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35–641 2008

THE RESULTS OF THE PRESIDENT’S TASK FORCE 

ON RETURNING GLOBAL WAR ON TERROR HEROES 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

MAY 9, 2007 

Serial No. 110–22 

Printed for the use of the Committee on Veterans’ Affairs 

( 


ccoleman on PRODPC74 with HEARING
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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 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

GINNY BROWN-WAITE, Florida 

MICHAEL R. TURNER, Ohio 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

MALCOM A. SHORTER, Staff Director 

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. 


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C O N T E N T S 

May 9, 2007 

Page 

The Results of the President’s Task Force on Returning Global War on 

Terror Heroes ....................................................................................................... 1 

OPENING STATEMENTS 

Chairman Bob Filner ............................................................................................... 1 

Prepared statement of Chairman Filner ........................................................ 33 

Hon. Steve Buyer, Ranking Republican Member .................................................. 2 

Prepared statement of Congressman Buyer ................................................... 34 

Hon. Ginny Brown-Waite, prepared statement of ................................................ 35 

WITNESS 

U.S. Department of Veterans Affairs, Hon. R. James Nicholson, Secretary ...... 5 

Prepared statement of Secretary Nicholson ................................................... 35 

SUBMISSION FOR THE RECORD 

Miller, Hon. Jeff, a Representative in Congress from the State of Florida, 

statement .............................................................................................................. 38 

MATERIAL SUBMITTED FOR THE RECORD 

Report of the Task Force on Returning Global War on Terror Heroes, April 

19, 2007 ................................................................................................................. 40 


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(1) 

THE RESULTS OF THE PRESIDENT’S 

TASK FORCE ON RETURNING 

GLOBAL WAR ON TERROR HEROES 

WEDNESDAY, MAY 9, 2007 

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

The Committee met, pursuant to notice, at 2:03 p.m., in Room 

334, Cannon House Office Building, Hon. Bob Filner [Chairman of 

the Committee] presiding. 

Present: Representatives Filner, Michaud, Herseth Sandlin, 

Mitchell, Hall, Hare, Berkley, Salazar, Donnelly, McNerney, Space, 

Walz, Buyer, Stearns, Baker, Brown of South Carolina, Boozman, 

Brown-Waite, Lamborn, Bilirakis, Buchanan. 

OPENING STATEMENT OF CHAIRMAN FILNER 

The CHAIRMAN. The House Committee on Veterans’ Affairs is 

called to order. We thank the members for their attendance. 

Mr. Secretary, we thank you for being here. We thank you for 

chairing the President’s Task Force on the Returning Global War 

on Terror Heroes and for the Task Force’s report to the President. 

Mr. Secretary, we will hear from you on the Task Force recommendations. I think that you know, and I know you feel it personally, the frustration amongst us all as to making sure that we 

clearly and professionally deal with the returning veterans from 

Iraq and Afghanistan and that while we are doing that keep services up for our older veterans. That is a challenge that you have, 

and that we all have, in working together to do that. We want it 

done today or yesterday or last week and I know you do too. So we 

are looking forward to your report and the implementation of the 

recommendations. I was disappointed at the charge that you got in 

that you had to stay within certain constraints, no new programs, 

no new money. 

I hope that you might give our Committee a report that does not 

have those constraints, that details what we have to do to make 

sure that we meet the needs, and we meet them urgently. 

Every one of us has had the experience, and I know you have because we have done it together, of talking to veterans around the 

country and looking into the faces of the spouses of troops, returning troops who have brain injury and knowing that they are going 

to have to spend 24 hours a day with them and lose their jobs. 

What is their future going to be? We meet people, young people 

with Post Traumatic Stress Disorder (PTSD) trying to cope with 


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this and trying to deal with a bureaucracy that sometimes seems 

unresponsive to them. 

So we have a job to do as a Committee and as a Congress and 

your agency is right at the frontiers of that. Everybody is looking 

to the VA to do its job correctly. So we hope that these recommendations do not sit around like so many other recommendations have done. 

There are other reports on the table. I know that there was a 

President’s Task Force to Improve Health Care Delivery for Our 

Nation’s Veterans in 2003. There was a report from the Congressional Commission on Servicemembers and Veterans Transition Assistance in 1999. And of all those recommendations, not all of them 

have ever been implemented. 

We want a timeframe for the implementation of your recommendations, who is going to be responsible for implementation; how 

will we be informed on the progress because we, as we have talked 

about, want to have accountability for all of this. So we are interested in time lines and implementation and we want to know what 

else we can do if we provide more resources. 

I think you know that in the first three budget bills that went 

through the House, only one of them signed by the President so far, 

that we were able to add close to $13 billion to the budget from 

last year, the highest increase in history. This is almost a 30-percent increase in healthcare revenues. 

So we think we are giving you the resources that you need, but 

we want to make sure that they are spent the right way and that 

our returning heroes do, in fact, get the kind of care and love and 

attention that we all want. 

I will say one more thing before I turn to Mr. Buyer for an opening statement, that we are discussing the war and the funding of 

that now. I just want to assure you, and the American people, that 

wherever we are on the war, wherever we stand, we are united in 

saying that every young person that comes back from that war gets 

all the care and attention, love, honor, and dignity that this Nation 

can bestow. 

I think many of us may have made mistakes in greeting heroes 

from Vietnam. We, as a country, are not going to make those mistakes again, and we look forward to working with you to make sure 

that that occurs. 

Mr. Buyer, you are recognized for an opening statement. 

[The prepared statement of Chairman Filner appears on p. 33.] 

OPENING STATEMENT OF HON. STEVE BUYER 

Mr. BUYER. Thank you very much, Mr. Chairman. I want to 

thank you for being responsive to my request to have the Secretary 

come up here today. This is a very good hearing. I appreciate your 

cooperating to make this happen. 

Mr. Secretary, thank you for being here today and for chairing 

this Task Force on behalf of the President and the country. 

The President has made clear his intent to establish a truly 

seamless transition for servicemembers between the military and 

the VA, as well as other agencies providing services to our veterans. You and your colleagues on the Task Force have produced 


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a thorough review of factors affecting seamless transition and you 

are to be commended. 

I must inform you, though, Mr. Secretary, over the past 15 years, 

I have seen, whether it is from the reports from the U.S. Government Accountability Office (GAO), the Inspector General (IG), commissions, task force reports, and reports on this issue, from my personal experience with seamless transition on this Committee, I 

know that at this point, there are few new discoveries. 

What we have regrettably seen and what I believe has compelled 

the President to directly intervene is a general lack of implementation. So to be fair, I believe the U.S. Department of Veterans Affairs (VA) has made most of the progress. It has, in fact, led the 

Federal effort, but the VA cannot do it alone. You need to have the 

cooperation and leadership from your counterparts at the Departments of Defense (DoD), Health and Human Services (HHS), 

Homeland Security (DHS), Labor (DoL), Education (DoE), and 

other agencies. 

So, Mr. Secretary, with the Task Force work behind us and this 

report now before us and the President’s intent made clear to you 

as the leader of this Task Force, we must now have implementation. 

Now, when I ask about implementation, you and I both recognize 

that there are some other things that are still out there. We still 

have the Dole-Shalala report that will be due later on in the summer and we have the Claims Commission. So while we have some 

overlap, we want to avoid duplication and redundancies, but there 

are things that we can do now. 

So in a few short weeks, the President I believe is due to receive 

a progress report on the implementation of recommendations from 

the report. We in turn will look to you and other agency heads, in 

particular Defense Secretary Gates, to work directly with you and 

your respective departments as you move forward. 

So in your statement, I am hopeful that you will touch on these 

relationships and how you foresee them as you proceed. 

So what happens is we want to talk about real progress. This report is nonetheless, I believe, encouraging. And among the Task 

Force’s 25 recommendations, a handful alone would dramatically 

improve transition and must become a high priority within the Administration. 

These include the development of a system of co-management 

and case management for returning servicemembers to facilitate 

transition between the Department of Defense and the VA. 

Second, the screening of all Global War on Terror veterans seen 

in VA healthcare facilities for mild to moderate traumatic brain injury (TBI). Now, it is often said about TBI being the signature injury of this war, yet the actual numbers that are actually being 

treated for TBI are relatively small. You will have to tell me what 

the exact number is. 

But there are individuals who are survivors of these improvised 

explosive device (IED) explosions that are excited that they survived, but they, in fact, may have some effects that they are not 

aware of. And that screening, I think, would be pretty important. 

And I know it is an issue that the Chairman is also pretty concerned about. 


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Expanding VA access to DoD records to coordinate improved 

transfer of servicemembers’ medical care through the patient handoff is a need that you and I witnessed as we went through the theater into Germany and saw those medical records taped to their 

chests. I know that is something vivid in your mind. 

Another goal is the development of the joint DoD/VA process for 

disability benefit determinations by establishing our cooperative 

Medical and Physical Evaluation Board process within the military 

service branches and the VA care system. Also among my goals 

here on the Committee is to ensure that the veterans have every 

opportunity to live full and healthy lives, that they can take advantage of the economic opportunities their service helped preserve. 

Among key recommendations, the Task Force report would help 

veterans transition to civilian life. As you mentioned, this would include increasing attendance at Transition Assistance and Disabled 

Transition Assistance Programs for active duty Guard and Reserve, 

requiring the Department of Education in cooperation with the Department of Labor to participate in DoD job fairs to provide returning servicemembers and their families with awareness of postsecondary education benefits, requiring the Department of Labor 

through the Veterans’ Employment and Training Service to participate in the Workforce Investment System in every State and territory, and partnering with private-public sector job fairs to expand 

the number of employers involved in active veteran recruitment. 

The accomplishment of these recommendations as well as others 

is critically important. Since 2003, this Committee held more than 

ten hearings and conducted fifteen site visits focusing on seamless 

transition. Our experiences collaborate the value offered by these 

recommendations. And that is why I compliment you. 

Mr. Chairman, there are two other things I would like to address, and that is, one, there were statements, Mr. Secretary, made 

by members of this Committee that have ended up in the press as 

of late, some of which concerned me and I would thus probably 

label them as freshman over-exuberance. And so let me address 

each of them. 

The CHAIRMAN. Mr. Buyer, we are here to hear the Secretary. I 

would prefer if we have time at the end that you go over those. 

Mr. BUYER. That would be fine. 

The CHAIRMAN. But as a prosecuting attorney once said, once you 

open that door, anybody else can walk through it. So I would like 

to get to the Secretary. 

Mr. BUYER. I will restrain myself and close with this: Mr. Secretary, we are pleased to have you here. We look forward to your 

report. 

The CHAIRMAN. Wait a minute. Please, Mr. Secretary, you are on. 

Mr. BUYER. So you have cut off my statement? 

The CHAIRMAN. You told me you finished your statement. 

Mr. BUYER. No. I said I will not refer to what I was about to discuss and just let me complete the statement. It is just a minute, 

Mr. Chairman. 

The CHAIRMAN. You have one more minute. 

Mr. BUYER. Thank you. 

Mr. Secretary, I want to compliment your initiatives out there, 

not only coupled with this report, but you have doctors in PittsVerDate Aug 31 2005 01:58 Apr 04, 2008 Jkt 035641 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 E:\HR\OC\35641.XXX 35641

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burgh right now in your efforts to reduce the staph infection rates 

and you are about to leverage that across the VA system. I extend 

great compliments to you. 

Your diabetes initiative, you know, is doing over 8,000 amputations a year. A lot of people do not realize why you are so good in 

that business. 

And you just announced a new formal Advisory Committee yesterday. So at some point, if you could let us know about what that 

is about. 

And thank you, Mr. Chairman, for your courtesy. 

[The prepared statement of Congressman Buyer appears on p. 

34.] 

The CHAIRMAN. Thank you, Mr. Buyer. 

Mr. Secretary, welcome, and we look forward to your report. 

STATEMENT OF HONORABLE R. JAMES NICHOLSON, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY HONORABLE PATRICK W. DUNNE, RADM, (RET.), 

ASSISTANT SECRETARY FOR POLICY, PLANNING AND PREPAREDNESS, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Secretary NICHOLSON. Thank you, Mr. Chairman and members 

of the Committee. I welcome the opportunity to come here to give 

a report on the work of the President’s Task Force on the Global 

War on Terror Heroes. 

The recent series of articles in the news media highlighted significant problems at the Army’s Walter Reed Medical Center. Many 

people have misconstrued this to relate to the VA healthcare system which is an entirely different entity. 

Servicemembers maintained on active duty for care were being 

housed in a former motel at Walter Reed that had not been properly maintained for some time. Conditions in what everyone now 

knows as Building 18 were deplorable. That our servicemembers 

would be expected to live in those conditions elicited outrage. This 

situation was unfortunate on many levels. 

My wife, Suzanne, and I have visited Walter Reed Hospital 

many, many times in the two plus years that I have been the Secretary. We continue to be impressed by the character of our young, 

injured servicemembers. We are as well impressed with the quality 

and the compassion of the medical care that they receive there, but 

that is a focus on the critically injured inpatients, not on those who 

are in the Army’s medical hold status. 

Upon learning of the Army’s situation in Building 18, I immediately did two things. First, I directed that a survey be conducted 

at all points of access to the VA healthcare system, our 155 hospitals and nearly 900 outpatient clinics, to ensure that we did not 

have situations comparable to those encountered in Building 18. 

Although the findings in large part were positive, those areas of 

concern identified were addressed immediately under my orders 

that the VA non-recurrent maintenance funds be used to rectify 

them. 

I also wrote to every member of the United States Congress and 

reiterated my own commitment to assure that our veterans receive 

the very best care possible in an environment of care that is appropriate to that care. 


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So I also asked them, you, to visit a VA medical center in your 

State or district at your earliest convenience. And to date, I am 

pleased to say that 305 members have done so and almost universally they have expressed their high regard for the quality of care 

being provided, the commitment of the caregivers, and the cleanliness of the environment in which that care is given. 

