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95–289 PDF 2004

DOES THE ‘‘TOTAL FORCE’’ ADD UP? THE IMPACT

OF HEALTH PROTECTION PROGRAMS ON

GUARD AND RESERVE UNITS

HEARING

BEFORE THE

SUBCOMMITTEE ON NATIONAL SECURITY,

EMERGING THREATS AND INTERNATIONAL

RELATIONS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

MARCH 30, 2004

Serial No. 108–181

Printed for the use of the Committee on Government Reform

(

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

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

DAN BURTON, Indiana

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

DOUG OSE, California

RON LEWIS, Kentucky

JO ANN DAVIS, Virginia

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

ADAM H. PUTNAM, Florida

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

NATHAN DEAL, Georgia

CANDICE S. MILLER, Michigan

TIM MURPHY, Pennsylvania

MICHAEL R. TURNER, Ohio

JOHN R. CARTER, Texas

MARSHA BLACKBURN, Tennessee

PATRICK J. TIBERI, Ohio

KATHERINE HARRIS, Florida

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland

ELEANOR HOLMES NORTON, District of

Columbia

JIM COOPER, Tennessee

——— ———

———

BERNARD SANDERS, Vermont

(Independent)

MELISSA WOJCIAK, Staff Director

DAVID MARIN, Deputy Staff Director/Communications Director

ROB BORDEN, Parliamentarian

TERESA AUSTIN, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING THREATS AND INTERNATIONAL

RELATIONS

CHRISTOPHER SHAYS, Connecticut, Chairman

MICHAEL R. TURNER, Ohio

DAN BURTON, Indiana

STEVEN C. LATOURETTE, Ohio

RON LEWIS, Kentucky

TODD RUSSELL PLATTS, Pennsylvania

ADAM H. PUTNAM, Florida

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

TIM MURPHY, Pennsylvania

KATHERINE HARRIS, Florida

DENNIS J. KUCINICH, Ohio

TOM LANTOS, California

BERNARD SANDERS, Vermont

STEPHEN F. LYNCH, Massachusetts

CAROLYN B. MALONEY, New York

LINDA T. SANCHEZ, California

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland

JOHN F. TIERNEY, Massachusetts

DIANE E. WATSON, California

EX OFFICIO

TOM DAVIS, Virginia HENRY A. WAXMAN, California

LAWRENCE J. HALLORAN, Staff Director and Counsel

KRISTINE MCELROY, Professional Staff Member

ROBERT A. BRIGGS, Clerk

ANDREW SU, Minority Professional Staff Member

(III)

C O N T E N T S

Page

Hearing held on March 30, 2004 ............................................................................ 1

Statement of:

Mosley, First Sergeant Gerry L., 296th Transportation Co., Brookhaven,

MS, U.S. Army Reserves; Specialist John A. Ramsey, 32nd Army Air

Missile Defense Command, Florida National Guard; Laura Ramsey;

Sergeant First Class Scott Emde, 20th Special Forces Group, B Co.,

3rd Battalion, Virginia National Guard; Lisa Emde; and Specialist

Timothi McMichael, U.S. Army Reserves, A Co., Medical Hold Unit,

Fort Knox, KY ............................................................................................... 4

Winkenwerder, William, Jr., M.D., Assistant Secretary of Defense for

Health Affairs, Department of Defense, accompanied by Lieutenant

General George P. Taylor, Jr., the Surgeon General, U.S. Air Force;

Rear Admiral Brian C. Brannman, Deputy Chief, Fleet Operations

Support, Bureau of Medicine and Surgery, U.S. Navy, and Wayne

Spruell, Principal Deputy Assistant Secretary of Defense, Reserve Affairs, Manpower and Personnel; and Lieutenant General James B.

Peake, Surgeon General, U.S. Army ........................................................... 147

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

Emde, Lisa, prepared statement of ................................................................. 94

Emde, Sergeant First Class Scott, 20th Special Forces Group, B Co.,

3rd Battalion, Virginia National Guard, prepared statement of .............. 89

Kucinich, Hon. Dennis J., a Representative in Congress from the State

of Ohio, prepared statement of .................................................................... 136

McMichael, Specialist Timothi, U.S. Army Reserves, A Co., Medical Hold

Unit, Fort Knox, KY, prepared statement of .............................................. 98

Mosley, First Sergeant Gerry L., 296th Transportation Co., Brookhaven,

MS, U.S. Army Reserves, prepared statement of ....................................... 7

Peake, Lieutenant General James B., Surgeon General, U.S. Army, prepared statement of ........................................................................................ 165

Ramsey, Laura, prepared statement of .......................................................... 80

Ramsey, Specialist John A., 32nd Army Air Missile Defense Command,

Florida National Guard, prepared statement of ......................................... 26

Winkenwerder, William, Jr., M.D., Assistant Secretary of Defense for

Health Affairs, Department of Defense, prepared statement of ............... 150

(1)

DOES THE ‘‘TOTAL FORCE’’ ADD UP? THE IMPACT OF HEALTH PROTECTION PROGRAMS

ON GUARD AND RESERVE UNITS

TUESDAY, MARCH 30, 2004

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING

THREATS AND INTERNATIONAL RELATIONS,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

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

2154, Rayburn House Office Building, Hon. Christopher Shays

(chairman of the subcommittee) presiding.

Present: Representatives Shays, Schrock, Kucinich, Turner,

Maloney, Ruppersberger, Tierney, and Jo Ann Davis of Virginia.

Staff present: Lawrence Halloran, staff director and counsel;

Kristine McElroy, professional staff member; Robert Briggs, clerk;

Jean Gosa, minority assistant clerk; and Andrew Su, minority professional staff member.

Mr. SHAYS. A quorum being present, the Subcommittee on National Security, Emerging Threats and International Relations

hearing entitled, ‘‘Does the ‘Total Force’ Add Up: The Impact of

Health Protection Programs on Guard and Reserve Units,’’ is called

to order.

When Reservists and National Guard members join their active

duty counterparts to form what is called the total force, they bring

unique health needs to the battlefield. Long deployments and separation from family can have an especially negative impact on

Guard and Reserve morale and performance. Cursory pre-deployment physical and mental health assessments might miss ailments

and conditions that would be diagnosed and treated in the more

closely monitored regular forces.

Accessing care during and after mobilization is too often a

dispiriting struggle against a bureaucracy prone to minimize or disparage their wounds, literally adding insult to injury. So today we

ask, do current deployment health programs meet the specific

health care needs of the citizen soldiers who make up a vital and

growing part of the force structure?

In the course of our oversight of 1991 Gulf war veterans’ illnesses, we learned that weaknesses in force health protections exposed U.S. forces to avoidable risks. Pesticides were widely dispersed without adequate warning or safeguards. Use of experimental drugs was not properly monitored. Poor medical recordkeeping shifted the burden of proof to the service members to prove

2

the source and extent of their exposures and injuries. A macho

warrior culture tended to punish or stigmatize health complaints.

After the first Gulf war, Congress mandated improvements to

force health protections, including pre and post deployment medical

examinations, mental health assessments and serum samples to

better establish baseline health data. Recordkeeping was to be centralized, more accurate and more timely. The Department of Defense [DOD], has incorporated these requirements into a broader

force health protection strategy that has enhanced both the quality

and quantity of health care for service members and their families.

But recent reports suggest that for some, military medicine is

still a contradiction in terms, an oxymoron describing the victory

of quantity over quality in the rush to front. Processing and treatment facilities have been overwhelmed by patients with conditions

that should have prevented their being deployed at all. Injured

Guardsmen and Reservists have languished in medical limbo,

awaiting care only to be told they are suddenly ineligible because

the paperwork extending their active duty status took too long.

Recordkeeping is still inconsistent or lacking altogether.

A recent survey of troops in Iraq found sufficient incidence of

mental health stressors, anxiety, depression and traumatic stress,

and that suicide prevention efforts are being strengthened. Our

first panel of witnesses will describe their personal experiences

with the deployment health system. We are grateful for their service, their continued courage, and their willingness to be here today.

DOD witnesses will then describe their ongoing efforts to improve health protections and the standard of care for deployed

forces. We look forward to their testimony as well.

This hearing is part of a sustained examination of issues affecting Reserve and National Guard units. Last year, with Government

Reform Committee Chairman Tom Davis, we exposed serious problems in Army Guard pay systems. Next month, the full committee

will convene a hearing on National Guard transformation. Finally

in May, this subcommittee will hear testimony on equipment and

training shortfalls.

At this time, the Chair would recognize Mr. Tierney for an opening statement.

Mr. TIERNEY. I have no opening statement, Mr. Chairman. I’d

like to get to the testimony as soon as we can.

Mr. SHAYS. I thank the gentleman. Mr. Schrock.

Mr. SCHROCK. Ditto.

Mr. SHAYS. We have Mr. Turner.

Mr. TURNER. In the spirit of the proceeding, then, I’ll pass also,

thank you, Mr. Chairman.

Mr. SHAYS. Ms. Jo Ann Davis, any statement you’d like to make?

Mrs. DAVIS. Mr. Chairman, thank you very much.

Mr. Chairman, I want to thank you for letting me be a part of

the discussion this morning, and thank you for holding this important hearing. I especially want to thank Sergeant First Class Scott

Emde and his wife Lisa for being here to testify. Scott and Lisa live

in the First District in Yorktown, VA, and I’m proud to represent

them.

I want you to know how much I thank you for your service to

our country. You and your family have made great sacrifices, all

3

because of your loyalty and your dedication to our Nation. Thank

you for all that you have done, and I look forward to hearing your

testimony.

Mr. Chairman, as we continue to fight the war against terrorism,

the Reserve component, including the Army National Guard, Army

Reserve, Naval Reserve, Marine Corps Reserve, Air National

Guard, Air Force Reserve and the Coast Guard Reserve has been

increasingly called upon to go to active duty. Out of the 1.8 million

members of the Reserve component, over 300,000 have been called

to active duty since September 11, 2001.

As more and more Guard and Reserve members are deployed, we

have to make sure that they are getting the health care and the

attention that they need. The issue of health protection programs

for members of the Reserve component is extremely important. We

don’t want to have a repeat of Operation Desert Shield and Desert

Storm, when more than 125,000 veterans of the Gulf war came

back and experienced health problems because of their military

service. And there were probably thousands more, but because of

lack of health and deployment data, we’re just not exactly sure.

The Department of Defense’s force health protection strategy was

developed as a result of the lessons we learned from the Gulf war.

Its purpose is to track service members, diseases and injuries and

to provide followup treatment for deployment related health conditions. I look forward to hearing more about how the force health

protection is working.

Mr. Chairman, I serve on the Armed Services Committee and I

feel very strongly about our Nation’s military. These people give

more than most Americans will ever be asked to give. And there

is no comparison to the dedication and commitment that they have

for our country. It’s the least we can do to make sure that their

health needs are taken care of.

I thank you again, Mr. Chairman, for holding this hearing, and

for allowing me to join you. I look froward to hearing the testimony

of the witnesses. Thank you, Mr. Chairman.

Mr. SHAYS. I thank you very much, Mrs. Davis.

Let me first take care of some housekeeping. I ask unanimous

consent that all members of the subcommittee be permitted to

place an opening statement in the record, and that the record remain open for 3 days for that purpose. Without objection, so ordered.

I ask further unanimous consent that all Members be permitted

to include their written statements in the record, and without objection, so ordered.

I ask even further unanimous consent that a March 29, 2004 letter from Congressman Ric Keller to the subcommittee be entered

into the record. The letter describes efforts to solve health care access problems on behalf of his constituent, Army Specialist John

Ramsey, who will testify this morning. Without objection, so ordered.

And also to welcome Mrs. Davis, she is a member of the full committee, she chairs the Subcommittee on Civil Service and Agency

Organization, and without objection, she will be allowed to participate in this hearing as well.

4

At this time, let me recognize the witnesses and then I will

swear them in. Before recognizing witnesses, I thank the second

panel, Dr. William Winkenwerder, for his acknowledgement that it

is valuable to have this panel go first, and thank Lieutenant General James B. Peake as well for that. They are extending their

courtesy and respect to this first panel, which this committee deeply appreciates.

This first panel is First Sergeant Gerry L. Mosley, 296th Transportation Co., Brookhaven, MS, U.S. Army Reserves; Specialist

John A. Ramsey, 32nd Army Air Missile Defense Command, Florida National Guard; Mrs. Laura Ramsey, spouse of Specialist John

A. Ramsey; Sergeant First Class Scott Emde, 20th Special Forces

Group, B Co., 3rd Battalion, Virginia National Guard; Mrs. Lisa

Emde, spouse of Sergeant First Class Scott Emde; and Specialist

Timothi McMichael, U.S. Army Reserves, Medical Hold Unit, Fort

Knox, KY.

As is the practice, we swear in all our witnesses, and invite you

all to stand and then we’ll swear you in. Raise your right hands,

please.

[Witnesses sworn.]

Mr. SHAYS. Thank you all very much. We’ll note for the record

that all have responded in the affirmative. We’ll do it as we called

you, and I think you’re sitting in that same order, so that’s how

we’ll start. Sergeant, we’ll start with you. Thank you and welcome.

STATEMENTS OF FIRST SERGEANT GERRY L. MOSLEY, 296TH

TRANSPORTATION CO., BROOKHAVEN, MS, U.S. ARMY RESERVES; SPECIALIST JOHN A. RAMSEY, 32ND ARMY AIR MISSILE DEFENSE COMMAND, FLORIDA NATIONAL GUARD;

LAURA RAMSEY; SERGEANT FIRST CLASS SCOTT EMDE,

20TH SPECIAL FORCES GROUP, B CO., 3RD BATTALION, VIRGINIA NATIONAL GUARD; LISA EMDE; AND SPECIALIST

TIMOTHI MCMICHAEL, U.S. ARMY RESERVES, A CO., MEDICAL HOLD UNIT, FORT KNOX, KY

Sergeant MOSLEY. Mr. Chairman and distinguished members of

the committee, on behalf of myself and hundreds of other mobilized

soldiers in the U.S. Army Reserve and National Guard, I am honored and pleased to have the opportunity to address the issues this

committee has been charged to investigate.

Pre-deployment health assessment forms are grossly inadequate

for use as medical screenings to determine if soldiers were medically capable in a duty combat setting. Soldiers with medical conditions that would be adversely affected by deployment were rubber

stamped as if fit for duty. Medical profiles were ignored.

I personally know of soldiers with profound hearing loss, insulin

dependent diabetes, a soldier with Tourette’s syndrome who would

not have access to proper medications, serious allergies requiring

refrigerated medications, cardiac disease, and unrepaired inguinal

hernias. I’m sure that this esteemed committee can appreciate the

significance and validity of my conclusions and recognize that these

cases are not isolated or infrequent in nature.

The process was a numbers game where the Army justified deploying troops. It was not about quality, healthy troops, it was

about the quantity of troops. It was only after the October 2003 reVerDate 11-MAY-2000 11:57 Sep 13, 2004 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 D:\DOCS\95289.TXT HGOVREF1 PsN: HGOVREF1
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port published by Mark Benjamin with UPI and the interventions

by Mr. Steve Robinson of National Guard Resource Center that

more emphasis was placed on better screening procedures. Those

individuals who are responsible for screening soldiers do not listen

or validate solider’s accounts of the physical and mental health

problems they are experiencing. The great motto, blow them off, get

them through, hey, let’s go to lunch.

The most telling incident of in-theater medical care was the experience of one of my own soldiers. He continually went to sick call

in Iraq complaining of painful urination, only to have my commander summoned to sick call. My commander was told this soldier was malingering and should be court martialed. That solider

has just returned from Walter Reed Army Medical Center, having

a cancerous bladder and prostate gland removed.

