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41–376 2008

CARE OF SERIOUSLY WOUNDED 

AFTER INPATIENT CARE 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

MARCH 13, 2008 

Serial No. 110–76 

Printed for the use of the Committee on Veterans’ Affairs 

( 


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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 

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 

VACANT 

MALCOM A. SHORTER, Staff Director 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

HARRY E. MITCHELL, Arizona, Chairman 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

CIRO D. RODRIGUEZ, Texas 

GINNY BROWN-WAITE, Florida, Ranking 

CLIFF STEARNS, Florida 

BRIAN P. BILBRAY, California 

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 

March 13, 2008 

Page 

Care of Seriously Wounded After Inpatient Care ................................................. 1 

OPENING STATEMENTS 

Chairman Harry E. Mitchell ................................................................................... 1 

Prepared statement of Chairman Mitchell ..................................................... 49 

Hon. Ginny Brown-Waite, Ranking Republican Member ..................................... 2 

Hon. Cliff Stearns .................................................................................................... 3 

Hon. Nick Lampson ................................................................................................. 5 

Prepared statement of Congressman Lampson ............................................. 50 

WITNESSES 

U.S. Department of Veterans Affairs, Mahdulika Agarwal, M.D., MPH, Chief 

Officer, Patient Care Services, Veterans Health Administration .................... 40 

Prepared statement of Dr. Agarwal ................................................................ 57 

Iraq and Afghanistan Veterans of America, Todd Bowers, Director of Government Affairs .......................................................................................................... 33 

Prepared statement of Mr. Bowers ................................................................. 55 

Owens, Corporal Casey A., USMC (Ret.), Houston, TX ....................................... 6 

Prepared statement of Corporal Owens .......................................................... 51 

Wade, Sarah, Chapel Hill, NC, on behalf of Sergeant Edward Wade, USA 

(Ret.) ...................................................................................................................... 9 

Prepared statement of Ms. Wade .................................................................... 52 

Wounded Warrior Project, Meredith Beck, National Policy Director .................. 30 

Prepared statement of Ms. Beck ..................................................................... 54 

MATERIAL SUBMITTED FOR THE RECORD 

Memorandum entitled, ‘‘Acceptance Requirements for VA Volunteers’’ from 

the William F. Feeley, MSW, FACHE, Deputy Under Secretary for Operations and Management (10N), dated February 22, 2007 ................................ 63 

Post Hearing Questions and Responses for the Record: 

Hon. Harry E. Mitchell, Chairman, and Hon. Ginny Brown-Waite, Ranking 

Republican Member, Subcommittee on Oversight and Investigations, 

Committee on Veterans’ Affairs, to Hon. James B. Peake, Secretary, U.S. 

Department of Veterans Affairs, letter dated April 17, 2008, and VA responses .................................................................................................................. 65 


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CARE OF SERIOUSLY WOUNDED 

AFTER INPATIENT CARE 

THURSDAY, MARCH 13, 2008 

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

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:00 a.m., in 

Room 340, Cannon House Office Building, Hon. Harry E. Mitchell 

[Chairman of the Subcommittee] presiding. 

Present: Representatives Mitchell, Space, Walz, Brown-Waite, 

Stearns, Bilbray. 

OPENING STATEMENT OF CHAIRMAN MITCHELL 

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

This is the Subcommittee on Oversight and Investigations and the 

hearing today is on the care of seriously wounded after inpatient 

care. 

We are here today to hear from veterans, their families, and the 

U.S. Department of Veterans Affairs (VA) about the long-term care 

of our most severely wounded Afghanistan and Iraqi veterans. 

We do know that the U.S. Department of Defense (DoD) and VA 

provide excellent inpatient healthcare for these warriors, but many 

of the most seriously injured require extensive outpatient care, 

some for the rest of their life. Their families need care and assistance as well. 

Unfortunately, once these veterans leave the hospital, the care 

they receive does not seem to be on par with what they receive directly following their injury. And I think we can do better. 

Planning for veterans health care was not planned very well at 

the outset of this war. The need to provide care and assistance to 

wounded servicemembers and their families in significant number 

and for the long term has been largely ignored. 

We will hear today what it has been like for some of them. Their 

stories are inspiring, but also discouraging. They are inspiring because even after they suffered terrible injuries, they carry no bitterness, only pride from their service, discouraging because they 

have been left to fend for themselves for too long. 

The DoD and the VA are large organizations with an overwhelming bureaucracy. Their care and services often overlap in 

messy, unpredictable ways. At a time of enormous stress, this bureaucracy only hurts the injured warrior and his family. 


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When our troops return from theater with serious injuries, they 

are met with a dozen seemingly unrelated people with different 

services. We addressed much of these problems last year with the 

passage of the Wounded Warrior provisions in the Defense bill, but 

there is obviously still more to be done. 

We need to realize that families are an integral part of treatment 

and recovery and have their own needs. Unfortunately, the VA is 

restricted from providing the many services families need and deserve when their sons and daughters, siblings, and parents return 

with service-connected injuries. 

We have been playing catch-up since the beginning of this war. 

It is irresponsible that the only support structure available to a 19- 

year-old wife of an injured soldier is the wife of a similarly injured 

soldier. We are going to hear from people that have been dealing 

with the difficulties of the system for a long time. 

On February 14, 2004, Sergeant Ted Wade lost his right arm and 

suffered severe traumatic brain injury (TBI), along with many 

other injuries in an improvised explosive device (IED) explosion in 

Iraq. Sergeant Wade is here today with his wife, Sarah. 

Marine Corporal Casey Owens of Houston, Texas, lost both his 

legs when his unarmored Humvee struck a landmine in Iraq on 

September 20, 2004. 

Corporal Owens and Ms. Wade will tell us about the frustrations 

and difficulties they have faced and we look forward to their testimony. 

Sarah and Ted Wade have devoted themselves to helping hundreds of other injured servicemembers and their families. 

Just 2 weeks after he was injured, Casey Owens told his family 

that he wanted a camcorder so he could document his progress 

from start to finish. He could only communicate by writing at the 

time of his request. He wanted to show his future children how far 

he had come and how good he had it. Today you can find Casey 

gliding down the slopes at Aspen. 

We owe Corporal Owens and Sergeant Wade a great debt. We 

cannot repay that debt, but we can make sure that Corporal Owens 

and Sergeant Wade, their families, and everyone like them get 

long-term care and services that are also world class. 

[The prepared statement of Chairman Mitchell appears on p. 49.] 

Mr. MITCHELL. Before I recognize Ranking Republican Member 

for her remarks, I would like to swear in our witnesses. And I 

would ask all witnesses if they would please stand, and raise their 

right hand. 

[Witnesses sworn.] 

Mr. MITCHELL. Thank you. 

Next I would like to ask unanimous consent that Mr. Lampson 

be invited to sit at the dais for the Subcommittee hearing today. 

Hearing no objection, so ordered. 

Mr. Lampson, please join us at the dais. 

I would now like to recognize Ms. Brown-Waite for opening remarks. 

[Microphone technical difficulties.] 


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OPENING STATEMENT OF HON. GINNY BROWN–WAITE 

Ms. BROWN-WAITE. Let us hope this works a little bit better. I 

am sorry. 

Good morning. Mr. Chairman, I thank you for holding this hearing and also for yielding. I am going to keep my comments short 

because I am looking forward to hearing from our witnesses on how 

we can make the system better. 

Over the past several years, this Committee has watched over 

the development of the Polytrauma Rehabilitation Care (PRC) 

units throughout the VA system. It has seen good work including 

one in my own neighborhood in Tampa, Florida. 

We are happy that we are doing better on inpatient care for our 

severely wounded servicemembers. What we have observed during 

our oversight visits is a dedicated staff and resources that are necessary to make sure that the care given to our veterans is second 

to none. 

However, this Subcommittee is concentrating its focus on what 

happens after the servicemember or veteran is discharged from the 

VA. How are these severely injured veterans and their families actually integrating back into their communities and back with their 

families? What kind of post hospitalization care and support services are they receiving? What avenues do they find opened or closed 

to them? Basically, what are the challenges that the veterans are 

facing? 

We are all looking forward to hearing from our first panel as to 

what they have encountered since their discharges. Hearing their 

stories is not only important to the Committee but also to the VA 

as they develop their Federal Care Coordinator Program to reach 

out to our severely injured veterans and assist them whenever and 

however they need it. 

Those who are serving on the front lines of battle do not consider 

where their actions will take them in the future. Our Nation’s heroes have sacrificed their time, energy, and often physical health 

to secure freedom and democracy throughout the world. 

And I think every American believes that they deserve the best 

possible care that we can give. Our obligation to care for severely 

injured servicemembers does not end when they leave the PRC but 

continues long after the discharge care process. 

Again, Mr. Chairman, thank you for holding this hearing and I 

yield back my time. And I apologize for the problematic microphone 

here and it is not my Blackberry because I handed it over. 

Mr. MITCHELL. Thank you. 

Congressman Walz. 

Mr. WALZ. I will reserve my time. 

Mr. MITCHELL. Congressman Stearns. 

OPENING STATEMENT OF HON. CLIFF STEARNS 

Mr. STEARNS. Yeah. Let us see if this works. Thank you, Mr. 

Chairman, for holding this hearing. 

Obviously today we are addressing a very critical issue facing our 

heroic wounded warriors and their families and, of course, their 

transition back into civilian life. 

A recent article in which former U.S. Department of Health and 

Human Services (HHS) Secretary Shalala commented, she indiVerDate Aug 31 2005 01:43 Dec 23, 2008 Jkt 041376 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 E:\HR\OC\A376.XXX A376

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cated if we are asking people to risk their lives and their future, 

then we ought to be willing to make this investment. And that is 

what we are trying to do here. 

Families are the most important factor in the successful transition back to civilian life for our warriors. Obviously they deserve 

all the support we can provide for them. 

I am very glad that on our first panel of witnesses, we will hear 

the personal testimonies from two individuals who have experienced these issues firsthand, Corporal Casey Owens, and Ms. 

Sarah Wade will be speaking on behalf of herself and on behalf of 

her heroic husband, Sergeant Edward Wade. 

And I want to thank both of them for traveling the distance to 

come here and take the time to testify before us. 

My colleagues, since 2003, I have been pleased at some of the initiatives that the VA has established to serve wounded warriors and 

their families. 

In June of 2005, the VA issued a directive expanding the scope 

of care it would provide to include psychological treatment for family members. This is very important. In addition, the VA has expanded their team of caseworkers, but we do need more. 

Intensive clinical and social work case management services 

have been created for the four regional traumatic brain injury rehabilitation centers now named the polytrauma rehabilitation centers. VA also established joint programs with the Department of 

Defense to ease the transfer of injured servicemembers to the VA 

medical facilities. 

In August of 2003, VA and DoD established a program assigning 

VA social workers to select military treatment facilities to coordinate patient transfers between DoD and the VA medical facilities. 

The social workers make appointments for care, ensure continuity 

of therapy and medications, and followup with the patients after 

their discharge. 

But I am concerned, first of all, that caseworkers seem to have 

too large a caseload which may inhibit the amount of time and 

focus they are able to spend with each and every family. Particularly when servicemembers are discharged from the VA polytrauma 

rehabilitation centers, most, if not all, still require followup care at 

the VA, at DoD, or private-sector facilities. 

I want to know if this transition system functions smoothly, 

whether the patient is going back to the military or is the patient 

going back to the private sector. 

In addition, most of the most severely wounded patients require 

long-term care and will become veterans eligible for VA care when 

discharged from active duty. 

So I look forward to this hearing, Mr. Chairman. 

I have had the opportunity, as I am sure many members have, 

to participate in the VA winter sports clinic out at Snow Mass, Colorado, and seeing the enormous energy disabled veterans put into 

that skiing clinic and to see how successful they are and it is inspiration for all of us. And so I welcome our witnesses today and I 

look forward to their testimony, Mr. Chairman. 

Mr. MITCHELL. Thank you. 

Mr. Space. 

[No response.] 


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Mr. MITCHELL. Thank you. 

I ask unanimous consent that all Members have five legislative 

days to submit a statement for the record. Hearing no objection, so 

ordered. 

At this time, I would like to recognize Congressman Nick 

Lampson of Texas who is here to introduce his constituent, Corporal Casey Owens. 

Congressman Lampson. 

OPENING STATEMENT OF HON. NICK LAMPSON 

Mr. LAMPSON. Thank you, Mr. Chairman. Hopefully this one 

works. 

I want to thank Chairman Mitchell and Ranking Member BrownWaite and Members for allowing me to come and sit in on this 

hearing with you today. I am honored to join you on this distinguished Subcommittee and very proud to introduce Corporal Casey 

Owens of Missouri City, Texas. 

Casey is an extremely exemplary young man and I commend him 

for his willingness to continue to serve his country and his fellow 

veterans. We are proud of his service to this Nation in many, many 

ways. 

I was impressed when we met yesterday for the first time by all 

of his accomplishments. A graduate of May Creek High School, he 

went to the University of Texas. But following the attacks on September 11, he decided to join the Marines. 

He was deployed twice, the first time from February 2003 to October of 2003 and the second time from August of 2004 until September 20, 2004, when he sustained his injuries. During this time 

in the Marine Corps, he received several medals in recognition of 

his distinguished service. 

Less than a year after sustaining his injuries, Casey successfully 

completed the Marine Corps marathon in 2005 using a handcranked wheelchair with a time of approximately 21⁄2 hours, probably better than any of us here could do. I know better than I could 

do. 

He is currently training as a member of the competitive ski team 

in Colorado that has been recognized by the Paralympics and the 

VA as an official training center. 

Even more impressive than the three accomplishments, than all 

of these accomplishments in my opinion, is Casey’s advocacy for 

veterans’ care. He has worked with Mayor Bill White, Houston 

Mayor Bill White’s Veterans Task Force which was established last 

year to address the needs of Houston’s veterans, both young and 

old, when it comes to housing, health and mental care, job training, 

and other issues. 

And he has come here today to testify before Congress about the 

challenges new veterans in this country continue to face as they 

transition from DoD to the VA system and try to navigate it. 

The most impressive, though, is the concern for his fellow veterans and those that will come after him. He is here today to ensure that our Nation’s future wounded warriors will not go through 

the same frustrations and feelings of neglect that he and his 

friends have experienced at the DoD and the VA and have struggled to adapt to a new breed of patients as they have struggled to 


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adapt. So they deserve much more in return for their service. And 

I commend Casey for his advocacy on their behalf. 

And, again, I thank the Subcommittee for allowing me to sit in 

and I yield back my time, Mr. Chairman. 

[The prepared statement of Congressman Lampson appears on 

p. 50.] 

Mr. MITCHELL. Thank you. 

At this time, I would like to recognize our first panel, Corporal 

Owens, Ms. Wade, and Sergeant Wade. 

And I just want to say that last evening, I met with all three in 

my office and we had a great visit. And I hope that you convey in 

a very matter-of-fact way what you told me yesterday because I 

think it is a very compelling story and everyone should hear it. 

So thank you very much. And we will start with Corporal Owens. 

STATEMENTS OF CORPORAL CASEY A. OWENS, USMC (RET.), 

HOUSTON, TX (U.S. MARINE CORPS COMBAT VETERAN); AND 

SARAH WADE, CHAPEL HILL, NC, ON BEHALF OF SERGEANT 

EDWARD WADE, USA (RET.) (U.S. ARMY COMBAT VETERAN) 

STATEMENT OF CORPORAL CASEY A. OWENS, USMC (RET.) 

Corporal OWENS. Good morning. Thank you, Chairman Mitchell 

and Members of the Subcommittee, for coming. 

I was injured September 20, 2004. I was serving with the 1st Battalion, 7th Regiment Weapons Company. I was in Al Anbar Province out west on the Syrian border. We were on a reconnaissance 

mission, dropped off a reconnaissance team. Minutes later, we got 

a call to pick them back up for a medivac mission. A Sergeant from 

reconnaissance had been shot in the throat who later succumbed 

to his injuries. 

On the way back to base, we were engaged again and ran over 

two anti-tank mines, which resulted in the loss of both my legs. I 

was flown to a field hospital in Iraq, stabilized, treated there, and 

to Landstuhl, Germany. I was there for 3 to 4 days and then flown 

to the Bethesda, Maryland Naval Hospital. 

I woke up about a month later from a coma to find my legs were 

missing. I had suffered two collapsed lungs, a pulmonary embolism, 

serious head trauma, broken my clavicle and my jaw, which now 

has a metal plate, and my teeth were knocked out, several shrapnel wounds to my neck and torso. 

From there, I had several surgeries over the next 2 to 3 months 

to stabilize me and was transferred to Walter Reed to join the amputee program there and to walk again. 

Over this time, I was a patient at Walter Reed and Brooke Army 

Medical Center and was discharged and retired February 26 of 

2006. And I did not have my right leg completed yet. I was still 

experiencing problems. 

Upon retiring in February, I needed another surgery, about 

March, early April. My right leg, which is my myodesis, which is 

kind of the muscle flap that goes over the end of your femur, kind 

of gives you a padding, it had previously, once about a year earlier, 

had torn completely off my femur and I had my leg amputated 

again about an inch, and my sciatic nerve cut. They reattached it. 

It looked good. 


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Over the next year, I still had more surgeries. I had problems 

with heterotrophic ossification, which is a bone growth which kind 

of held me back with my prosthetic care, my prosthetic progress. 