The President also took decisive, aggressive action. By Executive 

Order, he established two groups, the President’s Commission on 

Care for America’s Returning Wounded Warriors and the Task 

Force on Returning Global War on Terror Heroes, which he asked 

me to Chair. 

The President’s Bipartisan Commission is chaired by former Senator Bob Dole and former Secretary of Health and Human Services, 

Donna Shalala. That Commission is to report to him by the end of 

July. 

Our Task Force was to develop recommendations and report back 

to him in 45 days with an assessment of gaps that may exist in 

services needed by our servicemembers that could be addressed 

without additional legislative authority or appropriations. Those 

were the two constraints. 

The Task Force which I chaired included the Secretary of Defense, Robert Gates; Secretary of Labor, Elaine Chao; Secretary of 

Health and Human Services, Michael Leavitt; Secretary of Housing 

and Urban Development, Alphonso Jackson; Secretary of Education, Margaret Spellings; the Director of the Office of Management and Budget, Rob Portman; the head of the Small Business 

Administration, Steven Preston; and the Director of the Office of 

Personnel Management, Linda Springer. 

And I am proud of the work of this Task Force. There is a new 

era of cooperation and what we can do here can make a substantial 

difference. The recommendations of the Task Force focus on ways 

that we can immediately improve the services for those returning 

servicemembers from the war and how we can better reach out to 

them and their families to make them aware of what services exist. 

We developed 25 recommendations and I want to note here what 

I consider some of the most significant. 

In the context of healthcare, DoD and VA have agreed to a new 

system of co-management and case management for these combatants who are seriously injured as they move from one system to another. We have the most advanced polytrauma centers in the world 

bar none. Our patients’ transition from the military medicine arena 

to ours will be seamless for them and their families. 

We are going to work with DoD to develop a joint process for disability determinations which will provide consistency and speed for 

our veterans. 

We are now going to screen every Global War on Terror veteran 

who comes to us for any form of brain injury looking for the mild 

or moderate form of brain injury as a result of the environment 

they are in over there and the concussive blasts that are so prevalent. We want to identify it as early as possible and begin treatment. 

We are going to simplify the enrollment process for veterans to 

enroll for healthcare whether they enroll online or in person. And 


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we will continue to develop our world standard of electronic medical records. 

The DoD is taking action to increase the attendance at the Transition Assistance Programs known to you probably as the TAP 

briefings. The more our veterans understand about their benefits, 

the more successful their transition to civilian life will become. 

A few other areas I want to briefly highlight for you today include the VA and HHS collaborating to improve access to care for 

returning servicemembers in remote or rural areas. 

The SBA is expanding eligibility of the Patriot Express Loan Program to provide a full range of lending, business counseling, and 

procurement programs to veterans, service-disabled veterans, Reservists, and families if the desire for a returning servicemember 

or family is to obtain self-employment. 

The DoD and the Department of Labor are improving civilian 

workforce credentialing and certification allowing for greater exposure of a servicemember’s military experience to civilian job opportunities. 

The Department of Housing and Urban Development is expanding access to the national housing locator for servicemembers. By 

expanding its use, returning servicemembers will have a resource 

that provides safe, disability accessible, if needed, and affordable 

housing to ease in potential relocation to a new geographic area. 

The Department of Education in cooperation with the Department of Labor will participate in DoD job fairs to provide returning 

servicemembers and their families with more awareness of the 

postsecondary education benefits available to them. 

The Department of Education will provide education benefits 

training to the 211 Transition Assistance Programs and those sites 

would service more than 150,000 transitioning servicemembers 

every year. 

The Office of Personnel Management is expanding their military 

treatment facility outreach to promote the availability of Federal 

employment and veterans’ preference rights. 

So all in all, our focus, I think, really is very simple. It is to 

make the existing services that are there of the Federal Government the very best they can be for our veterans and for their families and for the survivors of those who paid the ultimate price. 

Thank you very much, Mr. Chairman. 

[The statement of Secretary Nicholson appears on p. 35 and the 

Task Force on Returning Global War on Terror Heroes report appears on page 40.] 

The CHAIRMAN. Thank you, Mr. Secretary. 

I will be calling on colleagues in just a second after one short 

question I have. 

Let me just give you an example of the frustration many of us 

feel when we see reports like this. You said we will screen every 

veteran that comes to us for TBI. Now, that is the recommendation 

of the Task Force. What I would like to hear you say is only X percent, it is fairly small, of returning veterans come to us. We should 

be screening them comprehensively and mandatorily for both TBI 

and PTSD before they are discharged or before they enter the civilian life. 


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We all have heard from experts that the sooner we catch this, 

as you mentioned, the better off the veteran is. Some symptoms are 

hidden until months later, so maybe we need a six-month screening 

and then a twelve-month screening and a twenty-four-month 

screening. That is our obligation. Part of the cost of war is dealing 

with the cost of caring for our veterans. 

And so we applaud that screening, but it is just a small part of 

what we really should be doing. And we need you to show—I know 

you know this—but tell us so we have a context in which we view 

these recommendations, as I said, on the one hand under the constraint of no new money, but on the other hand, what do you really 

want to meet the needs of our returning heroes. That is the kind 

of thing that I hope we can work together to solve. 

Mr. Michaud, who is Chairman of our Health Subcommittee, will 

start off the questioning. 

Mr. MICHAUD. Thank you very much, Mr. Chairman. 

And thank you, Mr. Secretary, for coming here today and for presenting this report to us. 

Looking at the report and having had a chance to read it when 

it first came out, I appreciate the fact that you are assigning a lead 

agency to look over some of these recommendations along with a 

target date for implementation so we can see where you are 

throughout the process. 

My concern, however, is, even though the Task Force did a great 

job, back at my office I have the Presidential Task Force for a 

Seamless Transition recommendations that came out in 2003 that 

currently is sitting there and it is the implementation which is extremely important. I compared those Task Force recommendations 

for a seamless transition to these Task Force recommendations to 

see how many are the same. These reports are not going to do any 

good unless we act upon them. 

I can tell you that I will definitely be keeping a close eye on the 

target dates when these recommendations are supposed to be implemented and, if they are not, see why the implementation has 

not moved forward. 

You heard the Chairman talk about how you were directed to do 

this with existing resources and existing authority. Do you feel you 

can do all these recommendations without any additional resources 

for your agency? 

Secretary NICHOLSON. Yes, I do, because we abided that constraint of the action items that we are taking pretty carefully. That 

was our mandate. 

Mr. MICHAUD. Okay. Are there any recommendations when you 

went through looking at the seamless transition and what was 

needed out there, are there any recommendations that actually 

might have cost funding that you could not do that are out there 

that we should look at? 

Secretary NICHOLSON. There is a possibility, Congressman 

Michaud, as some of these things would, you know, as they mature. 

For example, I think the very enlightened idea of simplifying and 

streamlining this discharge procedure. The way it works now is 

that if a servicemember is injured, the Army makes a determination or the Marine Corps or the services that they are either fit or 

unfit to be retained on active duty. And if they are fit, in theory 


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they go back to their unit. If they are unfit, they go into a category 

for determination of that degree of unfitness prior to their separation. 

And what we know is that if they are not happy with that, they 

have appeal rights within the Armed Services, but further they 

then can come to the VA and make a claim at the VA. And many, 

many of them do. And that entails months, if not years of time that 

they are sort of in limbo. In fact, that was the case at Walter Reed. 

I think some 600 people were in that medical hold category. 

What we are talking about is slicing through some of that. If 

they are fit, put their boots back on and go back to duty. If they 

are unfit, come in an expedited way to the VA and we then evaluate and process that degree of disability and work it into our compensation system. That could entail additional resources upon its 

full maturation. 

Mr. MICHAUD. It would be helpful if you can provide any other 

recommendations that came out of the Task Force or thoughts, but 

because it did not meet that criteria of within existing resources, 

it would be helpful if you could provide that to the Committee because I think we are very interested to make sure we do take care 

of our men and women who wear the uniform and those who become veterans. 

My last question is, what will happen, and I think the VA has 

done an excellent job when you look at medical records and what 

have you, and I think the Department of Defense has been slack 

in that area, what happens if there is a disagreement between DoD 

and the VA? How do you resolve those differences? How do you 

deal with that issue? 

Secretary NICHOLSON. Well, first, let me tell you a very encouraging note that the first meeting was held yesterday in Deputy 

Secretary England’s office over in the Pentagon with my Deputy 

and all three of the service Secretaries and the Deputy Chiefs of 

those services to discuss these very issues. 

And, further, there is an agreement for such a meeting to take 

place now every Tuesday afternoon. That is significant movement 

because there is, I think, a new awareness and there is a new command emphasis that comes from the President, and people are getting it, that we are just going to have to do a better job in getting 

these two big organizations to talk to each other, particularly with 

respect to medical records. 

Mr. MICHAUD. Thank you very much, Mr. Secretary. 

The CHAIRMAN. Thank you very much. 

I will yield to Mr. Buyer and also Mr. Stearns for his time. 

Mr. BUYER. Mr. Chairman, I will exercise the same courtesy that 

you did. 

But in my opening statement to the Secretary, I had asked him 

in his opening statement to comment on this reduction of the infectious disease of our hospitals because we are talking about, you 

know, our soldiers coming home and transitioning to what. And, 

Mr. Secretary, you are getting out in front of the reduction of the 

infectious disease rate and it is a good story. 

Can you tell us about what happened at Pittsburgh, the reductions, and how you are trying to leverage that? 


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Secretary NICHOLSON. Yes, I can. I can tell you, and maybe some 

of you have seen, there is a graphic out there that graphically portrays some of the things you do in life that are on a scale of very 

dangerous to very safe. And on the very dangerous thing that you 

can do in the United States today is—— 

The CHAIRMAN. Being a Cabinet Secretary? 

Secretary NICHOLSON. Pardon? 

The CHAIRMAN. Cabinet Secretary is right up there, right? 

Secretary NICHOLSON [continuing]. Is to go into a hospital. One 

of the very safe things you can do today is fly on a commercial airliner. And there are some things in between. 

So it is a fact that far more people are being killed today in today’s hospitals by mistakes than are dying on the highways. One 

of the problems are staph infections. There is a technical name for 

it which is called methicillin staph resistant aureus and the acronym is MRSA. And we at the VA, I think we have established an 

exemplary record for patient safety and performance measures and 

so forth, but we have had that problem as well. So we instituted 

a pilot project at our VA hospital in Pittsburgh to go after the 

MRSA. 

And in one year, we reduced staph infections by 70 percent. And 

it is not space science how we did it. It is a disciplined approach, 

sanitation, culturing patients when they come in. It is usually a 

swab in the nasal passage. It used to take two days to read the culture. We now have a new technology. We can read them in two 

hours. 

If they are a MRSA carrier, they are treated accordingly. The 

staff will scrub afterwards, regarb if they have close contact with 

that patient. We cut those infections 70 percent. 

So we had a discussion about taking this pilot to ten or fifteen 

hospitals. I said, no, let us take this to 155 hospitals. And I say 

I am very proud like I am in many ways of the leadership and the 

medical corps of the VA. They have embraced this and it is underway in our system. And I think we are going to see some just tremendous results from it. 

The CHAIRMAN. Mr. Stearns, you have five minutes. 

Mr. STEARNS. Thank you, Mr. Chairman, and thank you for having this hearing. 

I want to thank the Secretary for the job he is doing and the sacrifice he is making at this critical time. We appreciate your efforts. 

Yesterday we had an Oversight Subcommittee hearing in which 

we had a lot of the DoD and Veterans Affairs up here. And it was 

clear to us that the whole idea of inter-operability between DoD 

and Veterans Affairs is a long way off. 

And as you know, we have been working on this. There has been 

legislation. There has been studies and this has been going on for 

some time unsuccessfully. And we found yesterday that it could be 

as late as 2012 when they possibly will have inter-operability. 

And this goes to your policy directive, your Veterans Health Administration (VHA) directive of April 13th in which you said it will 

be the policy of the VHA that all Operation Enduring Freedom 

(OEF) and Operation Iraqi Freedom (OIF) veterans receiving medical care within VHA must be screened for possible TBI. Those who 

on the basis of the screening might have TBI must be offered furVerDate Aug 31 2005 01:58 Apr 04, 2008 Jkt 035641 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 E:\HR\OC\35641.XXX 35641

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ther evaluation and treatment by clinicians with expertise in the 

area of TBI. 

I guess my question is to you, is it not crucial and important that 

the Department of Defense provide you the medical information 

that they have so that the seamless transition when they move 

from active duty to veteran, that all that information, particularly 

dealing with traumatic brain injury, is available to the veterans? 

And I was just disappointed last night that it is still not being 

done and I just would like your opinion. 

Secretary NICHOLSON. Yes, it is. It is extremely important. It is 

critically important that we get what is available on the medical 

history of that servicemember since being injured. 

And as Congressman Buyer mentioned earlier, he and I had been 

in Iraq with other members. Two people were injured where we 

were one day near Fallujah and we happened to be going into the 

hospital in Landsthul the same time as they were coming in on 

gurneys and their medical records were taped to them with duct 

tape to their bodies—— 

Mr. STEARNS. Yeah. 

Secretary NICHOLSON [continuing]. Bespeaking, I think, the 

anomaly that there exists between how highly technical our Armed 

Services are with the state-of-the-art target acquisition, night vision optical equipment and, yet, still very rudimentary with paper 

records which are fraught with being illegible, things getting lost. 

It is not a lack of bad faith on their part. 

Mr. STEARNS. No. I think it is just getting all these departments 

together. 

Secretary NICHOLSON. It is problematic. 

Mr. STEARNS. You know, in my congressional district, I have a 

company called Banyan Biomarker and they are trying to determine through diagnostic blood samplings whether traumatic brain 

injury is—what category of seriousness it is. 

Now, when you say you are going to do this screening, I assume 

in addition to questions and answers, you are also going to do 

MRIs and things like that. I am asking you for the technical aspect. 