What justification is given to a member of the U.S. Army to assume a man with cancer is malingering? What justification is given

to this man to have him threatened to be thrown in jail? I ask you

to ponder for one moment, if it was you, your father, your mother,

brother, sister, son or daughter, how would you feel in a situation

like this?

Upon return to American soil, most soldiers have one thing in

mind, just as I did, getting home to the family. But upon return

from war with injuries or illness that causes a soldier to be unfit

for future military service, the inefficient, uncaring, progressively

escalating campaign by the U.S. Army of inflicting mental duress

called the Medical Evaluation Board proceeding, is started. The

U.S. Army must be proud of the bureaucracy at Fort Stewart that

is capable of driving a soldier to the brink of insanity while flippantly turning its back on the physical and mental health needs

of men and women who are just returning from war.

After the press coverage, it seemed things were improving. However, it didn’t take long for things to cool off, and we were still in

the same old holding pattern. You do see care providers more than

before, but it’s just more or less a how are you doing process. Instead of receiving specialty consults or aggressive treatments, soldiers get a prescription for a new pill, all we want is a fix me, don’t

pill me. I hold up today, before I mobilized in January 2003, an

empty bag of the medications that I took. If I took every pill prescribed to me on a daily basis, I would be taking 56 pills a day.

I would be taking pills, I couldn’t even get out of bed this morning.

MEB cases were dictated, having a soldier sign, concurring,

thinking that they would be rated on whatever was wrong with

them. That’s not the truth. Many times during our required meeting with our case managers, I would complain of both my arms

being numb, my neck hurting, stiff, and the shaking. It was only

after my Board that I was finally sent to a civilian neurologist, an

MRI was done, I have severe, inoperable cervical spondylosis and

also Parkinson’s disease. That was after many complaints, e-mails

to Brigadier General Farrissee at Medical Command asking her to

have someone call me, all this communication again. We were talking, no one was listening.

Medical recordkeeping is a simple statement, haphazard and inconsistent. There was no medical recordkeeping for Reserve soldiers in Iraq. Records for our company were not even brought.

6

I want to make these comments, but I’ll address the family support program. Each Reserve and National Guard unit has a family

readiness group. There are some that are strong and some that are

basically non-functioning. Most of our spouses are at home taking

care of our children or they’re working their own jobs.

I have served my country faithfully for 31 years. The feeling of

inequality between the Reserve and the active component is still

there. I can assure you that each time I was fired at by an Iraqi

soldier, I never heard the first one of them say, First Sergeant

Mosley, I’m sorry, we didn’t know you were a Reservist.

Let me assure you that the Reserve and the Guard were just as

willing to die defending this great country as the active component.

We sacrificed in some cases more, some Reservists and Guard are

mobilized on a reduced income.

The Reserve and Guard is a numbers game measured by money.

The Reserve command knows it is required to keep a certain number of troops to justify their budget request. You’ve never been

asked for less money next year than you were this year. There are

soldiers in each unit that cannot pass PT tests, there are soldiers

in each unit that do not come to drill, but yet the command keeps

them to keep that number.

Medical hold is a numbers game as well. A lot of soldiers feel

that the only improvement was living conditions, but that wasn’t

until 2 weeks ago, when now you have 16 soldiers in a 24 by 60

double wide with two restrooms. If an intestinal virus was to break

out, there would be problems.

There is a grave in Jackson, MS that I see every time I go to

visit my father’s grave. It’s of a World War II veteran, infantry soldier, bronze star recipient, and permanently inscribed on his grave

is, I have fought and I have fought well. I did not let my country

down, but my country let me down. My desire today for this committee is to see that you all do all you can in your power that not

another soldier dies defending this country going to his grave having something like that inscribed on a tomb.

I’d be happy to answer any questions, again, I thank you for allowing me the opportunity to be here, even if I did go over my time.

[The prepared statement of Sergeant Mosley follows:]

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Mr. SHAYS. Thank you, Sergeant. I know that you left out a good

part of your statement as well.

Sergeant MOSLEY. Yes, I did.

Mr. SHAYS. We do appreciate your statement and we do appreciate your trying to stay close to that 5 minutes, and you did. We’ll

ask the same of the others.

Specialist Ramsey.

Specialist RAMSEY. Mr. Chairman and distinguished members of

the committee, on behalf of myself and hundreds of other mobilized

soldiers of the National Guard and U.S. Army Reserve, I’m honored

and pleased to have the opportunity to address you today.

Mine will be nowhere near the length of my statement, my statement is over 20 pages, with over 30 documents attached to it. So

I’m going to brief in into a much smaller, condensed version.

I was improperly released from Fort Benning, GA, when I returned from serving my country in Kuwait and Iraq. When I returned, I had an injury that was documented in Kuwait. I had

damaged my right rotator cuff. I also had other issues and other

problems with numbness in my fingers in both hands. I addressed

this to the doctor there in Kuwait, he noted it at one point, that

I had the numbness in the hands, and addressed it as being overcompensation for the lack of strength in my right shoulder.

I returned with a completed LOD for the right shoulder and a

followup visit or a referral for an MRI once I returned to the

States. Being in Kuwait, Camp Doha, and in that general area,

they did not have the ability to do MRIs or nerve study tests that

were required of me once I returned to the States.

When I returned to Fort Benning, our process was to get us out

as quickly as possible, not to treat us. I went to the treatment facility there, the out-processing medical treatment facility and spent

approximately 15 minutes in the building. Between 3 and 5 minutes were spent with a PA who looked over my paperwork. Once

I had established that I had a completed LOD and established that

I had a completed referral for medical treatment, she said there

would be no problem with me returning to my Reserve unit in Orlando, FL for followup treatment.

At that point, I was under the understanding that I was not

being released from active duty, that I was being merely placed

over to my Reserve unit for continued treatment. Prior to leaving,

I called my wife and told her that I was probably going to be staying in Fort Benning for treatment, based on a conversation I had

with a sergeant major that was traveling with me. Obviously to the

delight of myself and to my wife and kids, I was coming home and

going to receive treatment at my home station.

I returned home to my Reserve unit, reported in the first business day that was available to them and explained my situation,

turned over my medical documents that I had. They were astounded that I was released from active duty and even voiced that,

that I should not have been released from active duty, and attempted to put me back on active duty. I was then told to seek an

orthopedic surgeon and have an appointment for a diagnosis/prognosis and a time before I returned to full duty. I followed the instructions while on my own leave, instead of spending leave with

my family, I went and took care of business for the Army.

23

I went to these appointments, and after several months of going

back and forth and having two surgeries on both shoulders and

still requiring two more surgeries on my elbows, it has now been

told to me that I at first did not qualify for incapacitation pay,

which is a basic pay recovery system for your civilian pay. It’s not

an active duty pay. There’s no active duty retirement points.

There’s no leave accrued. There’s no TRICARE for your family for

followup benefits. I was told I do not qualify for that, that I had

to be put on ADME. Then I was told I did not qualify for ADME

because I was released from active duty.

This fight went back and forth between the Florida Army National Guard, the National Guard Bureau and the active Army for

several months. Meanwhile, my family and I were going without a

paycheck for over 6 months.

Congressman Ric Keller got involved, and Channel 9, our local

news channel got involved. They made a difference in this. They

got the Army to agree to put me back on active duty starting December 1st and the National Guard to reimburse me for my lost

pay from the day I was released from active duty, June 27th

through December 1st. This was agreed upon by both parties.

On December 10th, I have now in my possession an e-mail from

Colonel Sherman, who’s the G–1 of the Army for the medical side,

who clearly stated in her e-mail that she was going forward with

the ADME, me being placed on ADME. On December 23rd, we had

a phone conference call between myself and several other parties,

including Colonel Sherman, at which time she said that she was

not going to place me back on ADME. Her first response to that

was because I had already been paid incap pay and she was not

going to mix an incap pay status with an ADME status. An ADME

status is an active duty medical extension.

Then later on in the conversation, she further stated that she

was not going to take on any new medical issues that she was not

apprised of prior. For example, if I had fallen and broken my arm

between the time I was released from active duty and December

1st and I required additional treatment for that, she did not want

to accept that as a medical treatment. She said that is something

that would have happened outside the scope of my active duty

time.

I truly understand that. But I’m not coming and asking for anything that I did not report or had documented prior to being released from active duty. When I was released from active duty, I

went to the doctor’s appointments that were required of me, I went

to the MRIs and the nerve study tests which were documented less

than a month after I was released from active duty. Those tests

clearly stated that I was injured while on active duty.

So after December 23rd, we went back and started looking at the

incap issue. I was basically given incap, which is, I have the choice

between incapacitation pay versus active duty medical extension. I

was never given that choice, I was told that this was all I was

going to get. So of course, I try to take as little bit as I can and

try to better myself and continue on, I took it.

Now, I’m being told that I’m being sent to Fort Stewart, FL

under an incap position. That’s an incapacitation pay, which does

not give me retirement points, does not give me leave accrual, does

24

not give me TRICARE for myself or my family, does not give me

the normal active duty things I would have if I was on active duty.

I now have, I went on February 11th to Fort Stewart this year,

and I met with the doctors, the Army sent me for a fit for duty

physical. When I spoke with the doctor there, the orthopedic PA

and the orthopedic surgeon, they both put in their document that

was signed, the FS 600, that I clearly was injured while on active

duty, and it was clearly done while in the line of duty. And it clearly stated that I should be placed back on active duty for medical

treatment, and if not back on active duty, that I should receive civilian treatment, paid for by the Army, until these issues are resolved.

I work for the Orange County Sheriff’s Department. That’s my

desire, is to go back to where I work. Now I can’t go back as a road

deputy. My safety is important to me, but more than that, it’s to

the other deputies and the civilians that I have work with and beside. I could never forgive myself if I went back injured because I

decided that I did not want to continue this fight with the Army

and get this treatment and something were to happen to somebody.

I’m being sent back, like I said, to Fort Stewart. I have to report

there tomorrow at 13. My flight is going to leave here at 9:30, so

I’ll be in around 1 a.m., in Florida. I’m going to have to be in a

vehicle driving to Fort Stewart, I’m going to have to report on a

daily basis in formation, in uniform, while all the time not receiving any type of retirement points, not receiving leave. So I’m going

to be just like every other soldier there, but with less. And this is

the thanks I get for serving my country, not once but several times.

This is not my first deployment.

If you’ll notice today, I’m not wearing my combat patch on my

uniform. I’m entitled to wear my combat patch and combat stripes,

as I’ve served in combat. But I’m not wearing it, because my combat hasn’t ended yet. I’ve only returned from one battle to another.

The military has created another issue for me, another battle. And

I feel like in so many cases I’m by myself fighting in a large entity

with no resolve here.

So I hope today that by me testifying that this is going to resolve

a lot of issues. I’d like to add just one last thing, I’m probably over

my time. My medical bills. I have over $15,000 still outstanding in

medical bills. It was well over $30,000. Because I signed the paper

saying that I would be ultimately responsible for this, even though

the military has given written documentation saying that they

would pay these medical bills.

My credit has now been affected. I receive on a daily basis at

least 5 to 10 calls a day from collection agencies and medical doctors’ offices asking me to pay these bills. The military has told me

countless times that these bills have been paid, they’ve been taken

care of, they’re in the works. And to this date, as late as Friday

before coming here, I was receiving calls from Florida Hospital still

saying that I owed over $15,000 for surgeries.

So whatever is said today by anybody that any medical bills have

been taken care of, I can tell you that some of them have been, only

because of the issues and them finding out I’m going to be testifying. But for the most part, they have not been. This right here is

just a stack of medical bills that I get on a daily basis that have

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not been paid. And of course, this is all my documentation and

medical treatments that I’ve had.

I just ask that this committee help me and other soldiers in my

situation, so we are no longer having to face these issues. Thank

you for the time.

[The prepared statement of Specialist Ramsey follows:]

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Mr. SHAYS. Thank you, Specialist Ramsey. We will be helping.

Mrs. Ramsey.

Mrs. RAMSEY. I would like to thank the committee for the honor

and privilege to testify from a wife’s perspective regarding Reserve

military family life. My husband, Specialist John A. Ramsey, comes

from a family with a proud history of serving the U.S. military. His

grandfather, Charles J. Bondley, Jr., a graduate of West Point, was

a two star general in the Air Force who served during World War

II alongside General MacArthur and General LeMay. His father,

Thomas W. Ramsey, Sr., also served two tours of duty during the

Vietnam War in the Army. His brother and half sister are currently in the military.

While John was a Reserve, he has been called to active duty to

support the firefighters during the wildfires in central and west

Florida, Operational Noble Eagle and Operation Enduring Freedom

and also Operation Iraqi Freedom. During his deployment of Operation Iraqi Freedom, John was injured while loading heavy equipment overhead. At no time was I notified of his injury, medical

treatment or progress of his recovery, either by the U.S. military

or his unit. The family residence program did e-mail a couple of

times, but nothing newsworthy concerning John. I received no

phone calls or personal visits from any military personnel. On the

other hand, the Orange County Sheriffs Office, John’s civilian employer, called me monthly.

John was deployed for 5 months in Kuwait and Iraq. This period

was very stressful on our two children, Chris, age 7, and Sarah,

age 2. Chris received counseling at his school and my daughter was

also having a difficult time with John’s absence. Our children had

a hard time with it. Even now our family struggles with the emotions due to John’s absence.

We supported and continue to support the efforts in Iraq. However, if it hadn’t been for mine and John’s family, as well as the

Orange County Sheriffs Office, during his deployment things would

have probably been emotionally and physically devastating, especially since I felt completely isolated from the military.

John contacted me upon arriving in Benning, GA, saying that he

would be receiving medical treatment and be staying there. He was

given an LOD and referral for medical treatment. The U.S. military released him to his unit to have his medical care administered

through them. Approximately 2 weeks after returning home, he

was discharged from active duty. His unit assured him that this

deactivation was a mistake and that they were taking action to reinstate him. His unit and the Florida National Guard fought with

the Florida National Guard Bureau and the U.S. Army to place

him back on active duty.

In that 8 months that they fought, John had two military authorized surgeries and was going through physical therapy. His civilian

doctors discontinued medical treatment and physical therapy in

February due to non-payment of his medical bills by the military.

As of today, the military still has not paid all his medical bills resulting in our receiving collection calls and notices on a regular

basis.

These 8 months from the time John returned home to the end

of June 2003 through March 2004 have been extremely stressful,

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emotionally exhausting and financially devastating. We did finally

receive payment in December from June to December, only after

the help of Florida Congressman Ric Keller and WFTB Channel 9’s

Josh Einiger being involved in the negotiations. But in that 8

months, we had completely depleted our savings account, had to

borrow money from our parents and children’s savings accounts to

pay our monthly expenses.

It then took the military another 3 months to issue John’s check

for December to February, which has started the debt cycle all over

again. It’s extremely difficult to budget for monthly payments when

the military is only paying ever 3 to 6 months, if at all.

The military is demanding copies of our 2002 and 2003 tax returns with no explanation of why they need them. John has started

smoking due to all the stress the military has caused him. And

Sarah, our daughter, doesn’t understand why her father can’t play

with her.

As my husband was saying now, the military is going to send

him back to Benning, GA, to continue his medical treatment, other

than being treated by the civilian doctors who initiated his initial

treatment, however, they seem to want him to report on a voluntary basis, since they are not wiling to restate him back to active

duty. In his absence, I will have to resume all the household responsibilities alone again, with no projected date of his return,

while comforting two children for the third time the military has

taken their father from them.

After considering my past experience with the military, I have

serious doubts as to John receiving proper medical treatment and

am skeptical whether he will be paid. I also have massive concerns

as to the treatment he will receive by the active military personnel

who he will be reporting to. Thank you.