So when I was retired, I had a 60-day window that you are still 

under the Department of Defense care. So I was able to return to 

Brooke Army Medical Center to have it repaired. That is where it 

had been done the first time. I went back there. They repaired it. 

Within a month, it had failed again for the third time. And when 

I say third time, the myodesis was performed on the initial injury. 

Failed the first time, second time, now third, so this would be the 

fourth time to fix it. 

I was now enrolled in the VA as of April 1, 2006. I went to the 

VA, said, you know, I think it is failing again. I know it is failing 

again. I can feel the bone coming through the muscle this time and 

you could see it. 

They instructed me to work with prosthetics, and that is use 

their standard procedure is prosthetics, you know, adjusting your 

prosthetics before, you know, surgery. I told them that, you know, 

this is the third time. I have been down this road. I know what I 

need. 

They did not agree with me. The first day, they did not agree 

with me. I said, I will be back in about 4 to 5 weeks. The condition 

is going to be worse. Sure enough, about 5 weeks later, over the 

weekend, the muscle started retracting, pulling back, leg, you 

know, was very painful. 

It was the weekend, so my choices were to go to the emergency 

room, which I knew would be come back Monday, see an orthopedic 

doctor. So I drove to Brooke Army Medical Center about 3 hours 

away, found one of my orthopedic surgeons that had performed the 

surgery the first two times. He looked at it right away and said, 

yes, failed myodesis. And I said, well, what are you going to do and 

what procedure. And he said, we will do what is called a Goshock 

procedure named after the doctor who invented it. 

He said, well, this has failed four times now or failed three 

times. This will be the fourth time to do the procedure. I said, you 

know, I do not have any more of my leg to give, so he pretty much 

said, well, that is what we can do. 

So I went home disappointed. I spoke to a prosthetist who told 

me about a new procedure, the Ertle procedure. Because he was 

prosthetics, he said, you know, this advice did not come from me 

and because in the past, he had been reprimanded for giving advice 

from an orthopedic because for some reason, that is not his field, 

even though prosthetics, orthopedics go hand in hand. 

So I found it. On the Internet, I found Dr. Ertle. I went to my 

doctors at the VA and said I would like to get this Ertle procedure 

done. They did not agree with me. 

So over the next 6 months, I debated with the VA until I finally 

got my surgery done, which the previous two times had taken me 

less than 72 hours to get it done. 

So during this time, I cannot move forward. I cannot go to work, 

school. I am in pain. I got back on my pain meds which I had already gotten off of. And also my insurance, my TRICARE insurance 

supposedly through a clerical error, was canceled. So that was another deal to deal with. 


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I did not have a social worker for the first 3 months, so I sought 

the advocacy of a friend with Marine for Life who kind of took over 

my case and Marine for Life, Wounded Warrior Project and other 

people who just stepped up to the plate and helped me out that 

were not even government agencies or people from the VA. 

I had the surgery done in Oklahoma. The doctor, well, he has VA 

benefits, so, you know, I was not really going outside the box. So, 

you know, I cannot understand what took so long for the approval. 

I never really got an answer other than sorry, we made a mistake. 

And I have had the surgery done. It has performed. It is doing 

well. But they had to amputate two more inches of my leg and cut 

another 3 inches of my sciatic nerve which now I suffer from chronic phantom pain. 

And I returned home. I went out to Aspen. I had to recover. I 

had several months before I could work with prosthetics, so I went 

out to Aspen. And I was invited out there to train for the 

Paralympics skiing, mono skiing. 

I returned home early summer. I went to the VA and said I am 

home. I am here to work solely on my prosthetics. This is my number one goal. I am not working. I am not in school. I had appointments about once a week, you know, for an hour which was not 

sufficient to me, so I said, you know, I need to get this done, you 

know. I am technically retired from the military, but, you know, I 

am ready to go back to school and move on, you know, with a job 

and career. And I cannot do it until I have this done because it is 

going to take several months of rehab. 

So they outsourced me because they said they had too many patients and not enough staff to meet my needs. So they outsourced 

me to a prosthetist in Houston, which there is only one prosthetist 

there. And he did not have a technician at the time either, which 

even slowed the process more. 

I spent the following summer, the next 8 months up until about 

December. And I had prior engagements with my race team starting early November and, you know, prior commitments to my sponsors for my racing. 

I put it off for 2 months until January, still trying to work on 

my prosthetics which finally resulted in him telling me I cannot fit 

you. You should look elsewhere. 

So I returned back to Colorado and finished my skiing. And next 

week I go to Oklahoma to a company, some specialists that other 

guys I know go to. But I am going there on the bill of the Wounded 

Warrior Project because it is too much of a hassle to deal with the 

VA and which it should be their responsibility. They are the ones 

who have failed to fit me. 

But, like I say, at times, it gets, you know, it is not even worth 

dealing with the VA because it so much of a hassle and that is how 

it has been. 

You know, I suffer from post traumatic stress disorder (PTSD) 

and the VA and all the problems I have dealt with have, you know, 

furthered it even more. And in that 6 months that I dealt with, you 

know, wondering why no one is helping me, why the government 

is not stepping up to the plate, and it just feels like I was abandoned. 


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And, you know, I did my duty and those that are in place are 

not doing theirs. And it is a very frustrating feeling to go through. 

And for me, it has been a harder battle coming back to the States 

and dealing with everything I have dealt with than it was going 

to the war both times. That was a cake walk compared to this. 

And so here I am now and my struggles, I have gone through 

and done on my own or a lot of my own through the help of, you 

know, advocates, but I do not want others to go through it either. 

So here I am. 

[The prepared statement of Corporal Owens appears on p. 51.] 

Mr. MITCHELL. Thank you. Thank you very much. 

Sarah, are you or Ted going to talk? 

STATEMENTS OF SERGEANT EDWARD AND SARAH WADE 

Sergeant WADE. Chairman Mitchell, Members of the Subcommittee, thank you for the opportunity to speak to you today regarding our experiences following my injury in Iraq. 

My name is Edward Wade, or Ted, as I prefer to be called. And 

this my wife, Sarah Wade. 

Ms. WADE. Hello. I am not as brave as Casey. I am going to actually read my comments because I am worried I will get off course. 

Ted sustained a very severe traumatic brain injury or TBI and 

his right arm was completely severed above the elbow. He suffered 

a fractured leg, broken right foot, shrapnel injuries, visual impairment, complications due to acute anemia, hyperglycemia, infections, and was later diagnosed with post traumatic stress disorder. 

Ted remained in a coma for over 21⁄2 months and withdrawal of 

life support was considered. But thankfully he pulled through. 

As an above-elbow amputee with severe TBI, Ted was one of the 

first major explosive blast polytrauma cases from Operation Iraqi 

Freedom that Walter Reed or the Department of Veterans Affairs 

had to rehabilitate. 

Much of his treatment was by trial and error and there was no 

model system of care for a patient like Ted. And there still does 

not appear to be a long-term model today. 

His situation was an enormous challenge as Walter Reed was 

only able to rehabilitate an amputee, not a TBI. The VA was able 

to nominally treat a TBI but not an above-elbow amputee and neither were staffed to provide appropriate behavioral healthcare for 

a patient with a severe TBI. 

Because Ted could not access the necessary services where and 

when he needed them, he suffered a significant setback in 2005 

that put him in the hospital for 2 weeks and would later take him 

probably a year to rebound from. 

Ted has made a remarkable recovery, by any standards, because 

we strayed from standardized treatment and developed our own patient-centered path. I had to educate myself about and coordinate 

additional outside care. Often access to the necessary services required intervention from the highest levels of government or 

pressed to personally finance them ourselves. 

But despite our best efforts, Ted is still unable to easily receive 

comprehensive care for all of his major healthcare issues due to 

shortcomings in the current system. And because of the time his 


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needs demand of me, I have been unable to return to regular work 

or school. 

We have been blessed to have family with the means to see us 

through these difficult times and to help with the expenses. I was 

fortunate to have the education of growing up in Washington, DC, 

and learning about the workings of the various Federal agencies, 

but our situation is not typical. 

We do have a few ideas to provide better long-term care for people like Ted that we would respectfully like to share. 

The first one is about special monthly compensation, particularly 

for reasons of integration, quality of life, dependent’s educational 

assistance, and respite care. 

Individuals like Ted who required someone to be available for assistance at all times are not compensated appropriately. These veterans would require residential care otherwise, but are not granted 

the higher level of aid and attendance because they do not require 

daily healthcare services provided in the home by a person licensed 

to perform these services or someone under regular supervision of 

a licensed healthcare professional. 

I would be more than willing to be supervised if that is what it 

took. But we feel the criteria should be clearly outlined so appropriate compensation may be granted in the case of an individual 

whose needs of assistance are managing their care and personal affairs or they require support outside of the home to rehabilitate 

and integrate into their community or to achieve a better quality 

of life. 

Both in the past and at present, we have paid someone to assist 

Ted outside of the home. This allows him the flexibility to hire a 

peer of his choice to provide community support and accompany 

him on sightseeing outings he has researched and planned with his 

therapist as part of his community reintegration, to provide transportation to the store to purchase books for homework assignments, 

go to the community center to swim laps, or help him balance his 

checkbook at the end of a day. 

Not only has this enabled Ted to come closer to achieving independence, but it has greatly improved symptoms of depression by 

restoring hope and self-confidence, allowed him to attain fitness 

goals and control his blood sugar without insulin injections, all 

while providing much needed respite care for me. 

Unfortunately, the current VA respite programs are not appropriate for a veteran like Ted. My option for that is to put him in 

an extended care facility for 30 days a year or, as my husband 

says, I could kennel him and the dogs and go on vacation. And that 

is not really something that I am interested in doing. I would rather go on vacation with him, or I could also have someone come provide care in the home, but they cannot take him to the places he 

needs to go and do the things he needs to do. 

And with better resources, I might be able to access the dependent’s educational assistance for which I qualify, but under the circumstances, I cannot use. And I think one of my great concerns is 

that these benefits do expire and I am, you know, already probably 

4 years into the expiration time. 

I would like to see a change maybe in that, but also someone provide the assistance we need for me to go to school because not only 


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would it give me the education that I have available to me, but I 

think it would also help increase the standard of living for Ted by 

increasing my earning capacity. 

Another suggestion we have is about the Compensated Work 

Therapy Program in the VA system. Largely due to the success of 

the program we have created for Ted, the next phase of his recovery will probably include some sort of vocational rehabilitation. He 

has already had the opportunity to participate in volunteer work 

through counseling and job coaching provided by a private practice 

near our home where he attends a day treatment program for behavioral health and TBI. 

But now he is ready for the next stepping stone to employment. 

The current Department of Veterans Affairs’ vocational rehabilitation and employment service is more of a challenge than is healthy 

for someone like Ted, with significant cognitive deficits and significant emotional needs. 

VA work therapy programs, while developing work tolerances 

and promoting effective social skills for more seriously impaired patients, are set in insulated environments. A work therapy program 

expanded to other community settings to accommodate patients 

like Ted who are better served outside of a sheltered atmosphere 

would be more effective. 

Volunteer internship positions or later a part-time job that 

sparks his interest would be more therapeutic. Not only would this 

help him acquire the confidence and independence he needs to 

someday become gainfully employed, but it would also aid in his reintegration by providing constructive, meaningful activities for him 

to participate in outside of the home. 

I think my last comment will be about counseling and life skills 

for patients like Ted with TBI and really patient-specific case management. 

Although many basic therapies are offered, rarely do they include 

teaching socially appropriate behaviors which are commonly an 

issue after TBI. This task often falls on the veteran’s family member or spouse, increasing the responsibility of the caregiver, and 

causing conflict with the veteran who feels like they are being 

treated like a child. 

Ted has had the advantage of a community support peer, but 

also a counselor at the private practice I previously mentioned to 

help him redevelop age-appropriate social skills and allow me to be 

his spouse while maintaining his dignity. 

She has also worked with Ted to develop healthy coping skills, 

to manage cognitive deficits, improve mental health, and develop 

patient-centered treatment plans, which focus specifically on his 

unique challenges. 

Again, our situation is not typical, though. This is something difficult to provide in an institutional care environment like the Veterans Health Administration without greater flexibility and more 

resources to provide increased face time with the patients and better injury-specific expertise. 

The challenges we have faced are the same as countless other 

veterans, many of whom have not had the resources Ted has had 

available to him or an advocate capable of negotiating the system. 


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A veteran I often think about who had a young wife with a newborn baby and nothing more than a high school education should 

have received the same world-class care as my husband but sadly 

did not nor will not. Despite my best efforts to be a support to his 

spouse, who is overwhelmed by motherhood while trying to negotiate a seemingly impossible system, she eventually left him because it was more than she could handle. I think it is a lot to ask 

any mother to neglect their child. 

A veteran’s care should not depend on what family they were 

born into, who they married, or whether or not family obligations 

allow their loved one to advocate for them, but sadly it does. 

Though we will never be able to fully compensate seriously 

wounded veterans for the sacrifice they have made on our behalf, 

we can certainly do a better job of managing their care, rehabilitating them to the fullest potential in a timely manner, and providing the necessary resources to maximize their quality of life. 

I am very pleased to see that the Subcommittee is taking a look 

back to explore ways to learn from the past and address the needs 

of the veterans injured yesterday. I think this will make a tremendous change for the people who are being injured today. 

And I want to thank you all again for having us here and look 

forward to answering any questions. 

[The prepared statement of Ms. Wade appears on p. 52.] 

Mr. MITCHELL. Thank you very much. 

And let me just ask a question of all of you very quickly because 

we know that Congressman Walz has to leave. But yesterday in 

talking to all of you, you all have some individual needs. You are 

saying that the VA, in a way, has a number of things set up, but 

nothing to deal individually. 

And I would just like, Corporal Owens, for you to tell the story 

that you told us yesterday about when you went to the methadone 

clinic, when they sent you out there because they did not know 

what else to do with you or something like that. But would you tell 

that story? 

Corporal OWENS. During the time, I was, you know, that 6 

months, waiting for my surgery, got too much to deal with anymore, so I started taking my pain meds again, still suffering from 

phantom pains and just the muscle tearing and just grinding 

against the bone and whatnot. 

So I was back on them. I had my surgery done, so I was still recovering. About 2, 3 months later, went to the VA, went to my doctor, primary care doctor, said I think it is time I want to get off 

these, but they are very, very strong narcotic medications. So, you 

know, your blood pressure elevates, you know, your body goes 

through a lot, you know, lack of sleep, sweating, shakes. 

So I said I would just like to be monitored, you know, I am ready 

to get off it. He said okay. So gives me an appointment. So a couple 

days later, I go up to see a doctor, to the floor, to the substance 

abuse program. First, they say, well, what are you here for. I said 

I do not know. I said I just want to get off my meds. I thought I 

was coming to see a doctor to monitor me. 

So he says, no, you must have been flagged. Do you have a problem? I said no. I said call my doctor, put him on speaker phone. 

He calls him, asks my doctor. My doctor is saying, no, he does not 


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have a problem, I just do not have the time, you know, big patient 

load. He said he just wants to be monitored and, you know, helped 

and, you know, blood pressure medicine, whatnot. 

So he gets off the phone. The guy says, well, we want to put you 

in the methadone clinic where you will come in every 6 days and 

you will get 6 days worth of methadone. I said I do not want any 

more drugs. I want to get off of them. 

So I left there and, again, went to an outside nonprofit veteran 

group and they sent me to a doctor and to a detox center and I got 

off of them, have not been on them since. 

But, you know, it amazed me that just a simple week-long monitoring could have taken care of it, but instead just led to more 

problems, more frustration, and giving me more of an attitude to 

not deal with the VA which I really do not do. And most of all my 

care since I have gotten retired has been from outside doctors and 

outside sources. I rarely use the VA. 

Mr. MITCHELL. Thank you. 

I just wanted you to kind of finish that and then we will get into 

our regular questions. 

Mr. Walz. 

Mr. WALZ. I thank the Chairman. I thank the Ranking Member 

for her courtesy. 

I do have another appointment, but I can tell you with absolute 

certainty there is no place more important in this country right 

now than being right in this room. And I am humbled to hear your 

testimony. I am also ashamed that this would happen to our warriors. 

We have talked about it time and time again that dealing with 

our wounded warriors is a zero sum proposition, that if one is not 

treated with all the care and all the dignity and their issues are 

addressed with the utmost concern, then we have failed. And that 

has been obvious in these cases, especially with Corporal Owens. 

I am not even sure what to say. 

And to make matters worse even, coming to this hearing today, 

we just came from over in the Rotunda where we had an Iraq and 

Afghanistan war remembrance where a lot of people spoke and 

talked about a lot of nice things and you are sitting over here telling us this story. 

And I think Senator Dole summed it up best when he came in 

and testified. He said you spent billions putting them in harm’s 

way, do whatever is necessary to get them out of harm’s way. And 

obviously we failed you. 

And Sergeant Wade, Ms. Wade, you brought up some very good 

points. I just have a couple of quick questions on this. 

Corporal Owens, you talked about how your TRICARE was canceled. And what is so troubling to me about this whole thing is that 

you have come to expect that we are going to fail you. I mean, that 

is obvious that your experience has showed that we are going to 

fail you. That means we failed. Our job is to provide that oversight. 

It does not matter. 

