U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

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

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

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

49–920 2009

U.S. DEPARTMENT OF VETERANS AFFAIRS 

MEDICAL CARE: THE CROWN JEWEL 

AND BEST KEPT SECRET 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

MAY 19, 2009 

Serial No. 111–22 

Printed for the use of the Committee on Veterans’ Affairs 

( 

jbell on DSKDVH8Z91PROD with HEARING

ii 

COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

DEBORAH L. HALVORSON, Illinois 

THOMAS S.P. PERRIELLO, Virginia 

HARRY TEAGUE, New Mexico 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

JOHN H. ADLER, New Jersey 

ANN KIRKPATRICK, Arizona 

GLENN C. NYE, Virginia 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

DAVID P. ROE, Tennessee 

Malcom A. Shorter, Staff Director 

SUBCOMMITTEE ON HEALTH 

MICHAEL H. MICHAUD, Maine, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

HARRY TEAGUE, New Mexico 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

GLENN C. NYE, Virginia 

DEBORAH L. HALVORSON, Illinois 

THOMAS S.P. PERRIELLO, Virginia 

HENRY E. BROWN, JR., South Carolina, 

Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

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

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

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

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

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

is further refined. 

jbell on DSKDVH8Z91PROD with HEARING

iii 

C O N T E N T S 

May 19, 2009 

Page 

U.S. Department of Veterans Affairs Medical Care: The Crown Jewel and 

Best Kept Secret ................................................................................................... 1 

OPENING STATEMENTS 

Hon. Harry Teague .................................................................................................. 1 

Chairman Michael H. Michaud, prepared statement of ....................................... 37 

Hon. Henry E. Brown, Jr., Ranking Republican Member .................................... 3 

Prepared statement of Congressman Brown .................................................. 38 

WITNESSES 

U.S. Department of Veterans Affairs, Paul J. Hutter, Chief Officer, Legislative, Regulatory, and Intergovernmental Affairs, Veterans Health Administration ................................................................................................................... 28 

Prepared statement of Mr. Hutter .................................................................. 61 

Altarum Institute, Ann Arbor, MI, John King, Co Director, Veterans Community Action Teams Mission Project ..................................................................... 14 

Prepared statement of Mr. King ..................................................................... 52 

American Psychological Association, Jeffrey W. Pollard, Ph.D., ABPP, Director, Counseling and Psychological Services, George Mason University, Fairfax, VA .................................................................................................................. 22 

Prepared statement of Dr. Pollard .................................................................. 59 

Easter Seals, Inc., Randall L. Rutta, Executive Vice President, Public Affairs . 20 

Prepared statement of Mr. Rutta .................................................................... 55 

Give an Hour, Bethesda, MD, Barbara Van Dahlen Romberg, Ph.D., Founder 

and President ....................................................................................................... 16 

Prepared statement of Dr. Romberg ............................................................... 46 

Iraq and Afghanistan Veterans of America, Reynaldo Leal, Jr., Representative ......................................................................................................................... 5 

Prepared statement of Mr. Leal ...................................................................... 40 

National Association for Uniformed Services, Richard A. ‘‘Rick’’ Jones, Legislative Director ....................................................................................................... 7 

Prepared statement of Mr. Jones .................................................................... 42 

Trilogy Integrated Resources, San Rafael, CA, Bruce Bronzan, President ........ 18 

Prepared statement of Mr. Bronzan ............................................................... 45 

Vietnam Veterans of America, John Rowan, National President ........................ 4 

Prepared statement of Mr. Rowan .................................................................. 38 

SUBMISSIONS FOR THE RECORD 

Florida Department of Veterans’ Affairs, Rear Admiral LeRoy Collins, Jr., 

USNR (Ret.), Executive Director, statement ..................................................... 70 

Stearns, Hon. Cliff, a Representative in Congress from the State of Florida, 

statement .............................................................................................................. 70 

MATERIAL SUBMITTED FOR THE RECORD 

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee 

on Veterans’ Affairs, to Hon. Eric K. Shinseki, Secretary, U.S. Department 

of Veterans Affairs, letter dated June 3, 2009, and VA Responses ................. 72 

jbell on DSKDVH8Z91PROD with HEARING

jbell on DSKDVH8Z91PROD with HEARING

(1) 

U.S. DEPARTMENT OF VETERANS AFFAIRS 

MEDICAL CARE: THE CROWN JEWEL 

AND BEST KEPT SECRET 

TUESDAY, MAY 19, 2009 

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

The Subcommittee met, pursuant to notice, at 2:08 p.m., in Room 

334, Cannon House Office Building, Hon. Harry Teague presiding. 

Present: Representatives Teague, Snyder, Donnelly, Perriello, 

and Brown of South Carolina. 

OPENING STATEMENT OF CHAIRMAN MICHAUD, AS 

PRESENTED BY HON. HARRY TEAGUE 

Mr. TEAGUE [presiding]. The Subcommittee on Health will now 

come to order. I would like to thank everyone for coming today. 

This Subcommittee on Health hearing will assess the U.S. Department of Veterans Affairs’ (VA’s) responsibility to conduct an outreach program to veterans of all eras, including internal coordination that takes place between the Veterans Health Administration 

(VHA) and other administrations of the Department. We also seek 

a more complete understanding of the VA’s outreach efforts and 

strategies, as well as the funding spent on these outreach activities. 

Today there are over 23 million veterans who have served this 

country. Of this total, the VA estimates that the number of veterans enrolled in the VA health care system will reach 8.3 million 

in 2009, and that the VA will treat nearly 6 million of the enrolled 

veteran population. Six decades separate the newest generation 

from the oldest generation, and 9 million veterans are over the age 

of 65. According to the VA’s Center for Minority Veterans, the minority veteran population comprises approximately 15 percent of 

the Nation’s 23.4 million veterans. Women veterans are included in 

these minority groups as well. 

This demographic data illustrates the sheer number of veterans 

who stand to benefit from improved VA outreach efforts. Additionally, it shows the importance of outreach strategies which must be 

individualized to meet the unique needs of subpopulations of veterans. For example, outreach strategies for older veterans should 

differ from that of younger veterans. Additionally, the outreach 

methods for rural areas may differ from that of urban areas. The 

VA is also faced with the challenge of developing effective outreach 

jbell on DSKDVH8Z91PROD with HEARING

2 

strategies which are culturally competent and thus able to overcome potential cultural barriers. 

Briefly recounting the legislative history of enacted legislation on 

outreach brings us to the Vietnam War. During the Vietnam War, 

increased awareness of veterans not receiving adequate information about health care benefits resulted in Congress enacting the 

Veterans Outreach in Congress Service Program, VOSP. To address this concern Congress charged the VA with the responsibility 

of actively seeking out eligible veterans and providing them with 

benefits and services. Under the current law, the Secretary is responsible for advising each veteran, at the time of discharge or release, of all benefits the veteran may be eligible for. 

Next, Public Law 107–14, the Veterans Survivor Benefit Improvement Act, VSBIA, was enacted in 2001 to further expand outreach to eligible dependents. This law also provided that the Secretary ensure the availability of outreach services and assistance 

through the internet, veterans publication, and the media. 

Finally, Public Law 110–389, or the Veterans Benefits Improvement Act of 2008, was enacted last year. Section 809 of this law 

gives the Secretary the authority to advertise in national media. 

Despite these legislative authorities, the VA has a self-imposed 

ban against paid public advertising, including public service announcements which was only removed recently in June of 2008. Although the existing statute does not prohibit the VA from conducting media outreach, the VA has only implemented a single 

media campaign on suicide prevention to the Subcommittee’s 

knowledge. VA has struggled in the past with effective outreach 

service. For example, pamphlets and other outreach material are 

often located in the VA’s own medical center, which means that 

this important information does not reach those veterans who do 

not already utilize VA’s services. 

Another example is a memorandum issued on July 18, 2002, by 

the VA Deputy Under Secretary for Health for Operations and 

Management to all Veterans Integrated Services Networks (VISN) 

of the VHA prohibiting marketing geared toward increasing enrollment. This was an effort to limit the fast growing demand for 

health care services, which exceed the VA resources. 

We also know that some veterans service organizations (VSOs) 

accuse the VA of not providing outreach to veterans and dependents in accordance with the law. Nearly 18 months later a second 

memorandum was issued by VHA instructing the directors to ensure that their facilities were in compliance with the responsibilities outlined in the outreach program. 

Clearly, these are serious issues deserving of this Subcommittee 

hearing today. The Subcommittee looks forward to hearing from 

the witnesses of the panel as we embark on this important task of 

exploring effective ways to improve outreach to our deserving veterans. 

I now recognize Ranking Member Brown for any opening statement that he may have. 

[The prepared statement of Chairman Michaud appears on 

p. 37.] 

jbell on DSKDVH8Z91PROD with HEARING

3 

OPENING STATEMENT OF HON. HENRY E. BROWN, JR. 

Mr. BROWN of South Carolina. Thank you, Mr. Chairman. I will 

be brief. I know we have 9, 8 minutes and 55 seconds before the 

votes are closed. When our servicemembers come home from the 

battlefield they think about getting back to their families and their 

civilian lives. Often they do not think about connecting with the 

VA. Yet, the process of transitioning back to the civilian world can 

be challenging for veterans and their families. I am deeply troubled 

when I hear stories about a veteran not knowing what services 

exist, where services can be obtained, and whether they are eligible 

for those services. 

Central to the mission of the VA is to reach out to make every 

veteran aware of what services are available to support them and 

assist them in using these services. That is why it is so important 

that we are holding this hearing today to examine how effective VA 

existing outreach is, and what more can be done to ensure that our 

Nation’s heroes know and have access to the benefits and services 

they need and deserve. 

It is encouraging that a high percentage of our returning warriors are seeking VA for their health care needs than in any previous war. I do want to commend former Secretary of Veterans Affairs, Dr. James Peake, for the great strides he made to improve 

outreach and the coordination of care for our veterans. Under his 

strong leadership, the VA launched a number of outreach initiatives, including lifting restrictions on advertising to promote awareness of VA programs and services, rolling out a new public service 

campaign about suicide prevention, establishing the Combat Veterans Call Center to telephone returning veterans to provide information about VA services, opening new rural outreach clinics, and 

expanding VA internet presence through YouTube, Facebook, and 

MySpace to reach younger veterans. 

I would like to thank all of the witnesses for taking the time to 

appear before the Subcommittee today. I look forward to hearing 

about issues you see and ideas you have for improving VA’s outreach, and relationships with the U.S. Department of Defense 

(DoD), State, local communities, and private organizations to help 

link veterans to VA services. 

Thank you, Mr. Chairman, and I yield back my time. 

[The prepared statement of Congressman Brown appears on 

p. 38.] 

Mr. TEAGUE. Thank you, Mr. Brown. At this time, we will recess 

to go vote, and we will come back as soon as possible after the 

votes. 

[Recess.] 

Mr. PERRIELLO [presiding]. At this time I would like to introduce 

the first panel. John Rowan, National President of Vietnam Veterans of America (VVA); Reynaldo Leal, Jr., Operation Enduring 

Freedom and Operation Iraqi Freedom (OEF/OIF) veteran and 

Representative of Iraq and Afghanistan Veterans of America 

(IAVA); and Richard A. Jones, Legislative Director of the National 

Association for Uniformed Services. You may please take your 

seats. Thank you so much for joining us today. Mr. Rowan, if you 

can please begin? 

jbell on DSKDVH8Z91PROD with HEARING

4 

STATEMENTS OF JOHN ROWAN, NATIONAL PRESIDENT, VIETNAM VETERANS OF AMERICA; REYNALDO LEAL, JR., REPRESENTATIVE, IRAQ AND AFGHANISTAN VETERANS OF 

AMERICA (OEF/OIF VETERAN); AND RICHARD A. ‘‘RICK’’ 

JONES, LEGISLATIVE DIRECTOR, NATIONAL ASSOCIATION 

FOR UNIFORMED SERVICES 

STATEMENT OF JOHN ROWAN 

Mr. ROWAN. Good afternoon, Mr. Chairman. 

Mr. PERRIELLO. Good afternoon. 

Mr. ROWAN. And thank you very much. It is good to see everybody. We have submitted testimony which I will not read verbatim. 

I would just like to say a few words about this particular subject. 

And I had an opportunity to read my colleagues’ testimony and Mr. 

Michaud’s testimony, and the others. So I noticed that many of 

them are focusing on the efforts by the VA to reach out to the 

newer veterans coming back from OEF/OIF. And while we would 

agree that there has been a lot of activity in that regard, and that 

certainly the VA is doing a lot of effort to reach out to those veterans, we still have some concern, even, about how effective that 

is. But we must say just generally, for all the veterans that the VA 

is supposed to serve, we believe they are doing a woefully inadequate job. 

Certainly for my veterans, the Vietnam Era veterans, and even 

for the Persian Gulf veterans from 1991, war changed somehow. 

And even if we go back to the World War II period, or even World 

War I with the gassing of the veterans in World War I, and of 

course in World War II we saw the atomic veterans. But when it 

came along to Vietnam, we had strange exposures to Agent Orange, for us. For the Persian Gulf veterans, of course, had all of 

these crazy things going on between the sarin gas and the oilfield 

fires, and depleted uranium shells, and it was like a toxic wasteland over there, which seems to be hanging around, by the way. 

From conversations that I have had with some Iraq and Afghanistan veterans that seem to run into these same situations. And of 

course, they have had other situations added on with anthrax shots 

and other kinds of things. 

The real problem is that most of us who walked off the battlefield unscathed, and for some extent even those who may have 

been wounded or hurt but went through rehab and felt like, ‘‘Okay, 

I got wounded but now I have my prosthetic device, or whatever, 

and I can move on with my life,’’ did not realize that 30 or 40 years 

later we could have, literally, diseases affecting us from our exposure from 30 and 40 years earlier that are literally killing us. Vietnam veterans are dying at a very high rate. We have very high 

rates of diseases like prostate cancer, diabetes, non-Hodgkin 

Lymphoma, and lung cancer, and a myriad of other different cancers. The number of diseases is becoming significant. 

Because of this we created a Veterans Health Council. We will 

get each one of the elected representatives here a copy of this package. This Veterans Health Council is a group of health care providers in the private sector, academic institutions, advocacy organizations, some of our friends in the pharmaceutical industry, and 

others who have come together to try to explain to the private secjbell on DSKDVH8Z91PROD with HEARING

5 

tor that 80 percent of the veterans are being treated by them and 

not by the VA. And that these veterans are basically going under 

the radar and they do not realize that the person sitting across the 

desk from them, the patient that they are talking to, the man or 

the woman, may have suffered exposures from their military service that are now impacting their health. Or, that because of those 

exposures they need even more concern about certain areas of interest such as Prostate Specific Antigens (PSA) screenings. PSA 

screenings may be important to all us old guys that turn over 50, 

and for those of us who are even over 60, but it is really important 

for Vietnam veterans. Because we are three times more likely to 

get prostate cancer than our peers. 

So it is because of those programs and those problems that we 

are trying to create this program utilizing a Web site called 

veteranshealth.org. And we have created some fliers that we have 

worked with folks to reproduce. Not only to talk about the Vietnam 

veterans but also to talk about the Persian Gulf veterans and the 

OEF/OIF veterans. Because all of these veterans need to understand that they need to look at things many years after they get 

out. And so we would, we are really concerned that the VA needs 

to be forced to do the outreach that they say they do. And they 

need to talk not only to the new vets going home but to those of 

us who have been home as many as 40 years. And we are clogging 

the Veterans Benefits Administration (VBA), frankly, as much as 

the new kids with all of these service-connected disabled veterans. 

And so frankly, we call upon you and your colleagues in the Subcommittee to take a look at creating legislation in that regard and 

we would certainly be happy to answer any questions you may 

have. Thank you. 

[The prepared statement of Mr. Rowan appears on p. 38.] 

Mr. PERRIELLO. Thank you very much, Mr. Rowan. Mr. Leal? 

STATEMENT OF REYNALDO LEAL, JR. 

Mr. LEAL. Mr. Chairman and Members of the Subcommittee, 

thank you for inviting me to testify today on behalf of Iraq and Afghanistan Veterans of America the Nation’s first and largest nonpartisan organization for veterans of the current conflicts. I would 

like to thank you all for your unwavering commitment to our Nation’s veterans. 

My name is Reynaldo Leal and I served in Iraq as a Marine infantryman with 3rd Battalion 5th Marines. And during my first 

tour, I participated in some of the Iraq War’s heaviest fighting during Operation Phantom Fury in Fallujah. And after that mission 

was complete, I assisted in securing the first democratic elections 

in that city. 

I was deployed for a second time 8 months after my first tour 

and conducted counter insurgency operations along the Euphrates 

River. As an infantryman, I did my job well and performed my duties with honor. 

When I was discharged from the Marine Corps in February 2008, 

there were two questions I feared the most. What was it like over 

there? And, did you kill anyone? Anxious about returning home, I 

delayed going back to South Texas for as long as possible. I could 

jbell on DSKDVH8Z91PROD with HEARING

6 

not bear the thought of being around familiar faces, and that fear 

led me to push away those who cared about me the most. 

As my wife prepared for the birth of our first child, I struggled 

with flashbacks and painful insomnia, which spiraled into a debilitating depression that alienated my family and threatened my marriage. I knew that my wife was suffering as much as I was and 

that I was not the same person she had fallen in love with. Suicide 

was not an option for me. But every day made me more and more 

anxious. It turned out I was suffering from a devastating invisible 

wound, post-traumatic stress disorder, or PTSD. 

My struggle with PTSD left me dependent on the VA for mental 

health care. And since there is no VA hospital close to my home 

in Edinburg, Texas, I have to either travel 5 hours each way to the 

nearest VA hospital in San Antonio or take my chances at our local 

VA clinic. The lack of funding for a permanent VA psychologist at 

this clinic pits me against my fellow veterans of all generations for 

limited appointment slots. 

Unfortunately, my experience is not unique. According to a 2008 

RAND study, nearly 20 percent of Iraq and Afghanistan veterans 

are experiencing symptoms of PTSD or major depression, but less 

than half are getting adequate treatment. PTSD is a silent killer 

for this generation of veterans. Left untreated, it has the potential 

to destroy marriages, careers, and in far too many cases, lives. In 

January of this year, the U.S. Army reported that 24 soldiers in 

Iraq and Afghanistan committed suicide, a figure that surpassed 

all combat deaths in those two theaters combined. 

But numbers and statistics are only part of the picture. This new 

generation of veterans is being left to fend for themselves because 

of an antiquated system that cannot seem to find a way to reach 

out to them. There are not any visible outreach campaigns to get 

these young men and women through the door of their local VA facility. When I was struggling with PTSD, there was never a sense 

that the VA was trying to reach out to me, or that anyone even understood. For me, there was the Corps, and then there was nothing. 

I felt that I had been abandoned and the fact that I had served my 

country honorably meant nothing. I did not know about the claims 

system. I did not know about the 5 years of medical care for Iraq 

and Afghanistan veterans. And I did not know that there were others that were going through the same situations that I was. 

It was not until I saw IAVA’s ‘‘Alone’’ ad on television and joined 

communityofveterans.org that I felt someone was trying to reach 

out to me. It is the responsibility of the Federal Government, and 

the Department of Veterans Affairs, to make sure every veteran 

feels this way. 

But are we doing everything we can to reach out to the veterans 

who have done so much for us? The VA has taken some important 

steps, especially setting up suicide hotlines, but the answer is still 

no. We owe it to our veterans to provide the best mental health resources available and currently we are falling too short of that 

goal. By fully funding the VA health care budget 1 year in advance, 

we could provide a simple solution that would give VA hospitals 

and clinics across the country the ability to provide stable care for 

decades to come. With the ability to plan ahead, these hospitals 

and clinics could meet critical staffing and equipment needs so that 

jbell on DSKDVH8Z91PROD with HEARING

7 

veterans like me are not left waiting. President Obama recently reiterated his support for advanced funding of the VA health care 

and we are glad to hear it. With the strong support of the President, and bipartisan leadership of Congress, advanced funding can 

and must move forward this year. 

Real action cannot come at a more critical time. As we saw just 

last week with the tragic events of Camp Liberty, our servicemen 

and women are under an incredible strain. As a Nation, we must 

have the same emphasis on giving our veterans the necessary tools 

to readjust to civilian life as we have in giving them the tools to 

survive in combat. 

Make no mistake about it, the veterans of this country want 

nothing more than to become successful and productive Members 

of the society we fought so hard to defend. Thank you. 

[The prepared statement of Mr. Leal appears on p. 40.] 

Mr. PERRIELLO. Thank you so much for your service to this country, and for your service to this Committee today, with your testimony. Mr. Jones. 

STATEMENT OF RICHARD A. ‘‘RICK’’ JONES 

Mr. JONES. Mr. Chairman, Members of the Subcommittee, on behalf of the National Association for Uniformed Services I am 

pleased to be here today as you examine the veterans health care 

system and its outreach to veterans. Your work is critical to ensure 

that VA outreach strategies bring the best possible care to returning troops, and a seamless transition to their well-earned civilian 

life. 

Approximately 6 million veterans annually come to VHA for all 

or part of their personal health care. With the draw down of troops 

from the battlefield of Iraq, VA is likely to face increased enrollments. Through the last quarter of fiscal year, for example, 2008, 

over 400,000 Operation Enduring Freedom and Operation Iraqi 

Freedom veterans have used VA. And with passage of Public Law 

110–329 last year, VA likely will have expanded enrollment of 

newly eligible veterans. Those are the Priority 8 veterans. 

As we work toward enrolling these qualified veterans, who desire 

to do so, into the VA system, we must ensure that all veterans returning from combat areas are aware of, and if possible already 

signed up for, their 5 years of VA medical care. We recognize, however, that some long-term health conditions, such as post-traumatic 

stress disorder or Traumatic Brain Injury (TBI) may not manifest 

conditions until many years later. Therefore, we encourage further 

opening of access to sick and disabled veterans beyond the current 

5-year allowance. 

Recent Congressional successes in providing increases in VA 

spending present the Department with an opportunity to advance 

an awareness of VHA accessibility and a readiness to meet health 

care needs. We applaud all that has been done to date. However, 

we can do better. In some cases, a successful outreach can be a 

matter of life and death. Veterans need to hear that VA is part of 

our Nation’s commitment to them. They need to hear that with appropriate care they can tackle stress and get themselves back on 

track. 

jbell on DSKDVH8Z91PROD with HEARING

8 

Of course, there is financial cost to improve outreach. But if we 

do not make the investment and we do not make veterans aware 

of the benefits and services available to them, there is a hidden 

cost in lives lost, families disrupted, long suffering and homelessness, stress, and related problems for decades to come. We have 

learned that over the years. The Persian Gulf effort is one of those 

lessons. 

We urge the Subcommittee to continue its excellent work with 

other champions in the Congress to ensure resources are ready, not 

only for the provision of a veteran’s earned benefit but for the veteran’s awareness of these services as well. It is important that we 

do so. After all, these brave men and women have shouldered a 

rifle, risked everything to accomplish their mission and protect 

freedom and our own country from harm. 

As you know, Mr. Chairman, these brave men and women did 

not fail us in their service to country. They did everything our 

country asked and more. Our responsibility is clear. We must uphold our promises and provide the benefits they earned through 

honorable service in the military. Mr. Chairman, you and your 

Members of the Subcommittee are making progress. We thank you 

for your efforts and look forward to working with you as you work 

to protect and strengthen and enhance the benefits that we provide 

these great men and women. Thank you very much. 

[The prepared statement of Mr. Jones appears on p. 42.] 

Mr. PERRIELLO. Thank you, Mr. Jones, for being such a great resource and advocate with this Committee, in helping us understand 

ways that we can certainly improve and continue to hold feet to the 

fire and make sure we are reaching out to folks. 

Mr. Rowan, you referred to the outreach as being woefully inadequate. And Mr. Leal, your story in many ways both captures everything wrong and also captures some hope. Wrong in that no one 

was reaching out to you at first. Hope in that that IAVA ad was 

able to reach you. I have seen those ads; they are powerful. I have 

talked to returning OEF/OIF veterans in my district about those 

and other ads. 

The first question I have is, while we know the woefully inadequate side is there, what are the success stories we need to build 

on? What are the most successful examples of outreach that we 

need to be taking to scale either through the VSOs or directly 

through the communications of the VHA? 

Mr. LEAL. Well, I think from the young veteran’s perspective, 

IAVA and their ad campaigns, and communityofveterans.org, which 

is sort of like a Facebook for veterans, it really brings out what we 

do. We do not go to, at least the young veterans that I know, we 

do not go to halls, we do not do things that way, not this generation, not that it is a wrong way to do it. But we just do not, we 

communicate through the internet. We communicate through networks, through network sites and different things like that. So the 

fact that IAVA went electronically, they went out in the internet 

and they went out in TV ads and did their outreach in that way, 

really helped bring these new generation of veterans, these young 

veterans, and let them know that there was somebody out there for 

them. And let them know that they were not alone. And I think 

if the VA can look at somebody, or an organization, to try to outjbell on DSKDVH8Z91PROD with HEARING

9 

reach to young veterans, it would be IAVA and what they are trying to do today. 

Mr. PERRIELLO. And a quick follow up before we go to Mr. 

Rowan. Is your sense that those are going to be better run in terms 

of tone, and a type of engagement, if they are independent but supported by the VHA? Or would you encourage that kind of online 

outreach, including the social networking functions, within the 

VHA itself ? Do you think that these organizations are going to be 

better able to build that kind of networking? 

Mr. ROWAN. Well I would think that even some of us old dogs 

learn some new tricks. And you would be surprised. It is amazing 

to me how many of my members have Facebooks and all kinds of 

things, and do use the internet. And, as I said, we created a Web 

site called veteranshealth.org. We are hoping to reach out and get 

our members, get veterans out in the public sector out there to 

reach out to learn about the illnesses that affect them from all the 

recent wars. 

IAVA did a wonderful program. The thing is that the VA should 

have doing that program instead of IAVA. I mean, they were just 

lucky enough that someone was willing to give them a grant, and 

they were able to produce a very nice public ad that certainly has 

reached out to their colleagues. It is just sad that they had to rely 

on public sector, private-sector donations to do that. Meanwhile, 

the VA spends billions on health care, does nothing on outreach. 

And we think that is wrong. 

And we think we need to reach out to our veterans. When we 

talk about suicides, I still have Vietnam veterans committing suicide. And we would, nobody knows how many Vietnam veterans 

killed themselves within the first few years after the War. I know 

personally, one of my things that I always say, I knew more people 

who died after the War than in the War. And a lot of that had to 

do with drug abuse but a lot of that drug abuse was fueled by 

PTSD. And was really trying to kill themselves in other ways. 

So I would just encourage, again, as part of our ideas of getting 

some sort of legislation out there, some sort of funding, either 

through the VA directly or by the VA through VSOs or communitybased organizations, to do the kind outreach we need to reach out 

to all the veterans, whether they came home 40 years ago or 40 

days ago. It does not really matter. 

Mr. PERRIELLO. Mr. Rowan, following up, the VA has discussed 

their collaboration with veterans services organizations, an effort 

aimed at expanding their outreach, has the VA really been working 

with the Veterans Health Council? 

Mr. ROWAN. No. 

Mr. PERRIELLO. Following up on that, what would you say is 

your vision of a comprehensive VA outreach effort? What does that 

dream, comprehensive effort look like? 

Mr. ROWAN. Well, I think we need a couple of things. We need 

to talk about educating medical personnel, both inside the VA and 

in the private sector, about veterans health-related issues. Getting 

them to understand they have to ask the question, ‘‘Did you serve 

in the military?’’ of men and women, of course now today given the 

high percentage of women. And then depending on the answer, 

have to then ask follow-up questions depending on where they 

jbell on DSKDVH8Z91PROD with HEARING

10 

served, when they served, what kind of work they did, how much 

they could be affected by PTSD, for example. All of those things 

that a doctor should ask of anybody. When they ask you, for example, what did you do for a living? If you may have been exposed 

to certain asbestos, or something, if you were in a particular line 

of work. Or worked in an area that was really polluted, or secondhand smoke. Just like any other patient they need to ask those veterans, the 80 percent of them that are sitting today, going to a private-sector physician, who I guarantee never asked them the question and in their patient history has no questions about military 

service. That is what we need to do. And the VA needs to do that. 

