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FIELD HEARING ON VETERANS’ ACCESS TO 

BENEFITS AND SERVICES IN APPALACHIA 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

APRIL 5, 2010 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

ROLAND W. BURRIS, Illinois 

ARLEN SPECTER, Pennsylvania 

RICHARD BURR, North Carolina, Ranking 

Member 

LINDSEY O. GRAHAM, South Carolina 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

SCOTT P. BROWN, Massachusetts 

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

APRIL 5, 2010 

SENATORS 

Page 

Brown, Hon. Sherrod, U.S. Senator from Ohio ..................................................... 1 

WITNESSES 

Greenlee, Rich, MSW, PhD, Dean, Ohio University Eastern Campus ................ 4 

Prepared statement .......................................................................................... 6 

Maupin, Lucinda, Veterans Service Officer, Belmont County ............................. 12 

Prepared statement .......................................................................................... 14 

Neutzling, Andrea Michele, Veteran, Meigs County ............................................ 15 

Prepared statement .......................................................................................... 17 

Graves, Kim A., Eastern Area Director, Veterans Benefits Administration, 

U.S. Department of Veterans Affairs; accompanied by Joyce Cange, Director, Cleveland Regional Office; Jack Hetrick, Director, VA Healthcare System of Ohio (VISN 10); Jeffrey Gering, Director, Chillicothe VA Medical 

Center .................................................................................................................... 26 

Prepared statement .......................................................................................... 28 

Bill Hartnett, Director, Ohio Department of Veterans Services .......................... 31 

Prepared statement .......................................................................................... 33 

(1) 

FIELD HEARING ON VETERANS’ ACCESS TO 

BENEFITS AND SERVICES IN APPALACHIA 

MONDAY, APRIL 5, 2010 

U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Cambridge, OH. 

The Committee met, pursuant to notice, at 11:18 a.m., at the 

Scottish Rite Auditorium, Hon. Sherrod Brown, Member of the 

Committee, presiding. 

OPENING STATEMENT OF HON. SHERROD BROWN, 

U.S. SENATOR FROM OHIO 

Senator BROWN. I call the meeting of the Senate Veterans Committee to order. Thank you all for joining us. Chairman Akaka and 

Ranking Member Burr, who were very cooperative, sent along both 

Democratic and Republican staff to Cambridge to assist us today. 

Senator Akaka, whose home State is Hawaii, likes to begin these 

hearings with ‘‘Aloha,’’ so I guess will do the same, but I don’t want 

you to think I’m going up town by acting like I speak Hawaiian or 

something. 

Welcome to all of you here. A special thanks to a whole host of 

people who have been particularly helpful: Tom Fisher, Carl Lambert, Troy Simmons, and David Moyer, who are doing the lights 

and sound, and are the facilities manager and the director of this 

beautiful theater. As I was walking in, I talked to Tom and Carl 

about how theaters like this bring back memories. If you’re my age 

or older you remember sitting up in the balcony and watching movies on a Saturday and putting gum underneath your seat and all 

the things people have done for 50 years in these theaters. Thank 

you for that memory, but more importantly what we’re doing here 

today. 

I have got a handful of introductions: County Commissioners 

Steve Allen, Tom Loughlin, and Steve Douglas are here; also Linda 

Secrest, who is out of the agency next door, the Linda Secrest Drug 

& Alcohol Abuse Programs, and she obviously has a direct impact 

some of these veterans programs, too. Outside I met the head of 

the Veterans Service Organization in Noble County. Is he here 

still? I appreciate his comments about how hard he has worked— 

he’s done this for 21 years, you said? 

UNIDENTIFIED SPEAKER. Yes. 

Senator BROWN. You have worked hard on making sure that 

every returning vet that comes to Caldwell or is anywhere in Noble 

County, a small, well-populated but rural county where people 

come and go and where you don’t necessarily know they’re in the 

2 

community—how quickly you have run to The American Legion, 

the VFW, and other veterans organizations to locate these returning veterans so they can get screening and treatment. There was 

one vet who was hit by a bomb—we call them IEDs—but they’re 

really bombs, in Iraq or was it Afghanistan? 

UNIDENTIFIED SPEAKER. Iraq. 

Senator BROWN. He didn’t think he needed treatment. He had already had treatment and didn’t need really much else, but the VSO 

convinced him to come in. Now they’re following his medical 

progress and helping him to make his life better. That’s why the 

community services that the VSOs are providing are so very, very 

important. 

I would like also to introduce before the hearing, in earnest, 

Doug Babcock, who is behind me. Doug is from Galion, OH, grew 

up near where I did in Mansfield. Doug is from our Washington, 

DC, office and works tirelessly on behalf of veterans. Doug’s wife 

is from Zanesville, so Doug is close to home, just one county over. 

Today’s field hearing is an official U.S. Senate Committee on Veterans’ Affairs hearing, or an official Senate hearing. Everything 

that will happen today—the rules, the procedures, the testimony— 

is just like you would see if you attended a Senate Veterans’ Affairs 

Committee hearing in Washington, DC. 

Chairman Akaka and the Committee are holding this hearing in 

Appalachian Ohio because it is important to hear directly from veterans in their hometowns and in their regions. Senior Committee 

staff members are here. The testimony will be recorded and available for every Member of the Committee, the Senate, and the 

public. 

Thank you, first of all, to the witnesses for testifying, who I want 

to introduce in a moment. Thanks for your service to our Nation 

and its veterans. Thanks also everyone here who works in their 

communities, with our State and Federal Government, and local 

governments on behalf of our veterans. 

Veterans in Appalachia face unique challenges, from social and 

economic isolation to distant health care facilities and misallocation 

and lack of resources. It is vital that these challenges are understood by the Committee and the Senate, so as laws and regulations 

are written, the concerns of these veterans are heard and are addressed. 

It’s fitting that this hearing is being held in Cambridge, OH. 

This great city predates the State of Ohio, when pioneer Ebenezer 

Zane named it while cutting roads through the Northwest Territory. For more than 200 years Ohioans have been calling these rolling hills home, building middle-class communities, raising families, 

and pursuing the American Dream. 

Across the street is the John Herschel Glenn, Jr. Post Office, 

named in honor of the famed astronaut and statesman. The former 

Marine pilot is a typical representative of Appalachian Ohio: patriot, hard worker, family man, principled, and true to his values. 

I am honored that we could bring this field hearing to his 

birthplace. 

Veterans in Appalachia don’t always go out and orbit the earth 

or serve in the U.S. Senate or become the epicenter of our Nation’s 

most historic moments of the 20th Century. Yet, in many ways, 

3 

veterans in Appalachian Ohio constitute the very character of our 

Nation, serving our country in times of war and returning home to 

become teachers and police officers, doctors, business and civic 

leaders, factory workers, and craftsmen. But too many Appalachian 

Ohio veterans continue to struggle with the results of their service 

to our country or otherwise face difficulties transitioning from soldier to citizen. 

Last week I visited the Chillicothe Veterans Medical Center, one 

of the most important medical centers of the country, serving this 

State, this part of the State, very well. 

In 2007 I held a Senate field hearing in New Philadelphia that 

focused on VA health care in Appalachia. At that hearing, Terry 

Carson, a hospital administrator from Cadiz, not too far away, testified about the challenges of providing care for rural veterans. He 

testified about how his hospital was trying to do the right thing 

when treating vets facing medical emergencies. But as much care 

as the hospital could provide, the hospital often got stuck with the 

medical bill because the VA, through a series of rules and regulations, prohibited it from getting reimbursed. 

After hearing his testimony, and that of Appalachian Ohio veterans, I introduced The Veterans Emergency Care Fairness Act of 

2007 to require the VA to reimburse a private hospital, which are 

more often than not in rural counties, for emergency care before a 

vet is transferred to a VA medical center. Congressman Zack Space 

of Ohio’s 18th District, who joined me at that hearing, introduced 

the House version of the bill. That bill is now law. 

While we were successful in enacting that law, it’s clear that 

challenges or problems facing veterans in Appalachia remain. Vets 

in our part of Ohio struggle with access to information about benefits, health care, education, and job training. Larger cities have 

more resources and veterans have shorter distances to travel to access them. The economic outlook happens to be tougher if you live 

in Guernsey County and any of the surrounding counties. The economic outlook is tougher here than it is in Columbus, just over an 

hour away. 

As citizens face difficult financial realities and barriers to economic opportunities, Appalachians struggle to keep up with their 

big city and suburban counterparts. Simply put, there are more 

economic resources available for veterans in the larger and more 

populated areas than there are in more rural areas, of course. 

There are more private resources, more non-profit resources, more 

governmental resources, and more people available to lend a helping hand. 

Despite these challenges, we recognize that veterans where ever 

they may live are entitled to benefits they have earned and deserve, benefits that include higher education, home ownership, and 

job training. Veterans have always been, as we know, the key to 

powering our Nation. 

When Franklin Roosevelt signed into law the original GI Bill in 

1944, it not only provided servicemembers with an education, it 

strengthened our Nation. Imagine in those years after World War 

II where seven million veterans took advantage of the GI Bill. It 

meant a great opportunity for each one of those seven million veterans in getting an education, getting work, building a home, and 

4 

starting a family. It helped quite a bit in creating the prosperity 

that this Nation enjoyed after World War II. That is an example 

of government helping both individual people and the larger public. 

The Department of Veterans Affairs Mission Statement reads: 

‘‘To fulfill President Lincoln’s promise ‘To care for him who shall 

have borne the battle, and for his widow, and his orphan’ by serving and honoring the men and women who are America’s veterans.’’ 

Thank you again for attending the hearing. We will now hear 

testimony from two panels of witnesses. Our first panel I’ll introduce and call for each of them to speak roughly 5 minutes, or however long they need, and then we’ll have questions. 

Our first panel of witnesses consists of three veterans. Two of 

them will describe their story and experience living in Appalachia 

as a veteran. We will start with Dr. Greenlee from St. Clairsville. 

Dr. Greenlee is an expert on Appalachia and will paint a picture 

of Appalachia and what people living here face in their daily lives. 

As a veteran, his perspective is particularly useful. Dr. Greenlee is 

a well known expert throughout eastern Ohio and earned his Ph.D. 

in social work from The Ohio State University. He has a Masters 

of Social Work degree from the University of Pittsburgh and a 

Bachelor of Science degree from the University of Maryland and 

currently serves as Dean of Ohio University’s Eastern Campus in 

St. Clairsville. 

We’ll then hear from Cindy Maupin, who served 8 years in the 

Army. Not only is she a veteran, but also serves veterans and their 

families every day as Director and County Veterans Service Officer 

in Belmont County. She has been in that position for the last 9 

years. She graduated in 1980 from Bellaire High School. She has 

worked for the Belmont County Veterans Office since June 2001. 

She’s a lifelong resident of Belmont County and currently resides 

in Bellaire with her husband Don and son, Woody. 

Our last witness is Andrea Neutzling from Pomeroy in Meigs 

County. She served active duty in the Army for 4 years, then 51⁄2

years in the Army Reserve. She was deployed to both Korea and 

Iraq. She was assigned to military intelligence. While in Iraq she 

was wounded in the shoulder, which put an end to her aspirations 

to be a police officer when she returned to civilian life. She is currently studying for a degree in counter-terrorism at Ohio University. Thank you all for your service to our country and thank you 

all for continuing to serve veterans. Dr. Greenlee will start. 

STATEMENT OF RICHARD W. GREENLEE, Ph.D., ASSOCIATE 

PROFESSOR OF SOCIAL WORK, DEAN, OHIO UNIVERSITY 

EASTERN CAMPUS 

Mr. GREENLEE. As a veteran of both the Army and Air Force, I’m 

honored to be able to speak to you today on Appalachian culture 

and veterans. 

Historically, the residents of Appalachia have faced chronically 

high rates of poverty, substandard housing, inadequate schools, 

poor health care for many generations, yet when they are called 

they serve. 

Despite these many challenges, they have survived and in some 

situations flourished. Resiliency is a major component of their constitution. The ability to get knocked down on many occasions and 

5 

get back up and take care of their families and themselves with 

limited outside help is commendable. Their environment has often 

required them to learn how to make do, make it last, and do without. They don’t ask for much from others. They rarely ask for help, 

but when they do ask, they ask that they be listened to in a respectful manner so that their voices can be heard and they can 

have some influence over their own lives and health care. 

Behringer has identified some important cultural barriers that 

have affected utilization of health care services in this region: (1) 

there is a general sense of mistrust of health care professionals and 

a fear of being taken advantage of by the system; (2) Appalachians 

also fail to assert themselves in seeking health care. This also promotes poor patient/provider communication and goal setting; (3) 

the cultural need for privacy and pride often leads to low health 

care utilization and poor followup with referrals; (4) there continues to be a general sense of fatalism that ‘‘whatever will be will 

be’’ and there is not much one can do about it, leading to less utilization of services; (5) some health care providers lack sensitivity to 

the cultural needs and concerns of Appalachian patients and are 

therefore incapable of establishing the necessary rapport with patients to be helpful. 

The following are recommendations for Effective Practice with 

Appalachian Veterans: (1) health care providers should consider 

doing the following: (a) learn about the local culture; (b) make 

themselves accessible; (c) provide flexible services; (d) build a personal relationship with patients first; and (e) involve patients in 

their own treatment plan. This will facilitate the development of a 

positive practitioner/patient partnership. (2) comprehensive public 

education programs are needed to help community members, social 

workers and clergy understand the signs and symptoms of diseases 

that veterans may be experiencing so they can conduct interventions to promote the utilization of health care services by veterans 

in the community with people they trust; (3) veterans and their 

families need to be apprised of all the services that they are entitled to as a veteran of the armed services; (4) health education is 

critical if we are to ensure that Appalachian veterans don’t base 

their health care decisions on inaccurate information they receive 

from family and friends, or wrongful interpretation of data they 

read on the Internet; (5) Browning and others suggest that practitioners: (a) help patients find the words to describe their condition; 

(b) be careful to assess the psychological aspects of physical complaints by patients; (c) connect with the patients’ feelings; (d) learn 

the local language for ‘‘nerve’’ conditions; and (e) be prepared to 

spend an adequate amount of time with patients to effectively listen, learn, and establish rapport with them. 

In conclusion, Appalachians value most their families and home 

place. They respect others and expect to be respected by others regardless of their station in life. They value the freedom to live their 

lives with limited outside or government interference. They take 

care of their own with minimal requests for outside assistance. 

However, in dire emergencies, when they have ventured out to seek 

assistance from government agencies, they have found these agencies to be disrespectful, overwrought with bureaucratic red tape, 

with stringent eligibility criteria that often left them with little or 

6 

no help. For those who received assistance, many feel they have 

had to pay too high a price for it, with their very self-worth and 

dignity sacrificed in the process. They have often encountered 

health care providers that have not treated them as a person, but 

rather as a case number, further alienating them from the health 

care system. 

For these reasons, many Appalachian veterans and their families 

never seek help; they do the best they can through self help. This 

is oftentimes not enough for those encountering depression, anxiety 

or post traumatic stress due to their previous combat experience. 

Thankfully this is not necessary. If we are to effectively help the 

Appalachian veterans and their families we will need to educate 

them and the public about the impact of the combat experience on 

these veterans. 

We will need to implement aggressive outreach programs informing veterans about the services that are available to them. We will 

need to treat them with dignity and create assistance that acknowledges them as people first, patients second. We will have to 

be vigilant in our advocacy for veterans when the system does not 

own up to its end of the bargain that veterans signed on for when 

they joined the military. If we do this Appalachians will do what 

they have always done. Their fighting spirit will rise again and 

they will take on these objectives and with the resilience that they 

are most famous for, they will put their lives back together in the 

place they call home, Appalachia. 

[The prepared statement of Mr. Greenlee follows:] 

PREPARED STATEMENT OF RICHARD W. GREENLEE, PH.D., ASSOCIATE PROFESSOR OF

SOCIAL WORK, DEAN, OHIO UNIVERSITY EASTERN CAMPUS

INTRODUCTION

As a veteran of the both the U.S. Army and the U.S. Air Force, where I served 

as a social work/psychology specialist in the Army and clinical social worker in the 

Air Force, I am honored to be asked to speak to you today about Appalachian culture and veterans. My family came to Belmont County, Ohio, in the early 1800’s. 

My roots in Appalachian Ohio run deep, and my commitment to the region is strong. 

