U.S. GOVERNMENT PUBLISHING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Publishing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

87–679 2015

ACCESS TO MENTAL HEALTH CARE AND TRAUMATIC BRAIN INJURY SERVICES: ADDRESSING 

THE CHALLENGES AND BARRIERS FOR VETERANS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATION 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

TUESDAY, APRIL 24, 2014 

Serial No. 113–66 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 


VACREP180 with DISTILLER
(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

BILL FLORES, Texas 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

DAVID JOLLY, Florida 

MICHAEL H. MICHAUD, Maine, Ranking 

Minority Member 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

JON TOWERS, Staff Director 

NANCY DOLAN, Democratic Staff Director 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATION 

MIKE COFFMAN, Colorado, Chairman 

DOUG LAMBORN, Colorado 

DAVID P. ROE, Tennessee 

TIM HUELSKAMP, Kansas 

DAN BENISHEK, Michigan 

JACKIE WALORSKI, Indiana 

ANN KIRKPATRICK, Arizona, Ranking 

Member 

MARK TAKANO, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

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

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

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

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

various electronic formats may introduce unintentional errors or omissions. Such occurrences 

are inherent in the current publication process and should diminish as the process is further 

refined. 


VACREP180 with DISTILLER
(III) 

C O N T E N T S 

Page 

Tuesday, April 24, 2014 

Access to Mental Health Care and Traumatic Brain Injury Services: Addressing the Challenges and Barriers for Veterans ................................................... 1 

OPENING STATEMENTS 

Hon. Mike Coffman, Chairman .............................................................................. 1 

Hon. Ann Kirkpatrick, Ranking Member .............................................................. 2 

WITNESSES 

Mr. Derek Duplisea, Regional Alumni Director, West Wounded Warrior 

Project ................................................................................................................... 4 

Prepared Statement ......................................................................................... 33 

Ms. Ariana Del Negro, Co-Founder, Veterans Leadership Assistance ................ 6 

Prepared Statement of Ms. Ariana Del Negro and Cap. Charles Galtin ..... 40 

Captain Charles Gatlin, U.S. Army (Ret.), Veteran ............................................. 7 

Mr. David Anderson, Veteran and American Legion Commander, Post 51, 

Sacaton, Arizona .................................................................................................. 8 

Mr. Jerry Boales, Veteran and Chairman of Rock Soldiers for Wounded Warriors ....................................................................................................................... 10

Prepared Statement ......................................................................................... 54 

Mr. John Davison, Father of a Wounded Warrior ................................................ 13 

Prepared Statement ......................................................................................... 56 

Mr. Bradley Hazell, Veteran ................................................................................... 15 

Prepared Statement ......................................................................................... 63 

Lisa Kearney, PhD, Senior Consultant, National Mental Health Technical 

Assistance, Office of Mental Health Operations, Veterans Health Administration ................................................................................................................... 23 

Prepared Statement ......................................................................................... 64 

Accompanied by: 

Dr. Joe Scholten, M.D., National Director of Special Projects, Physical 

Medicine and Rehabilitation Services, Veterans Health Administration 

Mr. Jonathan H. Gardner, MPA FACHE, Director, Southern Arizona 

VA Health Care System, Veterans Health Administration 

And 

Mr. Joshua D. Redlin, LCSW, Team Leader, Tucson Vet Center, 

U.S. Department of Veterans Affairs 

STATEMENT FOR THE RECORD 

Ms. Tina Ostrowski, COTA/L, CBIS, Community Bridges, Rehabilitation Institute of Montana ................................................................................................ 69 

Statement of Congressman Kyrsten Sinema ......................................................... 70 

Statement of Hon. Ron Barber ............................................................................... 71 


VACREP180 with DISTILLER

VACREP180 with DISTILLER
(1) 

ACCESS TO MENTAL HEALTH CARE AND 

TRAUMATIC BRAIN INJURY SERVICES: ADDRESSING THE CHALLENGES AND BARRIERS FOR VETERANS 

Thursday, April 24, 2014 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

Washington, D.C. 

The subcommittee met, pursuant to notice, at 1:00 p.m., in 

Southern Arizona VA Health Care System, Conference Room B, 

3601 South Sixth Avenue, Hon. Mike Coffman [chairman of the 

subcommittee] presiding. 

Present: Representatives Coffman and Kirkpatrick. 

Also Present: Representative Sinema. 

OPENING STATEMENT OF CHAIRMAN MIKE COFFMAN 

Mr. COFFMAN. Good morning. This hearing will come to order. 

I want to welcome everyone to today’s hearing titled ‘‘Access to 

Mental Health Care and Traumatic Brain Injury Services: Addressing the Challenges and Barriers to Veterans.’’ 

I would also like to ask unanimous consent that Representative 

Sinema of Arizona be allowed to join us here on the dais to address 

the issues before us today. 

Hearing no objection, so ordered. 

Providing the necessary care and treatment for traumatic brain 

injury has to be among the highest priorities of the Department of 

Veterans’ Affairs. The nation’s returning soldiers who have survived devastating blasts from improvised explosive devices and ordnance deserve the best possible medical care for their injuries that 

this nation can offer. 

They also deserve compensation for the disabilities connected to 

their military service. Given the prevalence of TBI among the veterans of Operation Enduring Freedom and Operation Iraqi Freedom, all veterans receiving medical care at VA are required to undergo screening for it. According to the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, more 

than 287,000 service members have sustained traumatic brain injury between 2000 and the third quarter of 2013. Almost 80 percent of these injuries were classified as mild TBI. According to Dr. 

Robert Petzel, Undersecretary of Health, there has been an almost 

70 percent decline in the number of severe TBI cases in recent 

years, while the number of mild to moderate cases has increased. 


VACREP180 with DISTILLER
2 

He said, ‘‘It costs much less to treat that group than the 

polytrauma cases.’’ As a result, the Administration’s budget request 

for Fiscal Year 2015 is for $229 million for TBI medical programs, 

down nearly 1.3 percent from Fiscal Year 2014. 

Today, we will hear from veterans and their families about the 

serious long-term consequences of traumatic brain injury. We will 

hear about the continued challenges veterans have to getting access to necessary services for TBI. Even with mild TBI, which constitutes the great majority of cases, VA is failing to provide proper 

screening and may be undercompensating veterans with very real 

disabilities. 

Today, Captain Charles Gatlin and his wife, Ariana Del Negro, 

will testify about the traumatic brain injury Gatlin suffered in an 

IED blast and about their subsequent struggles with VA. When 

Captain Gatlin was medically discharged from the Army, he had a 

70 percent disability rating from the Department of Defense. Notwithstanding the fact that Captain Gatlin had already undergone 

three comprehensive neuro-psychological tests by doctors at the Department of Defense that indicated mild TBI, Captain Gatlin was 

subjected to a perfunctory test by a psychologist at VA when he 

moved to Fort Harris in Montana in 2009. As a result of this test, 

Captain Gatlin received a rating of only 10 percent disability by 

the VA. Significantly, the psychologist who administered the VA 

screening has been brought up on adverse licensing charges by the 

Board of Psychologists for the State of Montana. The Board has 

reasonable cause to believe that the VA psychologist misused a diagnostic test and failed to conduct his assessment in accordance 

with the applicable standard of care. 

The VA has enlisted the Department of Justice to defend the psychologist on the grounds that state licensing laws are preempted. 

Essentially, the Department of Justice is arguing that VA can use 

unqualified personnel and substandard tests at its discretion in disability determinations. 

Substandard sampling for TBI research apparently is also a 

problem at VA. According to a recent study, only 5.4 percent of eligible veterans participated in responding to VA’s Markers for the 

Identification of Norming and Differentiation of TBI and PTSD. 

The MIND study is what it was called. The poor response rates 

cast significant doubt that the $3 to $4 million in taxpayer money 

on the MIND study over the past five years was well spent. 

I want to thank all the witnesses for appearing at this hearing 

today. Your testimony is important and in the end will lead to 

more consistent, comprehensive, and compassionate care for our 

nation’s veterans. It is our job to see that we get it right and we 

do not fail those who have sacrificed so much for this country. 

With that, I now recognize Ranking Member Kirkpatrick for 

opening statements. 

OPENING STATEMENT OF ANN KIRKPATRICK, RANKING 

MEMBER 

Mrs. KIRKPATRICK. Thank you, Mr. Chairman and Congresswoman Sinema, for being here today for the veterans and their 

families in District 1 in Arizona and across the country. 


VACREP180 with DISTILLER
3 

I would also like to acknowledge that our colleagues, Congressman Barber, Grijalva and Gosar, have members of their staff here 

today. They are in Yuma for the dedication of the John Roll United 

States Courthouse. 

I also thank all of you who are here today, whether to participate 

or to observe. Your presence is greatly appreciated. 

As members of the Oversight Investigations Subcommittee and 

as members of Congress, we have a duty to stand up for our veterans. It is our job to fight for those who have served. I called for 

today’s hearing because ensuring access to timely, safe, quality 

health care for our veterans is one of my top priorities. We need 

to examine the connection between TBI and PTS and access to 

care. 

Many of us are aware of the troubling reports about the Phoenix 

VA Medical Center and the patient deaths allegedly caused by long 

wait times for an appointment or consult. While we don’t have all 

of the facts, we do know that delayed care is denied care. And I 

have already called for a hearing on this after the Inspector General’s investigation is completed. 

I am deeply concerned that lengthy appointment wait times in 

the VA system may be discouraging veterans from seeking help 

when they need it most. With TBI being the signature injury of the 

Iraq and Afghanistan wars, we know that having a traumatic brain 

injury can amplify the symptoms of PTS. Many of our veterans suffered TBIs, and they also suffer from PTS. Their needs need to be 

sustained and they need quality care for the rest of their lives. 

In Arizona, many of these veterans live in rural areas, including 

our Native American veterans. These men and women need the 

same care and the same services as veterans in urban areas near 

large VA medical facilities like Tucson. 

The VA health care system must be able to provide timely, highquality care to the veterans who are already in the VA system and 

be ready for the expected increase in the number of veterans who 

will soon become part of the VA system. 

This hearing will focus on how VA is addressing the needs of our 

veterans who have sustained traumatic brain injuries and suffer 

from mental health conditions. From this hearing, I hope to identify where improvements by the VA are needed and to identify 

some best practices and resources to care for our veterans. I hope 

this feedback can help break down barriers for access to mental 

health services. 

The Tucson VA is one of 23 polytrauma network sites, and I look 

forward to hearing from our panelists from the Southern Arizona 

VA Medical Health System on how they are providing treatment 

for our veterans with TBI and PTS. 

I also want to thank our first panel for sharing your stories with 

us. I know it must be difficult, but hearing from you allows me and 

this subcommittee to better understand the challenges and barriers 

to proper care. I, along with the subcommittee, continue to hear 

stories of many struggles veterans face when trying to access VA 

mental health and TBI services. Whether it is a delay in care, a 

denial of care, or care is just not available, frustration with the system may lead to the veteran foregoing needed care altogether, 

which is unacceptable and can lead to crisis. 


VACREP180 with DISTILLER
4 

I look forward to hearing from our panelists today and have a 

productive discussion on these very important issues. 

Thank you, Mr. Chairman. I yield back. 

Mr. COFFMAN. Thank you, Ranking Member Kirkpatrick. 

With that, we have the first panel at the witness table. On this 

panel we will hear from Mr. Derek Duplisea, Regional Alumni Director of the Wounded Warrior Project; Captain Charles Gatlin, 

United States Army, retired, and his wife, Ariana Del Negro, CoFounder of Veterans Leadership Assistance. 

I would now like to allow Ranking Member Kirkpatrick to introduce the remaining witnesses on our first panel. 

Mrs. KIRKPATRICK. Thank you, Mr. Chairman. 

It is my pleasure to introduce a few members from our first 

panel. 

Mr. David Anderson is a veteran and the Post Commander at the 

American Legion. David is also Native American, and we are very 

interested in hearing your perspective. Thank you for being here. 

Mr. Jerry Boales, also a veteran, is Chairman of the Rock Soldiers for Wounded Warriors. He just had surgery, and this committee meeting was so important to him that he made it here 

today. Thank you very much. 

Mr. John Davison is a dear friend of mine from Flagstaff, father 

of a wounded warrior who just committed suicide, and I spoke at 

the funeral service. This is tough for me and for John and his family, so there may be some tears. 

Then I would like to introduce Brad Hazell. Brad is also a veteran, and Brad worked in my congressional office in Casa Grande, 

has a stunning reputation for helping our veterans, and we look 

forward to your testimony. 

Thank you. 

Mr. COFFMAN. Each of your complete written statements will be 

made part of the hearing record. 

Mr. Duplisea, you are now recognized for 5 minutes. 

STATEMENT OF DEREK DUPLISEA 

Mr. DUPLISEA. Chairman Coffman and Ranking Member Kirkpatrick, thank you for inviting Wounded Warrior Project to testify 

on behalf of both the professional and personal concern for me. In 

2006, in August, right before my second deployment to Iraq was to 

end, a suicide bomber left me severely wounded, effectively ending 

my 13-year U.S. Army career as a cavalryman, airborne-armor 

paratrooper, and scout. I spent the next two years recovering from 

injuries that included a severe penetrating traumatic brain injury, 

a shattered right femur, a completely shattered right arm that was 

nearly amputated, burns, nerve damage, and PTSD. I’ve been 

working with and on behalf of wounded warriors since a few 

months after I medically retired from the U.S. Army in 2008. 

I am proud to serve as the Western Regional Director for Wounded Warrior Project’s Warrior Engagement Programs. In addition to 

operating 20 direct-service programs for almost 50,000 warriors 

with whom we work, Wounded Warrior Project conducts an annual 

survey. Our most recent survey found that three most common reported health problems among our warriors are PTSD at 75 perVerDate Aug 31 2005 11:26 Aug 26, 2015 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 Y:\87679.TXT PAT

VACREP180 with DISTILLER
5 

cent, anxiety at 74 percent, and depression at 69 percent. More 

than 44 have experienced a TBI. 

The survey shows that for many, the effects of mental and emotional health problems are even more serious than the effects of 

physical problems, with more than 25 percent in poor health as a 

result of a severe mental health condition. 

On mental health care, access to mental health care is clearly 

vital, but access alone isn’t enough. Care must also be both timely 

and effective. We see wide variability in VA mental health care 

from facility to facility. My own experience at the Tucson VA has 

been very positive, but many other facilities still seem to lack 

enough mental health staff despite VA adding some 1,300 new 

mental health professionals. 

VA has also put a new emphasis on scheduling new mental 

health appointments within 14 days, but there is also a big difference between being seen for an initial assessment and actually 

starting treatment, which may not occur for weeks or months, leaving some veterans feeling desperate. 

Despite the hard work of dedicated, professional clinicians at 

many VA facilities, we still see evidence of a system that is understaffed and under stress. Here are some examples we see around 

the country. 

Veterans who need individual therapy are frequently being 

pushed into group therapy or taking the group option because the 

wait time for the individual treatment is too long. Some rural VA 

clinics are placing veterans who have depression or anxiety on 

waiting lists or not providing them treatment at all to give priority 

to those with combat-related PTSD. A large number of warriors are 

reaching out to our organization for help in finding mental health 

treatment options because of VA timeliness issues. 

VA facilities can seldom provide treatment proactively as needed 

and instead can only react when the veteran’s condition deteriorates to a point of crisis. And, as we learned from a recent survey, 

of those who sought VA care for military sexual trauma-related 

conditions, 49 percent reported difficulty accessing that care. 

We don’t suggest that these are simple problems, but it is not 

good enough to say that the VA has seen a high percentage of veterans when treatment is often sporadic or limited to providing 

medications. Access to timely, effective treatment should be the 

norm, not simply a distant goal. 

Regarding traumatic brain injury, we are particularly concerned 

about VA’s failure to implement bipartisan legislation Congress enacted in 2012. That law was aimed at providing long-term rehabilitation of veterans with TBI, and it calls for VA to apply a new 

model of TBI rehabilitation. Under the law, rehab services are not 

to be cut off based on the view that the patient has plateaued. The 

law also directs VA to provide any community-based services or 

support that might contribute to maximizing the veteran’s independence. 