And inside the VA, frankly, they need to do that better. They need 

to do the patient history that they do not take as well as they 

should. So even inside the VA they do not ask enough questions 

about combat exposure, for example. 

Mr. PERRIELLO. Mr. Jones, similarly to you, when you think 

about what a comprehensive VA outreach effort could look like, the 

gaps that are not being filled right now, what do you see as part 

of that vision? 

Mr. JONES. Well, I hate to look backward into history but there 

was a time at the VA when there was an enormous number of folks 

who were enrolling in the Veterans Health Administration that 

had to be cut off. That cut, when they made that ban and prohibited certain veterans from seeking service in the system that was 

developed for them, has sent a shock signal into the veterans community. That has to be overcome. But we still recognize that today, 

though, VHA serves uniquely some 6 million veterans, nearly 8 

million veterans are enrolled in the system. So at one point, VHA 

was doing a credible job of reaching out to veterans and letting 

them know about the availability. But recent decisions within the 

past decade have put a dent in that message. That message has to 

be recaptured and that would be my vision. I think the VHA, the 

medical centers, have done an extraordinarily good job in the past, 

but they have been handcuffed in the most recent past from searching out veterans and doing it through the stand downs that contribute to bringing veterans in from their homelessness. These are 

areas where VHA and the Veterans Affairs have been most helpful 

in making veterans aware of the services provided in the health 

care system. 

Mr. ROWAN. I would like to add something to that, too, about the 

Category 8s, which I think is extremely important. Yesterday’s 

zero-connected disabled veteran may be tomorrow’s service-connected disabled veteran. And I am the classic example of that. I 

had, I never had a service connection, ever, when I walked away 

from the Air Force 40-some odd years ago. But I am now a 90 percent disabled veteran because of diabetes related to my connection 

to Agent Orange, having served in Vietnam, and my neuropathy, 

and other secondary conditions. So I went from a zero to 90 overnight, at the age of, it should have been 48, by the way, which is 

when I first got diagnosed with diabetes. But it was not until I was 

almost 58 when they finally gave it to me as a presumptive disease. So that was a big mistake, as was pointed out earlier. Because if they stay in the system, and they should be aware of 

things. But even then, I, when I was doing service rep work, had 

jbell on DSKDVH8Z91PROD with HEARING

11 

clients who were being treated by the VA for diabetes, who were 

Vietnam veterans, and the VA never told them, ‘‘By the way, go file 

a claim for a service-connected disability.’’ 

Mr. PERRIELLO. In terms of the outreach that is going on right 

now, there is a certain amount of urgency in the sense that, in the 

Vietnam era, people were not treated early and cases became exacerbated because of the lack of care. Given the urgency with the 

folks coming home, what are the programs that are easiest for us 

to take to scale right away in terms of getting that outreach going 

right now? 

Mr. ROWAN. I will just add that I think that one of the programs 

that we have seen that is starting to reach out is reaching out 

again into the private sector, particularly in the mental health 

community. The other thing is we need to talk about the whole picture, of the family of these veterans. Many of these veterans today, 

unlike my generation when most of us were single, most of them 

today are married. A lot of them have children. You need to have 

a family practice, almost, to deal with the mental health issue that 

is occurring. Because it is not just the veteran. It is the veteran 

and the impact to their family. It is the wife or husband, for that 

matter, who has been sitting home for a year, dealing with all the 

family issues, etcetera. It is the children who are dealing with an 

absentee parent for a year. And also, coming home with, you know, 

Daddy or Mommy who is not quite the same as when they left. And 

so the idea of working with community-based mental health programs, and taking care of the whole family picture, would go a long 

way to doing that. Especially with the fact that so many of these 

veterans today are from the rural communities. And as Sarge said 

here, he had a tough time finding one near him because of rural 

Texas. It is a hard place, and rural upstate New York is in the 

same ballpark. Or Montana. Everywhere you go. Arkansas. You got 

it, it is going to be a tough time finding help. 

Mr. PERRIELLO. Well I have a lot of rural Virginia in my district 

and we have similar issues. Let me just ask one last question, Mr. 

Leal, to you. You know, coming from the ‘‘just say no’’ generation 

myself, there is a big difference between the effectiveness of the 

early anti-smoking ads that were written by adults and the later 

truth campaign ones written by actual teenagers in terms of effectiveness. How much of the problem right now is that we are simply 

not getting the message out? How much of it is that the message 

is not being written in a way that really connects with the younger 

generation of veterans? Do we do a good job of getting the message 

out, we just need better message delivery? Or is it both? 

Mr. LEAL. I think it is a little bit of both. It has to be better. If 

your only message trying to get out to this generation of veterans 

is written on a pamphlet that is inside the VA clinic, how are we 

ever going to get it? How are we ever going to find it? How are we 

ever going to know about it? Unless 1 day somebody comes up to 

us and says, ‘‘Hey, you need help.’’ And by that time, where are 

we? In what position are we by that time when somebody actually 

approaches us and says, you know, ‘‘Ray, you are not the same guy 

I knew before you left.’’ Is that, that is the point where we have 

to actually go into the VA, where we see that it has been enough. 

And that is where we find the pamphlet. It cannot be that way. It 

jbell on DSKDVH8Z91PROD with HEARING

12 

cannot continue that way. It has to be, it has to be before we go, 

when we come back, and everywhere in between. We have to be, 

there has to be something there to remind our veterans and to remind us that we are still, we are wanted and that people understand where we are coming from. And that there are programs out 

there to help us. Without that, you are going to continue seeing 

what you are seeing. If you continue to write pamphlets that are 

inside the facilities where we will never be able to see them unless 

we go. 

Mr. JONES. The best institutions that are ready, shovel ready so 

to speak, for making veterans aware of the system are the veterans, the health care system itself. But there must be incentives 

there. What incentive is there for a medical care center to reach 

out to the veterans community to bring in additional veterans if 

they themselves are already stressed, if they lack doctors, if they 

lack the care, if they do not have the ability to hire caregivers. You 

need to get the hiring in place and to assure these communities 

that you will back them up. That the resources will be there if they 

will help make veterans aware that the system is ready to help 

them. 

Individuals serve the system. And individuals, if you just pack 

too many demands on top of them, will break. So you have to have 

additional resources and personnel to reach out to veterans as well. 

The best system in place now to do the job is the veterans health 

care system. They can do a great job but they lack the incentive, 

until they have the resources in order. Now, Congress has done a 

terrific job over the last 3 years in pumping up the resources and 

making veterans and veterans health care a priority to this Nation. 

We applaud you for that. So perhaps those resources are there. But 

I do keep reading about doctor shortages. And those doctor shortages are not only lacking in the overall community but they are 

missing in the veterans health care system as well. 

Mr. LEAL. If I may say something about that, sir? That is exactly 

why advance appropriations is so important. If we cannot even 

make sure that we have enough people to take care of these veterans that you want to outreach to, where is the VA going to be? 

How can they, how can they set money aside to outreach if they 

cannot even set money aside to make sure that there are two more 

psychologists at my clinic? I think that is important. That is why 

advance appropriations is so important. If you force the VA to outreach and they just continue to, I guess, shred medical records because they are getting all these people coming in and they cannot 

really adequately treat them, we have to see that it is more than 

just outreach. It has to be an overarching strategy to make sure 

that everyone gets the care they absolutely need. 

Mr. PERRIELLO. With that, let me turn to my colleague Mr. Snyder and see if he has any questions for the panel. 

Mr. SNYDER. Thank you, Mr. Chairman. I will just ask one. I 

know we got behind with votes and you have other panels. If I am 

trying to sell cars, I figure my best target to sell cars is the family 

that walks into my car dealership. It costs me a whole lot more 

money and a whole lot more effort to try to reach the person that 

is raking the leaves in their backyard, and I am trying to catch 

them with a radio ad or that night watching TV and they are falljbell on DSKDVH8Z91PROD with HEARING

13 

ing asleep. How much of this burden on outreach do you think 

should be on the military while the family is still in the military, 

in terms of informing them about veterans and veterans benefits, 

and what is available out there for them, versus how much should 

the burden be on the VA health care system after the veteran is 

out? 

Mr. JONES. Clearly the military system is an important element 

in making future veterans aware of what is available. The screening must occur. There must be, we would like to see a better 

screening of individuals as they leave. 

Mr. SNYDER. Right. 

Mr. JONES. We would like to see more information provided to 

families of what to look for with regard to various symptoms that 

may lead toward discovery of problems in health. So the families 

need to receive an awareness package of some sort. I am not sure 

exactly how families are brought into this transition, because the 

transition is usually military deployment to the demob base, and 

you are gone, you are out. And in instances of National Guard, you 

are far away from your family when that demob occurs. So I am 

not sure exactly how that works. But you are exactly right. The 

family needs to know what the symptoms are so they can help the 

individual that they love get back on track. 

Mr. ROWAN. I would add that that is true. And I think that they, 

the military, plays a heavy role. And we keep talking about the 

seamless transition issue, which would take the health records 

right out of the military into the VA. But the real problem still gets 

to be with this exposure question that often does not manifest itself 

until years later. 

I recently had a cousin of mine who is an Iraq veteran. He is 42 

years old. He was a seabee reservist, did two tours in Iraq. And he 

has now got a Hodgkin’s Lymphoma in his shoulder that he believes may be related to toxic exposure that he had dealing with 

toxic waste sites. Now that did not occur until 2 years after he was 

already back home, sitting back to work, back in his civilian life, 

you know, going to some meetings once in a while. But if he does 

not, if we do not have a continual education process over time they 

are not going to understand the connection between their military 

service and some of these things that do not manifest themselves 

until much later. And that is certainly true, it is obviously way too 

late for all of us Vietnam veterans, and even the Persian Gulf veterans. I mean, they are long out. Even the ones who were, many 

of them who may have been, you know, people who were, you 

know, 20-year and 30-year personnel, many of them are all still 

gone now. There is no Vietnam vets left hardly in the military, and 

there are very few even Persian Gulf vets left. 

So it is a big issue, still. And so while the seamless transition 

thing is a good thing, and certainly a major improvement over our 

day, and certainly made simpler, perhaps, by the utilization of computerization, it still does not get past the point, we still have to do 

a continuing education process. 

Mr. SNYDER. Thank you. 

Mr. PERRIELLO. I want to thank you all for your expertise, for 

your time, and for your service. Again, we really appreciate all the 

ideas you have brought to us. This is an urgent issue and we hope 

jbell on DSKDVH8Z91PROD with HEARING

14 

to be able to move forward on this and make a difference in the 

lives of those who have served our country. So with that, I dismiss 

the panel with our thanks. 

Now let me call the second panel. Bruce Bronzan, President, Trilogy Integrated Resources; Barbara Van Dahlen Romberg, Founder 

and President, Give an Hour; John King, Co-Director, Veterans 

Community Action Teams Mission Project, Altarum Institute; Randall L. Rutta, Executive Vice President, Public Affairs, Easter 

Seals; Jeffrey W. Pollard, Ph.D., Director of Counseling and Psychological Services, George Mason University, American Psychological Association (APA); accompanied by Michael Johnson, Military and Veterans Liaison, George Mason University. 

Mr. King, we will begin with you. 

STATEMENTS OF JOHN KING, CO DIRECTOR, VETERANS COMMUNITY ACTION TEAMS MISSION PROJECT, ALTARUM INSTITUTE, ANN ARBOR, MI; BARBARA VAN DAHLEN ROMBERG, 

PH.D., FOUNDER AND PRESIDENT, GIVE AN HOUR, BETHESDA, MD; BRUCE BRONZAN, PRESIDENT, TRILOGY INTEGRATED RESOURCES, SAN RAFAEL, CA; RANDALL L. RUTTA, 

EXECUTIVE VICE PRESIDENT, PUBLIC AFFAIRS, EASTER 

SEALS, INC.; AND JEFFREY W. POLLARD, PH.D., ABPP, DIRECTOR, COUNSELING AND PSYCHOLOGICAL SERVICES, 

GEORGE MASON UNIVERSITY, FAIRFAX, VA, ON BEHALF OF 

AMERICAN PSYCHOLOGICAL ASSOCIATION; ACCOMPANIED 

BY MICHAEL JOHNSON, MILITARY AND VETERANS LIAISON, 

GEORGE MASON UNIVERSITY 

STATEMENT OF JOHN KING 

Mr. KING. Thank you, Mr. Chairman, Mr. Snyder, staff. We appreciate the opportunity to testify to you today. With me today is 

Dr. Lauren Thompson. She is a Deputy Group Director and a corporate sponsor of an innovative initiative titled Veterans Community Action Teams. I will further describe that. We call it VCAT. 

I will describe that in my testimony. Mr. Lincoln Smith, the Chief 

Executive Officer of Altarum Institute sends his greetings and regrets he could not be here with you today. He applauds your leadership in taking care of veterans and their families. 

Altarum is a nonprofit health systems research consulting organization serving public and private clients. The Institute combines 

research and analysis with business acumen in providing comprehensive systems-based solutions for complex problems. Altarum 

is a nonprofit health systems research consulting firm. Last year 

they initiated three mission projects and committed $8 million to 

address childhood obesity, to foster innovations in community 

health centers, and to develop veterans community action teams. 

Since 2002, more than 870,000 servicemembers have transitioned 

from active duty to veteran status. They have joined the ranks of 

23 million veterans. The multifaceted needs of both young and 

older veterans have created large service requirements on the Veterans Health Administration. We commend the VHA for their valiant efforts to improve access while maintaining the high quality 

of care that veterans deserve. However, we believe that no one enjbell on DSKDVH8Z91PROD with HEARING

15 

tity can solve the complex problems of outreach to improve access 

to VHA services. 

Altarum’s focus through the VCAT project is to build integrated 

community-based service networks to strengthen the safety net for 

veterans and their families who are experiencing issues and/or suffering the invisible wounds of war. We strive to complement the efforts of VHA by building bridges for well integrated community 

service providers to the national level VHA providers. We envision 

VHA’s outreach as a top down effort and the integrated community 

providers’ outreach efforts as a bottom up. 

We know that VHA uses the media, web-based tools, and holds 

public events to encourage access to their medical centers, CBOCs, 

and veteran centers, and more. Veterans and their families often 

seek a wide range of community services when they need assistance. They go to churches, community health centers, housing authorities, public assistance, and many other services. The coordination, collaboration, and integration of these service providers focused on the immediate needs and the rights and benefits of the 

veterans community will complement VA’s best efforts. 

The VCAT project will develop a collaborative community-based 

model to integrate the outreach and delivery of services for veterans and their families. The project will test this model in selective pilot communities to demonstrate the value of communitybased system of care for improving accessibility, scope, and quality 

of services available to veterans and their families. 

The strategies employed to connect the current generation with 

services needs to be different than those used with past generations, because the methods by which this new population receives 

and processes information is vastly different. Consistent with the 

previous testimony of Mr. Leal, and efforts of IAVA, we agree that 

networks of service providers must connect in like manner to the 

communication and social networks of the younger generation. 

Altarum recognizes the Nation’s indebtedness to the families of 

our country’s defenders. As mentioned before, the sacrifices of families are much greater than the general public either understands 

or appreciates. The well-served, well-informed family is better able 

to survive and thrive, and to assist their veteran Members when 

in need. 

While our overarching goal is to improve the lives of veterans 

and their families, it is also our hope that the model we develop 

and the lessons we learn from our demonstration project will help 

inform other communities. Ultimately, we would like the VCAT 

model of community-based service integration to be replicated in 

other communities across the Nation. We hope to serve and share 

with you the lessons we learn and offer policy and programmatic 

change that may lead to increased outreach and access to all benefits and services for veterans and their families. 

Thank you. That concludes my comments. 

[The prepared statement of Mr. King appears on p. 52.] 

Mr. PERRIELLO. Thank you, Mr. King. And my apologies for the 

personal disruption. Next, we will be going to Dr. Van Dahlen 

Romberg. 

jbell on DSKDVH8Z91PROD with HEARING

16 

STATEMENT OF BARBARA VAN DAHLEN ROMBERG, PH.D. 

Ms. ROMBERG. Good afternoon. Thank you for this opportunity to 

provide this testimony. As the founder and president of Give An 

Hour, a national nonprofit organization providing free mental 

health services to our returning troops, their families, and their 

communities, I am well aware of the many issues that now confront the men, women, and families within our military community. 

Our Nation is confronting an emerging public health crisis. Since 

the conflict in Iraq began, nearly 1.9 million servicemembers have 

deployed. Many of these men and women have deployed more than 

once, some as many as four or five times. As those who have fought 

will attest, everyone is changed by the experience. Some suffer 

physical wounds that require medical attention. Others suffer 

wounds of war that are not always easy to see. As a Nation, we 

must provide comprehensive, long-term care for all of those affected 

by their experience of combat, and we must embrace the reality 

that combat stress and other psychological consequences of war are 

normal human reactions. 

VA funding for the past 4 years is at unprecedented levels. We 

cannot assume that more money, more staff, more outpatient clinics, more Vet Centers, more clinics on wheels, and more organizational restructuring will enable the VA to meet the mental and 

physical health care needs facing this generation of combat veterans. This is a public health crisis that will take more than extended outreach. If returning troops are to truly and successfully 

reintegrate into our communities, then our communities must be 

involved in the solution. 

The issue is bigger than the efficacy of the VA’s current outreach 

efforts. The issue is, how can we systematize a broad range of services to sustain care for our veterans over the long term? Further, 

it is impossible to discuss this issue without also discussing DoD’s 

response to the men, women, and families who serve. While the VA 

and DoD operate as if there are two populations that require care, 

military personnel and veterans, there is really just one. Too many 

returning warriors get caught between the two systems and fail to 

receive the care they need, when they need it. 

No single agency, organization, or sector can adequately care for 

our returning warriors. I am proposing the development of a new 

kind of public works project and have outlined the support for such 

a program in great detail in my written statement. The need is 

clear: over 300,000 men and women have already returned from 

Iraq and Afghanistan with symptoms of severe depression or posttraumatic stress. Over 320,000 have suffered traumatic brain injuries. The Army calculates the current suicide rate is the highest in 

its history, a rate that is higher than the civilian rate. Seventeen 

percent of soldiers returning to War for another tour could have a 

traumatic brain injury. Many of our returning troops turn to substance abuse to ease the pain of wounds that they cannot see and 

they do not understand. Good kids end up in jail for crimes that 

no one believed them capable of committing. Divorce is on the rise 

in the military community, with about one in every five married 

servicemembers filing for divorce since 2001. 

There is a tremendous need for a full range of easily accessible 

mental health services for our veterans. Many live a great distance 

jbell on DSKDVH8Z91PROD with HEARING

17 

from formal VA services and many are reluctant to seek mental 

health services because of a perceived stigma. We need to develop 

additional education and treatment programs for servicemembers 

who suffer traumatic brain injuries. We need to develop programs 

that support employers who want to hire veterans, as well as veterans who want to be productive members of society. We need to 

develop programs specifically focused on the unique needs of 

women who serve, including programs that treat victims of sexual 

assault. We need to develop programs that train police, fire fighters, paramedics, and judges about veterans and the issues that 

come home with them. 

Our military culture promotes pride and inner strength along 

with self-reliance and toughness. Only through education and practice can veterans learn to face their fears and work through the understandable pain associated with the experience of war. Systems 

charged with providing care for those who serve, including the VA 

and DoD, have failed in their efforts to reach those in need. Both 

DoD and VA have been reluctant to forge critical relationships with 

community-based organizations that have developed over the last 

6 years. Opportunities have been missed for innovative collaborations that could have saved lives and healed families. 

The best solution is a new kind of public works project. We need 

a system that can streamline and simplify the process of providing 

and receiving all manner of care for returning warriors and their 

families within their own communities. We need a plan that ensures our communities are able to assist and support veterans and 

their families so that their lives are working for them. In 1933, the 

Public Works Administration in an effort to heal our Nation’s Depression-ridden economy. The goal was to heal our economy and 

ensure that our citizens were free to lead productive lives. Now we 

need to design and implement a similar public works project for the 

21st century that will weave together the resources needed to heal 

our military community and ensure that our military personnel are 

free to lead productive lives. 

But what do we need to do first? Bring together individuals representing organizations and entities that interact with veterans 

and military personnel. Form a group with these representatives to 

study efforts currently underway, including innovative and successful community programs. The primary task of this group will be to 

develop a plan that will serve to guide our communities throughout 

the country in their efforts to coordinate care. This group can assist 

with the implementation and the metrics needed to understand the 

success of this program. 

We have the resources, we have the vision and the commitment 

to ensure that our veterans and their families receive the care they 

need and deserve through a new kind of public works project. 

Thanks to the efforts of dedicated people working in and across our 

country we have the potential to create this based on these organizations so that we can provide comprehensive long-term care to 

those who serve our country. This is a historic and unique opportunity to harness our Nation’s resources and care for our military 

community. Thank you. 

[The prepared statement of Dr. Van Dahlen Romberg appears on 

p. 46.] 

jbell on DSKDVH8Z91PROD with HEARING

18 

Mr. PERRIELLO. Thank you very much, Doctor. And now, Mr. 

Bruce Bronzan. 

STATEMENT OF BRUCE BRONZAN 

Mr. BRONZAN. Thank you very much, Mr. Chairman and Members. I am Bruce Bronzan. I was a Program Director for Mental 

Health at the county level, and then a County Supervisor, and a 

California State Assemblyman with a 20 career in politics. I 

chaired the Health Committee and the Mental Health Committee. 

When I left elective office, I formed a partnership with Afshin 

Khosravi, who is behind me here in the audience, and we worked 

with the State of California with pilot projects called the Network 

of Care to try to do something different at the local level. Specifically, how do we get people more aware of all of the services that 

are available to them, regardless of the silo funds that connect to 

a given agency, Federal, State or local. The other way of looking 

at it is how do we connect a community more to the people in need 

within that community? There is actually a form of community organizing, county by county in the State of California. 

This project called the Network of Care turned out to be quite 

successful. A Network of Care for mental health was developed almost 8 years ago. It spread all over California almost instantly, 

and then around the United States. And now it is in almost 30 

States and some 500 locales. The Network of Care in aggregate 

reaches some 65 percent of the United States population and manages a total of 127,000 services that it serves up to people locally, 

in their own community. 

During the work on the Network of Care for mental health we 

became acutely aware of the severe strain that is being exhibited 

by both community mental health, DoD, and VA services for the returning soldier. And we were asked some time ago by Congressman 

Kennedy and Congressman Farr, friends of mine, and a number of 

veterans leaders and mental health leaders across the country to 

do one specifically for veterans. After 3 years of work, the first two 

State/national models are ready to go. Maryland’s has been 

launched about 4 weeks ago under the leadership of Lieutenant 

Governor Anthony Brown, who himself is the highest ranking elected official who is an Iraqi veteran. And this Friday at noon, in California, Governor Arnold Schwarzenegger will launch the California 

version of the Network of Care in each and every county in both 

States. 

So what I am here to show you is something very different. I 

know, Mr. Chairman, the title of this hearing. But what we are 

going to show you, and have been asked to show you, is something 

different. And that is, rather than looking at outreach through the 

lens of any given silo funded agency, look at outreach through the 

lens of a veteran and their family and what they need in the community in which they reside. It is a different model, but it is quite 

exciting. If we could turn on the screen? Okay. 

[Slide.] 

Mr. BRONZAN. What I am going to show you is the Los Angeles 

version, which is going to be officially launched Friday but you will 

see it ahead of everybody. This, by the way, in both Maryland and 

California, was a process that was quite extraordinary. The vetjbell on DSKDVH8Z91PROD with HEARING

19 

erans community and military leaders reached out across the space 

to the mental health community, and they joined hands to try to 

do something important regardless of their agencies’ parochial interests for the veteran. And I think you will see it had remarkable 

results. 

On this homepage you see Governor Schwarzenegger, Lieutenant 

Governor Brown will also appear in a couple of days on the Maryland site, but I could just play a moment here for you. Do we have 

sound? Oh, we do not. Oh, do not worry. 

Okay, well what he does is he gives a greeting saying how important it is for us to pay attention to the returning soldier and how 

they cannot be neglected, and that we have to reach out as members of a community to anyone that returns from War. These other 

tour guides are all veterans from different conflicts, different theaters of war, different backgrounds. Each one of them explains, as 

a veteran to a veteran, why it is important to use certain portions 

of the site. For example, the Vietnam veteran here, a good friend 

of ours down in San Diego, explains that when you are in crisis, 

you need help, it is okay to seek help and to deal with whatever 

situation you are facing right at that moment. Andre here, another 

good friend of ours from another part of the State, the Bay Area, 

talks about the fact that there is no shame in seeking shelter if you 

do not have it. Do not sleep out under the bridge, get some help. 

They direct the veterans who, or their family members who come 

to the site, to these buttons right here as the most important services that the site offers. 

With one click, this is every single crisis intervention that is 

available, regardless of agency, in their own community, community by community, starting with the suicide prevention hotline. 

Relative to homelessness, it is every single shelter and homeless 

provision in their own community, with one click. Relative to employment assistance, there is not only every single agency that 

serves veterans relative to employment, we have a partnership 

with VetJobs, a remarkable organization, headed by a veteran himself. And what we do is collaborate with this organization. They 

seek out jobs that are available to veterans, specifically for veterans. And what we do is bring it into each individual local community. So a veteran can choose a particular category, click search, 

and what is brought up into this window are the actual specific 

jobs that are currently, that day, available to veterans that they 

can find in their own community. It is quite a remarkable service. 

To the best of my knowledge it has never existed in our history before. 

Last, the fourth button that is on the homepage connects the person with whoever their county veterans services officer, often people extremely knowledgeable in helping them navigate the system. 

However, many of our returning soldiers simply do not know who 

they are or how to contact them. We put the name, the address, 

the phone number, and the email address with one click. 

Relative to the rest of this homepage, there is community announcements. We allow, we give a tool to the community mental 

health director as well as the veterans service officer where they 

can post up information directly, 24 hours a day, to their own community. Nationwide news from around the country, we cull through 

jbell on DSKDVH8Z91PROD with HEARING

20 

about 2,000 periodicals and post the top articles up every single 

morning at 6:00 eastern standard time. Exquisite translations that 

are both hand and culturally perfect, as well as audio/video presentations of those translations for family members who may not have 

literacy in a given language. 

The main content of this site is in these huge portals here. By 

the way, in spite of the fact of it being rather clean and simple 

looking, these are very, very deep sites. This took a great deal of 

work locally. The site you are looking at is about 250,000 pages 

deep. There is about 3 million lines of code that run it, and it is 

upgraded every single day. In the service directory, the service directory is every single service, Federal, State, and local, every not 

for profit, community-based organization, non-Government organization at the Federal level, every single thing in the United States 

and in that community. If you notice the search engine, it does not 

really care what agency it is from, what silo fund, or what bureaucracy it belongs to. It goes by what a person needs. So, as you drill 

down into these categories, you find everything that is relative to 

that particular concern and it is refreshed on a regular basis. 

When you get to an actual file, with one click you could drop that 

file into a personal health record. In the library section-oh, by the 

way, I am really sorry, I want to show you this. Just before we got 

started, we were approached by Military OneSource and a variety 

of organizations that formed together to form a joint family assistance program. We said, ‘‘We would be glad to help you. What is the 

situation?’’ They said, ‘‘Well, we have great programs but nobody 

knows we exist.’’ Which is something that we have heard all over 

the country. So what we have done is integrate their information 

into, with one click, into this site. And here are all of these family 

support programs with 24-hour hotlines and for the first time they 

can be broadcast into each and every local community for people 

to find that they are there. 