Having grown up in a coal mining family, I vividly remember the challenges I faced 

in adapting to the military culture when I moved from Bethesda, Ohio, to Ft. Knox, 

Kentucky, to Ft. Sam Houston, Texas, to my permanent duty station at Walter Reed 

Army Medical Center in Washington, DC. I learned to co-exist simultaneously within two very unique and different worlds. This life experience, along with my education and training as a social worker, have shaped my current understanding that 

culture is all encompassing. There can be little doubt that my Appalachian cultural 

experience, has had a significant impact on how I perceive and respond to the world 

around me, as it does others who come from the region. 

DEFINITION OF CULTURE

Culture as defined by Bates and Plog (1990) ‘‘is a system of shared beliefs, values, 

customs, behaviors, and artifacts that the members of a society use to cope with 

their world and with one another, and are transmitted from generation to generation through learning.’’ It ‘‘is the lens through which all things are viewed and how 

it is interpreted,’’ (Briggs, Briggs, & Leary, 2005, p. 95). Subsequently, culture impacts all that we see and how we experience events in our lives. 

APPALACHIA DEFINED

According to the Appalachian Regional Commission (ARC), Appalachia is a region 

defined by Federal legislation that extends from Mississippi to New York, through 

13 states, 420 counties, 205,000 square miles with 24.8 million people. West Virginia is the only state completely encased in the Appalachian region. Thirty-two 

counties located in the southern and eastern sections of Ohio are considered to be 

7 

part of the Appalachian region. Appalachia is characterized by slow population 

growth and a greater proportion of the population being over the age of 65 than the 

rest of the Nation. According to the 2000 census data, Non-Hispanic Whites account 

for 88 percent of the Appalachian population (20.1 million people). Twelve percent 

of the population are minorities with 8 percent being Non-Hispanic Blacks (1.9 million people), 2 percent Hispanic (465,000 people) and 2 percent defined as Other 

Races (471,000 people) which may include: American Indians, Asians, Pacific Islanders and multiracial persons (Pollard, 2004). 

APPALACHIANS DEFINED

The term Appalachian can be ambiguous and difficult to define. As noted by Keefe 

(2005), the term Appalachian is largely one used by outsiders and scholars and not 

commonly adopted by members of the Appalachian communities in which they reside. However, Friedl, (1978, p.2) provides us with a working definition for our purposes. He states, ‘‘* * * any person who was born, or one of whose parents was 

born, in a county designated by the Federal Government as falling within the Appalachian region’’ can be defined as an Appalachian. 

LACK OF MINORITY STATUS

In general, the residents of Appalachia are not protected as a racial or ethnic minority and as previously noted, most Appalachians do not recognize the term Appalachian, nor do they see themselves as part of this group. Nevertheless, Appalachians do, in many ways, reflect the characteristics of a minority group as defined by 

De Hoyos, De Hoyos and Anderson (1986): 

Any group whose members have limited access to conditionally rewarding 

roles, and therefore, are typically deprived of such social rewards as money, 

respect, social status, security, recognition, challenges, new experiences, opportunities to grow and so forth. (p. 64) 

Throughout its history, Appalachia has faced chronically high rates of poverty, unemployment, substandard housing, low educational attainment and poor health 

care. These challenges continue to be concerns as is evident in the recent findings 

of an Appalachian Regional Commission report (2010) entitled, Socioeconomic Overview of Appalachia 2010: 

• 116 counties with a poverty rate 1.5 times the U.S. average 

• Lower college completion rate than U.S. at large (17.6% Appalachian to 24.4% 

U.S.) 

• Lower per capita market income than U.S. ($24,360 Appalachian to $32,930 

U.S.) 

• Two-thirds of Appalachian counties now have higher unemployment rates than 

the United States as a whole (276 of 420 counties) 

• More Appalachians have become discouraged workers and have given up 

searching for jobs 

• Between 2000 and 2007 Appalachia lost more than 35,000 jobs in farming, forestry and natural resources and another 424,000 jobs in manufacturing (22% loss) 

To make matters worse, the public is still prone to promoting a fictitious image 

of the dumb, ignorant hillbilly who never existed (Slone, 1978). Slone (1978) states: 

These lies and half-truths have done our children more damage than anything else. They have taken more from us than that large coal and gas companies did by cheating our forefathers out of their minerals, for that was 

just money. These writers have taken our pride and dignity and disgraced 

us in the eyes of the outside world. When our children go into the cities 

for work or are drafted into the army, they are forced to deny their heritage, change their way of talking, and pretend to be someone else, or be 

made to feel ashamed, when they really have something to be proud of.’’ 

(pp. xii & xiii) 

Not too long ago, CBS made plans to put on a proposed reality show to find the 

quintessential ‘‘Appalachian’’ family based on The Beverly Hillbillies and Abercrombie & Fitch sold t-shirts that said, ‘‘West Virginia, It’s All Relative.’’ (Biggers, 

2006, p. xiii) These kinds of culturally insensitive acts that promote stereotypes 

need to be confronted and instead, educational campaigns that promote the many 

achievements of Appalachian men and women need to be established. 

8 

APPALACHIAN CULTURAL TRAITS

In a review of the literature, Susan Keefe identifies a set of core Appalachian values that include: ‘‘egalitarianism, independence and individualism, personalism, 

familism, a religious world view, neighborliness, love of the land, and the avoidance 

of conflict’’ (Keefe, 2005, p. 10). 

Egalitarianism is the ‘‘belief that fundamentally one man or woman is as good as 

another or at least can be if he or she tries’’ (Maloney, 2005, p. 328). Subsequently, 

Appalachians judge a person by their actions and not the degrees or credentials they 

hold. 

Independence is a shared value among many Appalachians. They cherish their 

freedom. They tend to be antagonistic toward government regulation (Greenlee, 

1993). In a study of the working poor of Appalachian Ohio (Greenlee, 1991), the author of this paper asked the following question: ‘‘Who do you trust around here to 

help you?’’ One respondent stated: 

* * * family, close friends, but as far as the government I’d rather not 

deal with them if I don’t have to. (p. 70) 

Another said: 

I think the government has been the least helpful. As for the needs and 

where to go for help, I think it has been individuals. The church has been 

terrific*** but the government agencies just don’t come knockin’ on 

your door sayin’ look this is available to you. (p. 70) 

Fiene (2005) found that women in alcoholic homes ‘‘guard family secrets’’, are ‘‘reluctant to acknowledge family alcohol problems publicly,’’ avoid ‘‘reliance on coworkers for help,’’ and rely ‘‘mostly on independent self-help as a means of coping’’ 

(p. 243). I would argue that this is a common response for many Appalachians for 

personal and family concerns. 

Individualism is the strong belief in self-reliance and the expectation that one will 

take care of his or her own problems without the assistance of others and that dependency on others for any reason reflects negatively on a person. Subsequently, individuals tend to deny they have health problems until they are so severe they have 

to seek help and by the time they seek help it may be too late to effectively treat 

the disease. In addition, as noted above by Fiene (2005), Appalachians will read 

books, consult with friends, and surf the Internet in an attempt to self-diagnose and 

treat their own problems. This can create a whole other set of problems from misdiagnosis, to over-analysis of the side effects of medication to rationalize not using 

them, and to the creation of a self-argument to discontinue seeing a physician because ‘‘he doesn’t know what he is doing.’’ 

Personalism is based on personal relationships, not titles. Here, failure on the 

part of practitioners to establish a relationship with the patient first, by using rote 

questioning and maintaining rigid procedures held in place by bureaucratic red 

tape, may lead the patient to feeling like a number and ultimately to patient alienation. Appalachians will tend to reject these providers and their services when they 

perceive that they are not being treated as an individual. 

Familism is a core value in Appalachia. Family is the primary source of support 

in times of difficulty and the reason why many will not leave the region in times 

of high unemployment and limited opportunities. They overwhelmingly prefer to 

stay with family and stick it out until times improve. 

In times of difficulty, the most common support for Appalachians is their family 

and friends. The second most highly regarded source of support is the church. In 

a study conducted by the author of this paper, ‘‘governmental services were the most 

talked about, the least used, and the most negatively viewed of all three support 

systems’’ (Greenlee and Lantz, 1993). 

Many Appalachians have a religious world view. They are distrustful of government agencies and services, but they trust in the church-based social services. Even 

when poverty-stricken, the church provides them with a sense of identity and selfworth. The church gives them opportunities to demonstrate their competence 

through volunteerism and provides them with a source of emotional and financial 

support. This informal network also provides them with a host of support services 

such as food, small loans, transportation and personal assistance in emergencies 

(Greenlee, 1993). 

The concept of neighborliness may be an asset that could be utilized by health 

care practitioners. These practitioners could arrange for family, friends or other 

community members who are driven culturally to help their neighbors and who 

have had positive experiences with the health care system, to share their experiVerDate Nov 24 2008 17:27 Mar 29, 2011 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6621 H:\ACTIVE\040510.TXT SVETS PsN: PAULIN
9 

ences and provide emotional support to Appalachian veterans who may be considering treatment options. 

Love of land and place are key ingredients in the character of Appalachians. It 

is important for them to own land and to look after it. This connection with the land 

provides them with a sense of meaning, safety and security that may go back several generations on the old home place. Loss of a home place can be very detrimental to the Appalachians sense of self and identity and promote disorientation. 

Appalachians often seek to avoid conflict at all cost. This can create problems 

when health care practitioners try to impose their will on clients by strongly encouraging them to adhere to certain aspects of a treatment plan without true agreement 

on the part of clients. Appalachian clients will often nod their heads in seeming 

agreement and approval of the suggestions, when they really do not agree and do 

not intend to follow through on the recommended treatment. 

In a qualitative study of a group of women in Appalachia who had been diagnosed 

with depression (Browning, Andrews and Niemczura, 2000), the researchers discovered that fatalism and the stigma of a mental health diagnosis caused these women 

to delay seeking treatment for their depression. Browning, et al. (2000) found that 

the women were afraid to tell others about their symptoms for fear of being made 

fun of or not being taken seriously. This resulted in an isolation that at some point 

results in a ‘‘paralytic crisis,’’ and a critical juncture in which they would finally 

seek professional help for their depression. These women reported that their husbands never asked what was going on and they never told them. Participants in the 

study ‘‘felt an overwhelming need for health care providers to understand the nature 

of their depression’’ (Browning, et al., 2000, p. 30). Many of them presented their 

problems as physical problems that are culturally more acceptable or referred to 

their depression as ‘‘nerves.’’ In addition, the researchers found that it was vitally 

important for medical practitioners to take time to listen to what the patient was 

really saying so they could accurately diagnose the depression and prescribe the appropriate treatment. 

VETERANS ATTITUDES TOWARD SOCIAL SERVICES

Military veterans have been found to be less likely than the general population 

to seek mental health services due to perceived stigma (Hoge, Castro, Messer, 

McGurk, Cotting, & Koffman, (2004). Combine this with the Appalachians resistance to seeking mental health treatment or help of any kind (Behringer and 

Friedell, 2006), and the combination of the two cultures, one military, the other regional affiliation, and it is highly unlikely that Appalachian veterans will voluntarily seek help for depression, anxiety or Post Traumatic Stress Disorder that they 

may be experiencing upon returning home from the service. These attitudes will require comprehensive education and outreach efforts to help them upon leaving the 

military. 

STRENGTHS OF APPALACHIAN VETERANS

Many of the Appalachian veteran’s cultural values can be positive attributes and 

curative factors if an astute health care provider can marshal them as resources. 

If the practitioner treats the individual with dignity and respect (egalitarianism) 

there is hope that a therapeutic relationship can be established where mutual respect can lead to effective implementation and follow through with a treatment regimen. 

If the practitioner can tap into the strength of the individual who needs to be 

treated like a person and not a number and empower them to make their own decisions about their diagnosis and treatment decisions, then their resistance to becoming dependent on others can be a good thing for long term efficacy of interventions. 

If the health care workers utilize the church pastor and friends who patients respect in the community, they are more apt to listen to their advice and utilize the 

support services that they provide due to the greater degree of trust they have in 

these organizations and people. 

It is important to recognize the safety, security and identity that come with Appalachian individuals being able to stay in their own homes, on their own land and 

in their own communities. Whenever possible, services need to be provided as close 

to home as possible to increase the likelihood that patients will follow though with 

these support services, not to mention their ability to find transportation to make 

appointments located long distances from their homes. 

Finally, it is important that medical providers listen to clients describe in their 

own words what they believe the problems are and how they can best be assisted. 

They need to listen to concerns about ‘‘nerves’’ and the need for ‘‘nerve pills.’’ They 

need to tune into the underlying message that may come with a myriad of physical 

10 

complaints that may actually be psychologically based stress disorders. If they do 

not listen, they will not hear, or they may not even be told, what is really going 

on in that patient’s life and subsequently, prescribe the wrong treatment for the 

wrong problem. 

Historically, the residents of Appalachia have faced chronic and severe poverty, 

substandard housing, inadequate schools, and poor health care for many generations. Despite these many challenges, they have survived and in some situations 

flourished. Resilience is a major component of their constitution. The ability to get 

knocked down on many occasions, get back up, take care of their families and themselves with limited outside help is commendable. Their environment has often required them to learn how to make do, make it last and do without (Greenlee, 1993). 

They don’t ask for much from others. They rarely ask for help, but when they do 

ask, they ask that they be listened to in a respectful manner, so that their voices 

can be heard, and they can have some influence over their own lives and health 

care. 

BARRIERS TO PROVIDING SERVICES TO APPALACHIAN VETERANS

The following are cultural barriers to effective utilization of health care services 

in the region, even when they are available, as identified by Behringer, Friedell, 

Dorgan, Hutson, Naney, Phillips, Krishman and Cantrell, 2007: 

• There is a general sense of distrust of health care professionals and a ‘‘fear of 

being taken advantage of by ‘the system’ ’’, (Behringer and Friedell, 2006, p. 3). • Appalachians often fail to assert themselves in seeking health care. This also 

promotes poor patient/provider communication and goal setting. • The cultural need for privacy and pride often leads to low health care utilization 

and poor follow-up with referrals. • For many rural Appalachians access to health care is limited due to limited income, insurance and access to reliable transportation. • Availability of health care services locally may be limited. • There continues to be a general sense of fatalism that ‘‘whatever will be will 

be’’ and there is not much one can do about it, leading to less utilization of services. • Some health care providers lack sensitivity to the cultural needs and concerns 

of Appalachian patients and are therefore incapable of establishing the necessary 

rapport with patients to be helpful. This is compounded by insider/outsider dynamics (McDonald), where providers will always be considered outsiders if they were not 

born and raised in the community, even after many years of residency. These outsiders (often health care practitioners) are often seen as temporary residents who 

are not really committed to the community and are not to be trusted. However, even 

though it may be more difficult for outsiders, once trust is established over time 

with members of the community, it is long lasting regardless of one’s insider/outsider status. 

RECOMMENDATIONS FOR EFFECTIVE PRACTICE WITH APPALACHIAN VETERANS

1. Health care providers should consider doing the following: a) learn about the 

local culture; b) make themselves accessible; c) provide flexible services; d) build a 

personal relationship with patients first; and e) involve the patients in their own 

treatment planning. This will facilitate the development of a positive practitionerpatient partnership. If health care providers are to be effective in working with veterans living in the Appalachian region it is critical that they become culturally competent and adept at communicating with Appalachian veterans in such a way that 

they are able to establish rapport. 

2. Comprehensive public education programs are needed to help community members, social workers and clergy understand the signs and symptoms of diseases that 

veterans may be experiencing, so they can conduct interventions to promote the utilization of health care services by veterans in the community. 

3. Prevention, education and outreach services by agencies that are respected in 

the community must be employed to increase utilization of health care services. 

4. Veterans and their families need to be apprised of all the services that they 

are entitled to as a veteran of the armed services. Aggressive outreach campaigns 

will be necessary and the establishment of a rural public transportation system to 

improve access to services. 

5. Key gatekeepers in the community must be educated about the mental health 

and health care needs of veterans and the services available to them. Sponsors, preferably veterans, need to be identified who can vouch for the effectiveness of treatment. Receiving help from people they know and trust is the most effective way for 

Appalachian veterans to overcome the fatalistic attitude of ‘‘it won’t make any difference what I do.’’ 

11 

6. Health education is critical if we are to ensure that Appalachian veterans don’t 

base their health care decisions on inaccurate information they receive from family 

and friends, or wrongful interpretation of data they read on the Internet. 

7. Browning, Andrews, and Niemczura (2000) suggest that practitioners: a) help 

patients find the words to describe their condition; b) be careful to assess the psychological aspects of physical complaints by patients; c) connect with the patients’ 

feelings; d) learn the local language for ‘‘nerve’’ conditions; and e) be prepared to 

spend an adequate amount of time with patients to effectively listen, learn and establish rapport with them. 