Last year, we talked about how much we were able to do in the 

VA. It obviously did not help you and that is a concern, this Committee’s primary concern. 

So what happened with that, with TRICARE? 


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Corporal OWENS. Supposedly it was when I got my medical ID, 

it was supposed to be if you are discharged with a hundred percent 

from the military, you only get care at—this is how it was explained to me—that you can only get care at the VA. So they discharged me with 90 percent and the VA found me a hundred percent disabled. And that way, with TRICARE, I can go to outside 

the VA. 

And when I got my ID, they gave me a hundred, the military, 

or I do not know who it was, gave me a hundred percent and so 

it canceled it. But it took several, I do not know how long, month, 

2 months or longer to reestablish it. 

Mr. WALZ. What happened during that time, I mean, as far as 

your care and bills and things like that? 

Corporal OWENS. I was going to the VA, so I was not billed anything, but it was just one more hassle, setting up appointments, 

calling people, and having to deal with it. 

Mr. WALZ. You mentioned a couple of times, too, about this resource issue and people are telling you we are just overburdened, 

we just cannot do it. 

Would it surprise you that members of the VA have sat in front 

of us and we have asked them if they needed more resources and 

they said no? 

Corporal OWENS. That is a good point. You know, I hear all the 

time about reports that 100, 200 new people have been added to 

the system to Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) patients. It looks good on paper, but in reality, that 

is just an extra nurse or something to the hospital, you know, a 

new doctor, delegate of the hospital that can treat OIF patients, 

not to OIF patients, you know. 

I mean, it is for us, but, you know, it is good for reports and good 

for Committees because it sounds like you are making progress. 

But the reality is, I do not see any results. I do not see any 

changes. You know, there are now OIF/OEF coordinators at all the 

VAs and whatnot, but the problem is, and this is a solution that 

I find, they need to have an OIF/OEF center. 

You know, they have psychologists, this and that set aside for us, 

but they are in all different parts, different wings of the building. 

There is no correlation or communication among each other. 

And, like I wrote in my testimony, a good example would be 

Johnny is not going to, say, his prosthetic appointments or other 

appointments and so he gets reprimanded, written up. They are 

like why are you not going, you are not doing anything to further 

your care. And the reality is he may be suffering from severe PTSD 

or his own emotional problems and so he just sits in his room. 

And what they need is they need to come together like they do 

at Walter Reed and Brooke where all, social worker, prosthetist, orthopedic, vocational worker, they all meet every week and discuss 

their cases and the patients. And it helps give insight into some of 

the people’s problems and the avenues of care they could give 

them. 

Mr. WALZ. Thank you. 

And then a final question as my time expires here. Ms. Wade, 

I think you have given a really powerful testimony and a really 

strong insight into an area that I think we are not addressing. And 


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it is the issue of respite care and what happens with the family 

and the caregivers, what happens to their career, what happens to 

their well-being. And there has been talk about that. 

And this country means well and all of my constituents want to 

do whatever they can to help, but I know what happens to you as 

you see people and they will say, oh, it is good to see you, you are 

looking good. It looks like Ted is doing well and all that. And then 

they see you another 4 or 5 months later and they say, gee, how 

are you doing, are things going well. They do not realize every hour 

of every day of the intensity that goes into that and this is all part 

of the care. It is all part of taking care of that veteran. 

So I appreciate your testimony. And I can tell you there are 

Members up here that definitely share this concern and believe 

this is the area, maybe the next big area where we should be focusing as quickly as possible to address that. 

So I thank the Chairman and Ranking Member. I do thank you 

again for your kindness to let me speak. 

And, of course, I am not sure what to say to you. Sorry is not 

good enough in this case. And everybody is going to stand in front 

of you and tell you that. You said you have heard it many a time. 

The only thing we can say to you is that we are going to give 

every ounce of effort that we can to address this and make sure 

that you do not go through this. And I know we may never gain 

your trust back in that system, but we owe it to those that follow 

you to do that. 

So thank you for being here. 

Mr. MITCHELL. Thank you. 

Ms. Brown-Waite. 

Ms. BROWN-WAITE. I will try this one again. 

[Microphone technical difficulties.] 

I guess I will not. 

All three of you, your statements certainly were riveting and sad, 

very sad. I visit the various hospitals as many other Members do 

and I have to ask a basic question. 

When you were going through this, did you ever contact your 

Member of Congress’ office for help? Because I know that many 

Members of Congress take the care of the veteran to be very, very 

personal. 

As a matter of fact, I have the VA hopping in giving me a report 

every 2 weeks on a veteran in my district that I know kind of 

slipped through the cracks. And I think it is very important that 

we know about it because I do not think there is a Member of Congress who, if he or she knew that this was going on would have 

not immediately jumped into action. 

So did any of you contact your Member of Congress about the 

problems you were having with care? 

Corporal OWENS. Well, for me, did I contact my Member of Congress, no. I do not know if other people on my behalf did. I know 

one incident, I had written the President and wrote a letter and 

gave it to Colin Powell to give to him, but it was returned the following week. But, no, I cannot say I did. 

Ms. BROWN-WAITE. Sergeant or Ms. Wade. 

Ms. WADE. I guess I have worked some with Senator Byrd’s office, one of our Senators from North Carolina. He came to me and 


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offered to help. I had tried to contact Senator Dole’s office and 

there was just too many hoops to jump through and too much red 

tape. 

And honestly I think this is one of the problems with people with 

severe brain injuries or someone that requires a lot of intensive 

long-term care. I do not have time. There is a lot of people that I 

need to ask for help in a lot of different areas. And I just gave up. 

I had contacted Senator Dole’s office about a military-related 

issue since she is on the Armed Services Committee and I was sent 

a VA waiver. And I just did not have time to explain that it was 

not a VA issue. 

And so I mean, honestly, the people that have helped me also, 

Senator Hagel, I had met by accident. It is an interesting story. I 

was quarantined with him during an anthrax scare, but, you know, 

there is a couple of Senators that I met that offered me help. And 

those are the people that I have gone to because there are just people that are trying mightily to get by every day and we do not have 

the time to get these things done. 

Ms. BROWN-WAITE. The reason I ask that is because every Member of Congress has staff that work on these kinds of issues and 

get the elected Member involved to make sure that things happen. 

I am sorry that you did not have a positive reaction and that you 

did not have action by the Congressional staff and the Members of 

Congress, the Senators that you mention. 

You know, maybe the House Members are so much closer and 

our districts are so much smaller that maybe we have the luxury 

that the Senators do not. I honestly do not know. But I know that 

every Member of Congress, every Member in this House on both 

sides of the aisle deeply care about veterans and followup on veterans’ care. 

Absolutely. Mr. Bilbray, Representative Bilbray from California 

just said, ‘‘that is what we are here for.’’ 

Let me ask each of you if you had any outreach from either the 

Department of Defense or the Department of Veterans Affairs after 

your discharge from inpatient care and what kind of support or 

care was offered to you or your family. 

Corporal, would you like to go first? 

Corporal OWENS. Nothing really stands out. I cannot say that 

they did not. But nothing stands out because when I was discharged, you know, this all happened within a month. You know, 

with my leg tearing, the muscle failing again all happened within 

a month and 6 months it took to get this done. 

So I cannot really think if they had, you know, I do not see what 

it would have taken this long. I went to them, to the VA, and told 

them, so they were aware of everything. It was obvious what was 

wrong with me. No, not that I can think of. 

Ms. BROWN-WAITE. Sergeant or Ms. Wade. 

Sergeant WADE. I do not—— 

Ms. WADE. Do you want me to start from the beginning since you 

were asleep? Okay. 

For Ted, he had a social worker initially at Walter Reed and Ted 

was retired from the military before he regained consciousness. So 

he quickly was not their responsibility. We did have a social worker 


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at Walter Reed, who even though he was not her jurisdiction, she 

still kept in touch with me and tried to help me out. 

I will say the person, the group that has been in touch with us 

from start until now is the amputee service at Walter Reed. That 

is the only group of people that have been with us through the 

whole ride. The amputee case manager there, I am convinced 

knows everything in the world. But Steve Springer, the amputee 

case manager, and the physician who ran the amputee program at 

Walter Reed who is now the Chief of Rehabilitation, Colonel Paul 

Paswena, they are the ones that have been with us throughout this 

whole ride. 

Ted’s care was very fragmented. We had a social worker when 

he was in Richmond where one of the level one polytrauma sites 

is now. But, you know, once we left there, there was not any contact with them anymore. 

When we got home, there is an OEF/OIF case manager at our 

VA hospital. She is there when I go to her for issues, but she is 

not really there for any kind of really injury-specific case management. It is out of her realm of expertise. So she was there when 

we were at Durham the first time and she was there when we were 

at Durham the second time. We have been through seven facilities. 

And really, I guess the last 3 years, our continuity has been the 

civilian place where Ted goes, the civilian practice he goes to. They 

have a brain injury case manager who from the first day we went 

there until just Monday was the last time I talked to her. 

Even when Ted is at a different facility for treatment, like right 

now he is at Walter Reed getting a new prosthesis and doing prosthetic training and rehabbing from some surgery, she still talks to 

Ted for an hour once a week regardless of where he is in the 

United States. 

So the amputee case manager at Walter Reed and the case manager at our civilian facility for TBI have been our most continuity. 

And what we are very hopeful about is the Federal Recovery Coordinator Program. Ted was recently assigned someone in the Federal Recovery Coordinator Program. And that has been maybe 2, 

21⁄2 weeks. She has already passed her first couple of tests which 

is a big thing with me. 

But we are hopeful that that will maybe create some better continuity. My concern, though, with that, is there are good reasons 

why they are starting off slowly with this program, because it is 

hard to get a hundred people out there, training them when you 

do not even know what you need to train them for yet and what 

kind of services people need. 

But one of my concerns is in starting off slowly and where a lot 

of the case management focus has been after the Walter Reed articles in the Washington Post, a lot of the focus has been on the military treatment facilities and the polytrauma sites. Polytrauma network sites, only a small handful, a few hundred people have been 

through those. It is a relatively small number compared to the 

large group of people being wounded. 

And needless to say, the military treatment facilities are short 

lived. 

My concern with the changes in case management, I know that 

I hear patients at Walter Reed are currently complaining that they 


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have to check in with five different case managers in 1 day and 

doctors complaining that the case managers are getting underfoot 

and they do not have time. 

Ms. BROWN-WAITE. Excuse me. Is that currently—— 

Ms. WADE. Yes, ma’am. 

Ms. BROWN-WAITE [continuing]. They are complaining about 

that? 

Ms. WADE. And so what I feel like is that it would be smart to 

have some sort of visibility of all the case managers that exist from 

all these different programs. I mean, Ted theoretically has five or 

six, because there are a lot of people who left the military treatment facilities like my husband who just dropped off a cliff. 

I really think that if some of these groups of case managers could 

be restructured and reassigned that someone needs to have the job 

of reaching back and finding the people that have been lost for the 

last few years and finding out if they ever got the treatment they 

needed. And if they did not, make it happen now. 

Ms. BROWN-WAITE. Thank you very much. 

Did you get a copy of the case plan for your husband when he 

was leaving the hospital, a case management plan, what they were 

going to do? 

Ms. WADE. No, ma’am. I do not think they were doing that. 

Ms. BROWN-WAITE. So there was no case management plan with 

followup care? 

Ms. WADE. I will say our Federal Recovery Coordinator, the first 

day I met with her, that was our first conversation was what were 

our immediate goals for the next 6 months and what were our 

goals for the next 5 years. And one of the big improvements, but 

it was about my goals too. It was the first time anyone has ever 

asked about me and, you know, what was going to happen to me 

in all of this. 

Ms. BROWN-WAITE. Thank you very much. 

I have exceeded my time and I thank the Chairman for being understanding. And I yield back. 

Mr. MITCHELL. Thank you. 

Congressman Space. 

Mr. SPACE. Thank you, Mr. Chairman. 

Corporal Owens, Sergeant Wade, Ms. Wade, I am really struck 

by your testimony. By the way, you did a wonderful job. I know 

this was not easy for you. I am struck by your sacrifice and your 

courage and your heroism. 

I think that Tim Walz, what he said is right. There is really no 

more important place in America than right here, especially for a 

Member of Congress. 

What you have done, what you have given up, and what you 

have gone through are quite remarkable. It is really important for 

you to be here. It is really important for me and my colleagues to 

hear your stories, again because it is important for us to know the 

kind of sacrifice that you are all making and you have made. 

Certainly it is important for us to understand what we have to 

do better to live up to our obligation to you that tragically we have 

not been as good as we should have been on. And perhaps most importantly, it is important for us, for the Members of Congress, to 

see firsthand the price that is being paid for this war. 


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And I thank you for being here. 

Corporal, I had one question I wanted to ask you about in response to your testimony. You had indicated that time and again, 

you differed in your own assessment of your own injuries and your 

own need for treatment from what VA hospital doctors were advising you on and that I think you had three or four different 

amputative procedures on the same leg and that as a result of 

what appear to be flawed procedures or diagnoses or opinions, you 

have endured a lot of pain and a lot of suffering that might not 

have otherwise occurred. 

And my question is this: You know, was there an avenue? Did 

you feel that there was an appropriate avenue for you to obtain a 

second opinion? I mean, it is something that many of us who are 

not within the veterans’ system take for granted. 

Did you feel that you had that kind of recourse that you could 

have seen a doctor efficiently, quickly, just to get a different assessment or did you feel that your options were limited in that respect? 

Corporal OWENS. It was kind of limited. And there is a team at 

an amputee clinic, you know, an orthopedic and kind of a primary 

doctor, so that is my point of reference or contact. And that is who 

did not approve of, you know, our—you know, who referred me 

back to Brooke who wanted to do the same procedure. And I said, 

well that is not what I want. So, I was really there and then come 

back to the VA and say, well, this is what they are going to do. 

It is not what I want. 

And so from there, I was just kind of on my own, you know. I 

did not really know where else to turn to find someone to back me 

up and say this is the procedure, you know, that I found and want. 

And the way I feel, it is my right to choose what care and what 

procedure I want. 

I mean, it is not like it was going to be something harmful or 

something that was just blatantly just going to be wrong. I mean, 

it is my preference and I researched it and read up on it. It is a 

medically proven procedure. It is not like some quack procedure or 

anything. It is done by qualified professionals. 

So, no, I did not really feel I had a lot of places to turn for a second opinion. 

Mr. SPACE. Okay. Thank you. 

And I just want to close. Corporal, are you the one from Congressman Lampson’s district? You know, I heard your testimony 

that you had not reached out to his office. I can tell you that you 

have one of the most compassionate and concerned Members in 

this body and I know that he would have been there for you had 

you reached out to him. 

But I think the point is that you should not have to reach out 

to your Member of Congress to get adequate just satisfactory baselevel care within the administration. And we want to make sure 

that we do everything we can to allow you to get that care without 

having to take those extraordinary steps. 

Thank you. I yield back. 

Mr. MITCHELL. Thank you. 

Mr. Stearns. 

Mr. STEARNS. Thank you, Mr. Chairman. 


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I had my staff here, so I had to go to another hearing, but I am 

very glad to be back. And I had some notes that she took and particularly with Corporal Owens. In your testimony, you talked about 

dealing with the VA and it is a bit of a hassle. I think those are 

your words. You also said that sometimes you feel like you are on 

your own and almost there is no support system. 

I notice in some of the notes here that the VA is trying to improve that and one of the things they have talked about is developing several Web-based applications, including a Federal Individual Recovery Plan and National Resource Directory. 

They are going to team with military healthcare personnel to use 

the recovery plan to create in one set of documents on the Web a 

so-called map for recovery for wounded veterans ill or perhaps obviously ones that are injured and their families. 

And I guess my question for you, I guess for both of you, Ms. 

Wade and Corporal Owens, would this Web portal that would provide all these benefits in one area be helpful for you? 

I have a bill, H.R. 3646, where you could go to the VA and find 

every job in the country that is giving affirmative action for veterans. So if you are in my hometown of Ocala and you have a disability and you want to find work in the government or in the private sector that is giving special preference to veterans, this Web 

site, this bill was established so that you could go and find this 

work. And it might be in Colorado, it might be in New Hampshire, 

it might be in Florida, but you could go to one area and find it. 

And so I think the Department of Veterans Affairs is trying to 

develop all this in one Web site and I guess it is sort of a clearinghouse. 

And so my question to you is, this Web-based application for individual recovery plans and National Resource Directory, health 

records, and creating one set of documents, sort of a recovery map 

for you, perhaps each of you might talk a little bit about that if 

that would be helpful. 

Corporal OWENS. It cannot hurt, but that is not where the effort 

and money and time needs to be spent. It is nice, but it is something to try to glitz and glamour, you know, just making a Web 

site. No one is going to go look at it. There are tons of Web sites 

out there. I can tell you that. I get papers all the time, go to this 

Web site, go to that. 

With the VA and stuff, there are vocational rehab jobs and, you 

know, several other places. That is not a problem finding a job or 

places that will take you. The problem lies on the ground. They 

need more foot soldiers. They need more people that are experienced and know the system and know how to work it and advocate 

for you when you need something, not turning to a computer or 

calling a hotline. 

You need someone. You call up and say here is my problem. You 

tell them that day and then you go carry on with your job and 

what you have else and leave it to them because with a Web site, 

that is just leaving stuff to you. And that is not our job to do this. 