The library function is a huge library. It took a great deal of 

Maryland’s and California’s money to build it. It has 4,000 topics 

and some 35,000 separate articles. If you were to print it, it would 

be about 50,000 pages long. And if you were to print it, it would 

be that long. And it is refreshed four times a year. 

Mr. PERRIELLO. Can you wrap up in the next 30 seconds? 

Mr. BRONZAN. Yes, thank you. We have a full blown social networking program that is commercial free, a legislative advocacy 

tool, every assisted device that is made in North America, every 

link in the United States that is not-for-profit or Government sponsored, some 20,000, and a full blown HL7 certified personal health 

record that is a consumer-based record, not a provider-based one. 

Thank you, Mr. Chairman. 

[The prepared statement of Mr. Bronzan appears on p. 45.] 

Mr. PERRIELLO. Thank you very much. Mr. Rutta? 

STATEMENT OF RANDALL L. RUTTA 

Mr. RUTTA. Sure, thank you, Mr. Chairman. It is a pleasure to 

be here today to speak on behalf of Easter Seals. Easter Seals, like 

the VHA, actually has a significant interest in helping our veterans, particularly veterans with disabilities. We are concerned 

about the thousands of injured servicemembers that are returning 

jbell on DSKDVH8Z91PROD with HEARING

21 

every month to this country looking to reintegrate into the community and lead their lives successfully. We are also concerned about 

other veterans who are working, they are raising families, they are 

aging in place, veterans of past conflicts, who have service-connected disabilities and other needs, and could use our help. We 

very much appreciate the good work of the VHA and the Veterans 

Affairs Department overall. Their broad spectrum of public benefits 

and private supports that are available to veterans is impressive, 

but we know that at any given time there are veterans with needs 

that fall through the cracks that are not getting the services they 

need, when they need them, where they need them. 

We do recognize that the VA is vast and complex. It is charged 

with an enormous responsibility, a large mission, a large and diverse constituency. And like any organization, be it the VA or providers like Easter Seals, that presents some challenges that can be 

daunting. You need to overcome fragmentation, bureaucracy, selfcontained service strategies, all of which really stand in the way 

of person-centered, veteran-centric, readily and consistently available services. We did note that in 2007 the GAO commended the 

VA for its work anticipating the needs of OEF and OIF veterans. 

But we saw and have shared in our concerns the VA not necessarily really reaching out to veterans in a way that they truly 

understood the services that where available to them; assuring that 

there was equal access, particularly in areas like rural areas where 

their facilities might not reach; and also were better at noting the 

implementation of infrastructure as opposed to services being delivered or the utilization of that infrastructure. 

For 90 years Easter Seals has served people with disabilities including veterans and their families. We serve about 1.3 million people every year, including veterans. And actually just this past 2 

years, we have really made a concerted effort to reach out and 

identify veterans much in the way those other members of the previous panel and this panel have said is important. Communitybased agencies absolutely have a role to play as a partner with the 

VHA, as an extender of their reach, and as an information resource 

that they can benefit from. 

Now we understand that as veterans fall through the cracks this 

is nothing new. People with disabilities oftentimes fall through the 

cracks. What we do not want is for that to continue to happen for 

veterans. It really is unacceptable. Let me just share a few things 

that are captured in our statement but I would like to have you 

note right now. 

Obviously no one organization can be all things to all people, and 

so my most important point would be to the VHA, to the Veterans 

Affairs Department, and to Congress in its role supporting that 

agency, please do everything possible to engage the community and 

the resources within the community to leverage infrastructure, tap 

best practices, build capacity and share, in the same way that the 

VA is a tremendous resource with regard to medical education, in 

the same way the community can be a laboratory, a pilot test, a 

partner, in helping veterans, particularly those with disabilities. 

Easter Seals supports the Gateway Initiative that was launched 

by the VA under former Secretary Peake. As far as we know, this 

initiative is still in place. It is an attempt to put a liaison office in 

jbell on DSKDVH8Z91PROD with HEARING

22 

place at the VA for organizations like Easter Seals to know who to 

talk to to better understand what are the current priorities, what 

are the activities, what kinds of things might we do to support and 

echo the good work of the VA. And so we would encourage the VA 

to continue to fully implement and support that Gateway Initiative. 

We also see that the VA has implemented 50 mobile clinics, primarily dedicated to helping veterans, particularly those living kind 

of far afield from the facility-based systems, with their mental 

health services. Easter Seals and others have offered to host those 

VA clinics when they come into town, be a partner in outreach 

making sure that enough people know about those services that 

they are fully utilized. And then be present in the community when 

that mobile clinic leaves so that those veterans and their families 

have continuity of care, some follow along services, a way to connect back to the VA that provided those services originally. 

We applaud the VA and the VHA for its efforts to reach out to 

younger veterans in ways that are meaningful to them. They are 

doing great things with regard to their Web site and leveraging social networking tools, much as we are trying to do as a nonprofit 

organization. We also say probably the most important thing we 

found is that to connect with veterans you have to reach them 

early, you have to reach them in the context of their family. These 

individuals respond very well to us when we engage in pre-deployment and post-deployment activities, and we are there as the individual transitions from military service. And so they recognize us 

as partners and friends to them bringing them into the VA system 

as a collaborator. 

So I would just encourage you to keep the community-based systems very much in mind as something for the VHA to reach out 

to, to partner with, contract with, outsource, and leverage in whatever way possible. We will certainly be there as a partner and a 

friend. Thank you. 

[The prepared statement of Mr. Rutta appears on p. 55.] 

Mr. PERRIELLO. Thank you so much, Mr. Rutta. Now we will go 

to Dr. Pollard. 

STATEMENT OF JEFFREY W. POLLARD 

Mr. POLLARD. Mr. Chairman, please allow me to express appreciation for the opportunity to speak on behalf of the 150,000 members and affiliates of the American Psychological Association regarding outreach activities for veterans on college campuses. I am 

the son of a decorated World War II veteran captured on December 

7, 1941, released in September 1946, and buried in Arlington National Cemetery. I have spent 30 years working as a psychologist 

committed to the mental and behavioral health of students on college campuses. Meeting the needs of increasing numbers of our Nation’s veterans, particularly on college and university campuses, is 

extremely significant to me. 

Our ability to diagnose and treat combat-related mental and behavioral health problems, including depression, traumatic brain injury, and post-traumatic stress disorder, has improved dramatically 

in recent years. Estimates suggest that between a quarter and a 

third of all veterans returning from Operation Enduring Freedom 

and Operation Iraqi Freedom will display symptoms of mental disjbell on DSKDVH8Z91PROD with HEARING

23 

order within a year of leaving military service. Many of these veterans are expected to benefit from the new Post-9/11 GI Bill by furthering their education at our Nation’s colleges and universities. 

These facts point to the important role that colleges and universities must play in our national efforts to meet the mental and behavioral health needs of our servicemembers and veterans. 

During the past year, George Mason University has been involved in a number of important activities to enhance our outreach 

to military personnel and veterans on campus. First we hired Mr. 

Michael Johnson to serve as our full-time Military and Veterans Liaison in our Military Veterans Office. Mr. Johnson, who has accompanied me here today, is a veteran of 17 years, both as an enlisted 

member and an officer in the United States Marine Corps. Mr. 

Johnson and his colleagues in the Military and Veterans Office currently serve approximately 1,000 active duty, Reserve, National 

Guard, and veteran students, offering assistance and information 

regarding issues such as veterans services and academic counseling, as well as information about the many benefits to which 

they are entitled through State and Federal Government programs. 

In addition, George Mason University has recently completed a 

needs survey of our military and veteran student population and 

established connections between the new Military and Veterans Liaison and virtually every component within the University. We 

have also established the Mason Military Outreach Group, which 

is a collaboration of students, faculty, and staff in support of our 

servicemembers, veterans, and their families. Further, the Mason 

Veteran Peers Initiative involves a group of veterans who are working with counseling and psychological services to provide peer support to veteran students. 

Last month, George Mason University was one of only 20 institutions of higher education awarded a Success for Veterans Award 

Grant sponsored by the American Council on Education and the 

Walmart Foundation. This $100,000 grant will help George Mason 

University Military and Veterans Office evolve further into a compliance-coordinated one-stop resource and support center to ensure 

academic, psychological, and transition support. We are grateful for 

this award. However, like most grants it will not cover the predicted level of need and it is time limited. 

Just as the community mental health system is stretched far too 

thin, so are college and university mental health resources. In fact, 

campus mental health faces significant systematic challenges, including an insufficient number of service providers, such as psychologists, psychiatrists, and case managers. Data indicate that 

students on college and university campuses are increasing arriving with more severe preexisting mental and behavioral health patterns, or develop these health concerns during their college careers. 

The increasing civilian mental and behavioral health needs on 

campus make it even more challenging for colleges and universities 

to provide sufficient services and support for the growing population of servicemembers and veterans on campus. 

While we at George Mason and our colleagues at colleges and 

universities around the country have been taking important steps 

to reach out to servicemembers and veterans on campus, much 

work remains ahead. I would like to provide a few recommendajbell on DSKDVH8Z91PROD with HEARING

24 

tions that may help our institutions of higher learning meet the 

mental and behavioral health needs of our military and veteran 

student population. 

First, sufficient resources must be made available to support targeted efforts on campus to address mental and behavioral health 

needs among servicemembers and veterans, including the concern 

of suicide. In recent years some, important Federal initiatives have 

been created through the Substance Abuse and Mental Health 

Services Administration (SAMHSA) to address the national problem of increased mental and behavioral health concerns on campus, 

including suicide. However, much more needs to be done. 

Senators Durbin and Collins and Representative Schakowsky 

have recently introduced the Mental Health on Campus Improvement Act and its programs will complement SAMHSA’s Campus 

Suicide Prevention Program to offer the full range of prevention 

and intervention services currently needed on college and university campuses. In addition, this legislation calls on grant applicants 

to include a plan, when applicable, to meet the specific mental and 

behavioral health needs of veterans attending institutions of higher 

education. 

Second, continuing education and training opportunities must be 

readily available for colleges and university mental and behavioral 

health professionals regarding some of the unique deployment and 

reintegration issues facing servicemembers, veterans, and their 

families. Both the Department of Defense and the Department of 

Veterans Affairs have unique knowledge and expertise in this domain. 

I recently had the privilege of attending a week-long training 

conducted by the DoD’s Center for Deployment Psychology, in 

which leading experts in the field provided clinical training regarding the deployment cycle, trauma and resilience, behavioral health 

care for the severely injured, and the impact of deployment on families. These are high quality programs and are worthy of continued 

attention and support. 

Third, we must develop mechanisms to conduct appropriate outreach to servicemembers and veterans who are beginning their 

post-secondary education online. Such online education opportunities may present unique challenges for our military and veteran 

students because of their potential isolating effect. Servicemembers 

and veterans who are enrolled in online education programs and 

experiencing mental and behavioral health problems are often 

more isolated than their on-campus colleagues, and this isolation 

can be contraindicated for their healthy readjustment and recovery. 

APA and the psychology community looks forward to continuing 

work with Congress, the VA, the DoD, and the veterans service 

community to welcome home our men and women in uniform, and 

to ensure that they receive the mental and behavioral health services and support on college and university campuses and in the 

larger community that they so honorably have earned. Thank you. 

[The prepared statement of Mr. Pollard appears on p. 59.] 

Mr. PERRIELLO. Thank you, Dr. Pollard. Congratulations to 

George Mason on the grant, and thank you for the heroism and 

sacrifice of your father as well. 

Mr. POLLARD. Thank you. 

jbell on DSKDVH8Z91PROD with HEARING

25 

Mr. PERRIELLO. Let me begin by asking a question of the panel. 

Many of you talked about the importance of the VA forming partnerships with the VSOs and other private groups to help reach 

more veterans, and community-based strategies. Could you say a 

little more about whether the barriers to that right now are primarily a cultural mindset? Is it bureaucratic and regulatory? Is it 

financial? And what specifically could the VA be doing better to develop those kinds of partnerships and community-based strategies 

you note? 

Ms. ROMBERG. I think it is all of the above that you mentioned. 

Maybe the least being financial, in terms of it has to start with 

conversations and dialog. And thus far, while in our case, our organization, initially the message was that the VA responded that 

they had it covered in terms of the mental health care. That was 

4 years ago. As time has gone on, we have developed a really nice 

relationship with the VA philosophically in terms of that we exist, 

and that we can be a resource. But there has been no systematic 

relationship formed so that throughout the country VA hospitals 

know about the free mental health services that our providers give. 

I think that it has, there has to be some conversations at the very 

top to change the culture, to open the doors. Not just with VA, but 

DoD as well, so that we can look at, I mean, just listening to this 

panel there are so many tremendous opportunities and organizations out there. Here in Maryland, there are some programs in 

Montana, in California, collaborative efforts. But they do not function together. No group or no State is able yet to access and speak 

to others in the other States so that we have a comprehensive system. 

So outreach is important, but if the people then do not know 

where to go from that initial point of outreach to the various organizations, the Easter Seals, George Mason University, for somebody with the GI Bill. So it really needs to be at the top level, that 

a change in culture and a structure needs to be developed so that 

we can knit these together. 

Mr. BRONZAN. Yes, I think it is a great question and it is a very 

important thing. I mean, in our work in these two States, county 

by county, we found two kinds of folks. There were some that were 

very inbred in their thinking that if they did not, whether it is VA 

or DoD or a private agency, that if they did not make it they did 

not want to do it. Or, if they could not control it they did not want 

to do it. And they did not really want to collaborate with anyone. 

But there are others who are, I think, of a much more newer thinking. That they cannot do it alone. They have to reach out and they 

have to work with other people, especially community-based organizations where people live. And it is that group that we worked 

with, and were fortunate enough in the two States because there 

was an outpouring of it. 

In fact, we had one State director, VA director, say to us that 

what he liked about the Network of Care as one model is that it 

was outside the VA and it was easier to connect with all the community-based organizations on behalf of the vet, which is a rather 

extraordinary comment that I am not sure you would have heard 

just a few years ago. So I think there is a new generation of thinking. And that thinking has to be encouraged and supported so that 

jbell on DSKDVH8Z91PROD with HEARING

26 

these two sides can reach across the space to each other and help 

the veteran in a more meaningful way. 

Mr. RUTTA. I would definitely agree with what has been said. I 

think two other perspectives. One, the Easter Seals really takes an 

individualized but family centered approach. And I think the VHA 

and the VA generally would do well to really look at the veteran 

in terms of the context of family, and how the family truly can be 

supportive and actually help the system overcome the resiliency 

training that many of these veterans carry from their military days 

where it is difficult for them to accept help, difficult for them to 

identify a problem. And so the extended family and organizations 

that they trust, like ours, can actually be a partner to the VA in 

that effort. But the VA has to recognize that important role of family in the holistic support of the veteran. 

The other piece would be for older veterans there is a lot of collaboration with the community-based organizations around adult 

day services. Although the Veterans Affairs Department and VHA 

does indeed offer adult day services themselves, they do frequently 

outsource that service within a tremendous amount of information 

sharing and mutual learning that occurs, which benefits the veterans and their families. There are some 1,300 other adult day centers that are out there that could really be a partner to the VA in 

maybe diverting some older veterans who might otherwise end up 

in VA supported nursing homes or in hospitals, helping them stay 

in the community. So reach out to the aging network, the Administration on Aging as a partner, in that natural other system of care 

that could be a partner to them. 

Mr. PERRIELLO. Let me ask a follow up question to that. You 

know, I represent a district that includes Charlottesville, Virginia, 

the University of Virginia, a very highly educated small town with 

a lot of hospital care. But it also goes to the North Carolina border. 

About two-thirds of my district is highly rural. How much of a discrepancy are you finding in interest in these strategies for, say, 

rural versus urban? And how much in terms of need are you seeing 

in geographical discrepancies? 

Ms. ROMBERG. Well there is a tremendous need in the rural communities. We are now developing State initiatives, and our first 

State initiative was with West Virginia because they have so few 

resources available. We are also working in Arkansas for the same 

reason. So the need, again, to develop a strategy to link together. 

That is what is missing. There has not been, yet, a strategy from, 

for our country to step up. This is not a VA issue. It is not a DoD 

issue. It is not a community-based resources issue. It is a national 

issue. And until we figure out a strategy and a plan to organize 

who is available in the rural communities—it is very doable. We 

are starting to look at that in States like West Virginia. Something 

very innovative, like working with the Council of Churches. Because they are who, those folks, the ministers, the pastors, they 

often see the veterans and their families first. But who do they contact to develop an approach in that way, is critical for those rural 

communities. Because there is not anyone there to provide services. 

Mr. BRONZAN. In our work, because we are statewide in many 

States, we are able to do surveys and learn some things. And it is 

very interesting, the Network of Care, looking at rural and urban. 

jbell on DSKDVH8Z91PROD with HEARING

27 

In the urban areas the sites are used more than all other mental 

health services in the county combined. But in the rural areas, 

they are used as much as three times as much as they are in the 

urban areas. And it is because modern internet technology is a way 

for people who are in rural, isolated areas to get information and 

to connect with other people. 

So it should never be underestimated, the value of internet technology, to gain information in the rural area. They use it very 

heavily. 

Mr. RUTTA. And I would just say for Easter Seals, because we 

are a nationwide organization, we have a special interest in outreach to rural residents with disabilities. In fact, almost 20 years 

ago, we worked with Congress to create a program called 

AgrAbility. It helps farmers and ranchers with disabilities. A significant percentage of those individuals are veterans. And what we 

found is, they frequently encountered the geographic barriers. They 

were not able to tap the VA services as often as they would like. 

And in some instances, those local VAs, often working through the 

State veterans office, would indeed engage Easter Seals or others 

in helping those veterans. And it would just provide some continuity, a watchful eye, someone to help that veteran and their 

family stay connected in a way that really benefited the larger organization. 

I know in Iowa our AgrAbility Program has got a contract with 

the VA to help do the home assessments and modifications. It is 

a wonderful role for us to play. It is a modest reimbursement to 

us, but critical, and that would be something we would like to see 

replicated. But what was mentioned on the panel is that that is 

often a case that has to be made, you know, medical facility by 

medical facility, very locally. It would be good to have that leadership from Central Office. 

Mr. POLLARD. In preparation for our conversation today, I spoke 

to my colleagues in counseling centers across the country using our 

listserv and asked them about their concerns. And it was interesting to hear from communities that are more rural and more separated having spent 23 years on a college campus that was quite 

rural before coming to Virginia. What I found was that there is tremendous concern on campuses that are distanced from resources 

that the Government provides, and that there is, that concern runs 

along these lines. One or two, three or four, veterans with high 

need could throw the resources in some of these colleges into a very 

difficult position. There is no way for them to really cope with some 

of the special needs that our returning veterans are displaying. 

And they are tremendously concerned. Some of the most heartfelt 

outreach from some of my colleagues came from places that talked 

about the fact that it may cost them literally thousands of dollars 

a week to accommodate a soldier who lost hearing because of a, you 

know, an explosion nearby. And these small universities are already on a very tight string, and that kind of cost puts them in a 

position where they are beyond their ability to, you know, the tuition does not take care of it. So they are very, very concerned that 

the returning vet on some of these campuses, especially with the 

GI Bill, is just not going to help. They are going to be going in negative territory. 

jbell on DSKDVH8Z91PROD with HEARING

28 

Mr. KING. The observation I would make is that, you know, the 

VCAT initiative is all about assessing communities, looking at the 

fabric of that community, the chemistry of the service providers 

that make services accessible to veterans. It was mentioned in the 

Network of Care and on the previous panel that one of the essential ingredients to a high functioning community is the accredited 

service officers, and the role they play, whether they are State, 

county, or national service organizations. And whether you are 

rural or urban, to be able to have veterans referred to someone who 

will serve as their legal advocate, develop a well-developed claim 

ready to rate, and produce the outcomes that basically requires the 

Federal Government, then, to perform. Those are pretty essential 

ingredients to sustainable outcomes for veterans and for the community. It is a return on the investment. If you cannot figure it out 

from here and here, let us help you understand from the pocketbook about how important it is to pursue the rights and benefits 

of veterans and their families. 

Mr. PERRIELLO. I really want to thank you all again for your contributions. I think it will be interesting to see, as Mr. King and Mr. 

Bronzan discussed the extent to which the internet does bridge this 

gap. Not just the establishment of a Web site but the interactive 

components of Web 2.0 technology, the social networking, telemedicine, and other issues, and how that may prove to be part of this 

conversation. Where it is not simply a producing of information but 

a dialog. We really appreciate all of your comments. Thank you for 

your time. And with that, I will dismiss the panel. 

Let me call up Paul Hutter, Chief Officer, Legislative, Regulatory, and Intergovernmental Affairs for the VHA; accompanied by 

Ev Chasen, Chief Communications Officer, Veterans Health Administration; John Brown, Director of Operation Enduring Freedom and Operation Iraqi Freedom Outreach Officer for the VHA; 

and Emily Smith, Deputy Assistant Secretary for Intergovernmental Affairs and the Officer of Public and Intergovernmental Affairs at the VA. 

Mr. Hutter, thank you for joining us. You may begin. 

STATEMENT OF PAUL J. HUTTER, CHIEF OFFICER, LEGISLATIVE, REGULATORY, AND INTERGOVERNMENTAL AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF 

VETERANS AFFAIRS; ACCOMPANIED BY EV CHASEN, CHIEF 

COMMUNICATIONS OFFICER, VETERANS HEALTH ADMINISTRATION; JOHN BROWN, DIRECTOR; OPERATION ENDURING 

FREEDOM AND OPERATION IRAQI FREEDOM OUTREACH OFFICER, VETERANS HEALTH ADMINISTRATION; AND EMILY 

SMITH, DEPUTY ASSISTANT SECRETARY FOR INTERGOVERNMENTAL AFFAIRS, OFFICER OF PUBLIC AND INTERGOVERNMENTAL AFFAIRS, U.S. DEPARTMENT OF VETERANS AFFAIRS 

STATEMENT OF PAUL J. HUTTER 

Mr. HUTTER. Mr. Chairman, thank you for providing me this opportunity to discuss VHA’s outreach activities to veterans. I am accompanied today by Emily Smith, Deputy Assistant Secretary for 

Intergovernmental Affairs; and to my right Ev Chasen, who is 

jbell on DSKDVH8Z91PROD with HEARING

29 

VHA’s Chief Communications Officer; and on my immediate left, 

John Brown, Director of the VHA OEF/OIF Outreach Office. 

VA’s mission is to care for those who have borne the battle, to 

honor those who have worn the uniform by providing them the 

highest quality health care and benefits available. This mission can 

only be accomplished when veterans know the full range of services 

we offer. VA is committed to reaching out to veterans and their 

families where they are to support these ends. This includes not 

only reaching into rural communities but entering virtual communities and establishing communications and connections there as 

well. 

Before I move on, Mr. Chairman, I want to say on behalf of the 

Department, I want to thank Mr. Leal of the previous panel for his 

service and his sacrifice, and appreciate this testimony and suggestions concerning outreach. I also thank Mr. Rowan, Mr. Jones, and 

Mr. Johnson for their service and their suggestions on behalf of 

veterans. And I also want to extend out thanks to the previous 

panel, the Members of the previous panel who are not veterans, 

who are still dedicated to their mission and to help us reach out 

to veterans in an effective way. 

My written statement, which I ask to be submitted for the 

record, highlights four forms of outreach. Direct outreach to separating servicemembers, program specific outreach, outreach to 

rural areas, and outreach using new technologies. In the few minutes I have now, I would like to show you some examples of the 

outreach we are doing and the new initiatives that we have underway. 

I would like to begin by showing two public service announcements (PSAs) that VA has produced and are currently airing across 

the country. The first features Deborah Norville, a two-time Emmy 

Award winner. The second features Gary Sinise, an Academy 

Award winner, whose portrayal of Lieutenant Dan in the movie 

Forrest Gump put an unforgettable voice and face to veterans returning from Vietnam. Mr. Sinise’s PSA is directed toward veterans, and Ms. Norville’s is aimed at the family members of veterans who may be in need of VA’s suicide prevention hotline. With 

the Chair’s permission, I would like to show those two videos now. 

[PSA video featuring Deborah Norville shown. Text of PSA video 

by Deborah Norville appears below:] 

‘‘You may be seeing warning signs of depression or suicide. Some of these 

warning signs can be that the veteran seems disconnected from family or 

friends, starts to give away prized possessions, displays anger or rage, or overreacts to problems. The VA is reaching out to help so please reach back. If your 

loved one is a veteran, and if you even think you see these warning signs, call 

1–800–273–TALK and press one. That is 1–800–273–TALK and press one. Do 

not second guess yourself. Reach out for help.’’. 

[PSA video featuring Gary Sinse was not shown due to technical 

difficulties.] 

Mr. HUTTER. Cannot get it to go? Okay. Mr. Chairman, the second PSA announcement from Mr. Sinise has in the last 6 months 

between October 13, 2008, and April 13, 2009, this PSA was broadcast more than 8,700 times by 155 stations in almost 100 markets. 

During this same time period, VA’s suicide prevention hotline received approximately 50,000 calls across the Nation, an increase of 

approximately 25 percent based on the previous 6 months. 

jbell on DSKDVH8Z91PROD with HEARING

30 

Last year, VA advertised the suicide prevention hotline on buses 

and Metro trains in the Washington, DC, area resulting in a significant increase in calls to the hotline from the area. This year we 

have begun advertising in Spokane, Washington, and will soon advertise on public transit systems in Miami, Los Angeles, San Francisco, Oakland, Phoenix, Las Vegas, and Dallas metropolitan areas, 

all locations where the suicide rate among veterans is higher than 

the national average. In addition, VA is working with a company 

to purchase advertisements on 20,000 buses nationwide. You have 

probably seen the advertisements VA displayed on Metro buses and 

railcars. Here are two pictures of our advertising in the Spokane, 

Washington, public transit system. 

So this, again, is focused on the suicide prevention hotline. In addition to these 20th century forms of outreach, VA has leaped into 

the 21st century by developing Web sites accessible to mobile devices, and by venturing into portions of the cyber community where 

veterans are most likely to congregate or visit. Thirty years ago 

VA’s outreach strategy was to visit the local VFW or, more recently, VVA halls. Today we post blogs and videos accessible to veterans wherever they are. 

We have two images of VA’s Web site as viewed on a mobile 

handheld device. So this is available on an iPod or something similar as well. First you can see an easy to use menu with information 

at the touch of a button. Second, you can see a news story, complete with image, that provides information to veterans about benefits or services that strike their interest. We understand veterans 

are busy and may need information on the go. So we are adapting 

our systems to meet their needs. These sites are available through 

any cell phone or other handheld device with internet access. 

The next slide provides a demonstration of VA’s presence on Second Life, a free, three-dimensional, virtual world where users can 

socialize and interact with one another. VA offers information and 

points of contact where veterans or family members can learn more 

about our programs. The following slide shows VA’s Facebook page. 

Here you can see images of VA’s winter sports clinic, a great 

venue for outreach and inspiration, where VA partners with our 

colleagues at Disabled American Veterans to support the rehabilitation of wounded or injured veterans. 

I am also proud to say that even bureaucrats can use YouTube. 

VA now posts videos with stories or services that impact the lives 

of veterans. 

And finally, Mr. Chairman, VA has also created a new Web site 

for returning veterans that provides useful information about eligibility, benefits, health care, and other services. This Web site features a blog with comments from veterans and family members. We 

recognize we must develop social networking strategies, including 

nontraditional outlets, and a wide variety of new media to communicate VA’s message about our services. 