But these scientists have pointed out that you really cannot fully 

detect traumatic brain injury or, for that matter, posttraumatic 

stress disorders. You have to do it diagnostically through blood. 

And we are not at that point, so there is going to be a lot of debate 

of a person who comes through and you say, no, you do not have 

TBI and, yet, the person says there is something wrong. 

And so I think you and your staff should be aware of that, that 

there is another state-of-the-art for this testing that through blood 

diagnostic you can find this. 

But I think the thing that I think is extremely important, and 

you have sort of confirmed it, is this inter-operability. In this age 

of information, we should be able to have that those records are not 

affixed, attached to a person, but should be electronically transmitted automatically. And I think that part of your whole Task 

Force is to continue to push on that effort. 

And I thank you, Mr. Chairman. 

The CHAIRMAN. Thank you. 

Mrs. Herseth Sandlin—— 


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Ms. HERSETH SANDLIN. Takes some getting used to. 

The CHAIRMAN [continuing]. The Chairperson of our Economic 

Opportunity Subcommittee. 

Ms. HERSETH SANDLIN. Thank you, Mr. Chairman. 

The CHAIRMAN. Congratulations on your recent marriage. 

Ms. HERSETH SANDLIN. Thank you. Thank you and the Ranking 

Member for having this hearing today. 

Mr. Secretary, thank you for your testimony. I would like to start 

out with the recommendation that you cited and that is in the materials from the Task Force work product to expedite adaptive 

housing and special home adaptation grants claims. 

I could not agree with that recommendation more and I am wondering if the Task Force looks specifically at the change in the law 

that we made in 2003 where active duty servicemembers could 

apply for these specially adapted homes because I have a constituent that has run into a lot of hurdles and was initially told 

that you cannot apply for the specially adapted housing grants 

until you have a DD–214 and a VA disability rating, but he is still 

on active duty. And we have more and more active duty status 

servicemembers who have suffered serious brain injuries. 

If you could elaborate as to whether or not the Task Force did 

look into that specifically in terms of implementing that legal 

change and what recommendations you might have. 

Secretary NICHOLSON. I am aware of that issue, Congresswoman. 

The answer, though, our Task Force did not look at that because, 

again, that would require legislation. And within the ground rules 

that we were operating and this expedited timeframe we had, we 

did not look at those things. 

Ms. HERSETH SANDLIN. Okay. Well, I just want to bring it to 

your attention so that you know that the Subcommittee may very 

well be interested in looking at what is needed to make sure that 

the implementation of the change that was made in 2003 for active 

duty and what VA needs to more quickly process these claims with 

the authority, I think, was given in 2003. 

But I think this is again an area where DoD, when a soldier is 

still active duty and under the way that the claims processing has 

always worked, you need to be discharged and have a VA disability 

rating. And we have got some folks out there that are either in 

polytrauma centers or they are in private rehabilitation facilities 

that are trying to apply and getting misinformation. 

The other area I wanted to explore was the specific recommendations in the health area for traumatic brain injured servicemembers. I know that you mentioned at the outset that one of the 

most significant recommendations in your opinion is developing 

that system of co-management and case management more broadly, but then specifically the polytrauma identifier as well as the 

traumatic brain injury database to track patients. 

And I am wondering, well, I would just make the comment that 

as you move forward in implementing these, a recommendation, 

suggestion again by the mother of one of my constituents in talking 

with the mother of another brain injured soldier is that the case 

management, managers could be trained specifically for TBI patients because untrained people may not be fully aware of what seriously injured, brain injured servicemembers may require. If we 


ccoleman on PRODPC74 with HEARING
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had this subset of trained case managers, it might help these families substantially. 

One last question. Did the Task Force specifically evaluate the 

suitability of existing programs and the restrictions on those programs in the Vocational Rehabilitation Employment Service for 

brain injured soldiers? 

Secretary NICHOLSON. I am sorry. Of the what programs? 

Ms. HERSETH SANDLIN. The existing programs under vocational 

rehabilitation and the restrictions on the participation of those programs and their suitability for brain injured servicemembers. 

Secretary NICHOLSON. Yes, we did. Looked at that quite carefully 

and have stepped up the efforts for awareness of those programs. 

Ms. HERSETH SANDLIN. I understand. I appreciate that and I appreciate the recommendation of extending the period of time because over two years or more we see cognitive functions continuing 

to come back and develop for these servicemembers. 

And so, again, the Subcommittee will work more closely with you 

and those that work with you to more closely evaluate the suitability and the need to maybe modify these programs to work best 

for these servicemembers and their families. Thank you, Mr. Secretary. 

And thank you, Mr. Chairman. 

The CHAIRMAN. Thank you. 

Mr. Baker, you have five minutes. 

Mr. BAKER. Thank you, Mr. Chairman. I appreciate your courtesy. 

Mr. Secretary, I commend you and the Task Force for identifying 

promptly the problems at Walter Reed and taking prompt corrective action. It is highly commendable. 

My observation today is we have a similar problem in Louisiana 

as a result of Katrina. Due to the destruction of the VA hospital 

there, veterans now may travel as much as eight hours to receive 

appropriate healthcare. 

It was February 23rd, 2006, that is for the Committee 15 months 

ago, when the VA and the State entered into an MOU to explore 

the feasibility of VA–State partnership for delivery of innovative 

care in the New Orleans area. 

Only recently, as in the last couple of weeks, has the State forwarded its proposal which I thought was rather unexpected in that 

its $1.2 billion scope and bed count was above earlier anticipated 

numbers. 

In the interim, since that report has initially been issued, there 

have been two statements for the record, one by Governor Blanco, 

one by the Chairman of the LRA, the Recovery Authority, indicating several points of consideration, the need of economic recovery, the need of an economic engine, financial necessity. It went on 

and on in the letter. I found it of interest in the three pages of correspondence the word veteran was not mentioned once. 

On April 10th, the Chairman and myself, the Ranking Member, 

Mr. Jefferson of New Orleans forwarded correspondence to your office requesting establishment of a date certain. We are not trying 

to tell anybody how to do it. We are only requesting that it get 

done. I am awaiting that determination. The problem is clear in 


ccoleman on PRODPC74 with HEARING
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Louisiana just like it was at Walter Reed. You see it, you decide 

what to do, and you went and fixed it. 

My reason for being here today is after 15 months is to say it 

is time for us to do something. We do not have to describe a plan. 

We do not have to tell the State what to do. We merely should say 

by a date certain. Whatever that date is, you are certainly free to 

make that determination. As I understand the MOU, either party 

can unilaterally withdraw for any cause whatsoever. 

But the plan now under consideration will require the acquisition 

of considerable private property interest. In one plan as few as 200 

parcels. In another plan as much as 37 acres, some of which is in 

downtown Orleans which has generated considerable discussion 

among those homeowners. 

The original plan contemplated to have begun planning and feasibility studies for the structure itself would have been engaged already, would not have allowed a ribbon cutting and service of veterans until 2012. 

With the added curve of the acquisition of new private property 

in order to facilitate a 60-acre site above the initial 37 proposed by 

the State, it would seem logical to me that control of the site for 

development may take not months but years. 

If I were to tell veterans they were to wait until 2012, which was 

plan A, they were not happy. To be honest, I cannot represent that 

to them anymore because I cannot tell them when it will be. 

My question, Mr. Secretary, is not how long I am going to have 

to wait. I am not important. But it is extremely important for me 

to be able to tell the veterans how long are they going to wait. 

When are we going to set a date, Mr. Secretary? 

Secretary NICHOLSON. Well, you do not have any more frustration there than I, Congressman. We did enter into the memorandum of agreement, making a lot of good sense to collaborate and 

share facilities such as parking, laundry facilities, certain other infrastructure, utilities, and did it in good faith with high expectations. 

And while we do not have all of the money that we need to build the hospital, you need to give us about another $300 million of authorization, we do have $300 million appropriated and authorized, 

plenty to start all the design work, engineering, site planning. But 

we have not been able to count on a site. 

So as you know, about two months ago, I said we cannot wait 

any longer for LSU. And I put out an RFP for alternative sites 

which we are now looking at with a view toward possibly having 

to build this hospital independent of a collocation with LSU. And 

we are going to be vetting out those sites soon. 

But as I sit here today, I could not give you a date certain. I just 

could not be honest about it if I did because we do not yet have 

enough—— 

Mr. BAKER. Will we likely wait another year, another two years? 

I mean, is there an outside limit? There has got to be. I mean, at 

this point, we have no plan. The State does not have the money. 

There are alternative private interests who are willing to make 

their facilities available within the region. 

I am just asking for a business decision and I am not going to 

ask for it today, but I think it highly inappropriate to have such 


ccoleman on PRODPC74 with HEARING
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uncertainty over something that is so important to the region. 

There is not any reason in the world to have someone have to drive 

to Houston or Biloxi. 

These are Louisiana veterans coming home and they have every 

right to expect care in their community because it used to be there. 

And all I am suggesting is a decision. I will be happy with a bad 

one, just we need a decision. 

I yield back. 

The CHAIRMAN. Thank you. 

Mr. Buyer and I have joined you and Mr. Jefferson in trying to 

do this and we share the frustration of Mr. Baker. 

The Chairman of our Investigations and Oversight Committee, 

Mr. Mitchell. 

Mr. MITCHELL. Thank you, Mr. Chairman. 

And thank you, Mr. Secretary, for being here today to report on 

the findings of the Task Force. 

You know, the Global War on Terror has been the reality for our 

Nation since 2001 and I am glad the President created this Task 

Force. But I have to admit I am disappointed that it took until 

2007 to do it. It seems to me that the Department of Veterans Affairs should have been prepared many years ago. 

Mr. Secretary, I visited the Carl T. Hayden Medical Center. That 

is the VA medical center in Phoenix. I have tremendous respect for 

the staff, but what they told me is that they are strained, that they 

are under-staffed and in some cases do not have the equipment 

they need. 

Aside from the Administration’s delay in addressing this issue, 

I am concerned that the VA may not have the resources it needs 

to get the job done. 

Veterans tell me and VA officials tell me that the VA is understaffed and lacking the equipment it needs. Do you believe that the 

VA is under-resourced and do you regret your decision not to ask 

for funds to allow the VA to handle the strain of the new veterans’ 

population? 

Secretary NICHOLSON. I think, Congressman Mitchell, the VA is 

adequately staffed to take care of this mission that we have. It is 

a dynamic and the VA is a very large organization with facilities 

from Maine to Manila. And overall, it is adequately staffed. 

The President, since he has been in office, has requested increases in spending for the VA that now are nearly 80 percent from 

when he came into office. 

And I think that while there may be exceptions because it is dynamic and patient demand is not static and sometimes it will cue 

up in certain places and we have an obligation to adjust to that, 

the VA healthcare system is, I think, doing an extraordinary job. 

And that is not just me, a proud Secretary, proud of the people out 

there doing it, but that is what others say about us. 

I was just sent a copy of a book here. It is written by a guy 

named Phillip Longman, whom I have never met, but I noted his 

credentials, and it said VA is the best healthcare anywhere. And 

it says why VA healthcare is better than yours. 

Mr. MITCHELL. Mr. Secretary, I understand that. And it sounds 

like what you are saying is you have all the resources and all the 


ccoleman on PRODPC74 with HEARING
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staffing you need. And I am not too surprised that you are saying 

that because it almost sounds like you have plenty of money. 

And as a result, I think, last week, the Associated Press reported 

that your top officials were paid the most lucrative bonuses in Government. 

Now, it kind of begs the question, but I think it is appropriate. 

I am going to ask you, do you think it is appropriate with all these 

political appointees receiving bonuses of $30,000 plus, and these 

are not salaries, these are bonuses, while veterans are waiting an 

average of 90 days for PTSD followup appointments, the backlog 

for claims range from 400,000 to more than 600,000 with delays 

averaging 177 days, and while the Phoenix VA facilities do not 

even have an MRI device? It seems to me that they are underequipped and they are under-staffed. 

Secretary NICHOLSON. I will respond to that, Congressman. I 

want to adjust your paraphrasal of my statement when I said I 

think the VA is adequately staffed and then you said, or it sounds 

like, you think the VA has all the money it needs. 

I would say given the size of the VA and the expanse of our capital system and its age, we can probably always make good use of 

more money at the VA. So I wanted to clarify that. 

Mr. MITCHELL. Okay. So let me ask this then. You say it is adequately staffed, but, yet, we find claims for PTSD to be an average 

of 90 days, the backlog of claims for disabilities are over 177 days, 

and you think you have enough people to handle all of these claims 

and all these appointments that are necessary, and you think this 

90 days for a followup appointment is adequate, and you think that 

the average of 177 days is also adequate? And that does not take 

equipment. That takes manpower. And you say that you are adequately staffed; is that right? 

Secretary NICHOLSON. I would say I cannot respond to your 90- 

day assertion about PTSD. I will have to look at that and get back 

to you. I am not aware that it is taking that long. If it is in Phoenix, I am not aware of that. It is not systemwide, I am sure. 

You are correct about the claims and that is exactly right. It is 

taking about 177 days and that is too long in my opinion. We have 

in the 2008 budget a request and so when I say we are adequately 

staffed, I incorporate our request for personnel in that budget request for 450 additional claims evaluators which we project will be 

able to bring that time down by at least 18 percent. 

Mr. MITCHELL. I yield my time. My time is up. 

The CHAIRMAN. Thank you, Mr. Mitchell. 

Mr. Buchanan, you are recognized for five minutes if you—— 

Mr. BUCHANAN. No. 

The CHAIRMAN. Mr. Lamborn. 

Mr. LAMBORN. Thank you, Mr. Chairman, but I have no statement or questions at this point. 

The CHAIRMAN. Mr. Hall, who is Chairman of our Disability Assistance and Memorial Affairs Subcommittee. 

Mr. HALL. Thank you, Mr. Chairman. 

Mr. Secretary, first of all, thank you for your service in the service and since then in your continuing work for our country. 