Our job was to recover and move on with our life, which all of us 

wanted to do and put this behind us. 

And the problem is not all these programs. The problem is the 

accessibility to the healthcare and the bureaucracy and red tape is 


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what needs to be fixed. And I see all the time they are setting up 

this program, they are setting up that. I think that is just a way 

to get more funding to make it look like attention has been going 

places. 

And I think probably what you hear at all these hearings is, because I know at least from my experience and all my friends, they 

do not have problems finding a job or training or education. They 

have a problem getting their benefits, getting their ratings. 

I know she is still dealing with it, you know, still trying to get 

his proper rating and what he is entitled to. And that was a problem for me. It took me a year and a half to finally, through the VA, 

to get my claims and everything processed. 

You know, I went through several months to do my med board. 

It took 3 to 5 months of meetings, addendums, talk to the psychologist, rehashing everything, getting ready only—— 

Mr. STEARNS. So you are just saying it is a multitude of bureaucracy and you have to jump through all these hoops, families do, to 

eventually get service which at some point is a breaking point for 

families because they are so frustrated. 

Ms. Wade. 

Ms. WADE. I have some concerns with this. I do think it would 

have helped me narrow down where to look for things, but you also 

have to keep in mind that I am someone who loves to research 

things and there are other people that are not very good at that. 

I think also a very important point to make and I think that the 

culture of the VA has to change. The culture of DoD has to change 

in expecting people to come to them. Someone like my husband is 

not capable of using a Web site like that. It is part of the impairment from his brain injury. 

And so for him, it would not be useful. And, again, it means then 

that it is falling on somebody else to do it for him. And there are 

also a lot of people with TBI who just are not able to initiate 

things. And so that is one of the difficulties with something like 

that. 

I do think it would be useful for someone like myself who likes 

to hunt down information. 

But part of the problem with it also is that so often, I just had 

this happen a couple of weeks ago when I was talking to some VA 

people in the polytrauma system, that, you know, it is we have X, 

Y, and Z. And I will say, well, I was actually looking for A, B, and 

C. 

I think that part of the problem with consolidating how to get to 

these programs is you have to know what program you need. You 

also have to have someone who knows the patient well enough to 

know when one of those programs is not available, you know, when 

there is something else they need that is not there. 

There just has to be more. You need a case manager who really, 

really knows the individual. I do not think it should be up to the 

individual to identify what their needs are. They may not know 

better. 

Mr. STEARNS. What happened if the VA provided a proactive person to help you with the portal, that that person would come over, 

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grams, and on a regular basis in one spot sit down with you and 

do it for you? 

Ms. WADE. Three hours later, my husband would not remember 

how to do it. He has memory issues. So for him, that would not 

help. 

Mr. STEARNS. But the family would benefit by seeing it and seeing the networking that they could go through. 

Ms. WADE. If they do not have a full-time job and children to 

take care of and they have the time to. I mean, I do think that it 

is a useful resource. I am just concerned that it is going to become 

some sort of catch-all. 

Mr. STEARNS. Both of you seem to be advocating that the VA 

should have more personnel to come into the home, help the families in a way to go through the bureaucracy without them having 

to funnel the attack against the bureaucracy. 

Ms. WADE. And to know the patient better. I mean, just recently, 

Ted had some issues with medication. Anybody who would have encountered him at the VA hospital would have just assumed that he 

was being agitated, getting easily agitated because that happens 

with TBI. 

His amputee case manager at Walter Reed who has known him 

for years encountered my husband and knows what his individual 

baseline is and knew that that was not how he usually is and 

asked me. Well, he actually looked up that there were some medication changes and he called me about it. 

But it is not just having anyone there to show me. Someone has 

to really know my husband. 

Mr. STEARNS. Someone that knows the history. Yeah, knows your 

husband. 

Ms. WADE. And really know him. 

Mr. STEARNS. Yeah. 

Thank you, Mr. Chairman. 

Mr. MITCHELL. Thank you. 

Mr. Bilbray. 

Mr. BILBRAY. Thank you, Mr. Chairman. 

First, I want to say to the panel, I want to thank you very much. 

And I do not think you realize what a service you are providing 

this Nation by being here today and by doing what you have been 

doing over the last how many months. It is a very measured, very 

effective message. 

I also have got to say that as somebody who grew up in the Navy 

and still hear my mother to this day as an 88-year-old lady talking 

about having to sit in the emergency room from six in the morning 

until six at night waiting for somebody to see you that bureaucracies, especially Federal bureaucracies, and even the military can 

be very frustrating sometimes. 

It is inherent that in a system where people neither get fired for 

doing the wrong thing nor get more pay for doing the right thing, 

the system inherently tends to be very insensitive to outcome and 

service. 

But I think that, you know, Ms. Wade, you have given us some 

good insight into two things. First, the concept of having a clearinghouse is something that some people could use and could help to 

improve it. 


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But I think when it comes down to it is while we may have a 

triage team to talk about the multi facets, we need to have a designated caseworker who is delegated the responsibility of being basically an ombudsman of making sure that when there is a glitch, 

you have somebody that you can contact. When there is a frustration with a certain bureaucrat, there is always that person you can 

come back to as your team or your advocate to help you in the system. 

And I guess the frustration always with working with government, any kind of bureaucracy is to have somebody to be your advocate who knows your case and your situation and knows the bureaucracy and how to navigate through it. 

And when we get too many people playing the games where you 

have five or six or ten people, you do not know who to go to to specifically address those issues. So you need to have that go-to person. And I hope that we can talk about that. 

And I have got to apologize to you, Ms. Wade, because you have 

really been very measured at the fact of starting this small process 

with a few trainees and working out. And the reason why they 

have to do that is that if we do train, we do have a big program 

and it does not work out, nobody wants to go back and correct 

those problems. 

You know, the biggest problem in Washington is not that we try 

new things and it is not that we make mistakes. The problem is 

when we try new things and make mistakes, we never want to be 

brave enough to go back and correct it and say we have had a problem. 

I really do not have any specific question except for the fact that, 

you know, am I right to assume that we really do need to give the 

returning heroes the ability to have one person and somebody that 

they can kind of rely on in this situation, because sadly, as the 

Congresswoman pointed out, we do not teach our kids in school 

which government agency to go to when you take care? 

I know Richard very well. The Senator is a good friend of mine 

and we sat together for 6 years in the House. But it is your representative in the House of Representatives who has a small 

enough district to be more responsive than a Senator. 

And sadly the people will call us about traffic lights and potholes 

in Congress and I say I do not do that anymore. I used to be a 

Mayor and now I am not. 

But then do not call when it is a specific issue and do not understand that Congressman are not up here. They are here to serve 

and that is why we are here to be your ombudsman until we can 

get you one in the system. 

So the question is, am I right to assume that the clearinghouse 

is a good thing, but what we really do need to do is simplify the 

oversight part and try to give a designee, one designee for you to 

go to? 

Corporal OWENS. Yeah. What you have to understand is that our 

needs are newer needs than past veterans. You know, we are a 

whole new breed of patients. Our survival rate is a lot higher. The 

type of injuries are different. And so it is going to require a new 

game plan and different mode of thinking than what has been implemented in the past. And that is what, I think, a lot of people 


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do not understand because they are not opening themselves up to 

a newer—that we need newer programs, a newer way of doing 

things. 

Mr. BILBRAY. Maybe our thing is we need to make sure their job 

reflects more on doing the right thing and less on worrying about 

making mistakes if they make mistakes. You know, that is the biggest problem we have is the bureaucracy tends to say the less I do, 

the less exposure I have of making a mistake and they only judge 

me by mistakes, not by successes. 

Ms. WADE. My only—— 

Mr. MITCHELL. Go ahead. We have got to go. And I want Mr. 

Lampson very quickly. Go ahead. 

Ms. WADE. My only comment with the one person is I do not 

want that to be misunderstood. I do need more than one person. 

I need a single point of contact. My husband’s amputee case manager is a very important thing for him. 

You know, like, for instance, the issue that Casey was having 

with his leg, an amputee case manager who has worked a lot with 

amputees that are recently injured would have known what to do 

in that situation. 

For me, I need a TBI case manager for Ted’s TBI rehabilitation 

plan. So what I have told many people is I need a case manager 

for my case managers. 

Mr. MITCHELL. Thank you. 

Ms. WADE. So I just do not need it to be one person. 

Mr. BILBRAY. That is good. 

Mr. MITCHELL. Thank you. 

We have to go vote and we will be back. And I want those people 

here to stay here. 

But, Mr. Lampson, before we go, would you like to make a comment? 

Mr. LAMPSON. I would like to make a comment, actually two very 

short comments and one question. And it follows up really on what 

Congressman Bilbray was just talking about. 

But, first, you know, it is as if the care they do receive has been 

by trial and error. And I think that is their point. It is something 

new. Corporal Owens just made the comment that it is a new set 

of problems. They are polytrauma patients today that we have not 

known how to take care of in the past. 

I am very impressed by your concern about those who you are 

trying to be a representative for and coming here to Congress in 

the hopes that someone else will not have to come here later on. 

My other point is the comment that both Congressmen Bilbray, 

Stearns, and Zach Space made about how we really do want to 

know about what is going on and try our best to be responsive to 

what is happening. 

I carry a card in my pocket, and have for more than a year now, 

with the names of the 19 men who have died from my district. I 

walk the halls of the veterans’ hospital in Houston, Texas, and at 

Walter Reed visiting with folks like this recovering from their injuries. Yet, it took being contacted by this Committee to find out that 

I had a person in my district who was having this kind of problem. 

So there is something that is even further broken. How do we get 

information? Here is my question of you all. How do we get inforVerDate Aug 31 2005 01:43 Dec 23, 2008 Jkt 041376 PO 00000 Frm 00028 Fmt 6633 Sfmt 6633 E:\HR\OC\A376.XXX A376

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mation out to other members of the service to know that they 

should be able to turn to any level of this government, whether it 

is their Representative, their Senator, their President, or whoever 

else, to be able to say something is wrong and I need special attention? Do you have any further comment that you can make about 

that? 

Corporal OWENS. It just never really crossed my mind because 

there is the hospital, the VA. That is what it is, for medical needs. 

So I do not think of my Senator or Congressman to turn to for medical needs, you know. And I have no doubt that you or any other 

person want to serve me. It is just I—— 

Mr. LAMPSON. My point is that we need to find a way that we 

can make sure that other folks in your situation know to contact 

us. We want to reach out to you. 

Ms. WADE. I guess part of the difficulty with that is patient confidentiality and overcoming those barriers. But I do know that 

somehow or other, one of our Senators does—I do not know if they 

scour newspapers to find out who has been wounded or what, but, 

I mean, we got a letter offering assistance if we needed it in the 

mail. 

Mr. LAMPSON. Well, we do both as well. And I have a retired Marine who returned from Iraq and went to work on my staff as the 

outreach person. And we even meet with on a bimonthly basis 

about 15 organizations of veterans, their leaders in my offices every 

other month. Still there are things that are falling through the 

cracks. 

I have a physician at home who has actually volunteered to repair the face, he is a plastic surgeon, of anybody who needs that 

special attention. Getting that information out is something that I 

think that we need to pay attention to. 

I think you are magnificent people for being willing to give your 

lives to our country. You should not have to be going through the 

difficulties that you are facing today. If there is ever anything that 

any Member of Congress can do, ask your friends to ask us to respond. I think we will do so. 

Thank you, Mr. Chairman and Ranking Member, for allowing me 

to come today. 

Mr. MITCHELL. Hopefully you will all be able to stay here. We are 

going to finish this up and we have got some other questions. And 

we will be back right after the vote. Thank you. 

[Recess.] 

Mr. MITCHELL. We are going to go ahead and get started. Others 

are on their way. 

One of the things that I wanted to ask both the groups here are, 

first of all, Corporal Owens, you mentioned last night that you 

have been trying to get your medical records and you have never 

received your records; is that correct? 

Corporal OWENS. Right. I have not. I have been trying to get my 

med board which is about four inches thick. I have not gotten it 

yet. 

Mr. MITCHELL. And I would hope that those of you who are here 

that have some responsibility of that make sure that Corporal 

Owens gets his medical records. He has never had them. About 

four inches thick. He has asked for them and asked for them. 


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And when were you injured? 

Corporal OWENS. September 2004. 

Mr. MITCHELL. September of 2004 and he does not have them. 

That is one of the things we have been trying to deal with, to get 

some kind of a seamless transition with DoD records and the VA 

records. There is no way he can get the right and proper care without all the records and he does not have them. 

The other thing that is interesting you told me last night is that 

you found in your records that you were not even awarded the Purple Heart; is that correct? 

Corporal OWENS. When I got to the VA, this was about a year 

ago or so or I do not know how long ago, several months ago, I was 

looking through my case manager’s computer and scrolled down. It 

said I did not have the Purple Heart. It said I did not have dental 

injuries. It did not have any of my claims. All it had was I lost both 

legs and that is it. 

Mr. MITCHELL. That is amazing that they have on there you lost 

both legs, but not a Purple Heart. And they rebuilt your jaw and 

your mouth and it had nothing about your dental. 

Corporal OWENS. No PTSD, no dental, no scars, nothing. 

Mr. MITCHELL. And I will tell you it is the lack of records and 

the continuity of them that has caused—you can imagine what it 

does to people who have PTSD and traumatic brain injury. It does 

not help. 

And, Ms. Wade, I think you suggested a similar situation with 

you. 

Ms. WADE. And I think what is hard for us, too, is that I have 

had so much on my plate trying to manage all Ted’s medical affairs 

that there are things that have just simply slipped my mind. 

I am trying to get a hold of some records. I want to get his PEV, 

his physical evaluation word file as well. There are some records 

from Germany I have never been able to get a hold of. Particularly 

I wanted his MRIs of his brain after his brain surgery. 

But, I mean one of the things that is difficult with this, I guess, 

lack of continuity in the records is I had a therapist recently comment that it seems like my husband was tracking strangely with 

his eyesight when they were working on a crossword puzzle. And 

it triggered a memory. And I went back and read an article that 

his speech therapist from the polytrauma center had written about 

him. And I had completely forgotten that my husband was having 

vision issues back in Richmond. Well, there was no followthrough. 

He had never been seen by an ophthalmologist. 

And come to find out Walter Reed referred Ted to a neuro-ophthalmologist and he has visual impairment. He has a blind spot in 

his vision and he also has some other visual impairment. 

But, you know, in this jumping from hospital to hospital and the 

lack of case management, the lack of records, you know, a nice, 

concise record and maybe a list of just his major injuries, it would 

have been nice. 

But we are also dealing with having his VA rating fixed. He just 

had his new one updated. I guess it was a 3-year update. And it 

was simply done on his VA medical records. Well, really the only 

thing he goes to the VA for anymore is speech therapy. And so they 


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did not have access to any of his other records. So I am going to 

have to file an appeal to have other things added in. 

And like Casey, there were new things that came up. There is 

not a complete record and there is not a complete diagnosis of all 

his issues. 

Corporal OWENS. But the problem with that is, and in my case, 

and it has got to be for her, since they do not have those records, 

you have to then be reevaluated by the VA. So since they did not 

have anything other than my legs, I had to go to the dentist, you 

know, or to, you know, dental. I had to set up an appointment, wait 

like a month for it. 

I had to have MRIs for different things. I had to see the dermatologist. I had to see all these different doctors, psychologists for 

my PTSD, another stranger I have never met, have to tell my story 

again, rehash old memories, and it just gets old time and time 

again doing it over and over when you have done it once for your 

med board by qualified, competent people. It is just like why can 

it not pass on to other people? And, you know, that is—— 

Ms. WADE. And Medicare included, I think, because we—I mean, 

I do not know if you had to do this, but we had to go through the 

whole welcome to Medicare exam also. There is a lot of repetition. 

Mr. MITCHELL. Right. And, you know, this hearing is not only to 

hear your story here, but it is also to send a message to those that 

can do something about it. And they are sitting behind you and 

they will be testifying later. And I hope that they look at this, that 

both of you are unique and that you have worked through the system. In spite of the system, you have gotten things done. A lot of 

them, as you said, do not have the time. They do not have the resources. They just cannot do it. 

And this is you serving as a model, that if this has happened to 

you and you are people who know how to work the system, think 

of how many others that it is happening to. And it should not. 

Okay. If there is anything else that either one of you would like 

to say? Okay. Yes, Ms. Brown-Waite? 

Ms. BROWN-WAITE. Thank you, Mr. Chairman. 

Ms. Wade, what disability rating did Ted receive? 

Ms. WADE. He was given both a hundred percent by the military 

and the VA. I had a couple people look at his rating that actually 

told me, and I am going to have to have this fixed, but based on 

the way his rating is written, I had a couple former raters read it 

and a couple—— 

Mr. WALZ. It is all in the wording. 

Ms. WADE. Yeah. It is all in the wording. They said that Ted actually may qualify for a next level of special monthly compensation 

if his injuries are worded differently. 

But part of the problem is and one of the reasons I brought up 

about the special monthly compensation is that those things are 

written based on physical residuals, not cognitive residuals. They 

have not been updated for the current injuries. 

I mean, again, even in some of the vocational rehab aspects, the 

Independent Living Program for vocational rehab is really designed 

for physical needs, not cognitive needs. And I think all of these 

things need to be updated to fit the current injuries. 