I want to point out, Mr. Chairman, that on the right side of this 

you see what is called a panel, and the more visible areas are the 

ones that veterans have clicked on to get those services. And that 

gives us an indication of how many, I am told that the word is not 

hits but encounters, on that particular part of the Web site. 

jbell on DSKDVH8Z91PROD with HEARING

31 

The other thing I wanted to mention is that the social networking sites that I mentioned earlier are also available from this 

central location, this central Web site. 

These new technologies have entered into health care delivery. 

One VA facility has begun piloting a program that uses text messaging to help veterans send their home-based blood pressure readings to their clinicians. Researchers found veterans who used this 

text messaging achieved their blood pressure goals 2 weeks sooner 

than those who used other methods. 

More broadly, VA could not serve veterans to the degree it does 

without the immeasurable help of veterans service organizations 

(VSOs), faith-based, and community groups. I would like to thank 

the Committee for inviting Mr. Leal as well as the representatives 

of the other panels to share their views. Because we see these hearings as an opportunity for exchanging information and for listening 

to those who matter most to us, our veterans. 

VA maintains constant contact and holds regular meetings with 

VSOs and groups at all levels of the organization to provide information about VA’s programs and offerings while soliciting feedback 

about concerns present in the community. Working with these community partners helps significantly expand VA’s reach to millions 

of people who may not otherwise hear of our offer of care and service. 

In conclusion, Mr. Chairman, VA understands that different veterans will receive messages in different ways and at different 

times. It is our duty to notify veterans of the repayment our Nation 

offers in gratitude for the sacrifices they have made. We must continue programs that are successful and develop new methods when 

our current measures are insufficient. Our mission is to reach out 

to family members, employers, community stakeholders, Reserve 

and National Guard units, and veterans to make sure they know 

how to access help when they need it. 

Thank you again, Mr. Chairman, for the opportunity to testify. 

My colleagues and I are prepared to answer any questions that you 

may have. 

[The prepared statement of Mr. Hutter appears on p. 61.] 

Mr. PERRIELLO. Thank you very much to you, Mr. Hutter, and 

to your team for being here today. It is exciting to see that the VA 

is working hard on the new technologies and other areas to break 

ground. Let me ask a few follow up questions. One is, with the increase in calls to the call centers, this is obviously a very urgent 

topic to all of us. My understanding from your submitted testimony 

is that you have had over 660,000 calls, but only been able to speak 

with about 160,000 folks. What is the strategy for follow up being 

conducted with those that you do not reach? 

Mr. HUTTER. Mr. Chairman, I am going to defer that question to 

my colleague, Mr. Brown, who can address that directly. 

Mr. BROWN. Thank you, Mr. Hutter. Mr. Chairman, we started 

the call center, combat veteran call center, in May of 2008, that 

was directed by Secretary Peake. Our attempt was to go back to 

October 2001 for all of those individuals, OEF/OIF, servicemembers 

that have separated, since October 2001 through December 2008. 

We had a twofold purpose. The first purpose was to call the 

servicemembers that we knew were injured. And that amounted to 

jbell on DSKDVH8Z91PROD with HEARING

32 

about 15,600. They were either severely injured, or they were ill or 

impaired. The purpose of that was to call them to find out whether 

their case managers were doing the right thing by them, whether 

they were actually being seen on time, and to ask whether they 

had any other issues that needed to be addressed, such as benefit 

issues. All of these things were documented. The second population 

were clearly those who had separated and had not had an encounter with the VA health care system. That was the 550,000 population. 

To date, your numbers are correct. The numbers that we submitted are on target. Out of the 660,000 that we have attempted 

to call, we have spoken with 160,000. This does not include the 

messages that have been left on answering machines or messages 

left with loved ones. If you look at that percentage it is not 24 percent, it is 74 percent. 

Our leadership, to include Mr. Hutter, thought it would be best 

that we show real numbers, the veterans that we actually spoke 

with. That is important. The attempt now is to look for a search 

engine, a database that would review financial records, Internal 

Revenue Service (IRS) records, and update phone numbers, and we 

will try to call him again. 

Mr. HUTTER. Mr. Chairman, if I could add to that answer? One 

of the things that you may have noted in our written testimony is 

that we are reaching out particularly to Reserve and National 

Guard servicemembers as they return in an iterative way. As they 

come back, Mr. Brown and our colleagues at our 153 medical centers are reaching out to each of these Reservists and National 

Guardsmen and signing them up, if you will, by filling out an enrollment form, our 1010EZ. And they are filling that out as they 

come back. We are then taking those forms and Fedexing them 

now, soon to be sending them electronically, to the medical centers 

where they will receive care. Because as they come to a demob center they are not necessarily going to receive care in that particular 

locus. 

So the idea, then, is to sign them up as they come in. We have 

now approximately a 93 percent enrollment rate based upon those 

folks that have come back using either the demobilization process— 

strike that. The demobilization event, or the post-deployment 

health assessment event, or the post-deployment reassessment 

event. And these occur iteratively because of the fact that as the 

soldier, sailor, airmen, Marine, Coast Guardsmen come back they 

are not particularly interested immediately after they get off the 

airplane or train in signing up for VA health care. So what we do 

is we track them and hit them at iterative spots. So we get to the 

teachable moment when they are most poised to listen to our message and realize the benefit. 

Mr. PERRIELLO. Sticking, for a moment, with this issue of the 

new technology communication, your fourth category, what indicators are you looking at for whether this is actually working? Is it 

number of friends on Facebook? And also, related to that, to what 

extent is this largely hitting our most recent veterans versus Vietnam vets and others who are also accessing the same technology? 

Mr. HUTTER. Mr. Chairman, I am going to defer that question to 

Mr. Chasen who is VA’s guru of the web. 

jbell on DSKDVH8Z91PROD with HEARING

33 

Mr. CHASEN. Paul, I do not think I accept that title. But I can 

answer the question, sir. There are several measurements that we 

are using. The most important one is the American Customer Satisfaction Index, and you have seen these on Web sites. As you click 

on a Web site it asks, ‘‘Would you take a moment and take a survey for us?’’ We have that on all our Web sites. If you click six 

times, you reach the sixth click, you are asked to take a survey. 

We take those surveys very seriously. They provide us information 

both on customer satisfaction and on the kind of information that 

those who are looking at the Web site are looking for, and whether 

they have what we need. 

We have had, I think, mixed success. Our ratings, other Federal 

agencies do the same thing, our ratings are now in the middle of 

the pack. We certainly hope to do better and to continue to do better. 

As far as Facebook goes, our best measurement, and we have 

been live on Facebook for about 6 months but we have actually 

been publicizing it only for the last couple because of cyber security 

issues. We have 1,800 fans. We hope to get a lot more. I do not 

know what to judge that against, other than the entire population 

of veterans. But we do look at it. We are looking for continued increase, not necessarily a number. 

The other thing that you asked about is who is using it. The answer from ACSI is veterans of all ages. Some of our sites, the OEF/ 

OIF Web site, obviously, is for veterans of Iraq and Afghanistan. 

But what we found is that in our more general portals and information that we have a lot of Vietnam veterans, some World War 

II veterans and family members. Everybody uses the web now. It 

is not just something for our newest veterans. 

Mr. PERRIELLO. Well, 1,500 fans out of 23 million veterans does 

not jump off the page at me. I think I may have more friends than 

that on Facebook. But it is early in the process and I think looking 

at the strategies that have been more or less successful, and having 

some experimentation there is a good thing. 

If I can also ask the panel to address some of the concerns and 

frustrations that were raised in the earlier panels? And specifically, 

comment on the issue of more partnership with communities and 

community-based strategies from the last panel. 

Mr. HUTTER. Mr. Chairman, as the Easter Seals representative 

indicated, in the last Administration we attempted to create a collaborative relationship with many of the community-based organizations that offered help, but did not know exactly where and how 

to connect and how to provide that help. As a result, we created 

a gateway and an ombudsman position whereby that person would 

take the good efforts and offers from community-based organizations and would direct those organizations to where the VA could 

use that help the most. And although the new Administration is 

working on this it is a work in progress and a partnership in 

progress. But we have taken the first steps to get that organized. 

Mr. CHASEN. Mr. Chairman, if I could add, tomorrow morning, 

this evening I am going to get on a plane to fly to Houston. Tomorrow morning I am going to be speaking to VA’s great effort in collaborative work with communities and community organizations 

which is our voluntary service program. We do have 140,000 volunjbell on DSKDVH8Z91PROD with HEARING

34 

teers. We do have, I think the number is 59 organizations who 

work with us and provide volunteer support to our hospitals and 

clinics, and to veterans. We are very, very grateful for that. I am 

not sure it is the model for the new issues that were raised, but 

we certainly have long had a great deal of involvement with community organizations and groups. 

Ms. SMITH. I would also like to add, if I could, first of all prior 

to coming to VA I was, I am, a licensed clinical social worker and 

ran a community mental health center in rural Iowa. So much of 

what our panel spoke to I related to from my prior experience. 

I have only been at VA for a little under 60 days. I have been 

incredibly impressed with the efforts that, across VA, are being 

made on behalf of our veterans, and the outreach that is taking 

place. There is a strong desire by the Secretary and by my boss, 

Tammy Duckworth, to coordinate those efforts throughout VA and 

the outreach that we are doing. We would also like to look at opportunities, in fact the Secretary tasked me just last Friday with 

coming up with a list of all the community organizations nationally 

that are interested in partnering with VA. So there is a huge desire 

to build those relationships as we move forward as a new Administration. 

Mr. PERRIELLO. Thank you. And we certainly appreciate Ms. 

Duckworth’s service to her country as well. Some of the VSOs have 

expressed concern—this is another metrics question—about how 

the VA tracks outreach expenditures. Could you say a little more 

about how the VA budgets and funds outreach activities? Is funding allocated on a facility-by-facility basis? And how has that been 

trending during the OEF/OIF period? 

Mr. HUTTER. If I could attack that question from VHA’s perspective and perhaps defer to Ms. Smith with respect to the Administration’s intent overall? With respect to VHA we use the medical 

centers as our bases of outreach. Each of our medical centers, for 

example, has an OEF/OIF program coordinator, whereby they provide outreach to the community and participate in the various welcome home events, the yellow ribbon program that is described in 

my written testimony, and partnering with DoD activities in the 

local communities. In terms of expenditures, then, that is those expenditures are rolled up, if you will, from the field based operations 

up through the networks and up to the headquarters in terms of 

those activities. 

That is certainly the basis not only of reaching out to OEF/OIF 

veterans but also with respect to any other targeted groups that we 

need to provide outreach for. Mr. Chasen mentioned our voluntary 

services coordinators and others in the medical centers who also do 

this outreach and the welcome home activities, and partner with 

community-based groups to reach out to older era veterans, or past 

era veterans, if you will. And so it is primarily a field-based operation that gets rolled up to the headquarters. 

Ms. SMITH. I think the Secretary’s vision for outreach for VA will 

look like a centralized management structure with decentralized 

execution. So hopefully, we will move to a point where much of our 

outreach is funded from one source. 

Mr. PERRIELLO. Right now most of the media campaign that has 

been run has been focused on suicide and suicide prevention. There 

jbell on DSKDVH8Z91PROD with HEARING

35 

is an obvious sense of urgency there. Is there a sense of moving 

into other issues that need to be communicated? Other health and 

benefits issues? Or is the current plan to focus primarily on that? 

Mr. HUTTER. Mr. Chairman, I will take just a moment to discuss 

that and then turn it over to Mr. Chasen. There are several programs that are teed up right now and ready to move out. And I 

would like to defer to Mr. Chasen to describe at least one of those 

in detail. 

Mr. CHASEN. Thanks, Paul. Mr. Chairman, first of all the suicide 

prevention program has a very, very simple message which is to 

get that number to a veteran or a loved one when he or she needs 

the number. So it is an ongoing program that will not stop, that 

we will continue to find new ways to get that information in front 

of people. That being said, we are working, and Dr. Victor Wahby 

who is in the audience behind me is responsible for some of these 

programs. We are looking at the issue of destigmatization of mental illness, which is very important to us. And we will be rolling 

out products related to that. We are going to be working on health 

literacy. Last year we did a considerable amount of work to try to 

inform veterans about the dangers of diabetes and the need to exercise and eat healthy. And we will continue to use the power of 

the media and our ability to mount campaigns to try to keep veterans healthier through the media. 

Mr. PERRIELLO. One of the things that I hear a lot anecdotally 

from veterans, and from those who have had some of the experiences we have heard about today, is that there has been at least 

as much success if not more reaching the families of veterans as 

reaching the veterans themselves. What strategies are we seeing to 

reach those families? Is there any indication that there is more or 

less success in those outreach efforts? 

Mr. HUTTER. Again, Mr. Chairman, we go back to the very successful efforts that we have had in reaching veterans as they come 

home, and iteratively reaching out to them. The Yellow Ribbon Program is a DoD program that we are heavily invested in as partners 

with DoD. And we talk to veterans and their families before the 

veterans deploys. We talk to families during the deployment phase 

so that we can get the family when the veteran is out of the country. Thirdly, we talk to families not at the demobilization but at 

welcome home events and at events that are targeted at the 30- 

day, the 60-day, and the 90-day mark after the veteran returns 

from deployment. All of these events are attempts to make sure 

that that families are aware of the health care benefits that the 

veteran is entitled to. For example, the 5 years that the veteran 

can use VA health care without otherwise being eligible. Also, the 

180 days of dental care that the veteran is entitled to. These are 

numbers and programs that resonate with the families. And so that 

they, even if it does not resonate with the veteran upon return, 

their family members will prompt the veteran to take advantage of 

these programs when they come back. So if you look at the deployment cycle as a circle, we are invested in every axis, if you will, 

of that circle along a radius so that the veteran and the family gets 

that advantage. 

One other point that I would like to make. We recently had a 

Post-Deployment Health Reassessment (PDHRA) event in Indianjbell on DSKDVH8Z91PROD with HEARING

36 

apolis for the 76th Brigade Combat Team that came back. About 

3,200 soldiers came back, and we did the post-deployment reassessment at that location. Those reassessments were conducted at VA 

hospitals in Indianapolis itself, Fort Wayne, and in Evansville. The 

soldiers were able to see not only what a VA medical center looked 

like, but were also able to see how much VA employees cared about 

them and made sure that they understand what a warm welcome 

and a warm battlefield handoff, if you will, there was between military health care, DoD health care, and VA health care. During that 

weekend, there were, tragically, a soldier was indicating suicidal 

tendencies. But that soldier was able to be taken care of right there 

on the spot during that reassessment program. Another soldier indicated homicidal tendencies. And we were able to get him into 

health care and into mental health care immediately onsite. So my 

point, sir, is that the VA’s forward leaning and working closely 

with DoD is enabling that family to see what the advantages of VA 

health care are. 

Mr. PERRIELLO. Thank you very much for that answer. Thank 

you again for your time today. We really appreciate it. The Subcommittee will be sending follow up questions for the record. And 

with that, this hearing is adjourned. 

[Whereupon, at 4:45 p.m., the Subcommittee was adjourned.] 

jbell on DSKDVH8Z91PROD with HEARING

(37) 

A P P E N D I X 

Prepared Statement of Hon. Michael H. Michaud, Chairman, 

Subcommittee on Health 

I would like to thank everyone for coming today. 

This Subcommittee on Health hearing will assess the VA’s responsibility to conduct an outreach program to veterans of all eras, including internal coordination 

that takes place between the Veterans Health Administration and the other administrations of the Department. We also seek a more complete understanding of the 

VA’s outreach efforts and strategies, as well as the funding spent on these outreach 

activities. 

Today, there are over 23 million veterans who have served this country. Of this 

total, the VA estimates that the number of veterans enrolled in the VA health care 

system will reach 8.3 million in 2009 and that the VA will treat nearly 6 million 

of the enrolled veteran population. Six decades separate the newest generation from 

the oldest generation and 9 million veterans are over the age of 65. According to 

the VA’s Center for Minority Veterans, the minority veteran population comprises 

approximately 15 percent of the Nation’s 23.4 million veterans. Women veterans are 

included in these minority groups as well. 

This demographic data illustrate the sheer number of veterans who stand to benefit from improved VA outreach efforts. Additionally, it shows the importance of outreach strategies which must be individualized to meet the unique needs of sub-populations of veterans. For example, outreach strategies for older veterans should differ 

from that of younger veterans. Additionally, the outreach methods for rural areas 

may differ from that of urban areas. The VA is also faced with the challenge of developing effective outreach strategies which are culturally competent and thus, able 

to overcome potential cultural barriers. Briefly recounting the legislative history of 

enacted legislation on outreach brings us to the Vietnam War. During the Vietnam 

War, increased awareness of veterans not receiving adequate information about 

health care benefits resulted in Congress enacting the Veterans Outreach Services 

Program (VOSP). To address this concern, Congress charged the VA with the responsibility of actively seeking out eligible veterans and providing them with benefits and services. Under the current law the Secretary is responsible for advising 

each veteran at the time of discharge or release of all benefits the veteran may be 

eligible for. 

Next, Public Law 107–14, the Veterans’ Survivor Benefits Improvement Act 

(VSBIA) was enacted in 2001 to further expand outreach to eligible dependents. 

This law also provided that the Secretary ensure the availability of outreach services and assistance through the internet, veterans publications, and the media. 

Finally, Public Law 110–389 or the ‘‘Veterans’ Benefits Improvement Act of 2008’’ 

was enacted last year. Section 809 of this law gave the Secretary the authority to 

advertise in national media. 

Despite these legislative authorities, the VA has imposed a self-imposed ban 

against paid public advertising, including Public Service Announcements which was 

only removed recently in June of 2008. Although the existing statute does not prohibit the VA from conducting media outreach, the VA has only implemented a single 

media campaign on suicide prevention to the Subcommittee’s knowledge. 

VA has struggled in the past with effective outreach services. For example, pamphlets and other outreach materials are often located in the VA’s own medical center, which means that this important information does not reach those veterans who 

do not already utilize VA services. Another example is a memorandum issued on 

July 18, 2002 by the VA Deputy Undersecretary for Health for Operations and Management to all Veterans Integrated Services Networks of the VHA prohibiting marketing geared toward increasing enrollment. This was an effort of to limit the fast 

growing demand for health care services which exceeded the VA’s resources. 

We also know that some Veteran Service Organizations accused the VA of not providing outreach to veterans and dependents in accordance with the law. Nearly 18 

jbell on DSKDVH8Z91PROD with HEARING

38 

months later a second memorandum was issued by VHA instructing the directors 

to ensure that their facilities were in compliance with responsibilities outlined in 

the outreach program. 

Clearly, these are serious issues deserving of this Subcommittee hearing. Today, 

the Subcommittee looks forward to hearing from the witnesses of the panels as we 

embark on the important task of exploring effective ways to improve outreach to our 

deserving veterans. 

f 

Prepared Statement of Hon. Henry E. Brown, Jr., Ranking Republican 

Member, Subcommittee on Health 

Thank you Mr. Chairman. 

When our servicemembers come home from the battlefield, they think about getting back to their families and their civilian lives. Often, they do not think about 

connecting with the Department of Veterans Affairs (VA). 

Yet, the process of transitioning back to the civilian world can be challenging for 

veterans and their families. And, I am deeply troubled when I hear stories about 

a veteran not knowing what services exist, where services can be obtained, or 

whether they are eligible for those services. 

Central to the mission of the VA is to reach out to make every veteran aware of 

what services are available to support them and assist them in using these services. 

And, that is why it is so important that we are holding this hearing today to examine how effective VA’s existing outreach is and what more can be done to ensure 

that our Nation’s heroes know and have access to the benefits and services they 

need and deserve. 

It is encouraging that a higher percentage of our returning warriors are seeking 

VA for their health care needs than in any previous war. And, I do want to commend former Secretary of Veterans Affairs, Dr. James Peake, for the great strides 

he made to improve outreach and the coordination of care for our veterans. Under 

his strong leadership, the VA launched a number of outreach initiatives including: 

lifting restrictions on advertising to promote awareness of VA’s programs and services; rolling out a new public service campaign about suicide prevention; establishing the Combat Veteran Call Centers to telephone returning veterans to provide 

information about VA services; opening new rural outreach clinics; and expanding 

VA internet presence through ‘‘You Tube’’, ‘‘Facebook’’ and ‘‘MySpace’’ to reach 

younger veterans. 

I would like to thank all of the witnesses for taking the time to appear before 

the Subcommittee today. I look forward to hearing about issues you see and ideas 

you have for improving VA’s outreach and relationships with the Department of Defense, states, local communities and private organizations to help link veterans to 

VA services. 

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

f 

Prepared Statement of John Rowan, National President, 

Vietnam Veterans of America 

Good afternoon, Chairman Michaud, Ranking Member Brown, and Members of 

this distinguished Subcommittee. On behalf of the Members of Vietnam Veterans 

of America and our families, I am pleased to offer VVA’s views on outreach activities 

of the Department of Veterans Affairs. 

The VA, by any standard, does an entirely inadequate job of reaching out to veterans and their families to inform them of the benefits to which they are entitled 

by virtue of their service, and health conditions that may derive from their time in 

service. I can’t tell you how many calls and e-mails we get from veterans, or their 

loved ones, with questions about illnesses that may be associated with their exposure to Agent Orange (dioxin) during their tour of duty in Vietnam. I can’t tell you 

how many times, when we meet with veterans and talk about health and health 

care issues, we are greeted with something akin to astonishment because no one has 

ever mentioned this to them before. 

Almost 80 percent of veterans do not use the VA for their health care. While most 

veterans have insurance that enables them, and their families, to go to private physicians of their choice, many of these folks are only a paycheck or two away from 

losing their insurance. Posters that decorate walls and pamphlets that populate kiosks at VA medical centers and outpatient clinics do not reach these folks. Nor do 

the video productions that are supposed to be run on televisions in the waiting areas 

jbell on DSKDVH8Z91PROD with HEARING

39 

of these facilities: Veterans waiting to be seen by a clinician watch CNN, or ESPN, 

or Oprah. 

It is precisely because the VA has, in our estimation, fallen down on the job that 

VVA, in concert with dozens of health advocacy organizations, health care firms, 

and others concerned about improving the health of our Nation’s veterans, has created the Veterans Health Council. The Council aims to fill a void that has long 

threatened to become an abyss. By working together, we hope to reach out to veterans and their families to inform them not only of the benefits to which the veteran 

is entitled by virtue of having donned the uniform, but about those diseases and 

other maladies that may derive from their time in service. We hope, too, to reach 

out to the wider health care community, to educate them about such health care 

conditions. It is our hope, through the Council’s Web site, www.veteranshealth.org, 

and the Web sites and publications of our partners, that we might reach hundreds 

of thousands of veterans who otherwise might not know that the disease that is 

plaguing them and eating away at their savings may be associated with their service in Vietnam, or Korea, or Kuwait, or Iraq, or Afghanistan, and that they are eligible for treatment and may qualify for disability compensation and pension as well 

as other benefits from the VA. 

You in Congress have been most generous in the past few years in providing the 

funds that the VA health care system needs to meet the demand for its services. 

But we ask you: Can you discern, from the VA’s budget submission, how much 

money is being allocated for outreach? We have long supported the efforts of Senator 

Russ Feingold to enact into law the requirement that there be a line-item amount 

for outreach not only for the entire department but also for its individual entities. 

The Senator’s bill this year, S. 315, the Veterans Outreach Improvement Act of 

2009, would require the Secretary of Veterans Affairs to ‘‘establish a separate account for the funding of the outreach activities of the Department, and shall establish within such account a separate subaccount for the funding of the outreach activities of each element of the Department.’’ 

While we have every confidence that Secretary Shinseki and his team will endeavor to make far greater efforts at outreach, we nevertheless believe that what is 

needed from Congress is legislation that would require the VA to devise with a coordinated outreach plan attached to budget numbers. Mr. Feingold’s bill, if enacted, 

is not enough, although it ought to be part of such legislation. Additionally, this legislation would: 

• mandate that a veteran’s military medical/health history (please see attached) 

be part of his/her treatment record if a veteran uses VA facilities or is able to 

and chooses to go to private clinicians; 

• require that clinicians ask, in the patient history that all of their patients fill 

out, if that patient ever served in the U.S. military and, if so, a series of followup questions to learn if the veteran was wounded or otherwise exposed to trauma, or was exposed to blood, or participated in any experimental projects, or 

was exposed to noise, chemicals, gasses, demolition of munitions, pesticides, or 

special paints; and 

• require that all VA clinicians, particularly primary care providers, take and receive certification for the VA’s Veterans Health Initiative curriculum every 3 

years. 

In conclusion, I want to reiterate: Far too many of our veterans simply are unaware of what they are entitled to and, more importantly, are ignorant about health 

issues that are associated with their time in service. It’s about time that we do 

something to fix this situation. VVA and the participants in the Veterans Health 

Council are doing our part. We hope that Congress will recognize the situation and 

do what is needed to rectify it. 

Mr. Michaud, and Mr. Brown, thank you for holding this very important hearing. 

I would be more than pleased to answer any questions you may pose. 

jbell on DSKDVH8Z91PROD with HEARING

40 

Appendix: Military History Card 

Military Health History Pocket Card 

What is the Military Health 

History Pocket Card? 

The Military Health History Pocket Card is a 

pocket-sized resource to provide all VA health professions trainees a guide to understanding health 

issues that are unique to veterans. 

VA’s students and trainees generally are young 

while our veteran patients are older and have had 

experiences in a different time and place. This card 

helps to bridge that gap. 

The card suggests questions that invite the veteran 

to tell his/her own story while the Web site provides 

information that will offer greater insight into the 

veteran’s story. 

It is important to make the patient aware that his/ 

her unique experiences as a veteran are of concern to 

VA clinicians. 

Who should receive the Military Health History Pocket Card? 

All health professions trainees. 

How is the Military Health History Web site used? 

It provides background information related to the questions on the Pocket Card. 

Summaries of veterans’ health issues as well as links to other Web sites are provided. 

The Card can be used to capitalize on many learning opportunities: 

• Give trainees better understanding of the veteran’s perspective. • Encourage trainees and staff to take more careful, veteran-centered histories. • Stimulate case discussions augmented by information found on the Web site. • Consider discussing issues presented on the card during daily work rounds or 

informal case-based conferences. 

http://www.va.gov/oaa/pocketcard/FactSheet.asp 

f 

Prepared Statement of Reynaldo Leal, Jr., Representative, Iraq and 

Afghanistan Veterans of America, (OEF/OIF Veteran) 

Mr. Chairman and Members of the Subcommittee, thank you for inviting me to 

testify today. On behalf of Iraq and Afghanistan Veterans of America (IAVA), the 

Nation’s first and largest non-partisan organization for veterans of the current conflicts, I would like to thank you all for your unwavering commitment to our Nation’s 

veterans. 

My name is Reynaldo Leal, and I served in Iraq as a Marine Infantryman with 

the 3rd Battalion 5th Marines. During my first tour, I participated in some of the 

Iraq War’s heaviest fighting during Operation Phantom Fury in Fallujah, and after 

that mission was complete, I assisted in securing the first democratic elections in 

that city. I was deployed for a second time, 8 months after my first tour, and conducted counter-insurgency operations along the Euphrates River. As an Infantryman, I did my job well and performed my duties with honor. After my two combat 

tours, I returned stateside seemingly unscathed, one of only two men in my platoon 

with that good fortune. 

But coming home from war was much harder than I imagined. I was still in the 

Marine Corps, and I remember being good at our Urban Combat training. Not because I was a natural at it, but because when I began to hear the popping and 

yelling I felt that I was back in Fallujah. I could feel and see myself fighting the 

enemy again. It would always take me a while to get back to reality after these 

training exercises. 

jbell on DSKDVH8Z91PROD with HEARING


49920A.001
41 

When I was discharged from the Marine Corps in February 2008, there were two 

questions I feared the most: ‘‘What was it like over there?’’ and, ‘‘Did you kill anyone?’’ Anxious about returning home, I delayed going back to south Texas for as long 

as possible. I couldn’t bear the thought of being around familiar faces, and that fear 

led me to push away those who cared about me the most. As my wife prepared for 

the birth of our first child, I struggled with flashbacks and painful insomnia, which 

spiraled into a debilitating depression that alienated my family and threatened my 

marriage. I knew that my wife was suffering as much as I was, and that I wasn’t 

the same person she had fallen in love with. Suicide wasn’t an option for me, but 

everyday made me more and more anxious. It turns out I was suffering from a devastating invisible wound: Post-traumatic stress disorder (PTSD). 