[The prepared statement of Mrs. Ramsey follows:]

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Mr. SHAYS. Thank you, Mrs. Ramsey. It’s very important that we

heard your perspective, and we thank you.

Sergeant Emde.

Sergeant EMDE. Good morning, Mr. Chairman and members of

the Subcommittee on National Security, Emerging Threats and

International Relations. My name is Scott Emde, and I have been

a member of the Virginia National Guard Reserves and active

Army since 1980.

On January 10, 2002, I was activated for Operation Enduring

Freedom and reported to Fort Bragg to train for a mission overseas. Most of the teams were sent to Afghanistan, but mine was

sent to Qatar. In June, my shoulder was injured and I was diagnosed with a torn rotator cuff. Twelve hours later I was on a plane

and the following day arrived in Landstuhl, Germany, where I assumed I would receive treatment and return to Qatar to be with

my teams. I remained in Germany for 2 to 3 weeks and then was

taken to Walter Reed for further diagnosis.

Once I arrived at Walter Reed, I was told I would have to stay

in the hotel on base as there were no rooms for enlisted people. The

rooms were nice, but they were $30 to $35 a night, and I would

be there weeks before I had an appointment. Additionally, I came

back from Qatar with four big boxes totaling roughly 1,000 pounds.

These boxes had to be stored in my hotel room, and there was no

room in the hotel, and I had to climb over the boxes to get where

I needed to go.

The 3 week stay for the doctor’s appointment was a bit unexpected, and the hotel bill was a bit of a strain financially. This was

of course paid back when I was able to file a travel voucher. Luckily, the equipment was only a minor inconvenience, as my wife

drove up from the Hampton Roads area with a U-Haul trailer and

the equipment was stored at my house. After the 3-weeks were up,

I saw Dr. Doukas and a surgery date was set for October 30th, 3

months later.

I was sent to Fort Bragg, where I spent the first half of the day

at battalion headquarters briefing the commander on situation reports and various ODAs in the countries of the world. I kept up

with the rest of the 20th group as they were getting ready to deploy to Afghanistan. The second half of the day was spent running

company B operations with another enlisted soldier. Shortly after

we received all the teams back, I went to Walter Reed for my surgery.

Immediately after surgery, my wife drove me 3 hours home to

the Hampton Roads area to recover. Physical therapy started the

following week at Fort Eustis for 6 weeks. Then I had to report to

Fort Bragg for 4 to 6 weeks for therapy and clear post. Then I was

sent to Walter Reed as a medical hold and that very afternoon sent

home again, as there was no room at the inn.

I continued therapy and volunteered in the PT department as I

waited for orders. This went on for 6 weeks. I then drove back up

to Walter Reed for a followup and visited a neurologist for problems I had in my neck. He wrote orders for an MRI and a CAT

scan to be done at Langley Air Force Base. Since they didn’t have

the equipment at Langley, I was then sent to Portsmouth Naval

Hospital, who didn’t want to accept the doctor’s order because there

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was no reason for tests given on the slip. When I called Walter

Reed for the correction, the doctor had left for vacation.

I kept calling to arrange for treatment between Portsmouth and

Walter Reed, and it was during this time that my orders were set

to run out. So I filled out the paperwork to extend the orders with

the hope of a continuous pay check. This did not happen in March

and again in June. I have noted 145 phone calls calling to extend

my contract in the Army, check on pay issues and make medical

appointments, calling everywhere from Walter Reed to the National Guard Bureau in Washington and to Fort Bragg, NC. This

is by no means the total amount made.

The last time that I didn’t receive orders, I went without a pay

check for 2 months. After my therapy ended in October, I reported

to Fort Bragg and they had no knowledge of my existence. I had

fallen through the proverbial cracks. With the process that frequently takes 3 to 4 days, mine took 3 to 4 weeks. Instead of extending my orders to the suggested date, they were extended for

a couple of days at a time.

The problem with this was that it took several days to process

the paperwork and the orders were late by the time they were sent

to Fort Bragg, so the process began again. I finally signed out at

14:20 on November 7, 2003.

But I must say, I’m more fortunate than these people beside me.

Even with all the problems I encountered, I was very pleased with

my medical experience. Like my wife, I was very skeptical of the

idea of military surgeon working on my shoulder, especially when

no x-ray or MRI was done for diagnosis. And then again when I

was told it would be an open procedure and not done otoscopically.

As a nurse working in the same day surgery setting for Sentara

Hospital, in my opinion the health care I received was as good or

better than any I have seen. I particularly appreciated the physicians seeing me in such a short timeframe on the days that I had

to drive 3 hours for two appointments that were 4 to 5 hours apart.

The physical therapy was an eye opening experience but went

smoothly despite being transferred from one installation to another.

[The prepared statement of Sergeant Emde follows:]

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Mr. SHAYS. We appreciate your statement.

Mrs. Emde.

Mrs. EMDE. Good morning, Mr. Chairman and members of the

subcommittee.

As a spouse of an activated National Guardsman, I felt both

pride and fear as my husband shipped out for Operation Enduring

Freedom in early May 2002, after 5 months training at Fort Bragg.

When he called in June to say that he had injured a shoulder and

would be shipped home, my first thought was that I did not want

him seeing a military doctor. After being raised in Tidewater, VA,

home of numerous military bases, Army, Navy, Air Force and Marines, I had heard many, many horror stories of treatment by military doctors and the incompetence of their nurses and staff.

My husband was fortunately assigned to Walter Reed Medical facility. After his surgery, and I met his surgeon in October 2002, I

was very, very pleased. His surgeon came out personally to speak

with me, took time to explain the surgery, post-operative treatment, even went as far as giving me his home telephone number

so that I could reach him in case I had any questions.

Despite the good medical attention my husband did receive, the

administrative runaround was deplorable. We had his orders lapse

four times during that time. One of the times we went 2 months

without pay. During that time, our mortgage was late, I was called

daily at my office by our mortgage company, it was reported to the

credit bureau that we were late on payments. That stays with us.

It will stay with us for many years to come.

It hasn’t affected us as far as trying to refinance our mortgage

now to get a lower interest rate. I had checks bounce because of

an automated payment that I could not stop coming out from a

schedule, it would come out on the 17th, payment did not come on

the 15th as was expected. I had to pay bank fees. Those were never

reimbursed to us. It’s something we will live with forever.

The stress that something like this causes on a National Guard

family is just extreme. I can’t imagine how families who have only

one income and encounter these types of pay glitches survive. We

were fortunate that we are a two income household and we were

able during these periods to pay for utilities, food, gas, all the

standard costs of living.

It’s hard enough for National Guard families to have their lives

disrupted for activation to full duty. However, the delay in prompt

medical treatment and surgery because of lack of doctors, lapses in

pay are both deplorable and unnecessarily add to this hardship.

For both my family and others of the National Guard who have

had problems similar to ours, I thank the subcommittee for their

time and effort on our behalf.

[The prepared statement of Lisa Emde follows:]

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Mr. SHAYS. I thank you for your testimony, Mrs. Emde.

Specialist McMichael, thank you very much for being here.

Specialist MCMICHAEL. Yes, sir. Good morning, Mr. Chairman

and distinguished members of the committee. I’d like to thank you

from the bottom of my heart for giving me the opportunity to speak

here today.

My fellow medical hold soldiers and I have prayed for a chance

to tell our story. I tried to include a few of their stories in my written statement. I realize that my poor writing ability fails to do

them justice. I can only hope that what I’ve written sparks some

sort of interest. Between my speech and written statement, I hope

to raise enough questions that somewhere, someone will look more

closely at what’s going on at Fort Knox.

The Army has repeatedly maintained that there is no difference

between the active duty soldiers and the National Guard and Reserve soldiers when it comes to their treatment. I invite each member to come to Fort Knox and see how we are treated and how we

are forced to live. Compare our living conditions to the active duty

soldiers. I ask that this committee also take a close look at the

physical evaluation board and the rulings and decisions. Many of

my fellow soldiers had their injuries or illnesses declared as existing prior to entering active service. You just have to ask, if they

are in such bad shape they can no longer remain on active duty,

why were they ever brought to active duty in the first place?

The few soldiers who do receive a disability rating or severance

are awarded amounts that are so low they’re insulting. I ask you,

how can they justify awarding 10 percent to a soldier who broke

his back? This man can never pick up his children again, he’s permanently disabled and can never enjoy what you or I take for

granted.

Soldiers have repeatedly asked, why such low awards? No one

has answered the questions. We are told that the VA will take care

of us. I thought that was the Army’s responsibility. Soldiers come

to me every day with horror stories of medical care gone wrong,

and in some cases absolutely refused. I agreed to come here today

because someone has to speak for these soldiers. Someone needs to

ask Congress to come to Fort Knox to hear their stories. Whoever

comes to Fort Knox needs to speak with the individual soldiers on

a one on one basis, without the command standing over top of

them.

They need to talk to the individual soldiers, not just the ones

that are hand picked by the command. The soldiers do want to talk

to you. However, they fear retaliation. I’ve been in the military for

18 years. Retaliation is real. It happens.

I don’t want the committee to also think everything I have to say

is negative. There have been a few positive things that have occurred in medical hold. Two officers in particular I want to talk

about, one is Lieutenant Fannon. When I arrived at Fort Knox, he

was the only medical officer who reviewed our cases. This is one

man reviewing 300 soldiers’ cases. It was his job to review every

single soldier and see every single one of us to receive the medical

care we needed. This officer showed that he cared about us, one of

the few that actually did. Often he was the only person who was

on our side.

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The other officer I have to tell you about is the hospital chaplain,

Major Norwood. It doesn’t matter what your religious affiliation is,

this man would talk to you. I have sent many soldiers to him that

have had problems and needed someone to talk to, because they

could not talk to the behavioral health representatives.

I have to tell you, this man has saved lives. There are soldiers

who have reached such levels of hopelessness and frustration that

suicide seemed like the only way out. Many have talked to him and

I know for a fact he has saved lives.

Soldiers in the barracks are resorting to alcohol and even drugs.

Recently several soldiers were punished for illegal drug use. If you

ask the soldier, I ask you, if the soldiers were not feeling so lost

and hopeless, would alcohol and drugs be such a problem? I think

that bringing these issues to light is the first step toward fixing the

problem.

The projected mission requirements mentioned by the Army have

shown that more and more Guardsmen and Reservists are going to

be called to active duty. This can only mean a steady stream of soldiers coming through medical hold. Some of the other members

here have mentioned some other issues, well, First Sergeant mentioned medication. That seems to be the answer to everything in

the Army, better living through chemicals. There are soldiers in my

barracks who are taking twice the medication that he is. I once

lined up all my empty pill bottles on the wall as a political statement and was punished for it—or excuse me, I was reprimanded.

I’ve been in medical hold since May 28th of last year. My unit

has never called, they’ve never called the Army to see how I’m

doing, they’ve never called my family, they’ve never notified my

family, they’ve never even asked how I am. And you were talking

about orders expiring, my orders are set to expire in 15 days. I’m

just waiting to see whether I’m going to be paid after that.

Thank you.

[The prepared statement of Specialist McMichael follows:]

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Mr. SHAYS. Thanks to all of you. We’ll start the questions with

Mr. Schrock. I think we’ll do 5 minutes for Members then we’ll do

a second round.

Mr. SCHROCK. Thank you, Mr. Chairman. It’s sort of like deja vu

all over again, we’ve been hearing this over and over again. I know

it takes time to get problems solved. But I think when we get to

the point where people’s credit is being ruined, they have to pay

for hotel advances out of their own pay instead of getting per diem

like it was when I was active duty Navy, I don’t know what the

answer is. We’ve had folks here before, actually, we need to address

the questions of the four gentlemen sitting behind you, and make

no mistake about it, we will.

As good as it was to have the men here testify, it’s even to me

more important to have the wives testify. Because the impact some

of these situations have had on the family are just outrageous, and

we simply have to get this fixed. I screamed about it, literally

screamed about it at a hearing a month ago, and maybe some of

the problems are getting solved. I certainly hope they are.

But if we don’t, then we may have to have a hearing every other

day. And if we have to go to Fort Knox to do it, then we’re going

to have to go to Fort Knox to do it. I don’t want this young men

and women hand picked, I want to be able to walk into a barracks

and say, what’s your situation. And for you to be on medical hold

for 10 months now, and nobody’s checking on you, something is

wrong somewhere. And I think those are the questions we need to

address to the Generals, the Admiral and the Secretary.

Fit for duty is supposedly what it’s all about. And the Army is

required to provide annual medical screenings, annual dental

screenings, selected dental treatment and a physical exam every 2

years for early deploying Reservists over age 40, and every 5 years

for early deploying Reservists under age 40.

To the gentleman, how often did you receive physical examination? First Sergeant?

Sergeant MOSLEY. I work full time as a civilian for the Army Reserve now, sir, so we’re a forward support protection package, we’re

required once we get 40 years old to have a physical exam every

2 years. And I scheduled a physical exam for the troops in my unit,

so I had mine every 2 years, sir. I have a copy of the one that was

done in May 2002, so that the only deficiency I had, sir, was a

hearing loss, and that profile was downgraded so I could go.

Mr. SCHROCK. Specialist Ramsey.

Specialist RAMSEY. Yes, sir. My last physical was in 2000. Any

physical after that, I did not receive one. It was more of just a

records check. My unit is a rapid deployable unit. We have the responsibility of deploying within 72 hours wherever for air defense.

So on a year basis, actually every 6 months, we go and do what

they call a MOB station, go through all the shots records and update all our medical files. But my last physical was in 2000.

Mr. SCHROCK. Any dental at all?

Specialist RAMSEY. No, sir. The last—I was deployed in 2001, the

end of 2001 and when I reached Fort Bliss, where our command

unit is housed, when I reached there they did a panoramic x-ray.

That was the last one I had, was in 2001. I have not had any dental updates since then.

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Mr. SCHROCK. Sergeant Emde.

Sergeant EMDE. Like the First Sergeant, I am required to have

an over 40 physical every 2 years. I recently went to Fort Eustis

and had my physical done in May of last year. I had my dental

things taken care of right about the same time.

Mr. SCHROCK. Specialist McMichael.

Specialist MCMICHAEL. Sir, my last physical was in November

2000. I was in the IRR, inactive regular Reserve, from August 2001

until a local unit pulled me out of the inactive regular Reserve and

mobilized me February 27th of last year. My physicals are current

and up to date.

As for dental, I haven’t had a panagraph or anything like that

in probably 10 years. But I did have dental work done at Fort

McCoy, which I have to praise their ability. They did good.

Mr. SCHROCK. Specialist Ramsey, did you want to make a comment?

Specialist RAMSEY. Yes, I just wanted to add one thing. I was,

because I stayed so close in contact with my Reserve unit in Orlando, FL, I was under the understanding that our annual

physicals were coming up and I was on that list. But because I was

currently on incap and not allowed to attend drills, because of not

receiving retirement points, I was passed over for that particular

physical, as well as my TB test. I received a TB test prior to leaving Kuwait, back to the States. I was supposed to get another one

6 months later for followup. I still have not received that.

Mr. SCHROCK. First Sergeant, I know my time is up, but explain

the pills, would you? What are they?

Sergeant MOSLEY. There’s probably 16 or 18 pills a day in there

for Parkinson’s disease, which my shaking is about 50 percent of

what it was 3 weeks ago. Pills in there, there’s Neurontin for the

backaches, there’s Percoset, Vioxx, there’s pills there for depression

and PTSD.

Mr. SCHROCK. Sounds like you’re over-medicated to me.

Sergeant MOSLEY. That’s what my statement was. If I was to

take every pill they told me to take here, sir, I wouldn’t be waking

up in the morning.