CONCLUSION

Appalachians value most their families and home place. They respect others and 

expect to be respected by others regardless of their station in life. They value the 

freedom to live their lives with limited outside or government interference. They 

take care of their own with minimal requests for outside assistance. However, in 

dire emergencies, when they have ventured out to seek assistance from government 

agencies, they have found these agencies to be disrespectful, over wrought with bureaucratic red tape, with stringent eligibility criteria that often left them with little 

or no help. For those who received assistance, many feel they have had to pay too 

high a price for it, with their very self-worth and dignity sacrificed in the process. 

They have often encountered health care providers that have not treated them as 

a person, but rather as a case number, further alienating them from the health care 

system. For these reasons, many Appalachian veterans and their families never 

seek help, and do the best they can through self-help. This is often times not enough 

for the veteran who is encountering depression, anxiety or post-traumatic stress due 

to their previous combat experience. 

Thankfully, this is not necessary. If we are to effectively help the Appalachian 

veterans and their families, we will need to educate them and the public about the 

impact of the combat experience on these veterans. We will need to implement aggressive outreach programs informing veterans about the services that are available 

to them. We will need to treat them with dignity and create a system that acknowledges them as people first, and patients second. And we will have to be vigilant in 

our advocacy for veterans, when the system does not own up to its end of the bargain, that veterans signed on for when they joined the military. 

If we do this, Appalachians will do as they have always done. Their fighting spirit 

will rise again, and they will take on these challenges, and with the resilience that 

they are most famous for, they will put their lives back together, in the place they 

call home... Appalachia. 

References 

Appalachian Regional Commission (2010). Socioeconomic Overview of Appalachia 

2010. Washington, DC: Appalachian Regional Commission. 

Bates, D.G. & Plog, F. (1990). Cultural anthropology. New York, NY: McGraw-Hill. 

Bauer, W.M. & Growick, B. (July/August/September 2003). Rehabilitation counseling 

in Appalachian America. Journal of Rehabilitation, 69, 18–24. 

Behringer, B. and Friedell, G. (October 2006). Appalachia: Where place matters in 

health. Preventing Chronic Disease: Public Health Research, Practice, and Policy, 3, 1–4. 

Behringer, B., Friedell, G., Dorgan, K., Hutson, S., Naney, C., Phillips, A., Krishnan, 

K., and Cantrell, E. (2007). Understanding the challenges of reducing cancer 

in Appalachia: Addressing a place-based health disparity population. Californian Journal of Health Promotion, 5, 40–49. 

Biggers, J. (2006). The United States of Appalachia. Emeryville, CA: Shoemaker & 

Hoard. 

Briggs, H.E., Briggs, A.D., & Leary, J.D. (2005). Promoting culturally competent 

systems of care through statewide family advocacy networks. Best Practices 

in Mental Health, 1, 77–99. 

Browning, D., Andrews, C. and Niemczura, C. (May 2000). Cultural influences on 

careseeking by depressed women in rural Appalachia. The American Journal 

for Nurse Practitioners, 22–32. 

De Hoyos, G., De Hoyos, A., & Anderson, C. (January-February 1986). Sociocultural 

dislocation: Beyond The Dual Perspective. Social Work, 61–67. 

Friedl, J. (1978). Health care services and the Appalachian migrant. Columbus, OH: 

Ohio State University. 

12 

Greenlee, R.W. (1993). Religion, faith, and the poor Appalachian family: An eco-existential perspective. Social Work and Christianity: An International Journal, 

20, 8–25. 

Greenlee, R.W. & Lantz, J.E. (April 1993). Family coping strategies and the rural 

Appalachian Poor, Contemporary Family Therapy, 15, 121–137. 

Greenlee, R.W. (1991). And yet they are poor: A naturalistic study of rural poverty 

and the working poor people of Appalachian Ohio. The Ohio State University, 

Columbus, OH. 

Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., and Koffman, R.L. 

(September 1, 2004). New England Journal of Medicine, 351, 13–22. 

Howell, B.J. & Fiene, J.I. (2005). Designing employee assistance programs for Appalachian working-class women: The alcohol and stress research project. In S. 

Keefe (Ed.), Appalachian cultural competency (pp. 247–264). Knoxville: The 

University of Tennessee. 

Keefe, S. (2005). Appalachian cultural competency: A guide for medical, mental 

health, and social service professionals. Knoxville, TN: The University of Tennessee Press. 

Maloney, M. E. (2005). Evaluating a rite of passage program for adolescent Appalachian males. In S. Keefe (Ed.), Appalachian cultural competency (pp. 315– 

334). Knoxville: The University of Tennessee. 

McDonald, F. (Summer 1990). A case study of insider-outsider dynamics in rural 

community development. Human Services in the Rural Environment, 14, 15– 

20. 

Pollard, K. M. (September 2004). A ‘‘New Diversity’’: Race and Ethnicity in the Appalachian Region. Washington, DC: Population Reference Bureau. 

Slone, V.M. (1979). What my heart wants to tell. Lexington, KY: The University of 

Kentucky Press. 

Senator BROWN. Thank you, Dr. Greenlee. Ms. Maupin. 

STATEMENT OF LUCINDA J. MAUPIN, EXECUTIVE DIRECTOR, 

BELMONT COUNTY VETERANS OFFICE 

Ms. MAUPIN. In the almost 9 years of working with the veterans 

in this area I have found that one of the biggest complaints from 

our veterans is access to health care. Our veterans are part of 

VISN 4 and use the VAMC in Pittsburgh, PA, which is 60 miles 

away and approximately 100 miles, in some cases more, for veterans living at the opposite end of the county. 

Our office provides transportation for veterans using the DAV 

transportation program. We have two vans that go up daily. We go 

Monday through Friday and we pay two full-time drivers from our 

county funds. When a veteran is scheduled for a compensation or 

pension exam they may have to go to Columbus or Mount Vernon, 

OH, which, there again, is about 120 miles from Belmont County. 

We provide transportation for those trips using our office van. Each 

trip means paying a part-time backup driver to drive the van. Even 

with the three vans that we have available, it does not seem to be 

enough. Our vans are full almost every day and there are times 

when we do not have the county van available to take a veteran 

to his or her compensation and pension exam. 

For an example, this Wednesday we had to deny transportation 

to a veteran to Mount Vernon. Our county van will not be available. I had a call from the St. Clairsville outpatient clinic on 

April 1 asking if we could provide a veteran who did not have 

transportation to the VA Primary Care Clinic or to the pickup 

point to go to Pittsburgh. Unfortunately we cannot do that due to 

the cost of another driver. The veteran who the clinic was calling 

about was tracked down by the clinic after calling the VA’s suicide 

hotline. This veteran could have died because the care he needed 

was not available. 

13 

Veterans in our area do not have access to emergency care. If a 

veteran visits a local emergency room he or she is charged for the 

visit unless the VA decided the visit was life threatening. When 

transportation is not available, a veteran may have no other option 

but to go to a local emergency room. Our county vans transport 

Monday through Friday. The first van leaves at 6 a.m. to Pittsburgh and comes back at noon. We have a van that leaves Belmont 

County at 10 a.m. to Pittsburgh and leaves Pittsburgh when the 

last veteran is finished. We do not cover the weekends or holidays 

or any nighttime transportation. With additional funds for drivers, 

we have the vans available, we could make a difference. 

Another problem we have in our area is that a lot of veterans 

and family members do not know we are here for them. We have 

put advertisements in the local papers and set up tables at the 

county fair and other events held throughout the county but we 

still do not reach everybody. Outreach can make a big difference 

to a veteran or his or her widow. I had a veteran from Powhatan 

Point, which is around 30 miles from our office, tell me I actually 

saved his life. He had lost his family in the floods in Shadyside on 

June 14 of ’92. Shortly afterwards lost his job and eventually he 

was planning on taking his own life. Someone had told him that 

our office would pay utility bills for him and he wanted to put his 

affairs in order before he killed himself. So he came to the Powhatan City Building where I have a satellite office open each week 

and I told him about VA Pension. He decided to apply and within 

3 weeks he had his claim approved, and he credits our office for 

saving him. I feel that if we had additional funds to advertise or 

to set up more satellite offices we could reach more veterans and 

possibly change more lives. 

Widows or widowers are a forgotten group who are, in some 

cases, worse off than the veteran when it comes to knowing who 

to look for when they need help. A veteran can usually find information from other veterans or service organizations. A widow or 

widower may not have anyone they can turn to to get information 

on benefits. I have recommended to some of the service organizations to advise their members to pre-plan for their death so that 

their spouses know exactly what paperwork is needed and what he 

or she will be entitled to upon his or her death. We need to seek 

out our elderly widows and widowers and our veterans who can no 

longer make it to our office to make sure they get the benefits they 

are entitled to. In order to do this we need additional funds. We 

would need funding to provide a service officer for additional satellite offices and transportation. 

Another problem facing Appalachia is the number of lost jobs in 

our area. So many of our veterans have been laid off from the steel 

mills and coal mines and other companies that have been affected 

by our economy. They do not have the education needed to find 

other gainful employment to compete with younger people who 

have an advantage over someone who may not have the training 

in computers or modern technology. Our older veterans who have 

lost their jobs have let their GI Bill or VEAP benefits expire. If 

they wanted to go to college they would be faced with having to 

take out student loans and after graduation they would have to 

start over with a large debt to repay. A veteran would be more likeVerDate Nov 24 2008 17:27 Mar 29, 2011 Jkt 000000 PO 00000 Frm 00017 Fmt 6633 Sfmt 6601 H:\ACTIVE\040510.TXT SVETS PsN: PAULIN
14 

ly to return to school if funds were available to help pay for his or 

her education. 

I feel that the county veterans offices are the link between the 

VA and the veteran. We need additional funding to develop and 

make our programs a success. Our office not only works with the 

veterans of Belmont County, we also help the veterans who come 

to us from West Virginia. We see the need for more transportation, 

easier access to health care, more service officers, and better education benefits every day. Rather than be bound to a county or 

State border, it would be great to be able to assist all veterans of 

our region. Thank you. 

[The prepared statement of Ms. Maupin follows:] 

PREPARED STATEMENT OF LUCINDA J. MAUPIN, EXECUTIVE DIRECTOR, 

BELMONT COUNTY VETERANS OFFICE

My name is Lucinda J. Maupin, I have been a lifelong resident of Belmont County, Ohio and I am a veteran of the United States Army serving on active duty from 

November 1981 to June 1989. In July 2001 I was hired as an administrative assistant to the Belmont County Veterans Service Officer. In January 2003 I became the 

Executive Director of the Belmont County Veterans Office. I am also a life member 

of the Veterans of Foreign Wars, a member of the American Legion, AMVETS, and 

an accredited County Veterans Service Officer with the Ohio State Association of 

County Veterans Service Officers and the National Association of County Veterans 

Service Officers. 

In the almost nine years of working with the veterans in this area I have found 

that one of the biggest complaints from our veterans is access to health care. Our 

veterans are part of VISN 4 and use the VAMC in Pittsburgh, Pennsylvania which 

is sixty miles away from our office and up to approximately one hundred miles for 

veterans living at the opposite end of the county. Our office provides transportation 

for veteran using the DAV transportation program. We have two vans that provide 

transportation to Pittsburgh Monday through Friday and we pay two full time drivers from our county funds. When a veteran is scheduled for a compensation or pension (C&P) examination they might have to go to Columbus or Mount Vernon, Ohio 

and we provide transportation for those trips using our office van. Each trip means 

paying a part time back up driver to drive the van. Even with the three vans that 

we have available it does not seem to be enough. Our vans are full almost every 

day and there are times when we do not have the county van available to take a 

veteran to his/her C&P exam. This Wednesday, April 7, 2010, I had to deny a veteran transportation to Mount Vernon, Knox Community Hospital because our county van will not be available. I had a call from the St. Clairsville outpatient clinic 

on April 1, 2010, asking if we could provide veterans who did not have transportation to the VA Primary Care Clinic or to the pickup points for the vans to Pittsburgh and unfortunately we cannot do that due to the cost of another driver. The 

veteran who the clinic was calling about was tracked down by the clinic after calling 

the VA’s suicide hotline. This veteran could have died because the care he needed 

was not available. 

Veterans in our area do not have access to emergency care. If a veteran visits a 

local emergency room he/she is charged for the visit unless the VA decides the visit 

was life threatening, when transportation is not available a veteran may have no 

other option but to go to a local emergency room. Our county vans transport Monday 

through Friday the first van leaves at 6:00 a.m. to Pittsburgh and leaves to come 

back to Belmont County at 12:00 p.m. We have a van that leaves Belmont County 

at 10:00 a.m. to Pittsburgh and leaves Pittsburgh when the last veteran is finished. 

We do not cover the weekends or holidays or any night time transportation. With 

additional funds for drivers (we have the vans) we could make a big difference. 

Another problem we have in our area is that a lot of veterans and family members do not know we are here for them. We have put advertisements in the local 

papers and set up tables at the county fair and other events held throughout the 

county but we still do not reach everybody. Outreach can make a big difference to 

a veteran or his/her widow. I had a veteran from Powhatan Point tell me that I 

saved his life. He had lost his family in the floods in Shadyside, Ohio on June 14, 

1992, shortly afterwards he lost his job and eventually he was planning on taking 

his own life. Someone had told him that our office would pay utility bills for him 

and he wanted to put his affairs in order before he killed himself so he came to the 

15 

Powhatan City Building where I have a satellite office open each week and I told 

him about VA Pension. He decided to apply and within three weeks (that was the 

only time I have ever had a claim approved in three weeks) he was approved and 

he credits our office for saving him. I feel that if we had additional funds to advertise or to set up more satellite offices we could reach more veterans and possibly 

change more lives. 

Widows or widowers are a forgotten group who are, in some cases, worse off than 

the veteran when it comes to knowing who to look for when they need help. A veteran can usually find information from other veterans or service organizations. A 

widow or widower may not have anyone they can turn to, to get information on benefits. I have recommended to some of the service organizations to advise their members to pre plan for their death benefits so their spouses know exactly what paperwork is needed and what he/she will be entitled to upon his/her death. We need to 

seek out our elderly widows/widowers and our veterans who can no longer make it 

to our office and make sure they get the benefits they are entitled to and in order 

to do this we need additional funds. We would need funding to provide a service 

officer for additional satellite offices and transportation. 

Another problem facing Appalachia is the number of lost jobs in our area. So 

many of our veterans have been laid off from the steel mills and coal mines and 

other companies that have been affected by our economy and they do not have the 

education needed to find other gainful employment and compete with younger people who have an advantage over someone who may not have the training in computers or modern technology. Our older veterans who have lost their jobs have let 

their GI Bill or VEAP benefits expire and if they wanted to go to college they would 

be faced with having to take out student loans and after graduating they would 

have to start over with a large debt to repay. A veteran would be more likely to 

return to school if funds were available to help pay for his/her education. 

I feel the county veterans offices are the link between the VA and the veteran. 

We need additional funding to develop and make our programs a success. Our office 

not only works with the veterans of Belmont County but we also help the veterans 

who come to us from West Virginia and we see the need for more transportation, 

easier access to health care, more service officers, and better education benefits 

every day, and rather than be bound to a county or state border it would be great 

to be able to assist all veterans of our region. 

Thank you. 

Senator BROWN. Thank you, Ms. Maupin. 

Ms. Neutzling. 

STATEMENT OF ANDREA MICHELE NEUTZLING, VETERAN, U.S. 

ARMY SPECIALIST, MILITARY INTELLIGENCE ANALYST 

Ms. NEUTZLING. I live with my father so I have someone to help 

care for my daughter while I’m in school. In December 2007 my father applied for the HEAP program to help with our heating costs 

for the wintertime. He was denied benefits for the HEAP program 

because of the fact where I was living with him and I had made 

too much the previous year. When they had called to inform us 

that we were denied, I was the one who answered the phone, and 

I asked them why. They said because I had made too much. I 

asked them—I explained to them—I go, ‘‘Well, I was in Iraq. I was 

in the war zone the entire year.’’ And she goes, ‘‘Well, I’m sorry, 

ma’am, but you just made too much.’’ So, OK, in other words, 

you’re punishing us because I was in the war. I’m a veteran, so 

you’re punishing us, ‘‘You made too much.’’ 

