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32-723 PDF 2007

S. HRG. 110–1

DOD/VA COLLABORATION AND COOPERATION

TO MEET THE NEEDS OF RETURNING

SERVICEMEMBERS

HEARING

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

JANUARY 23, 2007

Printed for the use of the Committee on Veterans’ Affairs

(

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

(II)

COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BARACK OBAMA, Illinois 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

LARRY E. CRAIG, Idaho, Ranking Member 

ARLEN SPECTER, Pennsylvania 

RICHARD M. BURR, North Carolina 

JOHNNY ISAKSON, Georgia 

LINDSEY O. GRAHAM, South Carolina 

KAY BAILEY HUTCHISON, Texas 

JOHN ENSIGN, Nevada 

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III)

C O N T E N T S 

JANUARY 23, 2007

SENATORS 

Page 

Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1

Prepared statement .......................................................................................... 2

Craig, Hon. Larry E., Ranking Member, U.S. Senator from Idaho ..................... 3

Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia ........................ 4

Prepared statement .......................................................................................... 4

Murray, Hon. Patty, U.S. Senator from Washington ........................................... 5

Brown, Hon. Sherrod, U.S. Senator from Ohio ..................................................... 7

Sanders, Hon. Bernard, U.S. Senator from Vermont ........................................... 8

Webb, Hon. Jim , U.S. Senator from Virginia ....................................................... 52

Obama, Hon. Barack, U.S. Senator from Illinois .................................................. 56

Prepared statement .......................................................................................... 56

WITNESSES 

Mansfield, Hon. Gordon H., Deputy Secretary, Department of Veterans

Affairs .................................................................................................................... 9

Prepared statement .......................................................................................... 12

Response to written questions submitted by: 

Hon. Daniel Akaka .................................................................................... 18

Hon. John D. Rockefeller IV ..................................................................... 24

Hon. Barack Obama .................................................................................. 28

Chu, Hon. David S.C., Under Secretary of Defense for Personnel and Readiness, Department of Defense ............................................................................... 30

Prepared statement .......................................................................................... 32

Response to written questions submitted by: 

Hon. Daniel Akaka .................................................................................... 39

Hon. John D. Rockefeller IV ..................................................................... 44

Hon. Barack Obama .................................................................................. 45

Hon. Larry E. Craig .................................................................................. 47

Hon. Arlen Specter .................................................................................... 49

Hon. Lindsey O. Graham .......................................................................... 50

(1)

DOD/VA COLLABORATION AND COOPERATION 

TO MEET THE NEEDS OF RETURNING

SERVICEMEMBERS 

TUESDAY, JANUARY 23, 2007

U.S. SENATE, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 9:36 a.m., in room 

SR–418, Russell Senate Office Building, Hon. Daniel K. Akaka, 

Chairman of the Committee, presiding. 

Present: Senators Akaka, Rockefeller, Murray, Obama, Brown, 

Webb, Tester, Sanders, and Craig. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, 

U.S. SENATOR FROM HAWAII 

Chairman AKAKA. The hearing of the Committee will come to 

order. I want to welcome the Members who are here for this, our 

first hearing, and also our witnesses, and I look forward to the responses that will be forthcoming. 

I want you to know that this is the Committee’s first hearing for 

the 110th Congress, and I look forward to working with our new 

and returning Members for this to be a productive session. I also 

want to say I am delighted to continue to work with Senator Craig. 

We have had such a good relationship, and we will continue to 

work in a bipartisan manner, as we have, and I look forward to 

working with him and with Members of this Committee. 

Today’s hearing will focus on cooperation and collaboration between the Departments of Veterans Affairs and Defense. There has 

been strong congressional interest dating back to the 1980s on improving how the two Departments work together on improving the 

transition process. We hope to hear today on where the two Departments are and where they need to be. 

I want to thank Secretary Mansfield from VA and Secretary Chu 

from DOD for joining us today. Today’s hearing will establish a 

benchmark for future hearings and will focus on specific health and 

benefits issues that relate to the two Departments. Where opportunities exist for sharing resources that benefit servicemembers and 

veterans, they must be seized. With tens of thousands of 

servicemembers in harm’s way, it is more important than ever that 

the Departments work together. 

The Departments must facilitate the seamless transition of 

servicemembers from active duty to veteran status. Prior to separation, servicemembers must know exactly how they can obtain the 

2

benefits and services available to them. This must be true whether 

someone is separating from active duty, the Guard, or Reserves. It 

is especially vital for those who are wounded or severely injured. 

I can only imagine the stress that a new veteran with a life-altering wound or injury endures when faced with transitioning from 

one health care system to another while still in the process of recovery and rehabilitation. The handoff between the Departments 

for those who are in the greatest need must be truly seamless. 

According to the Office of Management and Budget, there has 

been slippage since 2002 in the progress of implementing coordination of VA and DOD programs and systems. This is deeply concerning. It appears to me that much of this slippage has resulted 

from a failure to identify who is responsible for implementing recommended actions to improve cooperation and collaboration between the Departments. This perception is consistent with the 

2003 report of the President’s Task Force to Improve Health Care 

Delivery for Our Nation’s Veterans and by numerous GAO reports. 

VA and DOD must take advantage of local successes by implementing lessons learned on a national level. 

Let me be clear. There have been successes, and I congratulate 

the Departments on those areas where progress has been made. I 

hope that our witnesses today will help us understand what areas 

still require work. If there are particular areas where this Committee or Congress can be of help, I ask that you let us know. 

I have a longer statement that I will place in the record, and 

that is available at the press table. In the interest of time and to 

allow others to speak, I will end my remarks at this time. 

[The prepared statement of Senator Akaka follows:]

PREPARED STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,

U.S. SENATOR FROM HAWAII

Good morning and welcome to the Committee’s first hearing for the 110th Congress. As I said at our organizational meeting, I look forward to working with our 

new and returning Members, and for this to be a productive session for our Committee. 

Today’s hearing will focus on the current level of cooperation and collaboration between the Department of Veterans Affairs and the Department of Defense. There 

has been strong Congressional interest, dating back to the 1980s, on improving how 

the two Departments work together and improving the transition process. We hope 

to hear from our witnesses today, where the two Departments are and where they 

need to be. 

I thank Secretary Mansfield from VA and Secretary Chu from DOD for joining 

us today to testify on this important subject. It is my hope that their testimony will 

establish a benchmark for future hearings that will focus on specific health and benefits issues that relate to the two Departments. 

It only makes sense that, where opportunities exist for sharing resources that 

benefit servicemembers and veterans, we take advantage of these opportunities. As 

a senior member of the Armed Services Committee, I have looked at the issue of 

seamless transition from the vantage point of the military, and now, as Chairman 

of this Committee, I will look at it from the VA perspective. Today, with thousands 

of servicemembers in harm’s way, it is more important than ever that the Departments work together. 

The issue of the Departments working together goes beyond the sharing of resources. It must also include efforts to facilitate the seamless transition of 

servicemembers from active duty to veterans status. There is no reason why 

servicemembers, prior to separation, do not know exactly what VA can do for them 

and how they can obtain the benefits and services available to them. Given the current worldwide involvement of the total force, I believe strongly that the message 

needs to be consistent and universally understood by all, regardless of whether they 

are separating from active duty, the Guard or Reserves. This is especially true for 

3

those who are wounded or severely injured. I can only imagine the stress that a new 

veteran with a life altering wound or injury endures when faced with the challenge 

of transitioning from one health care system to another while still in the process 

of recovery and rehabilitation. I am sure it would be a daunting task under the best 

of circumstances. We need to ensure that the hand-off between the Departments for 

those who are in the greatest need is truly seamless. This is an area where we cannot improve enough. 

According to the Office of Management and Budget, there has been slippage since 

2002 in the progress of implementing coordination of VA and DOD Programs and 

Systems. This is deeply concerning. It appears to me that much of this slippage has 

resulted from a failure to identify who is responsible for implementing recommended 

actions that could result in improved levels of cooperation and collaboration between 

the Departments. This perception is consistent with the 2003 report of the President’s Task Force to Improve Health Care Delivery for our Nation’s Veterans and 

by numerous GAO reports. In my view, the two Departments are not making 

enough progress on a national level. I believe that VA and DOD can take better advantage of local successes, by implementing them on a national level. 

Let me be clear—there have been successes and I congratulate the Departments 

on those areas where progress has been made, including the degree to which the 

Departments share information, cooperate on transition issues, and deliver benefits 

and services. 

I hope that our witnesses today will help us understand what areas that still require work, and provide us with their respective Departments’ strategic plans on 

how they intend to improve the level of coordination and collaboration between the 

Departments and ensure that servicemembers truly have a seamless transition to 

VA. If there are particular areas where this Committee or the Congress can be of 

help, I ask that they let us know.

Chairman AKAKA. I would like to ask our Ranking Member, Senator Craig, for his remarks. 

Senator Craig? 

STATEMENT OF HON. LARRY E. CRAIG, RANKING MEMBER,

U.S. SENATOR FROM IDAHO 

Senator CRAIG. Well, Mr. Chairman, thank you very much, and 

also let me apologize for being late. That will not happen again. I 

always appreciate, as I know you do, getting these hearings started 

on time. 

Let me also thank you for your lead-off on this very important 

issue. It is clearly something that we and the Nation must focus 

on to make sure that those who have served and are transitioning 

out receive the benefits and the kind of continued treatment needs 

that are important. 

As you know, 2 years ago we held a series of hearings on this 

issue. The survivors’ transition hearings revealed confusion among 

survivors about the array of Federal benefits and services available 

to them and inconsistent service provided by military casualty officers. 

I am particularly interested in this issue, and I look forward to 

the hearing on the update today from DOD on the implementation 

of a uniform policy of casualty assistance that all of its service 

branches are using and whether the customized, integrated Web 

site on Federal survivor benefits is eliminating survivor confusion. 

Next in the series, the Committee examined the health care transition process of seriously combat-wounded servicemembers. Many 

of these veterans were caught in the long-term limbo awaiting discharge from the military. We learned about the specific treatment 

challenges, such as early intervention for mental health care and 

outreach to those in need of family therapy services. I remain 

somewhat concerned that DOD’s efforts to take care of its own are 

4

making the coordination of care and benefits between DOD and VA 

more difficult. 

Third, we held hearings on what steps VA, DOD, and the Department of Labor were taking to ease the transition process by 

providing veterans benefits such as disability compensation, vocational rehabilitation, and employment placement and training services. I hope to hear today that our returning servicemembers are 

being made aware of these benefits, that there is adequate followup to ensure a successful transition, and that seriously wounded 

combat servicemembers are being afforded some priority of service. 

And, finally, we held a field hearing following the return from 

Iraq of 1,700 of my fellow Idahoans with the Army National Guard 

116th Cavalry Brigade. These Guardsmen and reservists did not 

return to an Army base in Georgia or an Air Force base in Mountain Home, Idaho. Instead, as we all know, the Guard and Reserve 

units returned to their homes, and to civilian lives, in some respect, 

and to their regular job. I hope to hear today the update on how 

well we are doing in that regard in relation to the transition and 

where VA can step in at that point once they are out of active service and make available re-employment rights or assuring that those 

kinds of things continue to happen, as we will probably continue 

to need to use Guard and Reserve for the near future. 

‘‘Seamless transition,’’ in my opinion, is a very broad term that 

encompasses efforts by a number of different agencies and programs, and even includes making immediately accessible the medical records of the servicemember who is transferred from military 

treatment facilities to veterans’ medical centers. We are all proud 

of how the VA handles its medical records now. We need to make 

sure that there is a completion of process, that there are not shortcomings there as these two agencies work to make that happen. 

So I am pleased that you led with this issue, Mr. Chairman. I 

think it is tremendously important to our servicemen and women 

as they transition into civilian life or as they move from one care 

for their injuries to another care. 

Thank you very much. 

Chairman AKAKA. Thank you very much, Senator Craig. 

I would like to ask Jay Rockefeller for his statement. 

STATEMENT OF HON. JOHN D. ROCKEFELLER IV,

U.S. SENATOR FROM WEST VIRGINIA 

Senator ROCKEFELLER. Mr. Chairman, if I have your permission, 

I will put my statement into the record. 

Chairman AKAKA. Thank you very much, Senator Rockefeller. 

[The prepared statement of Senator Rockefeller follows:]

PREPARED STATEMENT OF HON. JOHN D. ROCKEFELLER IV,

U.S. SENATOR FROM WEST VIRGINIA

Chairman Akaka and Ranking Member Craig, I want to thank you for your dedication and commitment to oversight and bipartisanship—both are enormously important. I look forward to working closely with you. We truly have a moral obligation to meet the needs of our veterans—both those returning from combat today, 

and our older veterans from previous eras. 

The plans and reports on DOD/VA coordination and collaboration are important 

and vital. I appreciate your efforts to get the formal plans and agreements in place 

and underway. 

5

But, as encouraging as the testimony is today, this is not what I hear when I talk 

privately with West Virginia soldiers at roundtables back home. It is not what my 

caseworkers hear from veterans and their families in calls to our office. I believe 

we are making a good start, but there must be the adequate funding commitments 

and top leadership to make the promises of collaboration work. A promise made to 

veterans must be kept. 

We need to push harder to help our veterans with cooperation and coordination. 

Given the nature of the combat and the huge stress involved, we must improve our 

mental health services and our outreach for such services. I support the VA effort 

to expand both the staff and the number of Vet Centers to serve our veterans. I 

also want to work with Chairman Akaka to give our National Guard and Reservists 

5 years of access to VA care, instead of the current 2 years. 

Plus, we must take additional efforts to help our National Guard and Reservists 

who in recent years have been playing a bold and extraordinary role in our Armed 

Services. We need to recognize this and deal with unique challenges facing our 

Guard and Reserves, as well as their families.

Chairman AKAKA. At this time I would like to ask Senator Murray for her statement. 

STATEMENT OF HON. PATTY MURRAY,

U.S. SENATOR FROM WASHINGTON 

Senator MURRAY. Chairman Akaka and Senator Craig, thank you 

very much for holding this hearing. This is exactly the type of oversight and accountability we need to have to make sure our 

servicemembers get the services they need when they come home. 

And as I can tell you, we have got a lot of work to do. From the 

veterans I have talked to, it is clear that we do not offer them a 

seamless transition from the battlefront to the homefront, and that 

has really got to change. 

If we have a seamless transition, why are so many veterans coming home without jobs? Why are so many veterans unable to get 

housing? We have new reports out today that say that up to 1,000 

veterans from Iraq and Afghanistan are homeless today. That is 

unacceptable. 

If we have a seamless transition, why are veterans having to 

wait 6 months to see a VA doctor for primary care? Why are so 

many veterans having trouble getting help with PTSD? On Friday, 

in fact, our Army’s top medical officer said that some returning 

troops are not getting the help they need, and to me that is unacceptable. 

If we have a seamless transition, why are so many Guard and 

Reserve members unable to get help from the efforts like the Transition Assistance Program? Why are our Vet Centers overwhelmed 

with veterans seeking help? Why do our veterans have to wait 21⁄2

months to see a mental health care professional when they return 

from combat? 

We do not need a hearing to discover if we have a seamless transition. I know that we do not. And we do not need this hearing to 

find out if the Pentagon and the VA are working together enough. 

I do not think they are. We do need to use this hearing to find out 

from our witnesses what they are doing about it and how they are 

going to fix it. 

And I can tell you one thing: The veterans I talk to do not really 

care about Washington, DC, talk. They care about the reality they 

see in my State and across the Nation, whether they can get a job, 

whether they can get health care, whether they can get the benefits they need. And that should be the test we all use. 

6

If we do want to make progress, Mr. Chairman, I think we need 

to understand how we got here so we can change course. How did 

we get to a point where, 4 years into this war, we have a 2-year 

backlog for VA benefits, mental health care that is inaccessible, 

and long lines to see a VA doctor? We had better understand how 

we got here so that we do not make the same mistakes moving forward. 

Mr. Chairman, the first problem is that the Bush Administration 

did a miserable job planning for the aftermath of the war. The failures we have seen in the planning on the military side are mirrored by failures of planning on the VA side. We all know that the 

VA has some of the best employees in the world, and we are very 

proud of the work they do. But for too long, we have had a VA 

leadership that has not done an adequate job planning for the 

many veterans this war is creating, and the VA is still woefully behind in its projections. 

Last year, the VA planned to see 110,000 veterans from Iraq and 

Afghanistan. It ended up seeing more than 185,000. For this year, 

the VA projects to see 109,000 veterans, fewer than they saw last 

year. That does not make sense. We need an accurate plan from 

the VA that spells out the real needs and how the VA intends to 

meet those needs. 

The second problem is that the Bush Administration has never 

made a commitment to fund veterans’ health care as an essential 

part of the cost of war. This war is being paid for by 

supplementals, but those supplementals do not include funding for 

veterans’ health care. Funding for veterans’ health care has gone 

up, but it is still not tied to the real needs. We need to get the VA 

and the White House to match the funding to what the real needs 

are so our veterans are not left behind. 

And the third problem, Mr. Chairman, is that we have not been 

able to get straight answers or real numbers out of the VA. The 

GAO has found in report after report that VA has misled Congress, 

concealed funding problems, and based its projections on inaccurate 

models. That has to change because our veterans are paying the 

price. 

With all due respect to our witnesses, other officials from your 

agencies have sat at that very same table and assured us that everything was fine, when it certainly was not. I was assured many 

times that the VA had the funding it needed, only to learn later 

that the VA had a $3 billion shortfall and the agency had falsified 

budget savings over many years. 

So, today, Mr. Chairman, I hope we hear from Dr. Chu and Mr. 

Mansfield that you realize that there are serious problems on the 

ground and that you are committed to solving them. 

We are having this hearing at a very critical moment. The President has proposed escalating our military involvement in Iraq. Just 

4 days ago, the VA Secretary told the Houston Chronicle that sending more than 20,000 troops into Iraq will not have an impact on 

the VA’s backlog of claims. Secretary Nicholson described the impact of the surge on the VA as ‘‘minimal.’’

Well, I stood here in the Senate with nine veterans last week 

from the Iraq war, and they had a much different picture of that. 

They believe that the President’s escalation will further degrade 

7

our ability to care for our veterans. Today, without the surge, veterans are waiting for the services that they have been promised. 

If we are not meeting the veterans’ needs of today, how can we 

keep the promise to troops who are sent to an escalated war? 

Tonight the President is going to deliver his State of the Union 

speech. During last year’s speech, the President did not mention 

the word ‘‘veteran’’ once. I hope tonight finally he does talk about 

our veterans and acknowledges that our VA is overwhelmed and 

underfunded and outlines his plans for meeting our troops’ needs 

when they return home. 

Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Murray. 

Senator Brown? 

STATEMENT OF HON. SHERROD BROWN,

U.S. SENATOR FROM OHIO 

Senator BROWN. Thank you, Mr. Chairman. Thank you for the 

work that you and Senator Craig have done on behalf of the 25 

million veterans in this country. And, Senator Murray, thank you 

for your very poignant statement and what you have done for veterans in your State and in this country. 

There are more than a million veterans in my State of Ohio. 

When I am out talking to veterans, I hear several themes stand 

out: one, barriers to health care and long-term care; two, claims 

that languish for months, as Senator Murray said, without response; three, inadequate job and educational opportunities; and, 

four, unfair cuts in widow and other survivor benefits. 

In addition to these critical concerns, this Committee, as we have 

talked, Mr. Chairman, needs to pay attention to problems facing 

those veterans who may not come to our offices or who may not 

write us letters or whom we may not see as we are home in our 

States—those who are homeless, those who are in physical and 

emotional crises after sustaining a debilitating injury, those who 

are struggling with severe mental illness. Our Committee should 

spearhead efforts to fully fund the VA health care system to enhance VA mental health care and to abolish the disabled veterans 

tax which cuts pensions for those on disability pay. 

We should work to enhance educational and housing opportunities for veterans, as envisioned in the G.I. Bill for the 21st century. 

We should push for tax cuts for businesses who continue to pay 

servicemembers serving extended tours, and we should work to ensure that Reservists and Guardsmen can enroll their families in 

the TRICARE program on an affordable basis. 

We should advocate on behalf of widows and survivors and repeal the military families tax which reduces survivor benefits for 

family members of those who die of service-related injuries. 

Understanding we are working under daunting budget constraints and against a host of competing Federal priorities, but our 

Nation has made a promise to provide key benefits and service to 

veterans, and no priority overrides our obligations to fulfill that 

promise. 

Last week, I visited injured soldiers from my State at Bethesda. 

One of them has a pretty certain future, one of the soldiers I visited. One Marine has a pretty uncertain future, suffering from 

8

head injury. I am not at all confident, once he leaves Bethesda, 

that our military and our VA will track him well enough to be able 

to anticipate what problems his head injury may lead to as he tries 

to go back to work, as he tries to live a normal life. 

I am hopeful that our witnesses today can give all of us the confidence that the VA is really prepared, as this war escalates, as 

more troops come home with psychological and physical illnesses 

and injuries, that they will be ready to take care of the people to 

whom we have an obligation once they return to their homes. 

Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Brown. 

Senator Sanders? 

STATEMENT OF HON. BERNARD SANDERS,

U.S. SENATOR FROM VERMONT 

Senator SANDERS. Thank you, Mr. Chairman, and I will be brief, 

because there is not much that I can add to what Senator Murray 

and Senator Brown and others have said. 

When I was first elected to the Congress 16 years ago in the 

House, one of the things that I did was hold town meetings, many 

town meetings around the State of Vermont in order to inform veterans of the benefits to which they were entitled to. And the reason 

I did that is because we found that many, many, many thousands 

of veterans simply did not know the benefits to which they were 

entitled to such as the prescription drug program. And as a result 

of that, thousands of veterans entered into the VA system. 

Mr. Chairman, if we go to war, I think what we have to understand is that the cost of war does not stop the day that the war 

ends. The cost of war stops when the last veteran stops needing the 

benefits and the help that they should receive as a result of their 

service to this country. 

And let me pick up on the point that Senator Murray made, and 

let’s be very blunt about it. We had a major problem in the VA before the Iraq war began. Before the Iraq war began, in my State 

and all over this country there were very long waiting lists for veterans to get into the VA system. 

Now, how could that be? How could people who have put their 

lives on the line defending this country have to wait month after 

month after month to get the health care that they need? How 

could it happen that the Bush Administration, in order to save 

money, would throw hundreds of thousands of Category 8 veterans 

off of VA benefits entirely so that a 90-year-old veteran who calls 

my office who served in World War II cannot get into the VA because he is ‘‘too wealthy,’’ earning more than $27,000 a year? 

Mr. Chairman, let me go on record as saying that that is a national disgrace. 

So we start off with a VA system which is inadequate to deal 

with the veterans from World War II, Korea, and Vietnam. And 

then, lo and behold, we have the war in Iraq—22,000 veterans are 

wounded, almost half of them seriously. And then we learn from 

various studies that the impact of post-traumatic stress disorder is 

going to be worse from the Iraq war than it was in Vietnam. 

9

If anybody thinks that we have the resources to adequately deal 

with veterans who are coming back from Iraq plus all of our older 

veterans, they are sorely, sorely misunderstanding the situation. 

And, Mr. Chairman, I hope very much and I intend to do everything that I can with you and with my colleagues to make sure 

that the Bush Administration, instead of giving tax breaks to billionaires, starts adequately funding the VA so we do not continue 

to have the disgraceful situation that we currently do. 

Thank you very much, Mr. Chairman. 

Chairman AKAKA. Thank you, Senator Sanders. 

I would like to ask for the testimony of our witnesses, and I 

would like for our witnesses to summarize their testimony so that 

we can move on with the questions. We are delighted to have you 

here. May I first call on the Honorable Gordon H. Mansfield, Deputy Secretary of Veterans Affairs. 

STATEMENT OF HON. GORDON H. MANSFIELD, DEPUTY

SECRETARY, DEPARTMENT OF VETERANS AFFAIRS 

Mr. MANSFIELD. Thank you, Mr. Chairman, and thank you, 

Members of the Committee. Before I start my testimony, I would 

like to make a statement. 

When I hear words like ‘‘misled,’’ when I hear words like ‘‘concealed’’ and words like ‘‘failed to deliver,’’ it bothers me not just 

professionally but personally. And I would make a commitment to 

this body, to the Chairman and the Members, that if you have information on things like this, please contact me and I will guarantee you that I will follow up on that and make sure that nobody 

gets misled, nothing is concealed, and that we do not fail to deliver 

on issues. 

There is no doubt in my mind what the status of this agency is 

vis-a-vis the Congress of the United States, which authorizes the 

laws that we follow up on and appropriates the dollars that we are 

given to carry out those missions, and, therefore, obviously, has the 

right for oversight and information. So I would just like to make 

that as a first statement, that I would commit to you that if you 

have information on that, please contact me, and I will follow up 

on it. And I will guarantee you that Secretary Nicholson feels the 

same way about these issues. 

I am pleased to be here to present testimony. I am also pleased 

to be here with Dr. David Chu, my partner in leading the Joint Executive Council and, in effect, getting the two largest bureaucracies 

in the United States Government—DOD and VA—to come together 

and work together. Looking back, I think I can truly say that we 

are doing a much better job of taking care of DOD troops who will 

be veterans. 

In the area of seamless transition, in the big picture we have 

moved forward in the TAP and DTAP briefing areas. We are also 

making sure that we get letters from Secretary Nicholson out to all 

servicemembers who are leaving the Service to thank them and 

give them a snapshot on what benefits they are entitled to, and 

give them information on how to proceed to get that. We also have 

people overseas, and even we have had folks located on Navy ships 

returning from deployments to give them briefings in an attempt 

to bring this information to them. 

10

In the smaller, more defined seamless transition area, we have 

an Office of Seamless Transition, which is really devoted specifically to those troops who have been severely injured and in military treatment facility system. We have VA social workers, VA benefit workers, and others on-site in MTFs like Walter Reed or Bethesda or around the country, and they are working to make sure 

that the transition from those facilities to the VA facility is handled 

appropriately and to make sure we take care of all the needs of, 

not only the veteran, but the veteran’s family. 

We also have new outreach that we are doing, based on the fact 

that we have National Guard and Reserve troops coming back from 

the combat area. We now have MOUs or MOAs with the State Adjutant Generals to plan for and do briefings for servicemembers returning. And I can tell you, as I go around the country visiting VA 

regional offices where our benefits people are, or VA medical facilities where our health care providers are, I talk to our people. And 

everywhere I go, I know that these are folks who are spending 

weekends and nights going out to armories and other places in an 

effort to deal with National Guard troops and Reserve troops in an 

effort to make sure that we get them the information that they 

need. 

Also, we have Benefits Delivery at Discharge efforts at approximately 140 sites and efforts to get the departing servicemembers 

scheduled for information briefings so that they can get the information they need for their benefits on record and into the system 

before they leave the system. Also, we get the medical service 

records then, and we have a better chance of doing that, and also 

getting the medical exams completed so that we can get a decision 

for these folks in a reasonable time frame. We have also consolidated these BDD sites so that two sites—one at Winston-Salem 

and one at Salt Lake City—are concentrating on doing these 

issues. 

In the medical records area, which I know is of concern to the 

Committee, I would have to admit that there have been ups and 

downs. The latest JEC initiative from a year ago provided for a 

uniform data repository for DOD which the three services’ medical 

Departments would feed into, and then VA could use that as a 

source for information we needed for either health care or benefits 

issues. I would leave the explanation of the AHLTA efforts that 

have taken place within DOD to Dr. Chu, I am sure he would want 

to talk about them. 

We also have four or five Bidirectional Health Initiative pilots 

working under the FIP program that is funded by the JEC. Later 

on today Secretary Nicholson, Secretary Leavitt, and Assistant Secretary Winkenwerder from DOD will be making a joint announcement on the most important initiative in this area, and that will 

be at the American Health Information Council, chaired by Secretary Leavitt, a meeting that is taking place at the VA today. And 

this will be a move toward a single-record system which will be accessible and usable by both VA and DOD. 

In the JEC arena, since 2003 we have moved forward, and I 

think that we have done an excellent job in the planning arena. 

The current plan institutionalizes our collaborative efforts across a 

diverse range of health care and benefits. The broad-based areas 

11

include clinical practice guidelines in managing care, and that is 

both DOD and VA practitioners getting involved to develop these 

guidelines; in the mental health arena, specifically with PTSD; patient safety practices; in deployment health and research; in contingency planning; in financial management that addresses VA and 

DOD billing and reimbursement issues; in joint facility utilization, 

which I will talk about later; information management and information technology; in the pharmacy area; in medical materiel acquisition and procurement; in VA/DOD shared high-technology 

medical contracts; in shared continuing medical education and 

training opportunities; and also in benefits delivery. 

I think one of our signature successes has been in joint facility 

utilization. For example, at the North Chicago VA Medical Center, 

which is side-by-side with the Navy training facility in North Chicago, there was previously a VA medical center and a DOD hospital right across the fence from each other, probably about a mile 

apart or half a mile apart. We have gone forward in a joint effort 

that is a pilot, and the final stage is that the VA medical center 

stays in business. We have added surgical suites and an emergency 

room to that facility, which is usable by both the VA community 

and the Navy community. And we are in the process of designing 

and building an outpatient ambulatory facility that we will have a 

groundbreaking for later on this spring. That ambulatory facility 

will be right next to the VA. 

Chairman AKAKA. Mr. Mansfield, if you could wrap up. 