The point is that rehab services should not end when the veteran 

returns home. For many, the rehab journey only starts then. But 

we see no evidence that the VA has implemented this law or that 

it had any effect on VA practice. It remains common for warriors 

to have TBI rehab services discontinued after a set number of 


VACREP180 with DISTILLER
6 

treatment sessions or based on the view that the warrior has 

plateaued. Families report that they are left to their own devices 

to continue the warrior’s rehabilitation. The upshot is that 25 percent are paying out-of-pocket for services VA is not providing. Onequarter of those pay more than $300 monthly out-of-pocket to provide rehabilitative services. 

The Wounded Warrior Project is not just complaining. We have 

established a program of our own, providing 140 warriors with severe TBI the very kind of community support the VA should be 

providing. We will be expanding the program to help more warriors, but we also want VA to implement the TBI law and urge the 

subcommittee to press that point back in DC. 

Finally, we look forward to working with you here in Arizona and 

the nation’s capital to improve the care of veterans with mental 

health needs and those with TBI. In the Army, we were always 

taught to have faith in our equipment. My helmet here today testifies to that faith. If I was not wearing this helmet, I would not be 

here today. We now put our faith as warriors and veterans in you, 

the government and the VA. 

Thank you. 

[THE PREPARED STATEMENT OF DEREK DUPLISEA APPEARS IN THE

APPENDIX] 

Mr. COFFMAN. Thank you, Mr. Duplisea, and thank you so much 

for your service. I come from a Colorado military family. I am a 

congressman from Colorado, and my father was a World War II 

veteran. I was in the first Gulf War and Iraq War. 

Mr. DUPLISEA. Thank you. 

Mr. COFFMAN. Thank you. 

Ms. Del Negro and Captain Gatlin, you are now recognized for 

5 minutes. 

STATEMENT OF ARIANA DEL NEGRO 

Ms. DEL NEGRO. Thank you, Mr. Chairman, Ranking Member 

Kirkpatrick. My name is Ariana Del Negro, and my husband, Captain Charles Gatlin, and I would like to formally submit our written testimony for the record. 

We are here today to voice our profound concerns regarding the 

VA’s handling of C&P claims for residuals of traumatic brain injury 

and unethical practices not only at the Fort Harrison VA in Helena, Montana, but potentially across all VA systems. The consequences are far-reaching. The emotional, physical, and financial 

tolls placed upon the veterans and their families in seeking to right 

wrongs in the system is unacceptable and warrants immediate corrective action. 

As Chairman Coffman mentioned, my husband, whose scout 

recon platoon was retired from the Army in 2009 having received 

a 70 percent rating for his traumatic brain injury, which starkly 

contrasted with the Montana VA, who gave him a 10 percent. The 

discrepancy between the DoD’s rating and the VA’s rating and the 

failure in accountability of the latter are the basis of our concerns 

with the VA. The lower rating assigned was a consequence of the 

fact that the examiner, a clinical psychologist, was not licensed to 

conduct neuropsychological testing. The test he used was a screenVerDate Aug 31 2005 11:26 Aug 26, 2015 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 Y:\87679.TXT PAT

VACREP180 with DISTILLER
7 

ing measure for dementia, not TBI, and he misinterpreted the results, thus providing C&P raters medically inaccurate information 

on which to base their disability rating. 

As my husband will attest to next, our efforts to rectify this 

straightforward matter have been met with hostility and 

stonewalling from weak leadership. What will it take for a system 

to be held accountable, where the interests of the veteran are 

placed before the bureaucracy of the system? 

[THE PREPAPERD STATEMENTS OF ARIANA DEL NEGRO & CHARLES

R. GALTIN APPEARS IN THE APPENDIX] 

STATEMENT OF CAPTAIN CHARLES GATLIN 

Captain GATLIN. This stands as a Ranger creed: ‘‘Never shall I 

fail my comrades. I will keep myself fit and alert, physically strong, 

and morally straight, and I will shoulder more than my share of 

the task, whatever it may be, 100 percent, and then some.’’ The VA 

needs to learn that. 

Good afternoon, Honorable Chairman and Ranking Member 

Kirkpatrick. My name is Captain Charles Gatlin, and I thank you 

very much for the opportunity to participate and discuss an epidemic of dynamic proportions that has manifested within my State 

of Montana, the recently dysfunctional nature and incompetence of 

the Fort Harrison VA, VHA and VBA. 

I would like to submit my oral testimony annotating my unequivocal level of frustration with fraud, waste and abuse with respect to TBI systems operation and associated personal and professional misconduct of the Montana VA. 

The VA in Montana is experiencing problems with respect to accountability and patient care. While I realize that no one system 

is perfect, at what point do senior echelon staff and officials choose 

to ignore, even mitigate, major concerns brought to their attention 

by qualified veterans? To neglect these forces of action, which could 

be construed as the equivalent of fraud, waste and abuse to the 

veteran, and will only cost the American taxpayer a tidy sum, to 

place an additional social and emotional burden on our nation’s returning wounded, their families, and particularly those with varying levels of TBI and other injuries. 

Montana has a very challenging geography that already makes 

sustained access to care difficult. But to compound these issues 

with gross incompetence, neglect, and cutting corners is a tremendous disservice to our veterans perpetrated by staff at Fort Harrison and other regional offices. 

Ladies and gentlemen, this needs to be corrected, and this needs 

to be corrected immediately. 

To bring attention to the severity of the potential criminal nature 

of these acts, I will briefly highlight several observations within the 

Montana, Salt Lake, Denver VA offices and how their collusive 

interactions have led me to be sitting here before you today. 

Within the Montana VA, physicians are knowingly operating outside the scope of their licenses, which results in intentional and 

systematic lowering of the quality care and disability ratings. As 

an example, one such clinician, Robert J. Bateen, Ph.D., made clinical conclusions outside the scope of his expertise. In the eyes of the 


VACREP180 with DISTILLER
8 

VA, this is acceptable. However, he was in violation of several tenets of his license by his peers at the Montana State Board of Psychologists. 

When Dr. Trena Bonde, the Medical Chief of Staff, was approached with this objective and factual information, along with a 

request for formal and informal reviews, the veteran, myself, was 

referred to a VA attorney. I ask you, is this how we treat wounded 

vets? Substandard care and the argument that the VA is immune 

to state oversight, ethics, and administrative policies? Sadly, this 

type of behavior and disregard for patients and veterans are common occurrences within the Fort Harrison system. When veterans 

must be proactive and seek administrative recourse to correct injustices, they are ignored and told they are attacking the VA. 

When I asked to see an M.D. to administer a proper diagnosis, 

why am I referred to a VA regional counsel, Jeff Stacy? When veterans seek recourse through varying levels of leadership and appointed directorships such as Willy Clark and John Skelly, why are 

they referred to legal counsel? All of which, I might add, are in direct violation of internal VA policy, Federal code, and rules set 

forth by the Office of Regulation and Policy Management. 

When I speak with regional counsel to seek clarification and get 

a conference call between the VBA and the VHA to figure out what 

is going on, I am told I am disingenuous and faking my injury. Is 

this how the system operates? 

For all intents and purposes, I have just outlined fraud, waste, 

and abuse on the individual level, and there remains no accountability. 

I bring this up in hope of clarifying my position with this epidemic that is going on. 

Now consider this, and I will be very brief. Montana has the second-highest VA population in the United States, roughly 10 percent. Couple that with a very unique population distribution and 

challenging geography and you will see why the transparent accountability with respect to resources and care become evident. 

Thank you, Chairman, esteemed members of the committee, for 

the opportunity to speak on behalf of not only service men and 

women in uniform but retirees, honorably discharged vets, concerned citizens, and most especially caregivers. 

Thank you for your time. 

Mr. COFFMAN. Thank you both. And, Captain Gatlin, thank you 

again for your service. 

Mr. Anderson, you are now recognized for 5 minutes. 

STATEMENT OF DAVID ANDERSON 

Mr. ANDERSON. Thank you, Mr. Chairman and members of the 

committee. My name is David Anderson. I am from Akimel 

O’odham Tribe, better known as Gila River Indian Community. I 

am a 20-year veteran. I am also an American Legion Post Commander within the Gila River Indian Community. I am also a 

Founder and Chairperson for O’odham veterans. Native Americans 

as a whole are the largest minority in the Armed Forces, but we 

are the least amount in utilizing our VA benefits. 

Now, saying that, the VA does help us out. I mean, they have 

come a long way in the last 10 years. But people like Phyllis 


VACREP180 with DISTILLER
9 

Spears here in the Tucson VA, Mike Leone in the Phoenix office 

have helped me tremendously over the last four years trying to get 

Native Americans signed up for veterans benefits. 

I am saying that also there are—I don’t want to say there are 

only problems there because there are good people here in the VA. 

So I would like to say that. 

Like I said, I received a TBI in 1987 when nobody knew what 

a TBI was. I got promoted to E7 in seven years. I was at the top 

of the Army, 1 percent of the Army on my career progression. But 

after I got a TBI, I was on every urinalysis. Everybody didn’t know 

what was going on. Everybody was, like, ‘‘Oh, he’s on drugs.’’ When 

you go to that super-soldier and you are on that downward spiral, 

people didn’t know, and I am glad that we are looking at this to 

help our veterans. 

But in saying that, 22 veterans die every day in the United 

States. We are more suicides than what we have lost in Afghanistan and Iraq, which is a sad thing to say. 

When I got out in 2000, I started through the VA process in 

2003. Going through that process with my mental health caregiver, 

right off the bat the VA wants to give you drugs instead of dealing 

with the situation. I was sleeping 18 hours a day, and when I was 

told, I said I don’t want to sleep 18 hours a day, I am getting more 

depressed, I feel like I am falling off what I already had, you know? 

And their comments to me were, well, either take these drugs or 

we are done here. 

Of course, I had PTSD, TBI, and I said, okay, I guess we are 

done here, you know? And through my faith and my tribe and 

other veterans, I fought that and fought that, and somewhat recovered. From alcoholism to fighting with the police, getting thrown 

in jail, I went through that whole gambit of troubles that we see 

our young veterans going through. 

I counsel young veterans on a daily basis, and I see the problems 

that we are having. I have one veteran who said he had talked 

about hurting himself, so he got a one-way trip to here. They took 

him off the gurney, strapped him down and gave him drugs, 

pushed him in a room with 12 other people. 

There is no crisis management within the VA to deal with these 

situations, and I guess that is my whole deal. PTSD is not a new 

disease or a new anything within the U.S. services. I mean, our 

Native tribes, when we went away to battle, we could not come 

back to the village for three to five days until you got cleansed, 

until you got all of this out. It is nothing new, but the VA does not 

cure people. They medicate people. 

That is where we need to look at our professional services and 

to get away from those drugs and to really deal with the problem 

here, and that is what I am here to say. We need to out-source 

those problems. 

I am trying to get an MOU with our tribal hospital and the VA, 

which the VA in pamphlets has said, oh, yes, this is the best thing 

since sliced white bread. But they only want to pay for in-source 

kind. All tribal hospitals are small in size. We out-source things. 

We don’t have a cardiologist. We don’t have a bone specialist. We 

out-source them. But the VA is still not willing to pay for those outsourcings. 


VACREP180 with DISTILLER
10 

We don’t have the time, like these people are saying, to get these 

people proper medical treatment without the out-sourcing. We can’t 

send them to the VA because they will never be seen, and that is 

why we are looking to out-source them, our Native American veterans, to get the proper treatment. 

I guess I would look at this committee for help on that because, 

as veterans, like I said, we are the largest minority in the Armed 

Forces, and this is what we need, is to be able to out-source and 

to help our veterans. As we all know, most Native American communities are alcohol and drug abuse, which is not helping our veterans. But I think if we are allowed to out-source them to get them 

the proper treatment, then as Native Americans go, I think we 

would be a lot better off than trying to send them to a veterans 

hospital where there is no help. They are over-burdened. They are 

over-booked. 

I come from the Grande Office. We have one doctor for over 5,000 

patients. We had two more doctors come in. I got to see my new 

doctor. He was there for three weeks and then left. I have no idea 

who my new doctor is, or have I ever seen him because the snow 

bird is right here, and getting an appointment when they are here 

is non-attainable. 

I would like to say on my family side, my father put in 26 years. 

I have two brothers. All three of us retired from the military. My 

son just graduated AIT at Fort Huachuca, and he is going to Colorado, Fort Carson, 10th Special Forces Group. So, I am saying that. 

I thank the committee for letting me address you. Thank you. 

Mr. COFFMAN. Well, Mr. Anderson, thank you so much for your 

service, for the service of your family. 

Mr. COFFMAN. Mr. Boales, you have 5 minutes. Thank you. 

STATEMENT OF JERRY BOALES 

Mr. BOALES. Chairman Coffman, Ranking Member Kirkpatrick, 

and members of the committee, my name is Jerry Boales, and I am 

the Director of Rock Soldiers for Wounded Warrior non-profit. Here 

in Arizona we service wounded warriors here in Arizona. Anyway, 

the testimony I am going to give today is the first time I have spoken openly about my personal experiences concerning this issue. 

In 1989, I was stationed in the U.S. Army at Fort Riley, Kansas. 

During my time there I was attacked by three male soldiers, 

grabbed and pulled in a room. I was forcibly held down by two of 

the males while one forcibly raped me. I was then raped by the second male. The third male did not do anything except hold me while 

this was going on. I was told that if I said anything, I would be 

killed. I was in so much pain and shock that basically I was 

dragged to the stairs and was thrown down a flight of stairs, 20 

stairs, and left alone. I passed out and woke up by the cadre. I 

could not move, so they sent me to the hospital on base. I became 

paralyzed emotionally, which I literally had to have a cattle prod 

taken and pressed on my feet to bring me out of the paralysis condition. 

At this time I was so ashamed about what had happened that 

I did not report this incident, and I even told my father that I had 

slipped down some stairs and broke my arm. I had spent several 


VACREP180 with DISTILLER
11 

days in the hospital for this incident, knowing that I had been 

raped. 

In 1990 I was discharged from the Army, so for the next 16 years 

I kept this to myself. I was married, had three children, and one 

night because of a nightmare, something snapped within me. The 

nightmares became so bad that I could not sleep and literally I was 

a walking zombie for not allowing myself to sleep. Finally after six 

years, I started seeing a nurse practitioner/counselor at the Show 

Low VA. I told her my story, and after a year she left and I had 

to see someone else. I would have to start all over again, which I 

just couldn’t do. 

So after about a year and a half, my wife encouraged me to seek 

help once again. I was really not wanting to talk to a male doctor 

about my experiences. I wasn’t getting any better, so I did go back 

to the VA. I saw a physician, Dr. Davis. He could prescribe medications, so I continued to see Dr. Davis for almost two years. This 

was one-on-one counseling visits. 

This time, I was recommended by Dr. Davis to submit for PTSD, 

depression, unemployability, which he documented, and I can also 

add that in his notes he related the military sexual trauma. I was 

denied PTSD relating from the military sexual trauma due to lack 

of evidence. However, I was service connected for depression 100 

percent temporary, to be reevaluated after two years. I was originally denied Social Security disability twice, which took over another two years to get that approved through the use of a lawyer. 

This was because I could not work and was already diagnosed as 

chronic depression by the Veterans Administration. 

I lost my family. I found myself living in a cabin as a recluse in 

Show Low almost two years. Before the cabin, I lived in a room in 

my ex-wife’s home which I shut myself in and went out only after 

people were not around. I shopped at Walmart at 2 a.m. so I did 

not have to see people. I would go fishing at daybreak before anyone would be there. 

In August of 2010, my son serving in the Army had been wounded in Afghanistan. He broke his neck, shattered his leg. I spent 

from August 2010 to November 2010 at Brooke Army Medical Center during my son’s recovery. It was just me there with him. We 

had a lot of time to talk, but one of the last things he said to me 

during these conversations was, ‘‘Dad, promise me that you go seek 

help,’’ which I did after returning to Show Low, and I contacted the 

Tucson VA, not the Phoenix VA, the Tucson VA. 