From January 2008 to March 2009 I was attending Ohio University. I took a break from school and started back up at Rio Grande, 

the University of Rio Grande, this past January. Before I started 

my classes I spoke with my VA Education Rep and he informed me 

that I should put in for the Post-9/11 GI Bill since I would be 

granted 100 percent benefits. I applied was accepted for the Post9/11 program. Then, when I started receiving my monthly benefits 

16 

I found out I was actually getting less from the Post-9/11 than I 

was getting from the Montgomery GI Bill. 

In order for me to go back to the original GI Bill I would have 

to file an appeal with the VA and then they can decide whether or 

not to let me go back to the Montgomery GI Bill. I feel that there 

should have been some way for me to find out which I would have 

gotten more benefits from before I formally switched from one program to the other. 

A lot of my issues lay within the VA itself. In order for me to 

receive my care, I have to travel to the Chillicothe VA medical center, which is 2 hours away from me. Yes, there is an outpatient 

clinic in Athens, which is a 30-minute drive, but most of my issues 

cannot be handled at the outpatient clinic, along with some of the 

veterans from my county cannot who afford to the make drive to 

Chillicothe. We can go to the VSO and get a drive to the clinic as 

long as we notify them a week in advance. I am forgetful for medical reasons and so I do not usually remember about my appointment until the day before when the VA calls me to remind me of 

my appointment the next day. If there would be some way to get 

more VA outpatient clinics and have the VA send us to a local doctor or hospital it would be a lot easier for veterans in my area to 

get their health care taken care of. 

My shoulder injury has never fully recovered. I’ve had one surgery on it while I was in New Jersey on medical hold orders. I get 

prescribed Flexeril from the VA as a muscle relaxer, but it does not 

do me any good for I have developed a high tolerance to it while 

I was in Iraq. Most other muscle relaxers can make a person’s 

blood pressure drop. I already suffer from low blood pressure. It’s 

even documented in my medical records. The VA will not cover 

Metaflaxin, which is the only muscle relaxer that I’ve found that 

does not affect my blood pressure. Because it is not formulary, they 

will not cover it. The VA rated me zero percent for my shoulder 

saying I had no loss of range of motion, which I have. I’m currently 

seeing a civilian orthopedic doctor so I can submit paperwork for 

a reevaluation for my shoulder injury. 

I couldn’t be rated for PTSD because the VA couldn’t gather sufficient support. When I went to file for it, they wanted me to recount everything. At that time I wasn’t ready to discuss, let alone 

write down all my accounts of being raped, having a British soldier 

die in my arms, and seeing what happened after detainees would 

beat the life out of each other. The few times I went to Mental 

Health. I had one doctor ask me, since I had all these problems 

with the military, why I wanted to stay in. I told him it wasn’t the 

military I had problems with, it was some of the people in the 

military. 

The VA will not determine if I even had a mild TBI. When I injured my shoulder I blacked out, I’m not sure for how long, I just 

know that ever since then my moods change drastically. If it’s not 

military related I tend to forget things I just learned earlier in the 

week. This makes it even harder for me at school. 

Before I was sent to Iraq I was attending Hocking College in 

Nelsonville, OH, taking police science classes. I was working on becoming a police officer. But when I injured my shoulder, I could no 

longer do sit-ups and push-ups. Those two things are mandatory 

17 

for becoming an officer in the State of Ohio. I was using my GI Bill 

for this. I lost $5,000 of my GI Bill because I couldn’t continue. 

I tried to get into the VEAP program. I had to go to Columbus 

and take numerous skills tests, and then they said I would have 

to talk to people in my potential job field and ask them questions 

about things like what the benefits are, the pay and duties. I plan 

on going into a government job once I get my Bachelors degree. I 

know I can’t just go up to one of those types of agencies asking 

questions, so I was denied that benefit. I’ll run out of my GI Bill 

benefits before I get my degree. But many younger veterans will 

probably be facing that problem also because the GI Bill was designed when school cost roughly $50,000 for 4 years of education. 

The VA in Chillicothe has designated a specific team for some 

vets, but unlike Columbus VA there are men in the area. Chillicothe doesn’t have a permanent mental health doctor that is a 

woman. This makes it harder for any female vet with a military 

sexual trauma to go in and talk to them. 

Ever since I was in Iraq I’ve had problems with my lungs. I 

worked downwind from the burn pits on my camp, but the VA is 

mostly concentrating on the Balad burn pits. Camp Bucca’s burn 

pit is directly upwind from the internment facility, for the first 9 

months I was over there. I had even contracted pneumonia within 

those first 9 months. Now anytime I develop an upper respiratory 

infection I have to go and get a shot of antibiotics and oral antibiotics to take to prevent it from developing into pneumonia. But 

since I cannot prove I was downwind from the pit, I can’t claim it 

with the VA. 

I am the granddaughter of a Korean War veteran. My grandfather was very disillusioned by the VA. I do not want to be disillusioned by the VA. The VA has been specifically related to the oldfashioned combat where there is a line in combat, there’s lines 

drawn. This is where the VA is. They have not advanced their 

properties and their thinking into the type of combat situations 

veterans are facing in this day and age. 

[The prepared statement of Ms. Neutzling follows:] 

PREPARED STATEMENT OF ANDREA MICHELE NEUTZLING, VETERAN, U.S. ARMY

SPECIALIST, MILITARY INTELLIGENCE ANALYST

In December 2007, my father applied for HEAP, I live with him so I have someone 

to take care of my daughter while I am in school, and he was denied HEAP benefits 

because I made too much the year before. From June 2005 to August 2005 I was 

in New Jersey preparing to deploy. August 2005 until August 2006 I was stationed 

at Camp Bucca, Iraq. Upon returning I was kept at Fort Dix, New Jersey, to get 

my shoulder injury taken care of. I was released from active duty June 2007. The 

HEAP office called and spoke directly to me to inform us that we would not be 

receiving HEAP benefits. When I was told why, I got upset and even asked why 

it seemed that we were being punished pretty much because I served in a war. They 

said that wasn’t the reason at all, it was because I made too much the year before, 

I replied with I was in Iraq and then being treated for an injury that year. All she 

could say was I’m sorry you feel that way ma’am. 

From January 2008 into March 2009 I was attending Ohio University on the 

MGIB. I took a break from school from April 2009 until just this past January; I 

attend the University of Rio Grande. Before I began classes this year I talked to 

the VA Education rep at my school, was informed that I would probably get more 

money from the Post-9/11 GI Bill than I got from the MGIB. I did the paper work 

to switch over. When I began school and started getting my monthly payment I 

found I went to getting less a month under the new GI Bill. There should have been 

18 

a way to find out how much under both I would have gotten before I switched, so 

I could go with the better one. 

My county’s Veterans Service Officer has told me about numerous programs available to me as a veteran; including the Military Injury Relief Fund. I haven’t tried 

for anything other than the HEAP, Medical Card, and Food Assistance. 

Most of my issues lay within the VA itself. In order for me to receive my care, 

I have to travel to Chillicothe VA, which is a 2 hour drive for me; yes there is an 

outpatient clinic in Athens, a 30 minute drive away. Some of the Veterans in my 

county can’t afford to make the drive to Chillicothe. Yes we can get a ride to there 

through the county VSO, but we have to give them at least a week notice. I’m bit 

forgetful so I don’t remember about my appointment until the day before when the 

VA would call me. If we could get some more VA outpatient clinics, or even have 

the VA send us to a local doctor instead. Even for things like orthopedics and certain surgeries we have to travel to places like Columbus or Huntington, when there 

are places like Holzer and Pleasant Valley Hospitals closer for us. 

My shoulder injury has never fully recovered; I’ve had one surgery on it while I 

was in New Jersey on Medical Hold orders. I get prescribed Flexeril as a muscle 

relaxer, but it doesn’t do any good for me. I developed very high tolerance to it while 

I was in Iraq. Most other muscle relaxers can make a person’s blood pressure drop. 

I already suffer from Low Blood Pressure, it’s even documented into my medical 

records, and the only other muscle relaxer I’ve found to work for me and not mess 

up my BP is Metaflaxin a.k.a. Skelaxin. But I can’t get it from VA because it’s not 

Formulary. It doesn’t help that the VA rated me 0% for my shoulder, saying I had 

no loss of my range of motion, which I have. I’m currently seeing a civilian orthopedic doctor, so I can submit paperwork for a reevaluation. 

I couldn’t be rated for PTSD because the VA couldn’t gather sufficient support. 

When I went to file for it, they wanted me to recount everything. At that time I 

wasn’t ready to discuss, let alone write down my accounts of being raped, having 

a British soldier die in my arms, and seeing what happened after detainees would 

beat the life out of each other. The few times I went to Mental Health, I had one 

doctor ask me if I had all these problems with the military why I wanted to stay 

in. I told him, it wasn’t the military I had problems with; it was some of the people. 

The VA won’t determine if I even have a Mild TBI. When I injured my shoulder 

I blacked out; I’m not sure for how long unfortunately. I just know that ever since 

then my moods change drastically, and if it’s not military related I tend to forget 

things I just learned earlier in the week. This makes it even harder for me at 

school. 

Before I was sent to Iraq I was attending Hocking College in Nelsonville Ohio, 

taking police science classes. I was working on becoming a police officer. But when 

I injured my shoulder, I could no longer do sit-ups and then my push-ups became 

a problem also. Those two things are mandatory for becoming an officer in the state 

of Ohio. I was using my GI Bill for this. I lost $5000 of my GI Bill, because I 

couldn’t continue. I tried to get into the VEAP program. I had to go to Columbus 

and take numerous skills test, and then they said I would have to talk to people 

in my potential job field and ask them questions about things like what the benefits 

are, the pay, and duties. I plan on going into a government job once I get my Bachelors degree; I know I can’t just go up to one of those types of agency asking questions. So I was denied that benefit. I’ll run out of my GI Bill benefits before I get 

my degree. But many younger veterans will be facing that problem anyway, because 

the GI Bill was designed when school cost $50,000 for 4 years of an education. 

The VA in Chillicothe has designated a specific team for women vets, but unlike 

Columbus VA there are men in the area. Chillicothe doesn’t have a permanent Mental Health doctor that is a woman. This makes it harder for any female vet with 

a Military Sexual Trauma (MST) to go in and talk to them. 

Ever since I was in Iraq I’ve had problems with my lungs. I worked downwind 

from the burn pits on my camp. But the VA is mostly concentrating on the Balad 

burn pits. Camp Bucca had a burn pit directly upwind from the Internment facility, 

for the first 9 months I was over there. I had even contracted pneumonia within 

those first 9 months. Now anytime I develop an upper respiratory infection, I have 

to go and get a shot of antibiotics and oral antibiotics to take, to prevent it from 

developing into pneumonia. But since I can’t prove I was downwind from the bit I 

can’t claim it to the VA. 

I grew up looking forward to serve my country from the time I was about 8 years 

old. I’m the Granddaughter of a Korean War vet, and I don’t want to be disillusioned by the VA like my grandfather is. I expect the US Government to take care 

of all veterans no matter what generation they are in. My daughter, who is almost 

seven, plans on going into the military, either Air Force or Army; she hasn’t decided. I hope that the VA will be more adequately prepared for that time than they 

19 

are now. The VA seems to be stuck in thinking about how we fought wars in WWII, 

instead of advancing in preparing for the way the world changes and how wars are 

fought change with the times also. 

Senator BROWN. Thank you, Ms. Neutzling. Thank you all. I 

would ask that the second panel address the concerns of Ms. 

Neutzling and Ms. Maupin, specifically. I also would appreciate Dr. 

Greenlee addressing these issues raised. Some are about funding 

and some are more fundamental, so give us your thoughts about 

some of these issues. I’ll start with Ms. Neutzling. Does the Montgomery GI Bill provide more benefits to you than the new GI Bill? 

Ms. NEUTZLING. Yes. 

Senator BROWN. Do you know why, or did VA explain to you 

why, because that was not the intent? I know the new GI Bill is 

more updated and has other kinds of benefits. Can you tell me 

what you know about that? 

Ms. NEUTZLING. When I asked them about this, they say, ‘‘Well, 

your tuition is paid directly from us.’’ I was like, ‘‘Yes, but I was 

getting roughly, with the Montgomery GI Bill, I was getting just 

over $2,000 a month.’’ I was like, ‘‘I can pay that, pay my tuition 

with that monthly payment right there. But with the Post-9/11 I 

get my tuition paid to the school, but then I get housing which is 

only $941.’’ 

Senator BROWN. OK. I would like to hear from the VA about the 

math because that was never the intent of that bill, but if the situation is right with Ms. Neutzling that benefit would be less. So I 

really want to understand that better. You live in Pomeroy? 

Ms. NEUTZLING. Yes. 

Senator BROWN. It’s a half hour to Athens, so it’s two plus hours 

to Chillicothe or Columbus? 

Ms. NEUTZLING. Yes. 

Senator BROWN. Athens—you made reference to it simply not 

having the medical expertise for your shoulder, or is it the lung 

issue or all of them? 

Ms. NEUTZLING. Pretty much all of them. I find it’s easier if they 

just send me straight to Chillicothe; so it’s just easier to go to 

Chillicothe. 

Senator BROWN. Do you ever use Athens for basic care or for 

pharmaceuticals? 

Ms. NEUTZLING. I just go the Athens clinic for mental health care 

because they have an intern there that’s female to help with the 

PTSD and MST. So I was attending—I was going to Athens for 

that. That was the only reason I was going to Athens. 

Senator BROWN. In the issue of the bus and the van from Pomeroy to Chillicothe, they work with the VA on that and there ought 

to be a way they can get you that line so you can get a seat on 

the bus. 

Ms. NEUTZLING. If my appointment is made in enough time and 

maybe mail it out, mail a little letter, to remind me about 2 weeks 

before. Then I will usually put it somewhere to find it to remind 

myself to go and set it up, but then I completely forget where I 

placed it. 

Senator BROWN. Well, if you can’t remember you might have the 

Veterans Service Organization Officer in Meigs County help. There 

ought to be a way that they can sit down and work this through 

20 

with you so that you can have some help. Make a copy of it so they 

can make the reservation on the bus or whatever. 

I don’t understand, Ms. Neutzling, how when you’re going to 

Chillicothe for your shoulder, why VA would continue to say you’re 

zero percent disabled on your shoulder. Have you taken that up 

with anybody at the Chillicothe Hospital in terms of getting 

reclassified? 

Ms. NEUTZLING. I have discussed it with my county VSO and he 

told me that I just need to get some new paperwork to have it reevaluated, then I should have my rating changed. 

Senator BROWN. And the paperwork come from Chillicothe. 

Ms. NEUTZLING. They rated me zero percent, so I have refused 

to go to the VA, because of that; so I have been going to a civilian 

doctor for my shoulder. 

Senator BROWN. I would hope the VA can address that—Kim, if 

you would. I would hope that we can help you with that. The VA 

is an amazing institution that gives and makes fewer medical errors than any other facility and any other medical group in the 

country. But they’re also huge and still make some mistakes, you 

know. 

Ms. NEUTZLING. Even if I had to have surgery on my shoulder 

again a second time they would usually send me out to Huntington 

or Columbus. 

Senator BROWN. To the VA? 

Ms. NEUTZLING. To the VA, yeah; because the Chillicothe facility 

at the time didn’t have those services. 

Senator BROWN. I understand that. Chillicothe does some things 

better and that it has a terrific program. You have a building for 

homeless veterans, and you’ve got some other programs, as we 

pointed out. Each one has different specialties. Thank you very 

much. 

When you’re in school you have classmates who are veterans? 

Ms. NEUTZLING. A few classmates who are veterans. 

Senator BROWN. All right. One of the discussions similar to 

this—I was at Cleveland State with some veterans, a group of 

about eight or 10 veterans, and we walked around. Cleveland State 

and Youngstown State both have specific programs for integrating 

veterans into the university setting, understanding that a 22-yearold veteran who has come back from Iraq has a pretty different 

view of looking at the world than a 19-year-old straight out of high 

school going to Cleveland State, a more sophisticated view of the 

world, as you do, from your experiences. You saw things that many 

of us in this room have never seen and experienced things that 

many of us never will have to experience. So we’re trying to figure 

out ways of helping veterans integrate into a university setting. 

Do you feel that you and your veteran friends at OU are getting 

the right kind of experiences—or a better question: is there anything we can do better? 

Well, think about it. You don’t have to answer right now, but we 

would love to hear if you’ve got thoughts on that. 

Ms. NEUTZLING. Honestly about the only way is because when I 

was going to OU and I sit there with my classmates, and, I mean, 

at the time I’m 28 and all of my classmates were mostly all 17, 18- 

year-olds fresh out of high school as you say, and they would ask 

21 

me—they would just be like, ‘‘Did you kill anybody?’’ They would 

ask, you know, the typical questions after they find out that you’ve 

been over there. It does get a little annoying and sometimes you 

don’t want people to know you’re a veteran. 