Mr. MANSFIELD. We will then have a functionally integrated Federal health care facility that will be staffed by employees of both 

agencies with a single command-and-control structure. In this case, 

we will have a VA director of the medical facility and a Navy director of the facility. 

The other area I want to comment on——

Chairman AKAKA. Mr. Mansfield, will you please wrap up as 

soon as you can? 

Mr. MANSFIELD. I will leave it there. 

Senator ROCKEFELLER. Mr. Chairman, if I can be bold and slightly unkind, this is like every other presentation made by any Government agencies that I have ever heard in 23 years here. It is all 

cleared by OMB. You have said absolutely nothing, except yielding 

on one point where there might be a problem, except good news. 

You are telling us all the good things that are happening, whether 

they are or not, you are telling them to us. If you listened to us 

at all, we were not interested in that. We were interested in what 

is happening to suicides, to mental health, to PTSD, to speed of 

cure and care, and all of those things. You are simply not addressing them, and I would prefer that you just not finish your statement or that David Chu not give his statement if that is going to 

be the approach to us, because that is totally unresponsive to the 

Committee, it is totally unresponsive to the veteran, and it is a 

farce that I am long since sick of. 

Chairman AKAKA. Mr. Mansfield, would you——

Mr. MANSFIELD. I have completed my statement, Mr. Chairman. 

[The prepared statement of Mr. Mansfield follows:]

12

PREPARED STATEMENT OF HON. GORDON H. MANSFIELD, DEPUTY SECRETARY,

DEPARTMENT OF VETERANS AFFAIRS

Mr. Chairman and distinguished Members of the Committee, I am pleased to be 

here today to discuss the progress made by the Department of Veterans Affairs (VA) 

and the Department of Defense (DOD) toward improving the delivery of health care 

and benefits to our Nation’s veterans. 

Our two Departments understand that we are responsible for the same people, 

only at different times of their lives. We agree that we must leverage every opportunity to improve their transition from military to civilian life. And, as a result, we 

have cemented a relationship that works smarter in our separate but related missions. Our reinforced partnership cuts across a range of difficult issues and has reduced many of the problems encountered by previous generations of veterans. 

I am pleased to provide an overview of the groundbreaking programs and pioneering initiatives VA and DOD have implemented to improve coordination between 

our two systems as we deliver our programs, services, and benefits. 

VA/DOD JOINT EXECUTIVE COUNCIL AND STRATEGIC PLAN

First and foremost in our alliance is our Joint Executive Council (JEC). Established 4 years ago, the Council is the nexus for senior leadership management of 

communication, coordination, and resource sharing between VA and DOD. Today, 

the Council continues to direct appropriate resources and expertise to specific operational areas through its two sub-councils, the Health Executive Council and the 

Benefits Executive Council. 

The Council’s Strategic Plan is the primary means by which we advance and 

measure our performance and our progress. It provides a solid framework for 

achieving specific goals in delivering services and benefits to servicemembers and 

veterans alike. 

The current Plan institutionalizes our collaborative efforts across a diverse range 

of health care and benefits. These broad-based areas include: 

(1) Clinical practice guidelines in managing care for overweight and obese patients; 

(2) Mental health; 

(3) Patient safety practices; 

(4) Deployment health and research, to include surveillance and planning activities related to depleted uranium exposure and pandemic flu; 

(5) Contingency planning, as outlined in a VA–DOD Memorandum of Understanding for health care delivery during war or national emergency; 

(6) Financial management that addresses VA–DOD billing and reimbursement 

issues; 

(7) Joint facility utilization; 

(8) Information management and information technology; 

(9) Pharmacy; 

(10) Medical materiel acquisition and procurement in new VA–DOD shared hightechnology medical contracts; 

(11) Shared continuing education and training opportunities; and 

(12) Benefits delivery. 

The Strategic Plan has materially strengthened the capability of both Departments to better serve our beneficiaries. It fosters an unprecedented level of cooperation between VA and DOD as we work to remove institutional barriers and address 

operational challenges. The Plan represents a quantum leap in our joint ability to 

improve service and access for veterans, servicemembers, military retirees, and eligible dependents. 

SEAMLESS TRANSITION OF CARE AND BENEFITS

VA’s efforts on behalf of veterans begins early on. Our Benefits at Discharge Program enables active duty members to register for VA health care and to file for benefits prior to separation from active service. Our outreach network ensures returning servicemembers receive full information about VA benefits and services. Each 

of our medical centers and benefits offices now has a point of contact assigned to 

work with veterans returning from service in Operation Enduring Freedom (OEF) 

and Operation Iraqi Freedom (OIF). Many servicemembers are enrolled in the VA 

system even before discharge. 

The staff of the Veterans Health Administration (VHA) has coordinated the transfer of over 6,700 injured or ill active duty servicemembers and veterans from DOD 

to VA. We hold as our highest priority those returning from the Global War on TerVerDate 0ct 09 2002 14:48 May 29, 2007 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\32723.TXT SENVETS PsN: ROWENA
13

ror and transitioning directly from DOD Military Treatment Facilities (MTFs) to VA 

Medical Centers (VAMCs). 

In partnership with DOD, VA has implemented a number of strategies to provide 

timely, appropriate, and seamless transition services to the most seriously injured 

OEF/OIF active duty servicemembers and veterans. 

VA social workers, benefits counselors, and outreach coordinators advise and explain the full array of VA services and benefits. These employees assist active duty 

servicemembers as they transfer to VA medical facilities from MTFs. In addition, 

our social workers help newly wounded soldiers, sailors, airmen and Marines and 

their families plan a future course of treatment for their injuries after they return 

home. Currently, VA Social Work and Benefit liaisons are located at 10 MTFs, including Walter Reed Army Medical Center (WRAMC), the National Naval Medical 

Center Bethesda (NNMC), the Naval Medical Center San Diego, and Womack Army 

Medical Center at Ft. Bragg. 

A VA Certified Rehabilitation Registered Nurse (CCRN) is now assigned to 

WRAMC to assess and provide regular updates to our Polytrauma Rehabilitation 

Centers (PRC) regarding the medical condition of incoming patients. The CCRN advises and assists families and prepares active duty servicemembers for transition to 

VA and the rehabilitation phase of their recovery. 

Upon notification of the Veterans Health Administration (VHA), VA’s Social 

Worker Liaisons and the CCRN fully coordinate care and information prior to a patient’s transfer to our Department. Social Worker Liaisons meet with patients and/

or families to advise and ‘‘talk them through’’ the transition process. They register 

servicemembers or enroll recently discharged veterans in the VA health care system, and coordinate their transfer to the most appropriate VA facility for the medical services needed, or to the facility closest to their home. 

In the case of polytrauma patient transfers, both the CCRN and the Social Worker Liaison are an integral part of the MTF treatment team. They simultaneously 

provide input into the VA health care plan and collaborate with both the patient 

and family throughout the entire health care transition process. 

Case management for these patients begins at the time of transition from the 

MTF and continues as their medical and psychological needs dictate. Once the patient transfers to the receiving VAMC, or reports to his or her home VAMC for care, 

the VA Social Worker Liaison at the MTF continues to coordinate with VA to address after-transfer issues of care. Patients suffering severe injuries, or those with 

complex needs, receive ongoing case management at the VA facility where they receive the predominance of their care. 

One important aspect of coordination between DOD and VA prior to a patient’s 

transfer to VA is access to clinical information. This includes a pre-transfer review 

of electronic medical information via remote access capabilities. Video teleconference 

calls are routinely conducted between DOD MTF treatment teams and receiving VA 

PRC teams. If feasible, the patient and family attend these video teleconferences to 

participate in discussions and to ‘‘meet’’ the VA PRC team. 

The Bidirectional Health Information Exchange (BHIE) allows VA and DOD clinicians to share text-based clinical data in a number of sites, including WRAMC and 

NNMC, the two MTFs that refer the majority of polytrauma patients to VA. 

In addition to health care, Veterans Benefits Administration (VBA) counselors assigned to MTFs provide benefits information and assistance to servicemembers applying for these benefits. These counselors are often the first VA representatives to 

meet with servicemembers and their families and provide information about VA’s 

full range of services, to include readjustment programs as well as educational and 

housing benefits. 

Counselors assist servicemembers in completing claims and in gathering supporting evidence. While servicemembers are hospitalized, they are routinely informed of the status of their pending claims and given their counselor’s name and 

contact information should they have follow-on questions or concerns. For 

servicemembers who are seriously disabled in OEF/OIF, compensation claims are 

expedited to the appropriate VA Regional Office (VARO) with a clear indication that 

they involve OEF/OIF claimants. 

For a period of 2 years following separation from active duty, all veterans who 

served in combat locations are eligible for free health care services for conditions 

potentially related to combat service. These veterans can access VA health care, 

even those who have no service-connected disability. Veterans who enroll continue 

to be eligible for medical care after this 2-year window. This enrollment ‘‘window’’ 

applies to regular active-duty personnel who served in Iraq or Afghanistan, as well 

as Reserve or National Guard members who served in combat theaters. 

Each VAMC and VARO has a designated point of contact (POC) to coordinate activities locally and to ensure the health care and benefits needs of returning 

14

servicemembers and veterans are fully met. VA has distributed specific guidance to 

field staff to ensure that the roles and functions of the POCs and case managers 

are fully understood, and that proper coordination of benefits and services occurs 

at the local level. 

In March 2005, the Army assigned full time active duty liaison officers to VA’s 

four Polytrauma Rehabilitation Centers located at Tampa, FL; Richmond, VA; Minneapolis, MN; and Palo Alto, CA. The Army Liaison Officers support military personnel and their families from all Service branches by addressing a broad array of 

issues, such as travel, housing, military pay, and movement of household goods. 

In addition, Marine Corps representatives from nearby local Commands visit and 

provide support to each of the Polytrauma Rehabilitation Centers. At VA Central 

Office in Washington, DC, an active duty Marine Officer and an Army Wounded 

Warrior representative are assigned to the Office of Seamless Transition. All DOD 

liaisons play a vital role in providing a wide bridge of services during the critical 

time of patient recovery and rehabilitation. 

VA understands the critical importance of supporting families during the tumultuous time of transition. We established a Polytrauma Call Center to assist the families of our most seriously injured combat veterans and servicemembers. Initiated 

in February 2006, the Call Center operates 24 hours-a-day, 7 days-a-week to answer 

clinical, administrative, and benefit inquiries from polytrauma patients and family 

members. The Center’s value is threefold. It furnishes patients and their families 

with a one-stop source of information; it enhances overall coordination of care; and, 

very importantly, it immediately elevates any system problems to VA for resolution. 

VA’s mission is to deliver 21st century care to 21st century combat veterans. We 

are meeting our mandate through the life-saving and life-shaping medicine in our 

health care arsenal. 

VA OUTREACH

Office of Seamless Transition 

The Office of Seamless Transition is the lynchpin in VA’s outreach efforts. Two 

Outreach Coordinators one a peer-support volunteer and a veteran of the Vietnam 

War regularly visit seriously injured servicemembers at WRAMC and NNMC Bethesda. Their visits have established a uniquely personal and trusted connection 

with patients and their families. Our Outreach Coordinators offer support and encouragement as patients travel the often ‘‘rough and tough’’ roads of rehabilitation. 

These individuals help identify gaps in VA services by submitting and tracking follow-up recommendations. They encourage patients to consider participating in VA’s 

National Rehabilitation Special Events or to attend weekly dinners held in Washington, DC, for injured OEF/OIF returnees. They are first-responders in helping our 

injured servicemembers come to a renewed belief in themselves and in their future. 

In short, they are key to enhancing and advancing the successful transition of our 

service personnel from DOD to VA, and, in turn, to their homes and communities. 

The National Guard and Reserve 

VA has developed a vigorous outreach, education, and awareness program for the 

National Guard and Reserve. To ensure coordinated transition services and benefits, 

a Memorandum of Agreement (MOA) was signed with the National Guard in May 

2005. Combined with VA/National Guard State Coalitions in 54 states and territories, VA has significantly improved its opportunities to access returning troops 

and their families. We are continuing to partner with community organizations and 

other local resources to enhance the delivery of VA services. 

At the national level, MOAs are under development with both the United States 

Army Reserve and the United States Marine Corps. These new partnerships will increase awareness of, and access to, VA services and benefits during the demobilization process and as service personnel return to their local communities. 

Post Deployment Health Reassessment 

VA is also reaching out to returning veterans whose wounds may be less apparent. VA is a participant in the DOD’s Post Deployment Health Reassessment 

(PDHRA) program. In addition to DOD’s pre- and post-deployment assessments, 

DOD now conducts a health reassessment 90–180 days after return from deployment to identify health issues that can surface weeks or months after 

servicemembers return home. 

VA actively participates in the administration of PDHRA at Reserve and Guard 

locations in a number of ways. We provide information about VA care and benefits; 

enroll interested Reservists and Guardsmen in the VA health care system; and arrange appointments for referred servicemembers. As of December 2006, an estimated 52,000 servicemembers were screened, resulting in over 13,900 referrals to 

15

VA. Of those referrals, 32.5 percent were for mental health and readjustment issues; 

the remaining 67.5 percent for physical health issues. 

Outreach Readjustment Counseling 

Congress created the Readjustment Counseling Service (RCS), commonly known 

to veterans as the Vet Center Program, as the outreach element in VA’s Veterans 

Health Administration. Program eligibility was originally targeted to Vietnam veterans; however, it now serves all returning combat veterans. The program is the undisputed ‘‘gold standard’’ in veterans’ satisfaction (98 percent), employee satisfaction, and across other measurable indicators of quality and effective care. 

The program helped form the basis for the President’s New Freedom Commission 

on Mental Health. It is recognized as a National model for outreach and readjustment services, and emulated by other countries in their efforts to ease the readjustment of combat veterans to civilian life. 

The approximate number of OEF/OIF combat veterans served by Vet Centers to 

date is 180,000. The Secretary of Veterans Affairs approved the hire of 100 additional OEF/OIF combat veterans to support the Program by reaching out to active, 

National Guard, and Reserve veterans returning from Southwest Asia. This single 

action advanced the continuing success of our Vet Centers in their ability to assist 

our newest veterans and their families. VA Vet Centers have provided bereavement 

services to the families of over 900 fallen warriors. 

VA plans to expand its Vet Center Program. We will open 15 new Vet Centers 

and 8 new Vet Center outstations at locations throughout the Nation by the end 

of 2008. At that time, Vet Centers will total 232. We expect to add staff to 61 existing facilities to augment the services they provide. Seven of the 23 new centers will 

open during Calendar Year 2007. 

POLYTRAUMA/TRAUMATIC BRAIN INJURY

VA Clinical Reminders for Mild Traumatic Brain Injury (TBI) 

Veterans and active duty servicemembers with TBI recognized at the time of injury receive state-of-the-art, highly specialized care at both DOD and VA TBI Centers. However, less severe injuries may not become evident until military personnel 

return home to the care of their community physicians, DOD, or VA medical centers. Prompt diagnosis is often complicated by the fact that many who sustain mild 

brain injury do not recall the trauma that caused it. As a result, some patients with 

symptoms seemingly unrelated to mild TBI, such as headaches, sleep disturbances 

and depression, may go undiagnosed. 

To assist clinicians in the diagnosis of mild TBI, the VA Chief of Patient Care 

Services stood up the Traumatic Brain Injury Clinical Reminder Work Group to develop clinical reminders to identify possible TBI in OEF/OIF veterans. 

Membership is multidisciplinary and includes representatives from physical medicine and rehabilitation services, mental health, primary care, neurology, information 

technology, occupational and environmental health, as well as operations and management. The project’s scope encompasses development of a screening instrument, 

appropriate follow-up for potential positive screens, and integration with VHA 

Health Information Systems to support system-wide implementation. 

TBI Education 

To ensure that all VA health care providers are well prepared to recognize brain 

injury sequelae, clinical management, and treatment approaches, VA’s Under Secretary for Health has mandated a 4–hour continuing education course on Traumatic 

Brain Injury, to be completed by March 31, 2007. 

VA/DOD Memorandum of Agreement 

VA and DOD have in operation a longstanding MOA regarding referral of active 

duty military personnel who sustain spinal cord injury, TBI, or blindness to VA 

medical facilities for health care and rehabilitation. The MOA facilitates transfer of 

personnel to VA facilities that specialize in care and rehabilitation of these conditions. Effective January 1, 2007, the Assistant Secretary for Health Affairs, Department of Defense and the Acting Under Secretary for Health, Department of Veterans Affairs, renewed this MOA in support of VA/DOD resource sharing. 

MENTAL HEALTH ISSUES

In Fiscal Years (FY) 2005 and 2006, VA increased funding of new and enhanced 

mental health programs for OEF/OIF veterans and others with Post Traumatic 

Stress Disorder (PTSD). VA will do so again in Fiscal Year 2007 to better meet the 

clinical needs of all veterans. 

16

Additional funding initiatives are targeted to increase the mental health capacities of Community Based Outpatient Clinics and enhance telemental health capabilities in rural areas. VA’s goal is to make mental health services more accessible 

for all we serve. 

In Fiscal Year 2007, VA will fund enhanced integration of Mental Health and Primary Care services to increase our ability to provide veterans with comprehensive 

health care. Given the possible reluctance of some veterans to disclose emotional 

problems, increased mental health capacity in primary care will allow veterans to 

receive mental health services without actually going to an identified mental health 

clinic. 

In Fiscal Year 2006, under the auspices of specialized and general mental health 

programs, VA treated 345,713 veterans with a clinical diagnosis of PTSD. This represents an increase of 27,099 individuals over Fiscal Year 2005. Of those treated in 

Fiscal Year 2006, 241,884 (70 percent) had a primary diagnosis of PTSD. 

VA’s health care system features more than 200 specialized VAMC-based PTSD 

programs. Every VA medical center now has specialty PTSD capability. There are 

over 80 VAMC-based OEF/OIF programs operating in collaboration with specialized 

PTSD programs, general mental health clinics, and primary care facilities. Staff 

training to support these programs has been developed in collaboration with DOD 

counterparts at the U.S. Army and U.S. Marine Corps. 

Since the beginning of the OEF/OIF conflict, VA medical centers have seen nearly 

34,000 veterans with a possible diagnosis of PTSD, i.e., veterans who received a 

PTSD diagnosis from a health care provider on at least one occasion. There has been 

an increase of 17,827 new provisional diagnoses of PTSD in Fiscal Year 2006. 

Since hostilities began, more than 23,000 veterans received a provisional diagnosis of a depressive disorder, and 7,800 were provisionally diagnosed with alcohol 

or drug dependence. 

VA/DOD INFORMATION SHARING

VA and DOD have made significant progress in the development of interoperable 

health technologies that support seamless transition from active duty to veteran status. Advances include the successful one-way and bidirectional transmission of electronic medical records between DOD and VA, and the adoption and implementation 

of data standards which support interoperability. 

VA and DOD information sharing successes have resulted directly from implementation of the DOD/VA Joint Electronic Health Records Interoperability (JEHRI) 

Plan. JEHRI is a comprehensive strategy to develop collaborative technologies and 

interoperable data repositories, as well as adoption of common data standards. 

The DOD/VA Health Executive Council, co-chaired by VA’s Under Secretary for 

Health and DOD’s Assistant Secretary of Defense for Health Affairs, manages the 

day-to-day implementation activities of JEHRI. 

DOD and VA began implementation of the JEHRI Plan in 2002 with successful 

execution of the Federal Health Information Exchange (FHIE). Since then, FHIE 

has supported the secure one-way transmission of DOD electronic medical records 

to a shared repository, where records reside for review by clinicians treating veterans at VA hospitals and clinics. These same records are also available to VA 

claims examiners, who access FHIE data through an interface with the VBA Compensation and Pension Records Interchange (CAPRI). VA presently has access to 

FHIE data for more than 3.6 million unique beneficiaries. 

FHIE also supports the one-way transmission of pre- and post-deployment health 

assessment data from DOD to VA. The Departments have recently begun the transmission and viewing of post-deployment health reassessments (PDHRA) to (1) monitor the overall health condition of troops; (2) inform them of potential health risks; 

and (3) work to benefit the overall health of servicemembers and veterans. 

In 2004, VA and DOD leveraged FHIE technologies to develop the capability to 

support the real-time bidirectional exchange of electronic medical records. By using 

the Bidirectional Health Information Exchange, VA and DOD clinicians share textbased clinical data between medical facilities where patients (who receive care from 

both systems) are seen. BHIE also supports the real-time bidirectional exchange of 

outpatient pharmacy data, anatomic pathology/surgical reports, cytology results, 

microbiology results, chemistry and hematology laboratory results, laboratory order 

information, radiology text reports, and food and drug allergy information. 

BHIE data from every VA site are available at select DOD sites where BHIE is 

installed. DOD is continuing to install BHIE, and system implementation has been 

completed at 21 major sites. These include facilities where large numbers of OEF/

OIF servicemembers are seen, such as Walter Reed Army Medical Center and the 

17

National Naval Medical Center Bethesda, the Landstuhl Regional Medical Center 

in Germany, and the Naval Medical Center San Diego. 

As mentioned, JEHRI is a comprehensive strategy for sharing data. Where BHIE 

supports the bidirectional sharing of health data between legacy systems, JEHRI 

takes into account that both DOD and VA are modernizing their health information 

systems. The next phase of JEHRI, the Clinical Health Data Repository (CHDR), 

provides a means for VA and DOD to develop an interface between the DOD Clinical Data Repository (CDR) of DOD’s AHLTA system and the VA Health Data Repository (HDR) of the next-generation VistA system, known as HealtheVet. 

Through CHDR, DOD and VA have the groundbreaking ability to share computable data between next-generation systems featuring automatic decision support for 

clinicians, e.g., drug-drug and drug-allergy interaction checks. DOD and VA currently use this interface between the William Beaumont Army Medical Center and 

the El Paso VA Healthcare System to support care of shared patients as well as 

at Augusta, Georgia, and Pensacola, Florida, locations. VA and DOD are working 

to expand the types of clinical data available through CHDR, specifically laboratory 

data. 

Our Departments are also collaborating on an interface between CHDR and BHIE 

to accelerate bidirectional data sharing and make it available at all sites of care, 

not solely at select DOD BHIE sites. The CHDR–BHIE Interface will make the 

same data elements currently in BHIE available to VA from all 138 DOD locations 

where AHLTA and the CDR are deployed. VA and DOD also are planning to make 

additional data from AHLTA available to VA, such as provider notes, procedures, 

and problem lists. 

In addition to FHIE, BHIE and CHDR, VA and DOD have successfully developed 

a number of other applications that support information sharing, improve care, and 

support seamless transition. For example, the jointly developed Laboratory Data 

Sharing Interoperability (LDSI) software permits VA and DOD to serve as reference 

laboratories for one another. This typically occurs at locations where VA and DOD 

use each other’s facilities to order and conduct chemistry laboratory tests and results reporting. 

Our two Departments are also working to expand VA access to DOD inpatient 

documentation, particularly for severely wounded and injured servicemembers being 

transferred to VA for care. An early version of this electronic capability is currently 

in use between Madigan Army Medical Center and the VA Puget Sound Health 

Care System, where inpatient discharge summaries are exchanged. 

The Departments also are cooperating to modernize imaging systems using shared 

technologies and to transfer improved scanned images of paper-based medical 

records. Both these efforts will help to ensure VA has access to significant inpatient 

data, especially for severely injured servicemembers about to transfer to VA for care 

and treatment. 

VA has been widely recognized for its outstanding electronic health record. With 

this sharing of expertise, the two Departments will work on this initiative to benefit 

servicemembers and veterans, and the entire Nation as we move toward electronic 

medical records. 

VistA, the VA electronic health record, supports ambulatory care plus a 

segmentable but integrated inpatient care capability. VA is planning to modernize 

VistA, including its inpatient module. We believe that this is an opportunity to explore a ‘‘born seamless’’ approach for a joint inpatient electronic health record. 

It is likely that much of DOD and VA inpatient healthcare data, processes and 

requirements are similar. But there are some known differences. For example, the 

VA has no requirement for theater inpatient care and DOD does not provide longterm domiciliary care. 

The analysis will identify the areas of commonality and the areas of uniqueness. 

This project will document and assess DOD and VA inpatient clinical processes, 

workflows, and requirements, determine the benefits and impacts on each Department’s timelines and costs for deploying a common inpatient electronic health record 

solution and develop the business case analysis for alternative approaches. 

Center for the Intrepid: The National Armed Forces Physical Rehabilitation Center 

For the past year, the Department has been actively engaged with the Department of the Army and the Intrepid Fallen Heroes Foundation on operational plans 

for the Center for the Intrepid—a 65,000 square foot, state-of-the-art rehabilitation 

facility at Brooke Army Medical Center, Fort Sam Houston. 

When the Center is dedicated on January 29, 2007, seven VHA and two VBA staff 

members will be working side-by-side with Army colleagues to provide the best possible rehabilitative services to severely injured servicemembers and veterans. VHA 

will provide physical therapy, occupational therapy, prosthetics services, social work 

18

case management, and seamless transition liaison services. VBA will offer information and education about benefits and vocational rehabilitation services, and provide 

assistance with benefits claims. 

We envision that the Center will provide educational and research opportunities 

that will better prepare VA staff for assisting our Nation’s newest generation of veterans. 

The North Chicago VA Medical Center/Naval Health Clinic Great Lakes Initiative 

On October 17, 2005, I co-signed an MOA with the Assistant Secretary of Defense 

for Health Affairs that represents a historic collaboration between VA and DOD. 

Our joint effort ‘‘raises the bar’’ in standards of economy, efficiency, and management. The North Chicago VA Medical Center (NCVAMC) and the Naval Hospital 

Great Lakes are fully sharing all health services in one facility at North Chicago 

to provide all needed care to each other’s beneficiaries. 

The North Chicago initiative called for full modernization of NCVAMC’s surgical 

and emergency/urgent care facilities and for VA to provide health care services to 

the Navy’s beneficiary population treated at Great Lakes. The Naval Hospital Great 

Lakes was re-commissioned as the Naval Health Clinic Great Lakes. In 2006, 

NCVAMC began providing the Navy’s beneficiary population in that area all of its 

emergency, surgical, and inpatient care. 

The scheduled groundbreaking ceremony for the Federal Ambulatory Care Center 

is Spring 2007. Our working groups are continuing to develop detailed operational 

plans for its activation in 2010. 

CLOSING

Mr. Chairman, I believe our efforts and progress speak to a new era of cooperation between the Department of Veterans Affairs and the Department of Defense. 

The strides we have made toward transparent and seamless transition have been 

recognized by both the Inspector General and the Government Accountability Office. 

We have forged new ties and cast a revitalized, more productive relationship. We 

are working smarter to carry out our separate but related missions. We are better 

coordinating our overlapping infrastructure and services. We are striving to ensure 

more efficient use of taxpayer dollars. And we are continuing to seek out potential 

opportunities for partnership. 

Our Departments are singularly committed to the men and women we both serve. 

They are our highest priority. 

President Lincoln once said, ‘‘The struggle of today is not altogether for today it 

is for a vast future also.’’

Our greatest challenge, and our greatest opportunity, is to build systems that 

meet the needs of veterans and DOD beneficiaries for today and tomorrow. We will 

continue to persevere toward that goal. 

Mr. Chairman, this concludes my statement. I thank you and Members of this 

Committee for your outstanding and continued support of our servicemembers, veterans, and their families. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA

Question 1. In July 2006, the VA Office of the Inspector General (OIG) issued a 

report on the ‘‘Health Status of and Services for Operation Enduring Freedom/Operation Iraqi Freedom Veterans After Traumatic Brain Injury Rehabilitation.’’ The VA 

OIG identified problems with respect to VA and DOD coordination and collaboration 

that impacted the timeliness and access to rehabilitative services for 

servicemembers with TBI who remain on active duty status after completing their 

inpatient rehabilitative care at VA. What is VA doing to improve case management 

for veterans with traumatic brain injuries? 

Response: Case management is a critical function designed to ensure lifelong coordination of services for patients with polytrauma and traumatic brain injury 

(TBI), and is an integral part of the system at each polytrauma care site. The 

polytrauma system of care (PSC) uses a proactive case management model, which 

requires maintaining routine contacts with veterans and their families to coordinate 

services and to address emerging needs. As an individual moves from one level of 

care to another, the case manager at the referring facility is responsible for a ‘‘warm 

hand off’’ of care to the case manager at the receiving facility closer to the veteran’s 

home. The assigned case manager handles the continuum of care and care coordination, acts as the point of contact for emerging medical, psychosocial, or rehabilitation problems, and provides patient and family advocacy. 

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A polytrauma telehealth network has been established linking the four regional 

TBI/polytrauma rehabilitation centers and their respective network sites. This technology is an additional resource to the Department of Veterans Affairs (VA) TBI/

polytrauma clinicians for patient care coordination and family support closer to 

home. 

VHA is currently recruiting to hire 100 new transition patient advocates to assist 

severely injured Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) 

veterans. These new transition patient advocates will serve as the liaison for veterans and their families, helping them to communicate their needs to the VHA 

health care team and addressing their problems and concerns. Each transition patient advocate will be assigned to work with 25–30 severely injured OEF/OIF veterans and will follow those veterans across episodes and sites of care, beginning at 

the point their care is transitioned from the Military Treatment Facility to a VHA 

health care facility. Transition patient advocates will work collaboratively with the 

veteran’s health care team, particularly with the nurse and social worker case managers. VHA anticipates filling these positions expeditiously.