Mr. SCHROCK. Mr. Chairman, I know my time is up, thank you

for letting me have the time. As bad as the medical problems are,

and they are, this financial problem, people’s credit being affected,

bills not being paid that are supposed to be paid, to me this is a

horrible, horrible situation. And if a man or woman is trying to get

better medically and they have all this burden on them, how in the

dickens can they with all these medical bills?

I think it’s absolutely abhorrent that the military services aren’t

paying these bills and making sure these young men and women

are paid. It’s ridiculous. We need to get our hands around that and

get around it real quick, or we’re going to have some real bad problems with these folks, and nothing they created. Thank you.

Mr. SHAYS. Thank you, Mr. Schrock.

Mr. Tierney.

Mr. TIERNEY. Thank you, Mr. Chairman. I want to thank all the

witnesses for their service and for the difficulty they’ve gone

through, I regret that. There’s nothing that you testified to that I’m

unclear on. I think that all of you made very certain and very clear

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what the circumstances are, and I’m anxious to hear from the next

panel as to what we’re doing about that, and what we’re going to

do about it. But I would like to give any of you that feels you might

not be asked a question you want to answer or something that you

haven’t yet had a chance to say, I’d like to give you the opportunity

to do that, if there’s anybody who feels that their opening statement wasn’t adequate enough.

Specialist RAMSEY. I just wanted to add to what Mr. Schrock was

bringing up, the financial issues. My wife and I also, as soon as I

returned from active duty, we tried to refinance our house. We’re

at a 7 percent under the Soldiers and Sailors Relief Act, which I

am not able to receive right now, because I’m no longer on active

duty. My interest rate on my home is at 7 percent. I had the opportunity to refinance at 5 and a quarter percent.

Because I was late on my mortgage in November and December,

never been late on my mortgage any other time before that, because I was late on that, that affected my credit to the point where

they were, the mortgage company that I was looking at actually offered me a better rate of 7 and three quarter percent, and I’m at

7 and a quarter. So actually, they were going to offer me what they

thought was a better rate, which actually was going up.

Specialist MCMICHAEL. I do want to mention the medication

again. We have some soldiers at Fort Knox who are so medicated

they can’t even get out of bed to make formation. I personally take

60 milligrams of MS Contin, which is a morphine derivative, every

12 hours. A member of legislative affairs made a comment to one

of the clerks that work for you that she didn’t feel I was going to

be able to testify here, that I would not, as I understand it, be able

to make a coherent thought to where I could talk to anybody.

This is just the tip of the iceberg with medication. There’s a Sergeant Major Abbotts at Fort Knox that would welcome the chance

to speak to any one of the members of the committee, he’s in the

same boat, taking a ton of medicine. Soldiers that are diagnosed

with post-traumatic stress disorder, they’re basically medicating

these guys out of this world. Some of them don’t even know where

they are.

Mr. TIERNEY. Mr. Chairman, I don’t know that the next panel is

going to talk about anything other than process, how this works.

But I would think there are two distinct issues. One Mr. Schrock

brings up about the financial implications and what the military is

actually doing, and the second is the medications and how they’re

being distributed and all that. So whether it requires further hearings or simply a followup by this committee in terms of aggressive

oversight, those are at least two issues that I would like to recommend this committee look into in great detail.

And I want to thank again all the witnesses for your testimony.

Mr. SHAYS. Thank you. We actually are doing that in conjunction

with the full committee, trying to make sure we spread that workload.

Mr. Ruppersberger, you are entitled to go next, since you are full

committee, but if you don’t mind waiting for Mrs. Davis, we’ll have

her go next, if that’s OK. Mrs. Davis.

Mrs. DAVIS. Thank you, Mr. Chairman.

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I do have a question, but I would like to say something to the

Emdes and the Ramseys. In my prior life, before coming to Congress, I was a real estate broker. I can tell you, if you have 100

percent A plus credit everywhere but you’re late 1 day on your

mortgage, it will stop you from refinancing. So I can’t help you, Mr.

Ramsey, but Mr. and Mrs. Emde, if you will talk to my staff afterwards, we’ll see if we can get a letter from the Services and see

if we can’t clear up your credit on your mortgage.

The one thing I do want to ask each and every one of you, did

any of you have a pre-existing condition that should have been

caught before you were activated, or do you know of anybody that

had a pre-existing condition in your unit? Particularly you, Sergeant Mosley. How long have you had Parkinson’s?

Sergeant MOSLEY. They just diagnosed me in March. I’ve been on

my medicine 3 weeks. I had gone on my June 12, 2003 physical

exam, I indicated stiffness in my joints, numbness in my arms and

shakiness that I couldn’t control. That was June 2003. It was only

after my medical evaluation board was finished and I agreed if

they sent me to a civilian neurologist to find out where my vertigo

was from and the other problems, and they did the MRI and diagnosed me with the cervical spondylosis and the Parkinson’s disease.

Mrs. DAVIS. But you had the shaking in June 2003?

Sergeant MOSLEY. When I came back, I had some minor shaking.

I’m glad you didn’t see me 2 weeks ago.

Mrs. DAVIS. Did they do anything when you said you had the

shaking?

Sergeant MOSLEY. They kept telling me it was just nerves and

the pain, like the pain in my back and my neck, they just kept saying it was pain, that’s why I wasn’t sleeping good, that’s why I was

having some of the dreams I was having, and side effects of medicine.

You know, when you have a soldier go to a psychiatrist, and I’m

not talking about me, but I know the soldier that did this, tell him

how depressed he is and what his suicidal thoughts are, and he’s

threatened with malingering and UCMJ, he leaves and within

about 3 weeks cuts his wrists. Soldiers are talking, like I say, but

the folks there just aren’t listening.

Mrs. DAVIS. I’ll be leaving for Iraq in 3 weeks. I look forward to

seeing some of my Virginia Guard and Reserve there.

Sergeant MOSLEY. Have you taken the anthrax shot, ma’am?

Mrs. DAVIS. The anthrax shot? I live on a farm. I’m not worried

about anthrax.

Sergeant MOSLEY. I hear you.

Specialist RAMSEY. To answer your question, ma’am, no, I did not

have any pre-existing. I was 100 percent healthy. The only condition that I had is, I had a hernia surgery, a bilateral repair on both

sides in 2001. And I had some complications from it. That was the

only issue. I was cleared for full duty prior to leaving. It was not

interfering with my civilian job nor my military duties.

Mrs. DAVIS. Did they do a full physical before you left?

Specialist RAMSEY. No, ma’am, they did not.

Mrs. DAVIS. They just cleared you?

Specialist RAMSEY. They cleared me. They looked through my

service record.

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Mrs. DAVIS. On your word?

Specialist RAMSEY. Yes, ma’am. They looked through my service

record, they looked through the civilian doctor’s notes from my surgery and then cleared me to go on.

Mrs. DAVIS. Scott Emde.

Sergeant EMDE. I received a full physical prior to going overseas.

I had no pre-existing medical conditions whatsoever.

Mrs. DAVIS. Thank you, Scott. Specialist McMichael.

Specialist MCMICHAEL. Prior to being deployed, actually in 1992

I received knee surgery and was awarded a permanent profile because I could no longer run. It was P3, meaning I was nondeployable. During preliminary review with the 88th Reserve Support Command, a colonel took my P3 profile, downgraded it to a P2

so that I could be deployed. My P3 profile was actually awarded by

a medical evaluation board.

I had already been through medical board once before, was found

fit for duty and retained at a permanent profile. That was the only

thing wrong with me, it did not affect my ability. I actually wanted

to go. What happened to me occurred at Fort McCoy while I was

training and has nothing to do with my knees.

I do know of soldiers at Fort Knox, Sergeant Major Abbots that

I mentioned as well, he had neck surgery about 3 months before

he was deployed. His civilian doctor had stated, he is not to be deployed. Well, they sent him to the desert, he came back and had

to have surgery. There are other soldiers in the same boat.

First Sergeant mentioned behavioral health and psychology.

There’s a soldier over here at Walter Reed right now that’s a friend

of mine that was at behavioral health. He had made a suicidal gesture earlier that week, was sent to behavioral health. The next day

he slit his wrists. Behavioral health refused to help him. I know

of other soldiers who have gone to behavior health and asked for

drug or alcohol counseling, well, you’re National Guard, no, you’re

not entitled to it. There’s a Specialist Anderson, who’s now Private

Anderson because they refused to help him and he ended up getting two more DUIs.

Myself, I have gone to behavioral health because I have family

issues. And the psychologist, his main concern was how long I’ve

been in medical hold, not with helping me. I’ve had appointments

canceled with behavioral health and the soldiers—that’s why I

mentioned Chaplain Norwood, because the soldiers at Fort Knox,

the behavioral health doesn’t care about them. They go outside to

outside agencies, some have gone to the VA to find people to talk

to.

That’s all I have to say.

Mrs. DAVIS. I thank you all very much, and Mr. Chairman, thank

you so much for allowing me to be a part of the hearing.

Mr. SHAYS. We are delighted you are. And by the way, her offer

to assist you in the issue of financing issues, take her up on it. I

think it will be very helpful to you.

Mr. Ruppersberger.

Mr. RUPPERSBERGER. First, I’m sorry I was late. I have read the

files and been briefed on your testimony. There’s no question we

have a serious issue. First thing, the issue generally of our military

we have to deal with, because terrorism is, the war with terrorism

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is not going to stop, and we do need to move on and finish what

we have started.

However, the total force transformation, and I believe now that

the use of National Guard and Reserve is more now than it was

during World War II, so there are issues here, and that’s the reason we’re having this hearing. First, I want to thank you all for

your service, and understand that you’re going through a lot of difficulty and family issues. We’re having this hearing, and I want to

thank the chairman for having the hearing today, because we’re

trying to get to the issue to make it better.

To begin with, Specialist Ramsey, could you, I want to get into

the area of the difficulties in receiving adequate care you experienced. Do you believe they were caused by ineptitude of doctors, by

the incompetence of file clerks, or by incompatible recordkeeping

systems between the Reserve component and the active component?

Specialist RAMSEY. Yes, sir, that’s correct. All the above.

Mr. RUPPERSBERGER. Could you explain a little bit what your

analysis of those issues are?

Specialist RAMSEY. For example, in Fort Benning they have postdeployment checklists that you’re required to check off from each

station prior to leaving and being redeployed to your home residence. They have so many of them that the different sections, for

example, finance, medical, what have you, personnel, they choose

to check off whichever ones they want to check off. There’s not one

standard form there. It’s easier for them to push us through and

send us home than it is to do the extra paperwork or go through

the extra log or chart and treat us for the injuries that were incurred while on active duty.

Mr. RUPPERSBERGER. OK. Sergeant Emde, first you noted that

you made hundreds of phone calls to check on your payments, active duty status, medical appointments. How many phone calls

have you made where you feel you got the service or response you

were looking for, or do you feel you were just passed from one person to another, in a bureaucratic maze?

Sergeant EMDE. I would say probably roughly a quarter of them.

A lot of the problems were people not being around when I needed

to make an appointment or a lot of the problem for me anyway,

since I was at Walter Reed and I was trying to get some of my care

at a Naval facility, the computers didn’t mesh. Therefore, their procedures or the Navy’s way of doing things didn’t quite mesh up

with the way the Army did their thing. And their protocols, such

as one I noted that the physicians at the Naval facility wanted to

know why this doctor wanted an x-ray. To me, that’s absurd, but

that’s the Navy’s way. And had Walter Reed known about that,

then that may have been——

Mr. RUPPERSBERGER. Was it because of a lack of control of one

person that you could go to to coordinate this, did you see a lot of

duplication of effort? What would you have recommended if you

were a general that you could have done to fix your problem?

Sergeant EMDE. If there was perhaps a central person that took

care of everything, that may have alleviated some of it. But other

parts of it, there were two physicians I was seeing up at Walter

Reed, one for neurology, one for my shoulder. When the doctor I

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had for my shoulder, when he went on vacation, when he got back,

the neurologist left. So that was like 6 weeks that I was unable to

get any help whatsoever from that.

Mr. RUPPERSBERGER. Were these pre-existing conditions? I was

not here for your testimony. Were these pre-existing conditions?

Sergeant EMDE. No, they were not. Prior to me being deployed?

Mr. RUPPERSBERGER. Yes.

Sergeant EMDE. No, sir.

Mr. RUPPERSBERGER. OK. Mrs. Emde, the issues that you were

dealing with and the help and support, was the family support center at your husband’s base, was there a family support center

there?

Mrs. EMDE. There was no family support whatsoever. I received,

he was actually under active orders for almost 2 years. And during

that 2 year period, I received one call from the Virginia National

Guard basically to tell me about my commissary rights. That was

it.

Mr. RUPPERSBERGER. Were you told there was going to be support?

Mrs. EMDE. Oh, yes. We were told there would be support, that

if we had any questions, we could call this number. When we had

pay glitches, I called numbers, didn’t get anything.

Mr. RUPPERSBERGER. What happened when you called those

numbers?

Mrs. EMDE. We were told that they could not handle it, it was

an active duty issue.

Mr. RUPPERSBERGER. Was this the National Guard number you

got?

Mrs. EMDE. Right. The National Guard could not help us.

Mr. RUPPERSBERGER. Then did you go——

Mrs. EMDE. He had been under active duty and we no longer fell

under their umbrella. So they did not help us.

Mr. RUPPERSBERGER. Then what did you do? Did you go to the

active, the career?

Mrs. EMDE. When he had the medical extension orders. We were

told that there was only one person who could extend his orders,

and this person was Bob Vail, and it took, during the four lapses,

there were lapses of 2 weeks, 3 weeks, the longest that we personally experienced was 2 months.

Mr. RUPPERSBERGER. One last question. If you could have the authority to fix the problem, the frustrations you were going through,

what would you have liked to have seen?

Mrs. EMDE. More administrative help in order to process——

Mr. RUPPERSBERGER. A special person to coordinate between National Guard and career, or do you feel——

Sergeant EMDE. From my understanding, the National Guard

Bureau has one person that takes care of ADME orders. And I

called up there, the process goes through my chain of command at

Dove Street in Richmond, and then it goes straight to the National

Guard Bureau. This man goes through, reviews everything and

then it goes up to a colonel to get processed or get accepted. Then

it’s OKed, this colonel gives the authority to cut the orders, as I

understand the process.

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I cannot see for the life of me how one person can review every

single pay problem that is reviewed medically for the National

Guard. It’s just—but that’s what I was told, and that’s where the

system bogged down.

Mr. RUPPERSBERGER. Thank you.

Mr. SHAYS. I thank the gentleman. I’ll proceed to now ask some

questions.

We basically had the active so-called component, the active force

and the Reserve component, Reserve and National Guard. It is very

clear to this committee that they are not equal in a whole host of

ways. And they are not treated in the same way. And as my colleague just said, you all are expected to perform in the same way.

We know that the health provisions for active are different than

for those in the Reserve component. We know the pay has gotten

all screwed up. That has to impact your health. When you are

thinking you might lose your house and the frustration of thinking

that you can lower your mortgage costs and then find out you can’t,

it would drive me crazy.

We know that the training isn’t equal, and we also know the

equipment and protective gear is not equal. In Iraq, we had some

of our Connecticut National Guard trying to get their Humvees to

have the same basic armament that the others had. They had to

do makeshift efforts, literally go into Iraqi garages to have steel

plates put on.

So we know that in this committee, looking at all these issues.

Today we’re looking pretty much at health, and obviously the pay

is a factor. Sergeant Mosley, you were in Iraq, correct?

Sergeant MOSLEY. Yes, sir.

Mr. SHAYS. When were you in Iraq?

Sergeant MOSLEY. Cross with the 3rd FSB and the 2nd and the

7th on March 19th, sir.

Mr. SHAYS. March 2003, right?

Sergeant MOSLEY. Yes, sir, first day of the conflict.