Senator BROWN. That’s something we need to address. Thank 

you for that. 

Ms. Maupin, thank you again for your service as a veteran and 

for the service you still bring to veterans. You are actually based 

out of Bellaire? 

Ms. MAUPIN. St. Clairsville. 

Senator BROWN. St. Clairsville. Is there one in Steubenville? I 

should know that. 

Ms. MAUPIN. No. 

Senator BROWN. So you have people from Jefferson County, Harrison County, Monroe County, and a few from across the river? 

Ms. MAUPIN. A lot of our veterans come from West Virginia and 

Belmont County; and then I think Ed Massey over in Jefferson 

County, I don’t know, do your veterans use St. Clairsville? 

Mr. MASSEY. Yes. 

Senator BROWN. The CBOC—your understand that the CBOCs 

can’t do everything for Ms. Neutzling that a big hospital can do of 

course? You understand that? They never will. But are we providing the quality of service and the breadth of service that we 

should be? 

Ms. MAUPIN. You’ll hear it both ways, and unfortunately I can’t 

use the VA health care system because I make too much money, 

but that’s another issue. Anybody who has to see a specialist has 

to go to Pittsburgh. So, you know, the clinics are good if you’ve got 

a cold or if you’re going in for a checkup; the clinic provides excellent care, but the sicker veterans are the ones that have to travel 

the farthest. To me, that’s not acceptable. I mean, we have veterans who can’t—we don’t allow veterans on our vans who can’t get 

on and off by themselves. So you’ll have somebody come in who has 

to try to get to the hospital in Pittsburgh who is very sick. We do 

provide a special van. If we have somebody who can’t ride in our 

van we will take them in our county van. But, there again, our 

county van is spread so thin and it might be in Mount Vernon or 

Columbus. You know, we’re going in all different directions here. 

It just seems so bad to me that the sicker veterans have to go the 

farthest for treatment. 

Senator BROWN. So what is the solution to that? I mean, we can’t 

build Chillicothe-sized hospitals in 30 places obviously. So 

what—— 

Ms. MAUPIN. In our case it would be additional drivers. I mean, 

it would be additional money for additional drivers and additional 

vans. I know that right now that’s a county issue, you know, that 

our payroll comes from the county. But there has to be a better 

way for the veteran to get their treatment. There’s no reason in the 

world why she should have to, or any veteran, to have mental 

issues and have to worry about where or how they’re going to get 

treatment. 

Senator BROWN. One of the problems, whether it’s in Jefferson 

County or Noble County or Richland County, where I grew up, is 

to get benefits to veterans. I think Appalachia seems to have a litVerDate Nov 24 2008 17:27 Mar 29, 2011 Jkt 000000 PO 00000 Frm 00025 Fmt 6633 Sfmt 6601 H:\ACTIVE\040510.TXT SVETS PsN: PAULIN
22 

tle more difficulty because of people’s natural self reliance, which 

Americans have generally and Appalachians seem to have even 

more. There are all kinds of benefits out there for veterans, things 

like HEAP that Ms. Neutzling talked about, the energy assistance 

program, things like the earned income tax credit, you know. She 

and a lot of families are eligible for that. 

How do we get veterans to apply? What do you do as Veteran 

Service Officers in St. Clairsville or Flushing or Bellaire or, you 

know, anywhere else in Belmont County? What do you do to let 

veterans know they may be eligible for those programs? All Americans, not just veterans, but all Americans are eligible for something. Say they’re making $30,000 a year with a couple of kids, a 

single parent trying to make it, how can that individual get a significant tax break, get a thousand or $2,000 back, as a reward for 

working hard and playing by the rules? 

What are you doing about that? 

Ms. MAUPIN. What we count on, we count on the Service Organization to do a lot of spreading the word about what we offer. Now, 

we’re lucky, not all counties get the money to provide assistance. 

We have—our office is able to help somebody with a utility bill 

throughout the winter. We go from November to March just like 

HEAP does. If they’re eligible for HEAP they’re eligible to come in 

and get heating assistance from us, too. But a lot of people say they 

don’t know about it. The additional funds for outreach, you can’t 

reach everybody by setting up a table at the county fair or putting 

an article in the newspaper. 

Advertising, I was actually—no thanks to the county commissioners—I was criticized for getting into a parade, spending county 

money so we could hand out fliers for heating assistance. They 

didn’t want us to take our county funds and use it for that type 

of outreach. So everything we’ve tried to do, short of putting an ad 

over on TV, and I haven’t checked into the cost of that, but if 

they’re going to criticize us for getting into a local parade they’re 

going to criticize us for spending more money on ads. 

Senator BROWN. The Veteran Service Organization, the officers 

around the State talk to one another. Has there ever been a discussion on sort of the best way to let veterans know these kind of 

things? Is there any way of getting that word out to veterans about 

all this? 

Ms. MAUPIN. The Ohio Department of Veterans Affairs has come 

up with a poster that actually offers the 1–800 number; but then 

you have the veterans that have spent 3 years in the service who 

don’t think they’re entitled to benefits. They don’t know that 

they’re even considered a veteran. I think that’s where we lose a 

lot of people. I didn’t know until I started working for the veterans 

office that I would have been eligible for health care. 

Senator BROWN. I would hope Mr. Hartnett when he comes and 

testifies would talk about some of that. That’s not even counting— 

those are the posters you put in the Legion and the VFW. That’s 

not counting veterans that come home and don’t know what they’re 

entitled to. 

Ms. MAUPIN. Our local service organization, the average age of 

their members are probably 50 and over. The younger people aren’t 

23 

going into the service organizations. I don’t know if that’s in every 

area or in our area, but they’re not joining. 

Senator BROWN. They go home to Brilliant or wherever and 

never connect with you? 

Ms. MAUPIN. Right. 

Senator BROWN. Last question: what is your average day? How 

often do veterans walk in and say, ‘‘I’m home, is there anything 

you can do to help?’’ 

Ms. MAUPIN. We’ve recently relocated. We were in a building in 

St. Clairsville that wasn’t handicap accessible, it didn’t have any 

parking and nobody really knew we were there. There was nothing 

on the outside of the building. So just recently we moved to Bellaire. Our office is on the main street, it’s got a ramp into the 

building, it’s big, we have coffee and we advertise that a veteran 

can come in and sit and watch TV. We were donated a TV. 

Senator BROWN. Where are you located? 

Ms. MAUPIN. Belmont Street. 

Senator BROWN. You have offices in Powhatan, too? 

Ms. MAUPIN. We have a satellite office in Powhatan. I go down 

there once a week and I spend a couple hours down there. We have 

a satellite office in Barnesville, which is also quite a distance. We 

have a satellite office in Flushing. So when we moved, we readjusted our satellite offices to make sure that we tried to get the veterans in to see us. We work with the public libraries, and the libraries have let us set up there. 

Senator BROWN. The places in Barnesville and Powhatan—— 

Ms. MAUPIN. Are the libraries. 

Senator BROWN [continuing]. Are the libraries? You said Flushing is in a library? 

Ms. MAUPIN. In Flushing, yes. 

Senator BROWN. OK. You have posters up in all kinds of public 

places saying to call this 1–800 number or whatever? 

Ms. MAUPIN. Yes. 

Senator BROWN. OK, good. Thank you. 

Dr. Greenlee, how do you overcome the sort of American feel of 

self-reliance and the Appalachian view even more so that people 

want to be by themselves more and they have a wonderful system 

of community here? How do you overcome that, to let people know 

that we’re not giving you these things, you’ve earned this as a veteran; you’ve earned this education benefit, you’ve earned this 

health care benefit, you’ve earned these other benefits for community assistance and that sort of thing? How do you do that? 

Dr. GREENLEE. Well, it’s not an easy thing to do. But I think first 

off, I think you’ve got to get people they trust out in the community 

who are actually making a connection with them. But first they 

have to be educated about all of these issues that they face and 

their families need to be educated about this because they’re going 

to be the people who are most likely influencing them to go for 

help, even though they may not want to go for help. 

Social services are very complex about who is eligible for what. 

I think it’s hard for a flier to explain. I think most of us probably 

wouldn’t know what we are eligible for and in what context for almost anything. Because of that, people have to be very finely educated about that. We need to use clergy from the churches, we need 

24 

to use people from the schools, people from even their grade schools 

and their junior highs and their service organizations. I’m a member of the American Legion and I’m one of the younger people sitting in there on occasion. So it’s a much older group of people 

involved. 

I think that we need to engage every one of those areas in going 

out and reaching out to people and knocking on doors and talking 

to them about these services, then making sure they do understand 

this isn’t charity. The last thing anybody wants to do is take something for nothing. I think sometimes there’s ways you can acknowledge that for them so that they can feel more comfortable in accepting that. Then once you do get them the treatment, and it’s 

going a long ways away, if you ask anybody in our county, if you 

ask people—I’m on a fair board committee helping them, and no 

one from one side of the county will come to the other side of the 

county because they consider that to be so far away, that it’s 

unreachable. 

Then to ask people to go to a city, which they feel uncomfortable 

anyhow, to go to the veterans hospital, and when you walk in 

there, as soon as somebody is treated, and I understand the pressures of trying to accomplish a lot quickly, but as soon as you act 

like you’re in a hurry and ‘‘I want you to fill this out,’’ ‘‘Go down 

here,’’ ‘‘Get here,’’ they’ve already shown you that they don’t care 

about you, you’re only a number, and you don’t ever want to come 

back. 

Many of them are going to fire the agency, not tell them they’re 

fired, but never come back again. They would rather suffer through 

their pain than try to figure out looking on the Internet, talking 

to family and friends how the best way to handle it because they 

are, in many times, they feel they’ve been humiliated and they’ve 

been made to feel like this is charity rather than something they’ve 

earned by their service. 

I think what happens is you have a veteran who oftentimes is 

taught to be tough and then you look at the Appalachian culture 

that says the same thing, you’ve got a double whammy. It’s going 

to take personal face-to-face relationships to turn that around. It’s 

going to take at least some money because people can’t get out. 

They can’t even get out of the home they’re in because they don’t 

have a car that runs anymore. They don’t even have telephones 

that people are talking about. I can’t tell you how many people I 

know who do not have phones. 

If I could share one thing. This is a little short thing written 

by—it’s a poem that was written by a woman named Diane Gilliam 

Fisher. It kind of gives us an education on how fast you can alienate somebody. She is originally from West Virginia. She calls this 

thing Sheepskin. 

She said, ‘‘I told that doctor flat out what it was. He looks 

me right in my face, says, ‘Mrs. Chapman, you can worry 

a man sick, now, and John has got to work. You let me do 

the doctoring here unless you got a sheepskin somewhere 

I don’t know about.’ All I could think was that old story 

about a wolf in sheep’s clothing. I said ‘Sheepskin?’ He 

points to a picture frame propped on his desk, diploma 

wrote in Latin from some college in Virginia. I said, ‘No, 

25 

doctor, I got nothing like that.’ I did not hold John’s hands, 

speckled with coal tattoos, out to the doctor, did not say, 

‘Read this here, doctor, how easy the dust works in under 

his skin.’ I did not say, ‘You come home up with us. Read 

his handkerchiefs, read my pillowslips, grayed with dust, 

sprayed with coal-black flecks of coughed-up muck.’ I did 

not tell him my learning come nights, from the ragged, 

rocky-chested racket of my daddy’s cough and the only 

Latin we got to show for it is on his stone. ‘No. What I 

know is not wrote on sheepskin, doctor,’ I told him. I said, 

‘What I know was wrote on the wall.’ ’’ 

To me that’s how easily one statement like that can make a person feel like I’m this little. My father had an eighth grade education, was a coal miner. They don’t appreciate somebody like me 

with an education coming out and telling them what they don’t 

know when they know what they see in those rooms. They know 

what they see with that veteran. They know what they’re experiencing, but don’t necessarily know how to tell you about it or feel 

comfortable telling you. 

So it is a long uphill battle and it’s going to take person to person. It’s going to take people who have had experience coming out 

who live there, who are from their community, who are veterans 

that say, ‘‘All right. We’ve had some troubles, we’ve made some adjustments, people are growing. I want to take you and put you in 

a car and carry you there and I will sit there with you.’’ I see it 

all the time. 

When I was at Ohio University down in Athens, before I came 

to the Eastern campus, we brought in a young man that lived out 

in a house with no running water in the house. His mother said, 

‘‘I will find some way to get there.’’ I told her, ‘‘I will come get you.’’ 

It was out in the middle of Morgan County. She said, ‘‘I can’t get 

there.’’ I said, ‘‘I will come get you.’’ Then she said, ‘‘No, I’ll get 

somebody to get me there.’’ She was proud. She wanted to do it. 

Now, when I got there I took them hand by hand, I carried them 

to every place. I spent 3 hours with them walking through every 

place on that campus, getting them financial aid, getting him registered. At the very end I had to go to a meeting, so after 3 hours 

I said, ‘‘I got to go, but I’ll be right back.’’ She said, ‘‘You’re not 

going to leave us, are you?’’ After all that, she was afraid I was 

going to leave them. That’s what you got to do. 

Senator BROWN. Thank you all. Thank you for joining us. Thanks 

for your candor, your outspokenness, and your courage. Thank you 

especially for your service to our country. We’ll call the second 

panel forward. While we do I want to introduce Regina Bryant, 

who is sitting behind me and Doug. She is from Coshocton and is 

recording, making sure to prepare us the official recording for this 

hearing. 

Would the second panel please come forward as I introduce them. 

I would like to thank our second panel of witnesses for testifying. 

Kim Graves is Director of the Veterans Benefits Administration’s 

Eastern Area located in Ann Arbor. Despite your affiliation with 

Ann Arbor, thank you for your service to all the Buckeye veterans 

you serve. She’s accompanied by Joyce Cange, the Director of the 

Cleveland Regional Office; Jack Hetrick, the Director of the VA 

26 

Health Care System of Ohio; and Jeffrey Gering, the Director of 

the Chillicothe VA medical center. The three of them—Ms. Cange, 

Mr. Hetrick and Mr. Gering—will ask questions, not actually testify. I appreciate their being here. 

Ms. Graves is a U.S. Army veteran and has served her country 

in the military and with the VA for more than 25 years. She is a 

graduate of the University of Nebraska, where she earned a Bachelor of Arts in Psychology and Sociology with the assistance of the 

VA’s Vocational Rehabilitation and Employment Program. She also 

holds a Masters Degree in Public Administration. 

Bill Hartnett will conclude today’s testimony. Bill is from Mansfield, a town I know well and hold close to my heart. He is the Director of the Ohio Department of Veterans Services and is a U.S. 

Navy veteran of the Korean War era. He earned a Bachelors Degree in education from Kent State, his Masters in Education Administration from West Virginia University—I was rooting for 

them by the way, just so you know—and he has a Specialist in 

Education and Theory Degree from Kent State University. Bill 

served in the Ohio House of Representatives from 1998 to 2006. 

His first elected job was the same job and place, Richland County, 

as my first elected job. 

Ms. Graves, your testimony, please. 

STATEMENT OF KIM A. GRAVES, DIRECTOR, EASTERN AREA 

VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT 

OF VETERANS AFFAIRS; ACCOMPANIED BY JOYCE CANGE, 

DIRECTOR, CLEVELAND REGIONAL OFFICE; JACK HETRICK, 

DIRECTOR, VA HEALTHCARE SYSTEM OF OHIO (VISN 10); 

JEFFREY GERING, DIRECTOR, CHILLICOTHE VA MEDICAL 

CENTER 

Ms. GRAVES. Thank you, sir. Senator Brown and distinguished 

Members, it is my pleasure to be here today to discuss our efforts 

in meeting the needs of veterans residing in Ohio. As you know, 

joining me today I have very distinguished colleagues, and hopefully we will be able to answer any questions that you may have 

at the conclusion of today’s testimony. I also wanted to extend my 

thanks to the prior panelists and all of those who have joined us 

here today for their service to this Nation. 

In response to Secretary Shinseki’s mandate to transform the Department, our efforts in Ohio are focused on ensuring the delivery 

of benefits and health care services on a veteran-centric basis. Veterans’ needs are the principal drive of our efforts, and we are 

aware that reaching all of our veterans requires sustained emphasis. We are also aware that our programs have an economic impact, 

particularly in areas such as Appalachia, and we will continue to 

focus on the timely and effective delivery of benefits and services. 