And congratulations on your progress on the methicillin resistant 

staph infections. I know firsthand how difficult they can be and 


ccoleman on PRODPC74 with HEARING
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have family members who have suffered from drug-resistant bacterial infections and that is a really dangerous thing that is happening in our hospitals. And you are to be commended to be 

spreading your program to all 155 hospitals. 

I want to say that I share Congressman Baker’s frustration and 

I do not know if I was the freshman who was overly exuberant or 

not, but, what I reflect, I believe, is what I hear from the veterans 

in my district. 

And I am also one of the 305, I think you said, members of Congress who have visited VA facilities in my district and I do find 

them, the nurses, the doctors, the therapists, the caregivers in the 

hospitals, to be doing their very best as far as I can tell. And there 

are many things that our veterans are happy about with the VA 

system. 

However, our job, as you know, is not just to, and since we only 

have five minutes, it is not even mainly to pat you on the back for 

the things that are going well. 

I just want to ask, following up on Congressman Michaud’s question, with the revelation that the Army and the Marines appear to 

be providing ratings under 30 percent in an effort to prevent 

wounded members of the military from receiving benefits from the 

DoD, I am concerned about efforts to develop a joint process for disability benefit determinations. 

How will the VA ensure that ratings reflect the nature of a 

servicemember’s disability and not a bureaucratic need to minimize 

payments to the veteran? 

Secretary NICHOLSON. The VA makes its evaluation totally independent of the military’s. And, in fact, the military, they have a different set of criteria and they are guided by the specific disabling 

condition that would make one unfit for continuing military service. 

To illustrate, if they had a very seriously injured arthritic knee 

or they were immobilized, that would be the central claim because 

that is the question of whether they can remain in active duty. And 

if they had a hearing loss or other problems, that would not be considered as I understand it. 

At the VA, when they come to us, we consider all of those 

disablements that are service connected. And part of that process 

is to authenticate whether or not they are service-connected and we 

do that independent of what has gone on at DoD. 

Mr. HALL. Thank you. And on another topic regarding Congressman Mitchell’s question, what would you consider to be a reasonable time period for veterans to wait for a claim to be heard? If not 

177 days, what would be reasonable to you? 

Secretary NICHOLSON. There is a marker out there that was 

there when I came in. Just less than four years ago, it was taking 

about 220 days for these claims. But there is a marker that says 

it ought to be 125 days. 

I have asked Chairman Filner and he has consented that sometime, if we can ever all find the time, to just have a working session or roundtable and give us the opportunity to come over here 

and brief you on what is involved in making these claim evaluations because there is both law and case law. And I will just use 

one point to illustrate. 


ccoleman on PRODPC74 with HEARING
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If we must go back to a veteran for an additional piece of information to authenticate that he made a parachute jump in 1988 at 

Fort Bragg and was in the 82nd, he or she, the claimant, has 60 

days from the time we request that within which to respond to us. 

And those are linear, so that—— 

Mr. HALL. I understand. 

Secretary NICHOLSON [continuing]. It is difficult. There are other 

things about it too. But my goal is to get it soon down to 145 days. 

Mr. HALL. Thank you, Mr. Secretary. Excuse me for interrupting 

you, but I am about to run out of time. And I just wanted to ask 

you last, what is the evaluation process for determining the level 

of bonuses for officers in the VA or the Veterans Benefits Administration (VBA)? 

Secretary NICHOLSON. First of all, I want to clarify something 

that Congressman Mitchell also raised. These bonuses were not 

given to any political employees. They are all given to career SES, 

Senior Executive Service, professional Government employees. 

And there is a very detailed prescribed set of criteria that we get 

from the Office of Personnel Management of the Federal Government to use in determining who should be considered for these bonuses. And they are based on their performance in our organization 

and in the Government, including our organization. 

Mr. HALL. Thank you. Maybe you can supply that to the Committee, if you will, or we will write and ask for it. 

Secretary NICHOLSON. I would be happy to. 

Mr. HALL. Thank you very much. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you. 

We have scheduled that roundtable on claims for May 23rd and 

your staff, Admiral Cooper and Mr. Aument, are scheduled to join 

us for that. So thank you. 

Mr. Brown, you are recognized. 

Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chairman. 

Mr. Secretary, I understand yesterday that you formed a new 

Advisory Committee consisting of OIF and OEF combatants and it 

was led by Lieutenant General Barno. 

Could you kind of give us a little bit about the mission of this 

Task Force? 

Secretary NICHOLSON. Yes, sir. Since coming into this job and 

moving around and meeting with wounded servicemembers and 

their families, it is no secret to me that they have suffered frustrations, anxiety. I mean, it is a tough state, first of all, when they 

get seriously injured. 

And both DoD and VA have incorporated the families very much 

into the holistic effort of recovery and rehabilitation. And that is 

a positive thing. 

But there have been cases I have known of. So I started going 

around and gathering when possible servicemembers and family 

members and just having discussion sessions with them. And I got 

a lot of good and I got some that was not very good. 

Things like I remember one young mother telling me the time it 

took to get a new pad for her son’s wheelchair and that just should 

not happen. And that showed a need for better case management. 


ccoleman on PRODPC74 with HEARING
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And so what I decided to do is within the framework that I have 

of having advisory committees to formalize an Advisory Committee 

for OIF/OEF returnees, why family members, spouses, VSOs, certain Veteran Service Organizations are very involved with some of 

these, and survivors, of those who have been killed. They are not 

only to be a source of information to me, but for them to be out 

there meeting with other members that are similarly situated so 

that we know what is going on. They report directly to me, not 

through a bureaucratic screen, of what it is like, because then we 

can cut through and take better action. 

Mr. BROWN OF SOUTH CAROLINA. Thank you. I just applaud you 

for putting that Committee together. 

And I have no further questions, Mr. Chairman. 

The CHAIRMAN. Thank you, Mr. Brown. 

Ms. Berkley. 

Ms. BERKLEY. Thank you very much for your courtesy. I have 

been called down to the floor and I was very anxious to ask you 

a couple of questions. And it is lovely to see you again. I have three 

issues very, very quickly. 

There was a person from the State of Nevada, Lance Corporal 

Justin Bailey. His parents have testified in front of the Senate VA 

Committee. He returned from Iraq a few years ago. He sustained 

some injuries, but his primary problem was PTSD. He developed 

a serious drug problem. His parents encouraged him to get help 

and he eventually decided to seek help with the VA. And he was 

admitted into the West LA VA facility. 

He had a serious drug problem going in, but apparently nobody 

read his records closely enough. He was over-medicated by the VA 

when he died while he was at the VA facility trying to get clean. 

The VA gave him five different drugs at the same time, antidepressants, including Methadone, and he ultimately died of an 

overdose in our care. 

And I was hoping that you could look into this. His parents are 

absolutely beside themselves because they encouraged him to seek 

help with the VA and it seems as though we did not do our job. 

Now, I know that we cannot save everybody and mistakes happen, but this seemed to have been a tragedy that could have been 

avoided. 

The other thing that his parents were heartbroken about is it 

seemed that they felt they were treated with a tremendous disregard and apathy. When they went to collect his remains, they 

handed them their only son’s remains in a trash bag. And it was 

just the culmination of treatment that they felt was totally inappropriate. 

That is number one. I need to continue to communicate with this 

family and ease their pain, but they are very concerned that their 

son is not an isolated incident, that it is unfortunately widespread. 

I need a report back to me. 

The other thing, and this just happened two days ago in Las 

Vegas, you know my concern because we are in the process of 

building our VA medical complex, that I have got my veterans 

waiting to be picked up by a shuttle that takes them to ten different locations. 


ccoleman on PRODPC74 with HEARING
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Apparently there is a Mr. Key that contracted with the VA as a 

small disadvantaged business to provide the shuttle service. There 

was a problem between the VA and the bank and Mr. Key, and the 

VA was $600,000 in arrears to pay this man. 

The local VA administrator, John Bright, had no idea this was 

going on because Mr. Key was dealing with people above him in 

the VA system to get paid. He had been talking to them for months 

because he had not gotten paid. What he eventually did is he 

pulled the plug and he called the VA in Las Vegas and said I am 

not doing your shuttle service anymore. 

All my veterans were standing there stranded with no shuttle service because we did not pay this guy $600,000 that we owed 

him. Can you imagine how long it must have taken to accumulate 

$600,000? I really need a report on this and we need to fix this 

quickly. 

Now, I understand that Mr. Bright is all hands on deck and they 

have got some sort of shuttle service, but this is no way to run a 

business or a Government or a VA system either. 

And as long as I am on the subject of my VA medical complex, 

I know that there is a lot of dirt being moved and there is some 

vertical construction, but I would love somebody that you designate 

to come to my office and give me a briefing of where we are and 

how we are doing. 

I have been out to the site a number of times and I see progress, 

but I want to make sure that when I report back to my veterans’ 

groups, and they are asking me all the time what is going on out 

there, that I can give them an honest assessment and a true assessment of the progress. 

Secretary NICHOLSON. Thank you, Congresswoman Berkley. 

I am aware of the Bailey case and we are looking into that. I am 

not aware of the shuttle issue and we will look into that. Of course, 

we would be happy to brief you on the status of the construction 

of the new Las Vegas hospital. 

Ms. BERKLEY. Now, let me just mention this. This disadvantaged 

small businessman says he is now having to file bankruptcy. That 

should not be if they are dealing with a Government agency, that 

a disadvantaged small business has to file bankruptcy because we 

did not pay him. 

But that is a concern of mine. But the bigger concern is, it is 

going to be 110 degrees in Las Vegas a month from now and I just 

cannot have my veterans standing outside in the heat waiting for 

some shuttle that may or may not show up. 

Thank you. 

Secretary NICHOLSON. Thank you. 

The CHAIRMAN. Thank you, Ms. Berkley. 

Apparently what happens in Vegas does not stay in Vegas. 

Mr. Bilirakis, you are recognized. 

Mr. BILIRAKIS. Thank you, Mr. Chairman. 

Good afternoon, Mr. Secretary. I have one question. One of the 

Task Force recommendations included enhanced capacity for 

servicemembers to receive dental care in the private sector as the 

VA works to improve its capacity to provide these services at the 

VA facilities. Can you give us an update on that? Has any action 

been taken? 


ccoleman on PRODPC74 with HEARING
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Secretary NICHOLSON. Well, the action that is being taken, Congressman Bilirakis, is that we are expanding the availability of 

contracting out fee-for-service dental care, the result of more need 

for it. 

Mr. BILIRAKIS. Okay. Thank you. 

The CHAIRMAN. Thank you, Mr. Bilirakis. 

Mr. Walz, you are recognized. 

Mr. WALZ. Thank you, Mr. Chairman. 

And thank you, Mr. Secretary, for what you are doing and taking 

the time to come see us today. And I do think it is important as 

many of the members here have mentioned for us to stress the 

positives of what we are doing with the VA and with our veterans. 

Out in my district and out in Minneapolis at our polytrauma center there, which I would consider to be probably one of the more 

premier facilities in the world, and they are doing great work. 

And I sat up there in the polytrauma ward with mothers from 

Michigan and their sons who have multiple amputations and have 

TBI. And they will stress that the only thing keeping them going 

is the angels on that floor that are serving them. 

So I do think it is important that we are here because the bottom 

line on this is this is an outcome-based proposition that is zero 

sum. We will never rest until everyone is taken care of to the best 

of our ability. I know you share that with me and that is our responsibility. So I am not here with joyful enthusiasm. I am a new 

member, but I am not joyfully enthusiastic. I am here with a deep 

sense of solemn duty and a responsibility to get this right. So I 

thank you for being here. 

I also in my time prior to coming here, my postgraduate work 

was in organizational analysis, so I am looking at it when you are 

talking the gap analysis. I know it is one of many tools. I think it 

is very important for us not to forget words like optimal allocations 

of inputs and things like that. It is a way you have to use it as 

a management tool, but these are veterans, these are people, and 

we can never forget that. 

So when I heard things that everything is fine, we are reducing 

numbers, one is too many, and it gets frustrating. When my veterans see, they will see a document and they will see it is well done 

and they see great things in here and they will ask me the question, so what, I still cannot get in. And so that is why we are here 

and that is where we are coming. 

I want to ask one particular question. I noticed, and I am glad 

this was listed as P1, the recommendation and the process for disability determinations, which is obviously the big issue, and I see 

in here that we went through the gap, we did the recommendations 

for the gap and then we did the implementation and action target 

date. 

We have met those apparently and we had the joint meeting on 

May 3rd. What next? What do I tell my people? And what I see 

in here, Mr. Secretary, you said, and I appreciate you saying this, 

that you take personal responsibility to make sure these things get 

done. I appreciate you saying that, but I also state that you took 

that on when you took the job. Tell me now how this P1 is going 

to be implemented. 


ccoleman on PRODPC74 with HEARING
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Secretary NICHOLSON. Well, I mentioned, and I think you were 

here, that things are moving on that. And there was a big meeting 

yesterday in the Deputy Secretary of Defense’s office, Secretary 

England. Secretary Gates served on my Task Force. He attended 

the meetings. He is up to speed on those issues and has delegated 

to Secretary England to head up their endeavor. 

So this is really getting serious and I would say unprecedented 

command focus. And as I said they have agreed to meet every 

Tuesday and there is an energy, there is a force behind this. 

There are, like there are in almost everything always at least 

two sides to everything and this is a complicated issue with the 

welfare and the future of a lot of people involved, including members of the active force who have a stake in this, in how this comes 

out. And they, of course, are going to be heard and represented by 

their service secretaries and chiefs. 

But there is a real action going on that I have never seen before 

and I do not think ever existed before. 

Mr. WALZ. If we are sitting here in two years, will we expect to 

see disability determinations be made at a quicker pace? Would 

that be the outcome we are looking for? Is that something we cannot say can happen? 

Secretary NICHOLSON. I can safely say that, yes. 