Mr. SHAYS. Specialist Ramsey, you were in Kuwait?

Specialist RAMSEY. Yes, sir, I was in Kuwait and Iraq. I was assigned directly to the commanding general of the 32nd Army Missile Defense.

Mr. SHAYS. And you were there——

Specialist RAMSEY. I was in and out of Iraq anywhere from the

late part of March all the way up to my last trip into Iraq, which

I think was toward the end of May.

Mr. SHAYS. And Sergeant Emde, you were Qatar, is that correct?

Sergeant EMDE. Yes, sir.

Mr. SHAYS. When were you there?

Sergeant EMDE. I was there in the May and June timeframe of

2002.

Mr. SHAYS. It was our expectation that before you would be sent

into a combat zone, that you would have gone through a very compressive physical. I want to know if that was done for you, and

each of the three gentlemen I’d ask. Before you went.

Sergeant MOSLEY. No, sir, Mr. Chairman, we did not.

Specialist RAMSEY. No, sir, no type of physical.

Sergeant EMDE. Yes, sir, we did.

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Mr. SHAYS. Thank you. When you got back from the battle zone,

were you given any kind of general physical to determine how you

might be different than the, well, actually they didn’t see how you

went in. But were you given a physical on the way home?

Sergeant MOSLEY. I was, because I went through the medical

evaluation board process, sir.

Mr. SHAYS. Right.

Sergeant MOSLEY. But when our unit came back on August 22nd,

they were told, my commander was told, you’ve got 3 days to completely de-MOB and be off of Fort Stewart, 156 soldiers they’re

going to try to——

Mr. SHAYS. So they weren’t all given physicals?

Sergeant MOSLEY. No, sir, they were not.

Mr. SHAYS. OK. Specialist Ramsey.

Specialist RAMSEY. No, sir, I was not given any type of physical.

I reported to Fort Benning from Kuwait on the evening of, I believe

the 11th or the 12th, Wednesday evening. Thursday morning we

went and spent 2 hours doing out-processing, a few of the check

points. On Friday, we went to medical and did the out-processing

there, and then went to personnel and finished out-processing. At

4 a.m., on Saturday I was on an airplane heading for Florida. I

spent between 3 and 5 minutes in the physician’s assistant’s office,

a Lieutenant Mulener, who basically just fanned through my paperwork, said I had the appropriate documents to receive medical

treatment at my home station and even wrote in there to receive

medical treatment at home station. Then I was sent on my way.

Mr. SHAYS. Thank you.

Sergeant EMDE. Yes, sir, as part of the out-processing system at

Fort Bragg, all the National Guard Reservists that I saw there had

complete physicals done.

Mr. SHAYS. So you went in, you had a physical and when you got

back you had a physical?

Sergeant EMDE. Yes, sir.

Specialist MCMICHAEL. Sir, I need to make a statement about

the physicals. I worked at Fort McCoy. While I was on medical

hold, I was assigned to the SRC, which demobilized the soldiers.

And physicals were actively discouraged. When a unit came to deMOB, they were told, well, you can have a physical if you want.

But you’re going to be here another 2 weeks while your unit goes

home. And soldiers would be briefly assigned to medical hold for

about a week to 2 weeks while the results of the physical, blood

tests and other whatever tests had to be done. And that’s just for

a basic physical that didn’t find anything wrong. They actively discouraged the soldiers from requesting physicals.

I believe it was the——

Mr. SHAYS. You’re speaking in your capacity as a nurse?

Sergeant MCMICHAEL. No, my job was to do the DD–214s for soldiers when they came back. This was at Fort McCoy, WI, which

was a mobilizationsite. I believe it was the commanding general of

the Wisconsin National Guard actually went so far as to order all

his National Guardsmen will receive a physical when they deMOB. At McCoy, they actively discouraged it.

My unit spent 4 months at Fort McCoy. They hired Iraqi civilians to do our job, my unit went home the first of June. I was still

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on med hold, I stayed. But they did that with my unit when they

de-MOBed. They said, if you want a physical, fine, you can have

it, but you’re going to stay.

Mr. SHAYS. I need to—sorry, Sergeant Emde, you’re the nurse.

Specialist McMichael, I need you to explain what medical hold for

10 months means.

Specialist MCMICHAEL. When I was originally injured, I ruptured

my abdominal wall. That was back in April. I was assigned to medical hold in May, right when my unit went to demobilize.

Mr. SHAYS. Describe to me what medical hold means.

Specialist MCMICHAEL. Medical hold means you’re going to sit

around, you’re going to see the doctors when you have a doctor’s

appointment. The big thing——

Mr. SHAYS. Does it mean that you perform active duty while

you’re on medical hold?

Specialist MCMICHAEL. Right, you’re on active duty. At Fort

Knox, they try to find you jobs. You’re supposed to have a job working in your military occupational specialty, your MOS. A lot of soldiers don’t, because they’re not able to perform their job with the

restrictions they have on medical hold. Some people have lifting,

different types of restriction. While you’re on medical hold, you’re

still on active duty, you’re still at whatever military base. In my

case, I’m at Fort Knox, I’m in the barracks with about 150 other

medical hold people.

At McCoy, they have a medical hold, I’m not sure what the numbers were. Your job on medical hold is to go to your appointments

and to get well. Some of the bases have—they want you to be gainfully employed, doing something——

Mr. SHAYS. I understand that. And I’m sorry, I’m running over,

and I’ll let all the Members come back. So you’re on medical hold,

you are being given assignments, and you will be on medical hold

for how much longer?

Specialist MCMICHAEL. I’m scheduled to have surgery here at

Walter Reed on the 16th. Fort Knox, it took 4 months to see the

neurosurgeon here from Walter Reed. I’m going to have surgery to

repair something that occurred to my neck.

Mr. SHAYS. So when you have surgery, then what happens?

Specialist MCMICHAEL. I’m being medically boarded as well, and

I’m anticipating another 3 to 6 months in medical hold before I’m

medically discharged.

Mr. SHAYS. Let me just ask any of you here, do you believe what

you are telling us is unique to you or systemic to the issue? In

other words, that you are typical of others, there are many others

like you, or do you think that you’re unique and that my staff has

just done a wonderful job of finding you?

Sergeant MOSLEY. I would say we’re very systemic, Mr. Chairman. I was on med hold for 10 months.

Mr. SHAYS. So you’re saying my staff didn’t do a very good job

here, right? [Laughter.]

Sergeant MOSLEY. Oh, no, sir, I wouldn’t say that. I’d say some

of the Army folks would be guilty.

Mr. SHAYS. The bottom line though is you believe you are more

typical than unique. Would anyone disagree with that? I’ll assume

that if others don’t comment that you consider yourself more typiVerDate 11-MAY-2000 11:57 Sep 13, 2004 Jkt 000000 PO 00000 Frm 00138 Fmt 6633 Sfmt 6633 D:\DOCS\95289.TXT HGOVREF1 PsN: HGOVREF1
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cal of the problem rather than unique. That’s the way we’ll leave

it unless someone wants to counteract that.

Specialist RAMSEY. Sir, I just want to add one thing to that. I

think the reason that your staff found us is because there are very

few people that will stand up and speak their mind and stand up

against the Army.

Mr. SHAYS. You know what? I think that’s very true.

Specialist RAMSEY. And I’d just like to add one thing to what he

was saying, what you were addressing about having an assignment

or working while you’re on active duty medical extension. Per Colonel Sherman, the G–1 who decides who does and who does not get

active duty medical extension, in her e-mails and in her phone conversations that I have taped, she has made it very clear that if you

can perform your military job, you do not qualify for active duty

medical extension. However, in the Army regulations it says, you

must not be able to perform your normal military duties. She has

interpreted on her own that my MOS, military job, is what it

stands on.

There’s many soldiers out there that are still performing either

their same MOSs or some type of an activity at a post as we speak.

Mr. SHAYS. Mr. Ramsey, let me just be clear about this. You basically would like to be home with your family in your job working

as a sheriff, correct?

Specialist RAMSEY. Yes, sir.

Mr. SHAYS. If you do that, you then give up any hope of getting

medical attention and have these significant bills paid for, is that

correct?

Specialist RAMSEY. Sir, I cannot return to my civilian employer

because of workers comp issues and health insurance issues. They

will not accept me back until I am cleared by the military and by

a physician. They’ve made that very clear. The military has even

gone as far as calling them and asking them if they can put me

on a light duty status, and they’ve made it very clear to them that

they’re not in the practice of taking up the slack for the military

where they fall short in medical care for soldiers.

Mr. SHAYS. OK. I’d like to welcome our ranking member to the

committee. Nice to have you here, Mr. Kucinich. You have the

floor.

Mr. KUCINICH. Thank you, Mr. Chairman. I have a statement

that I would appreciate if the Chair would put into the record.

Mr. SHAYS. We will put your statement into the record, and I

thank you for that.

Mr. KUCINICH. And an accompanying letter with that statement.

[The prepared statement of Hon. Dennis J. Kucinich and the accompanying letter follow:]

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Mr. KUCINICH. As the Chair knows, and as the Chair has recognized over the past few years, many of us have expressed our concern about the treatment of our troops, about whether or not they

were, they had proper equipment, whether their health care was

sufficient, whether their pay and benefits were appropriate, and

raised questions about morale. This hearing that you’re having,

Mr. Chairman, is very important, because it continues this committee’s work and oversight in raising questions about just how well

those who serve this country in the military are being provided for.

I had the chance to look at Specialist McMichael’s testimony. It

was very telling in many areas. One area in particular I would just

like to focus on, just for the purpose of a brief question, is the area

where Specialist McMichael stated in his written statement that

some soldiers may or have even attempted suicide because of the

indifferent treatment they received. And this is an issue that many

Members of Congress raised back in December. It’s an issue that

Specialist McMichael raised, not only with respect to Fort Knox but

also with respect to Fort Bragg.

So I guess I’d like Specialist McMichael to say for the record, do

you believe this kind of mental stress and anguish, which is apparently resulting in suicide, is widespread from your experience?

Specialist MCMICHAEL. Yes, sir. From what I’ve read in reports,

it’s not just Fort Bragg and Fort Knox, I understand there was a

suicide at Fort Campbell as well as Fort Carson. It is widespread.

The soldiers in medical hold at the different bases, the living conditions, the differences, well, you’re National Guard, you’re Reserve,

create a level of frustration where they have no outlet. Some soldiers are flat out refusing treatment just to get out of there.

They’re taking the first amount that’s offered to them by the medical boards to get away from it, just to get out of that situation.

I personally in my position in the unit, a lot of soldiers come to

me and a lot of them tell me their stories. That’s why I was able

to refer some of them to the chaplain. I actually had a soldier go

AWOL, but I talked him into coming back, because he couldn’t get

in to see behavioral health. He told me that he had spent 3 to 4

months just waiting to see behavioral health.

Soldiers have gone to behavioral health with problems, saying,

I’m depressed, soldiers have admitted that they want to hurt themselves and they’ve been denied treatment. Soldiers have said, I

have an alcohol problem. Well, you’re National Guard, you’re not

allowed. Not that they’re not allowed, they would not let them into

the alcohol treatment problem.

Mr. KUCINICH. So you’re saying that when soldiers have expressed a cry for help, they are ignored?

Specialist MCMICHAEL. Repeatedly, sir. At one point in time I

protested because we had E5s, which are sergeants, in charge of

our building, because they aren’t able to tell when a soldier is in

crisis. That was my big issue, is that there were soldiers in crisis.

They brought some in. We’ve got some platoon sergeants and squad

leaders now that will sit there and talk to some of the soldiers.

I’m sure that since Mark Benjamin brought all this to light, all

the stuff that’s going on with medical hold, there have been

changes. I’m not saying things are totally deplorable. There has

been some improvement. But soldiers, in the realm of mental

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health, it seems the policy is, well, here’s medication. More and

more the answer is, well, here’s some medication, go take this, take

that.

Soldiers don’t want medication. They want someone to talk to.

They’re going to outside agencies. They’re going to the VA. They’re

going to churches off post to go find somebody to talk to, because

they feel that they can’t talk. Myself personally, I’ve had appointments canceled, doctor’s not going to be there. The doctor was there

on the one appointment. I went there that day. An active duty soldier had my appointment with the psychiatrist. I went there because I had issues that I wanted to discuss. They were only concerned with how long I’d been here, not helping me.

And I’m just the tip of the iceberg. The soldiers at Fort Knox, go

talk to them one on one. They’ll tell you. Sergeant Major Abbots

has post-traumatic stress disorder. The reason I use his name is

because a lot of soldiers are afraid to talk and a lot of them asked

me not to present my name to the committee. Sergeant Major Abbotts had told me, he and I have talked repeatedly and at great

length. He gave me permission to use his name because he wants

to talk to you guys.

But a lot of soldiers have been denied mental health. And they

feel they have nothing left.

Mr. KUCINICH. Mr. Chairman, one of the things that occurs in

hearing Mr. McMichael and also in reading his testimony is that

there appears to be a lack of appropriate attention paid to service

personnel who are expressing a need for mental health care. And

it would be interesting to have the committee staff maybe probe a

little bit more deeply into this issue of how is it that we’re starting

to see what some describe as an increase in suicides. Are service

personnel actually asking for help and they’re being spurned, and

therefore in their desperation, they take other alternatives that are

deadly.

Mr. SHAYS. If the gentleman will yield, you’ll have an opportunity I think to kind of pursue that issue with the next panel. And

we do thank again that panel for waiting.

Mr. KUCINICH. Thank you, Mr. Chairman.

Mr. SHAYS. Thank you. Let me just allow the two spouses to respond to this question, and then we’re going to come back after the

votes. We have two votes, a journal vote and a motion on PAY-GO.

The question I would ask is, it’s the general philosophy of the military to recruit the solder and retain the family. I’d like to know,

Mrs. Ramsey and Mrs. Emde, are you feeling retained?

Mrs. RAMSEY. No. As Mrs. Emde stated, my husband has been

in the Reserve for quite some time. When he went to deploy to

Iraq, we did have a conference and we were promised a bunch of

stuff. The family residence program was supposed to be there to

help. They did have ceratin programs right at the time he was deploying. But after that, there was nothing else. There was no other

kind of support. I never heard from his unit.

Luckily, I did have a friend of ours that’s also in the active Reserve that stayed back. He was not deployed, he was undeployable,

that actually kept me up to date on a lot of things that were going

on. I don’t know if the family residence program took that as an

assumption that I was being updated and I was informed of what

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was going on, but as far as the family residence program, it’s nonexistent.

Mr. SHAYS. Would you like to see your husband leave the Reserve?

Mrs. RAMSEY. At this point, with everything we’ve been through,

yes, sir.

Mr. SHAYS. When I said Reserve, the National Guard. Your recommendation to your loved one is, let’s get out?

Mrs. RAMSEY. At this point, with the hell the military has put

us through for the last 9 months, yes, sir, absolutely.

Mr. SHAYS. OK. We need honest answers. Mrs. Emde.

Mrs. EMDE. Well, I look at his age and I want him out.

Mr. SHAYS. He looks young to me.

Mrs. EMDE. I know he doesn’t like to hear that.

I just worry about him. I want him around later on. But he is,

I guess in May he re-ups, and he plans to re-up and stay in. So

I’ll support his decision.

Mr. SHAYS. But that’s in spite of your feelings, not because of

them?

Mrs. EMDE. Right.

Mr. SHAYS. I want to thank all of you. You’ve been wonderful

witnesses. I’d like to thank the committee members as well. We

have our second panel when we get back, I apologize to our second

panel, we’ll have some votes and then we’ll come back. But thank

you all very much. We appreciate each and every one of you. Thank

you.

We are in recess.

[Recess.]

Mr. SHAYS. The subcommittee will come to order.

