We talked about 

line of duty, combat-related, other ways we can define it. I think 

what we, in essence, finally concluded was that unless it is some 

reprehensible conduct—you are drunk, disorderly and you are injured or something—but if you are on a tower and you are in the 

line of duty and the wind blows you off, in my view, you are covered. 

Dr. SNYDER. Well, take the one you are crossing the street to the 

PX and you are hit in the parking lot, that would not be considered 

hazardous duty, right? 

Senator DOLE. Yes. 

Dr. SNYDER. We could have families living next door that are 

treated differently with similar injuries. 

Senator DOLE. I am not sure we would cover everybody crossing 

the street, but our intent was to make it broad—— 

Dr. SNYDER. Right, I see. 

Senator DOLE [continuing]. Not to limit it. You know, you don’t 

have to be shot to be—— 

Dr. SNYDER. Severely hurt. 

Senator DOLE [continuing]. To be injured in the line of duty serving your country, and you ought to have the same benefit. 

Dr. SNYDER. Right. Thank you. Thank you for your service. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you. 

Mr. Moran. 

Mr. MORAN. Mr. Chairman, thank you. Thank you to you and 

Mr. Buyer for holding this hearing today and it is a real privilege 

to be here with Secretary Shalala and Senator Dole and I want to 


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thank them for their distinguished service to our country and especially in this latest effort in regard to their Commission’s work. 

Senator Dole, of course, needs to make no statements to prove 

his credibility on the topic that is before us. Senator Dole, I was 

at the Dole Institute of Public Policy on Monday before returning 

to Washington, DC, where I welcomed 100 new U.S. citizens to our 

country and used you as the role model, the example of what one 

can attain in their life. With the recognition that in many ways, 

I suppose, you grew up an ordinary Kansan, but accomplished extraordinary things. 

And Kansans hold you in high regard, as do Americans, for your 

public service here in our Nation’s capital. But I really do think it 

is your service to our country in the military, the injuries that you 

incurred and your recovery that is the remarkable part of your life. 

And I appreciate the effort that you make on a daily basis to care 

for those who have been injured in service to their country. 

You tell in your book One Soldier’s Story that none of us who 

travel the valleys of life ever walk alone. And your personal story 

is one that is a reminder to all of us about how we do rely upon 

others. Your mother, Bina, and her day-to-day efforts in your recovery—— 

Senator DOLE. She was my coordinator, my mother, yeah. She 

was there every day. She even held my cigarette. She hated people 

who smoked, but it was a little habit I picked up because in World 

War II they gave you a little pack with four cigarettes in it for your 

dessert, so we all started smoking. But one of them dropped down 

my cast one day and we had to pour water down there and all that 

stuff, but—but again, you go out to Walter Reed and if you see a 

single soldier, I will bet you 10 to 1, in nearly every case, the mother is going to be standing right there, or the father or some family 

member. And that is another area that the Secretary and I want 

to address. 

Mr. MORAN. Well, your mother and your family, as well as the 

folks of Kansas, particularly your hometown of Russell, the cigar 

box story is one that is an inspiration, I think, to all of us. The 

community of Russell, which is a typical Kansas community, put 

the cigar box in the drug store and collected money for Senator 

Dole’s rehabilitation and today there are those in Russell who remember their efforts on behalf of the Senator and how well he 

is—— 

Senator DOLE. Well, if I could add, it was only $1,800 and I was 

wounded late in the war and all the good doctors, of course, wanted 

to go home, because the war was—I was wounded in April and it 

ended in Europe in May. In fact, I was wounded a hill apart and 

a week apart from where Senator Inouye was wounded and we 

ended up in the same hospital together and then later ended up in 

the Senate. 

But that is an indication—and I wish the Committee could give 

me some guidance on, there are all these wonderful groups out 

there trying to raise money to help veterans. I don’t know whether, 

Mr. Chairman, have you ever checked to be sure they are all bona 

fide? The volunteer groups are doing a great deal. In those days, 

in our little town of Russell, $1,800 was a big amount. In 1947, 

that was kind of a recession era. I remember one man, Mr. Wegley, 


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brought a duck. He didn’t have any money, but he brought a duck, 

which we couldn’t put in the bank, but we ate it. 

So just the generosity of the people and it is still out there and 

we want to tap into that, too. 

Secretary SHALALA. And I think that is also the point, Senator. 

We met a mother who is from Ohio whose community is paying her 

mortgage while she is down in San Antonio at Brooke coordinating 

the care. Three decades later, we are still doing the same thing and 

there are other ways to do this that are more supportive of family. 

Women are working now. They weren’t in an earlier generation 

and the whole family is working. 

Mr. MORAN. Well, I think you both have great credibility in 

bringing to us this idea of a support system for those who are leaving the military. I have one question, although I would like to tell 

you, Senator Dole, but for you, I have never seen any place outside 

Kansas. I grew up in a family where vacations were a very rare 

thing. We only went to Iowa on an almost annual basis on your behalf. Every time you ran for President we got to see the rest of the 

country. 

Senator DOLE. Yeah, well, it still—— 

Mr. MORAN. It didn’t work. 

Senator DOLE. It is still a possibility for 2008, but I don’t think, 

I don’t think so. 

[Laughter.] 

Mr. MORAN. Let me ask you—— 

The CHAIRMAN. We have an exclusive. 

Mr. MORAN. Let me ask you, Senator Dole, about contract care. 

One of the things that I worry a lot about on behalf of rural America, rural Kansans in particular, is the ability for us to have a continuum of care that exceeds just the boundaries of our cities. The 

VA traditionally has been bricks and mortar in large communities. 

I represent a congressional district, your congressional district. 

There is no VA hospital and we continue to push the VA to provide 

greater contract care where the veteran can access through his 

own, his or her own physician, local hospital, other providers. And 

I wonder if your Commission has looked at what we do to expand 

the opportunities across America, not just in the traditional places 

at the VA or a military hospital which can provide assistance. 

Senator DOLE. Right. You know, I wonder if I could just ask Ed 

Eckenhoff, a member of the Commission, to respond to that, because one thing we emphasize in our report, if you live in Las 

Vegas, you know, you have a big, wonderful VA hospital there. But 

in some of these rural areas, you have got to drive 300 or 400 miles 

to get access to good medical care if you are going to go to a DoD 

or VA facility. 

So we urge—well, we want Congress to make it possible to underscore that you can go to the private sector to get good care. 

And Ed, can we hear you? You have a good voice. 

Mr. ECKENHOFF. Well, if you can hear me, I will just stay right 

here. 

Senator DOLE. Yeah, Ed Eckenhoff. 

Mr. ECKENHOFF. We have talked a great deal about that and 

came to the conclusion that while you are absolutely right that 170 

plus Veterans Administration hospitals, 60 plus DoD hospitals, we 


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have 5,200 civilian hospitals, many of them practicing good acute 

rehabilitation. Now, within that population of civilian hospitals, we 

have roughly 1,100 that have acute rehabilitation units, anywhere 

from 10 to 50 beds. We have roughly 250 freestanding civilian rehabilitation hospitals, all of these very well-staffed, even though we 

do have our vacancy problems, understand rehabilitation extraordinarily well, particularly the traumatic brain injury, as we have 

discovered, is our signature injury within these two wars. 

Secretary SHALALA. Our first recommendation was for a recovery 

plan and with the recovery coordinator. The point of that plan is 

that with an interdisciplinary team, you can figure out and make 

adjustments to it when someone can go home, what care is available where, and particularly for these young men and women that 

want to go home, getting access to that care would be part of the 

recovery plan. So plotting it out so that someone could go home as 

soon as possible, get access to care, even the use of telemedicine. 

We have had a lot of experiences in this country now with rural 

healthcare. My family, part of it lives in North Dakota and there 

are a lot of soldiers in that place. And making sure people can get 

home and get care, the quality of care that they need, using local 

physicians, local rehab hospitals, traveling when they need to, 

ought to be part of that plan and the recovery coordinator ought 

to be able to get them to the right place at the right time. 

Senator DOLE. That is a good question. It is a big issue. 

Mr. MORAN. Mr. Chairman, thank you. I appreciate the gentlemen from Colorado, Mr. Salazar. He and I have joined together and 

have introduced as legislation the recommendations of the Commission. We now know that the Administration also has a plan to do 

something similar, but we would welcome any of our colleagues to 

join us. Thank you, Mr. Chairman. 

Senator DOLE. That may be, you know, it is subject to change, 

obviously. You may want to change it. I know the White House is 

working on a draft. They are actually liberalizing some of the 

areas. I think it is good to send a message, you know. We appreciate your introducing what could be modified later. 

The CHAIRMAN. Thank you. I now recognize Mr. Michaud, who 

chairs our Subcommittee on Health. 

Mr. MICHAUD. Thank you very much, Mr. Chairman, Mr. Ranking Member, for having this hearing and I really want to thank 

both Senator Dole and Secretary Shalala for all your work, not only 

on this, but your continued service to our country. Providing the 

best possible care for our men and women who risk their lives for 

our country should be, and is, one of our highest priorities. 