Mr. WALZ. All right. So if you and I are here in two years, we 

are going to take responsibility between the two of us to reduce 

that backlog and making sure that that is going to happen and this 

recommendation can help us get there? 

Secretary NICHOLSON. Yes. You know, I cannot wave a wand over 

all these different agencies. I chaired this Task Force. I reported 

it to the President. The President has taken it on board. It will be 

taken very seriously. And I also am in charge of the followup 

and—— 

Mr. WALZ. I am encouraged by that. I am encouraged that we are 

going to get this done. But you and I both know that if that does 

not translate into our veterans getting there quicker, it is not going 

to be for anything. And we have a deep responsibility to do that. 

So thank you. 

Secretary NICHOLSON. You are totally correct. And we have a lot 

of other things to do than to just go through another bureaucratic 

morass here. That is not my mindset on this at all, believe me. 

Mr. WALZ. Great. Thank you, Mr. Secretary. 

And I yield back. 

The CHAIRMAN. Thank you, sir. 

Mr. Boozman, you are recognized. 

Mr. BOOZMAN. Thank you, Mr. Chairman. 

I really do not have any questions. I appreciate the work of the 

Commission in coming up with this and really look forward to 

working with Ms. Herseth Sandlin in her capacity as Chairman of 

the Economic Opportunity Subcommittee and my capacity as Ranking Member of the Subcommittee and really looking at this and 

trying to see what we can do through our Subcommittee working 

with the full Committee to implement recommendations. 

So I appreciate your hard work. Thank you very much. 

The CHAIRMAN. Thank you, Mr. Boozman. 

Mr. Hare? 


ccoleman on PRODPC74 with HEARING
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Mr. HARE. Mr. Secretary, since part of this is also called returning Global War on Terror heroes that we are doing, many wounded 

War on Terror heroes seek care in our Nation’s outpatient centers, 

vet centers. 

Were you in receipt of a letter that was signed by 53 members, 

a bipartisan letter sent to you asking you to get back to us? It says 

we urge you to address these issues immediately. In addition, we 

would like you to know what actions are planned to meet the staffing crisis at the VA centers. How much Federal resources would be 

required to fully staff the vet centers over the next five years. I was 

just wondering if you were in receipt of that letter. 

Secretary NICHOLSON. Could you tell me the date on that, Congressman. 

Mr. HARE. April 27th of this year. 

Secretary NICHOLSON. I do not know the answer. 

Mr. HARE. Well, I share Mr. Baker’s comments about not getting 

a response. Here is the genuine concern that I have. We sent this 

letter out and I know we are going to have a hearing on this later. 

And you will probably get a little of my freshman exuberance 

here, but with the shortage that we have at our vet centers across 

this Nation, I cannot for the life of me imagine why $3.8 million 

is being sent out in bonuses. 

We have 600,000 backed up claims and, yet, when you came to 

us and asked on the General Operating Expense account, you 

asked for less money than 2007 which was a cut of nearly $9 million. So your comments about the VA having all the money it needs 

must be reflective. 

And let me just say this to you. It would seem to me that I do 

not know why our veterans have to err on the side of having to 

wait 177 days to get a claim adjusted. If these things are adjusted 

because, as you said, ‘‘they were based on performance,’’ I would 

suggest to you, Mr. Secretary, that the person in charge of that is 

doing a miserable job and did not deserve a $33,000 bonus. 

That said, I think our veterans are the ones that should have— 

the burden of proof should not be put on them. It should be put 

on us. If you file your income tax and you send it in, you are audited, you are not assumed to be a cheater. Our veterans are sitting here waiting for benefits that they want. 

I listened to Mr. Baker talk. Fifteen months for Gulf War veterans, 15 months, and the answer to him is, well, we do not know. 

Maybe another year, maybe another year and a half. 

My point is this. I may be new here, but I have listened to VSOs 

come here. I have listened to our Filipino veterans come. I have listened to vet after vet come and spouses of veterans come. I will tell 

you this. One hundred and seventy-seven days is inexcusable. To 

get it down to 145 days is not doing these veterans what I would 

consider to be a big favor. I think it is disingenuous. 

I also just want to say candidly from my perspective, we do not 

have enough money for our veterans in our budget and you do not 

have enough staff. You do not have enough polytrauma units. Your 

doctors have testified that you do not. We do not have enough people that are working in these clinics. 

I have four outpatient clinics in my district. I have a vet center 

one block from my district office in Moline. I worked for a member 


ccoleman on PRODPC74 with HEARING
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for 23 and a half years. I know post traumatic stresses. The VA is 

woefully unprepared for the number of post traumatic stress veterans that they are going to have coming back. 

So you will have to pardon me if I do not share your opinion that 

you have all the money that you need and that you are completely 

staffed up to what you desire. 

The fact of the matter remains, if we make a promise to veterans, and it makes no difference to me whether I am a freshman 

on this Committee or whether I have been here for 25 years, as 

long as I sit in this chair, my responsibility is to those men and 

women who gave everything they had for this country and they 

come back and we do not even have the DoD talking to the VA. 

You have the Walter Reed scandal that goes on. Our records are 

sent out left and right. 

I think that what we need is an overhaul here. I am not happy 

with the way our veterans have been treated. I have made that 

very clear. And let me suggest to you that I think we really need 

to get down to business here. We have really got to put our veterans first. 

And that to me, with all due respect, Mr. Secretary, from my perspective of sitting here in the four months that I have been here, 

just has not been the case. I have listened to the DAV. I have listened to the Paralyzed Veterans of America. I have listened to the 

VFW and the American Legion come before this Committee. Someone told them they were too late to come. I do not think it is ever 

too late for a VSO to come to this Committee and ask for money 

that we need in the budget. 

And if the answer is the money, and the Chairman has said before, all we are asking for is for the VA to tell this Committee what 

it is that you need to be able to clear up the backlog, what is it 

that we can do to quit erring on the side of the bureaucrats and 

start erring on the side of our veterans. That to me is very disturbing and I just do not think our veterans have gotten a fair 

shake, with all due respect. 

And I would yield back. 

The CHAIRMAN. Thank you, Mr. Hare. 

Mr. Space? 

Mr. SPACE. Thank you, Mr. Chairman. 

Mr. Secretary, my district, like so many other members of this 

Committee, is comprised of small towns and villages, very rural in 

nature. And I am interested in the Task Force recommendations 

regarding how the VA will work together with HHS to provide access to those members who come from rural or remote areas. 

Can you give us some insight as to what the VA and the HHS 

or the Department of HHS plan to do in this regard? 

Secretary NICHOLSON. Yes, Congressman. First, I will say that 

we have been mandated by law to develop a new rural health initiative and our response in that to you is September. And we are 

heavily underway in that. That is a concern of ours. It is a challenge of ours at the VA. 

And at the Task Force, we had discussions with HHS about the 

ways that we could collaborate and use our facilities or theirs, the 

community mental health facilities in ways that, you know, we can 

augment and supplement each other in the rural, remote areas of 


ccoleman on PRODPC74 with HEARING
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the United States where we know it is difficult for veterans, some 

who have to travel two, three hours to get to a community-based 

outpatient clinic, longer than that to get to a referred acute care 

facility, or hospital. That is essentially what we are looking at 

there. 

Mr. SPACE. And you say we can expect that to be completed in 

September of this year? 

Secretary NICHOLSON. I mentioned that just to make you aware 

that Congress mandated us with a law to develop a new rural 

healthcare initiative in the VA. And that is underway. This Task 

Force took a tangent from that in working with HHS to see ways 

that we could supplement our gaps using existing facilities that are 

in these remote areas. 

Mr. SPACE. I certainly trust that the situation will be taken very 

seriously. We have veterans who are in an impoverished area, 

many of whom have no means whatsoever of public transportation. 

Private transportation in many cases is limited. Compound that 

with the price of gas now at $3 a gallon and going up, it represents 

a considerable hardship for these folks. And I trust that the VA 

will, in fact, take their responsibility very seriously in that regard. 

Secretary NICHOLSON. We do. We are. I can also tell you that we 

have made some good advances using existing technology for rural 

health in telehealth and telemedicine and including telemental 

health. And we are finding pretty good results with that. 

Mr. SPACE. I yield back, Mr. Chairman. 

The CHAIRMAN. Thank you, Mr. Space. 

Mr. McNerney? 

Mr. MCNERNEY. Thank you, Mr. Chairman. 

And thank you, Mr. Secretary, for testifying before us today. Like 

Mr. Walz, I understand and I recognize a lot of good work being 

done by the VA and by the people that are employed by Veterans 

Affairs throughout the country. 

However, I am concerned about two issues which could, with a 

little creative thinking, have a joint solution. First, I am concerned 

about the possibility of closing an excellent facility in Livermore, 

California, that serves a number of my constituents and is currently under reviews with the Capital Asset Review for Enhanced 

Services (CARES) Project. 

First, I would like you to shed some light on the VA’s rationale 

here. Why would we be closing an excellent facility at a time of 

large-scale military action, at a time when large numbers of veterans from the Vietnam, Korea, and World War II are needing additional care? 

Secretary NICHOLSON. I am going to have to get back to you on 

the Livermore facility, Congressman, because I am not familiar 

with an action that we are taking there. I know we are not closing 

a hospital. And it is not on my radar, on the CARES screen that 

we have, the Capital Asset Review for Enhanced Services. 

So are you talking about a clinic; do you know? 

Mr. MCNERNEY. The Livermore facility has a hospital and a clinic and there is also one in French Camp and there is a nursing 

home. 


ccoleman on PRODPC74 with HEARING
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But what is the rationale for considering closing facilities anyway? I mean, I do not understand that at this particular point in 

time. 

Secretary NICHOLSON. Well, I can address that point. That comes 

to us from you, the Congress, pursuant to a GAO report that was 

done on the VA some several years ago and found that it was inefficient, in fact maybe wasting over a million dollars a day with 

maintaining unused or under-utilized facilities, and told to do 

something about that. 

And the response was the establishment of this system called 

CARES, which is the review of all the existing plant and equipment to see if it is being properly used. 

And it was found that veterans like all other Americans have 

made some demographic shifts from certain locales to the south 

and the west and the southwest and that there are more VA facilities needed where there are higher densities of veterans and less 

needed where they left from or used to live. 

Mr. MCNERNEY. Let me continue then. As Ranking Member 

Buyer suggested, the relatively low number of TBI and PTSD cases 

the VA is currently treating relative to the number that are estimated to have been exposed to conditions that might lead to such 

injuries. 

My question is this or my suggestion is this: If we disregard the 

assumption that no new funding or programs will be introduced, 

would the VA be interested in reprogramming some of the existing 

facilities currently under CARES review providing treatment for 

PTSD and TBI? 

Secretary NICHOLSON. Yes, indeed, if the need was shown. I can 

cite to you a couple of examples. 

We were looking at the Waco, Texas, facility, for example. The 

veteran population count was down from what it used to be. Many 

of these facilities were put in place right after World War II. That 

facility has been established as a Center of Excellence. Similarly in 

Canandaigua, New York, the same sort of demographic experience. 

It has been made a Center of Excellence and these will be for mental health facilities, mental healthcare. 

So the answer is yes. I mean, we will have the facilities that, you 

know, are needed. And this is a high priority. 

And I would like to correct something that, again, Congressman 

Hare said. I did not say here today that we have all the money that 

we need. We are big and we are dynamic and there are other 

things that we could do both program-wise and facility-wise. 

We have an excellent team of people, however, on board to treat 

posttraumatic stress disorder. I think we are the preeminent experts on that in the world and we have the preeminent research 

facility on that at White River Junction, Vermont. And we are now 

screening diligently for that and treating veterans for that. If we 

need additional facilities to do that, we will indeed come forth and 

request those. 

Mr. MCNERNEY. Well, it seems like we are going to be overwhelmed by that sort of injury fairly soon if we are not already. 

So thank you. 

I yield. 

The CHAIRMAN. Thank you, Mr. McNerney. 


ccoleman on PRODPC74 with HEARING
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As a part of housekeeping, I ask unanimous consent that all 

written statements be made part of the record. Without objection, 

so ordered. 

I ask unanimous consent that all members be allowed five legislative days to revise and extend their remarks. Without objection, 

so ordered. 

Mr. Buyer, you are recognized for five minutes. 

Mr. BUYER. Thank you. 

Let me pick up on Mr. McNerney’s point. The actual number of 

TBI cases that you treated in the VA is what, how many that you 

know of? 

Secretary NICHOLSON. I think that we are treating in the vicinity 

of 220,000 veterans for PTSD. 

Mr. BUYER. No. I am talking about at your polytrauma centers 

for traumatic brain injury inpatients. 

Secretary NICHOLSON. Oh, I am sorry. Yes. In our polytrauma 

centers, we have so far treated 369 veterans. 

Mr. BUYER. Three hundred and sixty-nine. An allegation has 

been made that you do not have the bed space at the polytrauma 

centers to care for all of them. Would you respond to that because 

I believe you have empty beds at the polytrauma centers? 

Secretary NICHOLSON. Yes. That is not the case. We have four 

level-one polytrauma centers and we have 17 level-two polytrauma 

centers. So we have one in every medical region of the country 

and—— 

Mr. BUYER. When you say that is not the case, what does that 

mean? What is not the case? 

Secretary NICHOLSON. If someone asserts that we do not have capacity, that is not the case. We have capacity. I might add that 

many of our patients in our polytrauma centers are active duty 

military because they are acutely brain injured. They come to us 

very soon not worrying about their status. 

The CHAIRMAN. Would you yield to me for one second—— 

Mr. BUYER. Yes. 

The CHAIRMAN [continuing]. Because this issue is very important. As I understand it, Mr. Buyer, Mr. Secretary, the centers are 

treating severe TBI, whereas so-called moderate or mild TBI, which 

I would rather call hidden because it is going to really influence 

people, are not being treated there. And that is where I am told 

we are going to have thousands of cases. 

Mr. BUYER. You are going right into where I was asking questions. 