I want to welcome our second panel. Two will be testifying, but

we will have more participants to respond to questions. We have

Dr. William Winkenwerder, Assistant Secretary of Defense for

Health Affairs, Department of Defense, who has come before our

committee on a number of occasions and we appreciate that. He is

accompanied by Lieutenant General George P. Taylor, Jr., Surgeon

General, U.S. Air Force, Department of Defense, and Rear Admiral

Brian Brannman, Deputy Chief, Fleet Operations Support, Bureau

of Medicine and Surgery, U.S. Navy, Department of Defense, and

Wayne Spruell, Principal Deputy Assistant Secretary of Defense,

Reserve Affairs, Manpower and Personnel.

And our second testimony will come from Lieutenant General

James B. Peake, the Surgeon General, U.S. Army, Department of

Defense.

Gentlemen, as you know, we swear in our witnesses. If you

would stand, please, and raise your right hands.

[Witnesses sworn.]

Mr. SHAYS. Thank you. Note for the record, all of our witnesses

have responded in the affirmative.

Dr. Winkenwerder, you have the floor. Given the importance of

your testimony and the importance that only two testify, 5 minutes

and another 5 minute rollover if you need it. That will be the same

for you, General, as well.

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STATEMENTS OF WILLIAM WINKENWERDER, JR., M.D., ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, DEPARTMENT OF DEFENSE, ACCOMPANIED BY LIEUTENANT

GENERAL GEORGE P. TAYLOR, JR., THE SURGEON GENERAL,

U.S. AIR FORCE; REAR ADMIRAL BRIAN C. BRANNMAN, DEPUTY CHIEF, FLEET OPERATIONS SUPPORT, BUREAU OF

MEDICINE AND SURGERY, U.S. NAVY, AND WAYNE SPRUELL,

PRINCIPAL DEPUTY ASSISTANT SECRETARY OF DEFENSE,

RESERVE AFFAIRS, MANPOWER AND PERSONNEL; AND

LIEUTENANT GENERAL JAMES B. PEAKE, SURGEON GENERAL, U.S. ARMY

Dr. WINKENWERDER. Thank you, Mr. Chairman. Mr. Chairman

and members of this distinguished committee, thank you for the

opportunity to be here today to discuss the Department of Defense’s Force Health Protection programs and how they impact our

Reserve component service members and their families.

Today we have nearly 190,000 activated National Guard and Reserve service men and women, including those serving in Afghanistan and Iraq. We are firmly committed to protecting their health.

Despite serving in some of the most austere and tough environments imaginable, today our disease and non-battle injury rates

among deployed personnel are the lowest ever. The Services have

improved medical screening to ensure forces are healthy, and they

have enhanced theater surveillance, allowing commanders and

medics to identify health hazards.

I would just state flatly and emphatically that the lessons from

the Gulf war have been learned and those lessons are being put

into place today. The Services evaluate all members, pre- and postdeployment and permanent health records are maintained. There

is some good news that we’ve learned as we’ve looked over all those

records of post-deployment health assessments of Reservists returning, and that is that they themselves have reported to us that

over 92 percent indicate that their health status upon return from

deployment is either good, very good or excellent.

Pre-deployment health assessments ensure that Guards and Reserve members are fit and healthy to carry out their duties. Improved pre-deployment screening in fact contributed to the backlog

of activated Reservists who were waiting clearance to deploy who

we heard from just earlier. The Army has worked to alleviate this

backlog, and the number of troops in this status is steadily declining.

I would note to you that of the roughly 4,000 plus service members that were in that status, Reservists in the November time period, roughly 3,000, actually a bit more than that, about 75 percent

have been processed through. There still are some. We heard from

one or two of them today. But considerable progress has been

made.

I’m also pleased with the good news that 97 percent of Reservists

and Guardsmen who are reporting to mobilize are fit to deploy. In

general, the Guardsmen and Reservists are fit and healthy.

Post-deployment health assessments gather information to evaluate concerns that may be related to deployment. About 127,000

Guardsmen and Reservists have had post-deployment health assessments done. Licensed medical providers determine the need for

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referrals for appropriate medical followup. I noted in the comments

from the panel who just spoke about the importance of engagement

with that licensed provider, and I would very much agree with

that. This is not nor should it be a process for just moving people

through. People need to be carefully examined and asked the appropriate questions.

About 20 percent of Reservists, according to our data, require referrals. And this is a rate that’s comparable to that for active duty.

In January, the Department began a quality assurance program to

monitor the Services’ pre- and post-health assessment programs.

This QA program monitors compliance with regard to completion of

work and includes periodic visits to military bases to assess compliance with all the protocols.

The Services continue to immunize troops from disease and

agents that can be used as biological weapons, including anthrax

to smallpox. To date we have vaccinated over 1 million Service

members against anthrax, and more than 580,000 against smallpox. Both programs are built on safety and effectiveness and they

are validated by outside experts.

To support combat operations in Afghanistan and Iraq, medical

care was provided far forward, available in most cases within minutes of injury. Over 98 percent of casualties who arrived at medical

care survived their injuries. Over one-third were returned to duty

within 72 hours. It’s clear that far forward medical care, improved

personal protection and solid procedures are saving lives, they’re

saving many lives, and that’s good news.

For those who are seriously ill or injured, we rapidly evacuate to

definitive care, using intensive care teams to treat patients during

transit. Specialized programs available at our larger medical centers, particularly Walter Reed and Bethesda Naval are in place,

and Walter Reed has a world class amputee management program.

I’m sure General Peake would be glad to talk more about that.

Mental health is integral to overall health. And the Services have

full mental health service programs for personnel at home and for

deployed. Suicide prevention and stress management programs are

supported by the leadership and tailored to the operation. In 2003,

24 soldiers deployed to Iraq and Kuwait committed suicide. That’s

a rate of about 17 per 100,000, compared with an overall Army suicide rate of about 12.8 per 100,000. This rate is higher than normal, but it is, I should note, and it’s very important to understand,

it’s actually below the age and gender adjusted rate for the civilian

population. Above the normal Army average, that age and gender

adjusted rate in the civilian population is about 21 per 100,000.

Of course, every suicide is a tragic loss, and the Army is significantly beefing up its effort and requiring suicide prevention training for all personnel in units now deploying. General Peake I’m

sure will be glad to talk in more detail about this important matter.

I want to commend the Army for its actions in performing a

study that’s never been performed before that I’m aware of in the

history of warfare, looking at the mental health status of service

members during conflict.

Malaria remains a threat overseas. Along with other preventive

measures, the Department uses chloroquine, doxycycline, priVerDate 11-MAY-2000 11:57 Sep 13, 2004 Jkt 000000 PO 00000 Frm 00152 Fmt 6633 Sfmt 6633 D:\DOCS\95289.TXT HGOVREF1 PsN: HGOVREF1
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maquine and mefloquine for malaria prevention. While all are FDA

approved, precautions for these medications must be followed. Investigations to date have not identified mefloquine, or Larium, as

a cause in military suicides. The FDA last year cautioned that

mefloquine should not be prescribed for persons with a history of

depression. DOD follows FDA guidelines on the use of mefloquine.

Our policy is that every service member who receives this medication also should receive information about possible adverse effects.

I’ve also directed a study to assess the rate of adverse events associated with mefloquine as prescribed to the deployed service members.

The Department has improved the transition of care for service

members to the Veterans Administration. VA counselors today advise our seriously injured on benefits, disability ratings and how to

file claims before the member is actually discharged from the hospital. We have implemented the first stage of the computerized

medical record and we are pursuing full sharing of health information with the VA.

While we are able to monitor the health status of active duty

troops after deployment, we need to improve the visibility of health

care obtained by deactivated Reserve component members. I recently assembled a task force to determine ways for us to better

monitor the health status of Guardsmen and Reservists after their

return to civilian life.

TRICARE eligibility for up to 6 months; that Congress recently

passed last year, following deactivation, and eligibility for service

through the VA for up to 2 years provides an excellent way to capture information and followup medical concerns. Let me be clear.

We aim to ensure that all returning Guardsmen and Reservists get

the care that they need.

Ensuring medical readiness of activated Reservists and providing

health coverage for their families is one of our highest priorities.

As we proceed, we must carefully review the need for permanent

entitlements and benefits to Reservists who have not been activated. That’s a topic that’s been under discussion. And perhaps we

believe the best way to do that is to look at the issue carefully

through a demonstration program to test program feasibility and

effectiveness.

Let me just close by saying that I’ve been on the job now for 21⁄2

years and I’ve had the opportunity to visit military medical units

worldwide. I’m extremely proud of the men and women who serve

in the military health system. They are courageous, dedicated, caring professionals. They are America’s best and I’m proud to serve

with them. Our Reservists and Guardsmen are doing a superb job.

With your support, we will continue to offer world class health care

to the men and women serving in our military.

With that, I’d be glad to answer any questions.

[The prepared statement of Dr. Winkenwerder follows:]

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Mr. SHAYS. Thank you, Dr. Winkenwerder. General Peake.

Lieutenant General PEAKE. Mr. Chairman, distinguished members of the committee, I am Lieutenant General James Peake, the

Army Surgeon General, and I thank you for the opportunity to appear before you today.

Mr. Chairman, I recall the day that you joined us in the Army

Operations Center and heard all the areas of the operation and the

extent of the current operations. At that time we were engaged in

Afghanistan. And I remember what you said, your comment that

from what you saw that day, the story of Army contributions was

not really widely known.

I believe in that same vein there is much to tell about military

medicine and the positive things that have been done, particularly

as it relates to our Reservists who play such an important role in

the total force readiness. In the Army, we have a selective Reserve

of about 213,000 and a National Guard of about 377,000. And we’ve

mobilized from Noble Eagle, Enduring Freedom through Iraqi Freedom some 240,000 of them. They are important as a group and as

individuals, and we care about them.

Reserve medical readiness has been and is an issue from dental

readiness to medical screening. Following Desert Shield and Storm

and well before September 11, there has been increasing attention

paid to this issue. The Army from 1995 to now has invested nearly

$.4 billion in National Guard and USAR medical and dental screening. Since 1999, this has been more programmatically funded, as

the FEDS-Heal program expanded access to USAR soldiers. Before

that it was mostly Guard and it was all targeted at the early

deployers. At least 120,000 USAR soldiers have been touched by

that program, and an even larger proportion of dollars were used

for the Guard over a longer period of time.

The current emphasis from Lieutenant General Helmly and Lieutenant General Schultz is apparent in the numbers, 34,000 dental

exams in 2003 and already in 2004 we have had 32,000 plus dental

exams done. And it is apparent as fewer soldiers are arriving at

our MOB stations in a non-deployable status.

On the front end of dental readiness, we have piloted a program

that we want to expand to all of our advanced individual training

sites, bringing all soldiers, active and Reserve, up to deployable

status before they return to their first unit active or Reserve. We

believe that this not only is good for deployability, but it sets the

right culture in terms of dental wellness being an important contributor to readiness. And Lieutenant General Dennis Cavin, our

war fighter trainer, has carved out the time out of the training

time to be able to do this kind of general readiness.

To get accountability built into the system, the measurements of

the individual medical readiness that we are promulgating as a

military health standard is a real step forward and will give commanders and we medics the tools to ensure that both our active

and our Reserves have the right medical status for deployment or

a plan to fix it on a real time basis.

The pre- and post-deployment medical screening is being done

and recorded. This is not a passive screening as it has been wrongly, I think, described in the press, but rather it is a process that

includes filing out a form for self reporting for sure, self reporting

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your status and concerns. And this is followed by a face to face review of that self report tool with a provider who explores any issue,

create a followup plan and further evaluations, laboratory work or

consultations as might be indicated.

Further, as you know, a serum sample is placed in our serum repository with approximately 30 million samples on record. Yes,

GAO did take a look at this some time ago when we were in the

Balkans, and we did not do very well with compliance. We have

made a concerted effort to do this better. The key is getting information into the central data bank. We initiated electronic records

for this process in Kuwait. Nearly 100 percent now are transmitted

overnight to our data base from Kuwait. Nearly 50 percent are

coming electronically out of Iraq, and even in that really more austere environment.

The GAO team has just completed their first visit with us, a visit

to Fort Lewis. They reviewed 194 records of soldiers deployed to

OIF from Fort Lewis from June to November 2003. Pre-deployment

surveys were located on 100 percent of these; 255 of soldiers who

returned to Fort Lewis from OIF from June to November 2003

were reviewed. Post-deployment surveys were located for 100 percent of these. A smaller percent of this group did not have a predeployment, about 60 percent did.

Documentation of required immunizations was also audited. The

assessment of my officer on the ground that was there with them

said, I think the GAO team left with a very favorable impression

of the results of increased emphasis on this program. I look forward to the rest of their visits to our installations.

I want to give you a flavor of why I believe we are doing better.

And it’s not just pronouncements from Washington. It is the quality of our people in the field. Their enthusiasm for doing what is

right in an area which, however important, might sometimes seem

mundane.

This note was forwarded to me. ‘‘I have attached the model we

use for our reintegration process. We have made several adjustments, to include adding the tobacco cessation program, clinical

practice guideline to one station and going all electronic by preloading the 2796 the night before. Almost all the ideas for improvement are coming from my soldiers who see something that could

be done better. I have a great group, sir, Jim Montgomery produced

the model, Kathy McCroary is the mastermind behind the setup,

Sergeant Stanton is the data quality person. She has a team that

loads 100 percent of the data every night.

Tamara Baccinelli, civilian, codes every post-deployment encounter by 1400 hours daily. The soldiers are pre-screening MEDPROS

and filling out the checklist to ensure that every soldier receives

the immunizations they need. The stress management team sees

every returning warrior also. They produce a list of soldiers daily

that they have concerns about, and we see them that same day.

During the reintegration, ortho and physical therapy are available

for the soldiers, and they like that. We are doing all of this and

maintaining a walk-in clinic for the community. To date, I can

think of only one patient that we have sent downtown because of

the reintegration process.

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The community has been great, they know what is going on and

they are waiting a little longer to be seen and doing it gladly. The

Red Cross has dressed up my lobby so it looks like a World War

II welcome home canteen. The soldiers love it, they sit, talk and

eat for hours. Personally, I’ve never enjoyed myself more.’’

How can we be better? We really need to move forward on the

clinical, the CHCS II, our computerized patient record, a joint system that will be promulgated across all three Services over the

next 30 months. It offers structured notes, a longitudinal, queriable

patient record. It takes investment to keep that kind of a program

moving.

We get better because we look at ourselves critically, and we

want to know our faults, so we look and we listen and we will listen to the panel before us and track those down. But when we find

them, we fix them.

It is why we proactively have sent teams into the combat zone

to look at pneumonia, to look at leishmaniasis, to look at the status

of mental health. It is why we have aggressively used environmental surveillance teams to go into theater to sample soil and air

and water, asses risk, mitigate it where found, and importantly, archive that information at our Center for Health Promotion and Preventive Medicine so we can go back should questions arise in the

future and answer with more than just conjecture.

We are good, and we get better because of our great people, like

this officer who volunteered to come back and serve with the Reserve, who writes: I am with the 1967th Eye Surgery Team in

Baghdad. We are attached to the 31st Combat Support Hospital

here in the Green Zone. Although my role is rather minor, I am

delighted to be here. I find it interesting as an older fellow to observe the young soldiers in the theater. I feel so proud of them.

They have such a difficult job, but go about it in a very positive

fashion.

I saw a young Marine lieutenant a couple of days ago in the

emergency room who had a rather severe arm injury along with

some minor facial trauma. I doubt that he will ever serve again.

He had to have been in a great deal of pain, but his only question

was, ‘‘When do I go back to my Marines?’’ I think this attitude is

the norm here.