Question 2. I am encouraged by VA’s implementation of its Seamless Transition 

Performance Measure, which monitors the transfer of injured veterans from DOD 

to VA facilities. As I understand it, this measure was fully implemented in early 

October 2006. What can you report as to its effectiveness? As a percentage, how 

many veterans are being contacted by a VA case manager within 7 days of VA receiving notification of their transfer from DOD? 

Response: In October 2006, VA implemented a seamless transition performance 

measure to ensure that every severely ill/injured servicemember or veteran who is 

transferred from a Department of Defense (DOD) military treatment facility (MTF) 

to any VA healthcare facility has a case manager assigned to him or her at the receiving facility before arriving at that facility. The receiving facility has 7 calendar 

days after notification of transfer in which to assign a case manager to the 

servicemember or veteran and to call him or her to facilitate the transfer. Between 

October 10, 2006 and January 17, 2007, 72 severely ill or injured patients were 

transferred from DOD MTFs to VA healthcare facilities. During this time period, 

65 (90.3 percent) of these patients were assigned a VA case manager within the 7 

day standard. For the 7 cases that did not meet the performance measure, 3 exceeded the 7-day time frame to contact the patients but case managers have been assigned. For the other 4 patients, case managers have also been assigned but have 

been unable to contact the patients.

Question 3. To what extent have efforts been made to coordinate with the Department of Labor to assist returning servicemembers in finding meaningful employment in a timely fashion? What employment related efforts have VA made on its 

own accord? 

Response: VA’s Vocational Rehabilitation & Employment (VR&E) service and the 

Department of Labor’s Veterans’ Employment and Training Service (VETS) updated 

their existing memorandum of understanding (MOU) in October of 2005. VR&E and 

VETS adopted a team approach to job development and placement activities to improve vocational outcomes for vocational rehabilitation program participants. All 

veterans entering a program of vocational rehabilitation are informed of the employment assistance available through the VETS program and are encouraged to register with the State workforce agency. 

The successful readjustment of disabled veterans into the civilian workforce is the 

mutual responsibility and concern of VA’s VR&E service and the Department of 

Labor, VETS. Combining the services of the disabled veteran outreach program 

(DVOP) specialists, local veteran’s employment representatives (LVER), and VR&E 

staff maximizes the employment services available to disabled veterans and increases the opportunities for successful placements. Both agencies are committed to 

working together to improve successful employment outcomes for our Nation’s veterans. 

Regional offices (RO) have MOUs with their State workforce agencies, which define their referral processes. Generally, the VR&E counselor provides a personal introduction to the veteran when the DVOP specialist/LVER is co-located with the 

VR&E. A referral form is completed and forwarded to the DVOP specialist/LVER 

when the DVOP specialist/LVER is not co-located. 

There are 71 DVOP specialists/LVERs at 38 VA offices. Having the DVOP specialist/LVER onsite enhances the teamwork between the two agencies. Whether a 

DVOP specialist/LVER is co-located at a VR&E or not, these VETS employees assist 

VR&E staff with the following tasks:

(1) Participate in the orientation to the VR&E program. 

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(2) Provide initial labor market information during evaluation and planning 

phase. 

(3) Provide ‘‘survival employment’’ (not necessarily ‘‘suitable employment’’) to the 

veteran to supplement finances while the veteran is receiving training/vocational 

services under the VR&E program. 

(4) Monitor/staff the job resource labs and assist veterans with job seeking activities. 

(5) Assist with locating supportive services (human service organizations) in the 

community when assistance outside the parameters of the VR&E program is needed. 

(6) Assist veterans in obtaining and maintaining employment by providing job development and placement services. 

(7) Serve as a referral source for employment services when a veteran is not eligible for the VR&E program. 

(8) Provide wage information and placement data.

VA’s VR&E program provides veterans with service-connected disabilities a wide 

range of employment assistance including, formal education needed for employment, 

on-the-job training, apprenticeships, and internships to meet their individual career 

goals. VR&E implemented the Five Tracks to Employment Process, which includes 

job resource labs, Web-based information resources (http;//www.VetSuccess.qov) 

and a standardized orientation. VR&E also stationed 72 employment coordinators 

(ECs) at ROs across the country. The primary function of the EC is to provide veterans with disabilities any necessary job readiness skills prior to and including job 

referral/placement. This network of ECs works closely with local employment resources, including the DVOP specialists and LVERs at the State workforce agencies. 

The ECs also support the Five Tracks to Employment Process. 

VR&E service continually seeks out and initiates new partnerships with employers and education/training institutions to meet the needs of injured returning 

servicemembers. Some of the recent initiatives launched by VR&E to meet the 

unique employment and rehabilitation needs of returning servicemembers are:

• Faith-based community initiative (FBCI), which focuses on improving veterans’ 

employment opportunities in the nonprofit sector. • Lockheed Martin’s new supply chain management apprenticeship program. • Federal Aviation Administration’s (FAA) new agreement to train veterans at 

the FAA Academy in air traffic control and as airway facilities specialists. • Federal non-paid work experience (NPWE) programs with Federal, State, and 

local government agencies as part of the coming home to work program. • Veterans Health Administration’s (VHA) prosthetic representative trainee program. • Improvements to the early outreach effort by VA to inform veterans/

servicemembers of their VA benefits.

Question 4. VA is in the process of moving from a decentralized to a centralized 

organizational structure for its Information Technology Program with IT funding 

and responsibility for systems development moving to the Department’s Chief Information Officer. Has the realignment impacted the initiative to develop the interface 

between VA and DOD’s health data repositories? 

Response: Centralization of information technology (IT) authority under the Chief 

Information Officer will enhance significantly the ability of the Department to advance VA–DOD collaboration. With the central authority, VA can now assure that 

resources and schedules are coordinated among all stakeholders so that there is an 

even stronger programmatic foundation for interdepartmental collaboration for IT 

initiatives. 

The VA CIO is committed to advancing VA–DOD collaboration; is aligned with 

VA strategic plan as well as VA–DOD Joint strategic plan; and supports both information interoperability to enhance service to veterans and joint development initiatives to reduce cost and time to market for new IT products.

Question 5. What measures does VA have in place to protect the personally identifiable information that is being maintained in its health data repository and how 

is VA securing the transfer of personally identifiable information to DOD? 

Response: Personally identifiable information maintained in the health data repository (HDR) is controlled through the standard Veterans health information systems and technology architecture (VistA) legacy security controls, which includes 

authentication using standard access and verification codes, and user access is controlled using Kernel security’s option and menu management and security keys. 

HDR completed certification and accreditation requirements per National Institute 

of Standards and Technology (NIST) and received authority to operate in August 

2006. 

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HDR does not transfer any data to DOD; that is accomplished through the Clinical/Health Data Repository (CHDR) system. Medical information data exchange for 

patients that are using both VA and DOD health care is done via machine-to-machine exchange, which does not involve end users. Data transmission is accomplished using a virtual private network (VPN) two-way communication channel that 

is compliant with DOD security standards.

Question 6. The 2003 Presidential Task Force to Improve Health Care Delivery 

for Our Nation’s Veterans (PTF) recommended that the Administration direct HHS 

to declare the two Departments to be a single health care system for purposes of 

implementing HIPAA regulations. How did VA and DOD respond to the recommendation? How have the HIPAA requirements impacted your health information exchange efforts? 

Response: VA’s response to the President’s Task Force (PTF) to Improve Health 

Care Delivery of Our Nation’s Veterans indicated VA’s agreement with the intentions of reducing data sharing impediments between the agencies. VA, however, 

maintained its belief that there are sufficient authorities within the Health Insurance Portability and Accountability Act (HIPAA) legislation to allow sharing of protected health information without becoming one single entity. 

In general, the HIPAA privacy final rule prohibits the nonconsensual disclosure 

of protected health information (PHI). This rule, however, includes a special exemption pertaining to DOD’s sharing data with VA. This exception, 45CFR 

164.512(k)(1)(ii), allows DOD to ‘‘disclose to Department of Veterans Affairs (DVA) 

the protected health information of an individual who is a member of the Armed 

Forces upon the separation or discharge of the individual from military service for 

the purpose of a determination by DVA of the individual’s eligibility for or entitlement to benefits under laws administered by the Secretary of Veterans Affairs.’’ In 

addition, there are several other authorities provided in the privacy rule that allow 

DOD and VA to share IIHI, including treatment purposes for which no patient authorization is required, pursuant to a signed authorization from the patient and 

other authorities that allow the covered functions in both organizations to share 

PHI for various other purposes. VA and DOD HIPAA, privacy and general counsel 

staffs worked diligently to resolve any differences in interpretation of these authorities. In the end, DOD and VA were able to implement a data-sharing MOU that 

outlines these agreed-upon authorities. 

The HIPAA privacy rule has not impacted VA’s health information exchange efforts as ample authority exists under this rule for the exchange of health information both with DOD and private and public health care providers.

Question 7. I understand that VA maintains eight full-time and two part-time VA/

DOD liaison positions at DOD hospitals. How were the DOD facilities selected and 

does VA plan to expand this program in Fiscal Year 2007 and beyond? 

Response: VA currently has nine full-time and three part-time VA/DOD Liaisons 

stationed at 10 MTFs located throughout the United States. Two new sites were 

added in 2006—Naval Medical Center, San Diego and Womack Army Medical Center, Fort Bragg, NC. DOD facilities were selected based on their workload of returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans. VA 

continues to monitor the volume of returning veterans and will expand the program 

as needed.

Question 8. In 2003, the PTF recommended that, there should be a mandatory 

physical exam for all separating servicemembers. I understand that currently a separation physical is only mandatory for those who are retiring. Do you believe that 

a separation physical should be mandatory for all personnel leaving the military? 

Response: We defer to DOD for details on their requirements of physical examinations for all separating servicemembers; however, we understand that all active 

duty members are provided with periodic health assessments. Individuals retiring 

from active duty or those returning from deployment and leaving service receive 

separation physicals. All other separating members are given a health screening 

questionnaire to determine whether a follow-up assessment is needed.

Question 9. For VA and DOD, the Joint Executive Council Strategic Plan is the 

primary way by which you advance and measure performance and progress. What 

specific measures are in place to evaluate the effectiveness of your efforts? 

Response: The VA/DOD Joint Strategic Plan for Fiscal Year (FY) 2007–2009 has 

34 specific performance measures in place to evaluate the effectiveness of the Joint 

Executive Council (JEC). Measures are linked to six broad goals:

(1) Leadership commitment and accountability; 

(2) High quality health care; 

(3) Seamless coordination of benefits; 

(4) Integrated information sharing; 

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(5) Efficiency of operations; and 

(6) Joint medical contingency/readiness capabilities.

While some measures are single event milestones, 17 are outcome measures designed to promote progress over time. Future strategic plans will include mostly outcome oriented measures. 

Two examples of performance outcome measures in the current Joint Strategic 

Plan are provided for the Health Executive and the Benefits Executive Councils 

(HEC/BEC).

1. HEC, Graduate Medical Education Working Group, will examine opportunities 

for greater VA/DOD collaboration and with implementation of four initiatives the 

expected result will lead to a 50 percent increase in the number of military trainees 

applying for positions in VA-affiliated residency programs within 2 years. 

2. BEC will oversee an increase in the percent of original claims filed within the 

first year of release from active duty at a BDD site (prior to a servicemembers discharge) achieving 57 percent in Fiscal Year 2007; 61 percent in Fiscal Year 2008; 

and 66 percent in Fiscal Year 2009.

Progress is monitored at quarterly meetings of the JEC. Results achieved are presented in the JEC Annual Report to Congress. 

The President’s Management Agenda is a joint initiative that is focused on activities intended to institutionalize increased sharing and coordination between DOD 

and VA. The Proud To Be (PTB) and President’s Management Scorecard are a focused subset of initiatives that are managed through the Joint Executive Council 

(JEC). OMB provides oversight for the PTB and scorecard documents. 

Specifically, the PTB has identified two strategic areas of focus intended to indicate the institutionalization of processes related to information technology (IT) and 

process changes to overcome technical and administrative barriers. 

The specific strategic areas in each subset are: 

1. Use of Information Technology to Institutionalize Processes 

Health IT 

1. Real-Time Bi-Directional Electronic Patient Medical Records 

2. Consolidated Health Informatics 

Benefits IT 

1. VA/DOD Military Personnel Data Sharing 

2. Process Changes to Overcome Administrative Barriers. 

Structure 

1. Establish National Defense Authorization Act 2003 Pilot Projects 

2. Cooperative Separation Process/Exam 

People 

1. Develop Joint Graduate Medical Education (GME) Pilot Program 

2. Increase non-GME Training and Education Sharing 

Procurement 

1. Joint Purchasing of Non-Drug Medical Supplies and Equipment

Question 10. I understand that VA’s Overseas Military Services Coordinators are 

only available in Europe for 9 months a year and that they are stretched too thin, 

with only 2 persons covering all of Europe at any given time. Is this a function of 

funding or a perceived lack of need, and what can be done to improve overseas transition assistance? 

Response: VA’s overseas military services program was implemented in 1994 

under a memorandum of agreement with DOD. Under this agreement, VA provides 

overseas military service coordinators, and DOD provides logistical support and 

travel funding. Since the beginning of the program, coverage has been less than 12 

months; however, VA is extending this coverage in Fiscal Year 2008. Beginning Fiscal Year 2007, VA will be funding the travel cost for the program, estimated at 

$489,000 for Fiscal Year 2007. 

The number of coordinators serving overseas has continued to increase. During 

Fiscal Year 2006, 7 coordinators were assigned to Europe and Asia for 9 months. 

In addition, Korea is covered on a full-time basis by veterans service representatives 

assigned to our BDD site at Yongsan Army Base. Approximately 500 benefits briefings were conducted by our overseas coordinators and attended by about 12,000 active duty personnel and family members. The coordinators personally interviewed 

over 3,000 individuals in conjunction with these briefings. Seven overseas coordinators will provide services from mid-January until the end of September 2007, and 

will be assigned as follows: two in Germany, who also serve Belgium and the NethVerDate 0ct 09 2002 14:48 May 29, 2007 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\32723.TXT SENVETS PsN: ROWENA
23

erlands; one in England, who also serves Bahrain; one in Italy, who also serves 

Spain and Portugal; two in Japan; and one in Okinawa. VA benefits briefings will 

be conducted at about 70 overseas military facilities. 

Effective in Fiscal Year 2008, VA will provide coverage 12 months a year with 

7 counselors covering the locations outlined above.

Question 11. In September 2005, DOD issued a policy memo to the Services Secretaries directing them to provide VA with the names of servicemembers entering 

DOD’s Physical Evaluation Board process. I understand that in May 2006, this initiative was put on hold because of DOD concerns about data security compliance. 

Why was the initiative put on hold and what is its current status? Are there any 

issues related to the May 2006 VA data theft that have affected VA’s and DOD’s 

ability to share data? 

Response: From October 2005 through May 2006, DOD was e-mailing a list of 

servicemembers entering DOD’s physical evaluation board (PEB) process via a password-protected Excel spreadsheet. In May 2006, VA asked DOD to cease sending the 

list in this manner, as it didn’t meet VA’s heightened security requirements. Transmission of the data was halted until VA and DOD could implement a secure method 

of transmitting the data between Departments. Currently VA and DOD are evaluating transmitting the data electronically via a Federal Information Processing 

Standards (FIPS) 140–2 compliant secure file transfer protocol (FTP) server or one 

of the existing VA/DOD data feeds, such as the Federal Health Information Exchange (FHIE). 

Additional factors have delayed the use of the PEB data. In conjunction with addressing the secure transfer, VA staff has been addressing PEB file quality issues 

that vary widely with each file and are therefore, difficult to mitigate. Further, the 

VA data incident in May 2006 created significant delays and disruption in the data 

exchange and process. 

DOD has suggested that they will seek a way to automate the collection of the 

PEB list. DOD made extra efforts to make this data available to VA for outreach; 

however, due to the issues noted, the use has been limited thus far.

Question 12. In May 2005, VA and the National Guard signed a memorandum of 

agreement that formalized a partnership between the National Guard Bureau and 

VA to enhance the ability for VA to have access to troops, and brief returning 

servicemembers and their family members. Please describe the impact of this agreement. Also, please describe how VA is working with the other Reserve components. 

Response: In order to support better communication between the National Guard 

Bureau (NGB) and VA, a MOA was developed between VA and NGB to institutionalize this partnership. The national MOA between VA and the NGB was signed 

in May 2005 outlining how the two organizations would work together to identify 

and solve problems, and collaborate to improve communication and information flow 

about VA healthcare/benefits for Guard and Reserve members. 

On December 8, 2005, a letter and copy of that agreement was sent to all RO directors as well as Veterans Integrated Service Network (VISN) directors and VA 

medical center (VAMC) directors. The letter outlined how each RO director and 

VISN/VAMC director should begin to work with the National Guard to develop a 

similar local MOA with related state and local services and organizations. The purpose of this effort was to develop regional and local partnerships between VA leadership, National Guard Adjutants General, and State directors of Veterans Affairs and 

community agencies to enhance access and services for returning veterans and to 

integrate the delivery of services for VA benefits and healthcare services through 

the development of state coalitions. 

In late 2005, the NGB hired 54 National Guard transition assistance advisors 

(TAAs) (formerly called State benefits advisors)—one for each of the 50 states and 

4 territories. With the expansion of their role, additional TAAs have been hired for 

Texas and California. The total number of TAAs is 57. 

The primary function of the TAA is to serve as the statewide point of contact and 

coordinator, to facilitate education and awareness for Guard and Reserve members 

and their families on VA benefits and services, and to assist in resolving access 

issues for VA healthcare, benefits, and TRICARE. VA hosted the first training conference in February 2006 on VA healthcare services, Veterans Benefit Administration (VBA), National Cemetery Administration (NCA) and TRICARE. The goal of 

this partnership between VA and National Guard is to educate all Guard members 

and their families on VA benefits and to assist with access to VA benefits and services. While the program was primarily set up to take care of Guard members and 

their families, TAAs provide critical support and facilitate the integration of VA and 

community services to all members of the active, Guard and Reserve components 

returning home to the State. 

24

VA has implemented a robust outreach program with VA staff participating in 

family day events, reunions, freedom salute and drill weekends with PDHRA screening events. These events provide opportune time for VA staff to provide one-on-one 

consultation to soldiers requesting information on VA services/benefits. 

TAAs assist National Guard and Reserve members with access to care and enrollment at VA healthcare facilities near their home of record. Additionally, they work 

with other Joint Forces Headquarters staff members and directors of State family 

programs to build a State coalition of support with VA and community organizations 

for Guard members and their families to access in their local community. 

Additionally, the TAAs were charged with working locally to develop and maintain State coalitions to tie together the resources of DOD, VA and NGB and State 

and local community resources in an effort to ensure Guard and Reserve members 

and their families receive the benefits and support when they return home. The 

State coalition provides a community-based support network of VA, State and community resources to assist Guard and Reserve members at the local level. 

As of December 2006, there were 25 signed local VA/NGB MOAs and another 21 

states reported that they were in the process of developing a local MOA in 2007. 

An MOA is currently in the final phases of development with the Army Reserve 

that will further support effective joint work and sharing to serve Army Reserve 

component soldiers returning home. Plans are in process for MOAs with the USMC, 

Navy and Air Force similar to those MOAs developed with the National Guard and 

Army Reserve. 

In February 2007, VA again participated in the training for the TAAs in Phoenix, 

Arizona, in partnership with the National Guard family programs. This joint conference provided networking with the NGB State family programs to support the 

special needs of returning troops and families when spouses are deployed or returning home. 

With the strong support for families and existing infrastructure within the NGB, 

one of the best methods of working with the Reserve components has been using 

the TAAs as a primary point of contact for both the returning Guard and Reserve 

personnel. Many TAAs work directly with the Marine, Navy and Coast Guard units 

in their State. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JOHN D. ROCKEFELLER IV 

Question 1. Overall Funding Issues. Whenever I can, I try to host a roundtable 

in West Virginia to talk to newly returned soldiers, including National Guard and 

Reservists. I learn a great deal from these heroes. I fully support the goals of DOD 

and VA in improving the transition, and many of the policies sound good. But when 

I talk to West Virginia veterans, I do not hear about these policies, I hear about 

problems getting care and delays in service. 

Question 1(a). What is the level of new funding committed to these important policies? What are top officials in DOD and VA doing to train staff and deliver on the 

good intentions and commitments? 

Response: VA has wide range of training and educational programs to ensure that 

VA clinicians and administrative staff have the tools they need to respond to the 

unique and sometimes complex healthcare needs of returning combat veterans. Our 

existing training and education initiatives include: 

VETERANS HEALTH ADMINISTRATION

Tools for points of contact (POC), case managers and other front line staff:

• VHA published three Directives in 2006 clearly stating VA’s expectations regarding returning OEF/OIF veterans. The three directives cover case management 

of OEF/OIF veterans, the PEB process, and the PDHRA program. • VHA communicates policies, guidance and tools to assist front line employees 

via the seamless transition Intranet Web site. • VHA hosts a monthly conference call for the VISN OEF/OIF POCs to discuss 

issues relating to OEF/OIF veterans. • VHA maintains two e-mail groups: one for VISN POCs and one for VAMC POCs 

and case managers to facilitate dissemination of information on OEF/OIF veterans 

and discussion of issues relating to OEF/OIF veterans. 

• VHA trained over 260 VAMC POCs and case managers to use the MTF tracking 

system (MTF2VA), which tracks servicemembers transitioning from MTF to 

VAMCs. The training also included VHA’s expectation on the seamless transition 

performance measure. • VHA developed and distributed outreach toolkits to assist VA staff participating 

in National Guard and Reserve outreach programs as well as PDHRA events. 

25

• VHA in partnership with employee education service (EES) implemented an 

awareness campaign to educate VA employees on the seamless transition process. 

The awareness campaign kits, distributed in October 2006, contained EES brochures containing a list of educational products geared toward treating OEF/OIF 

veterans, seamless transition brochures, handout cards depicting the transition 

process and a video showing transition from the battlefield to VA to the community.

Tools for VA healthcare providers: 

• VA and DOD developed clinical practice guidelines to assist clinicians treating 

combat veterans. • ‘‘A Guide to Gulf War Veterans Health’’ was originally on health care for combat veterans from the 1991 Gulf War. The product, written for clinicians, veterans 

and their families, remains very relevant for OEF and OIF combat veterans as 

many of the hazardous exposures are the same. • ‘‘Endemic Infectious Diseases of Southwest Asia’’ provides information for 

health care providers about the infectious disease risks in Southwest Asia, particularly in Afghanistan and Iraq. The emphasis is on diseases not typically seen in 

North America. • ‘‘Health Effects from Chemical, Biological and Radiological Weapons’’ was developed to improve recognition of health issues related to chemical, biological and radiological weapons and agents. • ‘‘Military Sexual Trauma’’ was developed to improve recognitions and treatment 

of health problems related to military sexual trauma, including sexual assault and 

harassment. • ‘‘We are Women Veterans’’ provides a personal view of the military experience 

of women. • ‘‘Post-Traumatic Stress Disorder: Implications for Primary Care’’ is an introduction to post traumatic stress disorder (PTSD) diagnosis, treatment, referrals, support and education, as well as awareness and understanding of veterans who suffer 

from this illness. • ‘‘Traumatic Amputation and Prosthetics’’ includes information about patients 

who experience traumatic amputation during military service, their rehabilitation, 

primary and long-term care, prosthetic, clinical and administrative issues. 

• ‘‘Traumatic Brain Injury’’ presents an overview of TBI issues that primary care 

practitioners may encounter when providing care to veterans and active duty military personnel. 

• All are available in print, electronic format, and on the Web at http://

www.va.gov/VHI.

Taken as a whole, these programs add up to a rigorous, thorough and systematic 

education and training program to ensure VA staff are knowledgeable about the programs and policies in place as well as the tools to assist them in providing care and 

services to OEF/OIF veterans. In the June 2006 the Government Accountability Office (GAO) report, GAO complimented VA’s numerous educational activities and online clinical tools to ensure VA medical providers and other staff are aware of and 

recognize the healthcare needs of OEF/OIF servicemembers and veterans. 

VETERANS BENEFIT ADMINISTRATION

We are currently increasing staffing levels to reduce the pending claims inventory 

and providing the level of service expected by the American people. We began aggressively hiring additional staff in Fiscal Year 2006, increasing our on-board 

strength by over 580 employees between January 2006 and January 2007. 

It is critical that our employees receive the essential guidance, materials, and 

tools to meet the ever-changing and increasingly complex demands of their decisionmaking responsibilities. To that end, VBA has deployed new training tools and centralized training programs that support accurate and consistent decisionmaking. 

New hires receive comprehensive training and a consistent foundation in claims 

processing principles through a national centralized training program called ‘‘Challenge.’’ After the initial centralized training, employees follow a national standardized training curriculum (full lesson plans, handouts, student guides, instructor 

guides, and slides for classroom instruction) available to all regional offices. Standardized computer-based tools have been developed for training decisionmakers (69 

modules completed and an additional 8 in development). Training letters and satellite broadcasts on the proper approach to rating complex issues are provided to 

the field stations. In addition, a mandatory cycle of training for all Veterans Service 

Center employees has been developed consisting of an 80-hour annual curriculum. 

Our plan is to continue to accelerate hiring and fund additional training programs 

for new staff this fiscal year. However, because it requires an average of 2 or 3 years 

for our decisionmakers to become fully productive, increased staffing levels do not 

26

produce immediate production improvements. Performance improvements from increased staffing are more evident in the second and third years. We have therefore 

also increased overtime funding this year and recruited retired claims processors to 

return to work as reemployed annuitants in order to increase decision output. 

Since the onset of the combat operations in Iraq and Afghanistan, VA has provided expedited and case-managed services for all seriously injured OEF/OIF veterans and their families. This individualized service begins at the military medical 

facilities where the injured servicemembers return for treatment, and continues as 

these servicemembers are medically separated and enter the VA medical care and 

benefits systems. VA assigns special benefits counselors, social workers, and case 

managers to work with these servicemembers and their families throughout the 

transition to VA care and benefits systems, and to ensure expedited delivery of all 

benefits. 

The Secretary of Veterans Affairs recently announced a new initiative to provide 

priority processing of all OEF/OIF veterans’ disability claims. This will allow all the 

brave men and women returning from the OEF/OIF theatres who were not seriously 

injured in combat, but who nevertheless have a disability incurred or aggravated 

during their military service, to enter the VA system and begin receiving disability 

benefits as soon as possible after separation.

Question 1(b). Will DOD and VA be seeking additional funding to meet the health 

care needs of our returning veterans? 

Response: For Fiscal Year 2007, VA will have the funding it needs to support the 

health care needs of our returning veterans and all veterans seeking care.

Question 2. Mental Health and Suicide. Last year, I cosponsored legislation with 

Senator Harkin and others to address the tragedy of suicides among our returning 

veterans. There have been too many tragedies, including ones in Iowa and West Virginia.

Question 2(a). I realize that OMB prevents direct comments on legislation, but we 

all know that mental health care is an enormous need given the overwhelming 

stress of serving in Iraq and Afghanistan. We know there is a stigma about seeking 

mental health care. Some estimate that only 26 percent of veterans get formal mental health care. 

Response: VHA is implementing a comprehensive program to prevent veteran suicides that is analogous in many respects to the programs proposed in both the 

House and Senate. It includes initiatives to further enhance the capacity, access and 

quality of overall mental health programs as well as activities that directly focus 

on suicide prevention. One of the major components will be funding for suicide prevention coordinators in each medical center as of the third quarter of Fiscal Year 

2007.

Question 2(b). GAO says that $100 million of VA funding for mental health went 

unspent. This is wrong. Why aren’t we doing more on mental health care, and particularly suicide prevention and awareness? 

Response: When GAO stated that VA funding for mental health went unspent, 

they were referring to delayed spending of approximately $86 million of $200 million 

that was available to enhance mental health services last year. This figure represents 3.6 percent of the total $2.4 billion spent for mental health services last 

year. It represented a slowed rate of enhancement, not a decrease in services. The 

delay was related to education, training, and both program and staff development 

activities that were necessary to ensure that funds, when spent, would be used effectively and efficiently to improve care. For Fiscal Year 2007, VHA is allocating 

$306 million to enhance mental health programs, with still more increases projected 

for Fiscal Year 2008.

Question 3. Timely Access to Care for National Guard and Reservists. I have 

heard from West Virginia National Guard personnel of several instances in which 

the standards you established in your October 2003 policy regarding timely access 

to care have not been met for Guard soldiers returning to the civilian world from 

deployment in Iraq and Afghanistan. It appears that the major injuries are usually 

taken care of prior to discharge from active duty, but then after they return home, 

the soldiers slip through the cracks for care recommended by their doctors for less 

critical combat injuries.

Question 3(a). What are you doing to ensure that these combat veterans receive 

all of the care that they need and that their doctors have recommended, and that 

they receive it on a timely basis? Have you established an effective quality control 

system? 

Response: All Guard/Reserve soldiers, sailors, airmen and Marines separating 

from active duty to continued Reserve status or to civilian status have the opporVerDate 0ct 09 2002 14:48 May 29, 2007 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\32723.TXT SENVETS PsN: ROWENA
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tunity to attend the transition assistance program (TAP) briefings at each of the demobilization sites. In this program they first learn about VA healthcare services 

(and how to enroll in care), VA benefits and how to file for disability claims with 

VA. This is the first opportunity to learn about healthcare services, the 2 years of 

eligibility for VA healthcare (also 180 days of continued TRICARE healthcare) and 

90 days to receive dental care at VA. While still at the demobilization station, all 

servicemembers while on active duty complete the PDHA and they are also given 

the opportunity to see a DOD healthcare provider for care prior to leaving the demobilization station for home and being separated from active duty. 