My struggle with PTSD left me dependent on the VA for mental health care. 

Since there is no VA Hospital close to my home in Edinburg, Texas, I have to either 

travel 5 hours each way to the nearest VA hospital in San Antonio or take my 

chances at our local clinic. The lack of funding for a permanent VA psychologist at 

this clinic pits me against my fellow veterans for limited appointment slots. If I 

can’t get through on the first of the month to book an appointment, or if both of 

the psychologist’s 2 daytime slots are full, I’m out of luck until the next month. 

Unfortunately, my experience is not unique. According to a 2008 RAND study, 

nearly 20 percent of Iraq and Afghanistan veterans are experiencing symptoms of 

PTSD or major depression. But less than half are getting adequate treatment. 

PTSD is the silent killer for this generation of veterans. Left untreated, it has the 

potential to destroy marriages, careers and, in far too many cases, lives. In January 

of this year, the U.S. Army reported that 24 soldiers in Iraq and Afghanistan committed suicide; a figure that surpassed all combat deaths in those two theaters combined. That alarming statistic does not include other branches of services like the 

Marines, or veterans who have already come home from the war. 

But the numbers and statistics are only part of the picture. This new generation 

of veterans is being left to fend for themselves because of an antiquated system that 

cannot seem to find a way to reach out to them. There aren’t any visible outreach 

campaigns to get these young men and women through the door of their local VA 

facility. If they don’t know about their benefits, or even where their clinic or hospital 

is, how can they get the help they need? 

When I was struggling with PTSD, there was never a sense that the VA was trying to reach out to me or that anyone even understood. For me, there was the Corps 

and then there was nothing. One day I had the best health care and support system 

available for both me and my family, and the next day it was gone. I felt that I 

had been abandoned and that the fact that I had served my country honorably 

meant nothing. I didn’t know about the claims system, I didn’t know about the 5 

years of medical care for Iraq and Afghanistan veterans, and I didn’t know that 

there were others that were going through the same situations that I was. It wasn’t 

until I saw IAVA’s ‘‘Alone’’ ad on television and joined Community of Veterans that 

I felt someone was trying to reach out to me. 

It is the responsibility of the Federal Government and the Department of Veterans Affairs to make sure every veteran feels this way. But are we doing everything we can to reach out to the veterans who have done so much for us? The VA 

has taken some important steps, especially setting up a suicide hotline, but the answer is no. 

We owe it to our veterans to provide the best mental health resources available, 

and currently we are falling far too short of that goal. At my VA hospital in San 

Antonio, the psychologist only works 2 days a week because that Texas clinic, like 

many VA clinics and hospitals throughout the country, has to stretch its funding 

to make sure the money lasts the whole year. They don’t know how much funding 

they’ll have next year because the VA budget is routinely passed late. In fact, in 

19 of the past 22 years, the budget has not been passed on time. 

So despite the fact that the VA’s mental health budget has doubled since 2001, 

thanks to the dedication of veterans’ supporters in Congress, the VA is still forced 

to ration care for the almost 6 million veterans that depend on its services. 

By fully funding the VA health care budget 1 year in advance we could provide 

a simple solution that would help give VA hospitals and clinics across the country 

the ability to provide stable care for decades to come. With the ability to plan ahead, 

these hospitals and clinics could meet critical staffing and equipment needs, so that 

veterans like me are not left waiting. President Obama recently reiterated his support for advance funding of VA health care, and we were glad to hear it. With the 

strong support of the President and bipartisan leadership of Congress, advance 

funding can and must move forward this year. 

Real action cannot come at a more critical time. As we saw just last week with 

the tragic events at Camp Liberty, our service men and women are under incredible 

jbell on DSKDVH8Z91PROD with HEARING

42 

strain. As a Nation, we must have the same emphasis on giving our veterans the 

necessary tools to readjust to civilian life as we have in giving them the tools to 

survive in combat. 

Make no mistake about it, the veterans of this country want nothing more than 

to become successful and productive Members of the society we fought so hard to 

defend. 

Very Respectfully. f 

Prepared Statement of Richard A. ‘‘Rick’’ Jones, Legislative Director, 

National Association for Uniformed Services 

Chairman Michaud, Ranking Member Miller, and Members of the Subcommittee: 

On behalf of the National Association for Uniformed Services (NAUS), I am 

pleased to be here today as you examine the effectiveness of VBA outreach efforts. 

Your work is critical to ensure that VA outreach strategies bring the best possible 

care to returning troops and a seamless transition to their well-earned civilian life. 

The National Association for Uniformed Services celebrates its 41st year in representing all ranks, branches and components of uniformed services personnel, their 

spouses and survivors. NAUS Membership includes all personnel of the active, retired, Reserve and National Guard, veterans community and their families. We also 

serve as the main contact for the Society of Military Widows, a support organization 

for women whose husband died in military service or in retirement. We support our 

troops, honor their service, and remember our veterans, their families and their survivors. 

It is well known that the Department of Veterans Affairs Veterans Health Administration (VHA) is the largest provider of health care in the Nation. Approximately 

6 million veterans annually come to VHA for all or part of their personal health 

care. As we take a measure of satisfaction in the quality of care provided at VHA hospitals and clinics, it is important to recognize that many veterans continue to view 

VA care through the eyes of a past era when VA care was sub-par or in some instances not realizing that the system is available to them. 

While we can never fully repay those who have stood in harm’s way, a grateful 

Nation has a duty and obligation to provide benefits and health care to its veterans 

as a measure of its share of the costs of war and national defense. 

As the National Association for Uniformed Services assesses the effectiveness of 

VHA outreach, we believe it is important that we first have an understanding on 

the number of OEF/OIF troops using the Department’s health care system. 

At present, nearly 2.0 million troops have served in the two theatres of operation 

since the beginning of the conflicts in Iraq and Afghanistan. In addition, with the 

drawdown of troops from the battlefields of Iraq, VA is likely to face increased enrollment. 

Through the last quarter of fiscal year 2008, 400,304 separated Operation Enduring Freedom and Operation Iraqi Freedom veterans have used VA health care. And 

with passage of Public Law 110–329, VA will develop provisions for expanded enrollment for certain Priority 8 veterans. 

In fact, the final rule for the regulation of accepting these newly eligible veterans 

is June 15, 2009, which is just around the corner. 

Expansion of Priority 8 Veterans 

Public Law 110–329 provides funding to allow an approximate 10 percent expansion on the numbers of Priority 8 veterans enrolled and treated at VA medical facilities. The proposed regulations were published in the Federal Register on Jan. 21, 

2009, and are expected to be finalized by mid-June. 

Eligibility will be based upon means testing and will be geographically based to 

allow for the variances in cost of living in the various regions of the country. 

VA expects approximately 266,000 additional Priority 8 veterans to be enrolled in 

FY 2010. We are pleased to hear the VA’s Under Secretary For Health state that 

Priority 8 enrollment is not capped. Any veteran who meets the requirement will 

be enrolled in the VA health care system. We applaud the effort to end the enrollment ban on veterans. 

The budget submission provides more funding to continue this expansion so that 

by fiscal year 2013 an additional 500,000 qualified veterans will gain access to VA. 

Although not specifically addressed in the budget, we would hope that part of the 

funding for outreach would be used to ensure that everything possible is done to 

bring awareness of the change in policy to those newly qualified veterans. 

jbell on DSKDVH8Z91PROD with HEARING

43 

The National Association for Uniformed Services is concerned that well-meaning 

intentions of the VA might not be enough to spread the word on the expansion of 

benefits to veterans who have been denied VA medical access for over 6 years. 

Many Priority 8 veterans tried to enroll after the January 17, 2003, prohibition 

and were denied, therefore, access to VHA care. We believe that the VA plan to mail 

all individuals previously denied enrollment is a good first step. We are hopeful that 

there will be follow-up to make sure measures are taken to contact those veterans. 

Enrolling those qualified veterans who desire to do so into the VA medical system 

should be a very high priority. 

In addition, we must ensure that all veterans returning from combat areas are 

aware of and if possible, already signed up for their 5 years of VA medical care. 

Both of these sets of veterans need to be aware of their benefits. 

We do recognize, however, that some long-term health conditions, such as posttraumatic stress disorder or traumatic brain injury, may not manifest conditions 

until many years later. Therefore we encourage further opening of access to sick and 

disabled veterans beyond the current 5-year allowance. 

Of course, Veteran and Military Service Organizations will gladly help spread the 

word to their memberships and others. That way we can, together, be better assured 

that more veterans will be advised of the changes. 

VA Budget Outreach Initiatives 

The National Association for Uniformed Services is encouraged that the fiscal 

year 2010 veterans’ budget request has numerous outreach programs that will help 

get the message about VHA to many more veterans and survivors. 

These initiatives include reaching out to veterans who live in rural areas of America. The funding requested would allow the VA to more aggressively reach out to 

these veterans and to possibly set up additional rural outreach clinics to help reach 

our National Guard and Reserve troops. There is also funding requested for more 

aggressive tactics to reach those who have mental health issues with expansions of 

outreach services at Veterans Clinics. 

The budget also includes additional funding for outreach by the newly created Office of Survivor Assistance (OSA) to help serve the numerous survivors who may not 

have the information on benefits they may be entitled to or apply for. 

Advancement in Battlefield Medicine 

As is well known, advancement in battlefield medicine has improved the chances 

of survival in warfare. However, many of our present day wartime casualties suffer 

from multiple severe injuries such as amputation, Traumatic Brain Injury (TBI) and 

post-traumatic stress disorder (PTSD). Care for these individuals requires an intense management of treatment for their injuries and special consideration of their 

families who stand by these returning heroes. 

Reports from VA indicate that, from fiscal year 2002 through the end of 2008, 39 

percent (325,000) of the total separated OEF/OIF veterans have obtained VA health 

care. Among this group, 96 percent were evaluated and been seen as outpatients 

only, not hospitalized. The remaining 4 percent (13,000) OEF/OIF patients have 

been hospitalized at least once in a VA health care facility. 

Last year, VA informed the National Association for Uniformed Services that of 

the OEF/OIF veterans who have sought VA health care approximately 166,000 were 

former active duty troops and 159,000 were Reserve and National Guard Members. 

The population seeking care is nearly half active duty and half Reserve Component 

troops. 

In total, over the last 6 years VA reports that 6 percent of the 51⁄2 million veterans in the VA medical care system are veterans of the most recent military conflict, OEF/OIF veterans. 

The Department attributes the rate of VA health care used by recent veterans to 

two major factors. First, the department says that recent combat veterans have 

ready access to the VA system, which is free of charge for 5 years following separation. In addition, the Department attributes a high rate of veteran-participation is 

due to an extensive outreach effort developed by VA to inform veterans of their benefits, including ‘‘a personal letter from the VA Secretary to war veterans identified 

by DoD when they separate from active duty and become eligible for VA benefits.’’ 

The National Association for Uniformed Services applauds efforts under the direction of the Department to establish a dedicated outreach program directed at nearly 

570,000 Afghanistan and Iraq combat veterans. The effort, according to VA, is to 

make sure these veterans are aware of VA’s medical services and other benefits for 

which they are entitled. 

The VA Outreach program targets OEF/OIF veterans who have been separated 

from military service but have not sought VA care or services. We encourage the 

jbell on DSKDVH8Z91PROD with HEARING

44 

VA health care community to continue its efforts to inform veterans and their families, as well as the medical community, about the availability of VA health care. 

The National Association for Uniformed Services asks VA it leave no stone 

unturned to reach these veterans. 

In examining the effectiveness of the outreach effort, it is important to recognize 

the stark difference in today’s VA’s efforts compared to those used in the recent past 

several years. 

While we commend the positive change in expression and tone, we remain attentive to see that the most recent effort and the improved tone it reflects does not 

fail. Clearly there are concerns. Though the system is clearly no longer our grandfather’s VA system, negative residue from a previous more closed-minded attitude 

remains within the system. 

Last year, for instance, we received callous reports about a message issued from 

a VA Medical Center, in Temple, Texas, that suggested time and money could be 

saved if diagnosis of PTSD were stopped or deeply discounted in its degree of severity. 

A PTSD program coordinator and psychologist at the Olin E. Teague Veterans 

Center sent an email with the subject line ‘‘Suggestion’’ to several VA staffers working with PTSD cases. The email suggested that VA doctors and clinicians give altered diagnosis to patents exhibiting symptoms of PTSD in order to save time and 

money. In the email, the staffer said, ‘‘We really don’t . . . have time to do the extensive testing that should be done to determine PTSD.’’ 

While VA has long since repudiated the wrong-headed message, it does represent 

a concern we all should share, namely that VA care may be arbitrary, directed more 

by budget considerations than the consideration of the treatment necessary for the 

health of the men and women who served in the Armed Forces. 

The incident is deeply troubling because veterans not only need to hear about the 

services they earned and deserve; they need to know that once they come to VA 

their exams are completed and their services are delivered. 

Awareness of Services 

Mr. Chairman, as we head toward Memorial Day next week, your Subcommittee 

takes a good, well-traveled road. In sending young men and women to defend our 

Nation, it is important that we let them know what our great and generous country 

provides them following their service. Indeed, it is critical. 

It is clear to the National Association for Uniformed Services that veterans are 

generally more aware about the availability of benefits and services than they were 

four to 6 years ago. But the value of timely, reliable outreach programs cannot be 

understated. 

Six years ago, for instance, the Administration was deeply opposed to spending 

resources aimed at making veterans aware of the benefits and services available at 

the Veterans Department. And facilities were in decline. 

At one point in that past period, a former Secretary of Veterans Affairs told the 

Nation that the Department budget was adequate. ‘‘Not a nickel more is needed,’’ 

he said. However, only a month later the Secretary reversed his statement to tell 

the Nation that his Department would fall $11⁄2 billion short of the resources needed 

to carry veterans services through the remainder of the year. 

Prior to this revelation, the National Association for Uniformed Services and other 

associations had presented ample witness to deficiencies throughout the system. We 

pleaded with Congress and the Administration that funding levels were totally inadequate and, if not addressed, would lead to critical reductions in the availability of 

veterans health care services, cuts in veterans education benefits, and logjams in 

veterans disability claims for service connected injury or illness. 

During that period, things were so bad that a memorandum sent out by the Deputy Under-Secretary for Operations and Management (July 19, 2002) actually directed all of its health care providers to stop marketing VA programs to veterans. 

In basic, the July 2002 memo said too many veterans were coming in for services 

and VA was spending too much money. It directed VA officials across the country 

to ‘‘Stop Outreach to Veterans.’’ VA employees were directed to stop participating 

in VA health fairs, Stand Downs and related outreach events that informed veterans about programs available to them. Medical facilities were prohibited even 

from putting out newsletters informing veterans about the services they were legally 

entitled to receive. 

We are thankful that we are beyond that deeply troubling period. If similar incompetence were in place today, many of OEF/OIF would struggle alone with their 

symptoms and illnesses following deployment. 

jbell on DSKDVH8Z91PROD with HEARING

45 

Stress and the Risk of Health Issues 

Studies conducted by The Army surgeon general’s Mental Health Advisory Team 

clearly show that our troops and their families face incredible stress today. According to the Department of Defense (DoD), 27 percent of noncommissioned officers on 

their third or fourth tour exhibited symptoms commonly referred to as post-traumatic stress disorder. That figure is far higher than the roughly 12 percent who 

show those symptoms after one tour and the 181⁄2 percent who demonstrate these 

disorders after a second tour. 

And among the approximately 1⁄2 million active-duty soldiers who have served in 

Iraq, more than 197,000 have deployed more than once, and more that 53,000 have 

deployed three or more times. 

A recent Rand Corp. study suggests that almost half of these returning troops will 

not seek treatment. Many of these veterans do not believe they are at risk or they 

fear that admitting to a mental health problem will mean being stigmatized. Yet 

if these brave individuals and their families are made aware of access to VA facilities, to which they are entitled, they are likely to find a treatment therapy that 

leads to health. 

If not addressed, stress symptoms can compound and lead to more serious health 

consequences in the future. 

Congress Champions Resources for VA 

Recent Congressional successes in provided increases in VA spending presents the 

Department with an opportunity to advance an awareness of VHA accessibility and 

readiness to meet health care needs. 

We applaud all that has been done to date. While commendable, we can do better 

and should do more. In some cases, a successful outreach can be a matter life and 

death. Veterans need to hear that VA is part of our Nation’s commitment to them. 

They need to hear that with appropriate care, our veterans can tackle stress and 

get themselves back on track. 

NAUS believes that your interest in targeting information to veterans marks a 

turning point in outreach efforts. We are optimistic. But it is clear that more needs 

to be done, including followthrough throughout the VA system, within the veterans 

community and in our educational assistance programs. 

Of course, there is a financial cost to improved outreach. But as important is the 

fact that if we do not make veterans aware of the benefits and services available 

to them, there is a hidden cost in lives lost, families disrupted and long suffering 

in homelessness and related problems for decades to come. 

We urge the Subcommittee to continue its excellent work with other champions 

in this Congress to ensure resources are ready not only for the provision of a veteran’s earned benefits but for the veteran’s awareness of these services as well. It 

is important that we do so. After all, these brave men and women shouldered a rifle 

and risked everything to accomplish their mission, to protect another people’s freedom and our own country from harm. 

As a Nation, we need to understand that the value of their service is far greater 

than the price we pay for their benefits and services. 

Appreciation for Opportunity to Testify 

As a staunch advocate for veterans, the National Association for Uniformed Services recognizes that these brave men and women did not fail us in their service to 

country. They did all our country asked and more. Our responsibility is clear. We 

must uphold our promises and provide the benefits they earned through honorable 

military service. 

Mr. Chairman, you and the Members of your Subcommittee are making progress. 

We thank you for your efforts and look forward to working with you to ensure that 

we continue to protect, strengthen, and improve veterans benefits and services. 

Again, the National Association for Uniformed Services deeply appreciates the opportunity to examine with you outreach efforts to veterans, families and survivors 

on the benefits available to them. 

f 

Prepared Statement of Bruce Bronzan, President, 

Trilogy Integrated Resources, San Rafael, CA 

Serving Those Who Served 

Maryland and California have taken an important step as national models in the 

way of local web portals that use the most advanced communication and internet 

technology to form a bridge between all Federal, state, local, and non government 

jbell on DSKDVH8Z91PROD with HEARING

46 

services and veterans and their families. It is called the Network of Care. The 

launching of the sites in Maryland was led by Lieutenant Governor Anthony Brown. 

The California launch will be led by Governor Schwarzenegger this coming Friday. 

The Network of Care project has been a creative joint effort between the mental 

health and veteran’s leadership in Maryland and California, the state and county 

governments, and Trilogy Integrated Resources. 

Last, this service is, in fact, an excellent ‘‘transition’’ resource of the first order. 

Every single veteran is able to access this comprehensive resource in their own community thus representing the most complete, permanent, and continuously accessible place for information and assistance possible. Given that within the Network 

of Care we currently have the database 120,000 service providers covering 65 percent of the Nation, this model can be replicated into every local jurisdiction in the 

United States within a year. 

DEMO OF THE NETWORK OF CARE 

1. Home Page 

—Crisis intervention, Shelter, employment, 

2. Service Directory 

3. Library 

4. Social Networking 

5. Legislate 

6. Assistive Devices 

7. Links 

8. Personal Health Records 

f 

Prepared Statement of Barbara Van Dahlen Romberg, Ph.D., 

Founder and President, Give an Hour, Bethesda, MD 

Thank you for this opportunity to provide testimony regarding the Department of 

Veterans Affairs’ current outreach efforts for OEF/OIF veterans. It is an honor to 

appear before the Subcommittee on Health of the House Committee on Veterans’ Affairs and to offer my assistance to those who serve our country. 

As the Founder and President of Give an Hour, a national nonprofit organization 

providing free mental health services to our returning troops, their families, and 

their communities, I am well aware of the many issues that now confront the men, 

women, and families within our military community. 

There is little doubt that our Nation is confronting an emerging public health crisis. It has been 6 years since the conflict in Iraq began. Since that time, nearly 1.9 

million servicemembers have deployed. Many of these men and women have deployed more than once; some, as many as four or five times. National Guardsmen 

and Reservists compose approximately half our Nation’s fighting force. As those who 

have experienced war will attest, everyone is changed by the experience. Some suffer physical wounds that require medical attention and care. Others suffer wounds 

of war that are not always easy to see. As a Nation, we must provide comprehensive, long-term care for all of those affected by their experience of combat, and we 

must embrace the reality that combat stress and other psychological consequences 

of war are normal human reactions to horrific experiences. 

My area of expertise is the young men and women who are returning OIF and 

OEF veterans. 58 percent are 29 years old or younger. If we expand this demographic to include one additional age range, then 80 percent of our fighting force 

is 39 years old or younger. Clearly, a huge number of young veterans with young 

families need our care now. Our Government is clearly working hard to assist this 

generation of combat veterans and families. VA funding for the past 4 years is at 

unprecedented levels and continues to grow. We cannot assume, however, that more 

money, more staff, more outpatient clinics, more Vet Centers, more ‘‘clinics on 

wheels,’’ more organizational restructuring, and more (and different) leadership will 

enable the VA to meet the mental and physical health care needs facing this generation of combat veterans. We see from all the statistics, which I will cover shortly, 

that this is a public health crisis that will take more than extended outreach. Yes, 

current outreach efforts are clearly insufficient. But even if the current outreach efforts were sufficient, it is evident that the system does not have the capacity to meet 

the growing and ongoing needs of OIF and OEF veterans who are experiencing a 

full range of ongoing physical and mental health concerns upon returning home. Finally, even if outreach efforts were sufficient and the VA had the capacity to meet 

jbell on DSKDVH8Z91PROD with HEARING

47 

most of the needs of returning servicemembers, this solution would still be inadequate. If returning troops are to truly and successfully reintegrate into our communities, then our communities must be involved in the solution. So the issue is bigger 

than the efficacy of the VA’s current outreach efforts. The issue is how we can systematize a broad range of services to sustain care for our veterans over the long 

term. 

A current article in Health Affairs (May/June 2009) by behavioral scientists from 

the Rand Corp. addresses the problems associated with providing adequate mental 

health care for returning OEF/OIF veterans. Although the article focuses on mental 

health care—arguably the most pressing current need within the military community—the conclusions drawn are applicable for the entire range of services necessary 

to care for our returning troops and their families. The authors note, ‘‘Improving the 

quality of mental health benefits and services in the DoD and VHA is undoubtedly 

a key step in improving care for this population. However, they are only part of the 

systems of care needed to address the mental health problems of returning veterans. 

Improvements in access to and quality of community based services outside of the 

DoD and VHA will also be very important.’’ 

Consistent with the findings of this most recent offering by Rand, I propose the 

development of a new kind of public works project. Before describing this project in 

detail, I would like to provide the Committee with the story behind the need for 

such a program. 

But before doing that I need to make one additional point. Although this Committee’s focus is on the outreach efforts of the VA, I will frequently make reference 

throughout my testimony to the Department of Defense and its efforts to care for 

those who serve. It is impossible to discuss issues affecting our veterans without discussing DoD’s response to the men, women, and families who serve. While the VA 

and DoD operate as if there are two populations that require care—military personnel and veterans—there is really just one. Too many returning warriors get 

caught between the two systems and fail to receive the care they need when they 

need it. The failure of coordination between these two bureaucracies erodes the 

sense of trust that returning troops have in our military and in our Government. 

No amount of outreach can overcome the potential damage that is done by what is 

often experienced as a betrayal. 

Background 

According to a 2008 Rand Corp. study, over 300,000 men and women have already 

returned from Iraq and Afghanistan with symptoms of severe depression or posttraumatic stress. Over 320,000 have suffered a traumatic brain injury. And only 

about half of these men and women have sought treatment. 

There are on average 18 suicides a day among America’s 25 million veterans, with 

more than one-fifth of those being committed by patients undergoing treatment by 

the VA. Army officials calculate the suicide rate at 20.2 per 100,000 soldiers, the 

highest in its history—a number that exceeds the civilian rate for the first time 

since the Vietnam War. Last year, our Nation lost more Soldiers and Marines to 

suicide than to combat deaths. 

Roughly 20 percent of U.S. combat troops who fought in Iraq or Afghanistan come 

home with signs they may have had a concussion, and some do not realize they need 

treatment. In fact, 17 percent of the soldiers returning to war (for another tour) 

could have a traumatic brain injury. The lifetime risk of suicide among those who 

have suffered a moderate to severe traumatic brain injury is three to four times 

higher than among those who have not. 

Many of our returning troops turn to substance abuse to ease the pain of the 

wounds that we can’t see and they don’t understand. Parents routinely contact Give 

an Hour reporting concerns about a son or daughter who returned home from the 

war and began drinking or drugging heavily. Family members are frightened and 

uncertain about how to help prevent the dangerous deterioration they see. And they 

have reason to be concerned. Sadly, we are already seeing a number of this newest 

generation of veterans joining the ranks of the homeless on our streets. 

Some veterans are getting into minor, and major, scrapes with the law and becoming entangled in the judicial system. Countless stories have been told in media 

reports of ‘‘good kids’’ who end up in jail for crimes that no one believed them capable of committing. Fortunately, several Veterans Courts have sprung up throughout 

the country, where veterans are assessed for symptoms of combat-related psychological injuries and given treatment in addition to, or instead of, jail time. While 

the veteran’s court is a superior solution to the alternative, it does not address the 

underlying issue—that many men and women who are willing to die for their country are not receiving the care they need and deserve. 

jbell on DSKDVH8Z91PROD with HEARING

48 

One young woman telling her story in the hope that it will allow others to receive 

help was 17 years old when she joined the Army. She served in the fourth rotation 

of Operation Enduring Freedom in Afghanistan in 2003. Her experience left her 

with severe post-traumatic stress and, unfortunately, she returned to a community 

that did not reach out to her. She felt confused and ashamed of the symptoms she 

experienced. She began using drugs and ended up homeless, living out of her car. 

Eventually, she sought care through the VA, but the experience was not a positive 

one and she turned to our organization for help. Fortunately, she found a provider 

who helped her understand what was happening to her, and she began to rebuild 

her life. Today, at 25, she proudly reports that while she still experiences symptoms 

of post-traumatic stress, the symptoms no longer control her life. She is married and 

has a beautiful baby girl. Although this young woman has become a successful 

Member of her community, her painful story is all too typical of what we hear from 

the men and women returning from these conflicts. 

Clearly the toll on military families is tremendous. Of those deployed, more than 

800,000 are parents with one or more children. Of these, 40 percent have been deployed more than once. Almost 35,000 troops have been separated from their children for four or more deployments. More than 2 million children have a parent who 

has been deployed; 40 percent of these children are younger than age five. Children 

whose parents have post-traumatic stress are at a higher risk of themselves developing symptoms of post-traumatic stress, anxiety, and depression. And studies have 

linked depression, anxiety, and emotional disorders in children to a parent’s deployment. 

Furthermore, when deployments began, reports of abuse quickly jumped from 5 

in 1,000 children to 10 in 1,000. Children from military families are twice as likely 

to die from severe abuse as other children are, and rates of abuse and neglect rise 

dramatically (40 percent) during the time the soldier is deployed. 

Divorce is also on the rise in the military community with about 1 in every 5 married servicemembers filing for divorce since September 2001. In a November 2008 

study, Army spouses were seen to have rates of mental health problems comparable 

to the rates among soldiers. 