The 31st has an extremely impressive staff and I greatly enjoy

working with them. I think the service they provide is truly superb

in every respect. I would hypothesize that the emergency care provided here is as good or better than any trauma center in the

United States. If I were wounded, I would be very comfortable

being treated here.’’

We are good because of people like that, and because of our

young soldiers on the front line, soldiers like Specialist Billie

Grimes, a 26 year old female Reservist with a bachelors degree, a

Reserve medic who joined the active force to serve in Iraq and who

is the middle person on this Time Magazine cover.

I thank you, Mr. Chairman and this committee, for your support

of these men and women and the thousands more like them across

our military, and I look forward to answering your questions.

[The prepared statement of General Peake follows:]

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Mr. SCHROCK [assuming Chair]. Thank you, General Peake and

Admiral and General Taylor, Mr. Spruell, thank you all for being

here as well.

I can’t imagine the men and ladies who spoke earlier are the exception rather than the rule. I hope they’re the exception, but I

gather they may not be. How do we know that we are truly deploying fit people to the battlefield if we’re not doing physicals on

them? It seems to me there are a lot of people slipping through the

cracks that might have been screened and pulled out before they

went into battle. Is that the exception or is that the rule?

Dr. WINKENWERDER. Let me speak first on that. I think we know

because I believe that we have a process that does identify individuals’ health status before they deploy. I don’t think there is any

hesitation on the part of people managing that process or the individual medical providers who see the service member across the examining table to pull that person out if he or she has a deployment

limiting condition or doesn’t have the appropriate physical status

to ensure that they can safely deploy.

We have, as I said, about 3 percent to date through that first 30

days from the Reservist community, after they are called up and

mobilized, that we determine now are not medically fit. We don’t

have the precise similar comparative statistic for active duty, because it’s a more regular, ongoing care situation. However, I would

say that we don’t really have any indicators to suggest that we’re

not appropriately picking up and screening these individuals. I

think there’s a high level of confidence that people that are deploying are fit and healthy to deploy and those that are being held back

are being held back for the right reasons.

Let me also add, I think there is an important change that we’ve

initiated in the overall medical readiness approach within the military. And that is that the services are moving to begin, I think

with the Air Force and the Army and Navy are coming on with

that, to have an annual, an annual, once a year health assessment,

where the individual sits down and goes through a checklist and

gets assessed. That’s a change for us. We believe with that process

being implemented the need for a complete physical exam prior to

deployment just doesn’t make sense.

Mr. SCHROCK. Before we go further, General Taylor, I understand you have a flight at 1:30. So don’t hesitate, don’t miss the

plane. I’ve been on a plane and it’s murder getting out of airports.

Lieutenant General TAYLOR. Yes, sir, I think they’ll wait for me,

though.

Mr. SCHROCK. Oh, it’s an Air Force plane. Oh. [Laughter.]

I didn’t realize that. I thought it was a commercial plane. In that

case, we’ll expect you here the rest of the day, right? [Laughter.]

General Peake, did you have a comment?

Lieutenant General PEAKE. Yes, sir. Actually, if you think

through that previous panel, there was screening for all of them.

The gentleman who was on the far left, I believe his name, he came

out of the IRR, that’s a different issue. They’re not part of the

SELRES and so forth, and had, as he described, multiple sequential problems. The First Sergeant described having every 2 year

physical examinations, which sort of suggests that maybe that’s not

necessarily the appropriate standard.

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As a physician, I can tell you, the most important thing is a quality history. That’s what our process tries to get at, is getting a good

history that points then in the direction so we can do the appropriate interventions, whether they’re diagnostic interventions or

therapeutic interventions or laboratory tests or whatever. So what

we want to do is, we don’t want people in theater that are not

medically ready to be there. It just puts a logistical burden and a

burden on the unit to do that.

Mr. SCHROCK. Sergeant Mosley said that he had, I think he said

he had physicals every 2 years. You think it should be more than

that?

Lieutenant General PEAKE. No, sir, I don’t.

Mr. SCHROCK. I thought you just said that.

Lieutenant General PEAKE. I’m just saying, the point is, he did

have those physicals every 2 years.

Mr. SCHROCK. So there is a record.

Lieutenant General PEAKE. Yes, sir. And if you listen to Specialist Ramsey, he had his physical, I think he said in 2000. That’s

within the 5-year time. So we had that. And he did not have a

problem before he went over.

So they’re really kind of different pieces that we heard about

over here that didn’t necessarily say we weren’t doing an appropriate job totally of screening folks going in. I think there’s a lot

of attention being paid to that, sir.

Mr. SCHROCK. And don’t get me wrong, I think you’re doing a

good job, and I know you’re trying to put this many people through

this big a pipe at one time, and I know it’s very difficult to do that.

Lieutenant General PEAKE. If I could just followup, one of the

things that we stumbled on and frankly, it occurred in November

when we went down and looked at Fort Stewart, as we were

prompted to do. We had a policy that if somebody came on and

they were non-deployable, we kept them. Now with that 25 day

rule, it allows us to do a look, and so those 3 percent or 3.3 percent

or so are going back home, because they were non-deployable. And

now what we’re doing is following through with their units to make

sure that they don’t just go back into the black hole, but in fact

there is followup through their chain of command.

Mr. SCHROCK. I have several more questions, but I see my initial

time is up. I yield to Mr. Tierney.

Mr. TIERNEY. I was just curious if anybody on this panel can

solve for us the dilemma that some of the first panel testifiers had

in terms of getting their medical bills paid. What’s the process that

we have to deal with an issue where there are mounting medical

bills and their credit is being affected and yet they can’t seem to

get those issues resolved?

Dr. WINKENWERDER. Let me comment on that, Congressman. I

heard the individual story. I actually spoke with Specialist Ramsey

and his wife in between sessions. I for the life of me could not understand why there was so much difficulty to do what was obviously the right thing. And so it was disturbing to me to hear his

comments.

What he had indicated in that conversation was that it seemed

to be some debate about who should pay the bill. It’s totally inappropriate. This is an issue where if the injuries take place, they

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take place as a result of active duty or while on active duty, no

questions should be asked.

Mr. TIERNEY. So we have a process that currently exists that

should have resolved this, is what you’re saying?

Dr. WINKENWERDER. Should have, but obviously didn’t.

Mr. TIERNEY. Without putting too much of a burden on you, are

you now going to take personal responsibility for Mr. Ramsey’s situation or designate it to somebody who might help him out?

Dr. WINKENWERDER. I think someone will be looking, I will ensure that someone looks into it and resolves it. I couldn’t understand from what was described to me, if the facts were as he presented them, why the bills still wouldn’t have been paid.

Mr. TIERNEY. What normally would happen? He would submit

the bills or the provider would submit the bills to the military and

they would just get paid?

Dr. WINKENWERDER. In this case, it sounded like there may have

been some discussion or debate as to whether it was the Guard

unit or whether it was the active unit that was going to pay for

it. That was the description. Who knows if that was the case or

not.

But if that was true, that’s not appropriate.

Mr. TIERNEY. There’s got to be a way to stop that from happening over and over.

Dr. WINKENWERDER. No question should be asked about that.

Mr. TIERNEY. Thank you.

Lieutenant General PEAKE. I’d just like to comment on that, in

fact, it is legitimate to ask a question, because if it is, and I’m not,

in fact, on March 23rd there were PGBA, which is our bill payor,

was, bills were forwarded to pay for Specialist Ramsey $7,600 for

the left shoulder, $6,300 for the right shoulder. So that is in the

process as of the 23rd. But the point is, it’s appropriate to ask the

question, sir.

Mr. TIERNEY. I don’t have any problem with the question being

asked, sir, it’s resolving it in quick enough time that their financial

situation doesn’t become critical.

Lieutenant General PEAKE. I agree with you.

Mr. TIERNEY. We all expect it to get paid out of the proper account, but hopefully we have a process where that moves expeditiously, so that the individual soldier doesn’t end up having his

family and himself have that kind of additional burden, that’s all.

Lieutenant General PEAKE. Sir, I couldn’t agree with you more.

Mr. TIERNEY. Is there anybody on this panel that can address for

me what we do in terms of oversight on medical prescriptions?

What is the process for making sure that our providers within the

Service are in fact issuing the right amounts of medication and

who oversees that, what kinds of reviews are done to assure that

they’re not being overmedicated or given the wrong medications?

Dr. WINKENWERDER. Let me turn to General Peake, General Taylor and Admiral Brannman on that.

Lieutenant General PEAKE. Sir, we have a very good system of

quality assurance within the military. I do appreciate the sense

that some people feel like that are, it may have an appearance of

overmedication. One of the issues about mental health in this country is, many of the people that suffer from depression don’t get the

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medicines that they need, they don’t get medicated for it. So you

know, what we have are credentialed, qualified providers that are

taking care of folks and prescribing the appropriate medications.

Sometimes you’re on a regime of medicines that may seem like a

lot, but we’re trying to work out the appropriate combination.

Mr. TIERNEY. I don’t mean to interrupt you, but this isn’t unique

to the military, so I don’t ask this in terms of saying like, oh, gee,

the military is making mistakes that regular hospitals don’t. But

I do think it’s an issue that happens in almost all medical settings,

and I see complaints from medical professionals, from the doctors,

from nurses and from patients that there probably in all medical

settings might not be enough of a holistic approach, someone

watching what the total prescriptive scenario is.

Lieutenant General PEAKE. Right, sir, and we have actually a

program, PDTS, which has actually won some awards that allows

us to look across and find out what all the medications, even if they

are coming from disparate providers. So in some ways, we’re a step

ahead of some other organizations that can do that.

But it is an issue that, the other thing we’re trying to do with

TRICARE actually is to get a primary care provider for folks to

allow those kinds of disparate things to come together and say,

well, are we doing the right thing from a more holistic picture. And

it’s one of the advantages of having a primary care provider.

Mr. TIERNEY. I suspect we might have another hearing or two,

as the chairman indicated, about that process, and perhaps even

the program that you’re talking about, to see how it’s working and

whether we can be helpful in it having it work a little more effectively or take individual scenarios. Some of it we heard. When the

Sergeant lifted up the bag of pills, even as a lay person, I thought

that was a little over the top. But I’ve seen that in other settings,

not just military settings.

Dr. WINKENWERDER. Yes, sir.

Mr. TIERNEY. So I think we probably need to have hearings, it

probably can’t be resolved here today, but we’ll have to followup on

that and see what’s going on there.

I yield back my time. Thank you.

Mr. SCHROCK. Thank you, Mr. Tierney. Chairman Shays.

Mr. SHAYS. Dr. Winkenwerder, I believe that there has been

progress that’s been made and I also believe that obviously you

can’t be held accountable for the failure to have equal treatment

as it relates to pay and training and equipment and protective

gear. Tell me your biggest challenge, though, as it relates to health

care being provided on an equal basis for our Reserve components.

What are your biggest challenges?

Dr. WINKENWERDER. Thank you, that’s a great question, Congressman. From my perspective, we need to do and are working

very hard to do the following. To make it easy for Reservists and

Guardsmen and their families to get onto the TRICARE benefit.

That’s sort of No. 1.

Second, we want to make it easy and understandable for them

to continue their benefit for the period after active service while

they are still eligible. And then——

Mr. SHAYS. Define while they are still eligible. What does that

mean?

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Dr. WINKENWERDER. Well, under the temporary provisions that

the Congress passed last fall, there’s a continuation of benefits that

goes for 6 months. And those activated Reservists and Guardsmen

continue to be eligible for TRICARE for 6 months after their active

duty period. And that should help ensure that there’s coverage for

needed medical care, that along with the fact that they’re eligible

for VA as well.

So that’s two things. And the third I think is ensuring the movement, appropriate movement of accurate medical information

throughout the system. So we’re working real hard, and part of the

charge that I gave to the task force that I described is to develop,

and it’s already been developed by the Army, a data base that captures the pre-deployment health information that’s in-theater and

the post-deployment information all in a data base, so that, and

then to be able to transfer that data to the Reserve or Guard unit

or to the VA hospital.

Mr. SHAYS. What is the deadline of the task force?

Dr. WINKENWERDER. I am looking for their report, for their initial report here within the next couple of weeks. They’ve been at

it for about 4 weeks. We’re both looking at the process for followup

care and ensuring that people understand their benefits and can

get the care that they need, as well as the medical informatics

piece of this. So both pieces are important.

Mr. SHAYS. What’s challenging for someone who’s a Reservist or

a National Guard is that they may be living at a higher level of

pay than they’re going to receive once they’ve been activated. Their

mortgage may be higher than their actual pay, and, and, and.

That’s the reality that we don’t really have a good resolution of.

But the one area that it seems to me is like a no-brainer, I was

looking at Ed Schrock and thinking, he served in the military and

the frustration I think he felt, I feel it differently, not having

served in the military but knowing that I sent them overseas. I’m

not clear why someone has to come to a Member of Congress or go

to the media before somebody, and I don’t want to say some idiot,

because it strikes me that you would have to feel extraordinarily

frustrated that they would allow it to get to that point.

Is there no one in the system that can kind of break through the

bureaucracy? Are people not empowered to see something happening that needs to be dealt with? That’s the question I’d like answered.

Dr. WINKENWERDER. You’re correct in identifying my frustration

with eliminating, totally eliminating the individual cases of this

sort that we heard about this morning. I believe we’re making

great progress, I really do. And we have given it very high attention. I receive a report weekly, generated by each of the three Services, that identifies every single individual going through this medical hold over and medical extension process. That was not in place

earlier.

I think it’s fair to say there was not the focus or attention that

there needed to be if one looks back 12 months ago. I think the way

I would describe this is that the system that was in place basically

was something that, if it had problems, they were not blatantly obvious because 15,000 or 20,000 or 25,000 Guardsmen and Reservists were about all that were being called up in the past years.

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We are obviously in a very different situation today. So the system was stressed, we had to identify new and better ways to take

care of people. One could argue that those should have been in

place all along. But make no mistake about it, we understand, we

appreciate that there are truly some issues that need to be addressed, and we’re aggressively addressing them.

Mr. SHAYS. Let me say, I made an assumption, falsely, General

Peake, that if you wanted to elaborate you would join in on this

dialog. So I apologize for not making that clear. Is there any question that I have asked that you want to comment on?

Lieutenant General PEAKE. I would just, I think I would just

echo the Secretary, we take this very seriously. There’s not a single

one of us that wanted to sit back and hear the kind of specific

issues that we heard from the first panel. But I don’t, I would not

suggest that I believe those represent really the majority. They are

issues that we need to address. Some of them were administrative,

some of them were medical. And we clearly have our, there’s an

overlap in those, and we will work those issues that we heard here.

But I think we are making the right strides forward to take care

of our soldiers, to recognize that they are an important part, an absolutely essential part of the total force. There is this notion that

sometimes there’s a perception that we treat a Reservist differently. In fact, Reservists have sometimes different circumstances

that require to take care of them properly we need to treat them

differently. In fact, our standards of access, we have increased

them so that we don’t keep people at a medical hold site at a longer

time.

Mr. SHAYS. Well, for me the bottom line is the Reservists and

National Guard sometimes don’t have, I don’t want to say hand me

down equipment, but I kind of had the sense like, I was the younger brother, I had three older brothers, I got their clothes. And I

think they do get that. It didn’t matter as much when we weren’t

calling as many because they could get new equipment. It matters

a lot more now that they’re an integral part of whatever we do

when we go into battle now. I mean, in other words, there are slots

that can’t be filled by anybody by the Reservists and National

Guard.

Let me just ask to hear from both the Navy and the Air Force,

I’m gathering, General Peake, that we asked you to testify because

we’re seeing more of the Reserve and National Guard in the military, the Army is so much larger. But maybe we should hear from

the Navy and Air Force about their challenge. Why don’t we start

with the Navy, only because my brother was in the Navy, sir.