Once the veteran is home, they schedule a VA primary care clinic appointment 

after enrolling in VHA care and will in most cases receive a VA appointment within 

30 days for evaluation of their deployment-related condition. While they attend the 

clinic appointment, a series of screening exams are performed such as for PTSD, depression, alcohol abuse, military sexual trauma, etc. Additional referrals are made 

for specialty care as the primary care provider requests follow-up of any medical 

condition which has been identified in the screening or physical examination. These 

times for receiving primary care appointments are tracked as national performance 

measures to ensure that Guard/Reserve members receive the care that they need 

in a timely manner and for all the conditions that have been caused or aggravated 

through their combat deployment. 

An additional program that offers screening for physical/mental health conditions 

occurs at the unit or use of a call center for screening exams for lingering mental 

health/physical conditions that are experienced at 90–180 days when they return 

home. This is a coordinated effort between VA and DOD (specifically the Guard/

Army Reserve) to offer a screening exam and schedule appointments to VA, 

TRICARE or private physicians for further evaluation of these deployment-related 

conditions. VA staff members are present at the unit to accept referrals and schedule appointments to the local VA for follow-up evaluation for any physical or mental 

health condition. Again, Guard/Reserve members will receive appointments for primary care within 30 days and Vet Centers. Guard/Reserve members may choose to 

visit a civilian provider through TRICARE or use their private insurance from their 

civilian employer.

Question 3(b). Is there an appeal or grievance process through the Veterans Affairs system? 

Response: For healthcare services, each VAMC has a patient advocate to assist 

with complaints for care or issues concerning eligibility. At each VAMC there is also 

an OEF/OIF coordinator who is an ombudsman for the Guard/Reserve or active duty 

servicemember requesting healthcare. Since many of the Guard/Reserve members 

are new to VA, they are frequently escorted to the eligibility clerk at the VAMC who 

will begin the enrollment process and facilitate appointments.

Question 3(c). What can be done to meet the health insurance needs of our medically retired National Guard members and their families? 

Response: The medically retired veteran will continue to receive healthcare at the 

local VAMC and Vet Center for the condition of their disability as well as other conditions that may appear later. These members may also be eligible for DOD benefits; however, we defer to DOD for additional information.

Question 4. Information Sharing. What can be done to facilitate a more efficient 

flow of communication between military medical facilities, to include Community 

Based Health Care Organization (CBHCO) and Military Treatment Facilities (MTF), 

and the individual state Adjutant General when an injured soldier transitions from 

one duty status to another? 

(From the National Guard’s point of view, there should be a point of contact clearly identified or established at every military medical facility, including CBHCOs and 

MTFs, who would be responsible for notifying the soldier’s Adjutant General when 

the soldier is admitted, discharged or transported to another facility. The Adjutant 

General would then assure the delivery of transitional benefits access and counseling to include Veterans Affairs healthcare options, TRICARE programs that may 

be available, VA benefits counseling such as home loan guarantee, education benefits, and or vocational rehabilitation services.) 

Response: Each of the 10 MTFs where the large number of severely injured 

servicemembers receive their initial care, have VA/DOD liaisons and VBA counselors embedded with DOD staff to facilitate the transition from DOD to VA to the 

community. Case managers in Medical Holdover and the eight community based 

healthcare organizations (CBHCO) are activated Guard Nurses who notify the Adjutant General or the J–1 staff in each State about the health and transition status 

of the active duty servicemembers in these programs. The TAAs in each State work 

for the Adjutant General and are trained by VA experts to assist the State director 

28

of Veterans Affairs in notification of returning servicemembers to the State. They 

coordinate with the J–1 staff in the State for updates of those returning 

servicemembers/veterans back to the State. They also help to facilitate the briefings 

to returning soldiers to ensure that they receive Federal and State veterans benefits 

when they transition from active duty to veteran status. The TAAs work collaboratively with the State family program directors to provide VA information to them 

for their retiring spouse. 

The Adjutant General, TAA and J–1 staffs assure access and counseling on transitional benefits to include VA healthcare options, TRICARE options, VA benefits 

such as home loan guarantee, education benefits, and vocational rehabilitation services. State directors of Veterans Affairs, county service officers, veterans’ service officers as well as VA staff from the hospital and regional office participate in the 

PDHRA events to provide outreach information to new veterans. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. BARACK OBAMA

Question 1. Electronic Health Records. As part of last October’s Defense Authorization Bill, Congress required a report on the feasibility of providing each 

servicemember with a secure electronic copy of their health and service records. I 

was hoping you could discuss the importance of the DD214 form to veterans applying for benefits and healthcare and the potential advantages of giving veterans more 

specific data about their service and medical histories through an individual electronic health record. 

Response: VA and DOD have made significant progress in sharing electronic 

health information and lead the Nation in sharing electronic health data between 

two large medical enterprises. Veterans’ benefits claims adjudicators have electronic 

access to the DD214 by using the VA personnel information exchange system to connect to the Defense personnel records retrieval system portal to the official military 

personnel files maintained by the services. The DD214 is a part of that official military personnel file and is an essential document for all veterans when they apply 

for VA benefits 

Veterans also have increasing access to their own medical information and other 

important health data through My HealtheVet (MHV). VA has currently deployed 

MHV as the eHealth portal and personal health record (PHR) for veterans and VA 

employees. MHV continues to release new iterations, and now includes a robust selfentered PHR, Internet prescription refill capability, and targeted clinical health information for conditions and healthy living. Participants can enter information 

about their health, conditions, medications, and care providers in one secure electronic eVAult; track health readings (e.g., blood pressure and blood sugar); keep 

health journals (e.g., food and activity journals); and print out summaries for their 

various health care providers. In December 2006, VA launched the second generation of the PHR. Veterans who receive care in the VA system may now choose to 

upgrade their account by undergoing a face-to-face authentication at an authorized 

VA care facility. They then can elect to receive more identifiable health information 

from VA’s VistA electronic health records, such as their appointments, medication 

names and laboratory results. The rollout of this VistA electronic health records information to MHV PHR is expected to take place over the coming year, and will include training for clinicians and patients, as specified by the VA clinical and patient 

education community. The use of information technology to improve the Veteran experience is a high priority. VA is actively working to help lead the Nation into a 

future of patient-centered health information.

Question 2. Aggregate Health Data. I am concerned that the military is not giving 

VA enough concrete data to help them conduct long-term planning. Let’s take mental health as an example. The Army’s Mental Health Advisory Team found that soldiers who deployed to Iraq for a second time were more likely to suffer mental 

health problems. Absent that data, what kind of data is VA using to anticipate the 

demand for mental health care? Did VA anticipate that 36 percent of Iraq/Afghanistan veterans entering the VA would require mental health treatment? 

Response: In additional to available data to project current demand for mental 

health services from servicemembers from OEF/OIF, VA looks at historical medical 

treatment trends from past periods of war. VA also considers capacity needs to meet 

that demand by conducting reviews of literature, past VA and DOD epidemiological 

studies, and utilization records. Based on our reviews, we anticipated that a proportion of OEF/OIF veterans would require mental health services. 

VA anticipated that 36 percent of OEF/OIF veterans entering VA would require 

mental health treatment based on review of the research conducted since the time 

of the Vietnam War, which found that increasing exposure to war zone stressors can 

29

result in an increase in vulnerability to PTSD and associated mental and emotional 

problems. Data from various studies of veterans of previous wars suggested that 

overall, the rate of mental problems can be in the range of 15–26 percent, or higher 

in certain populations exposed to extreme stress such as prisoners of war. That the 

number of veterans coming to VHA has a rate of mental problems in the 30 percent 

range has been evident since we began tracking the utilization rates for VHA services for returning OEF/OIF veterans in Fiscal Year 2002.

Question 3. Falling through the Cracks. In an average year, 10,000 to 20,000 

servicemembers are separated from the military through the Medical Evaluation 

Board and Physical Evaluation Board Process. These are soldiers who, because of 

a physical or mental health problem, are unfit to be deployed. 

Question 3(a). How many of these troops had benefits claims filed before they discharged? 

Response: Servicemembers undergoing medical evaluation board (MEB) or PEB 

proceedings with a discharge date are currently included in the BDD program. 

There were approximately 36,000 claims filed through the BDD program in Fiscal 

Year 2006. VBA does not separately track MEB/PEB cases; rather, all BDD cases 

are tracked and handled expeditiously.

Question 3(b). How many had their first VA medical appointment scheduled before they discharged? 

Response: Medical appointments are made according to the patient’s clinical need. 

For the seriously injured patients requiring inpatient rehabilitation and transfer 

from a DOD MTF to a VAMC, medical appointments are made prior to hospital discharge in all cases. Patients who are discharged from the DOD treatment facility 

to outpatient status elect where they will get their outpatient medical care. That 

care may or may not be provided by a VA treatment facility. If the patient elects 

to receive his or her care in the VA system, the VA personnel in the DOD treatment 

facility coordinate the appointment prior to discharge.

Question 3(c). What kind of comprehensive case management is being offered to 

these troops? 

Response: Each VAMC has designated an OEF/OIF clinical case manager to provide ongoing case management services to returning OEF/OIF servicemembers, veterans and their families. Although many OEF/OIF patients may not require intensive case management, VA requires the case manager to conduct an initial assessment to identify and assist with immediate needs. Patients with severe injuries or 

having complex needs will receive ongoing case management as their medical and 

psychosocial needs dictate. The case manager is accessible to the patient and family 

should additional needs arise in the future. In addition, VA requires that 

polytrauma patients receiving treatment at one of VA’s four polytrauma rehabilitation centers receive social work case management services at a ratio of one social 

work case manager for no more than six OEF/OIF polytrauma inpatients. 

VBA counselors and VHA social worker liaisons have been established at MTFs. 

ROs have established liaison with local MTFs to ensure contact with seriously injured OEF/OIF veterans. VBA counselors at key MTFs or VA medical facilities meet 

with every injured OEF/OIF servicemembers when medically appropriate. The 

servicemembers are made aware of all potential VA benefits and services as well 

as other benefits and services available through other sources. They are assisted in 

completing their claims and gathering supporting evidence. While servicemembers 

are hospitalized, they are routinely informed about the status of all of their pending 

claims. Servicemembers are given a business card that contains the VBA counselors 

name and contact information such as a telephone number.

Question 3(d). Concerning the 631,000 total Iraq/Afghanistan veterans, wounded 

or otherwise, what kind of one-on-one transition assistance did these veterans receive? 

Response: VA provides outreach to all returning servicemembers to inform them 

of the benefits and services for which they may be eligible. VA provides pre- and 

post-mobilization briefings as well as 3-day TAP workshops and disabled transition 

assistance program (DTAP) workshops which advise injured/ill servicemembers 

about benefits available through VBA’s Vocational Rehabilitation and Employment 

Program. To assist recently separated veterans, the Veterans assistance at discharge system (VADS) process generates a ‘‘Welcome Home Package’’ that includes 

a letter from the Secretary, VA Pamphlet 21–00–1, A Summary of VA Benefits, and 

VA Form 21–0501, Veterans Benefits Timetable. Servicemembers receive one-on-one 

transition assistance through the BDD program which allows servicemembers to 

begin the VA disability examination process up to 180 days prior to discharge. 

Veterans service center case managers are assigned for each compensation claim 

received from a seriously disabled OEF/OIF servicemember. The case manager beVerDate 0ct 09 2002 14:48 May 29, 2007 Jkt 000000 PO 00000 Frm 00033 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\32723.TXT SENVETS PsN: ROWENA
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comes the primary VBA point of contact for claims processing; however, the VBA 

counselors at the MTF may continue to be involved if the servicemember is still a 

patient at the MTF. 

VA continues to explore additional ways to meet the needs of both the active duty 

and Reserve and Guard members supporting OEF/OIF. The Secretary of Veterans 

Affairs just announced that VA is beginning a new initiative to provide priority 

processing of all disability compensation claims from OEF/OIF veterans. A second 

component of this initiative is focused on identifying additional enhancements that 

can be made to our outreach program for Reserve and Guard members. The Secretary is also creating a special Advisory Committee on OEF/OIF veterans and families, which will advise on the full spectrum of issues affecting these veterans and 

their families.

Question 4. Aggregate Health Data. The Pentagon provides limited data to the VA 

about servicemembers when they are separating, but does not provide comprehensive systematic data on the numbers of wounded that could help VA in long-term 

planning. A recent Harvard report put the number of American servicemembers 

wounded in Iraq and Afghanistan at more than 50,500. Some of these soldiers are 

sent to military hospitals in the U.S., but many are healed and returned to service. 

VA polytrauma facilities often care for injured Active Duty troops. What kind of lead 

time does the Pentagon give the VA before transferring these patients to VA care? 

What does that do to your budget planning? 

Response: The time between notification of the Polytrauma Rehabilitation Centers’ (PRC) intent to transfer a seriously injured servicemember or veteran to a VA 

health care facility and actual patient transfer is variable. That time can be hours, 

days or weeks before transfer. The process involves exchange of clinical information 

regarding patients to be transferred from the MTF. The VA Polytrauma system of 

care uses this information to monitor capacity and to plan clinical care. 

As to budget planning, the budget estimates are updated each year with the most 

current information available. This helps to ensure that the budget estimates are 

consistent with changes in the numbers of patients treated.

Question 5. Total Costs of Caring for OEF/OIF Veterans. A recent report by the 

Kennedy School of Government at Harvard put the lifetime costs of caring for Iraq/

Afghanistan veterans at $350 to $700 billion. Do you agree with this estimate, and 

if not, what estimate can you offer in its place? 

Response: The Administration reviews and funds the needs of veterans 1 year at 

a time. In Fiscal Year 2008, VA estimates that it will treat over 263,000 OIF/OEF 

veterans at a cost of approximately $752 million. This estimate is based on the actual enrollment rates, age, gender, morbidity, and reliance on VA health care services of the enrolled OIF/OEF population. OIF/OEF veterans have significantly different VA health care utilization patterns than non-OIF/OEF enrollees, and this is 

reflected in the estimates above. For example, when modeling expected demand for 

PTSD residential rehab services for the OIF/OEF cohort, the model reflects the fact 

that they are expected to need three times the number of these services than nonOIF/OEF enrollees. The model also reflects their increased need for other health 

care services, including physical medicine, prosthetics, and outpatient psychiatric 

and substance abuse treatment. On the other hand, experience indicates that OIF/

OEF enrollees seek about half as much inpatient acute medicine and surgery care 

from the VA as non-OIF/OEF enrollees. 

At this point in time, the full impact of the conflict remains uncertain. Many unknowns will influence the number and types of services that VA will need to provide 

OIF/OEF veterans, including the duration of the conflict, when OIF/OEF veterans 

are demobilized, and the impact of our enhanced outreach efforts. VA has estimated 

the health care needs of OIF/OEF veterans based on what we currently know about 

the impact of the conflict. To ensure that we are able to care for all returning OIF/

OEF veterans, we have made additional investments in our medical care budget.

Chairman AKAKA. Thank you. Thank you very much. 

May I now ask, Secretary Chu, for your statement. 

STATEMENT OF HON. DAVID S.C. CHU, UNDER SECRETARY OF 

DEFENSE FOR PERSONNEL AND READINESS, DEPARTMENT 

OF DEFENSE 

Dr. CHU. Good morning, Mr. Chairman, Members of the Committee. I have a statement for the record which I hope will be inVerDate 0ct 09 2002 14:48 May 29, 2007 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\32723.TXT SENVETS PsN: ROWENA
31

cluded in the proceedings of this hearing. It is a distinct privilege 

to appear with Gordon Mansfield——

Chairman AKAKA. It will be included in its entirety. 

Dr. CHU. Thank you, sir. It is a distinct privilege to appear here 

this morning with Gordon Mansfield, the Department of Defense 

Council and Secretary Mansfield, as our partner in addressing the 

issues that Members of the Committee have outlined this morning. 

I want to thank him and his predecessor, Leo McKay, for the partnership they have created over these last 6 years. It is a different 

relationship than it was 6 years ago, and I think the reason for 

that difference is commitment—commitment by the Administration, commitment by the two Cabinet Secretaries, commitment by 

the individuals up and down the line in the two agencies that are 

responsible for our military personnel and the veterans of the 

United States. 

The mechanism we use to move forward improvements to service 

in the two Cabinet Departments is, as Secretary Mansfield alluded, 

the so-called Joint Executive Council. This was formed during this 

Administration, sanctioned by the earlier President’s Task Force to 

Improve Health Care for our Nation’s Veterans, and enshrined in 

statute by the Congress. It oversees the work of the two separate 

councils—one on health, one of benefits—both devoted to strengthening the services and improving the delivery of services to our Nation’s veterans. The guidance document that we use is an annual 

Joint Strategic Plan that outlines goals in the six key areas touching on the very issues that Members of the Committee have addressed this morning. 

I believe that if you look at the record over the last half a dozen 

years, you will see progress in every area that your letter of invitation outlined, Mr. Chairman. I would like to call attention to just 

two issues of particular concern that are highlighted this morning, 

those being health and the transition to civil life. 

In the health arena, the Department now assesses the health 

status of each departing, deploying servicemember before he or she 

goes overseas. When the servicemember returns, there is a parallel 

assessment. That is the source of data on issues like mental symptoms, et cetera. And realizing especially that post-traumatic stress 

disorder will not necessarily evince itself at the point of return, we 

reach out to all returning servicemembers, including those who 

have left active duty, 3 to 6 months after that service. So there is 

now a record of their status at these three key points in time. 

We recognize that the two Departments have a special responsibility to those who have severe injuries. Each military service has 

its own program for caring for these individuals and assuring that 

their needs are met, but to be doubly sure that there is no issue 

that falls through the cracks, we constituted several years ago a 

Military Severely Injured Center. Its responsibility is to pick up on 

any issue that an individual might have. Those range from how the 

Transportation Security Agency treats veterans who may have 

prosthetic devices—for example, implants of various kinds—when 

they transition airport security, through the issue of what will 

their future look like. And, indeed, the model to which we are moving is one in which we proffer opportunities to them rather than 

waiting for them to seek out the opportunities that may be there. 

32

And certainly, the Department of Defense and I think the Veterans 

Affairs Department has a similar view. We view these as potentially attractive individuals who might well qualify for civil employment in our agencies, bring to those agencies the knowledge, the 

ethos, really, of military service that is so important to our future 

success. 

Transitioning to civil life is a challenge for all military personnel 

in every area. That is why the three Cabinet Departments have for 

some time now constituted the Transition Assistance Program. 

This is a multi-day program, a portion of which is mandatory for 

all separating personnel, that outlines the benefits to which they 

are entitled, outlines how they might approach those benefits. The 

Department of Labor in particular offers them assistance in locating positions, understanding what job banks are out there, and how 

to approach them, how to use the Department of Labor’s decentralized job referral system, and how to build their resume. 

Secretary Mansfield has highlighted what I think is an example 

of the continued success of the two agencies, and that is the commitment to a common electronic inpatient record. We have now in 

DOD a worldwide record for outpatient care, but we need to create 

a parallel record for inpatient care. We intend to do that in partnership with the VA so we have a single record. 

Do we need to do more? Of course. Will we do more? Yes, we will. 

And, in fact, tomorrow is the next quarterly meeting of the very 

Joint Executive Council that Secretary Mansfield celebrated in his 

comments. 

Thank you, Mr. Chairman. 

[The prepared statement of Dr. Chu follows:]

PREPARED STATEMENT OF HON. DAVID S.C. CHU, UNDER SECRETARY OF DEFENSE

FOR PERSONNEL AND READINESS, DEPARTMENT OF DEFENSE

Chairman and distinguished Members of the Committee, thank you for the opportunity to discuss a key element in the President’s Management Agenda—Department of Defense (DOD) and Department of Veterans Affairs (VA) collaboration. 

DOD sets a high priority on expanding existing efforts and identifying new opportunities for collaborative and cooperative activities with the VA. I am pleased to be 

here today to provide an overview and status update of many of these innovative 

programs and initiatives. 

While the two Departments have been working together in earnest for over two 

decades, the many professionals within both Departments are bringing DOD and VA 

closer together at a pace greater than at anytime before, under the guidance of the 

VA/DOD Joint Executive Council (JEC). The JEC provides guidance and establishes 

policy for the full spectrum of collaborative activities and initiatives between the two 

Departments. The JEC oversees and guides the activities of the VA/DOD Benefits 

Executive and Health Executive Councils (BEC and HEC, respectively), as well as 

their many working groups. The HEC is responsible for implementing a coordinated 

health care resource sharing program. The BEC is responsible for examining ways 

to expand and improve benefit information sharing, refining the process for records 

retrieval, and identifying procedures to improve the benefits claims process. 

Program managers and directors from both departments have been working closely with one another to improve access, quality and efficiency. DOD believes that 

none of our efforts are more important than creating an uninterrupted continuum 

of care for severely injured and ill servicemembers and their families, whatever 

their individual needs may be, as they transition from military service to veteran 

status. 

Tomorrow, VA Deputy Secretary Mansfield and I are scheduled to sign our Annual Report on Resource Sharing. The report will present in considerable detail 

what I believe are our accomplishments of the past fiscal year, and will offer a look 

into the future for our collaborative efforts as we endeavor to make transition between the two departments as seamless as possible. 

33

An important appendix to the report contains the third update to the VA/DOD 

Joint Strategic Plan for Fiscal Years (FY) 2001–2009. This plan guides our joint activities and serves as the primary instrument by which we measure progress and 

success throughout each year. As a testament to the firm foundation that has been 

established, the guiding principles have remained unchanged since their inaugural 

release in 2004. However, the current plan reveals lessons learned in the areas of 

identifying opportunities for improvement, developing goals and strategies to 

achieve these improvements, and developing performance measures. 

Accordingly, my statement today will address the many activities under way that 

reflect the shared commitment to delivering care and benefits across our departments. 

RESOURCE SHARING OVERVIEW

Health care resource sharing is a broad term used to describe a wide spectrum 

of collaboration between DOD and VA. Within this spectrum lie many areas of sharing, including general and specialized patient care, education and training, research 

and development, and health care administrative support. The departments provide 

these services to one another under mostly local agreements that involve reimbursement or exchange of services. At the end of Fiscal Year 2006, DOD military treatment facilities (MTFs) and Reserve units were involved in sharing agreements with 

157 VA Medical Centers. 

In addition to these local sharing agreements, which are the cornerstone of our 

collaborative relationship, there are a variety of systemic initiatives. Section 721 of 

the Fiscal Year 2003 National Defense Authorization Act (NDAA) required VA and 

DOD to establish an account in the Treasury, referred to as the Joint Incentive 

Fund (JIF), and fund the account on an annual basis. The JIF is intended to eliminate budgetary constraints that deter sharing initiatives by providing funding to 

cover the startup costs associated with innovative and unique sharing agreements. 

JIF projects are selected using criteria that include improvements in access, return 

on investment, and overall contributions to the goals and objectives of the Joint 

Strategic Plan. Fiscal Year 2006 projects embraced a broad spectrum of health care 

programs: mental health counseling, Web-based training for pharmacy technicians, 

cardio-thoracic surgery, neurosurgery, and increased physical therapy services for 

both DOD and VA beneficiaries. At the end of Fiscal Year 2006, 47 JIF projects accounting for $88.8 million of the $90 million in the fund had been approved by the 

HEC from a total of over 200 proposals. 

Section 722 of the Fiscal Year 2003 NDAA mandated the DOD and VA to execute 

no less than three health care coordination demonstration projects over a 5-year period. There are seven sites currently testing initiatives such as the Bi-Directional 

Health Information Exchange, on which I will elaborate later, as well as a Laboratory Data Sharing Initiative and Joint Market Workload Data Analysis. 

The DOD and VA also collaborate extensively in the area of education and training. There are 159 VA/DOD agreements involving education and training, including 

training for physicians and nurses. In Fiscal Year 2006, the HEC continued to monitor a pilot program for military physician residents placed at academically affiliated 

VA medical centers. The military residents rotate through VA facilities and provide 

care to VA patients under the supervision of university faculty. 

COLLABORATION RESULTS

While resource sharing is a fundamental part of our relationship with the VA, I 

am proud that this partnership has expanded further and now entails a significant 

number of programs within both the DOD personnel and health affairs communities. A particular focus is facilitating a coordinated transition, enabling 

servicemembers, veterans, and their families to navigate a complex benefits systems 

with relative ease—a seamless transition. I will describe several of our ongoing efforts. 

• One program under the purview of the BEC facilitated 130 Memoranda of Understanding between local DOD and VA facilities for a cooperative separation physical examination process. This program, called Benefits Delivery at Discharge 

(BDD), brings claims specialists from the Veterans Benefits Administration (VBA) 

to assist separating servicemembers in filing disability claims as soon as 6 months 

before they leave uniform. According to VA, BDD has reduced the average time for 

an adjudication decision to approximately 60 days. 

• The Army Liaison/VA Polytrauma Rehabilitation Center Collaboration program, 

a ‘‘Boots on the Ground’’ program, stood up in March 2005. The intent of this collaborative effort is to ensure that severely injured servicemembers who are transferred directly from an MTF to one of the four VA Polytrauma Centers in Richmond, 

34

Tampa, Minneapolis, and Palo Alto, are met by a familiar face in a uniform. DOD 

has a long-standing relationship with the VA, in which VA provides rehabilitative 

services for patients with traumatic brain injuries, amputations, and other serious 

injuries as soon after the incident as clinically possible. A staff officer or non-commissioned officer assigned to the Army Office of the Surgeon General is detailed to 

each of the four locations. The role of the Army liaison is primarily to provide support to the family through assistance and coordination with a broad array of issues, 

such as travel, housing, and military pay. The liaisons have also played a critical 

role in the rehabilitation process by promoting resiliency in servicemembers. The 

presence of a uniformed liaison reassures these servicemembers and their families 

that we appreciate their service and are committed to ensuring their needs are met 

by our sister agency. 

• The Joint Seamless Transition Program, established by VA, in coordination 

with the Military Services, facilitates a more timely receipt of benefits for severely 

injured servicemembers while they are still on active duty. There are 12 VA social 

workers and counselors assigned at 10 MTFs, including Walter Reed Army Medical 

Center and the National Naval Medical Center in Bethesda. They ensure the seamless transition of health care includes a comprehensive plan for treatment. VBA 

counselors visit all severely injured patients and inform them of the full range of 

VA services, including readjustment programs, and educational and housing benefits. As of December 15, 2006, VA social worker liaisons had processed 6,714 new 

patient transfers to Veterans Health Administration (VHA) at the participating 

military hospitals. 

VA social workers work on-site at the MTFs to respond to referrals to coordinate 

inpatient care and outpatient appointments at a VA medical center near the patient’s intended residence. They coordinate transfer of care and maintain follow-up 

with patients to verify success of the discharge plan, and to ensure continuity of 

therapy and medications. Case managers also refer patients to Veterans benefits 

counselors and vocational rehabilitation counselors. 

• The Department is committed to providing the assistance and support required 

to meet the challenges that confront our severely injured and wounded 

servicemembers and their families during the difficult time of transition. Each military Service has programs to serve their severely wounded from the war: the Army 

Wounded Warrior Program (AW2), the Navy SAFE HARBOR program, the Air 

Force Helping Airmen Recover Together (Palace HART) program, and Marine4Life 

Injured Support Program. DOD’s Military OneSource Center is part of this effort 

to augment the support provided by the Services. It reaches beyond the DOD to 

other agencies, the nonprofit world and corporate America. What makes the Center 

unique is that it serves as a fusion point of four Federal agencies—DOD, the VA, 

the Department of Homeland Security’s Transportation Security Administration, 

and the Department of Labor. 

The BEC also monitors the implementation of Traumatic Injury Protection under 

Servicemembers’ Group Life Insurance (TSGLI) program authorized by Public Law 

109–80. The first payments under this authority were released on December 22, 

2005, and as of the end of Fiscal Year 2006, 2,607 claimants were paid a total of 

$170 million with the average payment at just over $65,000. 

HIGH QUALITY HEALTH CARE

Having the right programs in place is not enough. There must be an unyielding 

commitment to quality when it comes to providing world-class health care to our 

Nation’s servicemembers and veterans. Thus, in addition to the four VA Polytrauma 

Centers and VA social workers in place at select MTF’s, VA and DOD have also 

begun or expanded collaborative programs in the areas of deployment health, evidenced-based clinical practice guidelines, and patient safety. 

DEPLOYMENT HEALTH

DOD has been performing health assessments on servicemembers prior to and 

just after deployment for several years now. These assessments serve as a screen 

to identify any potential health concerns that might warrant further medical evaluation. This includes screening the mental well-being of all Soldiers, Sailors, Airmen 

and Marines in both the Active and Reserve Components. 

Every year, members are screened for mental health problems when they complete a preventative health assessment. Now, they are again screened before they 

deploy. In addition, before returning home from deployment, members complete a 

post deployment health assessment, which contains questions aimed at identifying 

physical or mental health concerns; environmental exposure concerns; psychosocial 

35

concerns, such as acute post traumatic stress disorder, depression, anger, or interpersonal conflict; and potentially unexplained symptoms. 