The Cleveland Regional office provides services and outreach to 

servicemembers and veterans throughout Ohio including WrightPatterson Air Force Base in Dayton. The Regional Office administers a full range of benefits including disability compensation for 

veterans and their dependents; vocational rehabilitation and employment assistance; home loan guaranty and specially adapted 

housing grants for veterans in the six-state jurisdiction of Ohio, InVerDate Nov 24 2008 17:27 Mar 29, 2011 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6601 H:\ACTIVE\040510.TXT SVETS PsN: PAULIN
27 

diana, Michigan, Pennsylvania, New Jersey, and Delaware; and we 

provide outreach for all veteran and survivor benefits. 

The Cleveland Regional Office also oversees one of the Veterans 

Benefits Administration’s eight National Call Centers, staffing a 

toll-free benefits information line. In addition, the Cleveland RO 

houses VBA’s Tiger Team, which is a special claims processing 

team which supports the entire nation in reducing the number of 

claims pending for veterans over the ago of 70 and/or claims pending over 1 year. 

The Cleveland RO is responsible for delivering non-medical VA 

benefits and services to Ohio’s 913,000 veterans and their families. 

Approximately 108,000 Ohio veterans receive disability compensation and pension benefits. VA benefits paid in compensation and 

pension to Ohio veterans totaled nearly $1.1 billion in 2009. 

In fiscal year 2009 the Cleveland RO completed nearly 25,400 decisions on veterans’ disability claims, and the Tiger Team completed nearly 20,000 additional decisions for veterans from across 

the Nation. In addition, the call center employees answered approximately 44,700 calls per month. In fiscal year 2009 the Cleveland Regional Loan Center guaranteed over 8,200 loans in Ohio 

worth over $1.3 billion making home ownership in difficult economic times a reality for Ohio veterans and their families. 

Currently the Cleveland Regional Office has 573 employees. During fiscal 2009 the Regional Office was able to hire 60 additional 

employees, including 38 veterans, as a result of the American Recovery and Reinvestment Act or ARRA. The Cleveland Regional Office is continuously seeking ways to improve its delivery of benefits 

and services to Ohio veterans. 

During fiscal year 2009 the Cleveland Regional Office improved 

in most major benefits—excuse me, in most major performance indicators while the incoming claims volume have increased to nearly 

6.8 percent over the comparable period in fiscal year 2009. 

Like you, sir, I have been concerned about the well-publicized 

fact that veterans in Ohio historically receive lower disability compensation payments than veterans residing in other States. I assure you that we take this issue seriously and understand the impact of accurate rating decisions on Ohio’s veterans. Under the Veterans’ Benefits Improvement Act of 2008 the VA was required to 

provide a description of any discrepancies or differences regarding 

ratings for service-connected disabilities among various populations 

of veterans. The VA contracted with the Institute for Defense Analyses, or IDA, to perform this study. As in a prior study, IDA concluded that there are many demographic and claim reasons for 

variances among States. Reports identifying Ohio as one of the historically lowest States in compensation payments are based on the 

totality of benefit awards to all veterans currently receiving compensation which represents over 50 years of rating decisions. It is 

noted that in IDA’s most recent study it showed that for initial 

claims decided in fiscal years 2006 through 2008 Ohio’s average 

compensation ranks 30th of all States. 

To help ensure we reach as many veterans as possible, especially 

in the heart of Ohio’s Appalachian Country, the Cleveland Regional 

Office began providing benefits counseling services at the Chillicothe VA Medical Center in January 2010. By partnering with the 

28 

medical center, the regional office now staffs a benefits office 2 

days per week to assist veterans and their families. 

The Cleveland Regional Office also actively works with the Ohio 

Department of Veterans Services to identify and solicit claims from 

Ohio veterans from all areas of the State, including Appalachia. We 

look forward to further development of our working relationship 

with Director Bill Hartnett and the Ohio Department of Veterans 

Services as we work together to meet the needs of our veterans. 

The VA has made significant improvements in delivery of benefits to Ohio veterans, but we can always do more. Such improvements have helped prepare the RO for processing approximately 

5,000 claims we anticipate receiving as a result of the recently announced new Agent Orange presumptive conditions. The VA is 

committed to ensuring the best possible services available to Ohio 

veterans and their families. 

Senator, this concludes my oral testimony for today. Again, I 

greatly appreciate being here today and my colleagues and I look 

forward to answering any questions you may have. 

[The prepared statement of Ms. Graves follows:] 

PREPARED STATEMENT OF KIM A. GRAVES, DIRECTOR, EASTERN AREA, VETERANS

BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Senator Brown and Members of the Committee, it is my pleasure to be here today 

to discuss our efforts in meeting the needs of Veterans residing in Ohio. Joining me 

today are Joyce Cange, Director of the Cleveland regional office (RO), Jack Hetrick, 

Director of the Department of Veterans Affairs (VA) Healthcare System of Ohio 

(VISN 10), and Jeffrey Gering, Director of the Chillicothe VA Medical Center 

(VAMC). Today I will discuss important benefits and services provided to the Veterans of this state, including those Veterans living in Appalachia. I will also update 

you on improvements the Cleveland RO recently made in its service to Ohio Veterans, as well as the VA provision of health care services to Veterans in Ohio. 

In response to Secretary Shinseki’s mandate to transform the Department, our efforts in Ohio are focused on ensuring the delivery of benefits and health care services on a Veteran-centric basis. Veterans’ needs are the principal driver of our efforts, and we are aware that reaching all of our Veterans requires sustained emphasis. We are also aware that our programs have an economic impact, particularly in 

areas such as Appalachia, and we will continue to focus on the timely and effective 

delivery of benefits and services. 

BENEFITS PROVIDED BY THE CLEVELAND RO

The Cleveland RO provides services and outreach to Servicemembers and Veterans throughout Ohio including Wright-Patterson Air Force Base (AFB) in Dayton. 

The RO administers the following benefits and services: 

• Disability compensation for Veterans and their dependents; 

• Vocational rehabilitation and employment assistance; 

• Home loan guaranty and specially adapted housing grants for Veterans in the 

six-state jurisdiction of Ohio, Indiana, Michigan, Pennsylvania, New Jersey, and 

Delaware; and 

• Outreach for all Veteran and survivor benefits. 

The Cleveland RO also oversees one of the Veterans Benefits Administration’s 

(VBA) eight National Call Centers, staffing a toll-free benefits information line. In 

addition, the Cleveland RO houses VBA’s Tiger Team, a special claims processing 

team dedicated to reducing the number of claims pending in three categories: veterans age 70 and over with a claim pending over one year; claims pending over one 

year; and claims pending for veterans age 70 and over. The Cleveland RO’s goal is 

to deliver benefits and services in a timely, accurate, and consistent manner. This 

is accomplished through the administration of comprehensive and diverse benefit 

programs. 

The Cleveland RO is responsible for delivering non-medical VA benefits and services to Ohio’s 913,000 Veterans and their families. Approximately 108,000 Ohio VetVerDate Nov 24 2008 17:27 Mar 29, 2011 Jkt 000000 PO 00000 Frm 00032 Fmt 6633 Sfmt 6621 H:\ACTIVE\040510.TXT SVETS PsN: PAULIN
29 

erans receive disability compensation and pension benefits. VA benefits paid in compensation and pension to Ohio Veterans totaled nearly $1.1 billion in 2009. 

In fiscal year (FY) 2009, Cleveland completed nearly 25,400 decisions on Veterans’ 

disability claims, and the Cleveland Tiger Team completed nearly 20,000 additional 

decisions for Veterans from across the Nation. Cleveland RO employees conduct an 

average of 590 personal interviews per month and answer approximately 44,700 

calls per month in its National Call Center. The RO conducted 24 Transitional Assistance Program briefings to 572 Servicemembers in FY 2009. 

The Cleveland Regional Loan Center (RLC) administers VA loan services to Ohio 

Veterans. VA has guaranteed over 766,500 loans in Ohio with a cumulative loan 

amount of over $29 billion. In FY 2009, the RLC guaranteed over 8,200 loans in 

Ohio worth over $1.3 billion, making homeownership in difficult economic times a 

reality for Ohio Veterans and their families. 

To increase access to benefits, the Cleveland RO oversees benefits offices in Columbus and Cincinnati. RO employees are also available to assist Veterans at the 

Cleveland, Cincinnati, Dayton, and Chillicothe VAMCs, the Columbus VA Outpatient Clinic, and Wright-Patterson AFB. All Veterans, including those in more 

rural areas, are now able to obtain payment and claim-status information (notification, development, decision, or closure) via the eBenefits Web site. This web portal, 

created in conjunction with the Department of Defense, allows Veterans everywhere 

immediate access to information provided by VA. 

STAFFING

The Cleveland RO currently has 573 employees. During FY 2009, the RO hired 

60 employees, including 38 Veterans, as a result of the American Recovery and Reinvestment Act (ARRA). All ARRA employees directly contribute to improved benefits delivery by assisting with the development of claims and mail processing. The 

RO employees are very motivated and dedicated to making a difference in the lives 

of Ohio Veterans. 

IMPROVEMENTS IN SERVICE DELIVERY

The Cleveland RO is continuously seeking ways to improve its delivery of benefits 

and services to Ohio Veterans. During FY 2009, the Cleveland RO improved the accuracy of its rating-related decisions by over five percentage points to 88.4 percent. 

This accuracy rate, which is higher than the VBA national average, has been sustained this year. The Cleveland RO currently decides claims in an average of 161 

days. This is comparable to the VBA national average of 160 days and is a 45-day 

improvement over the Cleveland RO’s average processing time in FY 2008. Increased staffing, and improved proficiency of that staff as their training progresses, 

as well as the office’s focus on workload management, are the principal contributors 

to that improved performance. 

The Cleveland RO’s pending rating-related claims inventory currently averages 

approximately 10,800 claims. The RO has maintained this level of inventory even 

while the office’s incoming claims volume, through February of this fiscal year, has 

increased nearly 6.8 percent over the comparable period in fiscal year 2009. This 

represents a 28 percent reduction since the RO’s record-high inventory of 15,123 at 

the end of FY 2006. 

Like you, I have been concerned about the well-publicized fact that Veterans in 

Ohio historically received lower disability compensation payments than Veterans residing in other states. I assure you that the Cleveland RO takes this issue seriously 

and understands the impact of accurate rating decisions on Ohio’s Veterans and our 

stakeholders. Under the Veterans’ Benefits Improvement Act of 2008, VA was required to provide a description of any differences regarding ratings for service-connected disabilities among various populations of Veterans. VA contracted with the 

Institute for Defense Analyses (IDA) to perform this study. As in a prior study, IDA 

concluded that there are many demographic and claim-specific reasons for variances 

among states. Factors such as the number of claims received for disability compensation based on Individual Unemployability and Veterans’ military retiree status 

all play a part in state variances. Reports identifying Ohio as one of the historically 

lowest states in compensation payments are based on the totality of benefit awards 

to all Veterans currently receiving compensation, representing over 50 years of rating decisions. However, IDA’s recent study showed that for initial claims decided in 

fiscal years 2006 through 2008, Ohio’s average compensation ranked 30th of all 

states. 

To ensure that the Cleveland RO’s decisionmakers are consistent with other offices, the Cleveland RO developed an extensive training plan for all employees. With 

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30 

ployee involved in the claims process receives a minimum of 80 hours of technical 

training annually. This training consists of 40 hours of Core Technical Training, 20 

hours of standardized topics chosen by VBA, and 20 hours of training chosen by the 

RO for local issues and areas of concern. Such training includes having employees 

prepare mock decisions based on standard fact patterns. These mock exercises ensure that decisionmakers consistently review evidence and apply the law equitably. 

Furthermore, all new employees hired to work disability claims receive comprehensive training and a consistent foundation in claims processing through a centralized training program called Challenge. During FY 2009, the Cleveland RO had 

35 newly hired or promoted employees attend centralized training under the Challenge program. The Challenge concept also includes extensive prerequisite courses 

prior to attending the centralized training segment and a standardized, rigorous 

training curriculum following it. Standardized computer-based tools have also been 

developed for training decisionmakers. Training letters and satellite broadcasts/ 

NetMeetings on the proper approach to rating complex issues are also provided to 

all ROs. 

As a result of the Cleveland RO’s training efforts, the office has historically high 

pass rates on employees’ Skills Certification Tests, a standardized testing system 

used to promote employees. 

OUTREACH AND PARTNERSHIPS

To help the Cleveland RO reach as many Veterans as possible, especially in the 

heart of Ohio’s Appalachian Country, the Cleveland RO began providing VA benefits 

counseling services at the Chillicothe VAMC in January 2010. By partnering with 

the Medical Center, the RO now staffs a benefits office two days per week to assist 

Veterans and their families. Since the start of its on-site presence, the RO has 

served over 140 Veterans in Chillicothe. I am pleased that the RO is meeting a very 

real need to get information and assistance to these more difficult-to-reach areas of 

Ohio. 

I am also proud of the Cleveland RO’s successful relations with VA’s stakeholders. 

The RO provides office space to nine major Veterans’ Service Organizations in the 

Cleveland facility. The RO recently welcomed the arrival of a permanent service officer of the Ohio Department of Veterans Services. The RO provides quarterly training to all of Ohio’s 88 County Veterans Service Offices and recently completed a 

Congressional Liaison Seminar for local Congressional staffers. 

The Cleveland RO actively works with the Ohio Department of Veterans Services 

to identify and solicit claims from Ohio Veterans from all areas of the state, including Appalachia. The creation of this Ohio Cabinet-level department increased 

awareness of Veterans’ needs in the state. The RO looks forward to further development of its working relationship with the Director, Bill Hartnett, and the Ohio Department of Veterans Services, as we work together to meet the needs of Veterans. 

As one of its first shared tasks, the Cleveland RO is working with the Ohio Department of Veterans Services to pilot the use of a checklist for claims submitted by 

Ohio’s County Veterans Service Officers to ensure the timely submission of evidence 

to expedite claims processing. 

HEALTH CARE SERVICES

The VA Healthcare System of Ohio, Veterans Integrated Service Network (VISN) 

10, consists of four VAMCs, one health care center, and 30 community-based outpatient clinics (CBOC). VISN 10 provides mental health services at all 30 CBOC locations. The Louis Stokes Cleveland VAMC has a total of 13 Outpatient Clinics located throughout Northeastern Ohio. 

VISN 10’s strategic plan of providing access to primary care and mental health 

services within 30 minutes or 30 miles, as well as access to tertiary care within 60 

to 120 miles of all of Ohio’s Veterans, has been accomplished. VISN 10 consistently 

ranks highest across the Department in access to clinical care with less than 0.4 

percent of Veterans waiting more than 30 days for an appointment in FY 2009. 

These achievements are noteworthy, but there is always more we can do to improve 

the care Ohio Veterans receive. 

The Canton Outpatient Clinic is 25,000 square feet in size and serves over 12,200 

Veterans. Current services offered at the Clinic include primary care, mental health, 

optometry, podiatry, laboratory services, pharmacy benefits, home-based primary 

care, women’s health, and radiology. Two additional outpatient clinics located in 

Akron and New Philadelphia serve 12,380 and 2,800 Veterans, respectively. The Lorain CBOC is fully operational at the St. Joseph Community Center. Through the 

first five months of FY 2010, it has treated 6,152 Veterans. 

31 

VA is expanding the Middletown CBOC, more than doubling its size from 7,000 

square feet to more than 18,500. The Middletown CBOC currently provides onsite 

primary care, preventive medicine, laboratory services, outpatient mental health, intensive case management for mental health, optometry, home-based primary care, 

and pharmacy benefits. By 2011, when the expansion is complete, the facility will 

also offer occupational and physical therapy, as well as radiology. VA’s Office of 

Rural Health is awarding $1 million to establish an Outreach Clinic in Wilmington 

to provide primary and mental health care for rural Veterans. VA is working hard 

to establish this clinic, and the Department expects to activate the clinic by this 

summer. VISN 10 continues to explore further options for enhancing care in rural 

Ohio, and to improve home-based primary care, tele-medicine, optometry, podiatry, 

and mental health care. 

CONCLUSION

VA has made significant improvements in delivery of health care and benefits to 

Ohio Veterans. Such improvements have helped prepare the RO to process approximately 5,000 claims anticipated to be received as a result of the recently announced 

new Agent Orange presumptive conditions of ischemic heart disease, Parkinson’s 

disease, and certain leukemias. We have also improved the quality and availability 

of health care for Veterans across the state. VA is committed to providing the necessary resources to ensure the best possible service is available to Ohio Veterans 

and their families. 