I believe that in general we do a good job, but there are also, as 

you realize, significant gaps in services that our men and women 

receive. I not only thank both of you, but also your staff for all 

their hard work in putting this report together. I really appreciate 

it. I believe that your recommendations as they relate to PTSD and 

TBI, as well as those regarding assisting families, are very good 

and we will continue to hopefully move those ideas forward and I 

look forward to working with you as we do move this bill forward. 

My question is, I appreciate recommendation number two to simplify the disability and compensation system, but I want to make 

sure that we do not create an unintended negative system at the 


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same time. This would essentially create a rating system for current veterans and new veterans that will be coming into the system. My concern is that dual type system, but also, how does your, 

how do you envision this disability, how does that take into account 

veterans who, as you know, will manifest service-connected disabilities much later in life in some cases? How does this new disability 

system affect that? 

Senator DOLE. I am going to let you, but I—— 

Secretary SHALALA. Go ahead. 

Senator DOLE. One thing we do, and we do it in a positive way. 

Now, some may not like it. For the veterans with disabilities, we 

have a review every 3 years which will take care of anything that 

may arise in that 3-year period if there is a sickness or illness or 

something they discover. We think it is a very positive step. Particularly men don’t go to doctors like they should and there are all 

kinds of studies on that issue. I think we really tried to simplify 

the system. And I think in every case that we tried to look at, the 

veteran is better off under our system dollar-wise. 

Even more importantly, we had our eye on what we call outcome. 

What is the outcome? What condition will this person be in when 

they are finally free of all the hospitalization and education? Where 

are they going to fit in society? We think in both cases we did the 

best we could and I think Secretary Shalala has an added comment, with some help. Go ahead. 

Secretary SHALALA. The disability system will establish, the new 

system will establish a really good baseline. So if someone gets 

something else a little later, it will be easy to make that adjustment. The most important thing for people that have already gotten their disability determination is they will have a choice. They 

can keep the current determination or they can look at the new 

system and then make a choice of what is better for them. We believe that in the new system, people will be much better off. All of 

our recommendations, it will simplify it. If you combine the annuity, the extended disability payment that covers quality of life, as 

well as modernizes that actual decision, people will just be better 

off. 

If they were injured in an accident and there was liability and 

they were represented by a lawyer, they would get all these other 

payments. They would get the earnings stuff. They get the quality 

of life payment. Why is it that these young soldiers don’t get that? 

Because we have a very old fashioned system. And yet if they got 

a similar kind of injury in the private sector, all of those other 

things would be taken into account as part of the payment. 

Mr. MICHAUD. Okay. My next question, actually, Senator Dole, 

you had mentioned that, I believe it was in action plan, your fifth 

action plan, that the White House is coming up with actually a 

more liberal proposal and I couldn’t really figure out the distinction 

between the report versus what the White House might be coming 

up with. 

Senator DOLE. Well, I can’t tell you specifically. I do know in the 

TRICARE area they are going to extend it to more people and families. So that is a big, big step. It is probably a big cost. But that 

is already in the mix. As I said, I was there last week. The Secretary was there yesterday. She may have some later information. 


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I was very pleased because we have been pushing the people in the 

White House and, obviously, haven’t been pushing Members of 

Congress, but we have been letting Members of Congress know we 

were available. We wanted to follow up. We wanted something to 

happen. I don’t know whether they spell out any other areas. But 

they like our report. I think they really think we did a pretty good 

job in the time we had. 

We were together with the President at the local VA hospital 

where he, in effect, endorsed the report. We know there is another 

one coming out on benefits, but again, I think with minor differences. 

Did the White House add anything else you learned yesterday? 

Secretary SHALALA. No. This Presidential Commission made six 

recommendations that require congressional action. The White 

House is preparing draft legislation and has indicated absolute 

willingness to work with the Congress. From what we heard, and 

I was there yesterday, they are considering broadening both the 

definition of who is covered, extending the TRICARE benefit to 

those that are discharged for medical reasons and to their families 

further than we did. 

So I think that you will be very pleased with their proposal. And 

that, of course, is draft legislation to give you another touchstone 

to work from. So because it was a Presidential Commission, they 

will do the drafting of those six. All of the other recommendations 

are now being implemented by the Administration and they are 

marching through each one with, from what I could tell, because 

I have talked to the two secretaries as well as to the White House, 

pretty firm commitments. I can usually tell, since I have been there 

before, whether they are really doing it. They have pretty firm commitments from the agencies that need to do the implementation, 

with the expected push back and I think you can hear our enthusiasm because we think this is going to get done. 

I actually don’t believe in long commissions. I think you ought 

to be able to go in, see where you ought to intervene to make it 

better, identify pieces of legislation that need to be passed and just 

get it done. 

Senator DOLE. We have already had a report, and I assume 

that—if you don’t have it, we will send it up. But what is happening so far with DoD and VA and their joint meetings and the 

areas of our recommendations they have focused on is that they are 

starting to implement. So there is positive movement, so—— 

Mr. MICHAUD. Good. I thank you both very much. 

The CHAIRMAN. Thank you. Mr. Boozman. 

Mr. BOOZMAN. Thank you, Mr. Chairman. 

I want to thank you all for your work. I think you are a great 

example of how you can take individuals that are very well respected on both sides of the aisle and really accomplish a great 

deal. I think that you are a great example for all of us. 

In dealing with the 3,200, that group that is severely injured, I 

think the recovery coordinator is an excellent idea. All of us 

though, having been around the bureaucracy and things, and there 

is nothing inherently wrong. It is just the system. I would really 

encourage that hopefully those people, those recovery coordinators, 

will have a general officer, somebody with some clout that when 


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they run into a roadblock, they have somebody that can cut 

through the system that says hey, these 3,200 are individuals that 

were totally committed and have unique situations, many times, 

that can cut through the red tape. And I hope somehow we can integrate that into the thing. 

Secretary SHALALA. I think that is exactly right for accountability. I think of them as torpedoes which literally cut through 

with the authority to order appointments, to get agencies and services to work together, but more importantly, to make sure that individuals with very complex problems and their families get every 

benefit they are eligible for and get it on time. 

Senator DOLE. Our hope is, when they have that meeting when 

the patient arrives at Walter Reed and the doctors are hovering 

around there, one member of that team will be the recovery coordinator and he will be there from, or she or he will be there from 

whatever point. I really give full credit for that to Secretary 

Shalala, and I think it is a great idea and it is not a big, big layer. 

We are talking about 40 or 50 specialists, right? 

Secretary SHALALA. Yeah, not that many, you know, it is just a 

handful of people given the number of people that are involved. 

And I think the most important thing is they don’t get deployed. 

What happens now with the care coordinators is they are there for 

a year and then they get deployed. And so they keep changing and 

you have one for each kind of service. You just can’t do that when 

you have a complex situation. 

Mr. BOOZMAN. Right. Let me ask you another thing, too, or 

maybe you can comment. I have run into another situation. I am 

an optometrist and was asked to—I have been to Walter Reed several times. I went over to Walter Reed, was asked by the ophthalmologist and optometrist there, they have a situation where, with 

traumatic brain injury and they don’t really understand why, but 

many of these people have symptoms of not being able to read, you 

know, like they used to, comprehend. And so we are trying, we introduced a bill to provide them some money to go forward with that 

study. 

As you all know, it is very difficult and hopefully we can get that 

blended into this legislation or some other. But there ought to be 

a pool of money that as these things come up, you know, a small 

pool of money was something where they don’t have to have an act 

of Congress to go forward with these little, very, very important 

things. Does that make sense? You all are very familiar with this 

issue. 

Secretary SHALALA. You know, DoD has a lot of research money 

for health research, as does the National Institutes of Health (NIH) 

and there is no reason why a first class application for research 

money for a period of time on something specific like that ought not 

to be funded. 

Mr. BOOZMAN. And, again, I think you can help by cutting 

the—— 

Secretary SHALALA. But it is not that the resources aren’t available. We have just got to make sure that when those applications 

go in, that they have the priority they deserve. 

Mr. BOOZMAN. Exactly. 


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Secretary SHALALA. And there is an increasing interest. I am 

happy to talk to the Director of the NIH and to the DoD health research people. But you have put a lot of money in DoD research, 

as well as in NIH research. I come from a place that has the number one ranked eye hospital, Baskin-Palmer, and I know that our 

scientists are very interested in these kinds of questions. 

Mr. BOOZMAN. Well, again, that would be helpful, like I say, in 

getting some priority. 

Secretary SHALALA. I would be happy to have those conversations. 

Mr. BOOZMAN. The last thing, you mentioned unfit for service. 

And what does that, what does that entail as far as disability? 

That doesn’t mean 100 percent, does it, or does that mean the 

whole gambit or—— 

Senator DOLE. Well, DoD wants to keep as many people as they 

can. So you could have some problems, some health problems, some 

disabilities, but still be fit for service. And it doesn’t mean you are 

in perfect health and everything is fine. 

Mr. BOOZMAN. Sure. 