The Services are now implementing an additional health reassessment that is 

conducted 3–6 months after returning home—the Post Deployment Health Re-Assessment. Our experience has taught us that problems are not always apparent at 

the time servicemembers are immediately returning home, but they may surface a 

few weeks or months later. We want to assist in early identification of these concerns and facilitate ready access to care at the level most appropriate to the individual servicemember. 

CLINICAL GUIDELINES

DOD and VA have worked hard to develop joint evidenced-based clinical practice 

guidelines. The medical literature supports the premise that guidelines reduce variations in care, optimize patient outcomes, and improve the overall health of beneficiaries. There is a working group that works specifically on developing, updating, 

and promulgating these guidelines to clinicians in both health care systems. 

Because of challenges faced by our forces, some servicemembers may develop 

chronic mental health symptoms. Mental health experts from the DOD and VA developed joint clinical practice guidelines for acute and post traumatic stress disorder, major depressive disorder, substance use disorders, medically unexplained 

symptoms, pain, and general post deployment health concerns. DOD uses all available resources, including local military or TRICARE providers (a benefit extended 

for up to 180 days post deactivation for Reservists), to provide treatment for affected 

servicemembers. VA is a partner in this process by providing health care and counseling services to Operation Enduring Freedom (OEF) and Operation Iraqi Freedom 

(OIF) veterans who are no longer on active duty. 

PATIENT SAFETY

In addition to deployment health, the HEC is committed to ensuring that care is 

delivered with the absolute least risk to the patient. DOD and VA have highly respected patient safety programs and work with other government agencies, such as 

the Centers for Disease Control and Prevention and the Food and Drug Administration, to prevent harm to patients while they are receiving care. As a prime example 

of working together to minimize risk of adverse events and to support the commitment to provide the best health care treatment outcomes, in Fiscal Year 2006 DOD 

implemented a system for developing patient safety alerts that was modeled on the 

VA’s system. 

EFFICIENCY OF OPERATIONS

The JEC is committed to efficiency. Through the VA/DOD Acquisitions and Pharmacy Working Groups, the two departments have achieved substantial savings to 

the taxpayer, obtaining economies of scale through joint purchasing of capital equipment and pharmaceuticals. 

These working groups recently reported there are currently 46 shared contracts 

for medical and surgical equipment contracts: the Defense Supply Center Philadelphia reported sales in Fiscal Year 2006 from these contracts in excess of $170 million and VA reported another $201.5 million. The Pharmacy Working Group reported 77 Joint National Contracts that resulted in a combined cost avoidance of 

$423 million for pharmaceutical purchases in the first three quarters of Fiscal Year 

2006. 

INFORMATION SHARING

The programs and benefits earned by servicemembers could not be delivered without complete cooperation between the DOD and the VA in the area of information 

sharing. Indeed, information sharing is critical to an effective and transparent transition process, and that is why so much attention is paid to information management and information technology in the Joint Strategic Plan. 

Important to health care related information sharing is the requirement to comply 

with the Health Insurance Portability and Accountability Act (HIPAA). DOD and 

VA signed a Memorandum of Agreement governing the sharing of Protected Health 

Information (PHI) and other individually identifiable information in June 2005. 

The Federal Health Information Exchange (FHIE) supports the monthly electronic 

transfer of health information from DOD to VA at the time of the servicemember’s 

separation. The data contained in this transfer include: pharmacy and allergy data; 

laboratory and radiology results; consult reports; discharge summaries; admission, 

disposition and transfer information; and patient demographic information. Health 

36

care providers within VHA, and benefits counselors within VBA, access this information via the Computerized Patient Record System and Compensation and Pension Records Interchange, respectively. As of the end of Fiscal Year 2006, DOD had 

transmitted health data on over 3.6 million patients. DOD uses FHIE to transmit 

data to the VA regarding VA patients receiving care within an MTF, and has sent 

over 1.8 million individual transmissions. 

FHIE is also being used as a platform from which DOD transmits pre- and postdeployment assessment information for separated servicemembers and demobilized 

Reservists and Guardsmen. Over 1.5 million assessments on more than 623,000 individuals have been electronically transmitted to VA. 

Building from the FHIE, which is a one-way flow of information, DOD and VA 

have developed and begun deployment of the Bidirectional Health Information Exchange (BHIE). This exchange enables near real time sharing of allergy, outpatient 

prescription, inpatient and outpatient laboratory and radiology results, and demographic data between DOD and VA for patients treated by both departments. BHIE 

is operational at all VA medical centers and at 14 DOD medical centers, 19 hospitals, and over 170 outlying clinics. 

With an eye toward the future, the VA/DOD Health Information Technology Sharing Working Group began in Fiscal Year 2006 to establish an interface between 

BHIE and the DOD Clinical Health Data Repository in order to accelerate progress 

in sharing appropriate health information. This interface will ensure that all VA 

sites and all DOD sites worldwide will have the ability to view data from the other 

department for shared patients. We are also focusing on increasing the amount of 

inpatient data exchanged. Most recently, BHIE began to exchange inpatient and 

emergency department discharge summaries. Other inpatient documentation, such 

as operative reports and inpatient consultations, are planned for the future. 

DOD is aware of the concerns regarding the time it has taken to establish the 

desired level of interoperability. With the full deployment of DOD’s electronic health 

record (EHR)—AHLTA—across the Military Health System accomplished, we are 

poised to continue building on our significant achievements in sharing critical 

health information across department lines. The ultimate desired end-state will be 

a completely electronic health care record that is accessible and useable to the provider regardless of which health care system they are operating within. 

In pursuit of that goal, DOD and VA are developing an assessment of the clinical 

workflow and health information for the care of inpatients. Management of inpatient care is a future capability planned for AHLTA. VistA, the VA EHR, supports 

ambulatory care plus a segmentable but integrated inpatient care capability. VA is 

planning to modernize VistA, including its inpatient module. We believe that this 

is an opportunity to explore a ‘‘born seamless’’ approach for a joint inpatient EHR. 

I want to discuss two additional information sharing programs that provide VA 

with essential data in order to expedite the benefits delivery process. First, DOD 

is providing contact information for servicemembers when they separate. DOD 

began routinely providing VA rosters on recently separated OEF and OIF veterans—Active Duty and Reserve Components—in September 2003. VA uses these 

lists to send letters to veterans containing information on VA benefits related to 

service in a combat theater. Over 580,000 letters have been mailed. 

Second, DOD is transmitting to VA’s Office of Seamless Transition a monthly list 

of key demographic and contact information about servicemembers for whom a Medical Evaluation Board has referred them to a Physical Evaluation Board. This list 

enables VA case managers to make contact with servicemembers at the earliest time 

possible, while they are still in uniform. By the end of Fiscal Year 2006, DOD had 

provided VA with contact information for 13,622 individuals. 

To support streamlined benefits processing and reduce operating costs, VA and 

DOD continue to develop and implement military personnel data sharing initiatives 

under the auspices of the BEC. Movement toward a single bidirectional data feed 

between VA and DOD is achieved by incorporating necessary data sets into a data 

sharing schema and then eliminating legacy feeds. Specific data sets incorporated 

into the VA/DOD data sharing schema in Fiscal Year 2006 include Reserve and 

Guard activation and mobilization data, deployment data and combat pay indicators 

on all servicemembers and veterans, education eligibility data enhancements which 

support the Montgomery GI Bill and Montgomery GI Bill Selected Reserve programs, and medical eligibility for combat injuries. Additionally, DOD also made the 

Defense Personnel Records Information Retrieval System available to VA online to 

enhance VA employees’ access to the Official Military Personnel File. In Fiscal Year 

2006, the number of separate data exchanges flowing from DOD to VA were reduced 

from 31 to 20. From VA to DOD, the number of separate data exchanges dropped 

from 11 to 8. 

37

OUTREACH

Arguably the most important link in the value chain is the level of awareness and 

understanding among our beneficiaries and employees regarding the myriad benefits, their disparate eligibility criteria, and the processes for obtaining those benefits. Education and outreach must occur at multiple intervals throughout a 

servicemember’s career, beginning at accession into the military. The BEC has overseen the establishment and expansion of such programs. In November 2004, VA 

began distributing a pamphlet entitled A Summary of VA Benefits to all Service inductees at the Military Entrance Processing Stations. This year, distribution of this 

pamphlet was expanded to the Military Service Academies for graduates about to 

receive their commissions. 

There has also been an increased emphasis on training our employees and familiarizing them with their VA counterparts. While we often talk about coordinated 

transition in terms of programs and initiatives, a smooth transition requires personnel to understand the other department. It also means developing working relationships at the point of care or service. DOD has dedicated a series of presentations 

to this important topic within the annual Military Health System Conference, which 

is attended by leadership and professional staff from DOD sites across the globe. 

We also presented VA/DOD Collaboration and Coordinated Transition as a plenary 

session at the annual TRICARE Beneficiary Counselors and Debt Collection Assistants Conference, attended by approximately 500 front-line staff who daily assist 

servicemembers, retirees and veterans in understanding their benefits. 

DOD TRANSITION ASSISTANCE PROGRAM

Returning to private life after serving in the military can be a very complex undertaking. The DOD, VA, and the Department of Labor (DOL) are working together 

to provide servicemembers with the tools and information they need to fashion individual solutions to the challenges they face. 

The Montgomery GI Bill (MGIB) is vital to recruiting efforts—money for college 

ranks among the major reasons young men and women enlist. However, education 

is also an important transition tool, attractive to both servicemembers and their 

families. GI Bill enrollments increased from only 50 percent in its first year (in 

1985) to nearly 97 percent starting in the early 1990s and continuing at that level 

to this day. A total of 2.8 million men and women, from an eligible pool of 3.8 million, have taken advantage of the MGIB. Eligibility requires the Active, Guard, or 

Reserve member to serve at least two consecutive years on active duty. While a 

servicemember who has met the requirement may use the GI Bill while still serving 

on active duty, it is primarily a veteran’s benefit, thus, the program is administered 

by the Department of Veterans Affairs. 

The Transitional Assistance Management Program (TAMP) offers transitional 

TRICARE coverage to certain separating active duty members and their eligible 

family members. Under the Fiscal Year 2005 NDAA, TRICARE eligibility under the 

TAMP was permanently extended from 60 or 120 days to 180 days. After the TAMP 

eligibility expires, members and eligible family members may choose to enroll in the 

Continued Health Care Benefit Program (CHCBP). CHCBP provides a conversion 

health plan similar to TRICARE Standard for a specific time (18 months) to all 

former servicemembers and their families who pay quarterly premiums. 

DOD has improved access to the Verification of Military Experience and Training 

(VMET) document (DD Form 2586) by making it available to eligible members 

through a VMET Internet site. This document provides descriptive summaries of the 

servicemembers’ military work experience, training history, and language proficiencies. The VMET document also includes recommended college credits to be awarded 

based on an individual’s military experience and training, as determined by the 

American Council on Education, and related civilian equivalent job titles, when such 

information is available. The VMET Web site, https://www.dmdc.osd.mil/vmet, is 

available 365 days a year, and provides VMET documents on-demand. Since January 2003, over 1 million documents have been provided to current and former 

servicemembers. 

Since 1999, a DOL platform has been providing employment-related information 

for servicemembers and veterans. DOL established the DOD Job Search Web site 

(www.dod.jobsearch.org). This Web site provides employers with a link to 

transitioning servicemembers’ resumes and provides transitioning servicemembers 

with access to job opportunity listings with military-friendly employers. 

During the preseparation counseling phase of the Transition Assistance Program 

(TAP), servicemembers learn where and how to access information relating to licensure, certification and apprenticeship. The Army created ‘‘Credentialing Opportunities On-Line’’ or Army COOL. This robust Web site helps soldiers find civilian 

38

credentialing programs related to their military occupational specialty. It also helps 

them understand what it takes to obtain a credential and it identifies resources 

available to pay credentialing fees. In 2006, the Navy followed with Navy COOL. 

The preseparation counseling phase also includes a discussion of DOL’s Web site, 

‘‘America’s Career Info Net.’’ One of the tools on this Web site is the Credentials 

Center, which a servicemember can use to locate the examinations that test or enhance knowledge, experience or skills in an occupation or profession. Finally, DOD 

and DOL have established a ‘‘Credentialing Working Group’’ to develop appropriate 

goals, objectives, and outcomes that will help remove credentialing barriers that 

some veterans and transitioning servicemembers face. 

I want to point out that DOL established the Recovery and Employment Assistance Lifelines (REALifelines) as a joint initiative among the DOL, the Bethesda 

Naval Medical Center, and the Walter Reed Army Medical Center. REALifelines is 

designed to create a seamless, personalized assistance network to ensure that seriously wounded and injured servicemembers who cannot return to active duty are 

trained for rewarding new careers in the private sector. REALifelines staff provide 

employment assistance to severely injured and wounded servicemembers as they 

transition back into the civilian community to fulfill their employment potential and 

dreams. Today, REALifelines has expanded from its initial two locations to five additional military medical treatment facilities (Fort Carson, Brook Army Medical 

Center, Balboa, Madigan, and Tripler). 

Approximately 300,000 servicemembers have returned to the private sector every 

year since 2001. Of this number, 90,000 per year are from the Guard and Reserve. 

When TAP was initially developed in 1990, it was not designed with the needs of 

the National Guard and Reserve Components in mind. Their mission has changed 

dramatically since September 11, 2001, and therefore some TAP requirements warrant a fresh look. 

To better meet the needs of the Guard and Reserve, DOD, with the assistance of 

DOL and VA, is designing a new, dynamic, interactive, automated, Web-based system for delivery of transition assistance and related information. This portal architecture will become the backbone of the updated TAP processes. Usability, flexibility, adaptability, and individual customization are key to successful implementation of this new technology-enabled process. The portal will emphasize and augment 

the personal service provided by our transition counselors, while providing 

servicemembers access to crucial transition-related information anytime, anywhere. 

The goal for this new system is to increase servicemember accessibility, participation and satisfaction. 

All three partners are excited about the possibilities for this new portal. Its intent 

is to automate TAP services; standardize TAP information; create an external communication link between TAP customers and providers, whether DOD, VA, or DOL; 

and enhance the military-to-civilian experience. 

We are also updating our current pre-separation guide for active duty personnel, 

and creating a new transition assistance guide specifically for the Guard and Reserve. This effort should be completed by the end of February. Both guides will include traditional TAP subject matter, as well as links to a wide variety of other 

transition-related Web sites. As with the new portal, the Department is heavily engaged with all stakeholders, especially our partners at VA and DOL, to ensure the 

information in these guides is up-to-date. 

NEXT STEPS

The JEC will step up its efforts in monitoring the coordinated transition process 

and joint health care facility operations in the short term. The newly established 

Coordinated Transition Work Group will concentrate efforts to improve the transition process. This group is responsible for ensuring continuity of the service and 

benefits delivery value chain, which, as I’ve previously mentioned, must be characterized by an improved understanding of and access to the full continuum of health 

care and benefits available to servicemembers, veterans, and their families. 

The JEC will also be more involved in assisting local initiatives that feature joint 

operations. The newly created Joint Health Care Facility Operations Steering Group 

is a lesson learned from our experience with the collaboration between the North 

Chicago VA Medical Center and the Naval Health Clinic Great Lakes. The steering 

group is responsible for providing support to local leadership, identifying impediments to collaboration, resolving legal issues, and clarifying statutory interpretation. 

The TAP Steering Committee, with representatives from DOD, the Military Services, VA, DOL, and the Department of Homeland Security (Coast Guard) meets 

quarterly to discuss and address issues and challenges that fall under the transition 

39

umbrella. The Committee works to find solutions to problems, conduct pilots, and 

look for new initiatives that will enhance and improve our current transition program and the overall quality of life of all members of the Armed Forces. 

DOD and VA will continue to build on past successes as we move forward in Fiscal Year 2007, and beyond. I am proud of the hard work and dedication to duty that 

the professionals within both departments display daily as they intensify efforts to 

increase beneficiary and employee awareness, improve existing data exchanges, promote world-class health care and benefits delivery, and increase the value of the 

Transition Assistance Program to all stakeholders. 

Mr. Chairman, this concludes my statement. I look forward to working with the 

Committee in this new Congress to uphold our traditional outstanding support of 

American heroes—our Nation’s servicemen and women, veterans, and their families. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA

Question 1. To what extent have efforts been made to coordinate with the Department of Labor to assist returning servicemembers in finding meaningful employment in a timely fashion? What efforts has DOD made on its own accord? 

Response. The Transition Assistance Program (TAP) Steering Committee is the 

mechanism to coordinate with the DOL to assist returning servicemembers in finding meaningful employment in a timely fashion. This Committee is comprised of 

representatives from the DOD, the Military Services, Department of Veterans Affairs, DOL, and the Department of Homeland Security. 

The Deputy Under Secretary of Defense for Military Community and Family Policy, who has oversight for TAP at DOD, collaborated with the Assistant Secretary 

of Labor for Veterans Employment and Training Service regarding some new initiatives for this year. Those initiatives are outlined below. 

DOL INITIATIVES

DOL has taken the lead in developing 15 employment assistance modules specifically for the Guard and Reserve to receive the equivalent of the 21⁄2-day TAP Employment Workshop that is provided at major active duty installations for active 

component transitioning servicemembers. 

In addition, DOL is working to implement a methodology of seamlessly ‘‘handing 

off’’ servicemembers directly to a counselor at a DOL Career One-Stop Center close 

to the final destination of the servicemember and his or her family. 

DOD INITIATIVES

DOD staff is preparing a policy change that will strengthen the Department’s 

commitment to those servicemembers who want to attend an employment workshop. 

The updated policy will inform Commanders that they shall release servicemembers 

(who request attendance at a DOL, or Service equivalent, Employment Workshop) 

during duty hours to attend this important workshop. 

In addition, the Department has contracted with RAND to examine recent trends 

in veteran unemployment rates for 20 to 24-year-old veterans in relation to non-veteran counterparts, using administrative data on the receipt of unemployment compensation for ex-servicemembers. This effort will assist the Department in evaluating its current programs and policies with respect to unemployment benefits and 

the effectiveness of current programs aimed at assisting active duty and Reserve 

personnel transitioning from full-time military to full-time civilian employment. The 

study is to be completed in 2007. 

The Department is updating the current active duty Pre-separation Guide and 

creating a new Transition Assistance Guide for the Guard and Reserve. We also developed a new Pre-separation Counseling Checklist for demobilizing Guard and Reserve personnel. 

The Department developed a Pre-separation Counselor Training Course, through 

the National Learning Center, University of Colorado at Denver, to increase the professional proficiency of Pre-separation Counselors, by reinforcing the understanding 

of the requirements and how important their role is in the beginning of successful 

transition. 

The Department established the Interagency Demobilization Working Group to 

specifically address the needs of the Guard and Reserve. As a result, DOD is developing a new dynamic Web portal to provide access to transition assistance and other 

related information anytime, anywhere. ‘‘TurboTAP,’’ the Department’s nickname 

for the portal, will enhance the existing transition program.

40

Question 2. Given the increased obligations of the Guard and Reserves, there is 

a feeling among servicemembers and veterans that their education benefits do not 

match their service commitments. What, if anything, is being done within the Department of Defense to address these concerns? 

Response. Education benefits under the Montgomery GI Bill for the Selected Reserve have long been an effective tool to meet strength and force management objectives. Recognizing the increased obligation of the Guard and Reserve in an operational Reserve construct, the President proposed a new program that provides an 

enhanced educational assistance benefit for Ready Reserve members who have 

served in support of a contingency operation—the Reserve Educational Assistance 

Program (REAP). Congress included this provision in the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005, which was enacted on October 28, 2004. REAP recognizes the additional service performed by Guard and Reserve members and provides additional financial assistance to accommodate lost 

educational opportunities while activated and a readjustment benefit following activation. 

A key component in both of these programs is that eligibility for benefits requires 

continued participation in the Guard or Reserve. In particular, REAP serves as an 

incentive to remain in the Guard or Reserve following the rigors and stresses associated with mobilization and time away from families and employers—a time when 

pressure to separate may be significant. It is worth noting that a Reserve component member who meets the same service requirements as an active duty member 

is eligible for the same active duty benefit. But not all reservists serve on active 

duty for extended periods, so the REAP benefit was designed to provide an enhanced benefit for Ready Reserve members who serve on active duty for shorter periods. 

Although there have been some recruiting challenges, the Department’s success 

in meeting its recruiting and retention objectives suggests that the current educational incentives are having the desired effect, coupled with the other recent 

changes to recruiting and retention incentives. 

However, there has been interest in revamping educational benefits provided to 

all military members. One such proposal calls for consolidating the three separate 

programs into a single ‘‘Total Force’’ benefit. In light of the way we are using the 

force—active, Guard and Reserve—I think it is worth considering some consolidation or streamlining of the three educational assistance programs we have today. 

But, we must guard against undermining the original purpose of the various programs and their effectiveness in achieving their respective program objectives. 

To assess the impact of consolidating the various education programs, a joint 

DOD/Department of Veterans Affairs (DVA) working group was formed to examine 

the possibility of a ‘‘Total Force GI Bill.’’ This group has been meeting over the past 

several months. 

The DOD and the DVA, through the Joint Executive Council (co-chaired by me 

and Deputy Secretary Mansfield), will review the findings and recommendations of 

the working group, and any legislative changes to the various educational assistance 

programs supported by the Administration will be forwarded to Congress.

Question 3. Please explain the role of the Employer Support of the Guard and Reserves in helping servicemembers resume employment post-demobilization. 

Response. ESGR provides information, education, and informal mediation to 

servicemembers and employers through an ombudsman customer service center and 

grassroots relationships through a network of over 4,000 volunteers. 

Specifically, ESGR works collaboratively with each of the Services to establish a 

military unit employer support representative throughout the Reserve component. 

This specifically identified servicemember acts as the liaison between his or her 

unit’s members and the local ESGR military unit liaison volunteer. 

ESGR also helps provide briefings during the demobilization process to explain 

the servicemembers’ rights and responsibilities under the Uniformed Services Employment and Re-employment Rights Act (USERRA). 

ESGR’s aggressive efforts have resulted in a decline of requests for assistance 

with informal mediation to the ESGR ombudsman services for the past 3 years, 

from 486 per month average in Fiscal Year (FY) 2004 to a 390 per month average 

for Fiscal Year 2005 to an average of 262 per month for Fiscal Year 2006. Additionally, although ESGR does not have statutory authority to enforce USERRA, it does 

coordinate activities with the three Federal Government organizations with responsibility over USERRA—the Veterans’ Employment and Training Service from the 

Department of Labor, the Department of Justice, and the Office of Special Counsel—in order to better serve servicemembers and employers.

41

Question 4. How many servicemembers, by year, have been medically retired or 

given a disability discharge as a result of injuries or wounds sustained in OEF/OIF? 

Response. The following represents the number of servicemembers who have been 

separated or retired (in the year indicated) under Service Secretary authority (Chapter 61, title 10, United States Code) for wounds or injuries incurred in the line of 

duty, associated with OEF/OIF:

• 2003: 332 • 2004: 804 • 2005: 1,646 • 2006: 1,887

Caveats: Accounting represents those who were awarded a disability disposition 

as a result of: • Armed conflict or, • Instrumentality of war.

Source: Military Department Physical Disability Agencies.

Question 5. How many OEF/OIF veterans were separated from active status (by 

component—active, Guard and Reserves) between January 2002 and January 2005? 

Response. The number of OEF/OIF veterans separated from active status between 

January 2002 and January 2005 are as follows:

Component Separated/Retired 

Army Active Duty .............................................................................................................................................. 47,452

Navy Active Duty .............................................................................................................................................. 37,197

Air Force Active Duty ........................................................................................................................................ 20,631

Marine Corps Active Duty ................................................................................................................................ 22,804

Army National Guard ........................................................................................................................................ 21,818

Army Reserve .................................................................................................................................................... 12,049

Navy Reserve .................................................................................................................................................... 4,021

Air National Guard ........................................................................................................................................... 5,761

Air Force Reserve ............................................................................................................................................. 2,943

Marine Corps Reserve ...................................................................................................................................... 4,759

Total ........................................................................................................................................................ 179,435

Source: Defense Manpower Data Center. 

Question 6. The 2003 Presidential Task Force to Improve Health Care Delivery 

for Our Nation’s Veterans (PTF) recommended that the Administration direct 

Health and Human Services (HHS) to declare the two Departments to be a single 

health care system for purposes of implementing Health Insurance Portability and 

Accountability Act (HIPAA) regulations. How did DOD and VA respond to the recommendation. How have the HIPAA requirements impacted your health information 

exchange efforts? 

Response. Under the HHS HIPAA Privacy Final Rule, two or more covered entities who participate in certain joint activities may qualify as an Organized Health 

Care Arrangement (OCHA), which allows them to share protected health information about their patients in order to manage and benefit their joint operations. The 

VA and DOD do not qualify as an OCHA under the requirements currently promulgated by HHS in the HHS HIPAA Privacy Final Rule. To change those requirements, HHS would need to engage in the time consuming process of administrative 

rulemaking. Absent such administrative rulemaking, it is our belief that HHS lacks 

the authority to make such a declaration. 

DOD and VA responded to the recommendation by making maximum use of the 

authority already provided in the HHS HIPAA Privacy Final Rule to share protected health information for purposes of treatment at time of separation and between covered entities that are government entities providing public benefits. Given 

the existing authority which is currently available, which arguably provides for 

broader protected health information sharing than that available to an OCHA, DOD 

sees no benefit in petitioning HHS to engage in administrative rulemaking to 

change the OCHA qualification requirements.

Question 7. The Departments have indicated that their joint effort to develop the 

interface between VA’s and DOD’s health data repositories is expected to result in 

the secured sharing of health data between the new systems that each Department 

is currently developing and beginning to implement. What measures does DOD have 

in place to protect personally identifiable information that is being maintained in 

42

its health data repository? How is DOD securing the transfer of personally identifiable information from DOD to VA? 

Response. DOD has implemented the following security controls to tighten restrictions on access to our network and databases: isolating sensitive data from public 

data, expanding content of audit controls, enhancing training, implementing 

encryption of data at rest and updating network devices capability. We are also 

working with Defense Information Systems Agency to incorporate additional monitoring tools and intrusion detection devices to identify and address malicious activity immediately. 

The exchange of information between DOD and VA utilizes the DOD Business to 

Business Gateway to encrypt the transmission of patient identifiable data and incorporates authentication and auditing controls into the data exchange. 

The DOD’s AHLTA Clinical Data Repository complies with the following security 

requirements:

• DOD Instruction 5200.40, DOD Information Technology Security Certification 

and Accreditation Process (DITSCAP), dated 30 December 1997. • DOD Directive 8500.1, ‘‘Information Assurance,’’ October 24, 2002. • DOD Directive 8500.2, ‘‘Information Assurance (IA) Implementation,’’ February 

6, 2003. • Public Law 104–191, ‘‘Health Insurance Portability and Accountability Act 

(HIPAA) of 1996,’’ August 21, 1996. • FIPS 140–2, ‘‘Security Requirements for Cryptographic Modules,’’ May 25, 2001. • CJCSI 6510.01D, ‘‘Information Assurance (IA) and Computer Network Defense 

(CND),’’ June 15, 2004. • DOD Directive 4630.5, ‘‘Interoperability and Supportability of Information Technology (IT) and National Security Systems (NSS),’’ May 5, 2004. • Military Health System (MHS) IA Policy Guidance Manual, March 5, 2004. • DOD Regulation 6025.18–R, ‘‘DOD Health Information Privacy Regulation,’’ 

January 24, 2003.

Question 8. How will the Future Military Healthcare Task Force look at VA’s role 

when making recommendations about the future of DOD health care? 

Response. The Task Force has a representative from the VA (Mr. Bob Henke). It 

is anticipated that where DOD and VA can work together, that perspective would 

be part of findings and recommendations. Although not a specific task assigned to 

the Task Force, partnership with the VA remains part of the larger Department 

agenda under the VA/DOD Joint Executive and the Health Executive Councils. Recent agreement between the Secretaries of the Departments of VA and DOD have 

a focus on four major areas common to each Department: healthcare planning in 

joint markets; working toward a common Electronic Health Record, starting with a 

partnership on a joint inpatient record; focus on work with severely injured traumatic brain injury patients; and, joint work on mental health and associated diagnoses including Post Traumatic Stress Disorder.

Question 9. In 2003, the PTF recommended that there should be a mandatory 

physical exam for all separating servicemembers. I understand that currently a separation physical is only mandatory for those who are retiring. Do you believe that 

a separation physical should be mandatory for all? If not, why not? 

Response. I believe there should be a health screening at separation tailored to 

the military occupation. For example, a tank mechanic or jet engine mechanic 

should receive an occupation specific termination health screening at the end of 

their enlistment or, if they move out of that specialty. Currently ‘‘termination’’ 

exams are being accomplished across the Services for those individuals in certain 

occupational positions. We should consider the specific military occupational position 

and conduct a tailored screening. Mandatory comprehensive physical exams have 

not been shown to be cost effective for health screening.

Question 10. For VA and DOD, the Joint Executive Council Strategic Plan is the 

primary way by which you advance and measure performance and progress. What 

specific measures are in place to evaluate the effectiveness of your efforts? 

Response. The VA/DOD Joint Strategic Plan guides our joint activities and serves 

as the primary instrument by which we measure progress and success throughout 

each year. As a testament to the firm foundation that has been established, the 

guiding principles have remained unchanged since their inaugural release in 2004. 

However, the current plan reveals lessons learned in the areas of identifying opportunities for improvement, developing goals and strategies to achieve these improvements, and developing performance measures. 