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And I think part of that with the special monthly compensation 

and needing more assistance is one of the important things to keep 

in mind is that not everyone has family to help them out and they 

might need to hire someone to lend them a hand. 

Ms. BROWN-WAITE. Another question. Having served as basically 

a patient advocate for family members, I know it is all in the questions that you ask. Certainly when I was taking care of my mom 

and now my husband and I know you have to be specific and you 

have to press for the right answers. 

Along the line, did you find anybody purposely gave you incorrect 

information, Corporal? 

Corporal OWENS. No. 

Ms. BROWN-WAITE. Sergeant or Ms. Wade. 

Ms. WADE. I have been given incorrect information. Whether or 

not it was done on purpose, I do not know. I have been given incorrect information quite a few times, though, and I do not know if 

it is the people do not know the rules or if someone has interpreted 

them differently than I have when I have read them. But I have 

been given a lot of incorrect information. 

Ms. BROWN-WAITE. And I would like to ask both of you, on a 

scale of one to five, five being the highest, how would you rate the 

orthotic and prosthetic department of the facilities that you were 

treated in? 

Corporal OWENS. Well, I was treated at Walter Reed or Brooke. 

Five. 

Sergeant WADE. Five as well. 

Ms. WADE. We do not use the VA orthotics and prosthetics. I 

mean, like Casey’s situation, it was just too much of a hassle. And 

part of that is because of the nature of Ted’s injury, that the closest 

VA contractor to work on his arm is maybe about a 6-hour drive 

from us. It is easier for us to come to Walter Reed than to wait 

a few weeks to have someone work on his prosthesis. 

And there also is not a therapist with the expertise that they 

need for his prosthetic training at our VA hospital. So we just do 

not even bother. It is just easier to go back to the military because 

there are no hassles and we can just walk right in the door. 

Corporal OWENS. The problem for me is, and other people like us, 

is we are a different patient than what they usually deal with because they are usually dealing with diabetics, people that are older 

in age, that are retired. And so, you know, I want my stuff. I want 

to see them 4 or 5 days a week for an hour or two and get done, 

whereas some people are just, you know, they can come in, get 

fitted once, twice a week, and, you know, they are not as active and 

not as, I will not say motivated, but are not requiring them as 

much and needing them expedited, you know, not needing them as 

quick and as fast because I need it done so I can get back to school 

and go back to work. So it is accessibility, I guess. 

Ms. BROWN-WAITE. One of my concerns about the orthotic and 

prosthetic service providers is in many States, they have to be licensed. I know Florida when I was in the State legislature, we 

were like the second State to license them, but we had no effect 

on licensing for the Federal Government. 

And the Federal Government still does not require in States 

where a license is required that the VA providers or even the DoD 


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providers have to be licensed and meet all of the State qualifications. That is why I asked about how you would rank the level of 

service. 

Thank you very much. I have no further questions, Mr. Chairman. 

Mr. MITCHELL. Thank you. 

Just one last thing. I think it is something you are going 

through, but also for some of our next panelists. And that is how 

do inaccurate records, your medical records affect the ability to get 

VA benefits? 

Corporal OWENS. Well, you know, like I said, since they only had 

me under, you know, just missing my legs, I was a hundred percent, but if you do not have those other records and those claims, 

you can only go to a hundred percent, but having those claims, you 

get extra compensation. If you have all your claims, but you cannot 

get treatment for them unless it is claims because then it is not 

service connected. 

Ms. WADE. I think it is also, like my husband, I was looking at 

his records because I need to appeal his final medical board and 

we are looking at about 3,500 pages, and so it seems like there 

needs to be a better way to really highlight the major issues. 

But part of what is difficult with that, again, is the physicians 

have to know what exactly it is they need to document. They are 

not raters. And the raters have their set guidelines they are using 

and if the doctor does not know those guidelines, then they do not 

know how they are supposed to be documenting things. 

I mean, one of the things with my husband is, yes, he got a hundred percent for the traumatic brain injury, but he also has, one 

of the things we were discussing last night, he has very bad muscle 

spasticity. And at times, he loses voluntary control of his limbs. 

Well, his records say muscle spasticity. A friend of ours, it says 

loss of voluntary control of two limbs. His friend is rated as 

hemiplegic which gives him the next level of special monthly compensation. Ted just has muscle spasticity and, therefore, is not 

given anything for that residual. 

It means that he cannot use his prosthesis when he is having 

trouble. It gives him loss of use of his limb he has already lost. It 

is harder for him to compensate for the loss of his arm because of 

this medical condition. But if the person documenting this does not 

know how they are supposed to be wording it to meet what a rater 

is looking for, then it becomes an issue. 

Ms. BROWN-WAITE. Just one other thing. I would strongly suggest in getting your husband’s records that you do engage your 

Member of Congress. As many of us have said, that is what we are 

here for. And the congressional staff and the Congressperson do get 

involved in this. 

And I always apologize to my veterans that they have to come 

to me to get the records that they should be able to get. But getting 

records from DoD is not easy. And that is something that every 

Member of Congress on both sides of the aisle that their offices do 

regularly. 

Now, you will have to fill out a privacy form that authorizes your 

Member of Congress to help you, but it sure will speed things up 

if you have had a problem. And please pass that word on to other 


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families that you are in touch with. Please use us. We are here and 

we are grateful to help those who sacrificed so much for our country while in the military and the families. And with all you have 

been through, I am surprised you do not have gray hair. 

And I yield back. 

Mr. MITCHELL. Thank you. 

And I want to thank you not only for the sacrifice for the country, but what you are doing for other veterans. You are speaking 

for a lot of people, a lot of people. And I appreciate that. 

And I also in my opening statement, I pointed out that, you 

know, you may be disappointed, but you are not bitter. You are 

very proud to have served your country and that is admirable. And 

I appreciate everything that you are doing. 

And with that, we will conclude this panel. Thank you very 

much. 

And the second panel, Meredith Beck and Todd Bowers. And, 

Meredith, would you care to go first? 

Ms. BECK. Yes, sir. 

STATEMENTS OF MEREDITH BECK, NATIONAL POLICY DIRECTOR, WOUNDED WARRIOR PROJECT; AND TODD BOWERS, 

DIRECTOR OF GOVERNMENT AFFAIRS, IRAQ AND AFGHANISTAN VETERANS OF AMERICA 

STATEMENT OF MEREDITH BECK 

Ms. BECK. Mr. Chairman, distinguished Members of the Subcommittee, thank you for the opportunity to testify before you regarding post-acute care for seriously injured servicemembers. 

My name is Meredith Beck and I am the National Policy Director 

for the Wounded Warrior Project (WWP), a nonprofit, nonpartisan 

organization dedicated to assisting the men and women of the 

United States Armed Forces who have been injured in the recent 

conflicts around the world. 

During those conflicts in Iraq and Afghanistan, there have been 

approximately 30,000 soldiers, sailors, airmen, and Marines 

wounded in action. Fortunately, due to the advances in medical 

technology, the number of those killed in action are far fewer. 

However, in many cases, the wounded have suffered devastating 

injuries and require long-term outpatient care and rehabilitation. 

As they have suffered these injuries, WWP is pleased that the Subcommittee has chosen to focus on this aspect. 

As a result of our direct daily contact with these wounded warriors, we have a unique perspective on their needs and obstacles 

they face as they attempt to transition, reintegrate, and live in the 

communities where they have served. 

I also want to note that my job as the Policy Director is to speak 

directly to these families across the board. What I then do is create 

policy themes and proposals based on the themes that they have 

demonstrated. 

Unfortunately, my job is easy these days because the themes 

that the families are presenting are almost uniform in what they 

are presenting. The Wades, Casey, they are prime examples of 

that. 


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However, as Sarah noted, it is very important for you all to understand that these two, the Wades and Casey, are not typical of 

your daily average wounded veteran and their families. 

Sarah is very well-spoken. Casey is incredible at what he does. 

And the families that we deal with, and they represent them well, 

but the families they deal with do not in many cases have the capacity to be able to navigate these systems as well as they have. 

Because of our contact with these servicemembers, we have identified a number of areas, and you will probably hear some repetition from the two of them because they have come directly from 

people like them, and the following areas are common themes 

among these families. 

The options for care specifically with respect to those with traumatic brain injury, those suffering from TBI require individualized 

comprehensive care. And while the VA has made progress in this 

area, the Agency is still in the process of establishing extensive, 

consistent, long-term continuum of care available throughout the 

Nation. 

As such and due to the need for long ongoing therapy and rehabilitation, many seriously injured veterans and families have indicated that their number one request is increased access to options 

for care, including access to private facilities previously available 

to them while on active duty. 

The next topic is discrepancies in benefits. Many veterans and 

families of the seriously injured have indicated confusion, frustration, and disappointment upon learning that they are not eligible 

for the same benefits and care as veterans as they were on active 

duty and vice versa. 

For example, consider that an active-duty patient can be seen at 

a VA polytrauma center to treat his traumatic brain injury. However, while at the VA facility, the servicemember, due to his duty 

status, cannot enjoy VA benefits such as vocational rehabilitation 

or independent living services. They can be assessed for those benefits, but they cannot have them until they are actually retired. 

Alternatively, as mentioned previously, and unbeknownst to most 

families, a medically retired servicemember cannot use his or her 

TRICARE benefits to access private care as TRICARE does not 

cover cognitive therapy once retired. 

While there is an obvious need for and advantage to an activeduty service, those who are severely injured as a result of their 

service in an all-volunteer force deserve special consideration. 

The recently passed NDAA contained a provision intended to address those discrepancies. Specifically section 1631 authorizes for a 

limited period of time the Secretary of Defense to provide any veteran with a serious injury or illness the same medical care and 

benefits as a member on active duty and entitles the severely injured still on active duty to receive those veterans’ benefits, excluding compensation, to facilitate their long-term recovery and rehabilitation. 

While the provision recognizes the strengths of each Agency, and 

they do both have strengths, and the necessity of basing an individual’s care and benefits on his or her medical condition rather than 

on their status as active duty or retired, it is subject to significant 

regulation and will require oversight to ensure its success. 


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The next topic is respite care. I will say personally my brother 

is currently a Marine major serving in Fallujah. He has four children under the age of seven. If something happens to him, I want 

to know, and this is why I do this and why I talk to these families, 

I want to know that he is going to be taken care of and that his 

wife will have the ability to take care of their children and take 

care of him. 

For those who have suffered and who are seriously injured, one 

cannot discuss their care without discussing their caregiver. While 

the VA currently offers some respite care, the available options are 

often not entirely appropriate given the average age and types of 

injuries of those serving in Iraq and Afghanistan. 

For example, similar to the Wades, retired Army Sergeant Eric 

Edmondson from North Carolina suffered a severe brain injury in 

Iraq several years ago, but he is aware and responsive. In fact, he 

enjoys spending time with his family and recently went fishing 

with his 3-year-old daughter, Gracie. 

Eric’s family is unwilling to place him in a respite facility for fear 

it could cause a regression in his rehabilitation and cause Eric distress, which ultimately means his family does not get any form of 

respite. 

However, WWP has noted that similar to others, Eric’s family 

has used their personal funds to pay for an innovative type of individualized therapy that also provides a unique form of respite to 

the caregiver. 

In Eric’s case, rather than staying indoors all day, his family 

pays an individual out of their own funds to take him to the park 

and watch his daughter play. Eric thrives each time and his 

progress and enjoyment are noticeable. 

As a result of Eric’s success as well as others in similar situations, WWP proposes that the Department of Veterans Affairs initiate a pilot program partnering with local universities that the VA 

already has partnerships with to provide such a care and respite 

initiative for those with brain injury. 

As part of the veteran’s ongoing therapy, the program would 

draw graduate students from the appropriate fields, i.e., social 

work, nursing, psychology, train them to interact with the veterans 

and match them with the eligible veterans in their local area so 

that an individualized program can be developed. 

In return for making the requisite reports to the veteran’s physician on his or her status, the graduate student would receive 

course credit for doing such work. 

The creation of a program would have several positive effects. In 

recognition of the individual nature of brain injury, the program 

would encourage an innovative means of providing age-appropriate 

maintenance therapy to those suffering from TBI, which for the 

long term is absolutely necessary. Their rehab is never finished. 

While the veteran is benefiting from the therapy aspects of the 

program, the family caregiver would be offered much needed respite. 

And, three, interaction with the graduate students would increase general community awareness of the sacrifices of our Nation’s veterans and the needs of those suffering from TBI. 

Mr. MITCHELL. Could you wrap it up? 


jbell on PROD1PC69 with HEARING
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Ms. BECK. Yes, sir. 

Last, the oversight aspect of this. Finally, consistent with the 

recommendations of the Veterans’ Disability Benefits Commission 

and to ensure the best care and benefits for those who have sacrificed for our Nation, it is imperative that a joint permanent structure be in place to evaluate the changes, monitor the systems, and 

make further recommendations for process improvement. 

It should not require Casey and the Wades to be the ones who 

find the problems. They should be able to rely on the people who 

are providing their care to provide that oversight and the ability 

to give those recommendations for change. 

With the passage of time, as veterans’ issues fade from the national spotlight, it is necessary to have that structure so that we 

can all make sure that we are coordinating future intra- and interagency coordination. 

Thank you, and I look forward to your questions. 

[The prepared statement of Ms. Beck appears on p. 54.] 

Mr. MITCHELL. Thank you. 

Mr. Bowers, you have 5 minutes. 

STATEMENT OF TODD BOWERS 

Mr. BOWERS. Mr. Chairman, Ranking Member, and distinguished 

members of the Subcommittee, on behalf of the Iraq and Afghanistan Veterans of America (IAVA) and our tens of thousands of 

members nationwide, I thank you for the opportunity to testify 

today regarding this important subject. 

I would also like to point out that my testimony today is as Director of Government Affairs for the Iraq and Afghanistan Veterans of America and does not reflect the views and opinions of the 

United States Marine Corps of which I currently serve as a Sergeant in the Reserves. 

The tremendous advancements in frontline medical care have 

made many combat injuries more survivable. In Vietnam, the mortality rate of combat injuries was one in four while the mortality 

rate in Iraq is one in ten. That means today’s battlefield medicine 

has saved approximately 6,000 American lives that would have 

been lost if they were still using Vietnam era medical techniques. 

This is a tremendous success story for the DoD medical system. 

But the corollary of improved survival rate is an increase in the 

number of severely wounded troops returning home. As the Independent Budget states, and I quote, ‘‘We are seeing extraordinarily 

disabled veterans coming home from Iraq and Afghanistan with 

levels of disability unheard of in past wars.’’ 

Many of these young wounded veterans will require long-term 

care, not just at Walter Reed and Bethesda, but in their communities across this country. 

At the VA, these veterans with traumatic brain injury and blast 

injuries are confronting a system designed to treat diabetes and 

Alzheimer’s. 

The DoD and the VA have already taken some crucial steps to 

improve inpatient care for these young, severely wounded patients. 

There are four major polytrauma rehabilitation centers in Florida, 

Virginia, Minneapolis, Minnesota, and Palo Alto, California, which 

use teams of physicians and specialists that administer individVerDate Aug 31 2005 01:43 Dec 23, 2008 Jkt 041376 PO 00000 Frm 00037 Fmt 6633 Sfmt 6633 E:\HR\OC\A376.XXX A376

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ually tailored rehabilitation plans, including full spectrum care, for 

traumatic brain injuries. 

These centers are also part of the defense and veterans brain injury center network. These key centers offer cutting-edge treatment 

for severely wounded troops who are receiving inpatient care. But 

what is available to troops near their homes? 

As of 2003, according to the U.S. Government Accountability Office, more than 25 percent of veterans enrolled in VA healthcare, 

over 1.7 million, live over 60 minutes driving from a VA hospital. 

This number is likely higher today because the mission in Iraq has 

relied heavily on recruits from rural areas and under-served by VA 

hospitals and clinics. 

This places a tremendous burden on the families and also the 

veteran. With the current gasoline prices, for example, and many 

treatment centers hours away, treatment is often impossible to facilitate. 

Imagine, if you will, that your loved one has returned from combat wounded and it is your responsibility to make sure they are receiving the proper treatment. This is too much to ask of our 

servicemembers and their veteran families. 

In response, the VA has created regional network sites that work 

with major polytrauma centers to cater to patients closer to their 

homes. The VA is also planning to add new polytrauma support 

clinics to provide followup services for those who no longer require 

inpatient care but still need rehabilitation. 

The 75 polytrauma support clinic teams help veterans get access 

to specialized rehabilitation services closer to their homes and communities and also are responsible for ensuring these patients do 

not fall through the cracks after leaving full-time care. 

For hospitals without a polytrauma support clinic, a single person has been designated as the point of contact to coordinate care 

for local veterans with polytraumas. These are good first steps, but 

much more has to be done to get these wounded veterans the care 

they need. A single point of contact that can offer referrals to distant hospitals and clinics is simply not an adequate response to a 

wounded veteran’s healthcare needs. 

IAVA joins the other Independent Budget of veterans service organizations in calling for an increase in funding for home and community-based care and a detailed plan from the VA regarding their 

long-term response to the need of today’s veterans. 

I would be happy to answer any questions at this time. 

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

Mr. MITCHELL. Thank you very much. 

I have a question of both of you. Both of your organizations came 

about as a result of the wars in Afghanistan and Iraq. How many 

other organizations like that have spurred up as a result of this 

war? 