I requested to make arrangements to get into the inpatient substance abuse program. February 2011 was the quickest time that 

I could go there, which I did. I stayed inpatient for three months 

and was finally able to get into the military sexual trauma inpatient group, which is a one-year program. So after being inpatient 

for three months at the VA Medical Center, I then left and would 

live in Casa Grande. I would commute once a week to Tucson for 

my group sessions. I did this for nine months. The group counseling was very intense, starting with a group of eight male veterans ranging from the Korean War, Vietnam, and current war. We 

ended with three finishing the program due to the intensity and 

having to relive the actual experiences. 


VACREP180 with DISTILLER
12 

Currently, today I see a therapist at the VA CBOC clinic in Casa 

Grande averaging every two weeks since October of 2013. I have 

submitted three times to the Veterans Administration for PTSD related to the military sexual trauma. I have been denied three times 

because of lack of evidence. I did not speak up when this rape occurred. I was too ashamed. 

I want to acknowledge the Veterans Administration for finally 

recognizing that military sexual trauma is and has been an ongoing problem. However, being recognized is one thing; not being 

service connected and compensated with benefits is another. This 

feels that it is a slap in the face, like it never happened. If it is 

only being recognized for treatment, then the VA is only putting a 

Band-Aid on the problem. I am speaking for all male veterans who 

are going through these difficult experiences of military sexual 

trauma, as well as females too. 

I realize that military sexual trauma is very difficult for anyone 

to talk about. But more and more, we are now seeing these experiences come out in the limelight. What is needed now? We need fair 

evaluation of personal stressors and physician diagnoses to serviceconnect and give our veterans benefits, what they deserve and, 

most important, need. 

I would also like to comment on the veteran access to medical 

care, especially in the rural areas, based on my experiences. I first 

want to bring up that when I was in the military sexual trauma 

program for that nine months in outpatient, I had to drive 70 miles 

one way to attend sessions, Casa Grande to Tucson. This is 140 

miles roundtrip. Even today, to continue the military sexual trauma individual or group counseling, I would still have to drive that 

distance. The program is good; the distance is not for any veteran 

in this situation. 

I might add, even in Show Low, if it was to see a specialist for 

my knee or shoulder, I would have to travel to Phoenix, which was 

almost 400 miles roundtrip. Living in a rural area, I would like to 

see more specialists and physicians that can do immediate care, not 

having veterans constantly trying to get appointments. I recently 

had to deal with the same problem—— 

Mr. COFFMAN. Mr. Boales, you are over time. Please sum up. 

Thank you. 

Mr. BOALES. I would like to see a fully staffed VA clinic and 

maintain that VA staff to assure myself and all veterans quality 

health care in a reasonable timeframe. I also recommend a vet center in this area that veterans can go to and seek counseling for 

PTSD, TBI, sexual trauma and concerns related to these issues. It 

is important to me, and I know it is important to every veteran living in the Casa Grande Valley. 

[THE PREPARED STATEMENT OF JERRY BOALES APPEARS IN THE

APPENDIX] 

Mr. COFFMAN. Thank you, Mr. Boales. Thank you for your service. 

Mr. Davison, you are now recognized for 5 minutes. 


VACREP180 with DISTILLER
13 

STATEMENT OF JOHN DAVISON 

Mr. DAVISON. Thank you, Honorable Chairman Coffman, Ranking Member Kirkpatrick, Ms. Sinema. It is a pleasure to be with 

you today. I am here representing my son, Lance Clinton Davison, 

who is deceased, who we lost recently, just before sunrise on February 9th, Sunday, February 9th. He succumbed to his wounds 

that he received in two wars, Afghanistan and Iraq in the Middle 

East, and he took his life. 

I have submitted written testimony to the subcommittee with 

addendums that appropriately characterize and honor my son and 

his service to his country. But in the few minutes that I have, I 

wanted to read a letter that Lance had written in his defense to 

the Superior Court of Maricopa County about two years ago, and 

I think it pretty well sums up his circumstance and his frustration 

with not only the military and the VA but also with himself. So I 

will read that now. 

‘‘My name is Lance Davison. I am writing and petitioning to have 

my judgment set aside or vacated; also to reinstate my right to 

bear arms for employment purposes. I understand the initial severity and the potential of my actions on the night in question. It 

changed my life and deeply affected others. However, I contend this 

incident is a result of psychological stress from years of service to 

my country and community. 

‘‘I am a United States Marine in a Special Operations Unit 

known as MARSOC, Marine Special Operations Command, with 

nine years of service and multiple deployments to Afghanistan and 

Iraq. I was decorated multiple times for my actions. I was formerly 

a police officer, with citations for my actions in line of duty. 

‘‘For nearly seven years, my country asked me to perform acts of 

violence on its behalf. I have lived and experienced life well outside 

the normal human condition. I firmly believe there exists a mental 

threshold that each man owns. I may have spent mine. 

‘‘I developed a condition commonly referred to as PTSD. Years in 

combat zones have left me wounded both physically and psychologically. I have witnessed war on a very personal level, and have 

even become comfortable with it. When I returned home I was diagnosed with PTSD and immediately placed on drugs, in my best 

interest. My wife at the time was concerned that I had changed, 

and maybe the drugs would help. 

‘‘Post-traumatic stress was amplified after a shootout as a police 

officer in which I nearly lost my life again. I don’t fault the professionals at the Veterans Administration. I was kept on a regimen 

of drugs that have psychotropic properties, drugs I have found I 

was very sensitive to. The administering of drugs started after my 

last deployment after I sustained injuries in combat. These drugs 

were DoD approved. 

‘‘However, upon my discharge from the Marines, I was given another set of drugs through the Veterans Administration. Each regional hospital has its own formularies or set of drugs doctors administer, so the experimentation began to find a cocktail that 

doesn’t upset my mental chemistry. 

‘‘So when I moved from the Northern Arizona Health Care System to the Phoenix Regional Health Care System, I was administered a new cocktail of sleep aides, antidepressants and drugs that 


VACREP180 with DISTILLER
14 

classify as psychotropic. By the time I was finally pulled off the 

drugs and it was deemed that I was too chemically sensitive, I had 

32 different cocktails, 32 different combinations of drugs. 

‘‘The circumstances I found myself in was that I never had a consistent care provider. People would leave and move on to other 

jobs, so there was no safety net. Episodes would occur, and it was 

always attributed to PTSD. No one immediately examined the 

pharmaceuticals. 

‘‘On some level, PTSD was a major factor, but there was these 

drugs that were constantly changing. The dosages would increase, 

other drugs would be added, until I could barely function. 

‘‘I was taken off the drugs after there was concern that TBI, 

traumatic brain injury, may be causing some of the symptoms. 

After six years of being on medication, I stopped. That was February 8, 2011. No one fully knows the effect of these pills on an 

individual with blast injuries. 

‘‘There is also a condition called serotonin syndrome. Like any 

other drug, a detox period is needed. I had severe withdrawal. My 

mind was frayed. In no other state would I ever burn my porch and 

driven my truck into a pool. I was hallucinating and was simply 

reliving my time in Iraq in 2003. 

‘‘I experienced a dissociative episode that involved my brain’s inability to produce serotonin and other regulating chemicals. I urge 

you to read the medical records provided. I was drinking, and for 

that immediately the onus shifts. I was attempting to alleviate my 

symptoms and the kaleidoscopic mental circus. I have taken responsibility for my actions and poor decision to self-medicate with 

alcohol. I have taken responsibility for handling my situation and 

my condition poorly. I went above the court’s recommendation and 

spent 50 days in an inpatient PTSD and alcohol treatment program. 

‘‘However, just like in combat, there are no right answers. You 

just search for the best answer. This incident wasn’t born of malice 

or criminal intent, just an unfortunate sequence of events and an 

old, broken Marine trying to make sense of it all. 

‘‘I ask the court to vacate or set aside the judgment and reinstate 

my right to bear arms so I can continue with my profession, move 

forward as a successful, functioning, and contributing individual. 

‘‘Thank you for your time and consideration.’’ 

So from that point on, Lance took charge of his life. He created 

his own disabled veteran-owned business and was doing well, and 

we were all very blindsided by the tragedy that struck him because 

we thought he had been making such positive improvement. But it 

is obvious, as you can see, his past just was very problematic. 

So I hope that the subcommittee will take these issues very serious, and the best way to honor Lance and military personnel like 

him, veterans that have PTSD and TBI, is to correct the problem 

so that no other young men or women have to make this choice, 

because I do believe that Lance’s character is firm and that he just 

didn’t want to become what it was making him, so he had to make 

a choice. 

Thank you. 

[THE PREPARED STATEMENT OF JOHN DAVISON APPEARS IN THE

APPENDIX] 


VACREP180 with DISTILLER
15 

Mr. COFFMAN. Mr. Davison, thank you so much for your testimony and for the service of your son, and I am very sorry for your 

loss. 

Mr. Hazell, you have 5 minutes. 

STATEMENT OF BRADLEY HAZELL 

Mr. HAZELL. Thank you, Chairman Coffman, Ranking Member 

Kirkpatrick, Representative Sinema. Thank you very much for having me here today. 

I served in the Marine Corps from 1999 to 2005, where I served 

two tours in Iraq. During my second tour in Iraq as an infantry 

squad leader, my squad was hit by two IEDs, the second of which 

killed one of my Marines and wounded three, myself included. 

Upon returning to the States, I resumed my life and returned to 

my civilian job. I had already started to struggle with PTSD symptoms. Within a year of being home I had gotten to the point where 

I was self-medicating with alcohol daily. Eventually I came to the 

conclusion that I could no longer deal with these issues myself, and 

one night I called the Veterans Crisis Line. The following day I 

went to the closest VA clinic, which was located in Alexandria, Virginia. I was extremely fortunate that, due to my desperation, the 

VA counselor saw me that day even though I had not yet been enrolled in the VA system. 

I began weekly sessions with a counselor and had monthly appointments with a psychiatrist. Eventually I agreed to be treated 

at an inpatient facility located in Martinsburg, West Virginia. First 

I was treated for alcohol abuse, and then I was treated for PTSD. 

Unfortunately, due to the intense emotions that accompanied the 

PTSD program, I withdrew myself and returned to work. Within a 

year I decided to return home to Arizona, when I moved to Phoenix. I was given a three-month supply of medications with instructions to enroll in the VA Health care System upon my return. 

Upon arriving in Arizona, I immediately began looking for work. 

I had two jobs, both of which lasted two months. I ran out of my 

medication and attempted to manage my PTSD on my own. After 

being without medications for over a month, I became emotionally 

distraught and finally enrolled in the Phoenix VA Health care System. When I attempted to make an appointment to be seen by a 

psychiatrist so I could resume my medication, I was informed that 

I had to wait at least a month, if not longer. At this point, I had 

already been without medication for two months. 

I pleaded with the hospital to see if they could at least refill my 

prescriptions that I had when I had been living in the DC area. 

The Phoenix VA Hospital’s solution was to treat me inpatient at 

their mental health ward. This only made matters worse. Within 

three days I demanded to be released and signed myself out of the 

hospital. The doctor refused to put me on the same medication, 

stating that some of the medications were not in the Phoenix VA 

Health care System’s formulary. 

After leaving the mental health ward in Phoenix, I moved in 

with my mother in Casa Grande. Living in Casa Grande, I was 

now in the jurisdiction of the Southern Arizona VA Health care 

System. My experience has been much better since. I was seen 

within two weeks by a psychiatrist at the Tucson VA Hospital and 


VACREP180 with DISTILLER
16 

started therapy with a counselor at the Casa Grande Community 

Based Outpatient Clinic. The Southern Arizona VA Health care 

System fell under yet another formulary, and they were able to put 

me on the same medications that I was on while living in DC. Over 

several years my medication was decreased and I vastly improved. 

Unfortunately, PTSD hits in waves. I missed an anniversary date 

from an incident in Iraq during which several Marines from my 

unit were killed. This sent me into a severe depressive episode. I 

canceled my appointments with my counselor and my psychiatrist. 

After several months of this depressive episode I eventually tried 

to take my own life by overdosing on a three-month supply of sleeping pills. I awoke several days later in an intensive care unit and 

was then transferred to the Tucson VA mental health ward, where 

I stayed for several weeks. 

Prior to discharge, a safety plan was implemented and I was 

placed on a high-risk list with the VA Health care System. That 

being said, when I was discharged and I first tried to make a counseling appointment when I left the hospital, I was told it would be 

several weeks until I could be seen. When I informed the receptionist about my recent hospitalization, she saw the flag in the system and I was seen several days later. 

I remained on the high-risk list for several months until my mental health care providers deemed that I was safe to be taken off. 

Since that time I began working as a veterans’ advocate, helping 

veterans navigate the Veterans Benefits Administration. To this 

day, I am still treated by the Southern Arizona VA Health care 

System. 

Thank you very much for your time. 

[THE PREPARED STATEMENT OF BRADLEY HAZELL APPEARS IN THE

APPENDIX] 

Mr. COFFMAN. Mr. Hazell, thank you so much for your service to 

the United States Marine Corps, to this country. 

We will begin our round of questions. 

Captain Gatlin, you were examined by three Department of Defense physicians over the course of three years and received a 70 

percent disability rating for mild TBI when you were medically retired. How do you explain the 10 percent rating by the Veterans 

Administration? 

Captain GATLIN. Honestly, I can’t. I am still up in the air with 

it. I just can’t believe it. 

The way the VA works I think with the C&P exam is you have 

I think it is an hour video that you watch, and you have to post 

back questions on the Internet. We could all take it right now and 

we could all see patients because you don’t have to have a license 

to do it. I think that is a huge issue, first and foremost. 

Two, I think that the VA—and I can’t really speak to the larger 

picture, just the Montana, Helena VA, the Fort Harrison VA. Their 

system intentionally lowered ratings. They are using faulty tests, 

and they know it. Hopefully, that will come out a little bit later. 

And three, I think it is this. We all watch sports I guess to some 

extent, and if you ever keep up with the NFL, it changes. You have 

head concussion rules coming out there now. The kickoff has been 


VACREP180 with DISTILLER
17 

moved. They are talking about moving the extra point, which I am 

totally against, by the way. 

[Laughter.] 

Captain GATLIN. But when you look at the VA, with the quality 

of soldiers coming back, some of their socioeconomic-geopolitical 

problems, something has to change. I mean, I don’t know when 

these rules were put in place, but they have to change. They are 

not progressive, and they are so dug in. When you come in to get 

them, they tell you that you are attacking. I mean, what is a young 

soldier, let’s say 18 to 22 years old, TBI as a secondary injury behind a more primary life-threatening injury, married, a couple of 

kids, living in the middle of nowhere Montana, what are they going 

to do? I mean, maybe they don’t have the initiative or the attitude 

that I have sometimes—I get criticized for it a lot—to be able to 

come forward and stand up for themselves and stand up for others. 

So what they are doing, Congressman, is they are systematically 

lowering ratings and keeping their fingers crossed that nobody says 

anything about it. 

Mr. COFFMAN. Mr. Duplisea, VA has proposed diminished funding for TBI treatment. Please describe the Wounded Warrior 

Project’s reaction to this proposal, if there is a position. 

Mr. DUPLISEA. We consider the proposed cut in funding troubling. One big reason for that like I said in the testimony, is that 

Congress—you—have already enacted a law, that requires VA to 

improve long-term TBI rehabilitative care. We want VA to implement that law. Like I said in the testimony, when someone is suffering from a TBI—and I had a severe TBI, and clinicians use the 

word ‘‘plateau,’’that suggest there’s no room for further improvement. Personally I just don’t believe in that word in someone with 

a TBI. The brain is the most complex organ in the body. I think 

it is hard for a doctor or a clinician to say that someone has 

plateaued when that warrior inside knows they have not plateaued. 

And what is to say, too, that after that warrior has gone through 

step-by-step-by-step help, and we stop it, that warrior will not regress? 

Mr. COFFMAN. Ms. Del Negro, can you briefly describe the I 

guess it is RBANS—and I understand that is Repeatable Battery 

for the Association of Neuropsychological Status—assessment tool 

and how it was misused during the C&P examination? Do you 

know if it has been used elsewhere? 