Admiral BRANNMAN. I think all of us, throughout our service careers, strive to assure there’s a total force, or one force. You can’t

tell us apart. In the deployments I’ve been on, particularly most recently, several years ago I was in a joint forces command, we’re all

wearing camis, you can’t tell other than looking at the name tape

whether it’s a sailor, airman, marine, soldier, active or reserve. I

think that’s a situation you’re going to find on the front lines today

in the Persian Gulf, in Iraq or in Afghanistan.

And that’s truly the way we endeavor to treat our folks when

they’re on board in our treatment facilities. This is a family business. That’s the way—I grew up in a Navy family, but that’s, we’re

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taking care of our neighbors, we’re taking care of the people we

work with day to day. So there is a commitment to those people

that we serve to take care of them the right way. We hold ourselves to the same standards that are being held in your own community. We use the same accreditation organizations and we beat

their standards if you look at our scores on various things.

The issues that were described here are not the things that you

want to have happen in my hospitals or anybody’s facilities. You

search those things out and you try and find out why they’re occurring and take care of them. But this is a new ball game we’re in

right now in terms of the large number of folks we’ve got, and with

the Reserves being mobilized and integrating them into the system,

I think there have been some growing pains, but I think there’s a

strong commitment amongst all of us to make sure these things are

identified, you shine the light of day on them, get them fixed and

get on with it.

Mr. SHAYS. I have a red light, and the chairman will probably

want to move on, but let me just hear from you, General Taylor,

if that’s all right, Mr. Chairman.

Lieutenant General TAYLOR. Yes, sir. The Air Force has a long

experience in dealing with total force from the Persian Gulf war

forward. A large portion of our mobility forces, most of our air medical evacuation comes out of the Guard and Reserves. And over the

past 15 years, it’s very common to see units that look blended. In

fact, we’re sending out blended units today with Guard and Reserve.

So we’re very used to folks coming on active duty and then off

active duty, primarily through volunteer status. But we’ve also activated folks. So we’re pretty used to folks coming on and off. And

we knew fairly early that we had to run as smooth a system as

possible.

So based on that experience, the Assistant Secretary of the Air

Force for Manpower and Reserves set up a very fixed process of ensuring that we timely took care of people that were on hold, placed

on medical hold, either coming in or going out. He personally approves every single extension on hold. So we’ve had a very strong

process even from very early in the entire——

Mr. SHAYS. And you can do that because your numbers are

smaller or because you haven’t encountered the same kind of challenges?

Lieutenant General TAYLOR. I think because we smooth flow the

call-up, the call-up is more smooth flowed over time. Because we

do 90 day rotations or 180 day rotations and we haven’t had to do

very long periods of time. We also haven’t had the volume, very

clearly, that the Army has called for, so we’re able to handle this.

Finally, our greatest worry has been, the Congress has set up a

very wonderful benefit, medical benefit for folks when they’re activated through the TRICARE system and the military health care

system. Our greatest nightmare has been that the families

wouldn’t understand what this benefit was. So we’ve worked very

hard, the Guard and Reserves have worked very hard to ensure

that locally, benefits advisors were in place to make sure the families knew what these benefits were and how to take care of them

if issues arose.

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Mr. SHAYS. Thank you. Thank you, Mr. Chairman. Thank you,

Mr. Ruppersberger.

Mr. SCHROCK. Thank you, Mr. Chairman.

Before I recognize Mr. Ruppersberger, let me make a comment

that the Admiral made. He said we’re in a whole new ball game,

and we are. But I think we knew what the ball game was going

to look like, and I just can’t imagine why some of these things

couldn’t have been foreseen. That’s something I still haven’t

worked out in my mind. When I heard Mr. Emde say that he started out in Fort Eustis in Virginia, which is Army, and got transferred to Langley, which is Air Force, then across the bay to Portsmouth Naval, which is Navy, Navy couldn’t do something or other

because the paperwork wasn’t filled out correctly.

And I don’t blame Navy for that at all, and you were talking to

me earlier about this, Admiral. There is some system going into

place where everybody’s kind of talking about the level playing

field, the same sheet of music. How quick is that going to be put

in place?

Admiral BRANNMAN. I think as we speak, right now. The difficulty between Walter Reed and Portsmouth is that they’re not in

the same region right now. But within the Portsmouth, Fort Eustis,

Langley Air Force Base area, they basically try to function as one

organization, as one health care system across the board. We are,

as each day passes, basically expanding that network. We are

pushing, as technology will allow us, we are pushing that network

out.

The most recent change now is going from a large number of regions down to three, which were all the east coast, all the southeast, all the western areas, and interlocking our systems. Basically,

if you’re getting health care on one side of the system, you’re getting it all the way across.

Mr. SCHROCK. Well, that’s interesting, because I represent that

area. And until I heard Mr. Emde, I thought everything was moving smoothly, but I guess every once in a while, one falls through.

And I understand that. But as you say, they are working together

very well.

Mr. Ruppersberger.

Mr. RUPPERSBERGER. In order to really resolve the problem, and

you’re saying that there is a plan, the plan is starting to work, we

really need to get to the root, I think, of the medical care problem.

I’m wondering whether or not we need to do more as it relates to

the medical care problem when the Reserves members are working

in the private sector, before they’re being activated, and whether

we need a better system. Because if we have people that are coming on the weekends, once a month or whatever, and they’re not

ready and they’re called up right away, then that not only hurts

them, it hurts our country, it hurts anybody in Afghanistan, Iraq

or wherever we are.

What can we do? I should ask each individual, but I’m wondering

whether or not there’s a better way to give and to provide the medical insurances necessary, so when, and it looks like we’re going to

be at war with terrorism for a long time, this isn’t going to stop,

do you think we can really take the individuals that are working

for small companies and roll them into a plan?

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Now, of course, there’s a cost issue whenever you talk about that.

So could you comment, I guess the whole panel comment on that

issue, and maybe that’s where we need to start before we even activate them to the next level.

Dr. WINKENWERDER. Yes, Congressman, let me talk about that.

We currently, under the provisions that were just passed last fall

by the Congress, there is now authorization for the Reserve units

to perform screening, medical and dental exams and followup care

that to my understanding did not exist before. So I think that’s a

very important new change, it is a permanent change.

Mr. RUPPERSBERGER. Explain that, though. That means that the

Reserve will provide for the medical care and the physicals and——

Dr. WINKENWERDER. Screening.

Mr. RUPPERSBERGER. Screening.

Dr. WINKENWERDER. That’s correct.

Mr. RUPPERSBERGER. We have a large amount of Reserve and

National Guard throughout the country. Has it been implemented

yet?

Dr. WINKENWERDER. It’s being implemented as we speak.

Mr. RUPPERSBERGER. Every Reserve and National Guard unit in

the country?

Dr. WINKENWERDER. Well, I spoke about 3 weeks ago with General Helmly, and all the Reserve component chiefs, and they indicated to me that they were implementing this new provision. So I

think that’s a key step forward.

The second is what we’ve talked about. I don’t know if you were

here earlier when we spoke about this whole new metric called individual medical readiness. It’s a new system that we put into

place for active and Reserve and Guard that identifies all the

things that an individual needs to do to be medically ready and

identifies the interval of time that those types of things need to be

done on a regular basis, so that what’s important is that we have

a clear set of expectations, not just for our medical leaders, but for

our Reserve component and active component line commanders, so

that they know what they are accountable to do, to have all their

troops, sailors, soldiers and so forth ready.

This is a system that’s being implemented. It was actually developed by all three Services together. Air Force had a little bit of a

lead time on it and had been working on something similar to this

for the past couple of years, so they’re a little further ahead than

Army and Navy. But it is being implemented, we are looking at the

performance on a monthly basis. So I think that’s another very key

component. The question you raised is whether health insurance,

does that factor in here.

Mr. RUPPERSBERGER. Before that, let me ask you this question.

Is health insurance available to any member of the Reserve and

National Guard?

Dr. WINKENWERDER. If they are not on active duty or have not

been called up, they would obtain health insurance through their

employer.

Mr. RUPPERSBERGER. You didn’t answer my question. Is it available to any member of the National Guard or to the Army Reserve?

Dr. WINKENWERDER. Let me have Mr. Spruell answer.

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Mr. SPRUELL. I would just point out, Congressman, that about 80

percent of the Guard and Reserve members today have civilian employer health insurance. Of the other 20 percent, they’re mostly

young and single and they make a conscious decision, to a great

extent, not to elect health insurance. They would probably do the

same thing if the military would offer them coverage, for which

they would have to pay.

Mr. RUPPERSBERGER. But still, is there any insurance available

to Army Reserve and National Guard? That’s the question.

Mr. SPRUELL. Through their civilian employers, yes, sir.

Mr. RUPPERSBERGER. Not civilian. I mean, does the DOD provide

for those individuals that do not have medical insurance through

their employer or might want to choose? There’s no plan now that

exists for that?

Dr. WINKENWERDER. The current benefit covers those who are activated. Those who are activated.

Mr. RUPPERSBERGER. I know that. So what we’re really saying

then is, we don’t have a plan, even though we have a large group

of people, we don’t have a medical insurance plan for anyone who

decides to join the Reserve or National Guard, until they are activated? Is that the case?

Dr. WINKENWERDER. With some exceptions.

Mr. RUPPERSBERGER. I’m not trying to trick you.

Dr. WINKENWERDER. I understand you’re not, and I’m trying to

be as clear as I can. Currently, with the temporary provision that

the Congress passed last fall, there was a provision that would

have us implement a buy-in into TRICARE where the Reserve

member and family could buy in, if he or she was unemployed and

did not have access to employer based insurance. That’s a temporary provision that goes away at the end of this year.

Mr. RUPPERSBERGER. It seems to me, I talked in the beginning

about the root cause of the problem. When you have a large group

of people and now that we have asked more of our National Guard

and our Reserve, it would be in the best interest of our country,

I think, of our military, of our men and women on the front lines

to at least evaluate whether or not as a group we should provide

something there.

Now, again, cost is an issue, we have to look at it. But in the

end, if we have people that are not healthy on the front lines, that’s

not helping anybody, including our country, the men and women

that are with those individuals.

Dr. WINKENWERDER. Let me answer one part of that. We do want

to evaluate that. And we are suggesting a demonstration project to

look at that issue, because this is, if it were to be done in such a

major move, costing quite a lot of money and the question is, would

it have any impact on either readiness, retention or recruitment.

We believe it is something that ought to be studied.

Mr. RUPPERSBERGER. Because, you mentioned another issue

that’s very important, because of some of the issues that have occurred, and the problems that have occurred. It seems to me we

need incentives for recruitment and that would be a strong incentive.

But more so when you mentioned the individual who was young

and might not think they need insurance because they want to use

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that money for something else, those people, those individuals

might not be ready for when we need them. So I think it’s something we really have to look at and raise the issue. Mr. Spruell.

Mr. SPRUELL. I was just going to point out, sir, that we do offer

the TRICARE dental program, which is the same one that active

family members have, for selected Reserve members and their families. About 30,000 out of 870,000 selected Reservists have opted to

take that.

Mr. RUPPERSBERGER. You say selected.

Mr. SPRUELL. The selected Reserve consists of the units and individuals with the highest priority, highest readiness folks.

Mr. RUPPERSBERGER. OK.

Admiral BRANNMAN. If I could make a comment, part of that, the

argument is going to discuss about insurance, we’re trailing the

duck here. Where our focus really is going in DOD today is to get

these guys healthy and keep them healthy. We have initiated with

our active force and into our Reserve forces our preventive health

assessment system, where in addition to the physicals, we’re testing you on a semi-annual basis to ensure that you’re fit.

And part of that, as part of that fitness process, is to sit down

with you, have you do a health assessment which we track and it

has a list of indicators on there that if you answer yes to any of

these issues on here, then you have to have a followup medical examination to pick up problems early. We’re going toward a prevention and a health based system just so we head these things off——

Mr. RUPPERSBERGER. As you should. That’s the way it’s done.

Admiral BRANNMAN. And that’s the system that we really are

banking on for the future, is force health protections starts before

the war starts. You start with the soldier, the sailor, the airman,

the marine when you recruit them. They’re part of the team and

you take care of their health from day one, so that we don’t end

up with a first sergeant ready to mobilize who’s got a bag full of

prescription drugs. You knew that individual was developing stuff

when he was a private, and you’re keeping track of him, keeping

him in a healthy lifestyle. That’s the direction we’re moving for

today.

Mr. RUPPERSBERGER. I agree with what you said, and that’s the

way we want it to work. Implementation is another matter. But the

bottom line, you need to set up a system. It seems to me that if

we’re going to be relying on our National Guard and Reserve, and

also recruitment and retention, too, we need to deal with the issue

of benefits, but we need a system that works. If you have individuals and Reserve National Guard that are not ready from a medical perspective, as the career, and you put them all on the front

line together, then you’re going to have an issue that could be a

deterrent to our country, to our men and women in the military.

What I’m doing is just raising the issue. I think we have to look

at the whole system, especially whether or not we need to provide

that incentive, so that we make sure everybody who’s a member is

going to be taken care of, there’s a system of prevention, there’s a

system of examinations and then you prevent it before you get to

the level where it gets worse or before you’re activated and you’re

over in Iraq or Afghanistan and all of a sudden you have this seVerDate 11-MAY-2000 11:57 Sep 13, 2004 Jkt 000000 PO 00000 Frm 00188 Fmt 6633 Sfmt 6633 D:\DOCS\95289.TXT HGOVREF1 PsN: HGOVREF1
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vere medical problem that’s taking the space of somebody that

might have gotten shot.

So I’m raising that issue, I would hope you would take it back

and we can follow through on whether or not we should provide.

But of course, cost is an issue. But that cost factor could be brought

down if you put the right system in place, medical system. Thank

you.

Mr. SCHROCK. Thank you. Is there anything that you gentlemen

would like to add for the record?

Dr. WINKENWERDER. Just to say that we’re absolutely committed

to a world class health system for all of our forces, active and Reserve. You’ve identified, and this panel that preceded us identified

some issues. We’re committed to addressing those issues, to solving

problems and to continual improvement. I’ve got great confidence

that the Army, Navy and Air Force are focused to solve the problems that have been identified.

Mr. SCHROCK. Great. I appreciate that. I appreciate this panel,

and I appreciate the last panel. I think we need to remember, we

recruit soldiers and we re-enlist families. If we don’t keep mom and

the kids happy, dad’s not going to hang around very long. I think

the one thing we need to more of, I guess, is that we heard some

stories today, hopefully they are unique. If they’re not, then we

need to get our hands around it.

I think the one thing that I’m troubled about is the medical

issue, is the financial difficulties we’ve caused folks. The Ramseys

brought up an example. My guess is they had perfect credit ratings

until this happened and now their credit has been damaged, maybe

forever. When I was in the Navy I ran into this, somebody had a

Social Security Number very close to mine, and it caused me incredible grief for 2 or 3 years, and cost lots of money to get it fixed.

We created this problem for the Ramseys, and I include myself

in that, and we need to fix it. I want their banking institution to

know that we did that, and get them back on even keel. Because

I’ll tell you, the Ramseys, if you try to get a loan or refinance your

house, you’re going to buck up against this for years and years to

come, and we owe it to you and the others we’ve created this problem for to fix that, and I hope we’ll do that. That’s the one thing

I want to leave you with. I don’t want to hear any more stories

about people being damaged financially.

And it wasn’t done intentionally, I understand that. But the fact

is, it was, and we need to get that fixed.

Again, I thank the first panel, I thank you gentlemen for coming

here, and this hearing is adjourned.

[Whereupon, at 1:05 p.m., the subcommittee was adjourned, to

reconvene at the call of the Chair.]

[Additional information submitted for the hearing record follows:]

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