The CHAIRMAN. Okay. I am sorry. I yield back. 

Mr. BUYER. No, no, no. 

The CHAIRMAN. But that is where the issue is. 

Mr. BUYER. Right. 

The CHAIRMAN. And that is what we want the preparation for. 

Mr. BUYER. But I wanted to set the baseline. 

The CHAIRMAN. Okay. 

Mr. BUYER. The baseline is a relatively small number with regard to your treatment of these traumatic brain injured. It is traumatic. This is tremendous trauma. 

But we have a really strong concern. We have done well with regard to up-armored Humvees, some of the other vehicles, the BufVerDate Aug 31 2005 01:58 Apr 04, 2008 Jkt 035641 PO 00000 Frm 00031 Fmt 6633 Sfmt 6633 E:\HR\OC\35641.XXX 35641

ccoleman on PRODPC74 with HEARING
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falo, the V shape that we are going to, and the soldiers, they get 

out, they are in awe, they are in shock that they have survived. 

They are photographing, my God, I have just survived this and it 

is later on that they are having some difficulties, memory loss, in 

brushing their teeth, you know, weird things are happening to 

them. 

And these are the cases that Mr. Filner and I are pretty concerned about. So how do we discover them, track them, bring them 

into the systems, and that kind of thing? But I was just trying to 

establish the baseline. 

So we want to work with you on making sure that you have the 

capacity and you work inter-operably with DoD. Do you agree with 

that? 

The CHAIRMAN. Yes. 

Mr. BUYER. Okay. I also want to share my feelings with Mr. Filner in his opening with regard to the report, but you also had some 

restraints. You had to make some decisions inside the box with regard to what can you do without new resources. And I do want to 

have a follow on discussion. 

Maybe you can meet with Mr. Filner and me or other interested 

members about beyond that because even when we did Wounded 

Warrior, Mr. Filner and I worked together to do the electronic medical records and actually mandated them. Sure, it was in the 

Wounded Warrior legislation, but then when we put it in the DoD 

authorization bill, the Congressional Budget Office (CBO) came 

back and gave this huge number, billions that this would cost, so 

we had to scale it back to basically say Joint Patient Tracking Application (JPTA). And we could do that and make it inter-operable, 

bi-directional, and share the information and add no cost. 

So we also then were thrown back in the box, but there are some 

big things that we have to do and I think that sort of is the emotional flow of Mr. Hare. There are some big things out there that 

kind of need to be done. So I would like to do that with you, Mr. 

Secretary. 

Now I am going to jump really deep in the weeds. When I got 

to your to improve IT inter-operability, it is on page 72 of the report, HHS is going to be the lead agency on this. You are going to 

sign an MOU. 

And, Admiral, maybe you can help me here. When you establish 

this inter-operability with HHS, is this being done in the arena of 

risk management? 

In your reporting requirements in all of your hospitals and your 

outpatient clinics with regard to the adverse events because of the 

Prescription Drug User Fee Act (PDUFA) and Medical Device User 

Fee and Modernization Act (MDUFA), so you have adverse events 

reporting requirements under the post-marker reviews, and if you 

can electronically move this to HHS, we are reducing a tremendous 

amount of paperwork and burden. And this is part of the goal? I 

cannot get this from what you have here. 

Secretary NICHOLSON. Well, that is an important question, I 

think. What we are going to do is to have this joint group that is 

working on that. I mean, the President has thrown down a marker 

on trying to both standardize and universalize electronic health 

records in the movement and communication of it. 


ccoleman on PRODPC74 with HEARING
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And the Secretary of HHS, for example, has the responsibility to 

develop the protocols so that different organizations of the government and the private sector can establish their systems and their 

proprietary prerogatives. But they need to communicate. And this 

joint group has taken on this responsibility right now of working 

that. 

Mr. BUYER. Please place that into consideration in the interface 

with HHS on risk management—— 

Secretary NICHOLSON. All right. 

Mr. BUYER [continuing]. And post-marker review. The last thing 

I have, Mr. Chairman, is on this page 70 through page 74, you lay 

out all of these target dates for implementation. 

And so, Mr. Secretary, what assurances can you give the Chairman and the Committee that—what assurances do you have that 

other Federal agencies involved in this process, notably DoD—will 

take implementation of the Task Force recommendations seriously 

as you have? I mean, who is going to be the person? Has the President tasked you to turn to your counterparts and say this is the 

date, you have not implemented? I mean, who is the task master 

with regard to implementation? 

Secretary NICHOLSON. Well, they have signed on. They have 

signed an agreement to participate and to abide. I mean, these 

schedules were not developed by us in a vacuum. They were collegial. And I am happy to say that, you know, so far, so good on compliance, very encouraging. 

These things are considered extremely important to the mission 

which is serving these current combatants and so they have a 

sense of urgency about them and that was established early in this 

process. And we want that to remain there. 

You know, if they go slack, I will try to motivate them or indeed 

the Commander in Chief might get involved because he has a real 

interest in this. 

Mr. BUYER. In closing, Mr. Secretary, what you have proven to 

Mr. Filner and me is when you were faced with a tremendous challenge, you told us you will take ownership of that issue and you 

did. So whether it is IT or this, you have proven yourself to this 

Committee. 

Now we have a tremendous responsibility being in charge for the 

President with regard to these initiatives. And I suppose Mr. Filner 

and I are—I want to make sure we are touching the right person. 

Are you saying to us that each of them, your other Secretary 

counterparts, they are the ones who are now responsible for the implementation? I see a nod from the back of the room. That is what 

we are to assume and that you are going to be responsible for your 

piece of this. You are going to have to turn to Duncan Hunter or 

somebody else with regard to the other Committees with regard to 

implementation. So we do not come back six or eight months from 

now and go after you and say how come so and so missed their targets. In other words, when you step away, you are no longer the 

guy in charge of the Task Force? 

Secretary NICHOLSON. Well, I am coordinating it as the Chairman. I am coordinating it. I do not have command responsibility 

over those other service sectors, but I am coordinating it in this 

role that I have been given. 


ccoleman on PRODPC74 with HEARING
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Mr. BUYER. Okay. Thank you. 

The CHAIRMAN. Thank you, Mr. Buyer. 

Thank you, Mr. Secretary. 

Let me try to summarize what I think a lot of my colleagues 

have said and some of the frustration we have. We agree with you 

that there is a tremendous number of good things happening in the 

VA in the medical area and committed people everywhere you go 

who want to serve veterans. I know medical directors could probably earn twice as much outside the VA and they are committed 

to veterans. So we agree with you on that. 

On the other hand, I think what the American people want and 

I think what we want and I think what you want, and if there is 

a silver lining in the cloud that Walter Reed represented, it is that 

people are ready for bold action. 

You said there is a sense of urgency among everybody and yet 

what we see is a process. It seems to me that we are allowing the 

bureaucratic needs of not only your agency but every agency to set 

the pace rather than the needs of our veterans. 

Look at this report. This is stuff that you did not need any new 

money or any new authority I do and it goes on for a year, year 

and a half. We could do it today. 

The claims backlog that several people have brought up, I think 

we have to, and we have talked about it, cut through the whole 

mess. Give veterans the benefit of the doubt. Either work it like 

the IRS and send them the check and audit later, start some minimal check when we receive their claim. We are going to talk about 

all these things when we have this roundtable on May 23rd. But 

we cannot keep saying we have this backlog and we are going to 

solve it. We have got to cut through it. 

The health records interoperability, how many years have you 

been talking about this? This is not rocket science, as you pointed 

out. It takes somebody to say, ‘‘do it tomorrow.’’ We worked together at Chicago where they have, it looks like to me, made significant progress in this. 

If the VA has the better health records system, which I am told, 

the VistA System, order the DoD tomorrow to use that system. We 

cannot wait years and years and years and years and years, as everybody seems to suggest. 

These are kids. We have all been to see these kids with brain injuries and amputations and even World War II veterans are still 

very frustrated and Vietnam vets are frustrated. We cannot wait. 

We want bolder action. 

Take PTSD for instance, since everybody seems to have a greater 

appreciation of it. I do not think we have adequate staffing. And 

if you made that statement in a townhall meeting that any of us 

led with you, they would boo you off the stage. They have made 

calls. I have talked to people who have said you are either on a 

waiting list and then when I got mad at waiting lists, they stopped 

doing waiting lists and just said call back in three or four weeks. 

We know the story of the Minnesota Marine who was told that 

he would be 26th on a waiting list, so he committed suicide. We 

cannot wait. We have got to have the staffing there. 

And we have, I think, resources, Mr. Secretary, outside the VA 

that we need to welcome in and bring in. There are experts, and 


ccoleman on PRODPC74 with HEARING
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we are going to have a symposium on PTSD on May 16th, experts 

around the country on brain injury, trying to tell the bureaucracy 

‘‘we want to help’’ and, yet, bureaucratic needs outweigh the need 

for urgency. 

I have visited with dozens of people who have programs that 

they think could help veterans with PTSD. And I am sure that all 

of them work. And we talked about setting aside a certain part of 

the money to help these community groups. 

There is a young man named Sean Hughes in Los Angeles, came 

back as a Marine with severe PTSD. He did not think he was making much progress in normal treatment, so he started writing his 

own feelings down in the form of a play. His play was produced. 

It was called Sandstorm. Some of you may have seen it. To try to 

work out his feelings. And he felt so healed by that that he set up 

a group called Vet Stage that he invited his comrades in to write 

and act, do such things as lighting and directing plays. 

And I saw a play of his in Los Angeles called The Wolf. And it 

had a very powerful statement of what people feel when they get 

out of a combat situation. And he is running this program on a 

shoestring. Thirty people can see the play at once. 

I go a few minutes later over to the West LA complex where 

there are two theaters run, I think, by UCLA. Surely Mr. Hughes 

might use that theater when it is not being used by UCLA. 

Regarding the Livermore situation that Mr. McNerney brought 

up; I have not been there, but I am told it is a very beautiful site, 

very conducive to relaxing rehabilitation for PTSD victims. 

So, we have talked about being creative, being bold. People do 

not want to wait for this stuff. We will never respond as quickly 

as someone needs, but we have got to have a quick response as a 

goal. We cannot allow ourselves to be victims of processes to say, 

okay, it is going to take a year before we do this stuff. That is not 

an answer for the people we are calling heroes. We know they are 

heroes. We want to treat them as heroes. But, telling someone they 

are 26th on a waiting list, that is not treating them heroically. 

So as Mr. Buyer said, we look forward to working with you. People want bolder action. They do not want this process stuff. Let us 

announce some bold actions, whether it is targeting several hundred million dollars to the kind of thing that Sean Hughes is doing 

and people are doing all across the country, whether it is setting 

aside some of these facilities that have outlived their usefulness in 

the context that they were built but can serve other functions now. 

People have offered brain injury beds in their clinics. Let us do 

it and not just study it and set up a process. I think that is our 

frustration. I know it is yours too. But I think we have to have 

some evidence that we are cutting through it. 

Mr. Secretary you have listened to all of us all day. I would be 

happy to give you as much time as you want either to conclude or 

respond to anything anybody here has said. 

Secretary NICHOLSON. Well, thank you, Mr. Chairman and members of the Committee. I genuinely appreciate the chance to come 

over here, present the work of this Task Force so far, and to respond to your questions because I know they are sincere. 


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We are a big organization. Last night we got this letter from 

AARP, a bulletin called Vetting the VA and it is just extremely 

complimentary of the VA and the job it is doing. 

I have in my files letters from the heads of three Veteran Service 

Organizations complimenting the job that the VA is doing. 

So I say that because we are a big organization populated with 

people that I find to be very committed to the mission which is to 

serve veterans. And many of them, including many if not all of 

these Senior Executive Service people, working in this medical field 

could be making tremendously more money on the outside. I know 

what those people are making. Yet, they are staying there. 

So it is important, I think, that we recognize our shortcomings 

and we have some. We see over a million patients a week now. And 

as somebody said to me in St. Louis yesterday at the hospital, he 

said if we get it right 99.5 percent of the time, we are still going 

to have some problems. And we take those problems seriously, each 

of them, and see what we can learn from those and improve. 

But I have a real concern for the people who work at the VA, 

many, many of whom are veterans and their morale and their need 

to be, I think, shown some respect and gratitude as well. And I do 

that every chance I have. So I am doing it now as well. 

It is really a phenomenal organization with a clear mission to 

take care of what President Bush called last Veterans Day our Nation’s finest citizens. And we are hard at it, but we welcome the 

oversight and the constructive inquiry and criticism that we get 

from you. 

And somebody told me today in preparing to come over here that 

there are, I think, 66 agencies, including the VSOs, that are licensed, accredited to come in and inspect VA facilities. So we do 

have quite a lot of oversight. And I think that as I move around 

and visit with veterans as I do continually and ask them how we 

are doing, they are generally extremely grateful and complimentary 

of the care that they are getting. 

There is a frustration in the time it takes to adjudicate a claim. 

That is a top priority of mine. And we are working on that. We are 

looking at some of these creative ways of reversing the assumption 

about the validity of the claim. But that is in motion. 

But in summary, Mr. Chairman, I appreciate the chance for us 

to be here and I appreciate your leadership of the Committee and 

that of the Ranking Member, Congressman Buyer, because I know 

how much you care. Thank you. 

The CHAIRMAN. Thank you, Mr. Secretary. 

This hearing is adjourned. 

[Whereupon, at 3:58 p.m., the Committee was adjourned.] 


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A P P E N D I X 

Opening Statement of the Honorable Bob Filner, Chairman, 

and a Representative in Congress from the State of California 

The Committee on Veterans’ Affairs will come to order. I would like to thank the 

Members of the Committee for being here this afternoon. 

I would like to thank Secretary Nicholson, who chaired the Task Force, for appearing before us today to provide us with the results of the Task Force report, 

which was submitted to the President on April 19, 2007. 