Ms. DEL NEGRO. I am not a medical professional, but I do dabble 

a little in the medical arena. My familiarity with RBANS was nonexistent prior to this experience, and it was only upon us bringing 

it to the attention of the Board of Psychologists that we learned, 

in fact, that RBANS is a screening test that is primarily used for 

dementia in the elderly. It has been studied in various different 

very small studies for its application to evaluate cognitive dysfunction in other disease states such as Alzheimer’s, and in moderate 

and severe brain injury as well, but the results are not well established enough to be making firm generalizations about its use in 

practice. 

The psychologist who used the test, my impression dealing with 

the system is that the test was not endorsed by the system, the 

CPEP training, as my husband was mentioning before. Rather, 


VACREP180 with DISTILLER
18 

however, despite the fact that he used this test and he used it inappropriately—for instance, the results of the testing actually confirmed what my husband’s complaints were, but he disregarded 

those test results and attributed any complaints of cognitive disorder to PTSD. 

So it was just profoundly unprofessional all around, but the 

RBANS is being used or has been used previously at, I believe it 

was, the Texas VA, and that was at the admission of the psychologist in question, who issued in his statement that this was a test 

that had been used in other VAs, and his immediate supervisors 

condoned the test. They said he followed protocol. 

Mr. COFFMAN. Thank you. 

Mrs. Kirkpatrick. 

Mrs. KIRKPATRICK. Thank you all for your testimony and for 

being here today. I have a question for each one of you. I want to 

hear from each one of you. 

We know there are multiple problems in the system, but in an 

effort to move forward in a positive way after today’s hearing, I 

would just like to ask each one of you what would be the numberone thing the VA could have done to make a difference in your experience? 

And, Mr. Hazell, we will start with you. 

Mr. HAZELL. Whenever veterans move from one area to another, 

the VA doesn’t keep track of them. When I moved from DC to 

Phoenix, it would have been nice if there would have been something set in place to automatically transfer my files so I could have 

resumed receiving treatment immediately. Additionally, all the 

hospitals operate on their own independent system. As a result, 

none of them use the same criteria for how they prescribe medication. So once again, veterans have to start from scratch. Thank 

you. 

Mrs. Kirkpatrick. Mr. Davison. 

Mr. DAVISON. I just wanted to say that I think that one of the 

primary things that the VA needs to do is we need to have a complete and thorough investigation and review and evaluation and an 

updated strategy to deal with PTS and TBI. It is the signature 

medical condition for OEF and OIF veterans. Only through that 

kind of evaluation and scrutiny can we—we are learning new 

things every day in science and technology, and I think that just 

hasn’t been applied yet and we are really doing old-school-type 

things to deal with these veterans’ problems, and we need to come 

up to speed to the 21st century. 

Mrs. Kirkpatrick. Mr. Boales. 

Mr. BOALES. For me, it would be keeping our rural area CBOCs 

100 percent staffed and maintaining that 100 percent staffing. And 

even at 100 percent staffing, in certain departments such as Casa 

Grande CBOC, CBOC’s physical therapy department, it is not 

staffed near enough with only one person to accommodate the 

needs of all of our veterans recovering from major joint surgeries 

in Pinal County, let alone all the other physical therapy needs our 

veterans need. 

Mrs. Kirkpatrick. Mr. Anderson. 

Mr. ANDERSON. A big part where that would be is don’t start off 

with a big mixture of drugs, start off at a smaller dose. If they need 


VACREP180 with DISTILLER
19 

a little bit more, then go from there. Don’t start at the top and go 

from there, because then they want more and more. 

Also, I would like to see them utilize those veterans that are at 

a certain level of recovery from TBIs or PTSD, similar to the AA 

where you have another veteran that you can call that understands 

your problems, that understands what you are going through. You 

are like those people. Have a buddy system where he can call and 

you can talk about it, instead of getting strapped to a chair and 

shoved in a room and given drugs. 

One more deal on that is we have a lot of service members that 

got dishonorably discharged that aren’t eligible for veteran care, 

and a lot of that is PTSD. What about those soldiers? Mr. Chairman, you have been in the service. You know that you have seen 

those guys come back after a conflict and get into trouble, whether 

it be DUI, alcohol abuse, spousal abuse, domestic violence, where 

they are dishonorably discharged from the service. That is like having a felony on your record. Those people also need to be looked at 

and taken care of. 

Mrs. KIRKPATRICK. Thank you, thank you. 

I just have a few more minutes, so I will just quickly go through 

the last three. 

Captain GATLIN. 

Captain GATLIN. Leadership, honesty, transparency, and accountability. When you have a problem, maybe it is not a problem yet. 

At what point does Tier Level 1 leadership step down and kind of 

see what is going on? It is kind of like a general walking amongst 

the privates. ‘‘Hey, what’s going on?’’ The private kind of feels better. The general has firsthand feedback to what is going on. 

The VA just plays the VBA against the VHA. I don’t know if you 

have ever read John Grisham’s ‘‘The Rainmaker’’ with the great 

benefits, but that is the VA. That is how they operate. And you, 

if you don’t have the initiative or the resources, you get pushed out 

and you get frustrated when all these things these gentlemen were 

just talking about start to occur. 

So leadership, honesty, transparency, accountability by senior 

echelon leadership. 

Mrs. KIRKPATRICK. Thank you. 

Ms. DEL NEGRO. 

Ms. DEL NEGRO. I think that was very well stated in terms of 

picking which option I wanted to go with. I think I would just say 

that the system doesn’t care or is not aware of the stresses that 

are being placed upon the family. When you have a veteran who 

has a deep TBI, and then the emotional underlying issues, then the 

stresses from that situation are compounded, and that can affect 

the family members and the caregivers, and the burden the system 

is placing on those families is ridiculous. 

So I wish that they had been able to acknowledge that and address it accordingly. 

Mrs. KIRKPATRICK. Thank you. 

Mr. Duplisea. 

Mr. DUPLISEA. My experience at the Tucson VA has been exemplary. But for warriors, veterans outside of Tucson, I ask that Congress enforce the TBI law for lifetime care and give effective and 


VACREP180 with DISTILLER
20 

timely care for mental health issues such as PTSD, depression, 

anxiety in warriors that exhibit suicidal ideations. 

Mrs. KIRKPATRICK. Thank you all very much. 

Thank you for extending my time, Mr. Chairman. I yield back. 

Mr. COFFMAN. Congresswoman Sinema, you are now recognized. 

Ms. SINEMA. Thank you, Chairman Coffman and Ranking Member Kirkpatrick, for allowing me to participate today and for holding this hearing in Arizona. 

Chairman Coffman, thank you for coming to our state. We have 

a very proud military tradition here in Arizona, and this issue is 

important to all of us. 

Congresswoman Kirkpatrick, you are a great champion for Arizona veterans. 

So I am glad that you brought the committee here to Arizona to 

hear directly from veterans. 

And thank you to our panelists. Thank you for your service to 

our country, your sacrifice, your family’s sacrifice, and for your advocacy and courage to stand up for all of our nation’s veterans. 

I believe it is critical that our veterans have access to appropriate care. Traumatic brain injury’s mental health wounds are the 

signature wounds of the wars in Iraq and Afghanistan. But previous generations of our country’s warriors also have these wounds. 

As was noted by the panel, we lose 22 veterans a day to suicide. 

It is unacceptable. 

I am also extremely disturbed by recent allegations about the 

Phoenix VA Medical Center in my district that delays and may 

cause the deaths of upwards of 40 Arizona veterans. We must get 

to the bottom of this and hold accountable those who are responsible. 

I think that no veteran should ever feel like he or she has no 

place to turn, and no family should lose their loved one after he 

or she returns home. 

My first question is for Mr. Duplisea, Mr. Anderson, Mr. 

Davison. You each testified to either your own experience or the experience of your son who developed a relationship with a VA professional, only for that employee to leave and for the veteran to 

have little or no warning, forcing them into either a start-over period or, in some cases, without any care at all for an acceptable period of time. 

We know that many PTSD and TBI patients don’t have a reliable 

safety net. There was a veteran in my district, Daniel Summers, 

who committed suicide last summer. He had post-traumatic stress 

disorder and a traumatic brain injury. He was first placed into 

group therapy, which was not an effective place for someone who 

served in classified service. Later, his VA professional left with no 

warning, and with nowhere to turn he committed suicide. 

My question for each of you who either yourself or your family 

member have experienced something similar, do you have a suggestion of what the VA could do differently to ensure that veterans 

like yourself and your son are not left in a situation without the 

mental health care professional who they formed a bond with and 

who they trust? 

Mr. Davison, Mr. Boales, Mr. Anderson, Mr. Duplisea, feel free, 

any of you, to answer. 


VACREP180 with DISTILLER
21 

Mr. DAVISON. I think a critical component is to engage local communities. This would also be a cost-effective way to mitigate these 

problems for our veterans. If they worked with local veteran service 

organizations and communities and we all got involved, and the VA 

would consider out-sourcing and at least partially fund these type 

of efforts, I think it would bring it home for veterans. 

I know in my community there are a lot of veterans with PTSD, 

and what happened to Lance touched them deeply, and it was very 

tragic, and it shook them up, and they are starting to say we have 

to do something for ourselves. 

So if the VA would look at partnering with local VSOs and community groups and working together, because it is not just the VA’s 

problem, it is not just the United States military’s problem, it is 

our problem as a nation, and it is our duty, it is your moral obligation as leaders and as government officials to fulfill the promises 

that we have made to veterans. But it is also our duty as citizens 

and former veterans to come together to help them because, like 

you mentioned, 22 a day, it is a national tragedy and it is an epidemic that has extreme ramifications for the military and for our 

nation. 

You said it; it is unacceptable. We cannot allow this to continue. 

Ms. SINEMA. Thank you. 

Mr. Boales. 

Mr. BOALES. For me, Congressman Sinema, for me and my personal experience, I have seen over five health care providers, and 

each one of them, the reason why I saw them was because one left, 

and so I had to see another. It was hard for me to talk to a male, 

number one. So for me, the providers looking at the charts and 

reading up on the charts and knowing the patients, talking to the 

previous provider, knowing that this gentleman is not comfortable 

in certain situations. 

Two, maintaining staffing. 

And three, again, it is so imperative for me—all my care for the 

last 24 years, I have been in the Tucson VA system, which has 

been great, and I have been in the Phoenix VA Health care System, 

and the rural Health care system is so understaffed for the care 

that is needed. 

Telemed. For me, I cannot do Telemed, and that is provided. It 

is not one-to-one conducive to speak about. So that is not an option 

for me. So I am looking at 140 miles if I want to continue care, and 

I do the best I can. 

So staffing, reviewing the charts, knowing the patient, this gentleman is not going to be comfortable with a male. And yet, that 

is who I get. So I stopped. 

So that would be my suggestions. 

Mr. ANDERSON. And I am pretty much on those same sentiments. 

Like I said, my first health care provider, she basically told me 

when I first started was from Monday at 8:00 to Friday at 5:00, 

that is when she was on the clock, because I asked her to review 

some tests, psychological tests that I received. And talking to that 

psychologist in Phoenix, it was supposed to be an hour-and-a-half 

test. It turned out to be six hours, because he kept giving me these 

tests and he was telling me stuff about my life that made so much 

sense. And he said, well, I am contracted through the VA, I can’t 


VACREP180 with DISTILLER
22 

really treat you, because that was kind of crossing the line there. 

Get with your health care provider. 

So that was sent to her on Friday. I had an appointment with 

her on Monday. I was all excited to see her, and she said, well, I 

didn’t review that because I don’t work on the weekends. It was 

that type of attitude that just kind of shot me down. 

And then like he was saying, the teledoc, he doesn’t care. I mean, 

okay, you know what? You don’t want to take my meds? Then, you 

know what? We are done here, so we stopped. 

The big problem I see is that when we do have—especially our 

young soldiers. I speak a lot for our young soldiers. When they 

come in there and they have a problem, most of them have young 

families. And if there is alcohol, drugs, got out of the military, having trouble at home—because that is what PTS does, you know? All 

those little problems keep piling up and piling up, and you are 

digging that hole, and you are digging that hole, and it takes the 

VA so long to recognize it and to try to get them some help, whether it be psychological or financial. 

Meanwhile, that guy is going to China. He is digging this hole, 

and it is going deep, and there are a lot of problems out there with 

our younger veterans, and we are not doing nothing about it. 

Ms. SINEMA. Thank you. 

Mr. DUPLISEA. Well, the VA is a very complex system, and problems with the health care are also very complex, and there is no 

silver bullet or cure-all for these issues. But for me it comes down 

to staffing, and it also comes down to the accessibility of mental 

health care here in VA. You have to have invested proven staff that 

are invested in helping veterans, helping warriors with mental 

health issues. 

Here at the Tucson VA I have been very fortunate to have that 

since I came here in 2008, but it is not the same everywhere. I 

came here and I had one mental health clinician, then I went to 

another one, and they were very accommodating because I was 

working during the day and I couldn’t make the appointments. I 

asked if they had a plan in place where they could help me to come 

after hours, and they did have a clinician who accommodated that, 

and I greatly benefitted from that counseling that I received. Actually, it lowered my severe PTSD to mild PTSD, from 50 percent 

down to 10 percent. 

So I am proof that the system does work, again here in Tucson, 

Arizona, but it is not the same everywhere. Tucson is the model 

and it is an exception, but all VAs should be just like Tucson. 

Ms. SINEMA. Thank you. 

Thank you, Mr. Chair. 

Mr. COFFMAN. Thank you. 

Panel, I would like to thank you so much for your testimony 

today, for your service to this country, and for the members of your 

family that have served this country. 

Mrs. KIRKPATRICK. Thank you for your selfless courage in coming 

today and testifying. You have made history. You have helped the 

committee, given us some direction in how to move forward. So, 

thank you from the bottom of my heart very much. 

Mr. COFFMAN. I now would like to invite the second panel to 

come up to the witness table. 


VACREP180 with DISTILLER
23 

Again, thank you very much. 

On our second panel we will hear from Dr. Lisa Kearney, Senior 

Consultant for National Mental Health Technical Assistance of the 

Office of Mental Health Operations, Veterans Health Administration. 

She is accompanied by Dr. Joe Scholten, National Director of 

Special Projects for Physical Medicine and Rehabilitation Services, 

Veterans Health Administration; Mr. Jonathan Gardner, Director 

of Southern Arizona VA Health Care System; Mr. Joshua Redlin, 

Licensed Clinical Social Worker and Team Leader for the Tucson 

Vet Center; and Mr. Rod Sepulveda, Rural Health Program Manager of the Northern Arizona VA Health Care System. 

Dr. Kearney, your complete written statement will be made part 

of the hearing record, and you are now recognized for 5 minutes. 

STATEMENT OF LISA KEARNEY, PH.D., SENIOR CONSULTANT, 

NATIONAL MENTAL HEALTH TECHNICAL ASSISTANCE, OFFICE OF MENTAL HEALTH OPERATIONS, VETERANS HEALTH 

ADMINISTRATION; ACCOMPANIED BY JOE SCHOLTEN, M.D., 

NATIONAL DIRECTOR OF SPECIAL PROJECTS, PHYSICAL 

MEDICINE AND REHABILITATION SERVICES, VETERANS 

HEALTH ADMINISTRATION; JONATHAN H. GARDNER, MPA, 

FACHE, DIRECTOR, SOUTHERN ARIZONA VA HEALTH CARE 

SYSTEM, VETERANS HEALTH ADMINISTRATION; JOSHUA D. 

REDLIN, LCSW, TEAM LEADER, TUCSON VET CENTER, U.S. 

DEPARTMENT OF VETERANS AFFAIRS; ROD SEPULVEDA, 

RURAL HEALTH PROGRAM MANAGER, NORTHERN ARIZONA 

VA HEALTH CARE SYSTEM 

STATEMENT OF LISA KEARNEY 

Dr. KEARNEY. Thank you, sir. First, I would like to express our 

appreciation to the first panel. Thank you for sharing your stories 

with us. And especially I am very appreciative of the feedback that 

they all gave to you, and we have taken notes on that and will be 

following up on that. We very much appreciate that. And to Mr. 