The Strategic Plan is at Appendix A of the VA/DOD Annual Report to Congress, 

which will be delivered to the Senate Veterans Committee Chairman and Ranking 

Member by the end of February 2007.

43

Question 11. GAO has recommended that attendance at Transition Assistance 

Programs be mandatory for all separating servicemembers, or that, at minimum, 

servicemembers should have the opportunity to participate with the support of their 

supervisors. Do you believe that attendance should be mandatory? If the programs 

were mandatory, does DOD have the resources to support it? 

Response. Pre-separation Counseling is mandatory for all Military Services and 

for eligible demobilizing Reserve component servicemembers. 

The Department is updating existing policy to allow all servicemembers who wish 

to attend a Department of Labor or Service equivalent employment workshop to do 

so during duty hours. 

DOD supports attendance at Veterans Affairs (VA) Benefits Briefings for all eligible servicemembers. The Department has a responsibility to ensure all 

servicemembers are made aware of their VA benefits before separation or retirement. The Department is undertaking an effort to make transition resources available online. This will allow servicemembers who prefer a more hands on, automated 

approach to get the information on VA and other transition related information. The 

online service also will allow servicemembers to access this information as the need 

arises in the future (just-in-time access). 

The Department supports mandatory attendance at the Disabled Transition Assistance Program for all servicemembers referred to a Physical Evaluation Board 

and those put in a ‘‘medical hold’’ status by their Service. We also support a policy 

that allows members who may be separated or discharged with a Service connected 

disability to be released to attend. Commanders should release these individuals 

during duty hours to attend. 

Cost analyses will be conducted by each Department before addressing whether 

sufficient resources are available.

Question 12. In my view, all transitioning servicemembers should receive the 

same level of service and information, whether they separate in the United States 

or overseas. I am concerned that this is not happening. For example, I understand 

that VA’s Overseas Military Services Coordinators are only available in Europe for 

9 months a year and that they are stretched too thin, with only 2 persons covering 

all of Europe at any given time. I understand that in 2006, DOD notified VA it could 

no longer fund this program. What was the basis for that decision? 

Response. The Department is committed to servicemembers overseas receiving the 

same level of service as those in the United States. Since the implementation of the 

Overseas Military Services Program in 1994, coordinators have been available for 

less than 12 months each year. It is our understanding that, effective in Fiscal Year 

2008, VA will provide coverage 12 months a year. 

Agencies are responsible for providing necessary resources and delivering their 

component of the Transition Assistance Program. DOD is responsible for Pre-separation Counseling; Department of Labor is responsible for Department of Labor Employment Workshops; and VA is responsible for VA Benefits Briefings and Disabled 

Transition Assistance Program.

Question 13. In September 2005, DOD issued a policy memo to the Services Secretaries directing them to provide VA with the names of servicemembers entering 

DOD’s Physical Evaluation Board process. I understand that in May 2006 this initiative was put on hold because of DOD concerns about data security compliance. 

Why was the initiative put on hold and what is its current status? 

Response. Information containing the names, Social Security Numbers, and diagnoses of servicemembers referred by Medical Evaluation Board (MEB) to Physical 

Evaluation Board is Protected Health Information. Consistent with the provisions 

of the Health Insurance Portability and Accountability Act, transfer of PHI from 

DOD to VA requires that reasonable steps be taken to protect the confidentiality 

of such information. 

In October 2005, the Services’ medical departments began to forward MEB information to the Office of the Assistant Secretary of Defense for Health Affairs, which 

assumed responsibility for transfer of the information to the VA. Such transfer took 

place via encrypted email until mid-2006, when the VA concluded that more stringent measures were appropriate to protect the information. The e-mail transfers 

were suspended and the Departments began to weigh several alternative means to 

affect transfers electronically on a permanent basis. In the interim, 4 months of 

data were transferred in the autumn of 2006 via a password-protected compact disk, 

hand carried to the VA. The Departments expect to decide upon and implement an 

improved, secure transfer procedure this month. 

44

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JOHN D. ROCKEFELLER IV 

Question 1. Overall Funding Issues. Whenever I can, I try to host a roundtable 

in West Virginia to talk to newly returned soldiers, including National Guard and 

Reservists. I learn a great deal from these heroes. I fully support the goals of DOD 

and VA in improving the transition, and many of the policies sound good. But when 

I talk to West Virginia veterans, I do not hear about these policies, I hear about 

problems getting care and delays in service. What is the level of new funding committed to these important policies? What are top officials in DOD and VA doing to 

train staff and deliver on the good intentions and commitments? Will DOD and VA 

be seeking additional funding to meet the health care needs of our returning veterans? 

Response. The Transitional Assistance Management Program (TAMP) offers transitional TRICARE coverage to certain separating active duty members and their eligible family members. Under the National Defense Authorization Act for Fiscal Year 

(FY) 2005, effective October 28, 2004, TRICARE eligibility under TAMP was permanently extended from 60 or 120 days to 180 days. Estimated TAMP requirements 

developed for Program Objectives Memo (POM) 08–13 are: Fiscal Year 2007—

$167M, Fiscal Year 2008—$184M, Fiscal Year 2009—$202M, Fiscal Year 2010—

$223M, Fiscal Year 2011—$245M, Fiscal Year 2012—$270M, and Fiscal Year 

2013—$296M. 

TRICARE Reserve Select (TRS) is a premium-based TRICARE health plan available for purchase by qualified members of the Selected Reserve. Estimated TRS requirements developed for POM 08–13 are: Fiscal Year 2007—$127M, Fiscal Year 

2008—$381M, Fiscal Year 2009—$563M, Fiscal Year 2010—$714M, Fiscal Year 

2011—$763M, Fiscal Year 2012—$816M, and Fiscal Year 2013—$874M. 

One initiative aimed at increasing the level of familiarization among DOD staff 

with regard to VA is the Family Transition Initiative. This group is identifying variations and impediments to maximizing patient/family communication, specifically 

verbal guidance and written material provided by DOD and VA staff in anticipation 

of care transition. The group will also provide recommendations to the Health Executive Council for improvements in communicating with families. There will be an 

emphasis on sensitivity for the families’ prognosis, social and economic realities, and 

flexibility to incorporate individual timetable needs.

Question 2. Timely Access to Care for National Guard and Reservists. I have 

heard from West Virginia National Guard personnel of several instances in which 

the standards you established in your October 2003 policy regarding timely access 

to care have not been met for Guard soldiers returning to the civilian world from 

deployment in Iraq and Afghanistan. It appears that the major injuries are usually 

taken care of prior to discharge from active duty, but then after they return home, 

the soldiers slip through the cracks for care recommended by their doctors for less 

critical combat injuries. What are you doing to ensure that these combat veterans 

receive all of the care that they need and that their doctors have recommended, and 

that they receive it on a timely basis? Have you established an effective quality control system? Is there an appeal or grievance process through the Veterans Affairs 

system. What can be done to meet the health insurance needs of our medically retired National Guard members and their families? 

Response. The Community Based Health Care Organization (CBHCO) program 

was created to assist Guard and Reserve servicemembers injured in the line of duty 

to return to their homes where they will continue to receive care locally while they 

are evaluated for return to duty, medical release, or medical board. To be eligible, 

the servicemember must have a referral into the program from their respective 

branch of Service. While CBHCO is not available in all States, West Virginia is 

served by the CBHCO located in Richmond, Virginia. 

The Department of Defense (DOD) and VA have separate disability determination 

processes which provide differing economic and medical benefits with some overlap 

between the two. As a result, members often pursue both. All veterans with a VA 

disability rating can enroll with the VA for health services. The DOD disability system is, in essence, a form of compensation and benefit system for work-related injuries. When the member is eligible for services from both agencies, the member may 

choose. 

For 2 years after leaving the military, all combat theater veterans are eligible for 

VA hospital care, medical services, and nursing home care for any illness possibly 

related to wartime deployment, without having to prove that their health problems 

are related to their combat service. VA refers to the Certificate of Release or Discharge from Active Duty (DD Form 214) as proof of service in a designated combat 

theater of operations to determine this eligibility. 

45

After 2 years, these veterans may still be eligible for VA care as determined by 

the VA regulations. These regulations generally place a member in various priority 

categories considering type of disability, amount of disability, service connection, 

and the member’s economic abilities. For Service-connected injuries for which a disability rating is received, the VA beneficiary may receive care without cost. He or 

she may be eligible to receive care for non-Service connected disability needs at a 

cost share. The DOD respectfully defers to the VA for the details of its programs.

Question 3. Flow of Information. What can be done to facilitate a more efficient 

flow of communication between military medical facilities, to include Community 

Based Health Care Organization (CBHCO) and Military Treatment Facilities (MTF), 

and the individual state Adjutant General when an injured soldier transitions from 

one duty status to another? (From the National Guard’s point of view, there should 

be a point of contact clearly identified or established at every military medical facility, including CBHCOs and MTFs, who would be responsible for notifying the soldier’s Adjutant General when the soldier is admitted, discharged or transported to 

another facility. The Adjutant General would then assure the delivery of transitional benefits access and counseling to include Veterans Affairs healthcare options, 

TRICARE programs that may be available, VA benefits counseling such as home 

loan guarantee, education benefits, and or vocational rehabilitation services.) 

Response. I appreciate the opportunity to address this important topic. Two options come to mind, each of which requires more information from the Army. The 

first is to assign National Guard liaisons to each CBHCO and to each MTF. The 

second option is to add each State Adjutant General to distribution for admission 

and disposition notifications. I defer to the Army for further analysis of the efficacy 

of these options, as well as other possibilities. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. BARACK OBAMA

Question 1. Aggregate Health Data. I am concerned that the military is not giving 

VA enough concrete data to help them conduct long-term planning. Let’s take mental health as an example. The Army’s Mental Health Advisory Team found that soldiers who deployed to Iraq for a second time were more likely to suffer mental 

health problems. Dr. Chu, does the Pentagon systematically share information with 

VA on the total number of soldiers who have deployed to Iraq and the number of 

times each has deployed? 

Response. The Defense Manpower Data Center (DMDC) provides a monthly list 

of separated Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans to the VA using Service deployment data submissions and the DMDC’s most 

current Active and Reserve component files. The latest list is a cumulative roster 

of separated veterans who deployed in support of OIF/OEF anytime from September 

2001 to November 2006. Data provided include both the start and end date of each 

deployment that the VA can use to identify the number of times each individual has 

deployed.

Question 2. Falling Through the Cracks. In an average year, 10,000 to 20,000 

servicemembers are separated from the military through the Medical Evaluation 

Board (MEB) and Physical Evaluation Board (PEB) process. These are soldiers who, 

because of physical or mental health problems, are unfit to be deployed. How many 

servicemembers were separated from the military last year through the MEB/PEB 

process? How many of these troops had benefits claims filed before they discharged? 

How many had their first Veterans Affairs (VA) medical appointment scheduled before they discharged? What kind of comprehensive case management is being offered 

to these troops? What about the 631,000 total Iraq/Afghanistan vets wounded or 

otherwise? What kind of one-on-one transition assistance did these veterans receive? 

Response. The MEB/PEB process is designed and operated by the individual Services. The Services monitor the separations within their respective personnel communities. 

The VA reported in the VA/Department of Defense (DOD) Joint Executive Council 

Annual Report to Congress on Resource Sharing that, as of December 15, 2006, Social Workers Liaisons assigned to Military Treatment Facilities (MTFs) had processed 6,714 patient transfers to Veterans Health Administration health care facilities. VA Social Workers work onsite at the MTF to respond to referrals to coordinate 

inpatient and outpatient appointments at a VA Medical Center near the patient’s 

intended residence. They coordinate transfer of care and maintain follow-up with 

patients to verify success of the discharge plan, and to ensure continuity of therapy 

and medications. Case managers also refer patients to counselors from the VA who 

can speak about benefits in general, including vocational rehabilitation. 

46

The DOD has several different programs designed to provide assistance to 

servicemembers as they transition from active duty to veteran status. The Army Liaison/VA PolyTrauma Rehabilitation Center Collaboration program stood up in 

March 2005. The intent of this program is to ensure that severely injured 

servicemembers who are transferred directly from an MTF to one of the four VA 

PolyTrauma Centers, in Richmond, Virginia; Tampa, Florida; Minneapolis, Minnesota; and Palo Alto, California are met by a familiar face and a uniform. DOD 

has a long standing relationship with the VA in which they provide rehabilitative 

services for patients with traumatic brain injuries, amputations, and other serious 

injuries as soon after the incident as clinically possible. The role of this Army liaison 

is primarily to provide support to the family through assistance and coordination 

with a broad array of issues, such as travel, housing, and military pay. 

The Joint Seamless Transition Program was established by VA in coordination 

with the Military Services, to facilitate and coordinate a more timely receipt of benefits for severely injured servicemembers while they are still on active duty. There 

are 12 VA social workers and counselors assigned at ten MTFs, including Walter 

Reed Army Medical Center and the National Naval Medical Center in Bethesda. 

They ensure the seamless transition of health care which includes a comprehensive 

plan for treatment. 

The Military Severely Injured Center (MSIC) operates a hotline center which 

functions 24 hours a day, 7 days a week. servicemembers or family members can 

call a toll free number and speak to a care manager, who may become their primary 

point of contact over time. The Center’s mission is to augment the Service-specific 

programs—the Army Wounded Warrior Program, the Navy Safe Harbor Program, 

the Air Force Helping Airmen Recover Together Program, and Marine4Life—and 

work closely with each of these programs to ensure seamless care and benefits as 

long as it takes—even after members have left the Service. 

The Center features creative partnerships with the Department of Labor and 

Transportation Security Administration, in addition to the VA, and is augmented 

by field support in the form of a network of credentialed Counselor-Advocates who 

provide face-to-face assistance in nineteen locations across the country. Collectively, 

the personnel staffing the MSIC expedite processes help families and alleviate complex road blocks for the severely injured. The MSIC also works closely with nongovernment agencies to coordinate local assistance programs, such as Heroes to 

Hometown, in partnership with the American Legion and job fairs.

Question 3. Aggregate Health Data. The Pentagon provides limited data to the VA 

about servicemembers when they are separating, but does not provide comprehensive systematic data on the numbers of wounded that could help VA in long-term 

planning. A recent Harvard report put the number of American servicemembers 

wounded in Iraq and Afghanistan at more than 50,500. Some of these soldiers are 

sent to military hospitals in the U.S., but many are healed and returned to service. 

Does DOD provide comprehensive real-time casualty figures to VA, by that I mean 

the number injured, medically evacuated, and returned to duty every week or every 

month? 

Response. On a monthly basis, the DOD updates casualty figures on the publicly 

accessible Web site maintained by the Defense Manpower Data Center. The Web 

site includes month-by-month counts of the wounded in action (WIA) for each operation. The information is available at the following hyperlinks to the site: http://

siadapp.dior.whs.mil/personnel/CASUALTY/OIF-Total-by-month.pdf and http://

siadapp.dior.whs.mil/personnel/CASUALTY/oefmonth.pdf. 

Other monthly reports on the Web site detail the number of servicemembers 

whose injuries or illnesses have required their medical transport out of the theater 

of operation. These data are derived from the information system that is used to 

manage the air transport of injured and sick servicemembers. Common diseases 

that require transport include such things as lower back pain, chest pain, vertebral 

disc disease, inguinal hernia, mood disorders, and urinary stones. Common non-combat injuries include dislocation of knee, fractures of the leg, arm, ankle, and foot 

and shoulder dislocation. The information is available at the following hyperlinks 

to the site: http://siadapp.dior.whs.mil/personnel/CASUALTY/OIF-Total.pdf and 

http://siadapp.dior.whs.mil/personnel/CASUALTY/WOTSUM.pdf. 

As of January 22, 2007, these casualty data showed the following:

47

Category OIF OEF Totals 

Injuries Necessitating Medical Air Transport .......................................................................... 13,702 2,009 15,711

Wounded In Action .......................................................................................................... 6,911 648 7,559

Non-hostile injuries ......................................................................................................... 6,791 1,361 8,152

Diseases Necessitating Medical Air Transport ........................................................................ 18,547 3,671 22,218

Total Number Air Transported ........................................................................................ 32,249 5,680 37,929

The Web site also includes reports of the total Wounded in Action. As of January 

22, 2007, the total was 24,476. Of those, 7,559 required medical air transport for 

their wounds. The recent Harvard report used erroneous data from a VA Web site 

to estimate the number of wounded. The VA subsequently corrected the data on its 

Web site. 

All of the information above is readily accessible to the VA as well as to the general public; therefore, it is not necessary for the DOD to send such data in a special 

report to the VA. In addition, the vast majority of injuries resolve after appropriate 

treatment and convalescence, so reporting to the VA is unnecessary as they do not 

represent a future resource drain for the VA. The more applicable reporting would 

be of ‘‘severe injuries’’ that we know will require long-term rehabilitation, especially 

those where the VA will be the likely service provider, e.g., spinal cord injuries and 

amputations, but we are still working on how to prospectively identify this group 

of individuals. 

In addition, DOD provides data to the VA on servicemembers who have been referred to Physical Evaluation Boards (PEBs). These individuals are most likely to 

have Service-connected disabilities associated with their illnesses and injuries and 

are likely to transition soon to VA care after completion of their PEBs. Such data 

encompass all servicemembers, including those who have medical problems associated with service in OIF and OEF.

Question 4. Total Costs of Caring for OEF/OIF Veterans. A recent report by the 

Kennedy School of Government at Harvard put the lifetime costs of caring for Iraq/

Afghanistan veterans at $350 to $700 billion. Do you agree with this estimate, and 

if not, what estimate can you offer in its place? 

Response. This question addresses lifetime costs of caring for Iraq/Afghanistan 

veterans, the biggest piece of which will be Department of Veterans Affairs (VA) 

costs. The referenced report speaks to VA medical and disability costs for Operation 

Enduring Freedom/Operation Iraqi Freedom veterans. The quoted $350–$700 billion 

amount must, therefore, be assessed in the context of VA costs. Since we do not possess VA cost data, we respectfully defer to the VA and suggest that this question 

be redirected to them. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. LARRY E. CRAIG

Question 1. Two years ago, this Committee held a hearing on the quality of casualty assistance services provided to the spouses of those killed on active duty. We 

learned about problems in continuity of the personnel assigned for casualty services, 

confusion among survivors regarding the array Federal benefits available to them, 

and inconsistencies among the military branches. DOD was directed to develop a 

uniform policy on casualty assistance. Please provide an update of DOD’s efforts to 

comply with the law. Are survivors provided with electronic access to updated, integrated information regarding their benefits? 

Response. The Department takes very seriously its responsibility to provide assistance to families of fallen servicemembers and continues to explore new methods, 

procedures, and policies to enhance the current level of support or assistance. A 

guiding principle is this must be a zero-defect program and opportunities for improvement must always be pursued. 

Subsequent to the hearings of 2005, several policy improvements and initiatives 

were implemented to provide standardized assistance to families and eliminate inconsistencies among the Services wherever possible. In response to your specific 

question, ‘‘Are survivors provided with electronic access to updated, integrated information regarding their benefits,’’ it would be helpful if I explain the current process 

and then our plan on the way ahead to address this issue. 

The provision of information on all known Federal benefits and the availability 

of financial counseling are currently being provided to all applicable survivors and 

next of kin during the casualty assistance process. Information is provided in 

48

hardcopy, referral to applicable Web sites, and in-person with subject matter experts 

from the appropriate Agency. 

In March 2006, the Department published ‘‘A Survivor’s Guide to Benefits, Taking 

Care of Our Own.’’ The guide was subsequently updated in June and November of 

2006 and can be found on the Military HomeFront Web site at http://

www.militaryhomefront.dod.mil. The guide, developed in collaboration with the Military Services, including the Coast Guard, the Department of Veterans Affairs (DVA) 

and the Social Security Administration (SSA), details the Federal benefits available 

to families of servicemembers who die on active duty from the DOD, DVA, and SSA. 

The Department created, ‘‘The Days Ahead, Essential Papers for Families of Fallen Service Members,’’ a three-inch binder designed to assist families in organizing 

the avalanche of paperwork that is necessary as the family applies for and receives 

Federal benefits as a result of an active duty death. Spouses who receive ‘‘The Days 

Ahead’’ notebook will also receive a printed copy of the most recent version of ‘‘A 

Survivor’s Guide to Benefits,’’ and another excellent resource, ‘‘Military Widow—A 

Survival Guide,’’ which is the first book specifically focused on the unique challenges 

women face when they become military widows. This resource is available through 

Military OneSource. 

For the past few years, Service Relief Societies working with the Military Services 

have contracted with a local firm, the Armed Forces Services Corporation (AFSC), 

to purchase a lifetime membership, upon request, for eligible family members for 

AFSC’s services. The services provided by AFSC include the capability to consolidate 

all known Federal benefits into a single document that also forecasts benefits 

changes over time based on various data changes, e.g., children become the age of 

majority, spouse remarries, etc. Although the DOD does not currently have a system 

such as AFSC’s, the critical need for information is being addressed in this way. 

The Department is considering alternative options, including possibly contracting 

for this service on a Department-wide basis. The Army has developed a Web-based 

benefits information system called ‘‘myArmy Benefits,’’ which is currently being field 

tested and considered for possible DOD-wide application. In the interim, family 

members will continue to receive high-quality benefits counseling from appropriate 

agency benefits experts at no cost, or, if they accept, through services provided by 

AFSC, which is paid for by the Service Aid Societies. 

The Department’s policy on casualty assistance, DOD Instruction 1300.18, ‘‘DOD 

Personnel Casualty Matters, Policies, and Procedures,’’ will provide for standardized 

processes and procedures throughout the Department, with the exception of those 

unique customs and traditions of a Military Department. This Instruction is in its 

final stages of formal coordination.

Question 2. I have learned a lot about the transition experience of Idaho’s 116th 

Armor Cavalry Brigade, since their return from Iraq. In general, their experiences 

seem to have been positive. But, I do have concern over waiting sometimes as long 

as 6 months for their post-deployment health reassessments, understaffed call centers, long waiting times for 6-month check-ups, etc. What is DOD doing to improve 

timeliness on follow-up services and care once our Guardsmen and Reservists are 

back in-country and transitioning to civilian life? 

Response. The PDHRA was designed to be completed after the member returned 

home and had time to settle into their civilian life. It is conducted three to 6 months 

after return. In fact, our epidemiological research indicates that concerns continue 

to emerge over the first year. It would be ill-advised to complete this assessment 

earlier than 3 months after redeploying. This contrasts with the Post-Deployment 

Health Assessment (PDHA), which is completed within 30 days of return from theater. The benefit of having an extra post-deployment assessment, the PDHRA, is 

that it allows time for additional concerns to emerge, especially those related to reintegration with one’s family, friends, and community. 

The original contract to conduct the PDHRA for the National Guard and Reserves 

encountered unexpected surges rather than an even demand. For example, virtually 

all National Guard units drill on the first or second weekend of each month. Once 

this issue came to light, we implemented changes to increase staffing for those 

weekends. Initially, the Reserves indicated they would prefer to use a call center 

to accomplish PDHRAs throughout the week, but then realized that it would be 

easier for commanders to emphasize the importance of these assessments if they 

were completed at the unit during a drill weekend, which was also the first weekend 

of the month. Again, modifications to the supporting business processes remedied 

the workflow problem. 

The PDHRA is a new clinical process, so we were not surprised that we would 

need to make changes as the process matured. As we identify challenges and recognize more responsive ways to complete the PDHRA, we make rapid adjustments to 

meet the needs. 

49

The DOD requires returning servicemembers to undergo PDHAs to document current health status, experiences, environmental exposures, and health concerns. The 

assessments enable health care providers to promptly refer those needing medical 

evaluation and care. 

Completion of the PDHA takes place within 30 days of the expected date of redeployment from the theater to the servicemember’s home station. Use of the PDHA 

was mandated in an October 6, 1998 Health Affairs policy memo. A healthcare provider reviews the form, interviews the servicemember and recommends additional 

clinical evaluation or treatment as needed. Copies of the PDHA become part of the 

servicemembers’ medical records and are also stored in the central electronic database of the Defense Medical Surveillance System. Registered health care providers 

can access electronic copies of the PDHA forms via TRICARE Online. Additional 

post-deployment testing, such as serum samples, tuberculosis skin testing, etc., 

occur at specified intervals following redeployment. Post-deployment blood specimens are collected within 30 days of redeployment and are processed to produce 

serum that is frozen and archived in the DOD Serum Repository. A PDHRA occurs 

within 90–180 days following redeployment. 

Between January 1, 2003 and December 18, 2006, more than one million redeploying servicemembers have completed the PDHA process. Approximately 92 percent of returnees have described their general health as ‘‘good,’’ ‘‘very good,’’ or ‘‘excellent.’’

Copies of the PDHA forms are part of the servicemembers’ permanent medical 

records, which are provided to the VA through the Seamless Transition Program 

whenever an individual elects for VA care at the time of separation or retirement. 

DOD has successfully developed the capacity to add electronic pre- and post-deployment health assessment information on separated servicemembers to the monthly 

patient information being sent to the VA. DOD completed a historical data pull in 

July 2005 that resulted in approximately 400,000 pre- and post-deployment health 

assessments being transmitted to the data repository at the VA Austin Automation 

Center. Monthly transmission of electronic pre- and post-deployment health assessment data to the Federal Health Information Electronic data repository began in 

September 2005. DOD added the new PDHRA information to the monthly date feed 

in November 2006. As of December 2006, VA has access to over 1.5 million PDHA 

and PDHRA forms on more than 623,000 separated servicemembers and demobilized Reserve and National Guard members. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. ARLEN SPECTER

Question 1. Does the Department of Defense consider Post Exchange and Commissary services part of the compensation and benefits package offered to individuals serving in/retired from the military? 

Response. DOD policy recognizes the commissary and exchange services as part 

of the compensation and benefits package offered to active duty members of the 

Military Services. Because the commissary and exchange benefits provide an income 

effect through savings on purchases, the compensation status of the military member is the primary determinant when authorizing these privileges. Commissary and 

exchange shopping privileges are extended to Reserve and Guard members, retired 

servicemembers, veterans with 100 percent service-connected disability, Medal of 

Honor recipients, and the dependents of the authorized groups.

Question 2. When do DECA and AAFES plan to release the plan for implementing 

the BRAC 2005 law, related to Post Exchanges and Commissaries across the country? 

Response. Commissary and exchange activities are addressed within each of the 

individual installation closure plans. There are no DOD-wide commissary or exchange plans to implement the Base Realignment and Closure 2005 recommendations except that, under DOD policy, commissaries and exchanges normally close 

when the base closes.

Question 3. Has DECA and AAFES conducted the required study of the catchment 

area and usage levels in the tri-state area (western Pennsylvania/eastern Ohio/

northern West Virgina) of the Post Exchange and Commissary at the Kelly Support 

Center, Oakdale, Pennsylvania? If not, what is the time frame for the study to be 

concluded? 

Response. No, the Base Realignment and Closure (BRAC) process does not require 

a study of the catchment area and usage levels of the exchange and commissary in 

the tri-state area surrounding the C.E. Kelly Support Center. The commissary and 

exchange at C.E. Kelly are scheduled to close when the installation closes by October 2008. However, two smaller AAFES facilities in the Pittsburgh area (Pittsburgh 

50

Air National Guard, 171st Air Refueling Wing and Airport Air Force Reserve, 911th 

Airlift Wing) are unaffected by BRAC and will remain open. In addition, if a Military Department were to request establishment of new facilities in the Pittsburgh 

area, that request will be evaluated under Department established criteria.

Question 4. How will this information be used in determining the ongoing operation of the Oakdale facility? 

Response. The Base Realignment and Closure process does not require a study of 

the catchment area and usage levels in the tri-state area. At this time, there are 

no plans for ongoing operations at Oakdale, the location of C.E. Kelly Support Center. The commissary and exchange at the C.E. Kelly Support Center are scheduled 

to close by October 2008, when the installation closes.

Question 5. As the Army’s Kelly Support Center in Oakdale, Pennsylvania is the 

host of the Post Exchange and Commissary, and under Base Realignment and Closure (BRAC) 2005 law, the facilities will be closing, has any consideration been 

given to moving the Post Exchange and Commissary to an alternate location in 

western PA? 

Response. There are no plans to open new commissary and exchange facilities in 

western Pennsylvania. As long as sales warrant, the Army and Air Force Exchange 

Service plans to keep two stores at Pittsburgh Air National Guard, 171st Air Refueling Wing and Airport Air Force Reserve, 911th Airlift Wing. These locations are unaffected by BRAC.

Question 6. What role can the community serve as the Defense Commissary Agency and the Army and Air Forces Exchange Service evaluates the future of the Post 

Exchange and Commissary at the Oakdale, Pennsylvania facility? 

Response. The community should contact the Redevelopment Authority of Allegheny County, which is recognized as the Local Redevelopment Authority (LRA) for 

planning and directing the reuse of C.E. Kelly Support Center, Oakdale, Pennsylvania. The LRA has not proposed continuation of the commissary and exchange in 

the local reuse plan. A decision to continue operating a commissary or exchange at 

a closed base is based on established criteria, including the number of active duty 

servicemembers remaining in or around the closed installation. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. LINDSEY O. GRAHAM

Question 1. Interagency Coordination. We all support our troops, especially those 

who are disabled as a result of their service to our Nation. However, members and 

their families continue to report that they face an overlapping and confusing set of 

benefits that require our injured servicemembers or their family members to navigate, in many cases, several large bureaucracies (Department of Defense, Veterans 

Benefits Administration, Veterans Health Care Administration, Social Security Administration and Medicare). Because so many agencies are involved in the care of 

our veterans, how do you keep those other agencies informed of your efforts, and 

what is the process to resolve problems that exist between agencies? 