Senator, this concludes my testimony. I greatly appreciate being here today and 

look forward to answering your questions. 

Senator BROWN. Thank you Ms. Graves. Mr. Hartnett. 

STATEMENT OF BILL HARTNETT, DIRECTOR, OHIO 

DEPARTMENT OF VETERANS SERVICES 

Mr. HARTNETT. Thank you, Senator. Thanks for being here and 

joining with us in this field hearing that you have called. Your letter invited me to discuss the benefits and services available to Appalachian veterans. I also want to tell you about the efforts being 

made throughout all of Central Ohio, and especially our efforts to 

find veterans. 

An interesting comment made earlier was a lot of veterans don’t 

know they’re veterans. When the department was established 18 

months ago Governor Strickland made it very clear that our primary objective is to find our veterans and make them aware of the 

benefits they’ve earned. That’s why our State mission is likely to 

be identified to connect and advocate for veterans and their families. If we translate that mission into numbers from the VA and 

the Department of Defense we’re looking at 935,000 Ohio veterans. 

That vast majority of these veterans have never applied for State 

and Federal benefits, so we have no database as to where those 

veterans are; so how can we find them? Unfortunately, it’s very difficult to identify them; we just know they’re there. So we reasonably can’t contact all of the veterans. Let’s find a way for them to 

contact us. To that end we have carefully launched a marketing 

campaign to all veterans in Ohio inviting them to call 1–877– 

OHIO–VET to learn about the benefits they have earned. Our message is very simple: ‘‘Veterans! Your service may be worth more 

than you think. Call 1–877–OHIO–VET.’’ 

But first, it is important to define what person is a veteran. It’s 

important because there are thousands of veterans in Ohio, perhaps tens of thousands, who do not know that they are veterans. 

Let me explain that. These veterans see veterans only as people 

who are retired from the military. Or they think that people on active duty are not retired so they’re not yet veterans. So let’s define 

32 

what a veteran is. A veteran is any person who honorably wears 

or has worn a United States military uniform, or is a member of 

the uniformed services of the National Oceanic and Atmospheric 

Administration or the Public Health Commission Corps. 

So our mission is two-fold. First, we have to tell a lot of veterans 

they’re veterans and that their service may be worth more than 

they think. Second, we have to tell them to contact us, 1–877– 

OHIO–VET. Earlier I said that we launched this marketing campaign to get those veterans into our database. I say carefully because we have to move deliberately because we don’t want to overwhelm the County Veterans Service Officers. Many of them are 

understaffed and underfunded. 

The Appalachian Counties here in Eastern Ohio are good examples. They do great work, great work, as do the other 88 of our 

County Service Offices. But if we suddenly invite tens of thousands 

of veterans to call them for benefit information, they would simply 

be overwhelmed. We would have a few thousand very upset veterans making unanswered or unreturned telephone calls. 

Hire more people to take the calls? Well, that’s not easy. The 

county offices are funded by a half-mill of the county’s property tax 

receipts. Of course, property taxes differ dramatically from county 

to county and the less affluent counties get the least money. 

It’s no secret that Ohio’s Appalachian Counties are at a geographic disadvantage when it comes to connecting our veterans to 

extensive health care. Although the area is placed under Ohio for 

the most beautiful landscape, medical treatment for our veterans 

is a cross-country venture. A veteran in Marietta, for example, 

must travel 80 miles for treatment at a VA medical center in 

Clarksburg, WV. I address this issue carefully in my written testimony. 

We’re also doing some groundbreaking work with the VA Regional Office in Cleveland so that communication between our department and the VA is faster, easier, and clearer. How are we 

doing that? Well, we’re putting the Ohio Department of Veterans 

Services staff in the Cleveland Regional VA Office right now. I 

mean, literally, in the VA office and literally, right beside the VA 

staffers. 

With your permission I would like to recognize two people that 

are with us who are the primary movers in the efforts to get the 

veterans connected to get the benefits and services they have 

earned. First, Director Cange, who is my all time hero, and my second all time hero, Mickey Volkman, who is our person at the VA. 

I think that you will find that their work is going to do a great 

deal. You see, I told you that Ohio and VA are now side by side. 

I will also tell you that other States are watching Ohio pretty closely and that the VA in Washington is also watching. If this type of 

project works, and we have evidence that it is already working, 

other States I think will launch similar efforts. 

I want to emphasize something very, very important. We could 

not have established this cooperative relationship without the VA 

and the Cleveland Director Joyce Cange. Director Cange gets it. 

She recognizes the problem and she understands the solutions. The 

objective here is to speed up the front end of the application process. That’s the time between the veterans initial request for beneVerDate Nov 24 2008 17:27 Mar 29, 2011 Jkt 000000 PO 00000 Frm 00036 Fmt 6633 Sfmt 6601 H:\ACTIVE\040510.TXT SVETS PsN: PAULIN
33 

fits and the time when they receive a decision from the VA. Simply 

stated, very simply stated, the VA needs additional information in 

order to make that funding decision. It’s easier for somebody to 

walk 15 steps and ask one of his or her associates for help than 

it is to communicate with strangers 250 miles away. 

The backlog you heard about is real. But we can attack it with 

higher training standards at all levels. The Ohio County Commissioners, the County Veteran Service Commissioners and their offices are championing this additional training. We are excited every 

time we hear that Secretary Shinseki recognizes that the disability 

claim backlog could be eliminated from one key step, going 

paperless. 

Twelve days ago in Baltimore he said he wants the quantity resolved by 2012 when a modern system is expected to start rolling 

out. It’s all about computers, computers, computers, and when it 

comes to the backlog of disability claims, it’s time to leap into the 

nineties. Improved procedures can be adopted and identified and 

developed. Why do we have to wait for the veteran to make the 

first contact with the VA? Why can’t the Department of Defense 

automatically place veterans in the VA system the moment they 

enlist or when they are discharged or separated from service? If we 

did that, we would have veterans on file even though they have 

never applied for benefits. We could tell them about such things as 

the diseases that are presumed to be caused by their service in 

Vietnam, and now Afghanistan, Iraq, and the Persian Gulf. 

I hope that my point is clear, Senator. We acknowledge that our 

system is flawed, but we are not stuck in decades old time and tradition. Not only are we looking for new, more effective policies and 

procedures, we are finding them and implementing them all to improve our service to the veterans that have served us. We are actively identifying and connecting with and advocating for our veterans and their families and will never be satisfied until they’re all 

served. Thank you for your time. 

[The prepared statement of Mr. Hartnett follows:] 

PREPARED STATEMENT OF BILL HARTNETT; DIRECTOR, OHIO DEPARTMENT OF

VETERANS SERVICES. 

The mission of the Ohio Department of Veterans Services (ODVS) is ‘‘to actively 

identify, connect with and advocate for Veterans and their Families.’’ Since the department was established 18 months ago, we have concentrated on finding the 

935,000 Veterans that VA says are Ohioans. 

We started with a list of only 4000 names and addresses of Veterans 18 months 

ago and now we are up to 400,000 and adding approximately 20,000 new Vets each 

month. We are doing this with the help of our partnership, with the Ohio Bureau 

of Motor Vehicles and the Ohio Department of Jobs and Family Services. They are 

providing contact information from Veterans who renew their driver licenses, register their vehicles with military license plates or, seek assistance about jobs and 

family services. 

The VA has a list of Veterans in its database. These are Vets seeking help for 

challenges that are extremely private and their privacy is, of course, protected by 

VA. 

If we can’t contact those Vets, let’s find a way for the Veterans to contact us. To 

that end, we have carefully launched a marketing campaign to all Veterans in Ohio; 

inviting them to call 877–OHIO–VET to learn about the benefits they have earned. 

Our message is very simple: 

‘‘Veterans! Your service may be worth more than you think. Call 1–877– 

OHIO–VET.’’ 

34 

But first, it is important that we define, ‘‘who is a Veteran.’’ It is important, because there are thousands of Veterans in Ohio—perhaps tens of thousands—who do 

not know they are Veterans. Let me explain. 

These Veterans see Veterans only as people who are ‘‘retired’’ from the military. 

They incorrectly think that if they are on active duty, they are not Veterans; they 

incorrectly think that if they did not serve at least 20 years of active duty, they are 

not Veterans. 

They think: ‘‘I was in the military for only four years so I’m not a Veteran.’’ Or, 

‘‘I’m still on active duty so I’m not a Veteran.’’ 

A Veteran is any person who honorably wears or has worn a United States military uniform, or is a member of the uniformed services of the National Oceanic and 

Atmospheric Administration (NOAA) or the Public Health Commission Corps 

(PHCC). 

So, our mission is two-fold: 

First, we have to tell a lot of Veterans that they are Veterans and that they may 

be eligible for benefits. 

Second, we have to tell them how to contact us. 

Earlier, I said that we have carefully launched a marketing campaign to get those 

Veterans into our database. I say carefully because we have to move deliberately 

but slowly. Slowly, because we don’t want to overwhelm the County Veterans Service Offices (CVSO) which will be the primary agency that the veteran is to contact. 

Many of them are under staffed and underfunded. 

Most of the Appalachian counties here in Southeast Ohio are good examples. They 

do great work... great work . . . as do all 88 of our CVSOs. But, if we suddenly 

invite tens of thousands of Veterans to call them for benefit information, they will 

be overwhelmed. And, we would have a few thousand very upset Veterans making 

unanswered or unreturned telephone calls. 

Hire more people to handle the calls? Well, that’s not as easy as it may sound. 

As you know, the county offices are funded by a half-mill of the county’s property 

tax receipts. Of course, property taxes differ dramatically from county to county and 

the less affluent counties get the least money. 

So, we’re moving carefully...

With posters promoting our message and the 877 OHIO Vet number. Right now, 

they’re hanging in places where people walk and wait; at barbershops and beauty 

salons . . . at state parks... BMV offices... rehabilitation services commission offices... county one-stop centers and so on. 

We know that many Veterans gravitate to jobs that require uniforms. So, our 

posters are going to every fire department in Ohio... police departments and 

FOP lodges... Natural Resources and the Highway Patrol barracks. 

We’re working with the Ohio Council of Retail Merchants so that their member 

stores can give customers a pre-paid post card that they can fill out and mail back 

to us. That’s Kroger, Giant Eagle, Walmart, Best Buy, Target, Meijer and other retailers throughout Ohio. 

That’s how we’re working ‘‘to actively identify, connect with and advocate for Veterans and their families. 

We’re also doing groundbreaking work with the VA regional office in Cleveland 

so that communication between my department and the VA is faster, easier and 

clearer. How are we doing that? We have Ohio Department of Veterans Services 

staff in the Cleveland Regional VA office. I mean, literally, in the VA office and literally, right beside the VA staffers. 

A big thank you goes to the Director of the VA Regional Office in Cleveland, Joyce 

Cange for her partnership with our department. Our Deputy Director, Mickey 

Volkman, now works from the VA office in Cleveland. 

On her very first day, Mickey started working with the VA staff to implement a 

compensation check sheet for CVSO’s. This sheet not only helps the counties to submit a complete claim for VA Compensation, but it also helps the VA to identify and 

recognize a compensation claim that is ready to process. This can speed the processing time considerably. Just last month, two new claims were filed, they were 

processed within 30 days and given a rating decision. 

Not only are we working side by side with the VA but also with the military service organizations, such as the VFW, to assist with claims. Mickey, operating as a 

mediator in the VA, is helping to open the communications between the VA, CVSO’s 

and the veterans organizations. By establishing these relationships, we are building 

a strong teamwork attitude to help reduce the gaps between claims preparers and 

the claims processors and to speed up the process. The bottom line is better service 

for the Veterans of Ohio. 

35 

I can also tell you that other states are watching Ohio very closely and the VA 

in Washington also is watching. If this project works... and we have evidence 

that it already is working... other states could launch similar efforts. 

As the VA and the Ohio DVS learn more and more about each other, new ideas 

are born, new procedures are being developed, and new questions are being asked 

and answered. 

The backlog you’ve heard about is real but we can attack it with higher training 

standards at all levels. Several approaches are underway. 

Ohio has a well-positioned system of CVSO’s throughout the state with more than 

180 county Veterans service officers who are accredited by our Department of Veterans Services. However, all of them are not accredited with the Veterans organizations that do business at the Cleveland Regional office. When they are accredited, 

they can communication directly with VA to discuss a Veteran’s claim. Through 

those accreditations we are hopeful that our CVSO’s will be better able to follow the 

processing of the veterans’ claim and to keep the veteran informed of its progress. 

In Addition, if the Department of Defense would automatically place Veterans in 

the VA system the moment they are discharged or separated from the service, we 

would have Veterans on file even though they never have applied for benefits. And, 

we could tell them new benefits such as the diseases that now are presumed to be 

caused by their service in Vietnam . . . or Afghanistan . . . or Iraq . . . or the 

Persian Gulf. 

We have more great programs and initiatives that Ohio has implemented to better 

serve our Veterans: 

The Ohio GI Promise represents the most significant expansion of benefits and 

services for veterans in Ohio since the end of World War II. The creation of the GI 

Promise ensures that veterans in Ohio are given every opportunity to achieve the 

promise of a higher education. The Board of Regents, Ohio institutions of higher 

education, the Ohio DVS, and many others invite America’s veterans and their dependents to earn their college degrees here in Ohio, and ensure that they have the 

resources they need to succeed. In doing so, veterans and their families will make 

significant and important contributions to the state of Ohio in many ways: They will 

help expand Ohio’s skilled work force with their knowledge and education; they will 

bring their maturity and motivation to Ohio’s higher education classrooms; and, 

they will enrich Ohio’s communities through their leadership, selfless-service, and 

dedication. 

On election day 2009, 72 percent of Ohio voters went to the poles to say thank 

you to our Ohio veterans with the passing of Issue One, a bonus for Veterans of 

wars in the Persian Gulf, Iraq and Afghanistan. The passing of the bonus is expressing the gratitude to Ohio veterans for all they have done for us. Our department is working diligently on several crucial steps that must be in place before dispersing the checks. We want the bonus application and approval process to be easily 

understood, accurate and efficient. The department’s goal is to be mailing the first 

checks in November, one year from voter approval. 

Last April, our department partnered with the VA Healthcare System of Ohio to 

host the largest Women Veterans Conference in the Nation. We had almost 700 

women in attendance. The one-day conference was geared toward informing women 

Vets of the many benefits they may be entitled to. Our department is committed 

to continuing our efforts to reach women Veterans through various outreach initiatives. 

We also are very proud of the excellent care our State Veterans Homes provide 

to Ohio’s heroes. Both the nursing home and domiciliary in Sandusky as well as the 

newer home right here in Appalachia, over in Brown county, continue to provide 

much needed care for more than 750 residents. Our residents come from all walks 

of life but have a common bond of serving our Nation during our past and present 

conflicts and wars overseas. 

The homes also provide significant employment opportunities in the areas where 

they are located. Our home in Brown County has added nearly 200 good paying jobs 

to the Appalachian region and is now the 5th largest employer in Brown County. 

In the most recent Veterans Health Administration surveys conducted at both locations, the nursing home in Sandusky experienced just one minor citation, while 

the domiciliary in Sandusky and the Nursing home in Georgetown received perfect 

zero deficiency surveys. This performance is on par with the best state veterans facilities in the Nation. Surveys conducted by the Ohio Department of Health also 

substantiate the excellent care provided by the dedicated professionals who are caring for our residents. 

A program started nationally is being implemented here in Ohio by Supreme 

Court Justice Evelyn Lundberg Stratton. She is establishing Veterans courts to help 

returning Veterans with PTSD and other issues, whose problems may lead to inVerDate Nov 24 2008 17:27 Mar 29, 2011 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6621 H:\ACTIVE\040510.TXT SVETS PsN: PAULIN
36 

volvement in the criminal justice system. The veteran will be given the opportunity 

to be assessed for required treatment including alcohol, drug, mental health and/ 

or medical assistance. They will also be assessed for housing and/or job referrals. 

The Vet will have a rehabilitation plan for treatment and assistance with the VA. 

This is an opportunity to prevent Veterans charged with misdemeanors from falling 

into a life of crime. 

The Ohio Department of Rehabilitations and Corrections is working with the U.S. 

Department of Labor, Veterans Employment and Training Service on the Incarcerated Veterans Transition Program. This program is designed to help ex-offender 

Veterans who are at risk of homelessness to re-enter the workforce. It provides direct services—through a case management approach—to link incarcerated Veterans 

with appropriate employment and life skills support as they transition from a correctional facility into the community. 