Davison in particular, our hearts go out to you. 

Chairman Coffman, Ranking Member Kirkpatrick, and members 

of the committee, thank you for the opportunity to appear before 

you today to discuss access to treatment for veterans with traumatic brain injury or post-traumatic stress disorder once they return home. 

I am joined today by Dr. Joel Scholten, Special Projects Director 

for the Physical Medicine and Rehabilitation Program; Mr. Jonathan H. Gardner, Medical Center Director at the Southern Arizona 

VA Health Care System; Mr. Joshua Redlin, Team Leader at the 

Tucson Vet Center; and Mr. Rod Sepulveda, Rural Health Program 

Coordinator for the Northern Arizona VA Health Care System. 

VHA provides state-of-the-art, comprehensive health care and 

support services for veterans with both combat and civilian-related 

TBI through the Polytrauma System of Care. Through this program, the Department continues to advance the evaluation, treatment, and understanding of TBI in a variety of ways: by, one, developing and implementing best clinical practices for TBI; two, collaborating with strategic partners including veterans’ families and 


VACREP180 with DISTILLER
24 

caregivers, veterans’ service organizations, the Department of Defense and other government agencies, community rehabilitation 

providers, and academic affiliates; by providing education and 

training and TBI-related care and rehabilitation; and finally, by 

conducting research and translating findings into improved clinical 

care. 

This system is designed to assist veterans with TBI and 

polytrauma in a seamless transition between the Department of 

Defense and VHA. It also assists a veteran with their transition 

back to their home community through the provision of evidencebased rehabilitation services and care coordination. 

VA is one of the largest integrated health care systems in the 

United States that provides specialized mental health treatment 

for PTSD. In Fiscal Year 2013, over 530,000 veterans received 

treatment for PTSD in VA medical centers and clinics. VA provides 

care for PTSD in a variety of settings, delivered by more than 

5,200 VA mental health providers who have received training in 

the most effective known treatments for PTSD. 

VA also operates a National Center for PTSD that provides research, consultation, and education to clinicians, veterans, family 

members, and researchers. The National PTSD Mentoring Program, which works with every specialty PTSD program across the 

country, is designed to promote evidence-based practice within the 

VA. 

Southern Arizona VA serves as a polytrauma network site in 

VISN 18 and coordinates key components of post-acute rehabilitation care for individuals with polytrauma and TBI across the VISN. 

Since 2010, the facility has seen a 70 percent increase in TBI and 

polytrauma visits completed via TeleHealth with veterans residing 

in rural and highly rural areas, making up as much as 37 percent 

of the overall rehabilitation workload in Fiscal Year 2013. 

Southern Arizona has also worked closely with community partners to develop multidimensional programs such as the Adaptive 

Sports Program, the VISN 18 Program for Managing Veterans with 

Complex Pain, a Vision Therapy Clinic, and the Headache Management Clinic. 

Southern Arizona’s VA Polytrauma Network site also engages 

with the Arizona Governor’s Council on Spinal and Head Injuries, 

the Arizona Coalition for Military Families, the University of Arizona, Pima Community College, the Arizona Department of Economic Security, and others to better serve the vocational rehabilitation goals of injured veterans. 

On August 14th, 2013, Southern Arizona VA hosted a mental 

health summit with over 90 community participants. Southern Arizona VA will be hosting another mental health summit in August 

with a focus on mental health access. 

Southern Arizona VA provides comprehensive mental health 

services, which also includes primary care mental health integration. This program supports primary care PACT by providing a 

mental health psychiatrist and a team of social workers who are 

co-located in the primary care clinics. In Fiscal Year 2013, this program served over 5,000 unique patients with nearly 16,000 clinical 

encounters. 


VACREP180 with DISTILLER
25 

In addition to providing a wide range of social and psychological 

services to eligible veteran service members and families, the Tucson Vet Center also provides community outreach, education, and 

coordination of services with community agencies. 

In closing, first let me apologize, Congresswoman Sinema. I did 

not recognize you earlier. We are glad that you are here today. 

VHA provides comprehensive health care and support services 

for veterans with both combat and civilian-related TBI and PTSD. 

The VHA is continually working to further enhance these services 

through quality improvement initiatives, and we are grateful for 

the support of Congress and our community partners to assist us 

in these endeavors. 

Mr. Chairman, this concludes my testimony. Thank you for the 

opportunity to appear before you today. At this time, my colleagues 

and I are pleased to respond to any questions you may have. 

[The prepared statement of Lisa Kearney appears in the Appendix] 

Mr. COFFMAN. Thank you for your testimony. 

Dr. Kearney, the Administration’s budget request for Fiscal Year 2015 is for $229 million for TBI medical programs, down 1.3 percent from Fiscal Year 2014, the current year. In light of this reduction, how will VA ensure that veterans with TBI receive quality 

care and are not short-changed as they live with their disabilities? 

Dr. KEARNEY. Thank you. Mr. Chairman, we are very committed 

to continuing good care for each of these veterans. I would like to 

refer this question over to Dr. Scholten, our expert in traumatic 

brain injury. 

Dr. SCHOLTEN. Mr. Chairman, thank you. And again, let me 

thank the first panel for their testimony today. We do take their 

experiences back to VA central office, as well as to the medical centers where we practice, in order to improve our practices. 

In regards to the budget for traumatic brain injury care in VA, 

we have seen, fortunately, a decrease in the number of severely injured service members requiring inpatient rehabilitation from combat-related injuries. That does significantly affect the overall cost 

or the overall expenditure of TBI care. 

In Fiscal Year 2013, we were down to 54 foreign theater injured 

combat wounded that were treated in our polytrauma rehab centers. That was down from 132 in Fiscal Year 2012. 

When we look at all of the cases, all individuals with a TBI diagnosis in the system, there has been a significant downward trend 

in those individuals where the cumulative cost, the annual cumulative costs are greater than $50,00 per fiscal year. So in the OEF/ 

OIF/OND population, that has gone down from 4.9 percent in Fiscal Year 2010 to 3.6 percent in Fiscal Year 2013, which results in 

a significant decrease in total expenditure. 

Similarly, the percentage of non-OEF/OIF TBI cases with care 

costs greater than $5,000 per year have also decreased, down from 

12.2 percent in Fiscal Year 2010 to 10.5 percent in Fiscal Year 

2013. We feel that, in relation to the care that is being provided, 

we know that DoD has stepped up their efforts to identify individuals with traumatic brain injury. We know from the Congressional 

Budget Office that costs for TBI care decrease over time. So the 

first year is the most expensive, and we feel that that is contribVerDate Aug 31 2005 11:26 Aug 26, 2015 Jkt 000000 PO 00000 Frm 00029 Fmt 6633 Sfmt 6633 Y:\87679.TXT PAT

VACREP180 with DISTILLER
26 

uting to the overall decrease in the overall cost for TBI care despite 

the fact that we are seeing more individuals with TBI. 

Mr. COFFMAN. Dr. Kearney, can you explain how a veteran receiving 70 percent disability at the time of his military discharge 

due to a mild TBI can be reduced to only 10 percent by the VA? 

How can this in any way be considered a seamless transition? 

Dr. KEARNEY. Thank you for the question, sir. I cannot comment 

specifically about this particular case. I will tell you that each of 

our examiners are trained in a particular way using the training 

that they have put before them in order to reevaluate, but I can’t 

speak to this particular case. I don’t know the details of the case 

to be able to respond to that question. 

Mr. COFFMAN. Are those examiners required to be licensed in 

their respective states? 

Dr. KEARNEY. We have a requirement for our C&P examiners to 

be licensed. There is in the VA, for psychologists in particular, you 

can be hired as a provisional psychologist in which they are reviewed for two years and they have supervision during that time, 

and they must obtain licensure during that time before they can 

stay with the VA. If they do not obtain licensure in that time, they 

are under clinical supervision, much like our trainees. 

Mr. COFFMAN. I think the testimony today clearly states that 

there is a problem, and it needs to be resolved. 

Could you talk about how VA coordinates with Indian Health 

Services to ensure that Native American veterans receive adequate 

reimbursement, as well as quality medical care? 

Dr. KEARNEY. I don’t have any particular comment on Indian 

Health Services today, but I do want to ask Mr. Gardner if he 

could speak particularly to that in the Tucson area. 

Mr. COFFMAN. Coordination? Sure. 

Mr. GARDNER. From the coordination standpoint, again, we deal 

with the Tohono O’odham Nation, which is just south of us here, 

and we do have a coordinator that goes out on a regular basis, 

interacts with the staff of the Sells (Anqone) IH unit, as well as 

looking for veterans. We have several outreach efforts where, in 

fact, we look for veterans that are interested in becoming a patient 

of ours and go ahead and get them enrolled. 

We attempt to make sure with our Native American veterans 

that we are culturally sensitive. We have a program in place here 

in Tucson where we have trained over 400 staff, and we try to put 

them through a process where they learn a little bit about the Native American way, and they are taught by Native American healers, and it is important to us that happen. 

We also work closely with IHS, Mr. George Bearpaw, who is the 

regional director, and coordinate with him to make sure that services that eligible veterans can be connected with, we connect with 

them to make sure that transfer is made. 

Mr. COFFMAN. Thank you. 

Representative Kirkpatrick. 

Mrs. KIRKPATRICK. Dr. Scholten, nice to see you again. You and 

I visited your polytrauma unit and you gave me a tour. We talked 

about how we could prevent losing some of these veterans in the 

transition process and that it would be really good if the DepartVerDate Aug 31 2005 11:26 Aug 26, 2015 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6633 Y:\87679.TXT PAT

VACREP180 with DISTILLER
27 

ment of Defense would notify you before the member becomes a 

veteran. 

Are you seeing an improvement in that notification? Do you get 

medical records before the military member transfers out of the 

service? 

Dr. SCHOLTEN. Thank you, Congresswoman. I would like to answer that question in two parts, both from my position in VA central office, as well as a treating physician at the Washington, DC, 

VA. 

I think most importantly from a treating physician standpoint, I 

do get medical records as patients transition from DoD to VA. 

Some of those records are available through our Vista Web system 

within the medical records system, and I have been pleasantly surprised to be able to see more records even from care delivered in 

theater for veterans that have entered the system and maybe have 

gotten treatment a year or so before. 

When it comes to the most seriously injured, those individuals 

that are typically treated inpatient in a military treatment facility 

and then transitioned to one of our polytrauma rehab centers, that 

process is very seamless. We work very hard to introduce both the 

injured service member and their family to the receiving treatment 

team by use of a video teleconference. That allows the teams and 

the caregivers and the injured service member to talk about needs, 

to talk about transition issues and logistics of the transfer, as well 

as get to know what is going to happen when they arrive at the 

VA. 

In addition to that, the VA liaison that is embedded at the military treatment facility helps to make sure that all the records are 

available. They do a nurse-to-nurse handoff as well. And then some 

records are available in the computerized record system. But as a 

safeguard, veterans carry a hand-delivered CD copy of all of their 

records from the military treatment facility as a safeguard. 

For those individuals that are being treated at a military treatment facility and living in a warrior transition unit or residing in 

a WTU, the VA military liaison that is embedded there will contact 

the OEF/OIF/OND VA program manager at the receiving VA and 

ensure that information is transferred and that a case manager is 

assigned. The goal is for the case manager to contact that individual before the transfer actually happens, as well as begin to set 

up appointments and coordinate care once they arrive at the receiving VA. 

Mrs. KIRKPATRICK. And what about the drug formulary? Do you 

find that it is compatible, that you can continue the same course 

of treatment that they were receiving in the military when they get 

into the VA system? 

Dr. SCHOLTEN. That varies by patient or by individual veteran. 

There are some medications that are on the DoD formulary and 

not, for instance, on the Washington, DC, VA formulary. However, 

I think it is very important to note that the ordering of medications 

is done by the practitioner, the physician that is working with the 

patient, and there is a discussion about what has worked in the 

past, what the current medications are. And if a medication is not 

on the formulary that it is determined to be the correct medication, 


VACREP180 with DISTILLER
28 

there is a non-formulary process that you can go through and get 

that medication. So it does work. 

Mrs. KIRKPATRICK. Dr. Kearney, I know there has been a big increase in telemedicine, and a lot of the veterans I have talked to 

like that. But we heard in the first panel a veteran who doesn’t feel 

comfortable with that. So what accommodations can you make for 

folks who really aren’t comfortable talking with their doctor over 

the computer system? 

Dr. KEARNEY. Yes, I think that is a really important concern. We 

want to make sure that each of our treatment plans that we work 

collaboratively with our veteran is something that they are comfortable with. So that is part, when they are having those initial 

discussions about plan of care, are they comfortable with tele-mental health services, would they prefer group or individual treatment, asking them these different things. 

Another option that we are also utilizing more is some of the different smart phone apps that are available now—PTSD Coach, for 

example. There is also a concussion app. There is cognitive behavioral therapy for insomnia, for example. Some of these things can 

walk them through treatment at home if they don’t want to come 

in as frequently. 

We are also looking at our staffing levels at all of our CBOCs, 

as well as the medical centers, and trying to work with each facility who is maybe having difficulty recruiting and maintaining staffing there by having individual discussions with our VISN mental 

health leads and with our staff at central office to see are there 

other things that we can be doing to recruit providers to those 

hard-to-recruit locations. 

Mrs. KIRKPATRICK. Thank you. I yield back my time. 

Mr. COFFMAN. Thank you. 

Congresswoman Sinema, you are now recognized. 

Ms. SINEMA. Thank you, Mr. Chairman. 

Mr. Redlin, prior to my time serving in public office, I was a licensed clinical social worker. And during my time engaging in direct therapeutic relationships with consumers, I recognize how important it is to form that relationship with a client. Of course, 

equally important is the termination phase. 

But what we heard from a number of vets and vets’ family members today was the additional trauma that they experienced when 

finding an unexpected interruption of service delivery with their 

trusted therapist or provider. 

What action does your office take—and perhaps Dr. Kearney can 

also answer, and Mr. Gardner as well. What steps are taken to 

help vets prepare for interruption of services or termination from 

their provider and transition to a new, appropriate provider? 

Mr. REDLIN. Thank you, Congressman, and thank you for having 

me here today. 

At the Tucson Vet Center, what I can say as far as trying to keep 

that continuity of care when we have possibly a counselor retiring 

or taking another position is get a heads-up on it and try and recruit, especially within. Just recently I can give you an example 

where we actually did a very good job with this and were able to 

bring on a counselor two months before when we knew he was 

leaving. Unfortunately, that is not the case a lot of times, so clients 


VACREP180 with DISTILLER
29 

are left feeling that they have no care or their care has been severely disrupted. But that is typically what we do at the Vet Center. 

Were there other parts of the question I missed? 

Ms. SINEMA. No, thank you. 

Dr. KEARNEY. Thank you. One of the things that has been important that we have been rolling out across the VA is that every veteran within mental health would be assigned a mental health 

treatment coordinator, and that person, whether they were giving 

active treatment at that time or not, would be the person who 

makes sure that if they were transitioning, for example, to a substance use disorder treatment program, that they got in, they got 

started, things were not dropped. 

It also helps with the creation of that seamless plan of care with 

the veteran. That treatment coordinator is responsible for discussing those plans. So when a provider would announce they are 

retiring or they are transitioning to another job, to be able to have 

discussions with the mental health treatment coordinator on next 

steps, and also for the provider to be able to have those discussions. 

But another important thing that we are beginning to roll out 

within mental health is what we call behavioral health interdisciplinary programs, which is providing care by team, much like 

we do in our patient-centered medical home, the PACT, patientaligned care teams, in which there are three to four people providing care to a patient. So they are all familiar with that patient 

so that the care is not going to be as much disrupted because that 

veteran may know the treatment team at hand. So we are hopeful 

that that will help address some of these different things that we 

have heard about this morning. 

But also important is that the mental health treatment coordinator should make sure that the veteran gets the care he or she 

needs after that person leaves. 

Ms. SINEMA. Thank you. 