And parents who proudly launched their adult children into the world find themselves in the distressing position of watching their son or daughter fail in their efforts to reintegrate into their communities. One mother spoke to me about her son, 

who committed suicide after returning home from his tour of duty. While he appeared withdrawn and quiet, his family never suspected the depth of his despair. 

This grieving mother reported that her son had been through so much during the 

war that her family just wanted to give him some space. She felt such sadness that 

she hadn’t known the right questions to ask. 

Needed Services 

Returning veterans and their families need access to a number of services to ensure that they are able to move forward in their lives once they return to our communities. 

Mental health treatment. There is a tremendous need for effective and accessible treatment for the full range of mental health issues affecting those who serve, 

including post-traumatic stress, substance abuse, depression, anxiety, suicide, marital difficulties, family conflict, sexual dysfunction, behavioral and emotional symptoms in children, and domestic violence. There are also additional difficulties: many 

veterans live a great distance from formal VA services, and even those in closer 

proximity are often reluctant to seek mental health services because of a perceived 

stigma associated with treatment. We need to implement an ongoing screening program so that all who serve are periodically assessed for signs of psychological strain 

associated with their service. 

Traumatic Brain Injury (TBI) programs. There is a need to develop additional 

educational programs for servicemembers who suffer a TBI and their family members. Similarly, we need to expand, improve, and accelerate the delivery of 

neuropsychiatric services for all veterans, especially those returning from OEF/OIF. 

Finally, we need to make mental health services, rehabilitation, and job training opportunities available to those who have suffered a TBI. 

Care, training, and support for our wounded. Our wounded warriors receive 

the finest medical care available in the world while in our military facilities. Too 

often, however, they do not receive the continuity of care they need once they return 

to their communities. We must develop better coordination with community resources to ensure that our wounded (and their families) successfully heal from their 

physical and psychological injuries. In addition, we must provide appropriate job 

training and ongoing support once these wounded warriors return to the job force. 

jbell on DSKDVH8Z91PROD with HEARING

49 

Women’s support. We need to develop programs specifically focused on the 

unique needs of women who serve, including programs that treat victims of sexual 

assault. 

Employment. Employers want to hire veterans but often fear they are poorly prepared to support returning warriors. We need to develop programs that support the 

employers who want to hire veterans as well as the veterans who want to be productive Members of society. 

Police, judicial, and first-responder training. Many returning veterans find 

their way into the criminal justice system as a result of their combat experience. 

We need to continue to develop programs that train police, firefighters, paramedics, 

and judges about veterans and the issues that come home with them. 

Benefits and compensation. The system that determines benefits and compensation needs to be reworked. The current system leaves many veterans feeling 

dismayed, dismissed, or distressed, as they struggle to determine what benefits and 

compensation they are entitled to. 

Financial management. Many military families are poorly prepared to manage 

their finances, causing additional strain and distress. We need to develop programs 

to train the military community—especially the youngest Members who serve—how 

to make good financial decisions. 

Public education. Many veterans do not realize there are a variety of services 

and peer support opportunities available in their own communities that could be 

beneficial to them. There is also a dire need to educate family members about the 

unique needs and conditions of returning veterans. 

While the list of the services needed clearly presents us with a tremendous challenge, it is also true that we have a remarkable opportunity before us—the opportunity to create a comprehensive system of integrated care for the brave men, 

women, and families who sacrifice so much and ask so little. 

Barriers to Care 

Several factors contribute to our failure to adequately care for returning veterans 

and their families. Some of these factors lie within the systems responsible for providing appropriate care, while others stem from deep-seated beliefs and conflicts 

within the military culture and our society regarding the acknowledgment of needs 

and limitations. 

Regarding mental health care, these barriers are well known and documented. As 

discussed in the most recent study by Rand, the attitudes and beliefs of military 

servicemembers and veterans prevent them from seeking mental health care. Our 

military culture promotes pride and inner strength along with self-reliance, toughness, and the ability to brush off ailments or injuries. In addition, as humans, it 

is not our nature to turn toward emotional pain. We tend to deny problems until 

they overwhelm us. Sometimes, being overwhelmed provides us with the opportunity to address our struggles, but often we continue to deny their existence and 

continue to live an impaired or diminished life. Only through education and practice 

can veterans learn to face their fears and work through the understandable pain 

associated with the experience of war. Our society does not yet embrace this concept 

and so we do little to encourage our returning warriors to address their invisible 

wounds. 

The internal barriers that keep our warriors from seeking appropriate care for 

mental health concerns also play a role in preventing them from seeking assistance 

for other needs such as financial assistance, employment difficulties, and ongoing 

physical care. While it seems self-evident that someone who is in need of physical 

therapy for an injury suffered in conflict would follow up with recommendations for 

additional care, the decision to pursue care is often intertwined with other psychological reactions to seeking care, needing ongoing care, or being ‘‘less than’’ they 

once were. Moreover, if that care is difficult to find or access, and if it is recommended by someone the veteran has little if any relationship with, the likelihood 

of compliance with the recommendation is severely diminished. 

Systems charged with providing care for those who serve—including the VA and 

DoD—have failed in their efforts to reach those in need. Not that the task is simple, 

indeed it is extremely complex and labor intensive. Nonetheless, along with a strategic and innovative public education program, outreach is a critical component of 

a successful effort to care for the military community. While there are a few exceptions to this rule, too often these systems expect our veterans to come to them. As 

a result, many veterans and families who might benefit from the truly effective programs housed within never even know the programs exist. 

Similarly, both DoD and VA have been reluctant to forge critical relationships 

with community-based organizations that have developed over the last 6 years to 

jbell on DSKDVH8Z91PROD with HEARING

50 

fill some of the clear gaps in care. Opportunities have been missed for innovative 

collaborations that could have saved lives and healed families. 

As is true of DoD, there are many honorable and dedicated individuals within the 

VA who are working diligently to serve our veterans. Certainly, some VA systems 

receive praise for their efforts and ingenuity. In addition, the VA Medical Centers 

clearly provide the best medical care in the world. The problem comes when warriors and family members leave the medical units and return to their communities. 

They complain that there is little continuity of care or collaboration with community 

efforts; that they must drive long distances to reach the VA in order to receive services; that they wait for months or years for their disability claims to be resolved. 

Ultimately, it appears that at this time the VA is severely limited in its ability 

to create a successful and comprehensive system of care for our veterans. I recently 

spoke with a colleague who is in a senior position at a VA Medical Center in the 

Northeast. This mental health professional is a well-respected expert in post-traumatic stress and has been an advocate for the care provided by the VA for years. 

He told me in a moment of brutal honesty, ‘‘This is a disaster.’’ I asked what he 

meant by the statement, and he replied that he saw far too many veterans falling 

through the cracks and feared that the OEF/OIF generation would surely be ‘‘lost.’’ 

This was a very sobering admission from a man who has spent his professional life 

working within and championing the VA. 

The Big Problem: Operating without a Comprehensive System 

No single agency, organization, or sector can adequately care for our returning 

warriors. Several organizations—governmental and nonprofit—have attempted to 

organize the vast array of programs and services now available to servicemembers 

and veterans. But most of these efforts have resulted in cumbersome lists of available resources that do little to advance the mission of providing easy, accessible care 

to those who serve. Efforts to reach out to military personnel and their families can 

be successful only if we have a system in place that can reach everyone who serves 

and provide ongoing support to them. If we are willing and able to knit the available 

resources together into an integrated system of care that is available within our 

communities, we will succeed in our effort to provide for those who serve. 

The Best Solution: A New Kind of Public Works Project 

To effectively and efficiently care for our veterans, we need a system that can 

streamline and simplify the process of providing and receiving all manner of care 

for returning warriors and their families within their own communities. We need 

a plan that ensures our communities are able to assist and support veterans and 

their families so that their lives are ‘‘working’’ for them. There is no question that 

our citizens, our communities, and our Government supports the returning troops 

and their families. Everyone wants to help. The problem has been a lack of a coherent plan that will guide communities in this effort. 

In 1933, the Public Works Administration was formed in an effort to heal our Nation’s depression-ridden economy. Designed to provide unemployed workers with 

wages as well as to stimulate various industries, the PWA’s main focus was to design and implement large-scale construction projects. The goal was to heal our economy and ensure that our citizens were free to lead productive lives. Now we need 

to design and implement a similar public works project that will weave together the 

resources needed to heal our military community and ensure that our military personnel are free to lead productive lives. 

We have the resources to assist our returning veterans and their families. We 

have the desire to care for those who serve. We now need to organize and coordinate 

efforts across the country to assist our military personnel. With this public works 

mindset we can more effectively fill the current gaps in care, reduce the duplication 

of services, and enhance programs that are innovative and effective. 

Next Steps 

To realize the vision of a public works project that supports our returning troops 

and their families in their communities, the following steps are necessary: 

1. Bring together individuals representing organizations and entities that interact 

with veterans and military personnel including but not limited to the VA, the 

DoD, nonprofit and nongovernmental organizations, community-based mental 

health programs, public health organizations, higher education institutions, the 

faith-based community, law enforcement entities, and the U.S. Chamber of 

Commerce. 

2. Form a working group with these representatives to study efforts currently 

under way including innovative and successful community coordination projbell on DSKDVH8Z91PROD with HEARING

51 

grams in Rhode Island, California, New York, Colorado, and Montana, to name 

a few. 

3. Assign this working group the primary task of developing a strategic plan that 

will serve to guide our communities in their efforts to coordinate care among 

service providers for the military community and to engage in outreach to military citizens. 

4. Direct the working group to assist with nationwide efforts to implement the 

strategic plan. While state and local communities will refine the plan to fit the 

specifics of their population, the working group will be able to provide guidance 

and support as needed. 

5. Develop metrics to assess the implementation and effectiveness of this public 

works project. The strategic plan should be refined as data are gathered on the 

success of its efforts. 

Two technologically based initiatives currently being developed promise to contribute to the success of the public works project to support our military community. 

The Network of Care is an impressive platform that has already been shown 

to be effective in delivering a variety of services to millions of Americans throughout 

the country. One of the network’s components, the Network of Care for Behavioral 

Health, is itself an award-winning Web-based service developed by the California 

Department of Mental Health in partnership with Trilogy Integrated Resources and 

San Diego County Mental Health. The comprehensive Web portal spread rapidly 

throughout the country and now is implemented in more than 25 states over 400 

local areas and is one of the leading ‘‘transformation grant strategies’’ in the Nation. 

At the request of congressional, military, veteran, and mental health leaders, Trilogy began the development of the special portal for veterans. The following information, from the network’s project statement, provides a description of how it works 

and its potential to become the cornerstone for a national response to the needs of 

our veterans. 

The states of California and Maryland in conjunction with Trilogy, the creators of the Network of Care, are developing a virtual community and locally 

based Web portals for comprehensive, one-stop information resources specifically targeted to returning vets, other service personnel, their families and their 

communities. In addition to a comprehensive directory of all local, state and 

Federal services and support groups, the portal will contain innovative, userfriendly technology for: information-sharing and social networking, educational 

training programs, interactive recovery tools and strategies, best practices from 

around the Nation, and consumer based, interactive Personal Health Records. 

This valuable locally based service will serve as a critical information 

bridge for the individual veteran to tie together for the first time, all 

Federal, state and local service as well as programs and veterans themselves from all over the United States. 

The project has the formal support of the National Association of State Mental 

Health Program Directors, the National Association of County Behavioral Health 

Directors, the National Alliance on Mental Illness, andMental Health America. 

Maryland launched the Network of Care for Veterans and Servicemembers site 

in March. California will launch its site on May 22. Once established in Maryland 

and California, the program will be available for replication throughout the country. 

Funding is currently being explored in order to create a nationwide application. The 

cost for ongoing maintenance will be the responsibility of each local jurisdiction. 

Patients Like Me, founded in 2004 by three MIT engineers, is a privately funded 

company dedicated to making a difference in the lives of patients diagnosed with 

life-changing diseases or conditions. The goal of the company is to enable people to 

share information that can improve the lives of these patients. Accordingly, the creators of Patients Like Me developed a method for collecting and sharing real world, 

outcome-based patient data. In addition, they are establishing data-sharing partnerships with doctors, pharmaceutical and medical device companies, research organizations, and nonprofit organizations. 

The company’s creators are now developing a new version of their Web site, called 

Warriors Like Me, specifically for veterans, who will be able to share information 

with one another regarding treatments and procedures they find effective or promising. Providers and researchers will be able to access this data to determine best 

practices for conditions affecting those who serve, such as post-traumatic stress and 

traumatic brain injury. 

The effort to create a comprehensive and well-coordinated system of care within 

our communities for our veterans and their families can only be as successful as our 

jbell on DSKDVH8Z91PROD with HEARING

52 

efforts to educate those in need about the issues they face and the resources that 

are available. 

A significant public education campaign must accompany the public works project. 

Many different organizations have launched public awareness and educational efforts since the beginning of the wars in Afghanistan and Iraq. Many have been creative and compelling. It is not clear how effective any have been. While any one 

public education campaign can be effective in educating those who serve about the 

conditions they face and activating them to access the services available to them, 

successful outreach occurs when a variety of approaches are utilized. As with most 

complex situations, one size will not fit all. Technology has its advantages, but 

sometimes the human touch is required to make a connection and ensure follow 

through. 

To give but one example: Give an Hour recently provided the mental health support for a conference attended by many OEF/OIF veterans. One of our providers encountered a veteran who shared some of her personal struggles. Our provider offered to connect this young woman with a mental health professional in her city 

who participates in our network. The young woman accepted the offer and in a lovely e-mail message noted that she probably would not have followed through with 

the idea of counseling if our provider hadn’t gone the extra mile to direct her to 

someone offering care. 

Conclusion 

We have the resources, the vision, and the commitment to ensure that our veterans and their families receive the care they need and deserve. Thanks to the efforts of dedicated people working in and across organizations and localities all over 

the country, we have the potential to create an effective community-based, cohesive, 

and organized service delivery system capable of providing comprehensive, longterm care to those who serve our country. This is a historic and unique opportunity 

to harness our Nation’s resources and care for our military community. 

f 

Prepared Statement of John King, Co Director, Veterans Community 

Action Teams Mission Project, Altarum Institute, Ann Arbor, MI 

Good afternoon, Chairman Michaud, Ranking Member Brown, and Members of 

the Subcommittee. 

Thank you for inviting Altarum Institute to testify before this oversight hearing 

of the Subcommittee on Health. We appreciate the opportunity to offer our views 

on VA Medical Care: The Crown Jewel and Best Kept Secret. In our testimony 

today, we will address the methods and activities through which we have observed 

the Veterans Health Administration (VHA) communicating the availability of services to veterans. We also will share our observations regarding the differences in 

outreach strategies for the current generation of new veterans versus those used for 

older veteran populations. 

Altarum Institute (Altarum) is a nonprofit health systems research and consulting 

organization serving Government and private-sector clients. We provide objective research and tailored consulting services that assist our clients in understanding and 

solving the complex systems problems that impact health and health care. Our 

unique model combines the analytical rigor of a research institution with the business acumen of a traditional consultancy to deliver comprehensive, systems-based 

solutions that meet unique needs. 

In 2008, Altarum launched its Mission Projects Initiative, committing more than 

$8 million in internal resources to three critical areas of societal need. The purpose 

of the initiative is to solve pressing health care issues using our systems methods 

at the institutional, organizational, and community levels in partnership with the 

public and private sectors, with the goal of improving the quality of life for millions 

of Americans. 

Our Mission Projects are focused on three areas: developing systems changes to 

prevent childhood obesity, fostering innovation in community health centers, and facilitating integration and coordination of community health and social services for 

veterans and their families. Today’s testimony will focus on the last area. 

As you are well aware, since 2002, we have seen a tremendous influx of servicemembers transitioning from active duty to veteran status. More than 870,000 

servicemembers have separated from the active military and Reserve Component 

forces and transitioned to civilian life. These newly created veterans are returning 

to communities throughout the country after having served in Operation Enduring 

Freedom (OEF) and Operation Iraqi Freedom (OIF). These returning veterans and 

jbell on DSKDVH8Z91PROD with HEARING

53 

the existing population of aging veterans have multifaceted service requirements 

that are generally met by a number of independently administered services. Their 

requirements include health care, vocational rehabilitation, employment and training, care giving, social services, housing, and independent living assistance, to name 

just a few. 

Current public and private initiatives providing these services to veterans and 

their families have limited resources, not only to reach out and administer their programs to this growing population, but to integrate their services with other complementary programs being offered in the community. The increasing number of 

new initiatives, when added to an already confusing array of existing organizations 

and services, often leaves veterans and their families searching for the programs 

and services that best meet their needs. It is the absence of the integration of these 

services that presents the greatest challenge to veterans and their families, who are 

forced to navigate a complex web of care and programs that often are not well coordinated. This situation forces undue stress and burden on those who we believe 

are the most deserving of our support. 

We believe that veterans and their families deserve access to an integrated system of community services to achieve economic security, receive better health care, 

and improve their overall quality of life. With improved communication, coordination, and integration, a streamlined and responsive community-based system will 

enhance access to public, private, nonprofit, and volunteer services for veterans and 

their families. In turn, community service organizations will be more efficient and 

effective at delivering services, optimizing existing resources, and enhancing the 

population and community development. 

It is our observation that no one entity can meet all of these requirements. 

Altarum’s Veterans Community Action Teams (VCAT) Mission Project was started 

specifically to strengthen the web of care that currently exists for veterans and their 

families. Through the VCAT project, Altarum works with community service providers and advocates who not only understand the National debt to veterans and 

their families but are also the ones in the best position to render the appropriate 

services. 

The VCAT project will develop a collaborative, community-based model to integrate the outreach and delivery of services from public, private, and nonprofit organizations to veterans and their family members. The VCAT project will test this 

model in selected pilot communities to demonstrate the value of the communitybased system of care for improving the accessibility, scope, and quality of services 

available for veterans and their families. Multiple governmental agencies, nongovernmental organizations, and community-based organizations are being invited 

to collaborate. 

Currently, VCAT project leaders are communicating with leaders of communities 

with large veteran populations as well as public, private, and nonprofit organizations within those communities to establish the VCAT project pilot site(s). Strategic 

partnerships are already under way to ensure that the VCAT model will have longterm sustainability in the demonstration communities. Altarum will continue the 

VCAT project in partnership with the selected pilot communities through the end 

of 2010. 

Altarum’s focus through the VCAT project is concentrated on building integrated 

community-based service networks that strengthen service ‘‘safety nets’’ for veterans 

and family members who are experiencing readjustment issues and/or suffering the 

‘‘invisible wounds’’ of war. 

Based upon our collaborations with VHA in our search for the first VCAT pilot 

community, we have observed a significant level of cooperation and coordination 

among the VHA; the Veterans Benefit Administration; the Department of Defense; 

State, county, and local governments; and public and private organizations. The 

VCAT initiative is an effort to complement the work of the VHA by building bridges 

from community-level services to the National-level efforts of outreach and access. 

The footing for these bridges will be built from the community up, namely through 

the coordination, the collaboration, and ultimately the integration of the community 

providers. The community providers include Federal, State, and local governments; 

private and nonprofit organizations; and voluntary service providers. Some of the 

services include community mental health, spiritual wellness, law enforcement, education and training, and legal advocacy (including Veterans Service Organizations 

or VSOs). 

VHA accomplishes outreach to the veteran population through the media and network efforts of the Veterans Affairs Medical Centers, community-based outpatient 

clinics, and veteran centers and through partnerships with public and private VSOs. 

All of these outreach efforts are focused on connecting veterans and their family 

members to the health care services provided by VHA. This high level of collaborajbell on DSKDVH8Z91PROD with HEARING

54 

tion has the additional result of connecting veterans and families with organizations 

that offer other programs and services that are not necessarily health related (e.g., 

job placement centers, housing assistance, childcare providers). Our plan is to look 

at current ‘‘best practices’’ and to provide assistance to further integrate the community service providers. The goal is to develop models that can serve as guides for 

other communities to replicate the development of highly integrated community 

service networks. In the face of financial constraints on the Nation, which are felt 

especially at the community level, the efficacy of this initiative will enhance integration of existing programs and more effective and efficient use of associated resources. 

The outreach strategies employed to connect the current generation of OEF/OIF 

veterans with services needs to be different than those used with past generations. 

The methods used by this new population to receive and to process information are 

vastly different. What has not changed is the tendency of veterans (past and 

present) to base their trust of service organizations on familiarity; they trust other 

veterans and servicemembers and those to whom their trusted comrades refer them. 

It is the method by which they share this information that is different and that 

must drive the changes that the VHA and all other veteran service organizations 

must make in their outreach efforts. Our observation is that it is no longer adequate 

to simply create and launch a Web site of an organization’s services or even a portal 

to connect veterans to many organizations’ services. The current generation of veterans communicates through social networks that connect individuals based upon 

common interests, requirements, and mindset. Outreach is accomplished by connecting organizations and networks of providers in like manner to the social networks of the younger veterans. 

While our VCAT project will have a particular focus on OEF/OIF veterans and 

their families in the immediate future, we believe that well-integrated community 

providers will have the inherent capacity to serve all veterans regardless of age. The 

VCAT project has been up and running for almost a year; we are applying our existing knowledge and learning new information on the complex needs of veterans and 

their families to better understand the multifaceted services arena. Community providers need the collaborative support from all levels of Government and private 

partners so that they can ‘‘wrap’’ their services around veterans and their families. 

Services need to be seamless to ensure that no veteran or family member is lost 

as servicemembers transition from active duty to veteran status and continue to access services throughout their lives. The ease of access to services for veterans is 

the ultimate outcome that integrated communities are striving toward. 

The early evidence from our initial engagement of public and private partners 

within our potential VCAT pilot communities supports our hypothesis that the key 

to improving the delivery of services to veterans and families is the integration and 

improved collaboration of service providers. The degree to which the delivery of 

services is enhanced and outreach is improved within a community is directly related to the level of communication, coordination, and collaboration of public and 

private service providers from all levels within that community. Barriers to communications must be eliminated, bridges of relationship between all VSOs need to be 

built, and cooperation across those bridges must be promoted. 

While our overarching goal is to improve the lives of veterans and their families, 

it is also our hope that the model that we develop and the lessons that we learn 

from our demonstration project will help inform other communities. Ultimately, we 

would like the VCAT model of community-based service integration to be replicated 

in other communities across the Nation. We hope to share with you the lessons that 

we learn from the VCAT project soon and offer policy and programmatic changes 

that may lead to increased outreach to veterans and their families. 

In conclusion, we see the VCAT project as a great opportunity to support and assist our Nation’s veterans in receiving the care, support, and services that they 

need, ensured by an integrated network of organizations and service providers. As 

a nonprofit organization, Altarum Institute is committed to its mission: We serve 

the public good by solving complex health care systems problems to improve human 

health. I can imagine no greater reward than to help fulfill this mission by serving 

those who have given so much in service to our Nation. 

Mr. Chairman, this concludes my statement. I will be pleased to respond to any 

questions. 

Thank you. 

f 

jbell on DSKDVH8Z91PROD with HEARING

55 

Prepared Statement of Randall L. Rutta, Executive Vice President, 

Public Affairs, Easter Seals, Inc. 

Chairman Michaud, Ranking Member Brown, Members of the Subcommittee, on 

behalf of Easter Seals, thank you for the opportunity to come before you today to 

share our views on issues relating to the Department of Veterans Affairs’ Veterans’ 

Health Administration and its outreach to and care of our Nation’s veterans. My 

name is Randall Rutta and I am Easter Seals’ Executive Vice President of Public 

Affairs. 

NEED 

The crisis facing our Nation in meeting the physical and mental health needs of 

the 1.8 million members of the armed forces who served in Iraq and Afghanistan, 

as well as the needs of 23.4 million other veterans, is overwhelming and continues 

to grow. Thousands of injured servicemembers are returning home to communities 

nationwide with hopes of transitioning to a successful civilian life. While a broad 

spectrum of public benefits and private resources exist across the country, many 

servicemembers and veterans with disabilities are encountering barriers to accessing health care, job training and employment, housing, recreation and transportation as they transition back into their civilian communities. Nationwide, many 

communities are simply not fully equipped to respond appropriately and effectively 

to this population’s unique needs, nor are they aware of how to best coordinate with 

military and veterans systems in the process. These barriers often limit the ability 

of veterans and their families to live, learn, work, and play as full participants in 

civilian community life. 

In 2008, the RAND Corp released a study indicating that 1 in every 5 returning 

OEF/OIF servicemembers expressed indicators for post-traumatic stress disorder 

(PTSD) and 1 in every 5 had some level of Traumatic Brain Injury (TBI). This observation warrants concern as PTSD and TBI are among the leading medical conditions facing our returning heroes. According to Dr. Evan Kanter, a staff physician 

for the VA, who wrote in a November 2007 study by Physicians for Social Responsibility, titled ‘‘Shock and Awe Hits Home,’’ that ‘‘as many as 30 percent of injured 

soldiers have suffered some degree of traumatic brain injury.’’ These combat injuries 

significantly complicate a veteran’s ability to successfully transition from active duty 

to civilian life. Moreover, unlike injuries to a soldier’s limbs, injuries to a soldier’s 

brain are often difficult to diagnose and treat in a timely manner, and are often not 

apparent until months later. 

In a GAO report, the VA was commended for its efforts to prepare to meet these 

demands. However, concerns were noted about ensuring that all veterans have 

‘‘equal access’’ when wide geographic territories define a service catchment area. 

Concern was also expressed about the efficacy of several service strategies that appeared to build infrastructure, but did not provide direct service. Issues of access 

to and availability of fundamental services and supports are unfortunately a common part of daily experiences for an individual living with a disability in our country. It is reasonable, then, to conclude that such challenges will be a part of life for 

a veteran with a service-connected disability. Easter Seals believes that these barriers need not be inevitable for these veterans – or for the broad population of individuals with disabilities. We are committed to creating and implementing solutions 

to these challenges in work and in life, so that all veterans with disabilities have 

the opportunity to lead full and productive lives. 

EASTER SEALS BACKGROUND 

For 90 years, Easter Seals has been providing and advocating for services that 

change and improve the lives of those living with disabilities and their families. 

With a network of 78 affiliate organizations, we are the Nation’s largest provider 

of disability related services to individuals with disabilities and their families— 

touching the lives of more than 1.3 million people annually. We have a long history 

of helping veterans with disabilities through job training and employment opportunities, adult day services, medical rehabilitation, home modifications for accessibility 

needs, and recreation. Easter Seals is positioned to offer military and veterans systems of care with viable options to support and augment current transition and reintegration efforts. Additionally, Easter Seals has former servicemembers in leadership positions to guide program development and to train staff on how to be attuned 

to military and veteran cultural issues. In fact, Easter Seals has made Military and 

Veterans Initiatives a foundational pillar of Vision 2010, which is the guiding mission for the organization’s current work and resource allocation priorities. 

The vision of our Military & Veterans Initiative is that Easter Seals is a 

recognized and trusted partner with the Departments of Defense and Vetjbell on DSKDVH8Z91PROD with HEARING

56 

erans Affairs, and is a significant source of essential information, services 

and support for America’s military servicemembers, veterans with disabilities, and their families. 

EASTER SEALS CURRENT SERVICE CAPACITY AND EXPERIENCE 

Currently, Easter Seals provides a broad range of community-based services and 

supports—job training & employment, childcare, adult day services, medical rehabilitation, mental health services, transportation, camping & recreation, respite and 

caregiver services, and accessibility solutions and technology for home, work, and 

independent living—to military servicemembers and veterans with disabilities, and 

their families in civilian programs throughout the Nation. A summary of a few of 

these activities follows. 