Ms. BECK. Probably countless numbers of organizations. I am not 

sure that the number, though, who have—there are countless organizations that provide care support services benefits for servicemembers. Of the organizations that actually do policy work related 

to this area, I would say that we are probably the only two. 

Mr. BOWERS. Uh-huh. And we are good friends. 

Ms. BECK. And we are friends. 


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Mr. MITCHELL. The reason I ask that is that with this war, 

which is relying solely on volunteers and the growth in the number 

of organizations like yours to serve this war, it really seems that 

it is kind of market driven. The government is not doing its job and 

as a result, volunteers from the private sector are stepping forward. And that is really not a very good story. 

And I listened to Corporal Casey Owens, many times saying that 

he has completely given up on the government services and has 

gone completely to the private services and all those services are 

organizations like you. 

That is a sad commentary. And just a comment on that. 

Ms. BECK. If I could, sir, one thing about that, and, yes, the government certainly needs to be providing a lot of these benefits in 

a more organized, better fashion, and quality of care obviously in 

the past two situations we have seen. 

There is one aspect for the organizations, though, to make sure 

that the communities are aware. I know that Todd has a large 

campaign to make sure that the communities are aware of the 

needs of these servicemembers and to provide a means through 

which individuals can contribute and understand. 

So there is hopefully a need for them. But at the same time, I 

certainly agree that the government should be providing a better, 

more structured form of quality benefits for the individuals. 

Mr. MITCHELL. Well, and to comment along with that, most people are not personally affected—— 

Ms. BECK. No, sir. 

Mr. MITCHELL [continuing]. By this war. And very few are. And 

we see how affected those that are involved in this area. And I applaud you for doing that because we need to make people aware. 

It is just not a typical war. 

It has been said before by the first panel that it looks like they 

are dealing with a government organization or the VA that is not 

aware. Times have changed. It is a different war, different wounds, 

different conditions, and that we need to catch up. 

And I applaud your organizations because at least I gather that 

you are trying to do that very thing, to really turn things around 

and come up to speed with today’s war and today’s needs. 

Mr. BOWERS. Just to add on that, Meredith mentioned something 

that we are doing actually with IAVA is communication is key to 

let individuals know what resources are available not only through 

the VA or DoD but also what other veterans service organizations 

are there to help. 

And we have partnered with the Ad Council on a 3-year campaign that is going to communicate to the American public to let 

them know what services are available and also to destigmatize, 

and I emphasize this, to destigmatize the stigma related to servicemembers seeking mental health treatment. 

Mr. MITCHELL. Absolutely. 

Mr. BOWERS. Until that is broken, we are really going to have 

a hard time getting people to step into the doors to receive the 

treatment they need. And we are hoping that this campaign will 

be a good way to do that. 

Mr. MITCHELL. Absolutely. And you all are doing a very admirable job. And it is unfortunate. I have heard from hearing after 


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hearing where the veterans do not know what is available. Unless 

they know the right questions to ask, they do not know what is 

available. 

And I understand that is what you all are doing is reminding 

people what is available and how to ask the questions and how to 

access what it is that they should have because the government is 

not doing that. They are not telling everyone what they should get. 

Ms. BECK. The government tends to be in its own stovepipe essentially. So it is not only DoD and VA. DoD and VA, you know, 

for the most part recognize that there is a problem here and they 

are working on fixing it and they have got a ways to go, but they 

are working on it. 

These guys, they do not just have to deal with the DoD and VA, 

especially as the most severely injured. You have Medicare, Social 

Security Disability Insurance, the Department of Labor, the Department of Education, all of those agencies right in a row, and any 

one of them is difficult to navigate much less seven or eight of 

them as a severely injured servicemember or a 19-year-old spouse. 

Mr. MITCHELL. And I appreciate the fact that you are saying the 

VA recognizes they need to change. But, you know, that is in the 

long run. In the short run, you know, there are the Wades, the 

Owens. There are 19-year-old mothers. They have to live every day. 

And it is great that they see that they need to turn the ship 

around, but we have got people who are living right now. And that 

is who we need to take care of. 

Ms. BECK. Which is why it is so important, sir, that when we are 

creating—there is a common misperception out there that people 

like the Wades and Casey who were injured a little while ago that 

all of their problems are fixed now because they were injured a 

while ago. But it is so important that as we put these new policies 

and programs into place that we are reaching back to those families who came before and making sure that they are taken care of 

because they are the reason those programs were created in the 

first place. So that is of the utmost importance to the Wounded 

Warrior Project is to find those families who came before. 

Mr. MITCHELL. And just one last comment before I turn it over. 

Mr. Bowers talked about the need for bringing services out to the 

rural areas. It is a different kind of war. As you mentioned, it is 

not a draft. So most of the recruits are coming from rural areas 

and this is where the need is going to be. 

So instead of maybe in past wars where you can locate in large 

urban areas, the recruits, the needs are coming from different 

areas. And I think that is something that the VA needs to recognize. 

Mr. BOWERS. It is. And I would also add to that that it is very 

important to know that rural veterans do not necessarily have access to the Internet. So as we often hear that, well, we can put together a Web site and an outreach element, that is very effective 

for most, but only 8 percent of this country’s rural areas have access to broadband. 

You also have issues with individuals who have traumatic brain 

injury or post traumatic stress disorder. It is going to be extremely 

difficult for them to try and rely on a Web site to find answers. You 


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know, that is something that we have always said there needs to 

be that direct contact. 

And specifically at my Reserve center last weekend, we actually 

had the VA there. They were there to register every single Marine 

there. We also met with folks from the Vet Centers. There were six 

individuals there and we also completed an electronic version of 

our post-deployment health reassessment form. It was textbook. It 

was exactly what we needed to start doing the second these conflicts began and when troops started returning home. 

But there has been a long period of time since then and a lot of 

people have fallen through that gap. And the biggest takeaway was 

that it was not mandated. It was just my unit being proactive and 

saying we need to make sure our Marines get this. It is not a mandate by any way, shape, or form. 

Ms. BECK. Sir, Sarah will come after me if I do not point out 

that, yes, the rural veterans are certainly in need of the aspects. 

But what Sarah would point out and I will speak for her is that 

they were from Chapel Hill, North Carolina. They were in the 

heart of the research triangle and because of the way benefits were 

configured, they did not have access to the places they need to be. 

So that is also a concern. 

Mr. MITCHELL. Thank you. 

Ms. Brown-Waite. 

Ms. BROWN-WAITE. Thank you. Thank you, Mr. Chairman. 

Mr. Bowers, when I read your biography, it was one of those moments when you say ‘‘wow.’’ Thank you so much for your service 

as a Marine and for your two voluntary tours in Iraq. 

Mr. BOWERS. Another one coming up in January, too, so I will 

miss you guys. 

Ms. BROWN-WAITE. Please stay in touch by the Internet. You 

heard me before say about the importance of staying in touch with 

your Member of Congress. 

I congratulate you on your award for the Purple Heart. You 

know, it is amazing that the sniper round hit your rifle scope. You 

know, we can only hope that you, too, had him in the scope of your 

rifle. 

You had indicated that your organization has about 80,000 active 

members. 

Mr. BOWERS. Yes, ma’am. 

Ms. BROWN-WAITE. Could you tell us how many of the approximately 80,000 active members would fall in the category of today’s 

hearing, just a percentage, and can you give us any specific complaints, shortfalls, or perhaps unaddressed issues that we have not 

touched on today? In other words, people and issues that kind of 

fall through the cracks. 

Mr. BOWERS. I would say that of our membership, we have relatively low numbers of individuals who deal with polytrauma centers and who have been injured. With that said, I spend a lot of 

time up at Walter Reed and Bethesda just hearing from the 

servicemembers and finding out what their difficulties are. 

The biggest thing that I have come across is the lack of support 

for families. I would say that is the number one thing that we have 

heard from folks at a lot of different levels. Many times with families, and Ms. Wade was right on with this, you know, she is, you 


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know, bearing the brunt of a lot of the lack of support networks 

and things for these wounded servicemembers. And that is probably the biggest thing I have heard across the board there. 

Ms. BROWN-WAITE. Have you heard of any of the other polytrauma units actually hiring the spouse to work in the VA hospital? I know that down in Tampa in Haley Hospital, they actually 

do that. Is that happening around the country in the other polytrauma units? 

Mr. BOWERS. I have not heard of any cases. I have heard of one 

case where someone was offered a job, but the polytrauma center 

was 4 hours away, so they could not facilitate the move. 

Ms. BROWN-WAITE. This actually was a family that moved to 

Tampa to be close to the servicemember while he was being treated 

there. And I thought that is wonderful. We should encourage that. 

You know, if they want to work or if they need to work, that is a 

great way to provide families support and have that person right 

there in the hospital. 

Ms. BECK. Ma’am, if I could, one of the primary objectives of the 

Wounded Warrior Project, we do not have members, but that is our 

sole base is attempting to have caregivers compensated for the 

work that they are doing. 

The VA actually already has this program for spinal cord injury 

patients. And they train, certify, and make eligible for compensation those family caregivers. 

In many cases, I know that it may not be the most ideal situation for the family member to be providing that care, but they are 

doing it anyway. 

So what we would ask is that through those programs, looking 

at that San Diego VA where they provide that service, looking at 

replicating that especially for the most severely injured, brain injured servicemembers where their families are often leaving their 

jobs and providing that care really and suffering from extreme financial distress from doing so. 

Ms. BROWN-WAITE. Do you have an estimate of how much the 

proposed respite care pilot program would cost the VA? 

Ms. BECK. I do not have an overall estimate. I would say that 

since it would be done with the universities and the students would 

be not paid, they would be getting course credit for doing that, it 

would really be a cost of organizing and coordinating, not necessarily the payment process for providing that service. 

Ms. BROWN-WAITE. We are having the Blackberries going off and 

it is not to be rude, but we have to have them on so we know when 

once again we will be called to the floor. 

Do you have any additional suggestions that you did not include 

in your testimony? 

Ms. BECK. Gosh, I could go on forever, but I will not. 

Really I think Todd hit the nail on the head with the family aspect of this, including the families in the care aspect of it, and also 

understanding that without the families, the VA would be in a lot 

of trouble, and that we rely on them tremendously. And for that 

aspect, the issue of coordination among the agencies which I know 

is something that we have talked about before, but it is of utmost 

importance. 


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I had someone from the Department of Defense, from TRICARE 

tell me, we were trying to resolve a very complex issue that faces 

these servicemembers about their eligibility for Medicare and 

TRICARE, and her response was what do you want me to do, hand 

walk these guys through the process. That was my answer. So, yes, 

yes, actually. Then we solved the problem. 

Ms. BROWN-WAITE. That is that person’s job? 

Ms. BECK. The awareness factor here is tremendous and promoting that awareness of what these servicemembers do and how 

the families are suffering should not be borne by only those people 

who happen to be either interested in or happen to be suffering 

from it. So the increased awareness from Members of Congress, 

their staff, down to every citizen in the United States is absolutely 

imperative. 

Mr. BOWERS. One portion that I did not include in my testimony, 

but I would point the Subcommittee toward, the Independent Budget makes a lot of comments in regards to nursing home care. A tremendous amount of veterans are coming home and having to rely 

on nursing home care because of the increased amount of traumatic 

brain injuries that we have seen in the wars in Iraq and Afghanistan. 

What we have heard from our membership and from personal 

stories from individuals is that it is hard to be a 22- and 25-yearold in a nursing home, in a VA nursing home. There is not a lot 

going on for these younger veterans and they are still young, vibrant individuals who still have their entire lives to look forward 

to. And the resources are not necessarily made available to them 

to be able to continue to better themselves. 

And whether it be educational resources, social activities, things 

along those lines, there is a gap for a lot of those folks that are 

at the nursing homes. And there has also been some discrepancies 

that the Independent Budget also identifies that there has been a 

shortage of beds within these nursing homes also. 

Ms. BROWN-WAITE. I know that there is a program of assisted 

living where the person truly just needs some assistance. Do we 

need to focus more resources on that? And I happen to personally 

agree with you. I come from Florida. I know that the majority of 

people in nursing homes in Florida are elderly. And there is a great 

divide there and a lack of common interest even. And so is the answer more assisted living facilities and specific nursing homes for 

OIF/OEF returning warriors? 

Ms. BECK. I think we need to be careful, however, because we do 

have an opportunity here because this is a smaller population. But 

if we build these large facilities just for OEF/OIF servicemembers, 

then their families will have to travel to those facilities because 

there just are not enough of them, of a need there. 

So building a facility is maybe one option, but I think that looking at the options of, you know, thinking outside the box here. We 

have individuals with individual needs. We should take this as an 

opportunity that we have of such a small population and perhaps 

leverage community resources and leverage those things that are 

already there to be able to provide the best care and nursing home 

care near these people’s homes. 


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Ms. BROWN-WAITE. Do you think that the veteran population 

would resist perhaps, especially in rural areas, a contract with a 

service provider of respite care, of physical therapy? I mean, we 

want to make sure the services come to the veteran who needs 

them. 

Mr. BOWERS. I would definitely stand by that individuals when 

given the choice whether they need to stay at a nursing home or 

be at home with assisted living will much rather be at home with 

assisted living. It allows them to be out involved more with the 

community. So I would say yes to that. 

If they do require a nursing home, if they do not have the family 

support and, therefore, they do have to live in a nursing home, 

those steps to make it easier for these individuals would be much 

more effective. 

But I would agree with Meredith that by going out and developing centers specifically for OIF/OEF veterans may be a bit much. 

We need to think long term. 

And, you know, just speaking with my Marines, we know the 

Global War on Terrorism is never going to end. So we have got a 

lot of work to do. 

Ms. BROWN-WAITE. Please thank your Marines for us and thank 

you for again going back and thank you for your service. 

And, Ms. Beck, thank you for all that you do. 

I yield back. 

Mr. MITCHELL. Thank you. 

And thank you very much. 

I would like at this time to welcome panel three and I am probably going to mess your name up. I am sorry. Dr. Madhulika. 

Dr. AGARWAL. Madhulika Agarwal. 

Mr. MITCHELL. Agarwal. Thank you. Is the Chief Patient Care 

Services Officer for the Veterans Health Administration (VHA). We 

look forward to hearing from her and her team. 

Let me just say before you start, and I appreciate you being here 

and I know that you are also a messenger, and hopefully what you 

heard today, what we all heard today brings some results and some 

fruits because it is just frustrating when we hear these things and 

we write it down and it is just another report somewhere. 

You have heard today real needs and real concerns. And I suspect that you are in a position to do something about it, at least 

we hope so. Thank you. 

STATEMENT OF MAHDULIKA AGARWAL, M.D., MPH, CHIEF OFFICER, PATIENT CARE SERVICES, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; 

ACCOMPANIED BY KRISTIN DAY, LCSW, CHIEF CONSULTANT, 

CARE MANAGEMENT AND SOCIAL WORK SERVICE, OFFICE 

OF PATIENT CARE SERVICES, VETERANS HEALTH ADMINISTRATION; AND LUCILLE BECK, PH.D., CHIEF CONSULTANT, 

REHABILITATION SERVICES AND, PROGRAM DIRECTOR FOR 

AUDIOLOGY AND SPEECH PATHOLOGY PROGRAM, OFFICE 

OF PATIENT CARE SERVICES, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Dr. AGARWAL. Thank you. 


jbell on PROD1PC69 with HEARING
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Good afternoon, Mr. Chairman and distinguished Members of the 

Subcommittee. Thank you for the opportunity to testify before you 

on the Department of Veterans Affairs care for seriously wounded 

veterans after they complete their inpatient care. 

I am accompanied by Dr. Lucille Beck on my right, who is the 

Chief Consultant for Rehabilitation Services, and Ms. Kristen Day 

on my left, who is the Chief Consultant, Care Management and Social Work Services. 

I would like to request that my written statement be submitted 

for the record. 

Mr. MITCHELL. Yes, it will. 

Dr. AGARWAL. Thank you. 

With your permission, sir, before I begin my oral testimony, I 

would like to thank Corporal Owens, Sergeant Wade, and Ms. 

Wade. As you said earlier, they have tremendous courage and enormous resilience. I want to thank them for their sacrifice and for 

their service to our country. 

We have heard your story and with your input and your support, 

we will continue to work every day to enhance and improve our 

healthcare system. 

VA is committed to providing the scope of services that ensure 

a continuum of world-class care, which extends from acute rehabilitation to vocational and community reentry programs for all veterans at locations closer to their home and communities. 

In May 2007, VA expanded the case management program for 

OEF/OIF veterans in response to the President’s Commission on 

Care for America’s Returning Wounded Warriors. 

VHA and the Veterans Benefits Administration (VBA) established new procedures for the transition of care, coordination of 

services, and case management of the OEF/OIF veterans. 

This program represents an integrated team approach located in 

VA medical centers. Now the OEF/OIF veterans are screened for 

case management needs and those with severe injuries are automatically provided a case manager. Additionally, any veteran who 

requests a case manager is also provided one. 

VA provides clinical rehabilitative services in several specialized 

areas that employ the latest technology and procedures to provide 

our veterans with the best available care and access to rehabilitation for polytrauma and traumatic brain injury, spinal cord injury, 

visual impairment, mental health, and other areas. 