Response. While it is true that many agencies are involved, there are mechanisms 

in place to keep all agencies informed of the others’ efforts and to resolve problems 

that exist between agencies. 

For systemic issues associated with benefits, transition, or support of the severely 

injured and their families in general, a number of councils and programs are in 

place to facilitate communication and cooperation between Departments, as well as 

serve as the mechanism to resolve issues and find solutions to systemic problems.

• The Joint Executive Council (JEC) provides guidance and establishes policy for 

the full spectrum of collaborative activities and initiatives between the DOD and 

Veterans Affairs (VA). The JEC oversees and guides the activities of the VA/DOD 

Benefits Executive and Health Executive Councils (BEC and HEC, respectively), as 

well as their many working groups. 

• The HEC is responsible for implementing a coordinated health care resource 

sharing program. 

• The BEC is responsible for examining ways to expand and improve benefit information sharing, refining the process for records retrieval, and identifying procedures to improve the benefits claims process. 

• The Transition Assistance Program (TAP) Steering Committee, with representatives from DOD, the Military Services, VA, Department of Labor (DOL), and the Department of Homeland Security (DHS) meets quarterly to discuss and address 

issues and challenges. They work to find solutions, conduct pilots, and look for new 

initiatives that will enhance and improve the current transition program and the 

overall quality of life for all members of our Armed Forces. 

51

• DOD’s Military Severely Injured Center (MSIC) augments the support provided 

by the Services programs (the Army Wounded Warrior Program, the Navy SAFE 

HARBOR Program, the Air Force Helping Airmen Recover Together Program, and 

the Marine4Life Injured Support Program. The MSIC reaches beyond the DOD to 

other agencies, to the nonprofit world, and to corporate America. It serves as a fusion point for four Federal agencies—DOD, VA, DHS Transportation Security Administration, and DOL.

Additionally, to better meet the needs of the Guard and Reserve, DOD, with the 

assistance of DOL and VA, is designing a new, dynamic, interactive, automated 

Web-based system for delivery of transition assistance and related information. The 

Department completed phase one of the new site and released a ‘‘soft-launch’’ in 

February 2007. The site is called TurboTAP and can be accessed at http://

www.TurboTAP.org. On February 23, 2007, Secretary Gates established an independent review group, 

co-chaired by two former Secretaries of the Army, Togo West and Jack Marsh, to 

review the care and support for the wounded at Walter Reed Army Medical Center 

and National Naval Medical Center (Bethesda). On March 6, 2007, President Bush 

established a committee, co-chaired by former Senator Robert Dole and former Secretary of Health and Human Services, Donna Shalala to look more broadly at this 

issue. Both committees will offer opportunities to strengthen support and encourage 

interaction among agencies.

Question 2. Interagency Coordination. To what extent have your agencies interfaced with State government agencies which may also be of assistance to severely 

injured and disabled veterans? 

Response. Through the Department’s Heroes to Hometowns program, we have 

partnered with the National Guard Bureau, the American Legion, and most recently 

with the National Association of State Directors of Veteran’s Affairs (NASDVA) to 

tap into their national, State, and local support systems to provide essential links 

to government, corporate, and nonprofit resources at all levels and to garner community support. Support has included help with paying bills, adapting homes, finding jobs, education and job training, arranging welcome home celebrations, help 

working through the bureaucracy, holiday dinners, sports and recreation opportunities, mentoring, and, importantly, hometown support. 

Charter members of State Heroes to Hometowns Committees include the American Legion’s State Adjutant, the National Guard’s State Family Program Directors, 

and NASDVA’s State Directors of VA. The intent is for severely injured 

servicemembers and their families to dialogue with the State Committee members 

well in advance of their return home. The committee members can then work with 

their networks in the State and local community to coordinate government and nongovernment resources and establish support networks for servicemembers and their 

families so they can live productive lives. 

The American public’s strong support for our troops is especially evident in their 

willingness to help severely injured servicemembers and their ever-supportive families, as they transition from the hospital environment and return to civilian life.

Question 3. Electronic Medical Records. According to the Department of Defense, 

much more work is needed on development of a comprehensive inpatient health care 

record. What funds have been allocated by the DOD and the VA in 2008 to support 

the development of an inpatient electronic record that is compatible and interoperable between the two agencies? 

Response. A comprehensive electronic health record (EHR), to include inpatient 

care, is DOD’s goal; however, the first priority for AHLTA, the DOD EHR, was to 

address ambulatory care. The AHLTA inpatient electronic record development/acquisition is currently targeted to begin in Fiscal Year 2010. VA is embarking on a 

modernization of its EHR to include the inpatient component. 

Since both Departments were planning new inpatient electronic record acquisition 

or modernization, DOD and VA are initiating a project to work together on a 6-

month study to assess the benefits and impacts of various alternatives before making a final decision on a joint acquisition strategy for an inpatient electronic health 

record system. We anticipate a contract award to a study support contractor within 

the next 30–60 days. The completed study will make a recommendation on an acquisition/development strategy for an inpatient EHR. The study will provide data needed to determine the acquisition/development strategy, timelines, impacts on current 

systems, and projected costs. The Departments will then be able to evaluate alternatives for funding the chosen technical solution.

Question 4. Expanded Partnership between the DOD and VA in Health Care Services. S. 1042, the National Defense Authorization bill for Fiscal Year 2006, as 

passed by the Senate on November 11, 2005, contained requirement for the GAO 

52

to study an expanded partnership between the DOD and VA in the provision of 

health care services, including an assessment of the advantages and disadvantages 

for military retirees over age 65 and their dependents to participate in the VA’s 

health care system. Please share with the Committee your thoughts on the potential 

value of such an expanded partnership, especially for military retirees over the age 

of 65. 

Response. The proposal to shift all retiree health care to the VA appears to prohibit their use of DOD Military Treatment Facilities (MTFs), and would then be 

viewed by retirees as a breach of faith. 

TRICARE provides a comprehensive, integrated health care program of DOD 

MTFs and civilian providers for retirees and their families. Forcing all retirees to 

use the VA would be a radical change. All VA medical centers can already participate in the TRICARE program as network providers, where retirees and their families have the freedom to use them voluntarily. 

It is not clear what would be gained by converting a system of broad choice of 

health care providers into a system that makes using VA medical centers compulsory. For Medicare eligible retirees over the age of 65, under current law, the VA 

is not able to receive payment from Medicare and TRICARE is now the second payer 

for their care. Thus, if this group were required to use VA facilities there would be 

a large cost shift for the care of these individuals which would need to be addressed.

Chairman AKAKA. Thank you very much, Dr. Chu. 

Before I begin my questions, I would like to call on Senator Webb 

for any statement that you may have. 

STATEMENT OF HON. JIM WEBB,

U.S. SENATOR FROM VIRGINIA 

Senator WEBB. Thank you, Mr. Chairman. I am sorry I am late. 

We have got three Committee hearings backed up today on my 

schedule, and I very much appreciate your calling this hearing. 

I am sorry I missed the other opening statements, but I have a 

long regard for the capabilities of our two panelists today. I have 

known Dr. Chu for many years. We worked together in the Pentagon, and I have known Secretary Mansfield personally and by 

reputation, and I know these are people who are personally committed to the same things that those of us on the Committee are. 

I would like to say one precatory comment, however. I spent 4 

years of my life working every day on veterans issues as a Committee counsel on the House side, and the one really shocking piece 

of reality to me returning to this area was the bureaucratic stagnation in the VA that I see, and particularly in terms of claims. I 

want to make that one of my priorities to find a way that we can 

streamline this claims process and get more energy into it and get 

the answers out to the people who are trying to have their situations resolved. And I will be looking forward, Secretary Mansfield, 

to working with you on that. 

I have one other very brief comment. I was present at the creation of some of these DOD/VA cooperative efforts. And when you 

were talking about the Chicago situation, we worked on that. When 

I was Assistant Secretary of Defense for Reserve Affairs, that was 

one of our pilot programs. We were looking at that in terms of expanding usage of the VA in case we had to mobilize. That was one 

of the things that was on the table. But that has been a little more 

than 20 years since we did that, and this is an area where I hope 

we can, again, really put some energy into it. 

Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Webb. 

I have a question for both Secretary Mansfield and Dr. Chu. I 

understand that it may be 2012 before DOD and VA have an elecVerDate 0ct 09 2002 14:48 May 29, 2007 Jkt 000000 PO 00000 Frm 00056 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\32723.TXT SENVETS PsN: ROWENA
53

tronic medical record that can be shared and accessed by providers 

in both Departments. In the year 2003, the President’s task force 

believed that this could be in place by 2005. My question to both 

of you is: Why is this taking so long? Secretary Mansfield, you can 

respond first. 

Mr. MANSFIELD. Mr. Chairman, I would agree that this is one of 

the things I have mentioned we have had ups and downs, and it 

has been a combination of problems within the VA, I think, and 

within DOD. The VA system is an old system on an old platform 

that we need to take into the 21st century and upgrade. In the 

process of doing that, it would be good if we could work with DOD, 

and I think the announcement that we will hear later on today is 

that there will be a commitment to doing that so that we can agree 

that the VA has a record system that should be usable by both entities, and we can move forward to do that. 

As far as the timing, I think part of it has been, as I mentioned, 

we had this universal depository of information where the three 

medical services in DOD could put information in, and then we 

could get the feeds out of that. That was the agreement that we 

were working on for the last 2 or 3 years. We can take this quantum leap forward if we agree that we use one system, and it is time 

to do that, and we are going to do that. 

Chairman AKAKA. All right. Do you have an idea of when that 

may be? 

Mr. MANSFIELD. Sir, as always, it is a combination of not only 

the feasibility but also the ability to have the resources to make it 

work, and we are in the process of attempting to be able to justify 

what we need to the Congress of the United States, the Appropriations Subcommittees, in an effort to do that. I do not have an exact 

time frame right now. 

Chairman AKAKA. Dr. Chu? 

Dr. CHU. I think, Mr. Chairman, that we need to offer a little 

more detail on what has been accomplished. 

First of all, the Department of Defense has transmitted just 

under 4 million electronic records for veterans to VA, so there is 

a major repository of record data there. 

Second, as Secretary Mansfield said, we have initiated as pilots 

what are called bidirectional data exchanges, meaning that a provider in either facility, in real time or near real time, can look up 

the ongoing record of the individual. That is not a trivial information technology problem given that the two Cabinet Departments 

have very different information technology architectures, but it has 

been demonstrated at a handful of sites. 

Third, I do think we would all benefit from some precision about 

what we mean by ‘‘the medical record.’’ Do we mean a summary 

of the patient’s diagnoses? That is fairly straightforward. Do we 

mean the clinical notes that the clinician may have recorded? 

Which, of course, historically were written down. It would have to 

be transcribed. Do we mean actual X-ray images? That is a much 

more significant data requirement and much more difficult to assemble and maintain. Do we mean the pharmacological record for 

the patient? That is another set of data. 

So when we say ‘‘the medical record,’’ I think what I would emphasize is straightforward medical records in large volume have 

54

been and are continuously being transmitted to VA. The real issue 

going ahead is what Secretary Mansfield indicated. Can we create 

a record that is bidirectional, that is real time in nature, and that 

eventually does append these data storage device intensive records 

like X-ray images? That is a significant challenge. We think it can 

be done. We are committed to that goal. It will take time. I do not 

want to be naive about what is required. And I should emphasize, 

it would be the largest—we are already the largest such exchange 

in the country in terms of information. This would take all of that 

endeavor to an even more ambitious level. 

Chairman AKAKA. Thank you very much, Dr. Chu. 

I have other questions, but since my time will soon be expired, 

let me ask Senator Craig for the questions he has, and we will 

have a second round. 

Senator CRAIG. Thank you very much, Mr. Chairman. 

Gentlemen, thank you for your testimony. And, Dr. Chu, thank 

you for broadening the overall understanding of what we are attempting to get done here. We look at VA today and see its interoperability from center to center with total record movement, including X-rays. We assume you can put two wires together or wirelessly transmit, and that will happen with DOD. Unless you are all 

on the same electronic system, unless you are doing the input, then 

the transitional time is going to be considerable. But what I think 

is significant—and I am hearing it, I am beginning to hear it from 

both of you—is that work is underway. That is what this Committee and this Congress has insisted upon, and we are going to 

stay with it until there is total interoperability with these two systems. Then we will have accomplished a great deal in time and 

transition that is critically important, and in that process I would 

trust that the active becoming veterans would not fall through the 

cracks in a way that is being expressed today with great frustration on the part of many of my colleagues and myself. 

To both of you, many severely injured servicemembers are now 

being disability-retired from active duty, making them eligible for 

TRICARE. Clearly, as service-connected disabled veterans, they are 

also eligible for VA Care. All of us want to do whatever is necessary to assist service-connected veterans, but I would like to hear 

from both of you your thoughts as to whether your agencies, which 

are both trying to be all things to all severely disabled veterans, 

are creating some confusion and frustration on the part of beneficiaries as well as real problems for health care coordination by 

having dual eligibility. Gordon? 

Mr. MANSFIELD. Yes, Mr. Chairman, a good question. I think 

part of what we are looking at here has to be in the context of what 

the VA has set up and excels in. For example, the Spinal Cord Injury Network is one that is nationwide, provides individuals the 

only ability across the country to have the same type of care, the 

same degree of quality of care, and allows a spinal cord injured individual to be rehabilitated and to be taken care of and to have a 

long-term care plan for them within that system. 

If you look at the Inspector General’s recent report—last year, I 

believe, or late the year before—on traumatic brain injury, there 

was a finding in that assessment of the VA Care that we were 

doing as well as and probably better than the civilian sector in takVerDate 0ct 09 2002 14:48 May 29, 2007 Jkt 000000 PO 00000 Frm 00058 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\32723.TXT SENVETS PsN: ROWENA
55

ing care of traumatic brain injury, with the caveat that there was 

a problem, again, with the long-term care. But the IG suggested 

that we should look at the spinal cord injury system again as something to follow in the TBI area. 

I think it may well depend on the nature of the injury and who 

has the best ability to make this person as whole as possible or to 

give them the best care or to be able to rehabilitate them the best. 

And I think we have to look and make the decision based on that, 

what is best for the individual. And, something that we are learning, dealing with, and practicing, is, now we are not just dealing 

with the individual soldier or the veteran; we are also dealing with 

the family. Both the Spinal Cord Injury Network and the TBI Network are ones that have included the family in the process of designing a care program, moving through it, and having the family 

members understand what is happening and what the probable 

outcomes are. So, I think, those are the issues that you have to 

look at in making decisions about what really is best for that individual. 

And then the last issue that you have to deal with that we have 

seen some problems or some issues with is a geographic one, because we are not everywhere. We are not everywhere, and we cannot deliver care everywhere. So then it becomes a question of what 

the veteran or the veteran’s family wants as far as where do they 

want to be and what care can we provide in that location. 

Senator CRAIG. David? 

Dr. CHU. Senator, if I may add to Mr. Mansfield’s response, first, 

we recognize that providing people with more choices can create 

some degree of confusion. It is one of the reasons that the VA has 

moved to put counselors into the major hospitals to which the significantly wounded return, so that there are people on-site who can 

help people make these choices intelligently and with knowledge of 

what the pros and cons of the selection might be. 

Second, we established the Military Severely Injured Center to 

ensure that there was a backstop for all of this, a place 24 hours 

a day the families can call and get answers to their questions. It 

is a warm handoff to a human being, to a person who is going to 

deal with the issue at hand, whatever it might be. 

Third, as Secretary Mansfield outlined, we recognize that the 

country is better off if the two institutions specialize, and so as he 

suggested, for traumatic brain injury we turn to VA. We recognize 

they are going to be the premier source of care for those with significant degrees—there is mild concussion and so on. There is a 

whole gradation, as you recognize. I think the clinical staffs of the 

two Cabinet Departments, which do work very closely together on 

these issues, are charting a course of who is going to do what as 

we move ahead. So that while the veteran may select, based on geography or personal preference or provider relationship, a particular facility—and that is the veteran’s right—we try to direct 

people to the areas where they are going to get the best result. 

Senator CRAIG. Thank you. 

Mr. Chairman, thank you. 

Chairman AKAKA. Thank you very much, Senator Craig. 

56

I would like to ask Senator Obama, before I ask Senator Rockefeller for his questions, to make any opening statement he may 

have. 

STATEMENT OF HON. BARACK OBAMA,

U.S. SENATOR FROM ILLINOIS 

Senator OBAMA. Thank you, Mr. Chairman. I just want to commend the Chairman and Ranking Member for organizing this hearing. I think that we have all been concerned about the steps that 

we need to take to ensure that when our veterans come home, that 

they have got the best possible services available. I think that is 

going to be a heightened concern in the years to come, as we have 

Iraqi and Afghani eterans coming home. And so, rather than make 

a lengthy statement, I will submit my statement for the record, if 

there are no objections, and let Senator Rockefeller proceed with 

his questions. 

Chairman AKAKA. Thank you very much, Senator Obama. Your 

statement will be placed in the record. 

[The prepared statement of Senator Obama follows:]

PREPARED STATEMENT OF HON. BARACK OBAMA, U.S. SENATOR FROM ILLINOIS

Thank you, Chairman Akaka and Senator Craig,for holding this hearing. 

I’m pleased that the Pentagon and the Department of Veterans Affairs have taken 

some steps to smooth the transition from active duty to civilian life. For example, 

significant efforts have been made on behalf of the most severely injured 

servicemembers. But, when I look at the programs and systems put into place to 

help our veterans and compare them to the sheer numbers of servicemembers entering civilian life, I’m worried that many veterans—especially, the less severely injured and those with mental health problems—will fall through the cracks. 

The numbers are overwhelming. More than 630,000 servicemembers who were deployed in the War on Terror are now veterans. More than 50,500 soldiers have been 

injured in Iraq and Afghanistan. Yet the VA has only provided intensive casework 

assistance to 6,700 severely injured veterans. That means that a vast majority of 

troops leaving the military, including many injured men and women, do not have 

caseworkers dedicated to guiding them through the bureaucracy, scheduling their 

first medical appointments, and ensuring their benefits are coming through in a 

timely fashion. This lack of coordination may be the reason why fewer than onethird of Iraq and Afghanistan veterans have actually sought care at the VA. 

I’m pleased that the Committee will be holding hearings on transition, and I hope 

that the Committee will focus on several aspects of this issue. 

First, proper budget planning is critical. A recent Harvard report estimated that 

the total lifetime costs of providing disability benefits and healthcare to Iraq and 

Afghanistan veterans will range from $350 billion to $700 billion. The reality, however, is that the VA has little idea what those numbers actually will be. Over the 

last 2 years, the VA has experienced $3 billion in budget shortfalls, largely because 

it failed to account for the demands of new Iraq/Afghanistan veterans. DOD has 

taken some steps to provide the VA with data on separating servicemembers, but 

has not turned over the information that the VA needs to conduct accurate longterm budgetary planning. The VA is essentially operating in the dark, and we need 

to start keeping better track of soldiers and potential future demands on the veterans’ system. 

Second, we need to focus on electronic medical records. I know we cannot wave 

a magic wand and get interoperable health records, or real-time, two-way information sharing. But the Pentagon has dragged its heels in modernizing and sharing 

data, and veterans are suffering as a result. The GAO found that even in cases 

when DOD facilities set up information-sharing agreements with VA hospitals, the 

system is plagued with technical glitches. I’ve proposed that all servicemembers 

should receive secure electronic copies of their health and service record to simplify 

the process for applying for benefits and health care. I hope the Committee will act 

on my proposal. 

Finally, I’m concerned about the VA’s ability to deal with post-traumatic stress 

disorder and traumatic brain injury. Thirty-six percent of Iraq and Afghanistan vetVerDate 0ct 09 2002 14:48 May 29, 2007 Jkt 000000 PO 00000 Frm 00060 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\32723.TXT SENVETS PsN: ROWENA
57

erans treated so far have been diagnosed with some kind of mental health condition. 

Traumatic brain injury, the signature injury of the Iraq war, is one we still know 

little about. We need to make sure the VA has the expertise and manpower to care 

for veterans with TBI and PTSD. 

Thank you again Chairman Akaka, Senator Craig. I look forward to this hearing.

Chairman AKAKA. I want to tell our witnesses that your full 

statements will be placed in the record as well. 

Senator Rockefeller? 

Senator ROCKEFELLER. Thank you, Mr. Chairman. 

I want to say to our witnesses that I take it as a given what most 

medical journals now say, and that is that the VA system as a system is better than our private health care system. One of the two 

of you indicated such in one field, but I think it is generally true. 

But there is one major difference. The private health care system 

has a fairly predictable stream of people coming in and coming out. 

The veterans care system is based on, as we say these days, surges 

and they are very dramatic surges, and they take catastrophic, you 

know, substantive forms. 

I think about 25 percent of soldiers who have served in Iraq display symptoms of very serious mental health problems. On the 

other hand, almost 80 percent of soldiers serving in Iraq and Afghanistan who have exhibited those same traits are refused mental 

health services. If you can refute that, I will be happy. Of those 

who needed services, only 40 percent expressed an interest in receiving help. Now, that is an important thing because that is 

human nature, particularly human nature among men. They do not 

like to admit that. It comes out in horrible forms later on, but that 

accounts for half of the 80 percent. And, actually, only about 26 

percent are receiving the mental health care that they need, and 

that is not getting up to the suicide area. That is just regular mental health care. 

Now, I would like you to explain that to me. I make it a practice 

that virtually every weekend I go home, I have a no-pencil, nopress, no-staff, me—alone, my tie on—I will not take it off because 

I am not changing anything I am. So they do an ‘‘Arnold 

Schwarzenegger glasses’’ check on me. I pick none of them out, and 

12 or 13 of them decide that maybe I am OK to talk to. And then 

the most unbelievable surge of PTSD and mental health stress, suicidal tendencies come pouring forward. I clear my afternoon so 

these sessions can go 3 to 4 hours. And it is unbelievable, to waking up in the middle of the night and being convinced that the person lying next to you, who is otherwise known as your wife, is, in 

fact, an Iraqi—an Iraqi who has a knife who is about to slice your 

throat, and you run out of the house; to, you know, any clicking 

door anytime during the night, you are on full alert; people moving 

as far away from other people as they possibly can; and just endless examples of that sort. Painful, painful. One starts going, the 

others start going. And it incredibly painful, and it grounds me in 

the area of veterans. 

Which takes me back to what Senator Murray said, and that is 

that the President did not mention veterans. And I think veterans 

are sort of—this may be a little bit unkind, but it is my impression 

because I have no other way of expressing it—that it is a little bit 

like education or, you know, other things that we need to do in this 

country but after the war is over we will get to that. Veterans are 

58

a part and parcel—I do not have to tell you—of war. And as Jim, 

I think, said, until you do veterans, the war is not complete. Perhaps you said that. You do not complete the war. 

So I am just interested in this: number one, what do you do 

about the 40 percent who do not talk about it? You say you have 

specialists over there, and you have specialists at home, and they 

are available. That is what Vet Centers are for, so you do not have 

to go to veterans’ hospitals. They are more convenient. They are localized. People tend to take their families so it becomes cheaper. 

But they do not express that view. 

I can remember in Charleston walking into a Vet Center once 

when there were five gray-suited people that looked like I did, and 

I thought they were all, you know, auditors from the VA. Well, 

they were all there for PTSD appointments. And so everybody has 

their disguises; everybody has their ways of not discussing things. 

And so, number one, what do you do about that 40 percent? You 

know what the statistics are. You know what the probabilities are. 

And, therefore, how can you reach out to them earlier and later? 

Because you know they are going to explode at some point. 

And then, second—I guess my time is up. I will continue on the 

next round. 

Mr. MANSFIELD. Well, let me take it from there. Number one is 

that there can be some difference in what the numbers are, whether it is 40 percent or 25 percent. The bottom line is there is a problem, and we recognized that. And I think you can say that DOD 

has recognized that, and the VA definitely has recognized that. 

We recently went through the issue to put in place a new mental 

health plan in an effort to make sure that we had mental health 

practitioners across our system in all our——

Senator ROCKEFELLER. But is it enough? That is always the 

question. Of course, you have those programs. Of course, you attend to those matters. But are there enough of them out there to 

find out the people who have these problems? 

Mr. MANSFIELD. Well, no, there are not enough. I can tell you for 

people in——

Senator ROCKEFELLER. Why? Because you don’t have the budget. 

Mr. MANSFIELD. In Northfield, Massachusetts, right on the 

Vermont line, the last CBOC that I was up to dedicate, I went 

through that, and we went through the whole 7,000 square feet. 

That is where the primary care practitioners are. This is the mental health arena. But we cannot find a mental health practitioner 

that wants to come to this area to practice here. So that means——

Senator ROCKEFELLER. So that is a special problem for you, isn’t 

it? 

Mr. MANSFIELD. It is a problem. 

Senator ROCKEFELLER. That has to do with budget. 

Mr. MANSFIELD. So that means we have to send the people down 

the line to Northampton to the hospital and have them treated 

down there or try and get somebody from the hospital to come out 

and deal with it. 

So one issue is the ability to get enough practitioners and put 

them in place. That is an ongoing issue, but we have committed additional dollars and additional attention from the highest level to 

that to make it work. And I know, Senator, a long time ago, you 

59

were one of the ones who were saying the VA needs to have a mental health practitioner in every one of its CBOCs. We are moving 

toward that, and that is a way of recognizing that we do have a 

problem, we have to deal with it and solve it. 

The other issue is that DOD—and David can answer some of 

this—have people on the ground in the combat zone that are dealing with this issue, and we have also worked together to come up 

with this joint assessment record that allows us to attempt to identify those individuals who may need help, and then we can make 

the offer and start going into the system. 

Senator ROCKEFELLER. But why did you spend $100 million less than the $300 million you had on outreach to mental health folks 

last year? 

Mr. MANSFIELD. Well, part of it may be because we couldn’t find 

the practitioner to put in that clinic up there. 

Senator ROCKEFELLER. That is not an excuse. 

Mr. MANSFIELD. Part of it may be because we are rolling——

Senator ROCKEFELLER. That is an excuse in——

Mr. MANSFIELD. Part of it may be because we are rolling out——

Senator ROCKEFELLER. That is an excuse in the community 

health care system, but it is not an excuse in the Veterans’ Administration system. That is a unique system for unique individuals 

who render unique services, and that is not an excuse. 

Mr. MANSFIELD. And part of it may be that it is a new initiative 

that we just put the money into. We need to make sure that we 

keep the effort on from the highest levels to move this thing out 

through the organization to make sure that it does happen—recognizing from top to bottom that there is this problem, we do have 

to deal with it, it is an important issue. 

Dr. CHU. Senator, if I can come back to two parts of your question. 

Senator ROCKEFELLER. Yes. I am way over my time. The Chairman is going to shut me up for the next three meetings. 

Dr. CHU. If I might, very briefly, though, respond to two parts 

of your question. First, the numbers, the 25 percent figure that you 

cited, I believe that is a figure that does not indicate serious mental health problems. It is the fraction of people on the returning 

post-deployment health assessments who indicate any issue that 

might cause us to follow up as to whether there is a mental health 

issue or not. And that relates to the 80 percent figure that you described. It is not that they are denied care. In many of these cases, 

it turns out there is not a mental health issue that deserves followup. That is where the 80 percent comes from. 

Senator ROCKEFELLER. Thank you. 

Dr. CHU. To the latter part of your question, which is otherwise 

to reach out, we recognize that the reluctance of Americans to seek 

mental health care is an important question. We are not only pursuing, both DOD and VA, the classical remedies that have been 

employed, which is practitioners who are available to see people, 

but we are trying new routes. 

So, for example, we do have a Web-based self-assessment tool 

that we are publicizing to our people. It allows you privately, without any recourse to a practitioner, to ask yourself: Do I have an 

issue? Now, of course, you have got to be able to use that tool. That 

60

would be the next challenge. But it allows privacy, which is what 

is important to many of these situations. 

Likewise, as Secretary Mansfield said, in theater we have put 

mental health teams in the field to ensure that people who display 

symptoms or whose commanders are worried about their behavior 

are seen by appropriate mental health practitioners right then and 

there, again, to try to reach out in a different way than we have 

in the past. 

Senator ROCKEFELLER. Thank you. 

I apologize, Mr. Chairman, very much. 

Chairman AKAKA. Thank you. 

May I call now on Senator Murray, and she will be followed by 

Senator Sanders and Senator Obama. 

Senator Murray? 

Senator MURRAY. Thank you, Mr. Chairman. And thank you to 

both of you. None of us are questioning that both of you have a 

strong commitment to whom you serve, and we appreciate that. 

But you need to understand that the frustration that you are hearing comes from us because we do go home to our States, we do talk 

to these veterans, and we can no longer face them with the long 

waiting lines, the lack of care. The veterans, Senator Rockefeller 

talked about, these are people who are frustrated we see every 

week when we go home. And it seems to me when we are in a time 

of war, we should have a heightened sensibility within all of your 

agencies and an understanding that you all consider this to be a 

serious problem that needs to be addressed, and take that back to 

your agencies and the Administration, and we see that reflected in 

the budget back to us. 

It is not acceptable to us that money is not used simply to save 

money. We have to make sure these veterans are served, and that 

is the frustration you are hearing from all of us up here. 