Job Training & Employment 

Historically, Easter Seals has had considerable experience with the VA in providing employment related services to veterans with disabilities. Our affiliate in 

Hartford, CT provides vocational evaluations and assessments to veterans with disabilities. Easter Seals in Middle Georgia provides direct work experience for veterans with disabilities. With grant funding from the McCormick Foundation, Easter 

Seals headquarters is developing an educational curriculum to train employers on 

best practices for hiring, retaining, managing and accommodating veterans with disabilities, especially those with PTSD, TBI, and amputations that are trying to reenter the workforce. A number of Easter Seals’ corporate partners are pursuing strategies to hire veterans with disabilities throughout their organizations nationwide. 

Adult Day Services 

Several Easter Seals affiliates have contracts with the VA to provide adult day 

services to older veterans and are exploring potential opportunities for veterans 

with disabilities, specifically for younger veterans with significant injuries. Easter 

Seals Greater Washington-Baltimore Region operates a new intergenerational facility that delivers comprehensive services in Silver Spring, Md., approximately one 

mile from Walter Reed Medical Center. Plans call for the center to have resources 

for veterans and their families to support them during their time Washington, D.C. 

and in transition to their respective hometowns across the country. 

Community OneSource TM

A significant disconnect in the continuum of care exists between active duty recovery at military treatment facilities and post-discharge reintegration to civilian life 

and life with a disability for servicemembers with disabilities and their families in 

communities nationwide. The report issued by the President’s Commission on Care 

for America’s Returning Wounded Warriors supports the implementation of a comprehensive ‘‘Recovery Plan’’ that will help servicemembers obtain essential services 

promptly and in the most appropriate care facilities in the Departments of Defense 

and Veterans Affairs, and civilian settings. Easter Seals is responding to the Commission’s call to action for civilian settings by developing and implementing a ‘‘Community OneSourceTM’’ reintegration model program. 

Community OneSourceTM is a dynamic national initiative that will support successful community reintegration of America’s wounded, ill or injured servicemembers and veterans and their families. The program’s approach fosters systems 

change throughout the country to rally and support communities and regions in responding to the needs of this deserving population, while specifically establishing 

points of contact that will coordinate and provide services and supports to families. 

Community OneSourceTM leverages, integrates, and builds community capacity 

through convening and collaborative efforts amongst Federal, state, and local public 

and private systems and providers of service to meet specific needs for information, 

assistance, case management, system and resource navigation, and essential services from active duty demobilization or discharge to civilian status and successful 

community integration. 

SUGGESTED IMPROVEMENT AREAS 

Easter Seals recognizes and applauds the good work that the Veterans Health Administration (VHA) does for our Nation’s veterans community. The VHA has 7.8 

million veterans enrolled in its health care system and provided 51⁄2 million unique 

patient visits in 2007. In an effort to reach the entirety of today’s 23.4 million veterans, Easter Seals commends the many and varied communication and outreach 

strategies that VA utilizes to inform its service population. Efforts such as active 

participation in demobilization briefs (Transition Assistance Program, Disabled 

Transition Assistance Program), partnerships with Veteran Service Organizations, 

combined efforts with state VA efforts (county outreach coordinators), the implemenjbell on DSKDVH8Z91PROD with HEARING

57 

tation of online strategies, and the use of traditional media, public service announcements, brochures, billboards, and others have heightened public awareness and gone 

far to informing today’s veterans of the availability of support and care provided 

through the VA. 

Despite these good efforts, a strategic resource has yet to be fully leveraged in 

this process— capitalizing on the infrastructure, established networks, and grassroots reach of community-based organizations such as Easter Seals. 

1. Collaboration: No one organization can provide all the services that an entire 

segment of a population needs—and the VA cannot be all things, to all veterans, in all places. Veterans and their families are not all located conveniently 

near VA facilities, many live in rural areas where they are geographically isolated from VA services. Additionally, the VA does not maintain a full compliment of services at every one of its facilities nationwide, creating service 

gaps for those whose needs cannot be met locally. 

Recommendations: VA should use community-based NGOs as a vehicle for both outreach AND service delivery. The VA must reach out to 

community-based NGOs to leverage their best practices and service 

capacity in meeting the needs of veterans and their families in areas 

where VA services either do not exist, are inaccessible, or are insufficient through partnerships and outsourcing. This would allow the VA 

to formally recognize the capacity, ability, and desire of the community-based sector to serve veterans and their families. Additionally, VA 

should develop a strategic plan for teaming with and leveraging the 

Nation’s human service system in meeting their mission. 

2. NGO Access: Many Federal agencies have an established point of contact to facilitate organizational partnerships, learning, and team efforts. They serve are 

liaisons for understanding and supporting the organization’s strategic vision 

and service needs. The VA has a Veteran Services Organization (VSO) liaison 

that acts as an entry point for accessing to VA internal agencies for the VSOs. 

Recommendation: In support of the VA’s Gateway Initiative, VA 

needs to hire an NGO liaison, VA Ombudsman to fully realize this 

entry point for interacting with the VA and outside organizations 

seeking to help veterans. This staff Member would not only understand VA and veteran needs, but also the NGO system—including how 

to interpret their desire to partner and leverage resources. 

3. Mobile Vet Centers: The VA has established 50 mobile Vet Centers that specifically target veterans in more remote areas where VA mental health services 

do not exist. While Easter Seals applauds the VA for thinking outside the box 

with this initiative, we would ask what happens to veteran needs after the mobile Vet Center leaves the community. 

Recommendations: The VA should formally partner with local community NGOs like Easter Seals to host the mobile Vet Center during 

its visit, and contract for services that ensure continuity of care before and after the visit. Then once the mobile Vet Center leaves, the 

local community based NGO would be able to provide a level of follow 

up services to the veteran and/or family. Such a partnership should include outreach for VA services conducted by the NGO. 

4. Younger Veterans: The VHA has taken a number of steps to reach younger veterans, initiating age appropriate strategies to accomplish this objective. Online 

efforts such as a section within the VA’s Web site designed explicitly for Operation Enduring Freedom and Operation Iraqi Freedom veterans and My 

HealtheVet provide useful and relevant health care and benefits information. 

The VA has also initiated strategies to leverage the power of web-based social 

networking to reach out to younger veterans, with a growing presence on 

Facebook, informational videos on YouTube and involvement with Second Life. 

The involvement of OEF/OIF coordinators in reintegration events such as 

Stand Downs and Yellow Ribbon Reintegration events also targets getting information to today’s younger veterans as they seek to shift into civilian life. 

Recommendations: While these efforts are both appropriate and strategic, the VA could enhance their outreach efforts to younger veterans 

through increasing activities designed to target a veteran’s family— 

their parents or spouse. One unique strategy that has proven effective 

for National Guard Members is Easter Seals New Hampshire’s Veterans Count program, where Easter Seals, in partnership with the 

Guard and New Hampshire’s Department of Health and Human Servjbell on DSKDVH8Z91PROD with HEARING

58 

ices, initiates contact with Guard Members and their families pre-deployment. The Veterans Count staff then work with these families to 

prepare them for deployment, support the family while the servicemember is deployed, and then are positioned to support them post-deployment because of time invested with the family over the prior 18 

to 20 months. Such an approach significantly reduces the likelihood 

that a veteran will fall the cracks or be lost in the bureaucratic process in their attempts to return to their families. Easter Seals is then 

able to ensure that the veteran and his or her family is connected with 

the resources they need to successfully transition back into civilian 

life. This early intervention model provides a unique boots on the 

ground approach to outreach and is one that Easter Seals would like 

to see implemented across the country. 

5. Older Veterans Strategies: While Easter Seals applauds the efforts of the VHA 

to develop appropriate and targeted approaches to reaching younger veterans, 

we remain concerned that older veterans are not receiving similar organizational attention. While some older veterans will likely be able to found through 

younger veteran approaches, many of the over 9 million veterans who are 65 

and above will not benefit from these efforts, particularly those who are lowincome, have limited access to health care or lack access or skills to utilize current technologies. This short-coming results in those most in need of services 

and supports being left out or looked over by the very system designed to meet 

their needs. 

Recommendations: VHA should actively pursue a collaborative relationship with the administration on Aging (AoA) and create joint marketing and outreach strategies and materials which leverage the national network of senior services under the authority of AoA. Such a 

partnership could result in such outreach efforts as including information in Meals on Wheels deliveries about age appropriate veterans 

benefits for beneficiaries of this AoA service. Additionally, VHA should 

create partnerships with senior service organizations to utilize their 

networks across the country to provide information to seniors served 

by their systems. Further, local VHA facilities such as Vet Centers, 

Veterans Hospitals and Outpatient Clinics should actively reach out to 

local Area Agencies on Aging to install outreach strategies within 

their service delivery mechanisms and facilities such as senior centers 

or activities buildings. 

Finally, VHA should establish strategic relationships with our Nation’s adult day service network, which provides service to over 

150,000 seniors daily through a network of over 3,400 local centers. 

While adult day service is a fairly new offering from the VA, being 

added to the veteran benefit package through the Millennium Health 

Act 1999, the larger adult day service market has been strong for decades, and projects significant growth in the coming years as our Nation’s baby boomers age and desire the services provided by this industry. Many of the 9 million senior veterans are likely to need and 

receive these services. Easter Seals has worked with the VHA for a 

number of years on promoting the use of ADS within the community 

of veterans accessing VA services. We have also encouraged the VA to 

more actively engage the non-VA ADS network as strategic partner 

that could both extend information about VA benefits and provide 

quality services to older veterans. Non-VA ADS staff should be trained 

to identify, refer as appropriate and meet the unique service needs of 

older veterans; the VA is the logical entity to lead such efforts. 

6. Insular Culture: Many of the systems and departments providing services to 

veterans within the VA operate in a very insular manner, most notably at the 

local level. Specific functions are carried out in silos and stop short of shepherding the veteran to much needed additional resources during their community-based transition, continued recovery and rehabilitation. Often times Veterans Integrated Service Network (VISN) staff reflect this insular operational 

methodology in attitudes concerning the use and value of utilizing local NGOs 

to meet veterans’ needs. One significant outcome of this cultural insularity is 

lost opportunity, for the VA to meet its objectives and, sadly, for the veteran 

who either gets lost in the system or cannot access the full array of available 

services in his or her community. More often than not, our local affiliates’ expejbell on DSKDVH8Z91PROD with HEARING

59 

rience in attempting to partner with the local VA is met with initial resistance 

and then inability to execute. 

Recommendations: The VA must encourage key decision-makers in 

each VISN to embrace collaborative relationships to meet the needs of 

veterans within their service delivery region. VHA community leaders 

should partner with other local community NGOs to help meet the 

needs of the veterans they serve. Easter Seals offers services and supports that can augment those provided by VHA, especially when the 

veteran transitions to his or her home community. Additionally, 

Easter Seals would recommend systemic VA organizational culture 

change that changes the service delivery approach to veteran-centric. 

SUMMARY 

America’s warriors serve their country, fully, bravely and without question. Now, 

all Americans must rise together to fulfill our promise to care for those who have 

borne the battle and sacrificed so much, by assuring that our veterans have access 

to the services they need, wherever they live. Just as it takes a village to raise a 

child, so too does it take a village to welcome a veteran back home. 

As Executive Vice President of one of the Nation’s largest nonprofit disability 

health care organizations, I can say with an unwavering confidence that the VA has 

much to gain by embracing community-based organizations, like Easter Seals, in 

collaborative relationships that compliment the current array of Federal and state 

outreach and service efforts to our struggling veterans. It is these community-based 

organizations that hold the infrastructure to help meet this urgent need and should 

be viewed as an ally to further supplement, and not supplant, the efforts of the VA. 

Easter Seals is poised to substantially expand assistance to servicemembers and 

veterans with disabilities and their families. We have proven service solutions in 

place or within easy reach to address these immediate and long-term needs. The 

central challenge facing us in bringing needed information, services and supports to 

this population is the limited extent, to date, on the part of the Departments of Defense and Veterans Affairs to partner and outsource at substantial levels with private, nonprofit service providers to seed and sustain financial resources to conduct 

pilot projects and replicate effective models of service delivery nationwide that promote success in attaining individual and family goals and full community participation. 

As Secretary Shinseki stated earlier this year during his Senate confirmation 

hearing ‘‘. . . three fundamental attributes mark the starting point for framing a 21st 

Century Organization: people-centric, result-driven, and forward-looking.’’ A 21st 

Century VA must reach out across the table to community-based organizations to 

leverage best practices and local infrastructure in order to provide more effective 

services and supports to America’s heroes and their families . . . Easter Seals has 

its hand extended. 

Thank you again for the opportunity to address this Committee and for all that 

you do for our Nation’s veterans. I would be pleased to respond to any questions 

that you may have. 

f 

Prepared Statement of Jeffrey W. Pollard, Ph.D., ABPP, Director, 

Counseling and Psychological Services, George Mason University, 

Fairfax, VA, on behalf of American Psychological Association 

Mr. Chairman and Members of the Subcommittee, please allow me to express appreciation for the opportunity to speak on behalf of the 150,000 members and affiliates of the American Psychological Association regarding outreach activities to veterans on college campuses. I am the son of a decorated WWII veteran captured on 

December 7, 1941, released in September 1945, and buried in Arlington National 

Cemetery. I have spent 30 years working as a psychologist committed to the mental 

and behavioral health of students on college campuses. Meeting the needs of the increasing numbers of our Nation’s veterans—particularly on college and university 

campuses—is extremely significant to me. 

Our ability to diagnose and treat combat-related mental and behavioral health 

problems, including depression, traumatic brain injury, and post-traumatic stress 

disorder has improved dramatically in recent years. Estimates suggest that between 

a quarter and a third of all veterans returning from Operation Enduring Freedom 

and Operation Iraqi Freedom will display symptoms of a mental disorder within a 

year of leaving military service. Many of these veterans are expected to benefit from 

the new Post-9/11 GI Bill by furthering their education at our Nation’s colleges and 

universities. These facts point to the important role that colleges and universities 

jbell on DSKDVH8Z91PROD with HEARING

60 

must play in our national efforts to meet the mental and behavioral health needs 

of our servicemembers and veterans. 

During the past year, George Mason University has been involved in a number 

of important activities to enhance our outreach to military personnel and veterans 

on campus. First, we hired Mr. Michael Johnson to serve as our full-time Military 

and Veterans Liaison in our Military and Veterans Office. Mr. Johnson, who has 

accompanied me to today’s hearing, is a veteran of the United States Marine Corps, 

where he served for 17 years as both an enlisted Member and an officer. Mr. Johnson and his colleagues in the Military and Veterans Office currently serve approximately 1,000 active duty, reserve, National Guard and veteran students, offering assistance and information regarding issues such as veteran services and academic 

counseling, as well as information about the many benefits to which they are entitled through state and Federal Government programs. The office also assists veterans in adapting to collegiate life, connecting them to each other, and supporting 

them as they pursue their studies. 

In addition, George Mason University has recently completed a needs survey of 

our military and veteran student population and established connections between 

the new Military and Veterans Liaison and virtually every component within the 

university. We have also established the Mason Military Outreach group, which is 

a collaboration of students, faculty and staff in support of our servicemembers, veterans, and their families. Further, the Mason Veteran Peers (MVP) initiative, involves a group of veterans who are working with Counseling & Psychological Services to provide peer support to veteran students. 

Last month, George Mason University was one of only 20 institutions of higher 

education awarded a ‘‘Success for Veterans Award Grant’’ sponsored by the American Council on Education and the Wal-Mart Foundation. This $100,000 grant will 

help George Mason University’s Military and Veterans Office evolve further into a 

comprehensive, coordinated one-stop resource and support center to ensure academic, psychological, and transition support. We are grateful for this award. However, like most grants, it will not cover the predicted level of need, and it is time 

limited. Furthermore, our university may be unable to continue the program upon 

completion of the grant. Unfortunately, servicemembers and veterans attending colleges and universities that have not received such grant funding will not be able 

to benefit from the additional support to aid in the successful completion of their 

academic work. 

Just as the community mental health system is stretched far too thin, so are college and university mental health resources. In fact, campus mental health faces 

significant systemic challenges, including an insufficient number of service providers, such as psychologists, psychiatrists, and case managers. Funding for colleges 

and universities to provide the specialized mental and behavioral health care required by many servicemembers and veterans is unavailable. As more servicemembers and veterans are utilizing college and university mental health services, 

these facilities are experiencing the strain of increasing caseloads and case management needs. 

Data indicate that students on college and university campuses are increasingly 

arriving with more severe preexisting mental and behavioral health problems or developing these health concerns during their college careers. The increasing civilian 

mental and behavioral health needs on campus make it even more challenging for 

colleges and universities to provide sufficient services and supports for the growing 

population of servicemembers and veterans on campus. 

While we at George Mason University and our colleagues at colleges and universities around the country have been taking important steps to reach out to servicemembers and veterans on campus, much work remains ahead. I would like to provide a few recommendations that may help our institutions of higher learning to ensure that we are doing all that we can to meet the mental and behavioral health 

needs of our military and veteran student population. 

First, sufficient resources must be made available to support targeted efforts on 

campus to address mental and behavioral health needs among servicemembers and 

veterans, including risk of suicide. In recent years, some important Federal initiatives have been created through the Substance Abuse and Mental Health Services 

Administration (SAMHSA) to address the national problem of increased mental and 

behavioral health concerns on campus, including suicide. 

While these SAMHSA grants currently support education and outreach efforts related to suicide prevention on college and university campuses, there are currently 

only 49 programs in place to create greater awareness about suicide and strengthen 

suicide prevention efforts. Much more needs to be done. Initiatives are underway 

to enable SAMHSA to support direct services for students on campus, an increasing 

jbell on DSKDVH8Z91PROD with HEARING

61 

number of whom will be servicemembers and veterans, so that the full range of 

their mental and behavioral health needs can be met. 

Senators Durbin and Collins and Representative Schakowsky have introduced the 

Mental Health on Campus Improvement Act (S. 682/H.R. 1704) and its programs will 

complement SAMHSA’s Campus Suicide Prevention program to offer the full range 

of prevention and intervention services currently needed on college and university 

campuses. In addition, this legislation calls on grant applicants to include a plan, 

when applicable, to meet the specific mental and behavioral health needs of veterans attending institutions of higher education. This bill would also establish a 

College Campus Task Force, which includes representation from the Department of 

Veterans Affairs, to discuss mental and behavioral health concerns on college and 

university campuses. 

Second, continuing education and training opportunities must be readily available 

for college and university mental and behavioral health professionals regarding 

some of the unique deployment, reintegration, and readjustment issues facing 

servicemembers, veterans, and their families. Both the Department of Defense 

(DoD) and the Department of Veterans Affairs (VA) have unique knowledge and expertise in this domain. I recently attended a week-long training conducted by the 

DoD Center for Deployment Psychology in which leading experts in the field provided critical training regarding the deployment cycle, trauma and resilience, behavioral health care for the severely injured, and the impact of deployment on families. 

These are high quality training programs that are worthy of continued attention 

and support. 

Third, we must develop mechanisms to conduct appropriate outreach to servicemembers and veterans who are beginning their postsecondary education online 

while deployed or upon their return from service. Such online education opportunities may present unique challenges for our military and veteran students, not because these education programs are unworthy or ineffective, but because of their potential isolating effect. Servicemembers and veterans who are enrolled in online 

education programs and experiencing mental and behavioral health problems are 

often more isolated than their on-campus colleagues, and this isolation can be contraindicated for their healthy readjustment and recovery. 

APA and the psychology community looks forward to continuing to work with 

Congress, the VA, the DoD, and the veterans service community to welcome home 

our men and women in uniform and ensure that they receive the mental and behavioral health services and supports—on college and university campuses and in the 

larger community—that they have so honorably earned. 

f 

Prepared Statement of Paul J. Hutter, Chief Officer; Legislative, 

Regulatory, and Intergovernmental Affairs, Veterans Health 

Administration, U.S. Department of Veterans Affairs 

Mr. Chairman and Members of the Subcommittee, thank you for providing me 

this opportunity to discuss the Veterans Health Administration’s (VHA’s) outreach 

activities to Veterans. I am accompanied today by Ev Chasen, VHA’s Chief Communications Officer, John Brown, Director of the VHA Operation Enduring Freedom 

and Operation Iraqi Freedom (OEF/OIF) Outreach Office, and Emily Smith, Deputy 

Assistant Secretary for Intergovernmental Affairs, Office of Public and Intergovernmental Affairs. VA’s mission is to care for those who have borne the battle—to 

honor those who have worn the uniform by providing them the highest quality 

health care and benefits possible. This mission can only be accomplished when Veterans know the full range of services we offer. VA is committed to reaching out to 

Veterans and their families where they are to support these ends; this includes not 

only reaching into rural communities, but entering virtual communities and establishing connections there as well. My testimony today will highlight four forms of 

outreach VHA is conducting: direct, traditional outreach to separating servicemembers; program-specific outreach; outreach to rural areas; and outreach using 

new technologies. 

Outreach to Separating Servicemembers 

VHA currently maintains a variety of programs to respond to the specific needs 

of separating OEF/OIF servicemembers to assist them in transitioning from military 

service to Veteran status. The Department of Veterans Affairs (VA) and the Department of Defense (DoD) have established a comprehensive, standardized enrollment 

process at 60 demobilization sites (15 Army, 3 Navy, 3 Marines, 3 Coast Guard and 

36 Air Force). Through this process, VA has contacted more than 41,000 Members 

jbell on DSKDVH8Z91PROD with HEARING

62 

of the Reserve and National Guard and enrolled more than 38,000 of them for VHA 

health care. DoD provides VA with dates, numbers of servicemembers demobilizing 

and locations for demobilizing events. At these events, VHA staff representatives 

from the local VA medical center, benefits specialists and Vet Center counselors provide standardized 45-minute briefings during mandatory demobilization events. 

During the briefing, VA representatives provide demobilizing servicemembers information about health care enrollment and eligibility, including the most recent expansion extending VA health care enrollment period to 5 years to those servicemembers who served in combat following their separation from active duty. They 

are also educated about the period of eligibility for dental benefits, which Congress 

recently extended from 90 days to 180 days following separation from service, 

through the National Defense Authorization Act for Fiscal Year 2008. 

VA streamlined this enrollment process and, during the demobilization events, VA 

representatives show Veterans how to complete the Application for Health Benefits 

(1010EZ). This begins the enrollment process for VA health care. VHA staff members also discuss how to make an appointment for an initial examination for servicerelated conditions and answer questions about the enrollment process. VA representatives collect the completed forms at the end of each session. VA staff at the 

supporting facility match the 1010EZ with a copy of the Veteran’s DD Form 214, 

the discharge papers. Presently, data from these forms are entered into the Vista 

health record system. An email is sent to the Veteran’s preferred facility to complete 

the enrollment. A new process has been developed through a pilot program at Ft. 

Bragg to overnight all records from each of the 60 sites to VA’s Health Eligibility 

Center to complete the enrollment process. A letter is then sent from the Health 

Eligibility Center to the Veteran verifying their enrollment. 

In response to the growing numbers of Veterans returning from combat in OEF/ 

OIF, the Vet Centers initiated an aggressive outreach campaign to welcome home 

and educate returning servicemembers at military demobilization and National 

Guard and Reserve sites. Through its community outreach and brokering efforts, 

the Vet Center program also provides many Veterans the means of access to other 

VHA and VBA programs. To augment this effort, the Vet Center program recruited 

and hired 100 OEF/OIF Veterans to provide the bulk of this outreach to their fellow 

Veterans. To improve the quality of its outreach services, in June 2005, the Vet 

Centers began documenting every OEF/OIF Veteran who received outreach services. 

The program’s focus on aggressive outreach activities has resulted in the provision 

of timely Vet Center services to significant numbers of OEF/OIF Veterans and family members. 

Every VA medical center has established an OEF/OIF Program. The Program 

Manager, usually a social worker or nurse, manages programs for OEF/OIF Veterans, coordinates the efforts of clinical case managers and Transition Patient Advocates, links with military treatment facilities to ease transfers of patients and works 

with the Veterans Benefits Administration (VBA) to track claims. Each VISN has 

also identified an OEF/OIF Program Manager to coordinate inter-facility issues and 

practices. OEF/OIF case managers initiate contact with patients and families before 

they transfer from a military treatment facility (if they have received care there, 

otherwise, they work with patients and their families as they present for care) and 

assist an interdisciplinary team assigned to treat the Veteran’s medical needs. The 

OEF/OIF case manager is responsible for planning and coordinating all of the patient’s health care needs. 

In May 2008, VA began a Veteran Call Center Initiative to reach out to OEF/OIF 

Veterans who separated between FY 2002 and December 2008. We are now reaching 

out to Veterans who have separated through March 2009. The Call Center representatives inform Veterans of their benefits, including enhanced health care enrollment opportunities and determine if VA can assist in any way. This effort initially focused on approximately 15,500 Veterans VA believed had injuries or illnesses that might need care management. The Call Center also contacted any combat Veteran who had never used a VA medical facility before. Almost 38 percent 

of those we spoke with requested information or assistance as a result of our outreach. The Call Center Initiative continues today, focusing on those Veterans who 

have separated since 2001. As of May 6, 2009, VA has called 660,000 Veterans and 

spoken with more than 160,000 of them. We have sent almost 36,000 requested information packages to Veterans. 

Another area in which VA is supporting OEF/OIF transition is through the Yellow 

Ribbon Reintegration program. VA has assigned a full-time liaison with the Yellow 

Ribbon Reintegration Program office in DoD to facilitate VA support of the development and implementation of the program. The Yellow Ribbon Reintegration Program is currently active in 54 states and territories, and engages servicemembers 

and their families during the pre-, during and post-deployment stages, including 30, 

jbell on DSKDVH8Z91PROD with HEARING

63 

60, and 90 days after deployment. At the local level, VA supported 275 Reserve and 

Guard Yellow Ribbon Events during FY 2008 and through mid-February 2009. A 

total of 39,000 servicemembers have attended these events, along with 25,000 members of their families. 

VHA has been providing support to DoD’s Reserve and National Guard (RC) PostDeployment Health Reassessment (PDHRA) Initiative since its beginning in November 2005. VA has supported over 1,850 PDHRA events at local Reserve and National 

Guard Units along with supporting referral efforts from DoD’s 24/7 PDHRA Call 

Center operation. The RC PDHRA initiative has generated over 57,000 referrals to 

VA medical centers and over 24,000 referrals to Vet Centers during this time. 

For severely injured Veterans and servicemembers, VHA has stationed 27 social 

work or nurse case manager liaisons at 13 military treatment facilities across the 

country to identify and address the patient’s clinical needs as they transfer from a 

DoD facility to a VA facility. Similarly, VA houses approximately 90 military liaisons in VHA facilities to provide on-site, non-clinical support for Veterans or servicemembers at VA’s Polytrauma facilities and other locations. 

In October 2007, VA partnered with DoD to establish the Joint VA/DoD Federal 

Recovery Coordination Program (FRCP). Federal Recovery Coordinators identify and 

integrate care and services for the seriously wounded, ill, and injured servicemember, Veteran, and their families through recovery, rehabilitation, and community reintegration. The FRCP is intended to serve all seriously injured servicemembers and Veterans, regardless of where they receive their care. The central 

tenet of this program is close coordination of clinical and non-clinical care management across the lifetime continuum of care. 

Program-Specific Outreach 

VHA’s program offices and facilities also engage in outreach in their own areas 

in coordination to increase awareness of benefits and services they offer. VA employs management tools to ensure control and oversight of promotion efforts through 

coordinated messages with valid and up-to-date information. VHA’s Chief Business 

Office is undertaking efforts to increase awareness of the Universal Health Service 

Plan task force recommendations, including a streamlined health benefits application web portal and other robust communication products. 