In October 2007, as recommended by the Dole-Shalala Commission, we have partnered with DoD to establish the Joint VA/DoD 

Federal Recovery Coordination Program. The Federal Recovery Coordinator, or the FRC, is intended to serve all seriously injured 

servicemembers and veterans regardless of where they receive 

their care and has the unique authority to navigate within and between the VA, DoD, and the private sector. 

These newly established FRCs will collaborate with VA medical 

centers, military treatment facilities, and private-sector treatment 

teams during recovery and rehabilitation phase to ensure that veterans receive the right services at the right time. 

VA is committed to providing key services to assist caregivers 

with case management service coordination and support for the 

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sources such as legal assistance, financial support, and housing assistance. 

Eight caregiver assistance pilot programs were awarded grants 

in October 2007 to explore options, providing support services for 

caregivers in areas across the country, especially in areas where 

few such options are available. 

In February 2008, VA’s Under Secretary for Health approved 

funding to enhance programs that provide specialized support and 

care in home and communities that facilitate the transition and 

support of seriously injured veterans. 

These programs include the Volunteer Respite Program which 

will create access to the needed home respite services for family 

caregivers, and the Medical Foster Home Program which provides 

an in-home alternative to nursing home care, merging personal 

care in a private home with medical and rehabilitation support 

from specialized VA home care programs. 

These programs will aid seriously injured veterans living in their 

own homes and those who are no longer able to live independently, 

but prefer an in home alternative within their community. 

Moreover, in compliance with the 2008 ‘‘National Defense Authorization Act,’’ VA is collaborating with the Defense and Veterans 

Brain Injury Center to design and execute a 5-year pilot program 

to assess the effectiveness of providing assisted living services to eligible veterans to enhance their rehabilitation, quality of life, and 

community reintegration. 

VA is providing outreach both locally and nationally to veterans 

and servicemembers. This begins with a letter from the Secretary 

of Veterans Affairs providing information about healthcare and 

other benefits while thanking them for their services and welcoming them home. 

VA works with the DoD in implementing the post-deployment 

health reassessment and among National Guard and Reserve component. 

Additionally, VA established a national polytrauma Web site and 

a polytrauma call center. The call center is available 24 hours a 

day, 7 days a week for families and patients for questions about 

care as well a polytrauma system of care. This center is staffed by 

healthcare professionals. 

We are honored to provide care and service to America’s veterans. VA has the unique privilege of having a lifelong commitment 

to those who have borne the battle in service to our country. 

For those who return from combat with serious injuries or illness, we work closely with DoD to ensure a continuum of care, but 

we also work with those who do not need immediate care to make 

it as accessible as possible. 

Thank you again for the opportunity to testify before you and for 

your input. I will be happy to address your questions at this time. 

[The prepared statement of Dr. Agarwal appears on p. 57.] 

Mr. MITCHELL. Thank you very much. 

There is a couple of things that I heard about the programs you 

had and I think you heard some response by the first panel about 

some of the programs. 

And Web sites may be good, but what are we doing about individualizing, people who do not access the Web sites, people who 


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cannot access the Web sites, people who cannot because they do not 

know how, or they are not connected with the internet? 

You know, one of the things that I think, and I want to say this 

in general, because as we listen to these individuals, and this is a 

different war with different injuries, you are going to have a much 

different clientele than the VA is used to having. 

We heard even from the last panel about young veterans being 

in care centers, 24-year-olds, 25-year-olds. There is a difference. 

And I think that someone needs to recognize the difference and 

also the fact that it is great for the long term that we are changing 

the VA. 

But, again, these people are living right now and these people 

need services now. They need respite care now. They need people 

to guide them through now. And it is great to have long-term vision and do this, but I am concerned about what is happening right 

now. 

One of the things that I have been concerned about since the 

very beginning is the records and tracking the records. And I hope 

that you will be able to get the records that were asked for in the 

very first panel. 

And I am going to ask you again to get those records and we are 

going to check back that all the complete records that these people 

deserve and should have, are received. And if you would afterward 

find out how to contact them so they can get their records. 

Dr. AGARWAL. Yes, sir. 

Mr. MITCHELL. The other thing that is important, and I think 

you recognize this by listening to these people, that total care is a 

family thing and that if families do not get the help, and we heard 

earlier and in the very first panel where a 19-year-old mother finally just gave up and left. This is what we are dealing with. It 

is not just the soldiers. 

In fact, when I went to Iraq, we heard from the military people 

at that time that because this is an all-volunteer Army and all-volunteer service now, they are recruiting families. It is not just the 

soldier. So the families are a very important part of the total service and, therefore, the families should be treated in the same way 

that the individual servicemember is treated. 

One of the things that is important, and I knew this from being 

a government teacher and involved with all levels of government, 

you know, it is important to have a trust in government. And sometimes the only government agency, wherever it is, whatever level, 

that a person goes to gives them an attitude about the whole government in general. And I am not talking local or State. All of 

them. 

And it sounds to me from the very first panel that Corporal 

Owens just gave up. He did not trust the VA anymore. He went 

to private providers. This is horrible. And how do we get people to 

continue to volunteer not only for the military, but in government 

service in general if they lose trust because it is too much trouble, 

it is too big, they do not take care of their needs? 

And you are an important part of helping build trust in government because I do not know of anyone, and you have heard this 

up here, who does not believe that these soldiers, deserve the very 


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best. They are giving up more than the general public because this 

is a volunteer Army. 

The other thing I want to mention that there was an office, the 

Office of Seamless Transition that was created and it was supposed 

to be a point of contact between the veterans and the DoD. And 

this office was disbanded almost immediately after it was implemented. 

And we continually talk about a seamless transition from the 

DoD to VA. I want to ask if you know why this office was disbanded and why we have not been working toward a seamless 

transition? 

Dr. AGARWAL. I am sorry if I may answer the last question. We 

do have seamless transition processes currently in the Central Office. And, in fact, Kristen Day’s office in the Office of Patient Care 

Services has assumed a large part of that responsibility of working 

with the DoD as well as working within our own system in the VA. 

Mr. MITCHELL. So you are saying that the Office of Seamless 

Transition is in effect, it is there, or is it just individual departments within the VA that are trying to bring about a seamless 

transition? 

Dr. AGARWAL. I—— 

Mr. MITCHELL. If you do not know, that is okay. But I would like 

if you would check into it and get back to us. 

Dr. AGARWAL. I will check into it and get back to you. 

Mr. MITCHELL. What happened to this office? What has happened to making sure—— 

Dr. AGARWAL. Sure. I will do that. 

Mr. MITCHELL [continuing]. That there is a seamless transition? 

Dr. AGARWAL. Yes. 

[The following information from VA was subsequently received:] 

Question: Why was the Office of Seamless Transition dissolved? Who 

has taken on their responsibilities? 

Answer: The Office of Seamless Transition is not dissolved; rather, it is 

reorganized to best allow for the operation and management of the component parts. The component parts evolved as the mission expanded, and the 

logical placement of the work became evident. The Office of Seamless Transition has transitioned into the following three categories: clinical, outreach 

and policy. 

Care Management and Social Work Services (Care Management) is responsible for the clinical component. Care Management works closely with 

Polytrauma, Rehabilitation, Social Work, and Mental Health Services. 

These program offices are all under the single VHA organizational structure of Patient Care Services. Military liaisons, VBA and our internal social 

work and nursing staff members are responsible for patient issues. 

This new office’s missions are to coordinate patients’ health care and to 

partner with VBA in meeting their benefits needs. OEF/OIF coordinators 

at each VA medical center and benefits office coordinate with DoD discharge staff to facilitate a continuum of care and services at locations nearest the veteran’s residence after their military discharge. This coordination 

allows enhanced identification of these veterans at their local VA facilities 

for processing of benefits claims and continuity of medical care. 

VA/DoD Coordination is responsible for the VHA OEF/OIF outreach component. This component works with the Reserve and National Guard and 

closely with DoD. For example, starting in May 2008, VA/DoD Coordination 

began making phone calls to 17,000 veterans who may have a need for care 

management, and to 550,000 separating Guard/Reserve veterans who may 

not be aware of the VA health care system. VA/DoD Coordination also coordinates efforts with Reserve and National Guard Units on DoD’s Post-Deployment Health Reassessment (PDHRA) Initiative. During the period NoVerDate Aug 31 2005 01:43 Dec 23, 2008 Jkt 041376 PO 00000 Frm 00048 Fmt 6633 Sfmt 6621 E:\HR\OC\A376.XXX A376

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vember 2005 thru May 2008, Vet Centers staff have supported over 1,400 

PDHRA On-Site and Call Center Unit level events along with DoD’s 24/7 

PDHRA Call Center. These Reserve and National Guard PDHRA activities 

have generated over 60,000 referrals to VA Medical Centers and Vet Centers. 

The OEF/OIF Policy Coordination Office is responsible for the policy component. The Executive Director and staff serve the Under Secretary for 

Health in a special assistant role created to address the numerous Commission, Task Force and report recommendations that have come out in the 

past year. The Policy Coordination Office works with several offices, departments and agencies within and outside of VHA to facilitate changes. The 

office also serves as the Under Secretary for Health’s daily contact point for 

Senior Oversight Committee (SOC) activities. 

Mr. MITCHELL. And one last question before I turn it over. The 

Federal Recovery Coordinators, what kind of benefits will they provide? Are they going to be able to provide not only medical benefits 

and information but also the general benefits that every veteran is 

entitled to? 

Dr. AGARWAL. Sir, they are the overarching coordinators and so, 

therefore, they will have the ability and the authority to oversee 

all benefits. 

Mr. MITCHELL. Not only medical—— 

Dr. AGARWAL. Not just healthcare—— 

Mr. MITCHELL [continuing]. But all the benefits. 

Dr. AGARWAL [continuing]. But all, yes, sir. 

Mr. MITCHELL. We are talking about GI Bill, everything. 

Dr. AGARWAL. Yes, sir. 

Mr. MITCHELL. Thank you. 

Ms. Brown-Waite. 

Ms. BROWN-WAITE. Thank you. 

And as you can tell, we have votes that have started. 

Doctor, why are the VHA and VBA just now jointly developing 

a comprehensive list of severely injured OEF/OIF veterans? Is this 

not something that should have been done all along, that the Department should have been tracking? 

Dr. AGARWAL. Thank you for that question, ma’am. 

Yes, they have been tracking. But I think they are working on 

the proper requirements and the definitions in that list. There is 

such a list that exists at this point in time between the two departments and we are further refining it. 

Ms. BROWN-WAITE. When did the list start to be created? 

Dr. AGARWAL. In fact, very soon, we have an initiative in place 

which is going to work toward outreaching for all those that were 

mentioned earlier who may not have come into our system, to have 

the telephone contact so that we can then connect them to our 

OEF/OIF case management programs as well as to the right kinds 

of individuals in our own healthcare system. 

Ms. BROWN-WAITE. Let me make sure I understand what you 

said because I do not think you answered my question. How long 

ago did you start this list? 

Dr. AGARWAL. Ma’am, I will have to take that for the record and 

get back to you. I do not know when we started this list. 

[The following information from VA was subsequently received:] 

Question: Why are VHA and VBA only now tracking seriously injured 

(SI) veterans? When did this process start? 


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Answer: The Department of Veterans Affairs (VA) began tracking seriously injured veterans in 2003 by placing VA Liaisons for Health Care and 

benefits counselors at those military treatment facilities serving as key 

medical centers for seriously wounded returning troops. VA experimented 

with organizing this data several different ways, but found earlier versions 

were not sufficiently responsive to clinical and care management needs. VA 

is now working with the Department of Defense to consolidate data into a 

single, comprehensive list. 

VHA’s Care Management and Social Work Service, in collaboration with 

VBA, is overseeing the development of a VA national list of severely injured 

patients from Operation Enduring Freedom (OEF) and Operation Iraqi 

Freedom (OIF) treated in VA’s health care system. This national VA list integrates information across programs and includes patients receiving VA 

care management within the following programs: (1) Spinal Cord Injury, (2) 

Polytrauma, (3) Visual Impairment, and (4) Amputation. Each list also 

identifies Care Managers in these program areas, the VBA regional office 

of jurisdiction, and the OEF/OIF Coordinator responsible for case managing 

the servicemember or veteran’s claims. 

VA also developed a Web-based system that will identify care managers, 

by name, across the VA system for patients whose care falls into the four 

categories mentioned above. Additional features were built into this online 

system to identify care management follow-up timeframes and issues identified in the care management process. VA implemented the application on 

April 29, 2008. 

VA staff gathers critical information about servicemembers medically 

evacuated from the war zones in and around Iraq and Afghanistan shortly 

after their arrival at military treatment facilities in the United States. Additionally, VA medical centers and Regional Offices established local teams 

to provide benefits, services, and track care management locally throughout 

their program areas. In April 2007, VA implemented the Veterans Tracking 

Application (VTA), a modified version of the DoD Joint Patient Tracking 

Application (JPTA) that tracks the movement of medically evacuated 

servicemembers, and their medical information, from the theater of operations to MTFs. VTA merged information from existing spreadsheets and 

other programs to form one Web-based system that allows users from different locations to access real-time information about the servicemembers 

and veterans we serve. 

Not all servicemembers or veterans transition from an MTF to a VA medical center. The newly created Federal Recovery Coordination Program 

identifies these individuals and assists in coordinating their care as required. 

Ms. BROWN-WAITE. A ballpark. Last year, last 2 years, last—— 

Dr. AGARWAL. I am going to ask Kristen Day. 

Ms. DAY. The original Office of Seamless Transition began consolidating information and the list, I believe, in approximately 

2005. The clinical care of those individuals are consolidated in the 

new Office of Care Management and Social Work. 

And the coordination, we have VBA representatives in our office. 

We have DoD representatives in our office. And we are refining 

and building a list that is more comprehensive and has more data 

elements attached to it. So the list has been in existence for several 

years, but we are implementing a strategy that will go beyond a 

list and identify the single point of contact case manager, the current needs, and the current status. 

Ms. BROWN-WAITE. Okay. So it is a refined list is what I think 

I am hearing you say? 

Ms. DAY. Yes, ma’am. 

Ms. BROWN-WAITE. Okay. Doctor, in your testimony, you mentioned medical foster homes and volunteer respite services. We unfortunately have found that many times when you have volunteers 

that their intentions are not always what we would hope that they 

would be. 


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What kind of screening procedure do you have or plan on having? 

What kind of background checks are you going to be doing for these 

volunteers to protect the obvious wounded military person? 

Dr. AGARWAL. Yes, ma’am. Thank you for that question. 

May I just address the issue of the medical foster homes? This 

program has been in effect for several years at this point in time. 

It actually started in Arkansas and has been scaled to some other 

areas and has also been used in a pilot program setting with the 

spinal cord injury and disease programs. It has proven to be remarkably successful with seemingly high satisfaction rates much to 

the surprise of our own staff as well as, of course, the families and 

the veterans. 

So there is fairly intense screening that goes on before the veterans are placed in these settings, which includes home inspections, which includes regular visits, which includes all kinds of 

background checks, as well as constant vigilance. This is a medical 

foster home, so the individuals who are placed in these settings are 

also followed by our home-based primary care teams or the spinal 

cord injury and home care teams. 

And that is what is envisioned for the traumatic brain injury 

program at this moment. 

Ms. BROWN-WAITE. So I want to make sure that I fully understand what your plans are. You are going to have extensive background checks done on the volunteer respite program? 

Dr. AGARWAL. Ma’am, let me confirm the extensive piece of it, 

but I know that for—— 

Ms. BROWN-WAITE. Doctor, I am sorry. I did not mean to be disrespectful. If you do not do criminal checks, that is criminal. 

Dr. AGARWAL. I agree with you. 

[The following information from VA was subsequently received:] 

Question: Please describe the background checks VA performs on volunteers in the Medical Foster Home and Volunteer Respite programs, as well 

as any other programs where volunteers provide in-home assistance to veterans. 

Answer: Volunteers who have home respite assignments require a Special Agreement Check (SAC) for fingerprints, which serves as a criminal 

background check. Volunteers are also checked against the List of Excluded 

Individuals & Entities (LEIE) database and the Healthcare Integrity and 

Protection Data Bank (HIPDB), both of which are administered by the Department of Health and Human Services (HHS). 

VA’s Medical Foster Home Program follows Federal Regulations for Community Residential Care (38 CFR 17.61 to 17.72). The home caregivers or 

sponsors are not volunteers, as they are paid by the veteran. VA is revising 

Community Residential Care regulations to clarify that Federal or State 

criminal background checks are required to participate in VA’s Community 

Residential Care programs. Currently, VA follows State regulations regarding mandated background checks. 

All VISNs and VA facilities accept and process volunteers according to 

the same standardized procedures outlined in the VHA Handbook 1620.01, 

‘‘Voluntary Service Procedures,’’ and the memorandum titled ‘‘Acceptance 

Requirements for VA Volunteers’’ from the Deputy Under Secretary for Operations and Management (10N), dated February 22, 2007. This handbook 

and the memorandum are attached. 

[The VHA Handbook 1620.01, ‘‘Voluntary Service Procedures’’ will be retained in the Committee files.] 

[The Memorandum entitled, ‘‘Acceptance Requirements for VA Volunteers’’ 

from the Deputy Under Secretary for Operations and Management (10N), 

dated February 22, 2007, appears on p. 63.] 


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Ms. BROWN-WAITE. Mr. Chairman, I yield back. 

Mr. MITCHELL. Thank you. 