And, Dr. Chu, I specifically wanted to ask you, because I am concerned about where you are coming from and give you a chance to 

respond, because I was very disturbed to see an article in the Wall 

Street Journal—it is now a couple years ago—January 25, 2005, 

which quoted you talking about benefits for veterans. And you said 

that, ‘‘The amounts have gotten to the point where they are hurtful. They are taking away from the Nation’s ability to defend 

itself.’’

If that is what you said, that is a gross misunderstanding of our 

obligation to our American veterans, and I could find no record of 

apology or retraction. So I wanted today to give you a chance. Do 

you still believe that keeping our promise to American veterans 

comes at the expense of our military? 

Dr. CHU. That is not what I said, Senator. I never used the 

words ‘‘veterans’ benefits.’’ Others have mischaracterized my remarks that way and never, frankly—sorry. I should repeat myself. 

That is not what I said, Senator. I never used the words ‘‘veterans’ benefits.’’ Others have mischaracterized my remarks in an 

effort to distort them and to evade the issue. The issue I addressed 

was the award, often by the Congress over the objections of both 

the prior and the present Administration, of additional programs to 

honor individuals who had served a full career in the military—in 

other words, this is not the person who serves 2 or 3 years and 

61

goes home—who are well compensated for their military service, including a significant annuity, lifetime subsidized medical care, and 

so on and so forth. 

What I was trying to point out is that the burden of those expenses is starting to eat away at the ability of the American military to prepare for its future. That is a real problem. I think people 

inside and outside the Department recognize this problem. I regret 

that my remarks were distorted and mischaracterized in a way 

that suggests an assault on veterans benefits. That was not the 

purpose of my remarks. That was not the meaning of my remarks. 

That is not what I said at the time. 

Senator MURRAY. Do you agree that caring for our veterans is a 

part of the cost of war? 

Dr. CHU. We owe our veterans care for their injuries, support for 

their transition to civil life, support if they have difficulties in that 

transition, and I support the programs that accomplish those outcomes. 

Senator MURRAY. Well, since we have been funding this war 

through supplementals up to this point, would you agree that the 

supplementals should include funding to meet the needs of our veterans then? 

Dr. CHU. The question of what goes into the supplemental versus 

the base budget is a decision made by the Office of Management 

and Budget. I should say that in terms of the immediate funding 

issues that you outlined, as I think Members of this body are 

aware, it is now up to Congress to fund the Fiscal Year 2007 budget correctly. There has been talk of funding at the 2006 level because of the appropriation issue out there. The Administration is 

seeking to get the Veterans Affairs Department funded correctly. 

Senator MURRAY. Are you not willing to say that it should be 

part of the cost of war, part of the supplemental request——

Dr. CHU. The decisions on budget——

Senator MURRAY. [continuing].—or advocate for that? 

Dr. CHU [continuing].—structure are made by the Office of Management and Budget. In the end, once Congress appropriates the 

money, which is what counts for the execution of the programs, it 

matters little whether it is in the supplemental or in the regular 

budget. 

Senator MURRAY. All right. Let me move on. I wanted to ask a 

few more questions. I am very concerned that the VA, Secretary 

Mansfield, is not prepared to care for our Afghan and Iraq veterans 

when they return. As I said earlier, in Fiscal Year 2006, the VA 

planned to provide health care for about 110,000 veterans from 

Iraq and Afghanistan, and, in fact, they served 185,000. The VA 

was off by 68 percent. For 2007, the VA estimated that 109,000 

Iraq and Afghanistan veterans will need service. So we see now 

that the VA is assuming that they are going to see even fewer veterans this year than they saw last year, and that to me just defies 

common sense. 

Can you tell the Committee why you think the number of veterans served this year is going to be lower than last year? 

Mr. MANSFIELD. I am not sure which numbers you are using, I 

believe those numbers are the additional new veterans coming into 

62

the system, and they are added on to the ones that were in before. 

So you are really looking at a number that is 260,000 or 280,000. 

The other point I would make is that no matter how many of 

them come into the system—and I believe last year, while we did 

have more veterans coming in than we projected—the amount of 

money dedicated to caring for those veterans that was expended 

was less than we budgeted for. So we actually had more money 

budgeted for their care, even considering the one-third increase, 

than we had——

Senator MURRAY. I am having trouble following the logic, but 

just for this Committee——

Mr. MANSFIELD. It is a report that I can make sure that we get 

to you and show you, Senator. 

Senator MURRAY. What is the total number of veterans that you 

expect to see this year? 

Mr. MANSFIELD. I am sorry. I did not prepare to bring that number with me, but I can ask some personnel. 

Do we have that in a budget sense? 

It is going to be in the same range that we were talking about 

before, with some adjustment for what we have seen in the last 

couple of years. 

Senator MURRAY. Well, as I mentioned earlier as well, in Friday’s 

Houston Chronicle Secretary Nicholson said that the deployment of 

21,000 more troops to Iraq will have a minimal impact on the VA. 

Most of the veterans that I talked to at home, who are frustrated, 

disagree with that. And I would like to ask both of you what the 

impact of this surge will be on transition assistance, on health care 

waiting lists, and benefits backlog and, subsequently, what you are 

going to do to minimize the impact of this. 

Dr. CHU. If I may, Senator Murray, I think the source—I am 

merely speculating. I have not talked to Secretary Nicholson. 

Maybe Mr. Mansfield has more insight here. 

I presume the source of his comment is the fact that we enjoy 

and attribute, really, to young Americans today, we enjoy very high 

retention rates in both the active and Reserve services of the 

United States. So a high fraction of those who have served in Iraq 

and Afghanistan or in other theaters around the world in the Global War on Terror are still in military service. They are not, with 

some modest exceptions, eligible for the various benefits that you 

described. So I presume that is the basis of his statement. Most of 

the people who join the military today stay with the military today. 

Mr. MANSFIELD. I think part of it, too, Senator—and this, of 

course, is a macro view, and you are talking about talking face-toface with the individual at that level. But we treated approximately 5.3 million individuals during the course of last year, so the 

effect of 21,500 more and what percentage from there that may 

come into the system becomes a smaller number. 

But the issue you raised is to make sure that we can get those 

people in the system and access to and in a timely manner is the 

issue that we really have to pay attention to. 

But I would reiterate that last year the amount of money budgeted for care for Iraqi and Afghani returning veterans expended 

was less than was budgeted for, even though the number was higher. The reports show that. 

63

Senator MURRAY. Well, Mr. Chairman, I hope we can really look 

at that because that is disconcerting to me, that if we are budgeting money, we already know we have underbudgeted, and then 

we are not spending that money, we are saying it is less. Why are 

veterans not getting this care? Is it because of the waiting lines, 

they do not get in, and so they do not impact the budget? Is it because we are not reaching out and trying to find these veterans, 

as Senator Rockefeller was talking about, with PTSD? So, you 

know, obviously, they are not impacting the budget if they are not 

getting the services they need. 

I hope we can really take a look at that. I am very——

Mr. MANSFIELD. The returning veterans, new veterans for their 

first appointment are getting in generally within the 30-day period 

that we have set aside. And if it is an emergency care——

Senator MURRAY. We are hearing a 6-month waiting list to get 

in for primary care. 

Mr. MANSFIELD. Well, I would like to follow up with you, Senator, and find out exactly, where and when that is and see what 

we can do to fix it then. 

The information I receive on a monthly basis says that for 98 

percent we are getting them in within 30 days. The area where we 

have a problem, which I would admit, is the specialty care arena, 

where it is taking longer than we have planned for to get them into 

the next step. 

Senator MURRAY. And could you tell us, if you do not have it 

today, how many Iraqi veterans are enrolled today in the VA? 

Mr. MANSFIELD. I do not have that with me, but I can provide 

it for the record very soon. 

Senator MURRAY. Thank you. 

Chairman Akaka Thank you, Senator Murray. 

Senator OBAMA. Mr. Chairman, I apologize to Senator Sanders. 

Unfortunately, I have got a Senate Foreign Relations Committee 

meeting as well, so what I’d like to do is just submit my questions 

to the record. I apologize that I am not going to be able to ask 

questions. But if Dr. Chu and Mr. Mansfield would be willing to 

have their offices respond, that would be helpful. 

Thank you very much. 

Chairman AKAKA. Thank you, Senator Obama. 

Senator Sanders? 

Senator SANDERS. Thank you, Mr. Chairman. 

I think the key aspect of this discussion that we have been having this morning is that there are some of us up here who think 

that, among other things, the VA is significantly underfunded and 

is not responding in a timely manner or as effectively as it might 

to the needs of veterans. 

I would like to ask Mr. Mansfield, Are you and the Secretary 

going to recommend to the President a substantial increase in 

funding for the VA? 

Mr. MANSFIELD. Senator, we go through a process in internal 

budgeting which allows us to figure out how many people we believe we will need to take care of, and then we ask for the money 

to take care of them. 

Senator SANDERS. Right. 

64

Mr. MANSFIELD. So we have asked for and we have been granted, 

although it has not gone through the total process, significant additional dollars in the last number of years. 

Senator SANDERS. Yes, but the needs, as you have heard—we are 

in the middle of a war, so it is not a surprise that we use additional 

dollars. My question is: Are you going to ask for substantial increases in funding for the VA to address the needs that you are 

hearing today for the veterans of this country? Can we expect the 

President to say we have a serious crisis, we are going to take care 

of veterans, and to do that, we are going to substantially increase 

funding? Are you going to make that recommendation, sir? 

Mr. MANSFIELD. Sir, I would make the point that we would ask 

for what we believe we need to get the job done. 

Senator SANDERS. Do you believe that we need substantial increases in funding? 

Mr. MANSFIELD. I believe that we need some increases in funding 

and that we have asked for substantially that amount. Again, 

if——

Senator SANDERS. Well, it sounds to me, sir, like a non-answer, 

to be honest with you. Let me ask you another question, though. 

Last year, in the President’s budget, as I recall, he proposed doubling the costs of prescription drugs for our veterans, and he also 

proposed a substantial increase in the fees for many of the veterans. And, I believe, studies indicated that the increase in fees 

would drive some 200,000 veterans off of VA health care. Can we 

expect the President again to ask veterans of this country to pay 

more for their health care? 

Mr. MANSFIELD. That I do not know, sir. 

Senator SANDERS. Do you think that that is a good idea? 

Mr. MANSFIELD. I think that we presented an argument that 

showed across the board that there was unequity issue tied in to 

people that have served 3 or 4 years and are entitled to care and 

those that have served 20 or 30 years and are in the TRICARE 

arena and have to pay certain amounts to get the benefits there. 

Senator SANDERS. So what we are doing is saying some veterans 

are in need, more in need, and maybe we should drive some veterans off of VA health care. Do you think that is a good idea? 

Mr. MANSFIELD. Well, I would tell you, sir, I do not approach this 

with the idea that we are driving anybody off of——

Senator SANDERS. Well, the studies seem to indicate that if you 

propose—I believe it was. I may be wrong on this. Somebody can 

correct me. Was it a $250 increase in fees? Does that sound right? 

And I believe that I read that would result in driving hundreds of 

thousands of veterans off of VA health care? Do we think that is 

a good idea? 

Mr. MANSFIELD. I do not believe that the words ‘‘driving people 

off of VA health care’’ is, again, the approach that I would have 

taken to any of these——

Senator SANDERS. But if that is the—well, let me go back 

again——

Mr. MANSFIELD. People make decisions based on economics about 

which——

Senator SANDERS. They sure do. And if they do not have much 

money and they have to pay $250 to get VA health care, you know 

65

what some of them will do? They will say, ‘‘I am not going to go 

into VA health care.’’ Won’t they? Do you agree? 

Mr. MANSFIELD. Yes. 

Senator SANDERS. My question is: Are you going to recommend 

to the President not to increase fees for VA health care and not to 

double prescription drug costs? That is my question. 

Mr. MANSFIELD. We are in the process, sir, where a budget has 

been put together and will be presented at an appropriate time 

here on the Hill in the immediate future. 

Senator SANDERS. Well, Mr. Chairman, I think the difficulty is 

that we have some of us here who think that our veterans are in 

need of more help than they are getting. We would like to see the 

VA budget adequately funded, and some of us are a little bit disturbed that the VA is not there demanding that the President provide the kind of resources that, in fact, we need. 

I would yield back. Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Sanders. 

As you know, this oversight hearing is on collaboration and cooperation to meet the needs of returning servicemembers, and 

these concerns will be dealt with in this Committee. 

To the second round of questions, this is to Secretary Mansfield 

and Dr. Chu. Since 2002, OMB has lowered the grade from green 

to yellow for the President’s Management Agenda Initiative on coordination between VA and DOD. 

Secretary Mansfield, you first. What explains this drop in grade? 

And what is VA doing to improve performance? 

Mr. MANSFIELD. Sir, I believe part of it is the fact that the VA/

DOD cooperation element was included in the President’s Management Agenda for the first time only a year ago, and there is a process where they start out at the bottom, so you start out red and 

then you have to come up from there. 

The other point I would make is that Dr. Chu and I agreed when 

the JEC considered the plan that we offered, which was then 

looked at by the folks in the President’s Management Agenda to 

make the grades, we would rather reach as high as we could and 

set the bar as high as we could in an effort to make sure that we 

could go forward in a way to meet the full needs. So we did not 

back off of that and put in a lower-level plan. We put the bar as 

high as we could in an effort to make sure we were trying to drive 

this effort forward to the fullest degree we could. And that meant 

that on some of those issues, we did not get the accomplishment 

that we hoped for. 

Chairman AKAKA. Dr. Chu? 

Dr. CHU. If I may add to Secretary Mansfield’s response, the 

OMB grades typically reflect progress against a set of milestones. 

So in Period 1, if you get green, it means you have met the milestones for that period. In Period 2, much as Secretary Mansfield 

outlined, you have a new set of milestones. And if you do not meet 

all those milestones, you will not get quite as good a grade. 

It is intended to call management’s attention to areas that need 

reinforcement. We have done that. I think you will see the next 

grades will look better as a result. 

Chairman AKAKA. Secretary Mansfield and Dr. Chu, there are 

many programs in both DOD and VA that work with those who 

66

suffered serious injury in Iraq and Afghanistan. There is DOD’s 

Military Severely Injured Joint Support Operations Center. The 

Army has its Wounded Warrior Program. The Marines has the 

Marines4Life Program. The Air Force has its Helping Airmen Recovery Together program. The Navy has SAFE HARBOR. In VA, 

there is a National Polytrauma Rehabilitation Call Center 

Helpline. 

Dr. Chu, you first. What is being done to ensure that these programs are considered? And how is their effectiveness being measured? How are servicemembers and their families being helped in 

figuring out where to seek assistance? Dr. Chu? 

Dr. CHU. Mr. Chairman, it is a pleasure to address these programs because they are important to the rehabilitation and return 

to full productive life of our veterans who have suffered significant 

injuries. 

The separate service programs are stronger now than they were 

before. Therefore, the Severely Injured Center that you described 

will start stepping back as the services start stepping forward, each 

in its own lane to care for its own people. That is a model of decentralized effort that I think responds to some of the concerns Members have raised here this morning. Each service is closer to its 

people. There is a cultural affiliation, a warmth, a caring that is, 

I think, ennobling in terms of what they do. So we want the individual services to play a strong role. 

Now that they are more prepared to do so, we will step back, 

and, in fact, we will rename the Severely Injured Center as part 

of the Military OneSource Center, which is our broad outreach program to military families for all issues. 

The Veterans Affairs Department has a close liaison with us in 

these programs. As I indicated, it puts counselors in places like 

Walter Reed and Bethesda and other significant military hospitals 

around the country. There is a very strong partnership between the 

two. 

It is important to allow the veterans to choose how they best like 

to be cared for. Even if clinically we might have one recommendation, ultimately the choice of how they wish to proceed is theirs, 

and our responsibility is to ensure they know about those choices 

and can make a considered, thoughtful decision, that the bureaucracy is facilitating rather than standing in the way of their 

progress. And I think we have got quite a good track record. That 

is ultimately the measure: Are the families satisfied, are the veterans satisfied with the care that they are receiving? I think you 

have seen in news media reports the very fine remarks that those 

with severe injuries have given to the care they are getting at Walter Reed and Bethesda. 

Chairman AKAKA. Mr. Mansfield? 

Mr. MANSFIELD. Mr. Chairman, I would just make the point that, 

going back to the initiation of these programs, the VA cooperated 

with the Secretary of the Army and the Commandant of the Marine Corps originally to put these programs in place. Also, we cooperated with Dr. Chu to put VA people in the OSD office in an 

effort to make sure these programs went forward. 

We recognize that after a severe injury that causes the person 

to be removed from the battlefield in some cases, or in other cirVerDate 0ct 09 2002 14:48 May 29, 2007 Jkt 000000 PO 00000 Frm 00070 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\32723.TXT SENVETS PsN: ROWENA
67

cumstances, to a military treatment facility, then they are faced 

with the question of what happens next, the fact that they may be 

leaving the service is another issue that we have to deal with, and 

it is something that they worry about. And I know this personally 

from my own background and what happens as you go through this 

process. 

We have the social workers and the benefits counselors from the 

VA in Walter Reed or Bethesda to help that transfer and to work 

with that individual, that man or woman who is injured, as well 

as their family. This is a way to ensure that we have the representatives from the services in the VA facility. 

For example, yesterday, in preparation for this meeting, I met 

with the colonel from the Marine Corps and a representative from 

the Army who are in VA headquarters prepared to deal with any 

issues that come up from these seriously injured individuals as 

they make that transfer to a VA facility, to make sure that they 

do not get lost in the cracks, any issues they have that come up 

will be dealt with. So I think it is a very good way to make sure 

that this seamless transition is covered on both sides—the military 

treatment facility, DOD; the VA medical center, the VA. 

Chairman AKAKA. My time has expired. 

Senator Rockefeller? 

Senator ROCKEFELLER. I want to reflect a little bit on the Guard 

and Reserve. The third largest complaint of these listening sessions 

that I go to, if I may be frank about it, is the disdainful condescension of the regular military toward the Guard and the Reserve, 

which represents a large part of what West Virginia soldiers are 

doing in Afghanistan and Iraq. 

Now, I do not attribute that to either of you two. Gordon, you 

have been in my house many times. We are very good friends. You 

are now representing a different client than you used to be. Dr. 

Chu, I do not know you. But our General of the Reserve component 

remembers—feels that the following standards should be: no longer 

than 1 week for non-urgent routine medical care. Do you think this 

is possible? 

Dr. CHU. Sir, are you speaking to me or to Mr. Mansfield? 

Senator ROCKEFELLER. I am sorry? 

Dr. CHU. Sir, are you asking me or Mr. Mansfield? 

Senator ROCKEFELLER. I am asking you. 

Dr. CHU. For VA treatment or for——

Senator ROCKEFELLER. Yes. 

Dr. CHU. I really would not be competent to speak to what the 

VA standard ought to be. 

Senator ROCKEFELLER. Secretary Mansfield? 

Mr. MANSFIELD. A person needs an appointment and they should 

get it in 1 week; is that the question? 

Senator ROCKEFELLER. Yes. 

Mr. MANSFIELD. The Commander of the Reserve believes that? 

Senator ROCKEFELLER. For routine medical care. 

Mr. MANSFIELD. In the VA. 

Senator ROCKEFELLER. In the VA. 

Mr. MANSFIELD. These are folks that have now qualified for VA 

care? 

68

Senator ROCKEFELLER. Correct; otherwise, they would not be 

there. 

Mr. MANSFIELD. So they are out and about. The standard we 

have, sir, is 30 days for the initial appointment, and if it is emergent care, then it is taken care of immediately. So it is longer than 

1 week. It could potentially, depending on——

Senator ROCKEFELLER. OK. The second part of his question is no 

longer than 1 month for specialty care, which includes, of course, 

surgeries. Do you know that is possible? 

Mr. MANSFIELD. No, sir. Right now, it is not. Specialty care is an 

area, as I mentioned earlier, I believe, where we have problems 

meeting our current standards, and we are stretching times on that 

right now. 

However, I would make the point again that my medical advisers 

continue to tell me emergent care or an obvious need right away 

would be taken care of right away. 

Senator ROCKEFELLER. Do you know what I think this all comes 

down to, Mr. Mansfield? It comes down to the fact that, other than 

the Pentagon—and perhaps including the Pentagon—the Veterans’ 

Administration is the largest agency in Government. Now, that 

may be true of CMS and not the VA, but in any event, it is in the 

top two or three. 

Your answers to questions here today were that you have to do 

the best you can and you have to work through the ‘‘process,’’ a 

word which you used. The process is as follows: Every word that 

you spoke to us from your prepared testimony and every word that 

you spoke to us, Dr. Chu, from your prepared testimony—well, particularly you, Mr. Mansfield; I don’t know about Dr. Chu—was vetted by the Office of Management and Budget. That is the way the 

system works around here. You do not get to give what you think. 

You get to give what the company line is. I want people to understand that. 

So that when we ask you, ‘‘Do you think people are getting 

enough service?’’ You have to say, ‘‘Well, we are doing the best we 

can,’’ or ‘‘Yes,’’ or as they used to say when I went to Iraq, ‘‘We 

have enough troops to accomplish the mission, sir’’—which meant 

that they did not. 

Now, in this system where the OMB—and I do not know how 

many trips they make out to Iraq, and I assume they do make trips 

out to Iraq and Afghanistan. But they can only give you what they 

are told to give you, what the budget parameters of that year will 

allow them to give to you, which, by definition, means that the veteran is put into a second position, the recipient position. 

So there is only one way out of that. I tried it once on Vice President Gore, and it worked, because being Vice President is called 

‘‘up there.’’ And I had an issue on veterans health care, and I proposed to make a stink about it, and I called him up, and I said, 

‘‘Does the Government have any more money than this in the budget?’’ Well, the OMB budget had already been drafted. And he was 

not pleased by my phone call, was not pleased by me, and, nevertheless, at the end he yielded and the budget number went up. 

Last year, Danny Akaka and Patty Murray led the fight, not for 

the $3 billion which should have been the increase in the veterans 

care budget, for the $1 billion which they thought they could get. 

69

That overruled the OMB in that part of the process because it was, 

as you said, appropriated, voted, legislative funds, passed both 

Houses. 

So, if Senator Akaka had not done that, if Senator Murray had not done that, you would have a $1 billion shortfall, which then 

leads to the question: What do you all do about it? You are the 

ones—and I like you a lot. I respect you a lot. You know that. In 

spite of the tone of my questioning, you know that. And so the 

question is then: What do people like you and Dr. Chu do? Or what 

does somebody like Jim Nicholson do? 

There is only one recourse for him, and he can only use it once. 

And in the case of the veterans, I am not sure that he would have 

to use it more than once, and that is, he walks in to the President 

and he says, ‘‘If I do not get $3 billion more,’’ or ‘‘X’’ billion dollars 

more, or whatever it is, for mental health, for suicide prevention, 

for getting that 80 percent—the 40 percent of which do not declare 

themselves, but which an experienced eye can tell signs of out 

there in the field, much less back here. He says, ‘‘If I do not get 

that money, I am going to quit. And I am going to quit and I am 

going to tell the public why I quit.’’

That has an amazing effect on a President, I would guess. Veterans, Iraq-Afghan War—or, rather, Afghan-Iraq War is the central 

subject of our times and that, unfortunately, is the limit of the 

process. I can make a phone call to Gore, if I happen to know him 

and if it happens to work. I was Chairman at the time. We can legislate, you know, override OMB and we can legislate. 

You do not play a part in either of those, but you are the folks 

on the line. You are the guy who got the medal. You know what 

it is. So you are put into a position where you really cannot speak 

up for the veteran except for the money that is appropriated to you, 

which is never, under Democrats or Republicans, sufficient. Because always to this point, veterans have been considered by the 

body politic to be a subsequent matter, a subsequent item. 

Now, all of a sudden they are not. Maybe that began with—was 

it Rebecca Lynch? Hmm? Jessica Lynch—of West Virginia, no less. 

And she became sort of the voice, the image of the veteran, and 

then it progressed up from there. 

How many was it that were killed yesterday? Was it 79, in the 

last 2 days, 79? They will not be veterans. But others were wounded; they will be veterans. They now have these Iranian IEDs that 

put all these long shards of metal into you, and you live, but you 

probably wish that you did not because the pain is so horrible and 

so chronic, and it rests with you for the rest of your life because 

they cannot take those shards out because they are too close to 

vital veins and organs. So you live in agony for having served your 

country. 

You understand my point. I simply say that there have to be 

some people who are willing to put themselves on the line. Danny 

did. He could have lost. Veterans could have said, ‘‘Oh, he did not 

try hard enough.’’ They would not have said that about Danny, the 

Chairman. But he did it and he won. And Patty Murray, the 

schoolteacher in tennis shoes, did the same thing, and she won. 

Now, if they can win, so can you. Your concern is 24/7 about 

these folks, all the time. That is all you think about. You bleed 

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with them. You cry with them. You hug them. And you think about 

what you have to do to make their lives better. But you cannot, because you are under the thumb of the Office of Management and 

Budget. You are ruled by them—unless you find a way to supersede them, which is what I ask you and us to do. 

I thank the Chairman. 

Chairman AKAKA. Thank you very much, Senator Rockefeller. 

Let me close with a question to Secretary Mansfield. As you 

know, Secretary Mansfield—and we are talking about being on the 

line, and I feel that Vet Centers are on the line for the VA. And 

I have been working over the years to increase funding for the Vet 

Centers. I view the services they provide as being very, very critical 

to the mission of the VA. 

My question to you: Are the Vet Centers effectively connecting 

with returning servicemembers? Does VA have sufficient resources 

to meet the demand that these returning servicemembers will place 

on essential programs through the Vet Centers, Secretary Mansfield? 

Mr. MANSFIELD. Mr. Chairman, I would make the point that in 

my travels as I go out to VA facilities, I do try and visit Vet Centers every chance I get. And in the ones that I have visited lately 

over the course of the last year, in each and every one of them 

there have been Iraqi veterans present for the effort going forward 

or ones that have come in and signed up. 

We have twice gone out and made an effort to hire Iraqi veterans 

to bring them in for peer counseling, and each time that I visited 

a Vet Center, I have heard from those individuals, and they are 

going out, for example, to the National Guard units that they know 

about because they are from the town, or maybe they were from 

that unit, to the Reserve units, as well as active-duty units that 

may be in the area, and attempting to make sure that the Iraqi 

and Afghan veterans are aware of the services provided. 

I believe—and I have asked the question of my medical advisers—that they are funded sufficiently to get the job done, recognizing that we have given them additional people to get the job 

done. And I believe that we are adding significant numbers of new 

Vet Centers over the course of this Fiscal Year, should we get a 

budget, and also next year, in an effort to make sure we continue 

to reach out. 

The one issue that still comes up and that I am aware of is: Are 

we doing enough for family counseling? There have been some efforts to require that we get qualified or certified family counselors 

involved in the process for the effort to deal with the family members present. Right now, I think the approach is, these are Vet 

Centers and we are there primarily for the veteran. We do recognize that having the family involved helps the veteran, again, to 

get whole or get better, and we are making an effort to review that 

issue and come up with some final answers. 

I think we are doing a good job in that area. I know that there 

are a lot of Iraqi veterans that are coming in and are being helped. 

And in addition to that, we have also, as of 2 years ago, started 

doing bereavement services. I have been in some Vet Centers 

where families of veterans who are deceased have been brought in, 

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and they are having groups of them to help them through the bereavement process. 

So they continue to expand the work they do, and the issue of 

families, I think, is paramount in all that we are doing when we 

are talking about Iraqi or Afghan veterans. 

Chairman AKAKA. Our country is facing huge challenges when it 

comes to our veterans, and I am so glad you mentioned families. 

We need to extend it to them because families affect our troops 

wherever they are. 

There is no question that collaboration and cooperation is needed 

between Congress and the Administration, as well as between VA 

and DOD. We need bipartisan support in all of these, but the huge 

challenge is that we need to provide the kinds of services that are 

being demanded by our veterans, and many problems that arise. 

One of them is resources, funding, and we have talked about this 

today, the need to do that. And we need to find ways of doing it 

because with more resources we may be able to provide better services. 

There is also a need to look at and restructure what we have now 

in the VA services so that we can better serve the veterans. So 

many of these challenges now face us, and today is the beginning 

of all of that. And today’s hearing has been on collaboration and 

cooperation, and I mention that to you in the spirit that we want 

to try to work together to help the veterans of the United States 

of America. We owe it to them, and they need all the help we can 

give them. 

I want to thank you, Secretary Mansfield and Dr. Chu, for your 

testimony this morning. I do have a request. At these hearings, we 

often are unable to ask all the questions we would like, and as a 

result, we end up sending you post-hearing questions, as was mentioned by Senator Obama. And I do and other Members have posthearing questions. 

The record will be open for 2 weeks for submission of post-hearing questions. In the past, we have experienced difficulty in getting 

timely responses to post-hearing questions. I would like your assurances that you will do everything within your power to ensure that 

reasonable response times are met. 

Also, if you would each designate one point-of-contact person for 

any future questions on this subject, we would really appreciate 

that. 

Mr. MANSFIELD. Thank you, Mr. Chairman. You have my assurance. 

Dr. CHU. Thank you, Mr. Chairman. 

Chairman AKAKA. And so, again, thank you for your responses, 

and this hearing stands adjourned. 

[Whereupon, at 11:24 a.m., the Committee was adjourned.]

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