Senator DOLE. But there are certain, some things you can do in 

the service that if you are 100 percent you couldn’t do. So that is 

why we want to make certain that they make that finding and the 

VA does the rest. 

Secretary SHALALA. You know, the two young soldiers that were 

members of our panel, both of them could have stayed in the military, that is, in desk jobs. They chose not to. So they took their discharge and got on with their education. But it was basically their 

choice. And the military is trying to keep some people—first of all, 

they are great role models and there obviously are stories of people 

jumping out of airplanes, you know, who have a prosthetic limb. 

But I think they know pretty well who is fit to serve, but their incentive is to try to keep people. 

Mr. BOOZMAN. Thank you all very much. Senator, you mentioned 

the program, the vets coming up, you know, the World War II guys. 

Senator DOLE. Honored Flight. 

Mr. BOOZMAN. We had a group from Arkansas that you met and 

that was such a special thing. So we appreciate those little things 

that make such a big difference. Thank you very much. 

Senator DOLE. Yeah. Well, not many World War II veterans 

around are all that active. But I am sort of the official greeter. I 

try to go out there whenever I can and greet these World War II 

veterans. And if they are not doing it in your district, you ought 

to check into it, because it is just a great thing to do. It may 

change the life of some of these 80-year-olds, 85. I met one guy who 

was 92. He wanted to get a picture. He was in a wheelchair. I said 

you stay right there. He said no, no, I am going to stand up and 

he stood up straight and strong, but you can see the tears in their 

eyes and they probably reflected when they were young and what 

they were doing. It is a great program. You just raise the money 

locally. It is called Honor Flight. You can get information on their 

Web site. Some fellow that is not a big CEO, but some young businessman in Hendersonville, North Carolina, named Jeff Miller 

came up with the idea and it is really great. Every Saturday you 

can almost count on—last Saturday there were 600 from all over 


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the country. And I did have a good chance to meet, I met two Kansans in that group from Arkansas, so—— 

The CHAIRMAN. Thank you. Mr. Walz. 

Mr. WALZ. Well, thank you, Mr. Chairman and Ranking Member, 

and of course, a thank you to our guests, Senator Dole and Secretary Shalala. 

Senator Dole, you were out in Rochester, Minnesota, to our soldier’s field which we are very proud of our memorial out there and 

my friend, Wayne Steelman, and many of our veterans out there 

recall that day with intimate detail about your taking time to tour 

the memorial and it truly does matter. 

As a veteran, when I saw that the two of you were appointed to 

this, I couldn’t have been happier and the report you produced is 

one that I was hoping we would get. It is absolutely what we need. 

It comes from two distinguished voices on this and my regret is 

today that this hearing is not being covered with the same, the 

same gusto as was last week’s hearing, because listening to Senator Dole’s words, the two are intertwined. 

I see members out here of our veteran service organizations, veterans themselves, people who have worked on this issue for decades and we know you can’t separate the two and I think it is very 

important for this Nation to understand that this treatment is 

truly critical. And I think it is important when we talk about the 

VA to recognize the amount of great work that happens there. I 

have in Minnesota, at the VA medical center in Minneapolis, the 

polytrauma center there. The work that they are doing—when I 

hear mothers with severely injured sons and they say the only 

thing getting them through the day are those saints that are there 

on that floor, those nurses, those doctors, that is heartwarming. 

But the Senator made the point that all of us make on this. This 

is a zero sum proposition. One Sergeant Shannon is one too many. 

And that is what we have to get to. And I think in all of these 

areas, we are trying to figure out what are the systemic issues here 

and some of us are trying to understand the cultural inertia that 

happens in this. One area that I am interested in, and I am glad 

to hear it got reported on, is this issue of exchanging medical 

records from DoD to VA. I represent the City of Rochester, which 

includes the Mayo Clinic. And this is an area that has been working, an institution that has been working on this for years. This is 

a very complex issue. It doesn’t involve just getting a standardized 

database. It involves many things that go into what is on that 

record. 

And when I talk to the people at the Mayo who have been looking at this, they are convinced that the VA has the best in the 

world. They said this is the best system in the world. And their 

suggestion was, and this was made not, you know, this was a little 

more anecdotally when I was talking to them about it with their 

very intimate knowledge of this, that DoD needs to maybe adjust 

to that. 

Now, I had the opportunity after talking with the Mayo people 

in looking at this to mention this to some, a person in DoD on the 

Army side that would have the ability to influence these types of 

decisions. And they simply wanted to hear nothing about it. They 

didn’t want to hear about it. It wasn’t the right way to go. 


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My question to both of you with vast experience in the bureaucracy, talking about the torpedo, Secretary, of cutting through, how 

do we get to this issue? How do we move these electronic medical 

records, this record sharing? It is so important for the care of our 

soldiers, for the efficiency and for everything else. And I guess I am 

asking you maybe to answer a really, really difficult question here. 

But it is one that I think—this has been around for many of these 

Members’ entire tenure here and we still can’t get it fixed and it 

is a critical part of that seamless transition, so, please. 

Secretary SHALALA. Actually, I don’t think it is that complex, not 

if you look at it from the point of view of the patient. I was Secretary of HHS while the VA record system was being put in place. 

That technology certainly will need modernization and some investments in the years ahead. It seems so simple, why doesn’t the military just adopt it and be done with it. It is in part not the answer 

because the VA and DoD are doing different things. That is number one. 

But what we focused on is the soldiers now, and what can you 

do to get the interoperability of the two systems. We suggested, 

under the leadership of a member of our Commission who does this 

for the Cleveland Clinic and is an international expert on the subject, that there are a series of steps that will get us more rapidly 

to interoperability, which are now taking place. They have to do it 

as fast as they can to make sure that you have access to information necessary for both care and services. 

That is more important at this point in time than for us to suggest that you spend billions trying to get one new system built from 

the bottom up. And you can tell our pragmatism here, that first of 

all, those of us that have experienced the bottom up systems are 

a little nervous about starting that while the technology is changing. It is not that we would ever say we are opposed to it, but at 

the moment, what you want to do is serve these soldiers now and 

also the ones that come behind them. There are ways to do that. 

We have suggested a series of steps. You don’t have to pass any 

legislation on it. The government can do it. The two agencies can 

do it. They are in the process of doing it. And we have suggested 

action steps that can be measured and what the goals are of those 

steps so that we can actually hold the DoD and the VA accountable 

for making sure those systems work together. And they are in the 

process of doing that. That is the good news here. 

The bad news is that we actually did not take a vote or look at, 

you know, adopting one system versus another, because they actually do have different purposes and need different kinds of interactions, nor did we make a recommendation on a bottoms up, 

multi-billion dollar review. We looked at the practical ways to get 

the system to work for these soldiers now so it is not necessary to 

carry paper records across the street. 

The CHAIRMAN. Madam Secretary, we are going to have to adjourn very soon. But we have time for—I apologize to the Members. 

But if Mr. McNerney, Mr. Hare and Ms. Herseth each have one 

question before we adjourn—— 

Secretary SHALALA. Okay. We will try to answer it quickly then. 

The CHAIRMAN. Do you have a question before we adjourn? 


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Mr. MCNERNEY. Thank you, Mr. Chairman. I really wanted to 

compliment you all on your can-do attitude, which is inspiring, and 

on the simplicity of the approach. Sitting here on the Veterans’ Affairs Committee, we see problems that seem overwhelming and you 

have taken them by the horns and you have produced a report that 

makes it look like we can actually make significant progress. So I 

applaud you on that. 

One thing that was interesting was the proposal to ask for reevaluation on a continuing basis. And my concern is, wouldn’t that 

seem like it would make the backlog even more for evaluation of 

veterans? 

Senator DOLE. Well, that is one of the practical questions that 

we looked at and I don’t—it would seem to me, after maybe a couple evaluations it would stop. You don’t do this for the rest of your 

life because you are going to know, unless somebody has a deteriorating condition that you want to continue to check on. But we are 

just going to have to find the people. It is pretty much like the 

passport problem when we had this big backlog. Maybe we are 

going to have to bring in some of these people who have left and 

bring them back on a temporary basis and let them help us get rid 

of these backlogs. That could be a problem. 

The CHAIRMAN. Mr. McNerney, thank you. I—— 

Secretary SHALALA. But we do want to give the opportunity to 

upgrade someone’s benefits, so there is a positive and a negative 

here. But people ought to be able to look at someone’s file and 

make a pretty quick decision on whether you need to move forward 

on that evaluation, because in the vast majority of the cases it 

makes no sense. But we want to make sure that we can upgrade 

benefits if that is necessary. 

The CHAIRMAN. Thank you. Mr. Hare. 

Mr. HARE. Mine is just real quick. Thank you very much for 

what you both have done. The other day, the Secretary was here 

just yesterday talking about 177 days for a person as an average 

on a claim. And it seems to me, why, and I wanted to get your 

thoughts. Why can’t we err on the side of the veteran? In other 

words, start the process of the claim immediately the same way 

you do when somebody files their taxes and the claim begins. 