Dr. Scholten, you talked about the ability for a physician or perhaps a psychiatrist to prescribe a non-formulary drug, in particular 

a psychotropic drug, if the situation warrants. However, it appears 

from the testimony we heard from vets and Lance’s father, Mr. 

Davison, that it is not perhaps the standard practice in many facilities. 

Can you help us understand why different facilities have different formularies when those of us in the mental health profession 

know that psychotropic drugs cannot be easily substituted one for 

another, like an allergy medicine could be? And how can the VA 

system more effectively help prescribing physicians and psychiatrists understand the procedures to go off of the formulary when 

a situation warrants it, as in the case of Lance Davison and some 

of the other testimony we heard today? 

Dr. SCHOLTEN. Thank you for the question, ma’am. You are correct in the fact that there are differences in formularies. I, unfortunately, can’t speak to the rationale or the decision-making process 

that is made between each medical center. That would be a question for our pharmacy benefits group. 

In regards to medications for mental health treatment, I would 

like to ask Dr. Kearney for some help with that. 


VACREP180 with DISTILLER
30 

Dr. KEARNEY. Certainly. One of the things that we advertise 

quite a bit to our mental health psychiatrists and other prescribers 

is the clinical practice guidelines that are available within VA and 

DoD which provide guidance on what medications would be best for 

what particular diagnoses. So that is one particular area that we 

provide guidance through our individuals on. 

The other thing that we are beginning to roll out is the Psychotropic Drug Safety Initiative. We have heard concerns, and we are 

concerned as well and want to make sure that we are studying how 

these medications are prescribed, that we are helping prescribers 

get education as needed, that we are also helping to monitor improvements over time. So we are currently rolling this out across 

the nation to be able to better monitor at each facility how these 

medications are being utilized. 

Ms. SINEMA. Thank you. 

Mr. COFFMAN. There will be a second round if anybody has any 

additional questions. 

Dr. Kearney, please describe the credentialing and licensing requirements under VA directors for psychologists and other clinicians responsible for administering C&P examinations that involve 

TBI determinations. 

Dr. KEARNEY. So, we do have a licensing requirement—— 

Mr. COFFMAN. Can you speak more into the microphone, bring it 

a little closer to you? 

Dr. KEARNEY. Oh, I’m sorry. So, there are requirements for any 

provider hired within the VA by discipline. So for psychologists, 

psychiatrists, social workers, et cetera. For psychologists, that includes that they have obtained a Ph.D. or a Psy.D., a doctorate of 

psychology, from an accredited institution, and that they have also 

fulfilled a formalized training program thereafter. We require that 

they have two years of experience before becoming full licensed 

psychologists within the VA. We have credentialing boards that review these, along with our—this includes human resources. It 

would include local chiefs of psychology reviewing that they meet 

each of these particular standards. If not, they are not allowed to 

be hired within the VA. 

Mr. COFFMAN. So what happens if they are working with the VA 

and they lose their license, their state license? 

Dr. KEARNEY. They would no longer be able to be employed with 

the VA. The requirement for working at the VA is that they maintain their licensure. 

Mr. COFFMAN. That was certainly not the case in Montana. 

Dr. Kearney, is the Repeatable Battery for the Association of 

Neuropsychological Status, the RBANS that was discussed earlier, 

that assessment tool, how commonly is that used by the VA for TBI 

rating determinations? 

Dr. KEARNEY. That I could not answer. I would have to take that 

for the record, sir. 

Mr. COFFMAN. Okay. Are there any consequences for officials failing to properly manage and supervise C&P examinations involving 

TBI? 

Dr. KEARNEY. As with any concern that we have about an administrator or employee of our organization, we would be addressing 

that through our system of peer reviews, through reviews by our 


VACREP180 with DISTILLER
31 

human resources department, et cetera. I can’t speak specifically to 

C&P. 

Mr. COFFMAN. Is VA’s MIND study considered trustworthy given 

the very small percentage of available veterans who participated? 

Dr. KEARNEY. I will defer to Dr. Scholten on that. 

Dr. SCHOLTEN. We can take that question for the record. I am 

familiar with the study. One of the study sites was actually at the 

Washington, DC, VA, but I would defer to our research colleagues 

to provide an analysis of the number of subjects and if that reached 

a statistical power to make those results generalizable. 

Mr. COFFMAN. Ranking Member Kirkpatrick, any follow-up questions? 

Mrs. KIRKPATRICK. Just one quick question. 

Dr. Kearney, we heard from our first panel that out-sourcing to 

the local communities would improve care. So my question is two 

parts. First of all, do you have the ability to out-source? And if so, 

how are the decisions made when and if to do that? 

Dr. KEARNEY. And, yes, we certainly can out-source. We have fee 

basis that we can do. We certainly do contracts with individuals 

and with the different organizations outside the VA. One of the examples of that is in response to the executive order. We had 24 

community pilots with Health and Human Services in order to expand our services. So we are using that as models to expand to 

other areas as well in our rural communities. 

But certainly at each facility, an administrator can look into fee 

basis. It is not based on a geographical limitation. It is based on 

a number of different things, including is the service even available 

at the VA, is there wait time for that service, do we need to go 

ahead and refer that out to the community. 

So, yes, we are able to do this. 

Mrs. KIRKPATRICK. Thank you. 

I yield back. 

Mr. COFFMAN. Congresswoman Sinema. 

Ms. SINEMA. Thank you, Mr. Chair. 

In his testimony in the first panel, Mr. Boales described receiving 

health care for his service-related injuries but not receiving a benefit or designation from that service-related wound. My understanding based on conversations with other veterans is that this is 

kind of an isolated incident. 

In the cases in particular of military sexual trauma or military 

sexual assault in which the survivor often chooses not to report the 

incident at the time it occurs for reasons as we heard today from 

Mr. Boales, but for a variety of other reasons, what does the VA 

do or what can the VA do to ensure that the survivor does receive 

benefits at the time that he or she is able to report about that service-connected injury? 

Dr. KEARNEY. And we are very concerned about our veterans who 

have experienced military sexual trauma and want to ensure that 

they get timely treatment to care. I can’t comment about VBA’s decisions to give disability for any particular person overall. So, I’m 

sorry, I will have to take that for the record. 

Ms. SINEMA. I yield back. 

Mr. COFFMAN. Thank you, Congresswoman Sinema. 

Our thanks to the panel. You are now excused. 


VACREP180 with DISTILLER
32 

Today we have had the opportunity to hear from veterans and 

their families about the serious long-term consequences of traumatic brain injury. We heard about the continuing challenges veterans have in getting access to necessary services for TBI. We also 

heard from the VHA regarding the health care available to veterans with TBI. I expect the VA to use the discussions and issues 

heard today to improve upon services provided to our veterans. 

I ask unanimous consent that all members have 5 legislative 

days to revise and extend their remarks and include extraneous 

materials. 

Without objection, so ordered. 

Mr. COFFMAN. I would like to, once again, thank all of our witnesses and audience members for joining us in today’s conversation. 

With that—— 

Mrs. KIRKPATRICK. Mr. Chairman, I ask that the statement of 

Mr. Barber and Ms. Sinema’s full statement be submitted to the 

record. 

Mr. COFFMAN. So ordered. 

Mr. COFFMAN. I would like again to thank all the witnesses and 

audience members for joining us today. 

With that, this hearing is adjourned. 

[Whereupon, at 2:45 p.m., the subcommittee was adjourned.] 


VACREP180 with DISTILLER
33 

APPENDIX 


VACREP180 with DISTILLERInsert offset folio 1 here 87679.001
34 


VACREP180 with DISTILLERInsert offset folio 2 here 87679.002
35 


VACREP180 with DISTILLERInsert offset folio 3 here 87679.003
36 


VACREP180 with DISTILLERInsert offset folio 4 here 87679.004
37 


VACREP180 with DISTILLERInsert offset folio 5 here 87679.005
38 


VACREP180 with DISTILLERInsert offset folio 6 here 87679.006
39 


VACREP180 with DISTILLERInsert offset folio 7 here 87679.007
40 


VACREP180 with DISTILLERInsert offset folio 8 here 87679.008
41 


VACREP180 with DISTILLERInsert offset folio 9 here 87679.009
42 


VACREP180 with DISTILLERInsert offset folio 10 here 87679.010
43 


VACREP180 with DISTILLERInsert offset folio 11 here 87679.011
44 


VACREP180 with DISTILLERInsert offset folio 12 here 87679.012
45 


VACREP180 with DISTILLERInsert offset folio 13 here 87679.013
46 


VACREP180 with DISTILLERInsert offset folio 14 here 87679.014
47 


VACREP180 with DISTILLERInsert offset folio 15 here 87679.015
48 


VACREP180 with DISTILLERInsert offset folio 16 here 87679.016
49 


VACREP180 with DISTILLERInsert offset folio 17 here 87679.017
50 


VACREP180 with DISTILLERInsert offset folio 18 here 87679.018
51 


VACREP180 with DISTILLERInsert offset folio 19 here 87679.019
52 


VACREP180 with DISTILLERInsert offset folio 20 here 87679.020
53 


VACREP180 with DISTILLERInsert offset folio 21 here 87679.021
54 

PREPARED STATEMENT OF JERRY BOALES JR. 

In 1989, I was stationed in the U.S. Army at Ft Riley, Kansas. During my time 

there, I was attacked by three male soldiers, grabbed and pulled in a room. I was 

forcibly held down by two of the males while one forcibly raped me. I was then 

raped by the second male. The third male did not do anything except hold me while 

this was going on. I was told that if I said anything I would be killed. I was in so 

much pain and shock that basically I was dragged to the stairs and was thrown 

down a flight of stairs (20 stairs) and left alone. I passed out and woke up by the 

cadre, I could not move so they sent me to the hospital on base. I became paralyzed 

emotionally, which I literally had to have a cattle prod taken pressed on my feet 

to bring me out of the paralyzed condition. 

At this time I was so ashamed about what happened that I did not report this 

incident and I even told my father that I had slipped down some stairs and broke 

my arm. In 1990 I was discharged from the army. So for the next 16 years I kept 

this to myself. I was married, had three children and one night because of a nightmare, something snapped within me. The nightmares became so bad, that I could 

not sleep and literally I was a walking zombie for not allowing myself to sleep. Finally after six years, I started seeing a nurse practitioner—counselor at the Show 

low VA. I told her my story and after a year, she left and to see someone else, I 

would have to start all over again, which I just couldn’t do. So after about a year 

and a half, my wife encouraged me to seek help. I was not really wanting to talk 

to a male doctor about my experiences, I wasn’t getting any better, so I did go back 

to the VA , I saw a Physician ( Dr. Davis ), he could prescribe medications, so I 

continued to see Dr. Davis for almost two years. This was a one on one counseling 

visits. This time, I was recommended by Dr. Davis to submit for PTSD, Depression, 

unemployability which he documented and I can also add that in his notes he related the MST ( Male Sexual Trauma ). I was denied PTSD relating from the MST 

due to lack of evidence. However, I was service connected for depression (100% ) 

temporary to be reevaluated after two years. I was originally denied social security 

disability twice which took over another two years to get that approved through the 

use of a lawyer. This was because I could not work and was already diagnosed as 

chronic depression by the Veterans Administration. 

I lost my family and found myself living in a cabin as a recluse in Show low almost two years. Before the cabin, I lived in a room in my ex-wife’s home which I 

shut myself in and went out only after people were not around. I shopped at 

Walmart at 2 am so I did not have to see people. I would go fishing at daybreak 

before anyone would be there. 

In August of 2010, my son serving in the Army had been wounded in Afghanistan. 

I spent from August 2010 to November 2010 at Brooke Army Medical Center during 

his recovery. It was just me there for him. We had a lot of time to talk, but one 

of the last things he said to me during these conversations was, Dad, promise me 

that you go seek help, which I did after returning to Show low and contacted the 

Tucson VA. I requested to make arrangements to get into the inpatient substance 

abuse program. February 2011, was the quickest time that I could go there, which 

I did. I stayed inpatient for three months and was finally able to get into the MST 

inpatient group, which is a one year program. So after being inpatient for three 

months at the VA medical center, I then left and would live in Casa Grande. I 

would commute once a week to Tucson for my group sessions. I did this for nine 

months. The group counseling was very intense, starting with a group of eight male 

veterans ranging from the Korean War, Vietnam and current war. We ended with 

three finishing the program due to the intensity and having to relive the actual experiences. 

Currently, today I see a therapist at the VA CBOC Clinic in Casa Grande averaging every two weeks since October of 2013.I have submitted three times to the 

Veterans Administration for PTSD relating to the MST. I have been denied three 

times because of lack of evidence. I did not speak up when this rape occurred. I was 

too ashamed. I want to acknowledge the Veterans Administration for finally recognizing that Male Sexual Trauma is and has been an ongoing problem. However 

being recognized is one thing, not being service connected and compensated with 

benefits is another. This feels that it is a slap in the face like it never happened. 

If it is only being recognized for treatment, then the VA is only putting a band aide 

on the problem. I am speaking for all male veterans who are going through these 

difficult experiences of male sexual trauma. I realize that MST is very difficult for 

anyone to talk about. But more and more, we are now seeing these experiences come 

out in the limelight. What is needed now? We need fair evaluation of personal 

stressors and physician diagnoses to service connect and give our veterans benefits 

what they deserve and most important need. 


VACREP180 with DISTILLER
55 

I would also like to comment on the Veteran Access to medical care especially in 

the rural area s based on my experiences. I first want to bring up that when I was 

in the MST program for that nine months in outpatient I had to drive 70 miles one 

way to attend sessions (Casa Grande to Tucson ), this is 140 miles roundtrip. Even 

today, to continue the MST individual or group counseling I would have to still drive 

that distance. The program is good, the distance is not for any veteran in this situation. I might add, even in Show low, if it was to see a specialist for my knee or 

shoulder, I would have to travel to Phoenix, which was almost 400 miles roundtrip. 

Living in a rural area, I would like to see more specialists and physicians that can 

do immediate care, not having veterans constantly trying to get appointments. I 

would like to see a fully staffed VA Clinic and maintain that VA staff to assure myself and all veterans quality health care in a reasonable time frame. I also recommend a VET Center in this area that veterans can go to and seek counseling for 

PTSD, TBI, Sexual trauma and concerns related. It is important to me and I know 

it is important to every veteran living in the Casa Grande Valley. 

Respectfully, 

Jerry Boales Jr. 


VACREP180 with DISTILLER
56 


VACREP180 with DISTILLERInsert offset folio 22 here 87679.022
57 


VACREP180 with DISTILLERInsert offset folio 23 here 87679.023
58 


VACREP180 with DISTILLERInsert offset folio 24 here 87679.024
59 


VACREP180 with DISTILLERInsert offset folio 25 here 87679.025
60 


VACREP180 with DISTILLERInsert offset folio 26 here 87679.026
61 


VACREP180 with DISTILLERInsert offset folio 27 here 87679.027
62 


VACREP180 with DISTILLERInsert offset folio 28 here 87679.028
63 

PREPARED STATEMENT OF BRAD HAZELL

Thank you for this opportunity to testify to the House Committee on Veterans’ 

Affairs Subcommittee on Oversight and Investigations regarding ‘‘Access to Mental 

Health Care and Traumatic Brain Injury Services: Addressing the Challenges and 

Barriers for Veterans’’. My name is Brad Hazell I served in the United States Marine Corps from November of 1999 to June 2005. During this time period I served 

two tours in Iraq. The first tour took place during the invasion in 2003 where I was 

a Scout for the 1st Light Armored Reconnaissance Battalion. My second tour took 

place in 2004–2005 where I was an Infantry Squad Leader for 2nd Battalion 24th 

Marines. During the second tour my squad was hit by several IEDs, one of which 

killed one of my marines and wounded three (myself included). 

Upon returning to the states I resumed my life and returned to my civilian job. 

I had already started to struggle with PTSD Symptoms. Within a year of being 

home I had gotten to the point where I was self-medicating with alcohol daily. Eventually I came to the conclusion that I could no longer deal with these issues myself 

and one night I called the Veterans’ Crisis Line. The following day I went to the 

closest VA Clinic with was located in Alexandria Virginia. I was extremely fortunate, due to my desperation, a counselor at the clinic saw me that day even though 

I had not yet been enrolled in the VA Healthcare System. 