The Task Force was created, by Executive Order, on March 6, 2007. The mission 

of the Task Force was to: 

• identify and examine Federal services and benefits currently provided for returning servicemembers; 

• identify existing gaps in such services; 

• seek recommendations from appropriate Federal agencies on ways to fill those 

gaps as effectively and expeditiously as possible using existing resources; and 

• ensure that, in providing services to those servicemembers, appropriate Federal 

departments and agencies are communicating and cooperating effectively and 

facilitate the fostering of such agency communications and cooperation through 

informal and formal means, as appropriate. 

The Task Force report identified 15 ‘‘process’’ and 10 ‘‘outreach’’ recommendations. 

Of these 25 recommendations, the report states that ‘‘18 represent collaborative efforts among Federal entities.’’ The Task Force will reconvene in approximately one 

month to provide updates on the progress of the Government-wide action plan. The 

Committee looks forward to the Secretary’s report on these 25 recommendations. 

I know that I speak for many of my colleagues here today in expressing our fear 

that the recommendations of this Task Force report will meet the fate of so many 

other recommendations from other reports from the last decade—that there will be 

great fanfare and very little action. 

Many of these recommendations are not new. Many of these recommendations 

will face the same problems of implementation as so many recommendations of the 

past—the inability of the Department of Veterans Affairs and the Department of 

Defense to work together in an effective manner to address the problems and hurdles faced by our returning servicemembers. 

This Committee is sensitive to the difficulties involved in coordinating the activities of the Department of Defense and the Department of Veterans Affairs. These 

Departments do indeed have different missions and different requirements. 

But as we meet here this afternoon our servicemembers are in harms way. Many 

of these men and women will be killed or wounded. We have talked and talked 

about the necessity of providing a seamless transition for years. We no longer have 

the luxury of time, if we ever did—we simply must act today. 

It is my hope that Secretary Nicholson will provide us with concrete answers as 

to why this Task Force report will be different from the Report of the President’s 

Task Force to Improve Health Care Delivery for Our Nation’s Veterans, released in 

2003, and the Report of the Congressional Commission on Servicemembers and Veterans Transition Assistance, released in 1999. 

We seek a detailed timeframe as to implementation, the officials who will be responsible for implementation, and how the Secretary will inform this Committee as 

to the progress of implementation. This Committee seeks accountability and will 

look to Secretary Nicholson to provide this personal accountability. 

I note that the ‘‘Government Wide Action Plan’’ in the report lists a number of 

actions that were targeted to be completed after the release of the report and before 

today. As of today, Mr. Secretary, have all of these deadlines for action been met? 

Finally, I am concerned that the mission of the Task Force was constrained by 

being forced to concentrate on solutions using existing resources and available authorities. This reliance begs the question as to why these steps were not taken earVerDate Aug 31 2005 01:58 Apr 04, 2008 Jkt 035641 PO 00000 Frm 00037 Fmt 6604 Sfmt 6621 E:\HR\OC\35641.XXX 35641

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lier, if it was indeed only a matter of existing resources and available authorities. 

It also raises the larger question as to what resources and authorities the VA needs 

to provide the long-promised seamless transition between the VA and DoD once and 

for all. 

f 

Opening Statement of the Honorable Steve Buyer, 

Ranking Republican Member, and a Representative in Congress from the 

State of Indiana 

Good afternoon. 

Mr. Chairman, thank you for holding this hearing. 

Mr. Secretary, thank you for being here today and for chairing this Task Force. 

The President has made clear his intent that we once and for all establish a truly 

seamless transition for servicemembers between the military and the VA, as well 

as other agencies providing services to veterans. You and your colleagues on the 

Task Force have produced a thorough review of the factors affecting seamless transition, and are to be commended. 

However, over the past 15 years, I have seen one commission and task force report after another. From my own personal experience with seamless transition, I 

know there are few new discoveries. What we have regrettably seen, and what compelled the President to directly intervene, is a general lack of implementation. To 

be fair, VA has made much progress; it has in fact led the federal effort. But VA 

cannot do it alone. 

Mr. Secretary, with the Task Force’s work behind us, this report before us, and 

the President’s intent made clear, we now must have implementation. In a few short 

weeks, the President is due to receive a progress report on the implementation of 

the recommendations from the report. We in turn will look for department and 

agency heads, in particular you and Defense Secretary Gates, to work together to 

move your respective departments forward. 

When that happens, we can talk about real progress. 

This report is, nonetheless, encouraging. Among the Task Force’s 25 recommendations, a handful alone would dramatically improve transition and must become a 

high priority within the administration. These include: 

• Development of a system of co-management and case management for returning 

servicemembers to facilitate transition between the Department of Defense and 

VA. 

• Screening all Global War on Terror veterans seen in VA healthcare facilities for 

mild to moderate traumatic brain injury. 

• Expanding VA access to DoD records to coordinate an improved transfer of a 

servicemember’s medical care through patient ‘‘hand-off.’’ 

• Development of a joint DoD/VA process for disability benefit determinations by 

establishing a cooperative Medical and Physical Evaluation Board process within the military service branches and VA care system. 

Among my goals here on the Committee, is to ensure that veterans have every 

opportunity to live full and healthy lives—that they can take advantage of the economic opportunities their service helped preserve. Among key recommendations 

from the Task Force report that would help veterans transition into civilian life: 

• Increasing attendance at the Transition Assistance and Disabled Transition Assistance Programs for active duty Guard and Reserve. 

• Requiring the Department of Education, in cooperation with the Department of 

Labor, to participate in DoD job fairs to provide returning servicemembers and 

their families with an awareness of the postsecondary education benefits. 

• Requiring the Department of Labor, through the Veterans’ Employment and 

Training Service, to participate in the Workforce Investment System in every 

State and territory; and partnering with private and public sector job fairs to 

expand the number of employers involved in active veteran recruitment. 

The accomplishment of these recommendations, as well as others, is critically important. Since 2003, this Committee held more than 10 hearings and conducted at 

least 15 site visits focusing on seamless transition. Our experiences corroborate the 

value offered by these recommendations. 

Yet, it already appears there is some reason for concern over implementation of 

the Task Force’s 25 recommendations. The implementation target dates for 12 actions supporting the accomplishment of nearly half of those recommendations have 

already passed. At this point, we do not know if these actions have been completed. 


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Of additional concern is the apparent lack of a single point of accountability short 

of the President to ensure interdepartmental action. It is unclear to me who in the 

Administration is responsible for monitoring and enforcing timelines and implementation. Our odyssey with this issue, as well as our experience with moving the Department to a centralized system of information technology management unequivocally attests to the supreme importance of accountability. 

I look forward to learning about the Departments’ implementation of the Task 

Force’s recommendations, and to learning what is being done to fulfill the President’s intent in a timely fashion. 

Again, thank you, Mr. Chairman, and I yield back. 

f 

Opening Statement of the Honorable Ginny Brown-Waite, 

a Representative in Congress from the State of Florida 

Thank you, Mr. Chairman. 

I also want to thank Secretary Nicholson for appearing before the Committee 

today. 

Responding to the problems at the Walter Reed Army Medical Center, President 

Bush took the appropriate step of creating the Task Force on Returning Global War 

on Terror Heroes. This panel worked tirelessly to identify recommendations on how 

Congress can improve the care and support for our returning soldiers. Their findings 

focused on several key areas, including healthcare services, employment assistance, 

benefits, and outreach efforts. 

Mr. Chairman, with thousands of wounded soldiers returning from the front lines 

in Iraq and Afghanistan, Congress has an obligation to ensure that these individuals receive the best healthcare in the world. Never again should we see a breakdown like what occurred at Walter Reed. Congress, the VA, and DoD need to work 

together to bring about the changes needed in caring for our veterans. 

I look forward to hearing from the Secretary about the panel’s findings. Thank 

you. 

f 

Statement of the Honorable R. James Nicholson, 

Secretary, U.S. Department of Veterans Affairs 

Mr. Chairman, Members of the Committee, good afternoon. 

Thank you for the opportunity to discuss the Task Force on Returning Global War 

on Terror Heroes and the steps which will be taken to ensure that the Nation’s 

promises to those veterans and returning servicemembers are kept. 

In the past, Congress has demonstrated the value they placed on military service 

by creating programs to provide military personnel and eligible veterans with benefits and services to help them readjust to civilian life. 

Under President Bush, and at Congress’ direction, there have been tremendous 

strides in addressing the needs of our Nation’s veterans. 

As the War on Terror continues, however, it has become apparent that a government-wide approach which addresses all aspects of caring for our most recent heroes 

is necessary. Although VA’s healthcare is noted nationally as one of excellence, 

there are always ways in which we can improve both our medical care as well as 

processes to better serve our veterans. 

While DoD has been praised for the life-saving medical care that it provides on 

or near the battlefield beginning minutes after injury, the condition of Building 18 

of the Walter Reed Army Medical Center was a call to arms for those of us who 

took the oath to serve our returning servicemembers. The President, like the rest 

of the Nation, was infuriated by the conditions at Walter Reed’s outpatient facility 

and wanted to ensure that our servicemembers and veterans’ needs were being met 

and wanted to swiftly address any areas in which services to veterans could be improved. 

On a personal note, as you know I am a veteran of the Vietnam War. I am also 

the son of a veteran. I am the father of a veteran and the brother of a veteran. I 

am the uncle of four active duty colonels, one of whom is in his 14th month of service commanding a brigade in Afghanistan. In my capacity as the Secretary for the 

Department of Veterans Affairs, I have the ongoing privilege of meeting our Nation’s heroes from across the country. The issue of their care and meeting their expectations upon their return home is a personal one to me and one in which I can 

emphatically state that I know and understand. 


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To address the very real needs of returning servicemembers, President Bush created the Interagency Task Force on Returning Global War on Terror Heroes on March 6, 2007. This Task Force was given 45 days to review all government services 

upon which veterans and servicemembers rely when they return home. The membership of this Task Force consisted of the Secretaries of Defense, Labor, Health and 

Human Services, Housing and Urban Development, and Education, plus the Director of the Office of Management and Budget, the Administrator of the Small Business Administration, and the Director of the Office of Personnel Management. 

President Bush appointed me Task Force Chair. The Task Force’s structure provided an opportunity to establish interagency cooperation in delivering benefits to 

our Global War on Terror [GWOT] servicemembers and veterans. 

The President’s Executive Order directed the Task Force to: 

• Identify and examine existing Federal services that currently are provided to 

returning GWOT servicemembers; • Identify existing gaps in such services; • Seek recommendations from appropriate Federal agencies on ways to fill those 

gaps; • Ensure that appropriate Federal agencies are communicating and cooperating 

effectively; and • Develop a government-wide action plan that ensures that in providing services 

to these servicemembers, appropriate Federal agencies are communicating and 

cooperating effectively. 

We sought input from stakeholders. We considered this essential if we were to be 

successful. Within 48 hours of the Executive Order, the Task Force had a functional 

website to seek input from veterans, active duty personnel, veterans’ service organizations, federal employees, and other interested parties. 

We received over 2,400 communications by email, regular mail, and fax. Each was 

identified as raising either constituent casework and/or policy issues which needed 

further review by the Task Force. In addition, we met with Veterans Service Organizations (VSOs) to discuss their concerns and ideas as to how we could improve 

our service to veterans and servicemembers. Equally as important, Admiral Patrick 

Dunne, the Executive Secretary of the Task Force and my Assistant Secretary for 

Policy and Planning, and I met with servicemembers and their families to solicit 

their input for this Task Force. 

The Task Force utilized a ‘‘gap analysis’’ approach to determine the manner and 

extent to which services and benefits are provided to servicemembers and veterans. 

This approach defined what currently exists, identified what is needed or desirable, 

and determined the process to achieve the identified needs. It inventoried Federal 

services and benefits available to servicemembers and veterans. Work groups assessed and analyzed emerging themes related to the current delivery of services and 

benefits. The Task Force then developed recommendations that could be implemented within agency authority and existing resources. 

The Task Force’s 25 recommendations involve collaborative efforts among several 

federal entities to improve the timeliness, ease of application, and delivery of services and benefits to those who earned them. The Task Force focused on Healthcare, 

Benefits, Jobs, Education, Housing and outreach to servicemembers and their families about available benefits and services. The Task Force also addressed information technology such as enhancing VA’s Computerized Patient Record System, improving VA access to electronic medical records of servicemembers treated in VA 

healthcare facilities, and the improvement of the electronic enrollment process. 

I would like to highlight some of the recommendations in this report which improve services to veterans. 

One of the reports’ recommendations pertains to evaluating an injured servicemember’s disabilities. As part of this effort, DoD and VA will develop a joint process 

for disability benefit determinations by establishing a cooperative Medical and Physical Evaluation Board process within the military service branches and VA. Meetings have already occurred to begin this process. 

Another recommendation will develop a system of co-management and case management to ensure continuity of care, benefits, and services to injured military personnel and disabled veterans. Currently there is no formal policy that outlines the 

procedures to be used by VA and DoD when their case managers co-manage the care 

of a patient. 

In order to bridge the informational gap around the programs available, the Department of Education staff will participate in selected Department of Labor sponsored job fairs conducted for servicemembers and provide quarterly information for 

inclusion in VA’s GWOT newsletter. Another cross-cutting recommendation is the 

‘‘Hire Vets First’’ campaign. For this, the Department of Education will coordinate 


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with other Federal partners to integrate a campaign with existing job/career fairs 

to promote awareness of the campaign to employers and servicemembers seeking 

employment. 

The Department of Labor (DoL), along with DoD, has been tasked to improve job 

qualification, certification, and credentialing opportunities for transitioning servicemembers by working with certifying entities to develop credentials for military 

training and experience. 

The Small Business Administration will work with DoD, DoL, VA and all federal 

agencies with procurement authority to implement the PatriotExpress Loan Initiative in order to better meet the needs of veterans, service-disabled veterans, activated Reserve Component members, discharging servicemembers, spouses, survivors, and dependents of servicemembers who died in service, or of a service connected disability. 