If we want to audit this claim and we think that there is a problem with it, fine. But it would seem to me, and the Secretary said 

he supported a pilot program, but their goal is to get it down from 

177 to 145 days and for that veteran, I don’t think that is, I don’t 

think that is acceptable. So I wonder what your thoughts are on 

being able to err on the side of the veteran and at the VA here on 

disability claims. 

Secretary SHALALA. You know, I think we are always in favor 

of erring on the side of the patient, that this has to be patientcentered. We did not look at how to eliminate the backlog. I have 

had some experience in looking at that kind of thing, but our Commission did not actually review that specific issue. So I am reluctant to even comment on it, because there are different ways to approach it. But our point is that you get a patient-centered system 

that doesn’t delay people’s ability to get the help they need and 

doesn’t delay their ability to get educational benefits and get those 

investments on the front end as quickly as possible. 


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The CHAIRMAN. Thank—— 

Senator DOLE. And some people have a right to appeal and, of 

course, the appeal takes a long time and I think, yeah, what is it, 

12 months or something—— 

Secretary SHALALA. Yeah. 

Senator DOLE [continuing]. Can delay it. So there are other 

things that maybe we need to look at. We think with our new system we are going to streamline the process so you won’t have that 

big backlog. And you also, obviously, you get paid even though you 

will have to wait for a time, but you will get paid when it is finally 

adjudicated. 

The CHAIRMAN. Thank you. Ms. Herseth. 

Ms. HERSETH SANDLIN. Thank you, Mr. Chairman, and thanks to 

both of you. I commend you for your great work and the recommendations. I, too, like many others here, appreciate and would 

support the creation of someone who would coordinate recovery for 

servicemembers. I have had a number of constituents who I feel 

have been kind of caught between DoD and VA, one in particular 

who suffered a devastating traumatic brain injury. His family did 

not feel that he was getting the quality of care at a polytrauma 

center and, after some intervention, had him transferred to a private rehabilitative facility in California. 

And so I guess just two very quick questions. One, do you envision the recovery coordinator serving as the advocate for the patient? 

Secretary SHALALA. Yes. 

Ms. HERSETH SANDLIN. Okay. And then the other, in all of the 

interviews and surveys that you did over the past 4 months, did 

you find anything that would suggest that we prematurely moved 

traumatically brain injured soldiers to long-term care who did not 

receive aggressive ongoing therapy and rehab and, if they did, 

would be much better off today than if they were prematurely 

transferred to a long-term care facility? 

Secretary SHALALA. Our survey did not provide answers at that 

level of detail, nor did we have a health services research capacity 

to be able to answer that question. But it certainly is a question 

that ought to be looked at. 

Ms. HERSETH SANDLIN. And one final thought—— 

Senator DOLE. I would just add that Mr. Eckenhoff, who is a 

member of our Commission and the National Rehab Hospital Director—they have a number of, or have had a number of active duty 

people where they couldn’t get the best care. They can get the best 

care at his facility and we encourage that. 

Ms. HERSETH SANDLIN. Okay. Thank you. That answered the—— 

The CHAIRMAN. Thank you, Madam Secretary and Senator Dole. 

This has been one of the most productive and helpful sessions we 

have ever had here. It reflects your personalities, your enthusiasm, 

your commitment and we thank you so much and we intend to 

meet your challenge of speed and urgency and being patientcentered. And we thank you so much. We are going to have the— 

next week the Disability Commission will be in to testify and—I 

am sorry, the 10th of October. And we look forward to working 

with you on behalf of our combat veterans. Thank you so much. 

This meeting is adjourned. 

[Whereupon, at 11:44 a.m., the Committee was adjourned.] 


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A P P E N D I X 

Prepared Statement of Hon. Bob Filner, 

Chairman, Full Committee on Veterans’ Affairs 

On March 6, 2007, the President signed an Executive Order to establish the President’s Commission on Care for America’s Returning Wounded Warriors. 

The Commission was charged with the task of examining the effectiveness of returning wounded servicemembers’ transition from deployment in support of the 

Global War on Terror to returning to productive military service or civilian society, 

and recommend needed improvements. 

The Report of the Commission was recently released and today the Committee 

will be hearing from the Co-Chairs of that Commission—Secretary Donna Shalala 

and Senator Bob Dole. I look forward to a frank and open discussion of the recommendations made by the Commission. 

According to the report, there have been 1.5 million servicemembers deployed to 

Iraq and Afghanistan. Twenty-eight thousand have been wounded in action, with 

3,082 of those seriously injured. The nature of the injuries sustained on today’s battlefield is very complex and resource-intensive. Because of the advancements in battlefield medicine, protective gear and technology, the rate of survival is much greater than that of past wars. 

My concerns are focused on how we serve our troops when they turn from the 

Pentagon to the VA for their healthcare. In order for our troops to experience the 

seamless transition they deserve, the bureaucratic problems that prevent many from 

getting the care they need must be fixed. 

While VA and DoD have made adjustments and changes over the last few years 

in an attempt to address the issues surrounding the treatment of these injuries, as 

well as the transitioning of severely wounded servicemembers, many obstacles remain. 

As Chairman of the Committee on Veterans’ Affairs, I am sensitive to the difficulties involved in coordinating the activities of the Department of Defense and the Department of Veterans Affairs. These Departments do indeed have different missions. 

That being said, we no longer have the luxury of time, and we, as a country, must 

act. 

Right now, while we prepare to discuss this issue, our servicemembers are in 

harm’s way. Some of these brave men and women will be killed or wounded. We 

have talked about the necessity of providing a seamless transition for many years. 

This is our test as a Nation. And this is a test we simply must pass. 

I would like to welcome our two distinguished panelists this morning. 

In 1993, President Bill Clinton appointed Donna Shalala as the Secretary of 

Health and Human Services (HHS) where she served for eight years, becoming the 

longest serving HHS Secretary in our history. As HHS Secretary, she directed the 

welfare reform process, made health insurance available to an estimated 3.3 million 

children, raised child immunization rates to the highest levels in history, led major 

reforms of the FDA’s drug approval process and food safety system, revitalized the 

National Institutes of Health, and directed a major management and policy reform 

of Medicare. 

Secretary Shalala has dealt with large bureaucracies like the VA and DoD before 

and she is experienced in implementing programs that work for the people . . . not 

against the people. 

Senator Dole knows all too well the problems that our brave men and women face 

as they deal with the painful injuries of war. Senator Dole was twice decorated for 

heroism, receiving two Purple Hearts for his injuries, and the Bronze Star Medal 

with combat ‘‘V’’ for valor. In 1942, he joined the United States Army’s Enlisted Reserve Corps to fight in World War II and became a second lieutenant in the Army’s 

10th Mountain Division. In April 1945, while engaged in combat in the hills of 

northern Italy, he was hit by German machine gun fire in his upper right back and 

badly injured. He had to wait nine hours on the battlefield before being taken to 


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the 15th Evacuation Hospital before he began his recovery at a U.S. Army hospital 

in Michigan. 

I want to take this opportunity to thank you both for your service to our country 

and your dedication to our Nation’s veterans. We are all grateful for the work that 

you do. f 

Prepared Statement of Hon. Harry E. Mitchell, 

a Representative in Congress from the State of Arizona 

Thank you, Mr. Chairman. 

First and foremost I want to thank Senator Dole and Secretary Shalala for their 

efforts. 

These distinguished Co-Chairs have not only provided us critical information . . . 

they have provided us a model of bipartisanship on an issue of great importance. 

They know that the best way for us to help our Nation’s veterans is for all of us 

to work together. 

And as their report has demonstrated, we have our work cut out for us. 

We need to improve information-sharing between the Department of Defense and 

the Veterans Administration. This is not only inefficient, it poses a risk to the quality of care our veterans receive. 

We need to reduce the long wait times veterans are enduring at the VA, and ensure that the VA has the resources it needs to serve veterans in a timely manner. 

We need to do more to help the families of veterans who, in many cases, are 

forced to shoulder the burden of advocating for healthcare services. 

The President’s Commission outlined six specific changes to the current veteran 

care organization that can be made through Congress, which would improve the 

services that our Nation’s veterans receive. 

Some of these recommendations will be easy fixes requiring little negotiation or 

further investigation. 

Others, like the restructuring of disability and compensation systems, will require 

us to put our partisan differences aside and work creatively to arrive at the best 

outcome. 

The wars in Afghanistan and Iraq pose different challenges for our VA than previous conflicts. Many of our returning heroes are bringing back new and different 

kinds of injuries which need new and different kinds of treatments. 

Our challenges are great, but working together, I know we can meet them. 

Our veterans have served us, and they have a right to expect us to serve them. 

And that is exactly what we are going to do. 

I look forward to today’s discussion, and I yield back. 

f 

Prepared Statement of Hon. Jerry Moran, 

a Representative in Congress from the State of Kansas 

I want to first welcome our distinguished guests with us today. Senator Dole and 

Secretary Shalala have both experienced long and successful careers in public service. Today, we appreciate their willingness to use their time and talents for a most 

worthy goal: to ensure our country is providing the best care and services to our 

military men and women and veterans, especially for those wounded in service to 

our country. 