Perhaps the most notable example of program-specific outreach VHA has done is 

the Suicide Prevention public service announcements (PSAs) featuring Gary Sinise 

and Deborah Norville. In the 6 months between October 13, 2008 and April 13, 

2009, the PSA featuring Gary Sinise was broadcast more than 8,700 times by 155 

stations in almost 100 markets. During this same time period, VA’s Suicide Prevention Hotline (1–800–273–TALK) received approximately 50,000 calls across the Nation, an increase of roughly 25 percent based on the previous 6 months when the 

Hotline received approximately 40,000 calls. Last year, VA advertised the Suicide 

Prevention Hotline on buses and metro trains in the Washington, D.C. area, resulting in a significant increase in calls to the hotline from the area. This year, we have 

begun advertising in Spokane, WA, and will soon advertise on public transit systems in the Miami, Los Angeles, San Francisco/Oakland, Phoenix, Las Vegas and 

Dallas metropolitan areas (all locations where the suicide rate among Veterans is 

greater than the national average). In addition, VA is working with a company to 

purchase advertisements on 20,000 buses nationwide. 

More broadly, VA could not serve Veterans to the degree it does without the immeasurable help of Veterans Service Organizations (VSOs), faith-based and community groups. VA maintains constant contact and holds regular meetings with VSOs 

and organizations such as the Knights of Columbus, the American Red Cross, and 

the Salvation Army (among others) to provide information about VA’s programs and 

offerings while soliciting feedback about concerns present in the community. Working with these community partners helps significantly expand VA’s reach to millions 

of people who may not otherwise hear of our offer of care and service. 

Our facilities also conduct local outreach that, while essential, often goes 

unheralded. These efforts are possible because of the dedicated work of VA professionals who have established relationships with local communities, and their work 

continue to pay dividends. For example, in April alone: 

• The Little Rock VA Medical Center participated in two Post-Deployment Health 

Assessments for Members of the 39th Infantry Brigade of the Arkansas Army 

Guard; of the more than 850 soldiers screened, we initiated 252 new case appointments; 

• The West Palm Beach VA Medical Center participated in an outreach activity 

at the Palm Beach Community College, providing information to students who 

are Veterans on enrollment, benefits and employment; 

jbell on DSKDVH8Z91PROD with HEARING

64 

• The VA Central Texas Health Care System joined the Family Readiness Group 

of the 126th Forward Surgical Team for a welcome home celebration at Fort 

Hood as the Unit returned from a tour in Afghanistan; • The VA Palo Alto’s Polytrauma Rehabilitation Center and the Men’s Trauma 

Recovery Program held a small town hall meeting for all active duty soldiers 

being cared for in these programs, providing information on Medical Boards and 

other DoD issues related to their time at VA; • The Indianapolis, Fort Wayne and Evansville, Indiana Medical Centers hosted 

Post Deployment Health Reassessments for the 76th Brigade Combat Team for 

over 2,800 soldiers who returned from Iraq in December 2008; and • The VA San Diego Health Care System participated in a demobilization briefing 

at Camp Pendleton that approximately 800 Marines attended. 

Mr. Chairman, these are but a few of the many actions taken by VA staff Members to inform Veterans and to establish contact with them. I highlight these cases 

not to draw special attention to these facilities or any specific program, but as evidence of a trend too often missed. VHA Directive 2007–017, enacted in May 2007, 

requires each VA medical center to host an annual ‘‘Welcome Home’’ event for OEF/ 

OIF Veterans and active duty servicemembers, their families, and the community 

at large. These events are well-attended and offer health screenings, benefits information, and increase awareness about programs such as VA’s Safe Driving Initiative. 

The Department’s Safe Driving Initiative is an innovative effort designed to address an important concern. VA has determined that motor vehicle crashes are a 

leading cause of death among combat Veterans during the first years after their return home, and is working with the Department of Transportation and DoD to reduce these accidents. We have begun a new program designed to identify needed 

research and to increase awareness of the importance of safe driving among newlydemobilized Veterans. The program has included a summit meeting among leading 

researchers, posters, a soon-to-be-released Public Service Announcement featuring 

race driver Richard Petty, a Web site, and other activities. During calendar year 

2009, every VA medical center has been tasked to hold a safe driving event to inform returning Veterans of the need to drive safely. 

Our Vet Centers also provide services and points of access to Veterans in communities across the country. Vet Centers welcome home Veterans with honor by providing quality readjustment counseling in a supportive, non-clinical environment. By 

the end of FY 2009, VA will have 271 Vet Centers and 1,526 employees to address 

the needs of Veterans; any county in the country with more than 50,000 Veterans 

will have services available through a Vet Center. A fleet of 50 Mobile Vet Centers 

are being put into service this year and will provide access to returning Veterans 

and outreach to demobilization military bases, National Guard and Reserve locations nationally. This type of outreach spans across the range of areas covered 

today, as these Mobile Vet Centers utilize new technologies to reach younger Veterans, those immediately separating, those in rural or remote areas, and those in 

need of services. 

Rural Health Outreach 

Particularly important to VA is outreach to geographic areas, particularly rural 

and highly rural communities. Both the Office of Rural Health (ORH) and Veterans 

Integrated Service Networks (VISNs) participate in outreach efforts for these populations. VISN Rural Consultants collaborate with local communities to educate, support case management, and increase awareness. Additionally, VA’s Rural Health Resource Centers serve as regional satellite offices and educational repositories to expand and develop relationships with academic institutions and a range of other 

partners in communities across the country. VA understands that successful outreach must be tailored to local needs and conditions, and one of ORH’s primary aims 

has been to support this approach. 

ORH is supporting expansion of the Mental Health Care Intensive Care Management-Rural Access Network for Growth Enhancement (MHICM–Range) Initiative to 

provide community-based support for Veterans with severe mental illness. VA has 

been adding mental health staff to CBOCs, enhancing our capacity to provide telemental health services and using referrals to Community Mental Health Services 

and other providers to increase access to mental health care in rural areas. ORH 

collaborated with the South Central Mental Illness Research, Education and Clinical Center in VISN 16 to fund four research studies investigating clinical policies 

or programs that improve access, quality and outcomes of mental health and substance abuse treatment services for rural and underserved Veterans. 

VA has also taken the lead in opening new rural health care facilities, such as 

Rural Outreach Clinics. Last September, VA announced the opening of 10 new 

jbell on DSKDVH8Z91PROD with HEARING

65 

Rural Outreach Clinics this Fiscal Year; four of these are currently operational, including sites in Houlton, ME; Perry, GA; Juneau, AK; and The Dalles, OR. VA utilizes Rural Outreach Clinics to offer services on a part-time basis, usually a few 

days a week, in rural and highly rural areas where there is insufficient demand for 

full-time services or it is otherwise not feasible to establish a full-time CBOC. Rural 

Outreach Clinics offer primary care, mental health services, and specialty referrals. 

Each Rural Outreach Clinic is part of a VA network and meets VA’s quality standards. Veterans use Rural Outreach Clinics as an access point for referrals to larger 

VA facilities for specialized needs. 

VA recently announced a Mobile Health Care Pilot Project in VISNs 1, 4, 19, and 

20. The health care vans associated with this program will be concentrated in 24 

predominately rural counties, where patients would otherwise travel long distances 

for care. VA is focusing on counties in Colorado, Maine, Nebraska, Washington, 

West Virginia and Wyoming. This pilot will collaborate with local communities in 

areas our mobile vans visit to promote continuity of care for Veterans. It will also 

allow us to expand our telemedicine satellite technology resources and is part of a 

larger group of mobile assets. ORH is developing evaluation methodologies and 

measures to determine the effectiveness of this program and to identify areas for 

improvement. 

Outreach Using New Technologies 

VHA is not limiting itself to traditional forms of outreach. In order to become a 

21st century VA, we must add to the past methods used in communicating to reach 

a new generation of Veterans. By fostering and creating linkages across offices and 

throughout the Department, VA is harnessing new technology and venues, including 

Twitter, Second Life, Facebook, YouTube, and the television channel MTV to provide information to younger Veterans where they are most likely to see it and in 

media familiar to them. We have adapted our Web site to be viewable on mobile 

devices (m.va.gov) so Veterans and others can receive up to date information on VA 

services and locations wherever they are. VA is also employing public service announcements to raise awareness about VA, and has launched a new initiative to 

provide colleges and universities with information concerning the health care needs 

of returning Veterans. This latter effort provides training and education materials 

for administrators and students to help foster more accommodating academic environments for Veterans. 

VA has also created a new Web site for returning Veterans that provides useful 

information about eligibility, benefits, health care, and other services (http:// 

www.oefoif.va.gov/). This site also features a blog with comments from Veterans and 

family members (http://www.blogs.va.gov/returningservicemembers/). We recognize 

we must develop social networking strategies, including nontraditional outlets, and 

a wide variety of new media to communicate VA’s message about our services. 

These new technologies have even entered into health care delivery. One VA facility has begun piloting a program that uses text messaging to help Veterans send 

their home-based blood pressure readings to their clinicians. Researchers found Veterans who used text messaging achieved their blood pressure goals 2 weeks sooner 

than those who used other methods. 

Conclusion 

VA understands different Veterans will receive messages in different ways and 

different times. It is our duty to notify Veterans of the repayment our Nation offers 

in gratitude for the sacrifice they have made. We must continue programs that are 

successful and develop new methods when our current measures are insufficient. 

Our mission is to reach out to family members, employers, community stakeholders, 

Reserve and National Guard units and Veterans to make sure they will know how 

to access help when they need it. Thank you again for the opportunity to testify. 

My colleagues and I are prepared to answer any questions you may have. 

jbell on DSKDVH8Z91PROD with HEARING

66 

jbell on DSKDVH8Z91PROD with HEARING


49920A.002 49920A.003
67 

jbell on DSKDVH8Z91PROD with HEARING


49920A.004 49920A.005
68 

jbell on DSKDVH8Z91PROD with HEARING


49920A.006 49920A.007
69 

f 

jbell on DSKDVH8Z91PROD with HEARING


49920A.008 49920A.009
70 

Statement of Rear Admiral LeRoy Collins, Jr., USNR (Ret.) Executive 

Director, Florida Department of Veterans Affairs 

Mr. Chairman and distinguished Members of the Subcommittee, thank you for the 

opportunity to provide a statement to address the Veterans Health Administration’s 

outreach to veterans. 

Florida has almost 1.8 million veterans. The Florida Department of Veterans Affairs (FDVA) is a state veterans’ service agency created by the Florida Legislature 

following a successful constitutional initiative to authorize this department. We provide information, advocacy and quality long term health care services to our veterans. We maintain strong positive working relationships with both the Veterans 

Health Administration (VHA) and the Veterans Benefits Administration (VBA) leadership in Florida. 

We are an arm of state government which has statutory responsibilities concerning state veterans benefits and citizen services, as well as service delivery responsibilities representing veterans in their dealings with the claims process in 

VBA. FDVA continues to expand veterans’ facilities and services in Florida, primarily through the growth in the State Veterans Homes program and through new 

outreach programs to contact more of the veteran population in Florida. As a result 

of strong advocacy on behalf of veterans and dependents, their economic and health 

status is improved with benefits earned through military service to our Nation. 

FDVA currently employs 912 staff members. 

The primary challenge our Veterans Claims Examiners (VCEs) have in Florida is 

timely access to VA information concerning veterans, particularly those wounded in 

combat, returning to our state. Improved case information flow to state government 

is needed and vital to improving the timely delivery of state benefits information 

to these warriors and families. Our Florida Seamless Transition Program, the first 

of its kind in the Nation and adopted nationwide by the VA in February 2007, has 

helped, but more must be done. Electronic contact information of our state’s veterans upon separation would be a desirable enhancement (e.g. e-mail address on the 

DD 214 form). 

Enhanced outreach to veterans in large population states deserves more attention 

and resources to meet the needs of our newest generation of veterans. We appreciate 

the VA’s efforts to keep the various state departments of veterans’ affairs better informed on key topics of interest. We hope the VA will provide the states with an 

electronic list of the names, addresses and e-mail addresses of Veterans who claim 

that state as their home of record. Our newest veterans communicate via electronic 

social networking and tend to keep their electronic lines of communication consistent. Sharing this vital link is essential. 

We support the transitional efforts of the VA under Secretary of Veterans Affairs 

Eric K. Shinseki. His Veteran-centric approach to incorporate new technologies in 

the operation of the department should pay huge dividends, and Florida enthusiastically endorses his focus on modernizing outreach. In addition, we hope that the success of the Public Service Announcement by actor Gary Sinese on Veteran suicide 

prevention will lead to other high-visibility PSAs on Post-Traumatic Stress Disorder 

and Traumatic Brain Injury. 

Furthermore, we appreciate the VA’s response to the Post 9/11 GI Bill, but believe 

the agency should fund and certify campus veterans’ representatives, as they did following the Vietnam War. These campus VET–REPs can help veterans facilitate access to substance abuse and mental health services, enrollment in health care, issue 

resolution, claims development and advocacy. The hour is late to get this VET–REP 

effort underway nationwide in time to implement the new G.I. Bill in August 2009. 

FDVA convinced the Florida legislature to approve a VET–REP position for each 

state college and university campus, but the funding for the initiative eluded us. We 

believe the VET–REP issue needs your attention. 

Thank you for the opportunity to comment. This Subcommittee’s efforts to improve America’s benefits and services to our veterans is a noble cause. 

f 

Statement of Hon. Cliff Stearns, a Representative in Congress from the 

State of Florida 

Thank you, Mr. Chairman. 

I am pleased to be here this afternoon to examine the status of the Veteran 

Health Administration’s outreach efforts to all categories of veterans. The VA has 

a wealth of resources and services available to those who served our Nation, but 

these resources are wasted if no one knows about them. Unfortunately, that is what 

jbell on DSKDVH8Z91PROD with HEARING

71 

we often hear from our constituents and the veteran service organizations that represent them. 

Admiral LeRoy Collins, Jr. (Rear Admiral, U.S. Navy Reserve, Retired), who is the 

Executive Director of the Florida Department of Veterans Affairs, has submitted a 

statement for the record on the status of the VHA’s outreach to veterans in the 

State of Florida, and I would like to highlight a few of his key points. 

Florida is home to the second largest veterans population in the country, which 

is almost 1.8 million veterans. The goal of the Florida Department of Veterans Affairs (FDVA) is to provide information, advocacy, and quality long-term health care 

services to veterans. Additionally, the FDVA regularly and effectively communicates 

with the VHA and VBA leadership in Florida. These strong working relationships 

go a long way to ensuring veterans in Florida know about the VA’s services. However, it would be helpful if the VA could provide all states with an electronic list 

of the names, addresses, and e-mails of veterans who claim that state as their home 

of record. Sharing this information is essential to ensuring that claims examiners 

have timely access to key information and can reach specified groups of veterans. 

Importantly, Admiral Collins states that enhanced outreach to veterans deserves 

more attention and resources in order to meet the needs of our newest generation 

of veterans—those returning from Iraq and Afghanistan. The VA Secretary should 

be regularly using national media outlets to advertise VA services and draw attention to key health issues. Many also believe there is a need for more ‘‘high visibility’’ 

public service announcements such as the recent PSA by actor Gary Sinese on Veteran Suicide Prevention. The VA should create other effective PSAs on Traumatic 

Brain Injury (TBI) and Post-traumatic stress disorder (PTSD) to help erase the stigma associated with these increasingly prevalent behavioral disorders. 

The VA should never have to be pushed by Congress to legislate outreach efforts. 

I hope this hearing today affords us the chance to have a better dialogue with the 

VA on the need for differentiated outreach strategies to address the dynamic group 

of veterans in its health care system. 

jbell on DSKDVH8Z91PROD with HEARING

72 

MATERIAL SUBMITTED FOR THE RECORD 

Committee on Veterans’ Affairs 

Subcommittee on Health 

Washington, DC. 

June 3, 2009 

Honorable Eric K. Shinseki 

Secretary 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, D.C. 20240 

Dear Secretary Shinseki: 

Thank you for the testimony of Paul Hutter, Chief Officer for Legislative, Regulatory and Intergovernmental Affairs of the Veterans Health Administration at the 

U.S. House of Representatives Committee on Veterans’ Affairs Subcommittee on 

Health Oversight Hearing on ‘‘VA Medical Care: The Crown Jewel and Best Kept 

Secret’’ that took place on May 19, 2009. 

Please provide answers to the following questions by July 15, 2009, to Jeff 

Burdette, Legislative Assistant to the Subcommittee on Health. 

1. In your testimony you mentioned a pilot program currently being conducted at 

Fort Bragg. In this program, VA seeks to expedite enrollment by overnighting 

records from demobilization sites to VA’s Health Eligibility Center. Has this 

program been effective in streamlining the enrollment process? 

2. Your testimony largely centered on outreach efforts targeting OEF/OIF veterans. 

a. What programs does VA have that focus on Vietnam veterans and other 

such populations? 

b. How do programs targeting specific veterans groups differ from each other. 

3. You mentioned that VA has harnessed new technology such as Twitter, Second 

Life, Facebook, and YouTube. Can you elaborate on VA’s efforts toward utilizing these new mediums? 

4. Can you talk a bit about how local outreach conducted by VA facilities fits into 

the structure of VA’s overall effort? What does the central office do to support 

these local efforts? 

5. Some VSOs have noted the outreach efforts that will be required by VA’s upcoming effort to expand enrollment in VHA among veterans in priority group 

8. Is there a plan in place to notify veterans in this group that they may be 

eligible for enrollment? 

6. What are the roles and responsibilities with respect to outreach for the communications director for VHA? How does this compare to the roles and responsibilities of the now defunct office of Deputy Undersecretary for Coordination? 

Thank you again for taking the time to answer these questions. The Committee 

looks forward to receiving your answers by July 15, 2009. 

Sincerely, 

MICHAEL H. MICHAUD 

Chairman 

Question for the Record 

The Honorable Michael H. Michaud, Chairman 

Subcommittee on Health 

House Committee on Veterans’ Affairs 

Department of Veterans Affairs Medical Care: The Crown Jewel 

and Best Kept Secret 

May 19, 2009 

Question 1: In your testimony you mentioned a pilot program currently being 

conducted at Fort Bragg. In this program, VA seeks to expedite enrollment by 

overnighting records from demobilization sites to VA’s Health Eligibility Center. 

Has this program been effective in streamlining the enrollment process? 

jbell on DSKDVH8Z91PROD with HEARING

73 

Response: The Veteran Health Administration (VHA) Chief Business Office 

(CBO) Health Eligibility Center (HEC) proposed to VHA Outreach Office that the 

HEC provide additional administrative assistance to the medical center staff currently engaged in providing demobilization (DEMOB) site support. The pilot program which was initiated at Fort Bragg, North Carolina, commenced on May 1, 

2009, and is expected to run through August 31, 2009. The goal of the pilot is to 

streamline the Department of Veterans Affairs (VA) enrollment process, reduce the 

administrative workload of VA’s staff and improve Veterans’ satisfaction with timely 

enrollment into VA health care. Once the pilot program is complete, VA will evaluate its effectiveness and determine whether to expand the program nationwide. We 

expect to make that decision by October 1, 2009. 

Since May 1, 2009, the HEC staff has successfully processed all enrollment applications submitted from the DEMOB site pilot program at Fort Bragg, North Carolina, within 72 hours of receiving these applications. 

Question 2(a): Your testimony largely centered on outreach efforts targeting 

OEF/OIF Veterans. What programs does VA have that focus on Vietnam Veterans 

and other such populations? 

Response: VA has developed a great number of initiatives in response to the 

unique health issues and concerns of Veterans of the Vietnam War. Perhaps more 

than for any other U.S. military deployment, the Vietnam War generated a lasting 

and vivid impression among Veterans and all Americans about the environmental 

impact of this war on those who served. Today, VA has made it easier for Vietnam 

Veterans and, in some cases, their children to receive benefits and services for any 

illnesses or injuries they suffer that may be related to herbicide exposure. 

Eligible Vietnam Veterans have access to VA’s comprehensive health care system 

that includes programs specially tailored to their special concerns and needs. In 

1978, VA established a special health examination registry known as the Agent Orange Registry examination, in response to mounting concerns about health effects 

from herbicide exposure among Vietnam Veterans. The program offers a medical examination at all VA health care facilities, as well as the chance for Veterans to discuss their health concerns with a knowledgeable health care provider. The Agent 

Orange Registry is a computerized record of these examinations, and as of June 

2009, the program has provided for more than 542,174 individual Vietnam Veterans, including over 8,000 women Vietnam War Veterans. Each VA medical center 

has an environmental health clinician responsible for conducting Agent Orange Registry examinations, and an environmental health coordinator responsible for coordinating the exam and reporting results. Any Veteran who had active military service 

in the Republic of Vietnam between 1962 and 1975, and who expresses a concern 

relating to exposure to herbicides, may participate in the registry. 

VA is also working to ensure that all Veterans who served on the ground and inland waterways of Vietnam are aware of the conditions for which they may be presumptively service-connected. The Veterans Benefits Administration (VBA) and 

VHA are working together to identify in-country Vietnam Veterans who have received treatment in a VA facility for a condition related to herbicide exposure, but 

have not applied for disability compensation. Last year, approximately 28,000 ‘‘incountry’’ Vietnam Veterans were contacted and provided with information on the 

presumptive disabilities associated with agent orange exposure and where to apply 

for VA benefits for these conditions. 

Since the end of the Vietnam War, VA has developed many ways to communicate 

with Veterans about these issues, including: 

• The Agent Orange Review newsletter mailed to every Vietnam Veteran who has 

used VA. In 2004, the circulation of the newsletter increased to nearly 800,000 

copies mailed to Veterans’ homes. The last newsletter was published in August 

2008 and a new one is in preparation and will be published this summer. It 

is also available on our Web site; 

• An agent orange Web site; 

• A national toll-free telephone number; 

• The popular Federal Benefits for Veterans and Dependents and Survivors booklet, and 

• A series of agent orange fact sheets, agent orange brochures, and agent orange 

posters distributed throughout VA. 

VA’s Web site for agent orange-related matters is at www.va.gov/AgentOrange, 

which has virtually all of VA’s outreach material for Vietnam Veterans, including 

all the newsletters, brochures and posters, as well as information about special programs such as the Agent Orange Health Registry. 

jbell on DSKDVH8Z91PROD with HEARING

74 

Similar programs are in place for radiation-exposed Veterans, and Gulf War Veterans, as well as Veterans of Operation Enduring Freedom and Operation Iraqi 

Freedom (OEF/OIF). 

Question 2(b): How do programs targeting specific Veterans groups differ from 

each other? 

Response: The programs only differ in areas of concentration, i.e., radiation vs. 

agent orange. VA programs may target specific populations of Veterans, for example, minority and women Veterans, but benefits and services are open to eligible 

Veterans from every period of service. Eligible Veterans of every era have comprehensive health care benefits through VA from basic primary care issues to the 

most extensive traumatic brain injury care network in the world. Disability compensation, education, home loan guaranty, insurance and vocational rehabilitation 

are also available to Veterans who met the entitlement criteria. 

Question 3: You mentioned that VA has harnessed new technology such as Twitter, Second Life, Facebook, and YouTube. Can you elaborate on VA’s efforts toward 

utilizing these new mediums? 

Response: VA began establishing a Web 2.0 presence on Facebook, YouTube and 

Second Life in May 2008. The Second Life virtual world presence was recently enhanced from a small ‘‘office’’ to an ‘‘island’’ in May 2009. VA currently has three official Facebook accounts, VA, VHA and a Welcome Home (event) page, with plans to 

stand-up a fourth account for VBA in the near future. VA also has one official 

YouTube channel with over 50 videos posted and 1,076 subscribers to date. A Twitter account was recently enabled in May 2009 and VA currently has 570 followers 

which include many National Veterans Service Organizations. There is also a returning servicemember blog and a tag cloud on www.oefoif.va.gov. 

VA is currently planning to redesign its Web sites over the next 2 fiscal years. 

The redesign project will be focused primarily on content and usability. Improvements to the Web site will allow additional mediums of communication or Web 2.0 

tools to be added. 

Question 4: Can you talk a bit about how local outreach conducted by VA facilities fits into the structure of VA’s overall effort? What does the Central Office do 

to support these local efforts? 

Response: Aside from the more obvious support of staffing, VHA’s central office 

provides detailed guidelines, up-to-date information and coordination of research for 

the staff in the field who reach out to our Veterans each day. Nearly 20 different 

program offices function within VA’s central office to concentrate on issues of homelessness, rural health, minority and women Veterans, research, quality and safety, 

and other programs designed to acquaint Veterans with the services and benefits 

offered by the Department. These offices work directly with field staff in order to 

ensure that Veterans in local communities have the most relevant and updated information and are treated with proven evidence-based practices. 

To further enhance the coordination between central office and the field stations, 

the Office of Public and Intergovernmental Affairs (OPIA) is responsible for overseeing and coordinating all outreach activities Department-wide. 

Question 5: Some VSOs have noted the outreach efforts that will be required by 

VA’s upcoming efforts to expand enrollment in VHA among Veterans in priority 

group 8. Is there a plan in place to notify Veterans in this group that they will be 

eligible for enrollment? 

Response: Yes. VA is engaged in the implementation of a communications and 

outreach strategy that leverages technology and partnerships with other stakeholders to educate Veterans and their families about Priority 8 eligibility. 

• Direct Veteran Contact: VA has contacted, by mail, the approximately 420,000 

Veterans who previously tried to enroll for health care benefits but were rejected because of their income level. The letter explains that eligibility requirements have changed and provides Web-based and paper enrollment options for 

Veterans to use. VA will also use micro-targeting to mail to an additional 

150,000 Veterans who have not previously applied but live in low-income neighborhoods. If this test mailing is successful, VA will expand the universe to reach 

out to more Veterans using additional micro targeting criteria. 

• Web Content: VA has developed and released Web content and tools to help 

communicate with Veterans, their families, and other stakeholders. This conjbell on DSKDVH8Z91PROD with HEARING

75 

tent has been deployed to VA’s Web sites, other Government sites, and sites 

such as Wikipedia. 

• Expanded Web Outreach and Communications: VA is currently developing additional approaches to perform targeted Web-based outreach and communications. 

• Media: VA has placed op-eds and Web-based stories about Priority 8 in targeted media outlets. VA is also using traditional media sources and bloggers to 

communicate. VA is in the process of contracting with a public relations firm 

to develop additional outreach strategies to reach Veterans who might be eligible. Strategies will likely include a highly targeted, paid media campaign. 

• Partnering with Veteran Service Organizations (VSO), State Veterans Affairs 

Directors, County Veterans Service Officers, and Other Stakeholders: VA has 

partnered with stakeholders to communicate with the Veterans they serve. VA 

has educated stakeholders about the new eligibility criteria and placed content, 

links, and even Web-based eligibility calculators on its Web sites. VA is in the 

process of identifying other stakeholders to partner with. For example, the Office of Congressional and Legislative Affairs will provide a widget and an eligibility calculator that Members of Congress can post on their own Web sites. 

Question 6: What are the roles and responsibilities with respect to outreach for 

the communications director for VHA? How does this compare to the role and responsibilities of the now defunct office of Deputy Undersecretary for Coordination? 

Response: VHA’s chief communications officer supports, OPIA in the public affairs aspects of VA outreach, including news releases, internet communications and 

the possible use of paid advertisements to reach Veterans of all eras. VHA’s Office 

of Legislative, Regulatory and Intergovernmental Affairs (OLRIA) is responsible for 

outreach to OEF/OIF Veterans. The chief communications officer manages overall 

outreach policy and encourages VHA field organizations to implement advertising 

and direct contact campaigns to ensure that the opportunities for benefits and services are communicated to all Veterans. VHA’s OLRIA organization manages 11 different outreach programs focused on returning OEF/OIF Veterans to ensure their 

awareness of VA benefits and services, and to provide a ‘‘warm hand off’’ to Veterans from military health care to VA health care. These three offices have worked 

in the past, and will continue to do so in the future, to prepare and implement plans 

to reach out to Veterans and their families, informing them of the health care benefits they have earned. VA is unfamiliar with any position titled the ‘‘Deputy Undersecretary for Coordination’’ currently or in the recent past. 

Æ 

jbell on DSKDVH8Z91PROD with HEARING