The Ohio Military Injury Relief Fund (MIRF) was created by House Bill 66 in 

June 2005. The purpose of the MIRF is to grant money to servicemembers injured 

while serving in country under Operation Enduring Freedom and Operation Iraqi 

Freedom. The grant money paid to the servicemember will vary year to year, based 

on the amount of funds collected for the tax year. The application process is simple 

and usually it takes only four to six weeks to receive a check. This program has 

been very helpful to Vets and their family members. 

As you can see all our efforts are focused on better serving all Veterans of Ohio 

and continuing to build and enhance our partnerships. We acknowledge that our 

system is flawed but we are not stuck in decades old time and tradition. Not only 

are we looking for new and more effective policies and procedures, we are finding 

them and implementing them... all to improve our service to the Veterans who 

served us. 

We are ‘‘actively identifying... connecting with... and advocating for our 

Veterans and their families.’’ And never will we be satisfied. 

Thank you for your time and this opportunity to speak with you. 

Senator BROWN. Thank you, Director Hartnett. I appreciate your 

comments as always. 

Ms. Graves, Director Hartnett said that we can’t find all the vets 

in the State and across the country so we are making it easier for 

them to find us. Why can’t we, with technology, why can’t we correspond with virtually every veteran? We have military records 

that they’ve served, we have, in many cases, Social Security numbers and we have the technology. Maybe the better question is 

maybe not why, why can’t we, but what are we doing so we can? 

What are we doing nationally? 

Ms. GRAVES. Over the past several years there has been a significant effort from both the DOD and the VA to work much closer together to improve that transition, that seamless transition, from 

servicemember to veteran. I see a couple of improvements in that 

area. We are now receiving basically a direct feed from the DOD 

that tells us information about those who are serving. One of the 

ways we get information to process some of our claims is that direct feed of information from the DOD. 

Senator BROWN. I’m sorry to interrupt you. I know we’re doing 

better. One of the first conversations I had with Secretary Gates 

was in January, or whenever it was in 2009. I was urging him, as 

our Committee has, and he was beginning to interface between the 

DOD and VA so that when people leave the service they don’t go 

back to Belmont County or Jefferson County or Guernsey County 

or Muskingum County never to be seen. So they are doing better 

and helping veterans ultimately have a seamless transition with 

medical records beginning when they join the service. 

But for all those veterans that are older, that have served in 

other wars—I think we’re making significant progress and doing 

the right thing for those that are the soldiers, Marines, and sailors 

37 

now—but what about those that fought in World War II or Korea 

or served during the fifties or the sixties or what have you? What 

are we doing about them? 

Ms. GRAVES. I think, sir, the thing that we’re trying to do, just 

as they are at the State level and the county level, is the outreach, 

getting our people, along with the county and State, out in the 

community reaching out to veterans, being in places where veterans go. 

Senator BROWN. But we’re not doing any kind of systemic outreach to the Korean War veteran that never goes to the VA. My 

dad served in World War II, he served in several countries, though 

he didn’t talk about it a lot. Most veterans don’t. I wish they would 

talk more. We could learn a lot from them, but that’s their choice. 

They don’t go into the veterans organizations. 

There are ways of using technology. I appreciate all those things 

like what Director Hartnett is doing. It’s very, very, very important 

that VA work with them and get the posters around. What are we 

doing to find those that don’t go to these organizations? 

Ms. CANGE. Let me just speak about Cleveland and the veterans 

in the State of Ohio. Again, our partnership with the Ohio Department of Veterans Services is very key and critical to reaching out 

to these veterans in the State of Ohio. What Director Hartnett has 

started to do, which you might want to speak to the Director, is 

he’s reaching out and asking veterans through the State licensing 

board, ‘‘Check a box if you’re a veteran.’’ Then that information 

gets back to Director Hartnett. Then our next step is to work to 

reach out to those veterans that have identified themselves so we 

can go out and tell them what the benefits are that they’re entitled 

to. Doing that outreach is essential. So that’s what we’re doing in 

Ohio. 

Senator BROWN. I appreciate that, and I’m not in any way belittling or demeaning that, but isn’t there a way when DOD has some 

records—I would imagine Social Security numbers of many, many, 

many of the Korean and Vietnam War vets and others for example. 

We have a way from all kinds of databases from the Department 

of Motor Vehicles, hunting licenses, fishing licenses, and all of that; 

isn’t there a way to—and the State can’t do this, but isn’t there a 

way for the VA to find—and maybe this is a huge problem, it 

seems like it probably is—but isn’t there a way to use technology 

like e-mail or to direct mail notifications or something to reach veterans? 

Ms. GRAVES. Secretary Shinseki is bringing a culture of advocacy 

to the VA and, that is, definitely taking this information back and 

ensuring that we haven’t done these type of things, that we haven’t 

done that. I would be happy to report that back through your staff. 

Senator BROWN. Let me go to two of the problems that we’ve 

identified over and over. I encourage any of the five of you, the 

three in the middle, to speak up at any point to some of the things 

that Ms. Maupin brought up and Ms. Neutzling or Dr. Greenlee, 

but especially the two more specific problems. One is the backlog 

and the second is the level of—you know, that fact that we rank 

fifth in the Nation in the level of benefits. Maybe I’m dense about 

this, but I can’t still understand why Ohio seems to have a backlog 

that’s larger than most States and why our benefits are lower than 

38 

most States. You represent more than one State, so why is it worse 

in Ohio than in Michigan? What do we tell these people and what 

do we do about those? Do you know? 

Ms. GRAVES. You’re absolutely right. Those are intense problems 

that we’re dealing with on a daily basis. One of the things through 

Secretary Shinseki’s leadership is we are now looking at all kinds 

of ways that we can work in our regional offices to cut the backlog. 

This means looking for unique and innovative ways to use the staff 

that we have. 

We have been very fortunate to be able to hire many new staff, 

but it does take time, a significant amount of time, to get those 

folks to a very proficient level. We are trying to use those individuals in the most effective manner that we can while they’re still 

training and learning to have the most impact on improving the 

process. We are looking at unique and innovative ways to streamline the process all the way from looking at things we can individually do in our regional offices to ensure that we have a smooth 

transition to looking at procedural and regulatory areas that might 

be improved upon to increase our efficiency in providing services. 

As Director Hartnett noted earlier, technology is significant, but 

it won’t be everything that we need. With improved processes and 

increased capitol, again, those are areas where Secretary Shinseki 

has been very up front about maybe trying to take advantage of all 

of these types of technologies. 

With the impending regulation for—regarding Post Traumatic 

Stress Disorder, we are working to ensure that those claims come 

in and we can begin to address them as effectively as we can. At 

my level, I have responsibility for 16 offices. I work with them to 

look at individual components in the regional offices to make sure 

that we have the resources where appropriate and we take appropriate action to hold our staff accountable for improving service. As 

Director Hartnett said, it is key when looking at individual States, 

that we are getting out in into the community and reaching out to 

veterans and doing everything that we can to improve the services 

that we provide. 

Senator BROWN. Thank you. Director Hartnett. 

Mr. HARTNETT. Thank you, Senator. I think that I look at this 

kind of from a veteran in my era or Vietnam. But the issue is that 

right now I think one of the VSOs’ most difficult problems is to 

prove a medical claim. Because we have nothing—we don’t know 

anything about them. When they got out, I bet most of their physical exam was, ‘‘How do you feel?’’ ‘‘You know, I want to get home.’’ 

So to go back to connecting a current disability with something 

that happened to them while they were serving is very difficult. I 

think that, you know, the VA deals with billions of dollars. Obviously I think they want to preserve the treasury, but there are 

times with the senior veterans where it’s a little different than the 

current veteran who hopefully will have that medical record and 

make it much easier for them to attach a future problem to something that was verified when they get out. 

The issue that you bring up I think is real important and that 

is about how all of these 135,000 veterans we have in Ohio have 

the problem of proof. It seems to me that, I don’t know what all 

of the standards are for approving it, but I know that it takes a 

39 

long time. I think the length of time is something we have to look 

at. I mean, we have a backlog not because we have too many to 

serve at any one time, but we’re serving all of those that are ready 

at one time, plus all of those that we’ve put away because we 

haven’t been able to verify or to get an appropriate answer back 

to the veteran. 

So I think that there’s two things that can happen. Going forward we should understand that we, as an office, being in a place 

for a long time should have a better handle on this. When we started we knew 4,000 veterans, their names and addresses. That’s all 

we could verify, and it came from a women’s veterans group that 

met in Ohio. We are at 435,000, and we still have to protect those 

names. What we’re trying to do is not only use the 1–877–OHIO– 

VET, but we’re also partnering with the retail merchants in Ohio 

to give a guy, or a woman, a postcard that says, ‘‘If you’re a veteran, send this in.’’ 

So we’re going to build a better bank of veterans, but we still, 

especially in Southeast Ohio, I think it’s very difficult as the doctor 

said before. We need to tell them they are a veteran. We need to 

be using our Veterans Service Offices and the director’s office to get 

people to tell us they’re veterans so we can help them. 

Senator BROWN. Mr. Gering, I was in Chillicothe a few days ago. 

I think you’re in charge of five CBOCs? 

Mr. GERING. That’s correct. One of them we’re just opening in 

Wilmington, so we have five and one-half. 

Senator BROWN. Just down the road in Southgate Parkway is the 

Cambridge CBOC which has a new mental health program I understand with a psychiatrist specialist in house. Are there more 

plans or programs so that the CBOCs will all have that specialty, 

at least among your area, Mr. Gering, or Ms. Graves or Mr. 

Hetrick, that will be available multiple days of the week? 

Mr. GERING. I really think under Secretary Shinseki’s leadership 

our relationship will increase with Ohioans and the VA in putting 

mental health out there in CBOCs, and the clinics. I know last 

year we put mental health presence in CBOCs. We have a mental 

health social worker. 

Senator BROWN. Beyond the five? 

Mr. GERING. I can speak for our five. We have a mental health 

social worker in each one of ours. We have a mental health psychologist at each one of those clinics. And starting next week we 

will have a psychiatrist at each one of those clinics as well. So if 

you go—like in Cambridge here you will be able to see a psychiatrist on site. In Athens, we have, again, a mental health social 

worker, a psychologist full time. She has a practice in Athens. 

She’s been on board about a year. So we’ve done an awful lot of 

outreach for getting access to mental health services for veterans 

in Appalachia, in Southeastern Ohio. 

Senator BROWN. Mr. Hetrick, do you want to respond? 

Mr. HETRICK. Actually in Ohio we’ve had more mental health 

and we’ve only been enhancing it over the past couple of years. But 

in addition to that, I think it’s important to note, as was appropriately noted earlier, it’s difficult to fill a void every place we 

might perceive it to be needed, but on the CBOC system of 30 

CBOCs around our State that we are responsible for, we have been 

40 

adding additional specialty services as well, based on the number 

of patients that have visited them. These kind of services keep veterans from traveling to a large city where they generally don’t like 

to go to. 

In addition to that, I believe that at Mr. Gering’s location last 

week we had the first telemedicine connection between—or specialty service between surgery with a specialist in Cincinnati to 

keep a female veteran from having to travel 2 hours to Cincinnati. 

During that live consultation he determined that while she was actually being prepared for surgery that it was not really the right 

procedure, so there was a revisit of the treatment plan. I think 

those are the kinds of things we want to do more of. Our telemedicine program right now is serving more veterans in the State of 

Ohio than most other CBOCs that I’m aware of. We’ve been fortunate to have the technology and the resources to do that. 

In addition, we’re competing for VA funding that would expand 

additional home-based health care teams in all the rural areas that 

we serve in Ohio. So that would play to the kind of services and 

enhancements that we need. We’re waiting to hear; it’s a competitive process. We don’t have as many rural areas as other areas of 

the country, but we certainly are trying our hardest to get those 

closer. 

Senator BROWN. Thank you. I have one question to ask all of you 

fairly, and I prefer you use about 1 minute, if you can. The question is: on Wednesday I’m going to see Secretary Shinseki in Cincinnati. If you could ask him one question, or tell him or give him 

one piece of advice anonymously, even though this is a Congressional Committee Record, if you would like to tell me one thing 

that you would either ask him or tell him and I know I’m not giving you much time to think about it. Mr. Hartnett has more time 

than Ms. Graves because I’m starting with you and working down 

there. Tell me what I should say to him or ask him? 

Ms. GRAVES. I think that with Secretary Shinseki’s leadership we 

are approaching a new day at the VA and I would encourage him 

to continue to push us to do better and ensure that we are providing services to our veterans. 

Senator BROWN. A little less commercial, but thank you. Thank 

you for your services, Kim. 

Ms. CANGE. I echo Kim’s comment that it is a new day in the 

VA, and more important, it is a new day for veterans. Secretary 

Shinseki met with all of the directors of the regional offices in Louisville probably 3 weeks ago now and he wants to break the backlog, break the back of the backlog. He said it over and over again. 

He has inspired us and gotten us motivated. I have drilled it down 

to my employees. Last week I went to the Congressional Liaison 

Summit Seminar. Director Hartnett and I were there with a variety of other staffers and I emphasized that, you know, we have a 

backlog and we have more claims coming. With the presumptive 

Agent Orange that are coming, we need to figure out a way to do 

something different. We cannot keep doing the same work over and 

over. We’re going to need your help; if we can change laws to 

streamline it. We ask for your support. But I would say Secretary 

Shinseki has energized me and I believe in my staff and my entire 

41 

staff is ready for the change. They are up for it. We want to make 

a difference for veterans. 

Senator BROWN. Thank you. 

Mr. HETRICK. Well, I may be at the same place you are, so you 

might know where this is coming from. I would say that the Secretary has spent more time talking to the leadership in the field 

than I have ever experienced before and I would encourage him to 

continue to encourage others to do the same thing. I think that he 

has learned from us and we have learned from him. With that kind 

of support, we want to go out and challenge assumptions that we’ve 

all lived by in the past that has created an environment where we 

really think we can go forward and are supported to do the right 

thing for the people. 

Senator BROWN. If I had thought and done this question a little 

better I would have asked Ms. Neutzling this question. What do 

you think she would say? 

Mr. HETRICK. I think we go back to what Dr. Greenlee said. 

Senator BROWN. I understand what her grandfather told her. 

Mr. GERING. In rural America and Appalachia we have a unique 

challenge. Like Dr. Greenlee and the faculty at Ohio University 

talked about, the issues with mental health access in rural America 

which is different. It’s different than Pittsburgh, and it’s different 

than Cleveland. You can have a generation which has had intentions and hopes with the government to serve their needs and has 

been let down. How do we deal with that? How do we reconnect? 

Outreach is essential. Getting in touch with the family is essential. 

We need to regain that trust and keep that trust. That’s critically 

important, probably more so, again, in rural American and Appalachia than in urban America. 

Senator BROWN. I would like to ask you to assign one person 

from Chillicothe to work directly from the VA to deal with the 

issues specifically of Ms. Neutzling. Is Andrea still here? 

Mr. Hartnett, close it by just—you’re the only one that doesn’t 

technically work for General Shinseki. I think he’s done a terrific 

job and I appreciate all that. I love what the VA does 97 percent 

of the time. If you want to say something about the other three you 

can. 

Mr. HARTNETT. Well, I’ve waited 78 years for a second class petty 

officer to advise a general. You know, Senator, I would encourage 

him to do what he is doing. I think he’s radically changed. I don’t 

think he’s fit into the culture yet, and I hope he never does. I think 

that the fact that he’s out talking to people, that he is pushing his 

troops. I think that’s—I think General Shinseki has the opportunity to change the culture that we all operate under, whether it’s 

at a State level or Federal level, by simply saying we owe it to 

them and have to find ways of doing it. 

Senator BROWN. OK. Thank you, all five of you, very much for 

your service to veterans and your services to Americans. Thank you 

very much. Ms. Neutzling, Ms. Maupin, and Dr. Greenlee, thank 

you. 

Thanks again to Regina Bryant behind me; to Tom fisher, Carl 

Lambert, Troy Simmons, and David Moyer for their work in making this run smoothly today. Thanks to this panel and all of you 

42 

in the audience that are serving veterans, the VSOs, and other 

places. 

There will be 1 week for anyone to amend or add to the statements, including those of Ms. Neutzling, Ms. Maupin, and Dr. 

Greenlee. If you want to add anything to the statements or submit 

anything else that will be part of the record, you have 1 week from 

today to do that. 

Again, thank you. This hearing is closed. 

[The hearing concluded at 12:57 p.m.] 

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