A couple years back, Senator Dole published a moving memoir titled ‘‘One Soldier’s Story.’’ In this book he chronicles his powerful story of growing up in Russell, 

Kansas, going off to war, being wounded on a battlefield in Italy, and his struggle 

to overcome the odds to recover and rebuild his life. What I found remarkable about 

the Senator’s recovery period was not only his personal courage, but also the help 

that he received from those around him. Senator Dole wrote, ‘‘None of us who travels the valleys of life ever walks alone.’’ From his mother who was by his bedside 

night and day, to the gifted Army doctors, to the Russell community who collected 

donations in a cigar box to pay for his surgeries, the system of support for wounded 

servicemembers matters. 

Our military members and veterans today deserve a strong support system, one 

that matches the times. The Wounded Warrior Commission—after several months 

of visits to DoD and VA facilities, public meetings, and patient surveys and interviews—recommends that improvements can and should be made. Change is needed 

to modernize the current system to adjust to the realities of today’s wars and improve the quality of life of soldiers and their families. The Commission has put forth 

a set of action items to do this. 


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It is now Congress’s turn to take a serious look at these recommendations. To 

move things along, Congressman Salazar and I have introduced the Wounded Warriors Commission Implementation Act, H.R. 3502, to enact the recommendations of 

the Commission requiring congressional action. Before the Commission’s report was 

released, both the House and Senate acted to pass legislation addressing some of 

the concerns later identified by the Commission. This was a good first step to improving care and services, but clearly more comprehensive action is needed. I encourage my colleagues to move quickly to make the changes necessary to support 

those who have sacrificed so much for our country. 

f 

Prepared Statement of Hon. Ginny Brown-Waite, 

a Representative in Congress from the State of Florida 

Thank you, Mr. Chairman. 

Senator Dole and Secretary Shalala, I want to thank you for testifying before this 

Committee today. I would like to commend you for your work on the President’s 

Commission on Care for America’s Returning Wounded Warriors. When we send the 

brave men and women of our armed forces into battle, we better make sure they 

have everything they need when they come home. 

Your recommendations suggest the need in some instances to make sweeping 

changes to the way the Department of Veterans Affairs conducts its business. I will 

be interested in hearing exactly how you think these recommendations can be implemented 

I was pleased to see the recognition you gave to the importance of addressing 

post-traumatic stress disorder and traumatic brain injuries in our returning soldiers. This along with strengthening the support for their families, will go a long 

way to help soldiers transition back to life as a civilian. 

Once again, I welcome you to the hearing and look forward to hearing your 

thoughts on the issue before us today. 

f 

Prepared Statement of Hon. Donna E. Shalala, Co-Chair, 

President’s Commission on Care for America’s Returning Wounded Warriors 

(Former Secretary of the U.S. Department of Health and Human Services) 

Good morning, Chairman Filner, Congressman Buyer, and distinguished Members 

of the Committee. Thank you for giving me the opportunity to testify today, along 

with my fellow Co-Chair, Senator Bob Dole, about the recommendations our Commission presented to the President in late July. 

It was a true privilege to serve on the President’s Commission on Care for America’s Returning Wounded Warriors, especially with Senator Dole, whose knowledge 

and dedication was an inspiration to us all. We were joined by a stellar group of 

Commissioners, each of whom gave their full energy and attention to the critical 

mission we faced. 

As you know, we had an extremely short timeframe to complete our mission—but 

we were propelled by a sense of urgency that the issues before us required. Mr. 

Chairman and Members of the Committee, we know you share this sense of urgency 

and that’s why we are so pleased to be with you today to discuss not only our recommendations, but the critical need to implement them. 

We have been truly heartened by the response our report has received in the 

White House, the halls of Congress and throughout the country. The Nation has rallied behind the need to help those who have put their lives on the line in service 

to our country—and we are optimistic that Congress and the Administration will 

move quickly to respond to this need by enacting our recommendations. 

As we were reminded again by the article in Saturday’s Washington Post, the 

problems facing our injured service men and women have not gone away. Congress 

and the Administration have spent a great deal of time the past few weeks discussing the future of the war in Iraq. And while this is a debate that our Nation 

must have, I implore you not to forget about those who have already sacrificed so 

much—our injured men and women. They need to be front and center in congressional debate and within the Administration. 

The story of Staff Sgt. John Daniel Shannon, as told in the Washington Post, is 

a story that we heard throughout our time with the Commission—a story of numerous case managers, none of whom held sole responsibility for spearheading an integrated care system—a story of lost paperwork and frustration—and a story of a disability system that was in desperate need of repair. 


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It’s stories like this that sparked the creation of our Commission—and stories like 

this that should and must drive immediate congressional and White House action. 

This past July, it was the Commission’s honor to present to the President, Congress and the public, six groundbreaking patient and family centered recommendations that make sweeping changes in military and veterans’ healthcare and services. 

The recommendations include the first major overhaul of the disability system in 

more than 50 years; creation of recovery plans with recovery coordinators; a new 

e-Benefits Web site; and guaranteeing care for post-traumatic stress disorder from 

the VA for any servicemember deployed to Iraq and Afghanistan. Our report—Serve, 

Support, Simplify—is a bold blueprint for action that will enable injured servicemembers to successfully transition, as quickly as possible, back to their military duties or civilian life. Our report calls for (and I quote) ‘‘fundamental changes in care 

management and the disability system.’’ I respectfully request that this report be 

submitted for the record. 

Specifically, our six recommendations will: 

• Immediately Create Comprehensive Recovery Plans to Provide the 

Right Care and Support at the Right Time in the Right Place • Completely Restructure the Disability Determination and Compensation Systems • Aggressively Prevent and Treat Post-Traumatic Stress Disorder and 

Traumatic Brain Injury • Significantly Strengthen Support for Families • Rapidly Transfer Patient Information Between DoD and VA • Strongly Support Walter Reed By Recruiting and Retaining First Rate 

Professionals Through 2011 

Our six recommendations do not require massive new programs or a flurry of new 

legislation. We identify 34 specific action steps that must be taken to implement the 

six recommendations. Only six of these 34 items require legislation, and that’s 

what we will focus on today. A complete list of the action steps for the six recommendations is included on the last page of my testimony. 

I will summarize the first three actions that require legislation, and, then, Senator Dole will cover the remaining three. 

The first is to improve access to care for servicemembers with Post-Traumatic Stress Disorder. 

We call on Congress to authorize the VA to provide lifetime treatment for PTSD 

for any veteran deployed to Iraq or Afghanistan in need of such services. This ‘‘presumptive eligibility’’ for the diagnosis and treatment of PTSD should occur regardless of the length of time that has transpired since the exposure to combat events. 

The current conflicts involve intense urban fighting, often against civilian combatants, and many servicemembers witness or experience acts of terrorism. Five hundred thousand servicemembers have been deployed multiple times. The longer 

servicemembers are in the field, the more likely they are to experience events which 

can lead to symptoms of PTSD. The consequences of PTSD can be devastating. The 

VA is a recognized leader in the treatment of combat-related PTSD, with an extensive network of specialized inpatient, outpatient, day hospital, and residential treatment programs. Therefore, we ask that any veteran of the Iraq or Afghanistan conflicts be able to obtain prompt access to the VA’s extensive resources for diagnosis 

and treatment. 

Next, we ask Congress to strengthen support for our military families. 

In our travels across the country, it became abundantly clear that we not only 

needed to help the severely injured, we needed to help their loved ones too. These 

loved ones are often on the frontlines of care and they are in desperate need of support. Therefore, we call upon Congress to make servicemembers with combat-related 

injuries eligible for respite care and aide and personal attendant benefits. These 

benefits are provided in the current Extended Care Health Option program under 

TRICARE. Presently, DoD provides no other benefit for caregiving. Yet we know 

that many families are caring for their injured servicemember at home—and many 

of these servicemembers have complex injuries. These families, forced into stressful 

new situations, don’t need more anxiety and confusion, they need support. Families 

are unprepared to provide 24/7 care. Those that try, wear out quickly. By providing 

help for the caregiver, families can better deal with the stress and problems that 

arise when caring for a loved one with complex injuries at home. 

We also recommend that Congress amend the Family and Medical Leave Act 

(FMLA) to extend unpaid leave from 12 weeks to up to six months for a family 

member of a servicemember who has a combat-related injury and meets other 

FMLA eligibility requirements. According to initial findings of research conducted 

by the Commission, approximately two-thirds of injured servicemembers reported 


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that their family members or close friends stayed with them for an extended time 

while they were hospitalized; one in five gave up a job to do so. 

Getting family members to the bedside of an injured servicemember is not the 

problem. The services have developed effective procedures to make this happen, and 

the private sector has stepped up to provide temporary housing. Because most injured servicemembers recover quickly and return to duty, the family member’s stay 

may be short. However, for those whose loved one has incurred complex injuries, 

the stay may last much longer. Extending the Family and Medical Leave Act for 

these families will make a tremendous difference in the quality of their lives. Congress enacted the initial Family and Medical Leave Act in 1993, when I was Secretary of Health and Human Services. Since then, its provisions have provided over 

60 million workers the opportunity to care for their family members when they need 

it most—without putting their jobs on the line. 