I began weekly sessions with a counselor and had monthly appointments with a 

psychiatrist. Eventually I agreed to be treated at an inpatient facility located in 

Martinsburg West Virginia. First I was treated for alcohol abuse, then for PTSD. 

Unfortunately due to the intense emotions that accompanied the PTSD program I 

withdrew myself from the program to return to work. Within a year I decided to 

return to my home state, Arizona. I was given a three month supply of medications 

with instructions to enroll in the VA Healthcare System in Arizona so that I could 

continue my treatment for PTSD. 

Upon arriving in Arizona I immediately began looking for work. I had two jobs, 

both of which last less than two months. I ran out of my medication and attempted 

to manage my PTSD on my own. After being without medications for over a month, 

I became emotionally distraught and finally enrolled in the Phoenix VA Healthcare 

System. When I attempted to make an appointment to be seen by a psychiatrist, 

so I could resume my medication, I was informed that I had to wait at least a month 

if not longer. I pleaded with the hospital to see if they could at least refill my prescriptions that I had been when I lived in the D.C. area. The Phoenix VA Hospital’s 

solution was to treat me inpatient at their mental health ward. This only made matters worse. Within three days I demanded to be released and signed myself out of 

the hospital. The doctor refused to put me on the same medication stating the some 

of the medications were not on their formula. 

After leaving the mental health ward in Phoenix I moved in with my mother in 

Casa Grande. Living in Casa Grande, I was now in the jurisdiction of the Southern 

Arizona VA Healthcare System (SAVHCS). My experience was much better with 

SAVHCS. I was seen within two weeks by a psychiatrist at the Tucson VA Hospital 

and started therapy with a counselor at the Casa Grande CBOC. SAVHCS fell 

under yet another formula and they were able to put me on similar medications that 

I was on while living in the D.C. area. Over several years my medication was decreased and I vastly improved. 

Unfortunately PTSD hits in waves. I missed an anniversary date from an incident 

in Iraq during which several marines from my unit were killed. This sent me into 

a severe depressive episode. I canceled my appointments with my counselor and my 

psychiatrist. After several months of this depressive episode I eventually tried to 

take my own life by overdosing on a three month supply of sleeping pills. I awoke 

several days later in an intensive care unit and was then transferred to the Tucson 

VA Hospitals Mental Health Ward where I stayed for several weeks. 

Prior to discharge a safety plan was implemented and I was place on a ‘‘High 

Risk’’ list with the VA healthcare system. That being said when I called to make 

my first counseling appointment when I left the hospital the day after my discharge; 

I was told that it would be several weeks until I could be seen. When I informed 

the receptionist about my recent hospitalization, she saw the flag in the system and 

I was setup with an appointment within a couple of days. I remained on the high 

risk list for several months until my mental healthcare providers deemed that it 

was safe to take me off. 

Since that time I began working as a veterans’ advocate helping veterans navigate 

the Veterans Benefits Administration. To this day I am still treated by the Southern 

Arizona VA Healthcare System. 

Respectfully, Brad Hazell 


VACREP180 with DISTILLER
64 

PREPARED STATEMENT OF DR. LISA K. KEARNEY

Chairman Coffman, Ranking Member Kirkpatrick, and members of the Committee, thank you for the opportunity to appear before you today to discuss access 

to treatment for Veterans who have suffered from a Traumatic Brain Injury (TBI) 

or Posttraumatic Stress Disorder (PTSD) once they returned home. I am joined 

today by Dr. Joel Scholten, National Director of Special Projects, Physical Medicine 

and Rehabilitation Service, VHA, Mr. Jonathan H. Gardner, Medical Center, Director Southern Arizona VA Health Care System (SAVAHCS), Mr. Joshua Redlin, 

Team Leader, Tucson Vet Center, and Mr. Rod Sepulveda, Rural Health Program 

Manager Northern Arizona VA Health Care System. 

VHA TBI Program 

VHA provides state-of-the-art comprehensive health care and support services for 

Veterans with both combat and civilian-related TBI, leveraging its nationwide resources through the Polytrauma System of Care (PSC). Through this program, the 

Department continues to advance the evaluation, treatment, and understanding of 

TBI in a variety of ways by developing and implementing best clinical practices for 

TBI; collaborating with strategic partners including Veterans Service Organizations, 

community rehabilitation providers, and academic affiliates; providing education 

and training in TBI-related care and rehabilitation; and conducting research and 

translating findings into improved clinical care. In fiscal year (FY) 2013, VA invested $231 million in TBI care for Veterans. Of this amount, $49 million was for 

care of Veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND). 

All OEF/OIF/OND Veterans who receive health care within VA are screened for 

possible TBI, and from April 13, 2007, through December 31, 2013, over 804,000 

OEF/OIF/OND Veterans have been screened. More than 151,000 of these Veterans 

screened positive for possible TBI and were referred for comprehensive TBI evaluations by specialty teams; over 65,000 of these screened Veterans were diagnosed 

with sustained mild TBI (mTBI) and received appropriate follow-on care. Veterans, 

who were initially screened positive but were later determined not to have TBI, 

were referred for medical follow up as appropriate for their condition. Veterans with 

moderate to severe TBI receive initial diagnosis and treatment on inpatient hospital 

wards. Patients who were diagnosed as having sustained a TBI and continued to 

experience chronic problems requiring rehabilitation and treatment received an Individualized Rehabilitation and Community Reintegration Plan of Care to help coordinate services across episodes and sites of care. In this way, problems that may 

be related to TBI and polytrauma are addressed early on and proactively so they 

can be managed effectively before they become chronic disabilities. 

The PSC has a four-tier design that ensures access to the appropriate level of rehabilitation services based on the needs of the Veterans recovering from TBI and 

multiple, co-occurring injuries (i.e., polytrauma). This system of care includes: 

• 5 regional Polytrauma Rehabilitation Centers, that serve as regional referral 

centers for acute medical and rehabilitation care and as hubs for research and 

education; 

• 23 Polytrauma Network Sites (PNS), that coordinate polytrauma services 

within the Veterans Integrated Service Networks; 

• 87 Polytrauma Support Clinic Teams who provide specialized evaluation, 

treatment, and community reintegration services within their catchment areas; 

and 

• 39 Polytrauma Points of Contact who deliver a more limited range of rehabilitation services and facilitate referrals to the other PSC programs, as necessary. 

The tiered model of the PSC helps ensure that Veterans with TBI and polytrauma 

transition seamlessly between the Department of Defense (DoD) and VHA, and back 

to their home communities through the provision of evidenced-based rehabilitation 

services and care coordination. 

VHA PTSD Treatment 

VA is one of the largest integrated health care systems in the United States that 

provides specialized mental health treatment for PTSD. In FY 2013, over 530,000 

Veterans (including over 140,000 OEF/OIF/OND) received treatment for PTSD in 

VA medical centers and clinics, up from just over 500,000 Veterans (including over 

100,000 OEF/OIF/OND) in FY 2011. VA provides care for PTSD in a variety of settings including inpatient, residential, as well as specialty PTSD outpatient programs and general outpatient care. 

VA provides state-of-the-art care for Veterans with PTSD delivered by more than 

5,200 VA mental health providers who have received training in Prolonged ExpoVerDate Aug 31 2005 11:26 Aug 26, 2015 Jkt 000000 PO 00000 Frm 00068 Fmt 6621 Sfmt 6621 Y:\87679.TXT PAT

VACREP180 with DISTILLER
65 

sure and/or Cognitive Processing Therapy, the most effective known therapies for 

PTSD. Medication treatments also are offered and may be especially helpful for specific symptoms of PTSD. 

VA operates a National Center for PTSD (NCPTSD) that provides research, consultation, and education to clinicians, Veterans, family members and researchers. 

The national PTSD Mentoring Program, which works with every specialty PTSD 

program across the country is designed to promote evidence-based practice within 

VA. NCPTSD’s award winning PTSD Web site (www.ptsd.va.gov) provides researchbased educational materials for Veterans and families, as well as for the providers 

who care for them. To help Veterans access needed care, AboutFace, which can be 

found at http://www.ptsd.va.gov/apps/AboutFace/ was added in 2012, is an online 

video gallery dedicated to Veterans talking about how PTSD treatment turned their 

lives around. Each June, NCPTSD runs a national campaign to raise awareness 

about PTSD and its effective treatment during PTSD awareness month. NCPTSD’s 

Consultation Program was established in 2011 to reach any VA provider who treats 

Veterans with PTSD, including those in VA PTSD specialty care, those in other 

areas of mental health, primary care providers, and case managers. The Consultation Program helps with questions about assessment and treatment services for Veterans with PTSD. By the end of FY 2013, there were over 650 consultations completed, over 550 for PTSD and over 75 for Suicide Risk Management, a feature 

added this year to the Consultation Program. 

Interdisciplinary Pain Management 

There has been an ongoing and broadening collaborative approach within the National Pain Management Program Office, Rehabilitation and Prosthetic Services 

(RPS), Primary Care Services, Mental Health Services, Specialty Care Services and 

Nursing Services to educate the field on the stepped-care model for pain management. On December 15, 2010, the Under Secretary for Health chartered the Interdisciplinary Pain Management Workgroup to assist Veterans Integrated Service 

Network (VISN) Directors in establishing which specialty pain services will be available to all Veterans and how best to determine the need for tertiary pain care and 

pain rehabilitation services. The Pain Medicine Specialty Team Workgroup, chartered on January 26, 2012, is providing support to Patient Aligned Care Teams 

(PACT)/primary care and pain specialty care services through collaborative care 

models and participation in provider and team education through telehealth, econsults, and Specialty Care Access Network-Extension for Community Healthcare 

Outcomes (SCAN–ECHO). VA SCAN–ECHO experts provide didactics and casebased learning to PACT members using videoconferencing technologies to strengthen the competencies of providers in pain management. 

As of January 2014, VA has ten sites in seven VISNs with Commission on Accreditation of Rehabilitation Facilities-accredited pain programs. RPS has collaborated 

with the Employee Education System to provide a wide variety of TBI and painrelated training offerings to all VA clinicians at their desktop via VA’s Talent Management System, including handouts, management algorithms, video lectures and 

workshops, and training courses. Other ongoing training venues available to primary care clinicians and nurses include: 

• Conference calls and training • Post-Deployment Integrated Care Initiative (PDICI) Community of Practice 

(CoP) 

• Pain PACT CoP (monthly) • PSC/TBI System of Care • Primary Care Mental Health Integration • Health Services Research and Development (HSR&D) ‘‘Spotlight on Pain 

Management’’ calls 

• List serve Web sites (Physical Medicine and Rehabilitation Program Office 

Web site, Pain Management Program Office, PDICI Wiki on post-deployment 

care) 

• SharePoint sites (Primary Care Staff Educational Resources SharePoint for 

PACT, OEF/OIF/OND National SharePoint) 

• Training applications for clinicians on smart phones and tablets (TBI APP 

available 4th Quarter of 2013 and T2 mTBI Pocket Guide) 

SAVAHCS Mental Health Services 

SAVAHCS, in Tucson, Arizona, provides comprehensive mental health services to 

Veterans in the Tucson metropolitan areas and Southern Arizona. These services include Inpatient Psychiatry, the Evaluation and Brief Treatment of PTSD Unit 

(EBTPU), Inpatient Geropsychiatry, Primary Care-Mental Health Integration (PC– 

MHI), Opioid Replacement Treatment, Substance Use Disorder Treatment Programs 


VACREP180 with DISTILLER
66 

(SUD–TP), Substance Abuse Residential Treatment Program (SARRTP), General 

Outpatient Mental Health, Outpatient Primary Care for Seriously Mentally Ill 

(SMI) Veterans, Homeless programs, Mental Health Intensive Case Management 

(MHICM), and Psychosocial Rehabilitation and Recovery Center (PRRC). 

SAVAHCS monitors access to mental health clinics and programs to enhance access for our Veterans. Access to mental health services is managed through PC– 

MHI. This program supports Primary Care PACT by providing a Mental Health 

psychiatrist and a team of social workers who are co-located in Primary Care Clinics. This team provides same day management of Veterans’ mental health concerns 

thus reducing time and location barriers to access to care. In FY 2013, the 

SAVAHCS PC–MHI served 5,168 unique patients. This included 15,699 PC–MHI 

clinical encounters and 2,752 new PC–MHI patients. In FY 2013, PC–MHI exceeded 

all Mental Health Screening performance measures related to alcohol use, post-traumatic stress disorder, and depression. In FY 2013, the Mental Health Clinic at 

SAVAHCS provided 28,003 encounters and treated 7,233 unique patients. 

SAVAHCS has established strong relationships with the community. On August 

14, 2013, SAVAHCS hosted a Mental Health Summit which focused on coordination 

of care for homeless Veterans, and access to mental health services for Veterans and 

their families. Over 90 community participants attended this summit and provided 

valuable information about resources available to Veterans in the community. 

SAVAHCS will be hosting another Mental Health Summit in August 2014 with a 

focus on mental health access. In addition, SAVAHCS will be hosting a Homeless 

Summit in May 2014 which will bring together community partners and SAVAHCS 

staff who work with the homeless. This summit will provide an avenue for developing further outreach activities. SAVAHCS is also participating in the ‘‘25 Cities 

Initiative’’ which is a collaborative effort between local community leaders, 

SAVAHCS, VHA’s Homeless Program Office, and our Federal partners, the Department of Housing and Urban Development and U.S. Interagency Council on Homelessness. The goal of this initiative is to identify and prioritize community resources 

and assist communities in removing barriers. 

Our Supportive Education for Returning Veterans (SERV) program provides credit-bearing courses for student Veterans utilizing their GI Bill benefits to increase 

retention and successful graduation rates at the University of Arizona. SAVAHCS’ 

SERV program is a best practice, and this model has been adopted at colleges and 

universities throughout the country, including the Universities of South Dakota, 

New Mexico, and Mississippi State University. SAVAHCS staff are currently consulting with the Universities of Montana, South Carolina, Rhode Island, Rutgers 

University, and Massachusetts Institute of Technology to help with the development 

of SERV programs at these institutions. 

The EBTPU is a unique program in VA. It provides evidence-based treatment to 

cohorts of six Veterans struggling with combat-related PTSD. The program is administered over 4 weeks in an inpatient setting and accepts referrals from all over 

the country. Outcomes data have demonstrated sustained reductions in PTSD symptoms and high levels of Veteran satisfaction. 

SAVAHCS’ Polytrauma Network Site (PNS) 

SAVAHCS serves as the PNS in VISN 18 and coordinates key components of postacute rehabilitation care for individuals with polytrauma and TBI across the VISN. 

Since 2010, VISN 18 has experienced a 47 percent growth in the number of Veterans treated in polytrauma clinics. The VISN has improved access to interdisciplinary teams of rehabilitation specialists, case management, and psychosocial support 

services. Rehabilitation services for TBI include screening, comprehensive evaluations, and interdisciplinary treatments that promote independence and community 

re-integration including various therapies, counseling, vocational rehabilitation, and 

prescription of prosthetic and adaptive devices. 

TBI frequently occurs in polytrauma patients combined with other disabling conditions, including depression, PTSD, and other mental health conditions. The hallmark of rehabilitation care provided at the PNS is the collaboration of specialists 

from different disciplines in the evaluation and treatment of symptoms related to 

TBI and polytrauma. Mental health professionals are key members of the interdisciplinary polytrauma teams (IDT) participating in the individualized assessment, 

planning, and implementation of the plan of care for Veterans served at the PNS. 