Another example of this Task Force’s work is the recommendation to better educate transitioning servicemembers on the benefits available to them with regard to 

financial aid. For this, a financial aid information module will be developed for the 

Transition Assistance Program and Disabled Transition Assistance Program (TAP/ 

DTAP). This module can be integrated into any presentations currently provided. 

The report was submitted to the President on April 19, 2007 and Admiral Dunne 

and I briefed him on the Task Force and its recommendations. The President welcomed the Task Force’s recommendations and directed me to begin implementation 

and report back to him in 45 days on their progress. The action plan contained in 

the report specifies required steps for each recommendation and a timeline for those 

actions which we are tracking closely. In addition, there were Congressional Committees and VSO briefings on the final report. 

Although the report has been completed, the Task Forces’ work is not done; only 

when the gaps noted in the report are successfully closed will we have fulfilled the 

President’s charge as outlined in the Executive Order. I take personal responsibility 

in assuring Congress, veterans and servicemembers that this report will be accompanied by definitive and measured actions to achieve its goals. 

Toward that end, the President asked me to communicate directly with the Commission on Care for America’s Returning Wounded Warriors led by former Senator 

Dole and former Secretary Shalala to ensure both groups exchange ideas, advance 

reform efforts, and, to the extent possible, provide assistance to their report so they 

can build upon the work of the Task Force. I have spoken to both Senator Dole and 

Secretary Shalala about our efforts and my staff has continued contact with the 

Commission as they proceed with their work. 

There is much work to be done but we can and must work together to ensure that 

our returning heroes receive the best healthcare and the full range of benefits and 

services they deserve. 

In addition to the recommendations identified by Interagency Task Force, VA is 

focusing on other areas in which we can improve services to veterans independent 

of this report such as information technology and data security. The VA leads the 

world in the use of electronic medical records. Every one of our nearly 8 million enrolled patients has an electronic medical record allowing a veteran to access his or 

her records anywhere in this vast system. Additionally, while Katrina required us 

to evacuate thousands of people, we didn’t lose a patient or a medical record. The 

same cannot be said of the civilian sector. 

Secondly, we have a high rate of diabetes among veterans that we are treating. 

Nearly a quarter of the veterans we treat have been diagnosed with diabetes. In 

response, we have initiated educational programs, in collaboration with HHS, to ensure that individuals understand the causes of Type II diabetes and what they can 

do to control the disease, including weight control. 

Thirdly, in response to a U.S.-wide rise in methicillin resistant staph infections, 

we have begun an initiative in our Pittsburgh facility, which has cut staph infections by 70 percent. This program, which focuses on disciplined sanitation measures, 

will be enacted throughout our entire system. 

I should note that over the years, a number of commissions, advisory panels and 

government study groups have looked at similar issues and provided recommendations. In addition, numerous Government Accountability Office reviews have encouraged the Departments to pursue cost-effective resource sharing. Many of the recommendations of those studies and reports have been adopted in whole or in part. 

I would like to take a moment to highlight some of these successes. 

For example, past recommendations have suggested changes and improvements in 

our Education, VocRehab and Outreach efforts. In its 1999 report, the Congressional 

Commission on Servicemembers and Veterans Transition Assistance, noted the evolution of the delivery of higher education—along with the increasing price tag— 

since the inception of the Montgomery GI Bill. In partnership with Congress and 


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the Administration, the VA worked to implement the recommendations needed for 

a modern and enhanced benefits package for those completing honorable service. 

For example, VA worked with Congress to broaden the range of Montgomery GI Bill 

options to include entrepreneurial courses, licensing courses, and high technology 

certification courses. Benefits for tuition have been increased, including those for 

high-cost technology courses. An automated enrollment system has been fully operational since July 2001. That commission also pointed out the need for VA to improve the Vocational Rehabilitation and Employment (VR&E) Service and there now 

is a long-range strategy to emphasize employment outcomes. As for outreach, VA 

is expanding its outreach to National Guard and Reserve troops with a Post Deployment Health Reassessment and Readjustment Counseling at our Vet Centers with 

the hiring of an additional 100 OIF/OEF combat veterans as peer counselors. 

Past commissions have made healthcare recommendations as well, a number of 

which we have implemented. One notable example is the 1991 Commission on the 

Future Structure of Veterans Healthcare’s recommendation that VA continue to lead 

in specialized areas which will lead to VA’s advancements in TBI and polytrauma 

care. 

And of course, we have initiated and responded to calls for action to enhance 

healthcare resource sharing. As you may be aware, VA and DoD created mechanisms to enhance healthcare resource sharing by forming the Joint Executive Council (JEC) in February 2002. The JEC mission seeks to enhance collaboration; ensure 

the efficient use of federal services and resources; remove barriers and address challenges that impede collaborative efforts; improve business practices; enhance sharing arrangements that ensure high-quality, cost-effective services for both VA and 

DoD beneficiaries; and develop a joint strategic planning process to guide the direction of joint sharing activities. 

On behalf of the Task Force agencies, I can pledge to you that we are all committed to this effort. 

Mr. Chairman, this concludes my remarks. I would be happy to answer any questions you may have. 

f 

Statement of the Honorable Jeff Miller, 

a Representative in Congress from the State of Florida 

Thank you, Mr. Chairman. 

I appreciate your holding this hearing to review the 25 recommendations made 

by the President’s Task Force on Returning Global War on Terror Heroes. 

We, as a grateful nation, depend on the members of our Armed Forces to defend 

our freedom. Similarly, these brave men and women and their families rely too on 

their government to deliver the benefits and services they have earned in an effective and forthright manner. 

I want to commend the President for his leadership in establishing this Task 

Force. I also want to thank Secretary Nicholson and the members of the Task Force 

for their swift and decisive action in undertaking this critical review of how we are 

providing services to our returning Global War on Terror (GWOT) servicemembers. 

As a Member of both the Committee on Armed Services and the Committee on 

Veterans’ Affairs, we have been examining a number of the issues put forth by the 

recommendations of the Task Force for several years. As Ranking Member of this 

Committee’s Subcommittee on Health, I am particularly interested in the 11 recommendations geared toward the provision of health services to those who serve 

and have served in the GWOT. 

In March, the Health Subcommittee held a hearing to review how the needs of 

the veterans suffering TBI are being met. Our review found that there are significant barriers between the care provided between the Department of Veterans Affairs (VA) and the Department of Defense (DoD). In response, I joined as an original 

cosponsor of H.R. 1944, the Veterans Traumatic Brain Injury Treatment Act of 

2007. The bill, among other provisions, would require the screening of all veterans 

for TBI, establish a comprehensive program of long-term care for post-acute TBI in 

four geographic regions, and create TBI transition offices. It is encouraging to note 

that several of the Task Force recommendations support the requirements in this 

legislation. 

The Task Force also recommended that VA and DoD, in coordination with HHS 

expand collaboration and work with Community Health Centers to improve health 

services provided to Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) servicemembers who live in rural areas, with about 41 percent of our 

returning OEF/OIF veterans hailing from rural settings. 


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The target date provided by the Task Force for establishing a working group between VA, DoD, and the Department of Health and Human Services (HHS) was 

April 30, 2007. This recommendation included that VA, DoD, and HHS would formalize an agreement to determine the needs of OIF/OEF returnees to interact with 

the CHCs and other HHS supported providers. While I understand that this initiative was tasked to HHS, I hope VA and DoD are tracking these recommendations 

and encouraging timely action. 

VA and DoD are to develop a standard system of co-management and case management. VA and DoD were to have a draft Memorandum of Agreement and complete a charter to standardize processes between the two agencies in regards to case 

management by April 30, 2007. 

Additionally, the Task Force recommended that DoD improve VA access to health 

records of servicemembers treated in VA facilities. VA and DoD have had the authority to share since 1982, with the enactment of Public Law 97–174, the VA/DoD 

Health Resources Sharing and Emergency Operations Act. In 2003, Public Law 108– 

136 created the Joint Executive Committee, an interagency Committee to enhance 

the sharing between the two Departments. While some progress has been made, I 

am still disturbed by the sufficient lack of progress that remains. 

Both DoD and VA should take notice that we will no longer accept business as 

usual. Missed deadlines are simply unacceptable. We expect both Departments to 

own up to the problems and take immediate action to implement the recommendations of the Task Force. I intend, as I am sure everyone will agree, to continue monitoring both the actions of VA and DoD to ensure that no servicemember ‘‘slips 

through a crack.’’ 


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ccoleman on PRODPC74 with HEARINGInsert 35641A.033
70 


ccoleman on PRODPC74 with HEARINGInsert 35641A.034
71 


ccoleman on PRODPC74 with HEARINGInsert 35641A.035
72 


ccoleman on PRODPC74 with HEARINGInsert 35641A.036
73 


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ccoleman on PRODPC74 with HEARINGInsert 35641A.038
75 


ccoleman on PRODPC74 with HEARINGInsert 35641A.039
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ccoleman on PRODPC74 with HEARINGInsert 35641A.040
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ccoleman on PRODPC74 with HEARINGInsert 35641A.041
78 


ccoleman on PRODPC74 with HEARINGInsert 35641A.042
79 


ccoleman on PRODPC74 with HEARINGInsert 35641A.043
80 


ccoleman on PRODPC74 with HEARINGInsert 35641A.044
81 


ccoleman on PRODPC74 with HEARINGInsert 35641A.045
82 


ccoleman on PRODPC74 with HEARINGInsert 35641A.046
83 


ccoleman on PRODPC74 with HEARINGInsert 35641A.047
84 


ccoleman on PRODPC74 with HEARINGInsert 35641A.048
85 


ccoleman on PRODPC74 with HEARINGInsert 35641A.049
86 


ccoleman on PRODPC74 with HEARINGInsert 35641A.050
87 


ccoleman on PRODPC74 with HEARINGInsert 35641A.051
88 


ccoleman on PRODPC74 with HEARINGInsert 35641A.052
89 


ccoleman on PRODPC74 with HEARINGInsert 35641A.053
90 


ccoleman on PRODPC74 with HEARINGInsert 35641A.054
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ccoleman on PRODPC74 with HEARINGInsert 35641A.055
92 


ccoleman on PRODPC74 with HEARINGInsert 35641A.056
93 


ccoleman on PRODPC74 with HEARINGInsert 35641A.057
94 


ccoleman on PRODPC74 with HEARINGInsert 35641A.058
95 


ccoleman on PRODPC74 with HEARINGInsert 35641A.059
96 


ccoleman on PRODPC74 with HEARINGInsert 35641A.060
97 


ccoleman on PRODPC74 with HEARINGInsert 35641A.061
98 


ccoleman on PRODPC74 with HEARINGInsert 35641A.062
99 


ccoleman on PRODPC74 with HEARINGInsert 35641A.063
100 


ccoleman on PRODPC74 with HEARINGInsert 35641A.064
101 


ccoleman on PRODPC74 with HEARINGInsert 35641A.065
102 


ccoleman on PRODPC74 with HEARINGInsert 35641A.066
103 


ccoleman on PRODPC74 with HEARINGInsert 35641A.067
104 


ccoleman on PRODPC74 with HEARINGInsert 35641A.068
105 


ccoleman on PRODPC74 with HEARINGInsert 35641A.069
106 


ccoleman on PRODPC74 with HEARINGInsert 35641A.070
107 


ccoleman on PRODPC74 with HEARINGInsert 35641A.071
108 


ccoleman on PRODPC74 with HEARINGInsert 35641A.072
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ccoleman on PRODPC74 with HEARINGInsert 35641A.073
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ccoleman on PRODPC74 with HEARINGInsert 35641A.075
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114 


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ccoleman on PRODPC74 with HEARINGInsert 35641A.080
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ccoleman on PRODPC74 with HEARINGInsert 35641A.082
118 


ccoleman on PRODPC74 with HEARINGInsert 35641A.083
119 


ccoleman on PRODPC74 with HEARINGInsert 35641A.084
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ccoleman on PRODPC74 with HEARINGInsert 35641A.085
121 


ccoleman on PRODPC74 with HEARINGInsert 35641A.086
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ccoleman on PRODPC74 with HEARINGInsert 35641A.088
124 


ccoleman on PRODPC74 with HEARINGInsert 35641A.089
125 


ccoleman on PRODPC74 with HEARINGInsert 35641A.090
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128 


ccoleman on PRODPC74 with HEARINGInsert 35641A.093
129 


ccoleman on PRODPC74 with HEARINGInsert 35641A.094
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ccoleman on PRODPC74 with HEARINGInsert 35641A.095
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133 


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ccoleman on PRODPC74 with HEARINGInsert 35641A.106
142 


ccoleman on PRODPC74 with HEARINGInsert 35641A.107
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ccoleman on PRODPC74 with HEARINGInsert 35641A.108
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ccoleman on PRODPC74 with HEARINGInsert 35641A.109
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ccoleman on PRODPC74 with HEARINGInsert 35641A.110
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ccoleman on PRODPC74 with HEARINGInsert 35641A.111
147 


ccoleman on PRODPC74 with HEARINGInsert 35641A.112
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ccoleman on PRODPC74 with HEARINGInsert 35641A.113
149 


ccoleman on PRODPC74 with HEARINGInsert 35641A.114
150 


ccoleman on PRODPC74 with HEARINGInsert 35641A.115
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ccoleman on PRODPC74 with HEARINGInsert 35641A.116
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ccoleman on PRODPC74 with HEARINGInsert 35641A.118
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ccoleman on PRODPC74 with HEARINGInsert 35641A.119
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ccoleman on PRODPC74 with HEARINGInsert 35641A.120
155 


ccoleman on PRODPC74 with HEARINGInsert 35641A.121
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ccoleman on PRODPC74 with HEARINGInsert 35641A.122
157 


ccoleman on PRODPC74 with HEARINGInsert 35641A.123
158 


ccoleman on PRODPC74 with HEARINGInsert 35641A.124
159 

Æ 


ccoleman on PRODPC74 with HEARINGInsert 35641A.125