We were pleased to see that the Senate has already unanimously passed the Support for Injured Servicemembers Act which implements this recommendation. 

We hope the House of Representatives will quickly follow suit. 

Mr. Chairman, having served in government a good deal of my life, I believe that 

government can work to improve the lives of its citizens. But sometimes, people of 

good will want to solve a problem and their idea of a fix is to add a program or 

a new regulation. What we’ve done is strip some of that away to simplify the system, to go back to basic principles and to make necessary programs more patient 

and family centered. 

Above all, our recommendations are doable. Whether requiring congressional legislation or implementation by DoD or VA, we made sure that what we were recommending could be acted upon quickly. Our seriously injured servicemembers must 

not be made to wait. They deserve a healthcare system that truly serves, supports 

and simplifies. 

On behalf of the Commission, I want to thank the Committee again for the opportunity to discuss our recommendations. And because those of you who know me 

know I don’t mince words, I leave the Committee—and the Administration—with 

these three simple words—Just do it! And, Mr. Chairman and Members of this distinguished Committee, I know that through your leadership, our recommendations 

WILL become a reality for our servicemembers and their families. 

Thank you and I look forward to joining Senator Dole in answering your questions. 

f 

Prepared Statement of Hon. Bob Dole, Co-Chair, 

President’s Commission on Care for America’s Returning Wounded Warriors 

(Former United States Senator from the State of Kansas) 

• Good morning, Mr. Chairman and Members of the Committee. It is a pleasure 

to appear before you today, along with my fellow Co-Chair Donna Shalala. 

• We look forward to working with you to support this Nation’s goal of assuring 

that our service men and women receive the benefits and services they deserve. 

• It has been an honor to serve on this Commission, especially with Secretary 

Shalala. I have said it before and I will say it here today, she’s been a ‘‘Triple 

A’’ Co-Chair. She has boundless energy and kept us going as we tackled this 

important challenge. It has been a great experience to work with her and our 

fellow Commissioners. 

• Our recommendations were guided by the Commission chaired by General 

Omar Bradley in 1956, which said: ‘‘Our philosophy of veterans’ benefits must 

be modernized and the whole structure of traditional veterans’ programs 

brought up to date.’’ 

• Problems accompany change—wars change, people change, techniques change, 

injuries change, and we need to keep our military and veterans healthcare system up to date. I find it remarkable that 50 years later we are finding so much 

of what General Bradley had recommended is still relevant today. 

• Secretary Shalala has outlined our recommendations and some of the action 

steps to be taken by Congress. I will now review the remaining three action 

steps that require legislation and are part of our call for a complete restructuring of the disability and compensation systems. 

• In our next action step, we call on Congress to revise the DoD and VA disability 

systems. Right now each of these Departments assesses each injured servicemember’s disability level, based on different objectives. Each assessment leads 

to a rating of the amount of disability. The two systems often disagree, they 

take way too long, and the process is way too confusing. 


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• There are differences in ratings depending on which military service determines 

the DoD rating and which VA regional office determines the VA rating. In our 

national survey of injured servicemembers, less than half understood the DoD’s 

disability evaluation process. And, only 42 percent of retired or separated servicemembers who had filed a VA claim understood the VA process. • We recommend that DoD retain authority to determine fitness to serve. Servicemembers whose health makes them unfit for duty would be separated from the 

military. DoD would provide them a lifetime annuity payment based on their 

rank and years of military service. • We believe that only one physical exam should be performed, rather than the 

two required now—one by each Department—and it should be performed by the 

DoD. The VA should assume all responsibility for establishing the disability rating based on that physical and for providing all disability compensation. • This new structure makes timely, reliable, transparent, and accountable changes 

in both systems. • Under this action item, DoD and VA can focus on what they do best—determining fitness standards and the health and readiness of the military workforce. The VA can focus on providing care and support for injured veterans, including providing education and training early in the rehabilitation process. It 

is a much simpler system that better supports the needs of those transitioning 

between active duty and veteran status. • In our fifth action step, we recommend healthcare coverage for servicemembers 

who are found unfit because of conditions that were acquired in combat, supporting combat, or preparing for combat. Congress should authorize comprehensive lifetime healthcare coverage and pharmacy benefits for those servicemembers and their families through DoD’s TRICARE program. • We believe this action item would help these individuals find employment that 

fits their needs without worrying whether the job provides adequate family 

healthcare coverage. • And, in our final action step, we would like Congress to clarify the objectives 

for the VA disability payment system by revising the three types of payments 

currently provided to many veterans. The primary objective should be to return disabled veterans to normal activities, insofar as possible, and as quickly 

as possible, by focusing on education, training, and employment. We recommend 

changing the existing disability compensation payments for injured servicemembers to include three components: transition support, earnings loss, and 

quality of life. • ‘‘Transition Payments’’ are temporary payments to help with expenses as disabled veterans integrate into civilian life. Veterans should receive either three 

months of base pay, if they are returning to their community and not participating in further rehabilitation; or an amount to cover living expenses for up 

to four years while they are participating in education or work training programs. 

• ‘‘Earnings Loss Payments’’ make up for any lower earning capacity remaining after transition and after training. Initial evaluation of the remaining workrelated disability should occur when training ends. Earnings loss payments 

should be credited as Social Security earnings and would end when the veteran 

retires and claims Social Security benefits. 

• And ‘‘Quality of Life Payments,’’ which should be based on a more modern 

concept of disability that takes into account an injury’s impact on an individual’s total quality of life—independent of the ability to work. 

• The disability status of veterans should be reevaluated every three years and 

compensation adjusted, as necessary. 

• By overhauling the DoD and VA disability systems, Congress will make the systems less confusing, eliminate payment inequalities, and provide a solid base 

and incentives for injured veterans to return to productive life. 

• I really believe, and I can say this having voted on a lot of military and veterans bills, having met on other commissions, having been a service officer in 

my younger years, and having worked hard to help veterans in the Legion and 

the VFW, that these are really bold action steps. They will do justice for our 

brave servicemembers fighting in Iraq and Afghanistan. I also believe these actions, which support our six recommendations, will benefit past and future generations of American servicemembers. 

• You know, in Vietnam 5⁄8 seriously injured servicemembers survived; today 7⁄8 survive—many with injuries that in World War II would have been fatal. 

Over 1.5 million servicemembers have been deployed in the Global War on Terror. At the time of our report, 37,851 had been evacuated from Iraq or Afghanistan for illness or injury—23,270 of these individuals were treated and returned 


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to duty within 72 hours. We believe that the number of seriously injured is 

small—on the order of 3,000, based on the number who have received Traumatic Servicemembers’ Group Life Insurance (TSGLI). • Both of us are grateful that Congress is determined to improve the system of 

care for America’s injured servicemembers and their families. We call upon you 

to move quickly and implement the actions we have discussed today. To make 

the significant improvements we recommend requires a sense of urgency and 

strong leadership. • Congress plays a critical role in helping to change the way our military and veterans healthcare systems work. Together, we are truly creating a system that 

serves our bravest men and women who have made the ultimate sacrifice for 

our Nation. • In closing, Mr. Chairman, let me emphasize again that our report is doable and 

necessary. We ask that you draft legislation to implement the six action items 

that Secretary Shalala and I have just discussed. 

Thank you. f 

Statement of Joseph A. Violante, 

National Legislative Director, Disabled American Veterans 

Mr. Chairman and Members of the Committee: 

The Disabled American Veterans (DAV), a national veterans service organization, 

was founded in 1920 and chartered by Congress in 1932 to represent this Nation’s 

war-disabled veterans. DAV is dedicated to a single purpose: building better lives 

for our Nation’s disabled veterans and their families. While representing the interests of all service-disabled veterans, DAV counts among its membership 1.3 million 

war veterans who were injured in service to the Nation. On behalf of DAV, I appreciate the opportunity to submit testimony to the Committee on the matter before 

you today. 

The President’s Commission on Care for America’s Returning Wounded Warriors 

(hereinafter, ‘‘Dole-Shalala’’) was ordered by President Bush following the public 

outcry earlier this year on discovery of substandard living conditions and confusing 

bureaucracy affecting hundreds of wounded soldiers at Walter Reed Army Medical 

Center. All of us were justifiably outraged that our Nation’s newest wounded and 

disabled military servicemembers were being forced to live in deplorable conditions 

and experienced frustrating delays to get their disabilities adjudicated by the military service departments. But even today, Mr. Chairman, injured and ill veterans 

continue to be denied benefits to which they are rightfully entitled, and I will explain our stance on this issue further in this testimony. 