In order to expand the availability of specialty TBI services across VISN 18, we 

focused on provider education and on the use of telehealth technologies. The 

SAVAHCS PNS program has established mini-residencies targeting provider education and training on TBI evaluation, treatment, and care coordination. Clinicians 

completing this training are mentored via additional telehealth observation until 

competencies in TBI evaluation and management are demonstrated. We also leverVerDate Aug 31 2005 11:26 Aug 26, 2015 Jkt 000000 PO 00000 Frm 00070 Fmt 6621 Sfmt 6621 Y:\87679.TXT PAT

VACREP180 with DISTILLER
67 

aged the increased availability of telehealth technologies to allow specialists from 

VA’s larger medical centers to reach out and provide medical services and consultation to Community- Based Outpatient Clinics (CBOC) located in rural and highly 

rural areas. Since 2010, we have seen a 70 percent increase in TBI and polytrauma 

visits completed via telehealth. The number of telehealth consultations with Veterans residing in rural and highly-rural areas has also increased steadily to make 

up as much as 37 percent of the overall telerehabilitation workload in FY 2013. 

In addition to the leadership role in coordinating TBI rehabilitation services 

across VISN 18, the SAVAHCS PNS has implemented innovative programs that facilitate community re-integration of Veterans with TBI and polytrauma. Noteworthy 

among these are the series of group activities that provide injured Veterans with 

opportunities to learn new skills and to apply them in community-based environments. These programs have the added benefit of engaging Veterans’ families and 

services outside VA to support Veterans in their community re-integration efforts. 

Through SAVAHCS PNS outreach efforts, other VA programs and community 

partners have been brought together to develop multidimensional programs that address the complex needs of Veterans with TBI and polytrauma. Among the results 

of these efforts are the Adaptive Sports Programs, the VISN 18 program for managing Veterans with complex pain, a vision therapy clinic, and the headache management clinic. The SAVAHCS PNS also engages with the Arizona Governor’s Council on Spinal and Head Injuries to link education, rehabilitation, and employment 

resources together to serve the vocational rehabilitation goals of injured Veterans. 

Other partners in this effort include VA Vocational Rehabilitation, the Arizona Coalition for Military Families, the University of Arizona, Pima Community College, 

and the Arizona Department of Economic Security, Rehabilitation Services Administration. 

SAVAHCS’ Relationship With Native American Community 

Native Americans serve in our Nation’s military at the highest rate per capita of 

all ethnic groups. We, at SAVAHCS, honor their service through our programs and 

services for Native American Veterans, our relationships with Indian Health Service 

https://eop.skillport.com/skillportfe/login.action (IHS) and other Native American 

community organizations, and cultural awareness training of our staff. In collaboration with IHS, SAVAHCS also honors and celebrates their service and sacrifices 

with an annual Gathering of American Indian Veterans event, which draws 

attendees from around the State of Arizona, to help American Indian Veterans learn 

more about the benefits they have earned. 

SAVAHCS respects the unique needs of our Native American Veterans by having 

a dedicated Native American Veteran Program. SAVAHCS is a place of healing for 

our Veterans, and through our Native American Veteran Program, we have learned 

invaluable lessons from Native Americans about the holistic healing process which 

we have incorporated into our programs. For example, SAVAHCS has a 24-day, inpatient EBTPU which helps Veterans who come from across the country. At graduation, the Veterans are blessed with a Native American cleansing ceremony. We also 

host weekly Native American Talking Circles. 

Our relationship with IHS provides a vital connection to the five local Native 

American tribes. To better identify the needs of our Native American Veterans, 

SAVAHCS has trained 250 IHS Benefits Coordinators concerning eligibility for VA 

health care services. 

Additionally, we have completed five (5) VA and IHS local implementation plans 

under the December 5, 2012, National Reimbursement Agreement between VA and 

IHS, under which VA reimburses IHS for direct care services provided to eligible 

American Indian/Alaska Native Veterans in IHS facilities. Under the National Reimbursement Agreement, approximately 700 SAVAHCS Native American Veterans 

are eligible to receive VA reimbursement to IHS for services provided by IHS. 

SAVAHCS is committed to our Native American Veterans and continues to build 

partnerships with organizations that can bring additional services to all Veterans. 

Our Rural Health Coordinators and Community Referral Center Case Managers 

routinely meet with our IHS partners to ensure that all health care needs are meet 

for the eligible Veterans. We want to be present in our community and actively engage in building a more Veteran-centric community. Since October 1, 2013, 

SAVAHCS Eligibility and Enrollment outreach staff have conducted 57 outreach 

events, connecting with over 4,800 Veterans and their family members; several of 

these events were specifically targeted to Native American Veterans. 

Readjustment Counseling Service 

VA’s Vet Centers present a unique service environment—a personally engaging 

setting that goes beyond the medical model—in which eligible, Veterans, 


VACREP180 with DISTILLER
68 

Servicemembers, and their families can receive professional and confidential care in 

a convenient and safe community location. Vet Centers are community-based counseling centers, within Readjustment Counseling Service (RCS), that provide a wide 

range of social and psychological services including professional readjustment counseling to eligible Veterans, Servicemembers, and their families; military sexual trauma (MST) counseling for Veterans; and bereavement counseling for eligible family 

members who have experienced an active duty death. The Tucson Vet Center, like 

those throughout the country, also provides community outreach, education, and coordination of services with community agencies that link Veterans and 

Servicemembers with other needed VA and non-VA services. A core value of the Vet 

Center is to promote access to care by helping those who served and their families 

overcome barriers that may impede them from using those services. For example, 

all Vet Centers have scheduled evening and/or weekend hours to help accommodate 

the schedules of those seeking services. 

The Vet Center program was the first program in VA, or anywhere, to systematically address the psychological traumas of war in combat Veterans. The program 

was established a full year before the definition of PTSD was published in the Third 

Edition of the American Psychiatric Association Diagnostic and Statistical Manual 

(DSM III) in 1980. 

There are currently 300 Vet Centers located throughout the United States, Puerto 

Rico, Guam, and American Samoa. Vet Center staff provide a wide range of Veteran-centric psychotherapeutic and social services to eligible Veterans and their 

families in the effort to help these individuals make a successful transition to life 

after service in a combat zone or area of hostility. VA has a fleet of 70 Mobile Vet 

Centers that provide outreach and services to Veterans and families in areas geographically distant from existing VA services. These vehicles also are used to provide early access to Vet Center Services to Veterans newly returning from war via 

outreach to demobilization active military bases, National Guard, and Reserve locations nationally. 

These services include: 

• Individual and group counseling for eligible individuals and their families; 

• Family counseling for military-related readjustment issues; 

• Bereavement counseling for families who experience an active duty death; 

• MST counseling and referral, if required; 

• Educational classes on PTSD, Couples Communication, Anger and Stress 

Management, Sleep Improvement, and Transition Skills for Civilian Life; 

• Substance abuse assessment and referral; 

• Employment assessment and referral; 

• Screening and referral for medical issues, including mTBI, depression, etc.; 

and 

• Referrals for Veterans Benefit Administration benefits. 

Like Vet Centers throughout the country, the Tucson Vet Center is a small team 

of six staff members reminiscent of a military squad. The Tucson Vet Center is 

staffed by a team leader, three readjustment counselors, an office manager, and an 

outreach specialist. The staff also includes a qualified MST Counselor and a Family 

Counselor. 

The Vet Center’s ability to rapidly and effectively respond to acute PTSD and 

other post-war readjustment difficulties makes it an integral asset within VA. As 

the community’s first point of contact with many Veterans returning from combat, 

Vet Centers also serve as the front door for referring many individuals for other 

needed VA services. Vet Centers also promote collaborative partnerships with VA 

health care and mental health professionals to better serve Veterans requiring more 

complex care. In addition to maintaining a bi-directional referral process with local 

VHA facilities, Tucson Vet Center staff also participate in weekly care coordination 

meetings with VA medical center mental health clinicians to ensure that all shared 

Veteran clients are receiving the best possible care from VA. 

For individuals who are distant from the Tucson Vet Center, staff are bringing 

readjustment counseling to them through the creation of community access points 

in the communities in which they live. At these locations, counselors can provide 

services on a regularly-scheduled basis that are in line with the needs of that community. For example, the Tucson Vet Center maintains a community access point 

in Sierra Vista, Arizona and provides readjustment counseling twice a week to eligible local Veterans and Servicemembers stationed at Fort Huachuca. 

The Vet Center Program remains unique in the eyes of those who have served 

thanks to the ability of Vet Center Staff to personally engage the individual Veteran 

or Servicemember in a safe and confidential environment that minimizes bureaucratic formalities. Confidentiality with our Veterans and their families is of paraVerDate Aug 31 2005 11:26 Aug 26, 2015 Jkt 000000 PO 00000 Frm 00072 Fmt 6621 Sfmt 6621 Y:\87679.TXT PAT

VACREP180 with DISTILLER
69 

mount importance. Vet Center staff respect the privacy of all Veterans and 

Servicemembers and hold in strictest confidence all information disclosed in the 

counseling process. No information will be communicated to any person or agency 

outside of RCS unless authorized by law. 

Conclusion 

VHA provides comprehensive health care and support services for Veterans with 

both combat and civilian-related TBI through its nationwide Polytrauma System of 

Care. VHA also provides care for Veterans with PTSD through a variety of settings 

including inpatient, residential, specialty PTSD outpatient programs and general 

outpatient care. Care for PTSD is delivered by more than 5,200 VA mental health 

providers who have received training in Prolonged Exposure and/or Cognitive Processing Therapy, the most effective known therapies for PTSD. These TBI and PTSD 

programs enable timely access to treatment as part of the VA’s efforts to deliver the 

high quality health care and support our Veterans have earned. 

Mr. Chairman, this concludes my testimony. Thank you for the opportunity to appear before you today. At this time, my colleagues and I would be pleased to respond to questions you or the other Members of the Subcommittee may have. 

f 

FOR THE RECORD 

STATEMENT OF TANA OSTROWSKI

Thank you for this opportunity to submit a written testimony on this most important topic. My name is Tana Ostrowski. For disclosure purposes, I am currently 

serving in my third term as Chair of the Governor’s Traumatic Brain Injury Advisory Council for the state of Montana. I am also a direct care provider with a post 

acute brain injury rehabilitation program located in Missoula Montana. I am submitting this written testimony as a concerned citizen and not specifically representing either of the previously mentioned groups. 

As members of the committee are aware, combat related traumatic brain injury 

disabilities have increased among our Veterans. Traumatic brain injury has been 

recognized as a major public health issue for as long as I have worked in the field 

and I am now entering my 27th year providing rehabilitative services to survivors 

of TBI. Montana has a statistically high number of Veterans. The majority of our 

state is classified as rural and/or frontier. This is relevant as it emphasizes the barriers that citizens of Montana encounter when trying to access TBI related therapies, Veterans as well as civilian. 

I am writing today to support efforts that facilitate Veterans, their family members and care providers’ access to skilled civilian providers within their geographic 

locations. There is significant evidence that indicates rehabilitation outcomes are 

improved when individuals are closer to their homes and support systems. In terms 

of resources, it is more cost effective to have a Montana Veteran receive TBI rehabilitation within the state of Montana vs. sending them to Colorado or other out of 

state facility. What is even more important is that TBI affects each individual differently. Service providers who specialize in TBI rehabilitation understand the 

unique needs of the person served. Cognitive changes, whether they are related to 

basic functions such as attention, memory or information processing, or executive 

skills like self monitoring/self regulation, organization, mental flexibility etc. all impact an individual’s day to day function. The rehabilitation process does not end in 

the clinic. Allowing Veterans to access skilled civilian providers will allow for improved rehabilitation outcomes, significantly improved continuum of care and follow 

up, reduce stress and is certainly more cost effective. 

It is truly a disservice to our returning Veterans and their family members, to 

not provide them with the most effective traumatic brain injury rehabilitation available. 

Respectfully, 

Tana Ostrowski, OTA/L, CBIS 

Addendum: I feel that it is important to note the following: In 2011 the Community Bridges post acute brain injury rehabilitation program of the Rehabilitation Institute of Montana applied for and received a contract with the VA. At that time, 

the Bridges program had three components to the program, Residential, Day Treatment and traditional Outpatient BI rehabilitation. The contract was part of a pilot 

program with the VA and was awarded based on the Bridges program’s continuum 

of care. In the Residential program, an individual with TBI reside in apartments 


VACREP180 with DISTILLER
70 

within a community setting. The residence is staffed and in addition to traditional 

therapies individuals learn how to become skilled at implementing their compensatory strategies post TBI in real life situations. All aspects of recovery are addressed including behavior regulation. As of 2013 no referrals had been received 

from the VA. In late 2013 the Residential program was closed, limiting access to 

this highly successful rehabilitation environment. 

An additional concern is the funding cuts to the Yellow Ribbon program. The Governor’s TBI Advisory Council was success in obtaining two $50,000 one time funding 

during the last legislative session, in effort to provide direct outreach and training 

to rural Montanan’s with an emphasis on Veterans and their family members. For 

months the Council committee worked in collaboration with a member of the National Guard, developed a plan to divide Montana into 10 geographical regions. The 

plan includes but was not limited to travel to the designated locations to provide 

education related to the long term effects of TBI, but most importantly provide 

training to participants to better manage difficult issues that may persist post TBI. 

Providing family members, Veterans and when needed, care providers, (most often 

family members and/or spouses), with tools that they can effectively implement on 

a day to day basis on extremely important. This would have been at no cost to Veterans and their families. I believe that having education, understanding why one 

is experiencing what they are experiencing and how it impacts their goals and 

IADLs is fundamentally important for successful management of persistent post TBI 

symptoms. I also believe that these tools could have a direct impact on reducing the 

number of suicides among our returning Veterans. It was extremely disappointing 

when the DoD cut the funding to the Yellow Ribbon program. The Council committee will follow through with outreach, education and training. It is important to 

note however that without the direct involvement of the VA, National Guard or 

other direct Service organization participation from Veteran’s and their family members and/or care providers will be significantly reduced. 

f 

STATEMENT OF CONGRESSWOMA KYRSTEN SINEMA

Thank you Chairman Coffman and Ranking Member Kirkpatrick for allowing me 

to participate today and for holding this hearing in Arizona. 

Chairman Coffman, thank you for coming to our state. We have a proud military 

tradition here and this issue is very important to us. 

Congresswoman Kirkpatrick, you are a great champion for Arizona’s veterans and 

I am glad you brought the Veterans Affairs Committee to Arizona to hear directly 

from our veterans. 

Thank you for holding a hearing on this important topic: Veterans’ access to mental health care and traumatic brain injury services. 

Finally, thank you to our panelists. Thank you for your service to our country, 

your sacrifice and for your advocacy for our nation’s veterans. 

Our state has a proud history of military service and it is critical that our returning veterans have access to appropriate care. 

Traumatic brain injury and mental health wounds are the signature wounds of 

the wars in Afghanistan and Iraq, but previous generations of veterans also have 

these wounds. 

Ensuring access to care is critical, but while resources and attention are now more 

focused, too many of our veterans our not getting the support they need. 

Tragically, 22 veterans lose their lives to suicide every day. This is unacceptable. 

I am also disturbed and concerned by the allegations at the Phoenix VA Medical 

Center that delays in care may have caused the deaths of Arizona veterans. We 

need to get to the bottom of this and hold accountable those responsible. 

This battle cannot be one that is fought by our veterans alone, or by their families 

or by the VA. 

We have to work together as a community and as a country to end this tragedy. 

No veteran should feel they have no place to turn and no family should lose their 

loved one after he or she returns home. 

Again, thank you Chairman Coffman and Ranking Member Kirkpatrick for holding this hearing and for your leadership. 

And thank you to our panelists for sharing your very personal stories and for 

working to help other veterans and military families. 


VACREP180 with DISTILLER
71 

REP. RON BARBER (D–AZ–02) 

I am sorry that I cannot be with you. I am in Yuma today for the dedication of 

the John Roll United States Courthouse. 

Our nation owes each of our veterans a debt greater than gratitude. I will continue working in Congress with my colleagues, like Congresswomen Kirkpatrick and 

Congressman Coffman, to ensure that each of our veterans and their families receive the care, the benefits and the opportunities they have earned and deserve. 

We need to do all we can as a Congress, a community and a country to guarantee 

care for those who’ve served and sacrificed for our nation. 

Thank you for coming to Southern Arizona to explore the critical issues of mental 

health care and traumatic brain injury services for our veterans. 

Æ 


VACREP180 with DISTILLER