In general the report issued July 25, 2007 by Dole-Shalala strikes a positive chord 

in advocating improved support to the immediate families of the wounded; calling 

for better coordination between the Department of Veterans Affairs (VA) and the 

Department of Defense (DoD) across a number of separate, but overlapping responsibilities; and, establishing within both VA and DoD better guidance and more informed assistance for wounded servicemembers, veterans and their families. These 

are very good ideas and should be implemented rapidly. We support them and commend the Commission for making these recommendations. In fact DAV, in our 

Stand Up For Veterans initiative (www.standup4vets.org), is developing our own 

legislative recommendations, for consideration by Congress, covering areas very 

similar to the Dole-Shalala recommendations of better supporting family caregivers 

and improving coordination of care. We hope to have our recommendations from 

that initiative, formulated by consultants now working with DAV after completing 

significant careers in the VA healthcare system, in legislative form to you by the 

end of this session of Congress, and for further consideration by the Committee 

early next year. 

Over the years DAV and other veterans service organizations have testified before 

this Committee and others on numerous occasions to identify many existing gaps 

in health and benefits systems, and to urge they be filled by actions within either 

VA or DoD, or both, or by Congress. Congress has responded to many of these initiatives, and we appreciate that assistance. Nevertheless, we believe a few of the DoleShalala recommendations that seek the same goals are in fact misguided or fail to 

recognize a degree of effectiveness that we at DAV understand and appreciate from 

decades of direct experience working in this very field, helping veterans obtain their 

rightful government benefits. 

Recalling the explosion of media reports earlier this year to document the Walter 

Reed Army Medical Center scandal, it is ironic that the recommendations from a 

well-conceived, 2-year study by the President’s Task Force to Improve Healthcare 


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Delivery for Our Nation’s Veterans issued in 2003, with broad support from the entire veterans community, have gone nowhere. Yet the Dole-Shalala recommendations—some of which could do harm to the very system now in place and intended 

to help veterans—are apparently being put on a fast track to implementation. DAV 

was invited with others to a White House briefing only a few days ago to be informed that the Administration is in the final stages of developing proposed legislation to carry out the Dole-Shalala recommendations, less than two months following 

the report of the Commission. We at DAV hope this Committee—one that will have 

the major responsibility to consider the Administration’s proposal—will very carefully evaluate the potential consequences of this bill. Its untoward affects in some 

areas that seem to help one group of disabled veterans may well damage the best 

interests of another group. DAV’s policy is to protect the interests of all service-disabled veterans, not one group to the detriment of another. 

In respect to protecting the interests of all disabled veterans, a major strategic 

goal of DAV, we appreciate the Committee’s interest in scheduling a hearing next 

month on the need for reform of funding of VA’s healthcare system—a key issue ignored by the Dole-Shalala Commission’s report. The Senate Committee on Veterans’ 

Affairs held such a hearing on July 25, 2007, the same date that the Dole-Shalala 

Commission issued its report. The President’s earlier Task Force in 2003 specifically 

pointed out the obvious mismatch between funding made available through the discretionary appropriations process now in use, versus meeting the true financial 

needs of VA healthcare. This President’s Task Force hypothesis was validated in 

2005 and 2006 by very public and embarrassing developments in VA healthcare 

when, during both periods, the VA Secretary reluctantly admitted to Congress that 

VA needed major emergency supplemental funding to keep the system financially 

solvent. Congress eventually provided that needed extra funding, but we continue 

to believe that significant reform is necessary. DAV strongly supports conversion of 

VA healthcare funding to a mandatory status as our top legislative goal, and we 

look forward to further discussions of this issue at your upcoming hearing. 

Mr. Chairman, most of the six Dole-Shalala recommendations are already being 

addressed in the Department of Veterans Affairs. For example, early on in these 

wars VA established polytrauma rehabilitation centers to treat traumatic brain injuries and other polytrauma cases from the wars in Iraq and Afghanistan, and VA 

has been the pioneering force and recognized expert in the treatment and research 

on post-traumatic stress disorder (PTSD). So, in many ways, VA is far and away 

ahead of the Dole-Shalala recommendations. 

The VA has an established nationwide healthcare system that is a recognized 

leader in specialized treatment (including long-term medical and vocational rehabilitation) of the kinds of injuries and psychological wounds occurring in the wars in 

Iraq and Afghanistan. Yet, initially Dole-Shalala has recommended that DoD take 

the lead role in coordinating long-term care for men and women with traumatic 

brain injury and post-traumatic stress disorder after they’ve been released from the 

military medical system. The report recommends these individuals, as veterans, retain lifetime access to DoD healthcare through its TRICARE program, rather than 

make a smooth transition to VA care as the primary locus of their long-term rehabilitation. While we do not object on its face to continued TRICARE eligibility for 

this newest generation of veterans, no former injured veteran group has ever been 

given this government benefit (even following the Persian Gulf War, when casualties were light). This proposal, if approved by Congress, would set a precedent to 

continue for veterans of any future U.S. conflict. After several decades of growing 

reliance on DoD, rather than VA, by service-disabled veterans, we question whether 

the VA healthcare system we know today would be able to retain its viability if 

wounded war veterans were still attached on a long-term basis primarily to military 

medicine. The military’s top mission in healthcare is the maintenance of readiness. 

Giving the military a new mission to provide lifelong care to severely disabled veterans will sap resources and challenge the military services’ ability to sustain a 

strong readiness posture. 

Mr. Chairman, we are most troubled by an ill-advised Dole-Shalala recommendation for a seemingly wholesale and radical overhaul of the disability evaluation and 

compensation systems in use today in DoD and VA. Dole-Shalala would establish 

a complicated and different system of compensation payments for our newest injured 

military members while failing to address the accuracy and timeliness problems 

that have plagued both the VA and DoD for many years. Dole-Shalala would have 

the government adjudicate disability for new and future injuries based on two primary factors—loss of earnings and diminished quality of life—instead of retaining 

and fixing the highly structured disability compensation system now in use that collectively considers both factors. Even more troubling is the Dole-Shalala recommendation to drastically reduce the level of government disability compensation 


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when a veteran stops working or gains eligibility for receipt of Social Security benefits. 

Based on DAV’s eight decades of contact with, and work in, the VA and DoD disability adjudication systems, DAV testified before the Dole-Shalala Commission and 

called for adequate staffing, structured training programs, and strict accountability 

for claims processing in VA. Unfortunately, the Commission ignored our recommendations. Our testimony to the Commission is attached to this testimony to provide the Committee an opportunity to fully consider our views as provided previously to the Dole-Shalala Commission. Dole-Shalala had the opportunity to push 

the VA to take the first genuine steps toward effectively reducing to a minimum 

the present massive claims backlog. Sadly, it chose not to do so by failing to address 

the staffing, accuracy and timeliness problems that have plagued both VA and DoD 

and instead proposed a program exclusively attuned to new combat-wounded veterans. Without that important and vital mandate as suggested by DAV, the VA may 

never be fully responsive to the needs of disabled veterans already in its claims adjudication queue. We question where this leaves the 600,000 veterans of earlier military service now awaiting resolution of their VA claims. Implementing this DoleShalala recommendation would set a dual standard for disabled veterans—one that 

DAV could not support. 

Mr. Chairman, it may be good to remind the Committee that this is not our first, 

nor probably our last, war. Currently, like many other veterans organizations, members of DAV are largely drawn from the Vietnam War generation. We at DAV are 

wartime veterans and have suffered many of the same kinds of injuries that are 

being suffered now in Baghdad or Kabul in our latest wars. Had it not been for the 

existence of a caring, attentive VA system almost 40 years ago, including its health 

and compensation programs that sustained us and our families through the longterm rehabilitation process, and the VA’s Vocational Rehabilitation Program (under 

title 38, United States Code, Chapter 31), that enabled us to embark on many rewarding careers, as disabled veterans we simply could not know where our lives 

might have taken us. The VA healthcare system has been an intimate part of our 

lives for decades since those traumatic ‘‘Alive Day’’ events in the early lives of DAV 

members. The quality of care and dedication to purpose and commitment of VA employees would be difficult to match elsewhere, in public or private systems. 

We believe VA has a system that has worked well for years, is time tested and 

proven, but is now under fire because of the process, as opposed to the fundamentals. We believe the fundamentals are sound at VA and should be preserved. To provide VA what it needs in financial resources to employ and train sufficient staff, 

and to hold them accountable for the work they are supposed to do, would go a long 

way to keeping the system solvent well into the future to meet the needs of older 

veterans, the newest generation of wounded combat veterans, and future generations to come. Said another way, we at DAV do not see the need for wholesale 

changes and the development of an entirely new compensation and benefit system 

at VA to replace, for new veterans what has worked successfully to assist veterans 

over many decades. 

In 2004, in section 1501 of Public Law 108–136, the National Defense Authorization Act for FY 2004, Congress authorized a Veterans Disability Benefits Commission to examine VA’s disability compensation system, and to make a report with 

recommendations for any needed reforms. The report of that Commission is due for 

release next month. We hope this Committee will examine that report at least as 

closely as you examine this one from Dole-Shalala, to determine a proper and equitable disability compensation policy for war-wounded veterans, whether new or old. 

Mr. Chairman, in summary DAV is concerned about the Dole-Shalala Commission 

report, especially in the areas indicated. When the Administration’s legislative proposal is released to implement the intent of the Commission’s recommendations, we 

are hopeful DAV will have an opportunity to review it and provide the Committee 

further commentary before you act on that proposal. 

Mr. Chairman, this concludes DAV’s statement. Again, on behalf of DAV, thank 

you for the opportunity to provide this testimony. 

f 

Statement of Hon. Jeff Miller, 

a Representative in Congress from the State of Florida 

Thank you, Mr. Chairman. 

Providing top-notch medical care and a seamless transition for separating servicemembers between the Department of Veterans Affairs (VA) and the Department of 


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Defense (DoD) is a priority. This is especially important when we address care provided by VA to the severely wounded warriors from the Global War on Terror. 

Serving on both the Committee on Veterans’ Affairs and the Committee on Armed 

Services, I take great interest in the medical care and services available to our Nation’s veterans, and the men and women serving in uniform. 

Today we will review the recommendations to improve the care and services for 

our wounded warriors and veterans from the President’s Commission on Care for 

America’s Returning Wounded Warriors, co-chaired by Senator Bob Dole and Secretary Donna Shalala. 

The Dole-Shalala Commission based its recommendations on three goals to 

prioritize patients and families, so that we simplify the complicated systems that 

are in place while serving and supporting our wounded warriors from the Global 

War on Terror. These are important goals as we address the needs of our veterans 

and wounded warriors. The Commission framed its recommendations by these goals. 

Among the specific recommendations reported by the Dole-Shalala Commission we 

find the immediate creation of comprehensive recovery plans to provide the right 

care and support at the right time and place to help establish a continuity of care. 

Providing a plan would fulfill the goals to serve, simplify, and support. These concepts will be valuable to review as the Committee moves forward this Congress. 

Continued support for the severely wounded is imperative. We must ensure that 

we are able to provide care and services for our wounded, and I look forward to the 

discussion today. 

Senator Dole and Secretary Shalala, I appreciate your service to America and its 

veterans. Your contribution is appreciated. 

Thank you, Mr. Chairman. I yield back the balance of my time. 


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POST-HEARING QUESTIONS AND RESPONSES FOR THE RECORD 

Committee on Veterans’ Affairs 

Washington, DC 

October 18, 2007 

The Honorable Donna E. Shalala 

President 

University of Miami 

P.O. Box 248006 

Coral Gables, FL 33124–4600 

The Honorable Bob Dole 

Alston & Bird, LLP 

950 F Street, NW 

Washington, DC 20004 

Dear Ms. Shalala and Senator Dole: 

In reference to our Full Committee hearing ‘‘Findings of the President’s Commission on Care for America’s Returning Wounded Warriors’’ on September 19, 2007, 

I would appreciate it if you could answer the enclosed hearing questions by the close 

of business on November 16, 2007. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for materials for all Full Committee and Subcommittee hearings. Therefore, 

it would be appreciated if you could provide your answers consecutively and singlespaced. In addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your response to Debbie Smith 

by fax at 202–225–2034. If you have any questions, please call 202–225–9756. 

Sincerely, 

BOB FILNER 

Chairman 

Response to Questions from the Honorable Bob Filner, Chairman, 

Committee on Veterans’ Affairs, to Hon. Donna E. Shalala, Co-Chair, 

President’s Commission on Care for America’s Returning Wounded 

Warriors, and President, University of Miami, and Hon. Bob Dole, 

President’s Commission on Care for America’s Returning 

Wounded Warriors 

Recommendation #2 

Completely Restructure the Disability and Compensation System 

The report recommends that the VA update its current disability rating system to 

reflect current injuries and modern concepts of the impact of disabilities on quality 

of life. 

Q. What kinds of problems did you see with the current disability rating 

schedule? 

Response: The current system is not contemporary and reflects neither quality 

of life nor earnings loss adequately. For example, results from the Center for Naval 

Analysis study provided to the Veteran’s Disability Benefits Commission identify 

the inadequate treatment of Post-Traumatic Stress Disorder in the rating schedule. 

We heard from several of the Nation’s leading disability experts that the system is 

in need of fundamental change, a finding that has been confirmed by two recent reports from the Institute of Medicine, and by the Veteran’s Disability Benefits Commission. 

Q. What would you like to see modified or added to the current system? 

Response: We have called for the addition of Quality of Life payments and a top 

to bottom revision of the disability system. We have also recommended routine and 

regular evaluation and updating of the system going forward. 


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The report recommends that all disability-related payments and benefits for veterans would be obtained through VA. There are listed three types of payments: transition payments, the earnings-loss payments and the quality-of-life payments. It is 

not clear in the report how these payments affect other government payments. The 

earnings-loss payments, similar to compensation payments of today, are to make up 

for any reduced earning capacity. Right now, a disability compensation payment is 

not taxed. 

Q. Under the proposed changes, would this payment be taxed? 

Response: The Commission did not take a position on taxation of disability-related payments. 

Q. What happens to this payment once a veteran is eligible to receive Social Security? Does the payment stop? 

Response: Under the proposed new system for payments to disabled veterans, 

the annuity payment and quality-of-life payments would continue throughout retirement while earnings loss would convert to Social Security payments after retirement. 

The streamlined disability compensation system calls for periodic reassessments 

of veterans’ disability ratings. 

Q. Where did the Commission get the 3-year timeframe from? 

Response: The Commission considered the frequency of recommended health 

evaluations for many stable medical evaluations, ranging from annual exams for 

breast cancer screening to every five years for colon cancer screening. We selected 

every three years as an average. We believe that annual evaluations would present 

a burden to the system and to the veteran. However, given the nature of some problems, like Post-Traumatic Stress Disorder, we believed that 5 years would be too 

long. 

Q. Is that the average length of time under the current system that veterans generally apply for an increase in a service-connected disability? 

Response: Not that we are aware of. 

Q. Will this reassessment take the place of the veteran’s current ability to 

apply for increases in service connection disability ratings if and when the 

disability becomes more debilitating? 

Response: No. 

Q. Is it the Commission’s intention to limit those types of claims so VBA 

can cut down on their workload? 

Response: No. Resources should be provided to be sure that veterans are taken 

care of in a timely manner. 

Q. Is it the Commission’s intention for the streamlined system in the report to apply to all veterans or just those that are severely injured? 

Response: All veterans. 

Recommendation #5 

Rapidly Transfer Patient Information Between DoD and VA 

Recommendation 5, Rapidly Transfer Patient Information Between DoD and VA, 

lists three caveats with it. One of the caveats is: underlying organizational problems 

must be fixed first, or information technology merely perpetuates them. VA and DoD 

have struggled for years to find a fix. 

Q. Could you elaborate on what some of the organizational problems are? 

Response: None of the services have systems that easily ‘‘talk to each other.’’ We 

provide a number of specific examples in the Commission’s Subcommittee Report on 

Information Systems (page 115 in the Subcommittee report). Each service has a separate personnel system that feeds only some information to a central DoD data archive. The Army computer systems and the Air Force computer systems are not 

fully compatible, and we found that electronic medical records for Air Force servicemembers may not be available to the Army physicians who may treat them. Most 


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information systems have been developed to support specific functions and were not 

originally designed to be integrated. This information exchange is further compounded by the need to share information between the VA and the DoD. Even the 

VA’s path-breaking Vista medical record system today consists of 128 different systems at individual medical facilities and it does not achieve full interoperability. 

Thus inter- and intra-departmental issues abound. 

Q. What does the Commission recommend as a ‘‘fix’’ to the underlying organizational problems? 

Response: It is necessary to focus on the outcome—information availability—not 

the computer systems themselves. The first step is to assure that all information 

that supports the development and implementation of the patient’s recovery plan 

and is needed to provide healthcare and benefits is viewable by relevant DoD and 

VA staff within the next year. That means that clinicians, administrators, and benefit administrators must be able to see the relevant information in electronic form 

so that appropriate decisions may be made and patient progress may be monitored. 

We have supplied in our Subcommittee report on page 131 a template for a Scorecard for Information Exchanges that can be used as an aid to track the progress 

for sharing specified categories of essential data. 

f 

Response to Questions from the Honorable Joe Donnelly, Member, 

Committee on Veterans’ Affairs, to Hon. Donna E. Shalala, Co-Chair, 

President’s Commission on Care for America’s Returning Wounded 

Warriors, and President, University of Miami, and Hon. Bob Dole, 

President’s Commission on Care for America’s Returning 

Wounded Warriors 

Q.(1). Would you support a shift away from the current claims process to 

approving veterans’ disability claims based on a presumption of service connectedness? 

Response: The scope of the Commission’s recommendations did not include the 

topic of presumption of service connectedness for the purpose of VA claims filing. 

We did, however, look at the Benefits Delivery at Discharge system, which has been 

successful in expediting VA disability evaluation for servicemembers before they 

leave military service with a medical separation or retirement. That program would 

presumably mitigate the need for presumption at the time of hospitalization with 

a known outcome of military discharge. 

Q.(2). To what extent would such a change be applied? Would you only 

apply the presumption process to new claims of recent veterans, or for new 

claims by all veterans? 

Response: Again, we did not explore the presumption concept and, therefore, cannot comment. 

As questions 3–5 also pertain to presumption and were not a focus of the Commission, we are unable to provide comment. 


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