Again, we are going to wrap up because we have had all the panels, but I just want to emphasize that I hope that you get the 

records for Corporal Owens and for Sergeant Wade, the medical 

records that they have been asking for since their injuries and get 

them to them. 

[The following information from VA was subsequently received:] 

The FRC provided hard copies of the results to Mr. and Mrs. Wade during their face-to-face meeting on March 6, 2008. Corporal Owens confirmed 

the receipt of his records on April 25. Additional information was provided 

to the Subcommittee, which will be retained in the Committee files. 

Mr. MITCHELL. Thank you very much—— 

Dr. AGARWAL. Thank you. 

Mr. MITCHELL [continuing]. For being here. And I want to thank 

all our witnesses and thank you all again for something that is 

very important to all of us. 

Thank you. This Committee is adjourned. 

[Whereupon, at 1:00 p.m., the Subcommittee was adjourned.] 


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A P P E N D I X 

Prepared Statement of Hon. Harry E. Mitchell 

Chairman, Subcommittee on Oversight and Investigations 

We are here today to hear from veterans, their families, and the Department of 

Veterans Affairs about the long-term care of our most severely wounded Afghanistan and Iraq veterans. We know that DoD and VA provide the excellent inpatient 

healthcare for these warriors. But many of the most seriously injured require extensive outpatient care, some of them for life. Their families need care and assistance 

as well. Unfortunately, once these veterans leave the hospital, the care they receive 

does not seem to be on par with what they received directly following their injury. 

I think we can do better. 

Planning for veterans’ healthcare was not planned very well at the outset of this 

war. The need to provide care and assistance to wounded servicemembers, and their 

families, in significant number and for the long term has been largely ignored. We 

will hear today what it has been like for some of them. Their stories are inspiring 

but also discouraging. They are inspiring because—even after they have suffered 

terrible injuries—they carry no bitterness, only pride from their service. Discouraging because they have been left to fend for themselves for too long. 

The Department of Defense and the VA are large organizations with an overwhelming bureaucracy. Their care and services often overlap in messy and unpredictable ways. At a time of enormous stress, this bureaucracy only hurts the injured 

warrior and his family 

When our troops return from theater with serious injuries, they are met with a 

dozen seemingly unrelated people with different services. We addressed much of 

these problems last year with the passage of the Dignity for Wounded Warriors bill. 

But there is obviously still more to be done. 

We need to realize that families are an integral part of treatment and recovery, 

and have their own needs. Unfortunately, the VA is restricted from providing the 

many services families need and deserve when their sons, daughters, siblings, and 

parents return with service-connected injuries. 

We have been playing catch-up since the beginning of this war. It is irresponsible 

that the only support structure available to the 19 year old wife of an injured soldier 

is the wife of a similarly injured soldier. 

We are going to hear from people that have been dealing with the difficulties of 

the system for a long time. On February 14, 2004 Army Sergeant Ted Wade lost 

his right arm and suffered severed traumatic brain injury, along with many other 

injuries, in an IED explosion in Iraq. Sgt. Wade is here today with his wife, Sarah. 

Marine Corporal Casey Owens of Houston, Texas lost both his legs when his 

unarmored Humveee struck a landmine in Iraq on September 20, 2004. Corporal 

Owens and Mrs. Wade will tell us about the frustrations and difficulties they have 

faced, and we look forward to their testimony. 

Sarah and Ted Wade have devoted themselves to helping hundreds of other injured servicemembers and their families. And just 2 weeks after he was injured, 

Casey Owens told his family that he wanted a camcorder so he could document his 

progress from start to finish. He could only communicate by writing at the time of 

his request. He wanted to show his future children how far he had come and how 

good he’d had it. 

Today, you can find Casey gliding down the slopes at Aspen. We owe Corporal 

Owens and Sergeant Wade a great debt. We cannot repay that debt, but we can 

make sure that Corporal Owens and Sergeant Wade, their families, and everyone 

like them, get long-term care and services that are also world class. 

f 


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Prepared Statement of Hon. Nick Lampson 

a Representative in Congress from the State of Texas 

Thank you, Chairman Mitchell and Ranking Member Brown-Waite for inviting me 

to today’s hearing. I am honored to join you on this distinguished Subcommittee and 

am proud to introduce Corporal Casey Owens of Missouri City, Texas. Casey is an 

exemplary young man, and I commend him for his willingness to continue to serve 

his country and his fellow veterans. 

I was impressed when we met yesterday for the first time by all of his accomplishments. A graduate of Mayde Creek High School, he went on to the University of 

Texas. But following the attacks on September 11, he decided to join the Marines. 

He was deployed twice—the first time from February 2003 to October 2003 and the 

second time from August 2004 until September 20, 2004 when he sustained his injuries. During his time in the Marine Corps he received several medals in recognition 

of his distinguished service. 

Less than a year after sustaining his injuries, Casey successfully completed the 

Marine Corps Marathon in 2005 using a hand-cranked wheel chair with a time of 

approximately 21⁄2 hours—probably better than any of us here. He is currently 

training as a member of a competitive ski team in Colorado that has been recognized by the Paralympics and the VA as an official training center. 

Even more impressive than these accomplishments, in my opinion, is Casey’s advocacy for veterans’ care. He has worked with Mayor Bill White’s Veterans Task 

Force, which was established last year to address the needs of Houston’s veterans, 

both young and old, when it comes to housing, health and mental care, job training, 

and other issues. And he has come here today, to testify before Congress about the 

challenges new veterans in this country continue to face as they transition from 

DoD to the VA system and try to navigate it. 

Most impressive, though is the concern for his fellow veterans and those that will 

come after him. He is here today to ensure that our Nation’s future wounded warriors will not go through the same frustrations and feelings of neglect that he and 

his friends have experienced as the DoD and VA have struggled to adapt to a new 

breed of patients. They deserve much more in return for their service, and I commend Casey for his advocacy on their behalf. 

Thank you again, Chairman Mitchell and Ranking Member Brown-Waite for allowing me to join the Subcommittee today for this hearing. As a Representative 

from a State with of one of the Nation’s largest veterans’ populations, I sincerely 

appreciate your invitation, and would like to commend your leadership and the entire Committee for your commitment to all of our Nation’s veterans. I am especially 

pleased to be here to listen to the testimony of my constituent, Casey Owens, as 

well as the other witnesses. 

Care for veterans such as Edward Wade and Casey Owens was by trial and error, 

as there was no system of care in place for these new types of injuries—both external and internal. Casey expressed to me his worry that there are still issues with 

care for polytrauma patients today. And I was most impressed with his concern for 

those who will come after them and his hope that they will not come to Congress 

with the same exact issues, complications, and frustrations as we are hearing today. 

I am proud that this Congress has taken steps to address the issues—through 

record funding levels and new initiatives to address the injuries of these conflicts— 

multiple amputations, TBI, PTSD. The DoD and VA have initiated new, and innovative ways to help OEF and OIF veterans, but the system is still daunting and adapting to a new model for care has proven difficult. Casey pointed out however, that 

as he has traveled across the country, meeting and competing with fellow veterans, 

he has realized and encountered the disparity in care at VA centers across the country. He also brought up an important point to me—what are the new caseworkers 

and nurses doing? How is the new funding being put to use exactly? What are the 

results? As we are knee-deep in the budget season and approach the appropriations 

process, I believe these are critical questions that MUST be answered—so that veterans 2 to 3 years down the line do not come to us with the same problems. These 

wounded warriors deserve no less—they truly have made the ultimate sacrifice for 

our country and they do not deserve to be feel that they must jump through hoops— 

or worse, that they have been neglected, when they need our help the most. 

Over the past couple of years I have heard about the same issues from veterans 

across my district—as well as from the testimony we will hear today: increase options for care, increase coordination between DoD and VA regarding records and 

evaluations, increase coordination between departments of the VA, and the need for 


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more help for families and caregivers. Last year this Congress approved record 

funding levels and other legislation to address these issues—and I am eager to hear 

about the progress. As we are continuing to hear about these issues, I fear we still 

have a long way to go. The hurdles our soldiers and their families face should not 

be so difficult. 

f 

Prepared Statement of Corporal Casey A. Owens, USMC (Ret.), Houston, TX 

(U.S. Marine Corps Combat Veteran) 

I was seriously injured on September 20, 2004 while serving under 1st Battalion 

7th Regiment. I was assisting in a medivac (medical evacuation) to rescue Sgt. Foster 

Harrington when I ran over two anti-tank mines, which resulted in the loss of both 

legs. Consequently, I also suffered two collapsed lungs, numerous shrapnel wounds, 

pulmonary embolism, broken clavicle and jaw, perforated eardrums, trauma to my 

head. I was flown to Landstuhl, Germany from a field hospital in Iraq, and awoke 

from a coma 3 weeks later in Bethesda Maryland Naval Hospital. After numerous 

surgeries to stabilize me, I was transferred to Walter Reed Army Medical Center 

and Brooke Medical Center for my recovery phase. Over the next year and a half, 

I received more than sufficient care from these centers. 

I was retired February 26, 2006. Shortly thereafter, I had to return to Brooke 

Army Medical Center to have my right myodesis repaired for a second time. I enrolled into the VA on April 1, 2006. I had transitioned to care under the VA system 

and was no longer in the Department of Defense’s system. By this time, my right 

myodesis failed for a third time. After bringing it to the attention of the VA doctors, 

I was instructed to return to Brooke Army Medical Center for treatment. The doctor 

had suggested that I undergo the same procedure that I had the first two times 

again. I did not approve of their recommendation, and my objections had fallen on 

his deaf ear. I returned to the Houston VA letting them know I was not satisfied. 

It was not until 6 months later that the procedure I had requested and wanted 

was performed. The two previous surgeries took less than 72 hours to be approved. 

I decided to call on non-profit organizations for assistance. Organizations such as 

Semper Fi Fund, Marine for Life, Wounded Warriors and other non-government personnel helped me and their help was colossal. In my opinion, this reflects poorly 

upon the culture and decisions of the VA system currently in place. While some of 

the problems I have encountered have been resolved, many have not. The learning 

curve of VA’s system is steep and its bureaucratic maze is hard to understand. It 

has been 30 years since the last major war and what lessons has the VA learned 

since then? Did no one expect another war or learn anything from Viet Nam? What 

have the educated and highly paid personnel who have been appointed to correct 

the system been focusing their attention on? While the system continues to be broken, where is all the government funding going that is supposed to be fixing the 

system and what are they doing with it? 

A tremendous problem that I have encountered is the double standard of the VA 

and the Department of Defense’s claims and rating for veterans. It took me 3 to 5 

months of agonizing appointments and addendums to finalize my medical board, 

which were performed by competent and qualified military and civilian personnel. 

After I had completed my medical boards, I thought I was finished with that process, only to find out I was not. When I enrolled in the VA, it took almost another 

year and a half to finalize those claims. It is actions like this that make veterans 

avoid the VA. My qualms are not that the VA does not have enough programs in 

place to benefit veterans or the adequacy of it rather, it is the bureaucracy and red 

tape that are the problems. While many problems have been addressed, it is time 

for SOLUTIONS. 

A key solution to solving many problems is establishing an OIF/OEF Center. 

Though this idea has been explored by setting up OIF/OEF coordinators at every 

VA, it is not enough. There needs to be a centralized building or group of personnel 

specifically for them. A great example for the VA to emulate is something I experienced at Walter Reed and Brooke Army Medical Centers. There, key staff met weekly to discuss all aspects of patient care and kept an open line of communication between departments. For example, Joe Marine does not show up for physical therapy 

or his prosthetic appointments. With all of the departments communicating with one 

another, a psychologist may intervene and have some insight as to why he may be 

avoiding these appointments. It may be because he is suffering from severe PTSD 

and does not want to leave his room. From there, the department heads can agree 

on the best course of treatment and can initiate it in a holistic approach. Another 

matter I take great issue with, and have experienced it and continue to do so, is 


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the sharing of medial records between the Department of Defense and the VA. One 

solution may be the implementation of an ID card, similar to that which is in place 

for Active duty personnel. Each ID card has a microchip, which could contain all 

of their military and medical records accessible by a computer. 

The impression that I get from the VA is that some within the organization think 

it is the duty of the veteran to endure and resolve these problems on their own. 

Those, like me, who were paid as a Marine Corp Grunt to do their job to the best 

of their ability never questioned whether if we got injured my government would 

be there for me. We all knew it would. It is now time for those who are responsible 

for the VA to care for those who did their duty. 

This is my sworn testimony and I stand by it just as I stand by my Marine Corp 

and the job we did in Iraq. 

Semper Fi 

f 

Cpl. Casey Owens, 1–7 US 

Prepared Statement of Sarah Wade, Chapel Hill, NC 

on behalf of Sergeant Edward Wade, USA (Ret.) 

(U.S. Army Combat Veteran) 

Chairman Mitchell, Members of the Subcommittee, thank you for the opportunity 

to speak to you today regarding our experiences following my husband’s injuries in 

Iraq. My name is Sarah Wade. I am the wife of SGT Edward Wade, or Ted as he 

prefers to be called. 

My husband joined the Army’s 82nd Airborne Division during the summer of 2000, 

and following the attacks of September 11, he was called on to serve first in Afghanistan and later Iraq. On February 14, 2004, his humvee was hit by an Improvised 

Explosive Device on a mission in Mahmudiyah. He sustained a very severe traumatic brain injury, or TBI, his right arm was completely severed above the elbow, 

suffered a fractured leg, broken right foot, shrapnel injuries, visual impairment, 

complications due to acute anemia, hyperglycemia, infections, and would later be diagnosed with Post Traumatic Stress Disorder. He remained in a coma for over 21⁄2

months, and withdrawal of life support was considered, but thankfully he pulled 

through. 

As an above elbow amputee with a severe TBI, Ted was one of the first major 

explosive blast ‘‘polytrauma’’ cases from Operation Iraqi Freedom, Walter Reed 

Army Medical Center or the Department of Veterans Affairs (VA) had to rehabilitate. Much of his treatment was by trial and error, as there was no model system 

of care for a patient like Ted, and there still is no long-term model today. His situation was an enormous challenge, as Walter Reed was only able to rehabilitate an 

amputee, not a TBI, the VA was able to nominally treat a TBI, but not an above 

elbow amputee, and neither were staffed to provide appropriate behavioral health 

care for a patient with a severe TBI. Because Ted could not access the necessary 

services, where and when he needed them, he suffered a significant setback in 2005, 

that put him in the hospital for 2 weeks, and would take a year to rebound from. 

Ted has made a remarkable recovery by any standard, because we have strayed 

from standardized treatment, and developed a patient-centered path. I had to educate myself about, and coordinate, additional outside care. Often, access to the necessary services required intervention from the highest levels of government, or for 

us to personally finance them ourselves. But despite our best efforts, Ted is still unable to easily receive comprehensive care for all of his major health issues, due to 

shortcomings in the current system, and because of the time his needs demand of 

me, I have been unable to return to regular work or school. We have been blessed 

to have family, with the means to see us through these difficult times, and help 

with the expenses. I was fortunate to have the education, of growing up in Washington, D.C. and learning about the workings of the various Federal agencies. Our 

situation is not typical though. 

We have a few ideas, to provide better long-term care, we respectfully wish to 

share: 

Special Monthly Compensation for Integration, Quality of Life, Dependents’ 

Educational Assistance, and Respite Care 

Individuals like SGT Wade, who require someone to be available for assistance 

at all times, are not compensated appropriately. These Veterans would require residential care otherwise, but are not granted the higher level of Aid and Attendance, 

because they do not require daily healthcare services provided in the home by a person licensed to perform these services, or someone under regular supervision of a 


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licensed healthcare professional. We feel the criteria should be clearly outlined, so 

appropriate compensation may be granted in the case of an individual who needs 

assistance managing care, personal affairs, or requires support outside of the home, 

to rehabilitate and integrate into their community, or to achieve a better quality of 

life. 

Both in the past and at present, we have paid someone to assist Ted outside of 

the home. This allows him the flexibility to hire a peer of his choice, to provide community support, and accompany him on sightseeing outings he has researched and 

planned with his therapist as part of his community integration, to provide transportation to the store to purchase books for homework assignments, go to the community center to swim laps, or help him balance his checkbook at the end of the 

day. Not only has this enabled Ted to come closer to achieving independence, but 

it has greatly improved symptoms of depression by restoring hope and self confidence, allowed him to attain fitness goals and control his blood sugar without insulin injections, all while providing much needed respite care for me. Unfortunately, 

the current VA respite programs are not appropriate for a veteran like Ted. With 

better resources, I might be able to access the Dependents’ Educational Assistance 

for which I qualify, but our circumstances do not allow me to take advantage of, 

before the benefits expire. This would not only help me get back to having a life 

of my own, but raise Ted’s standard of living as well, by increasing my earning capacity. 

Compensated Work Therapy (CWT) for TBI 

Largely due to the success of the program we have created for Ted, the next phase 

of his recovery will probably include some sort of vocational rehabilitation. He has 

already had the opportunity to participate in volunteer work, through counseling 

and job coaching provided by a private practice near our home, where he attends 

a day treatment program for behavioral health and TBI. Now he is ready for the 

next stepping stone to employment. The current Department of Veterans Affairs Vocational Rehabilitation and Employment Service is more of a challenge than is 

healthy for someone with the significant cognitive deficits and the emotional needs 

Ted has. VA work therapy programs, while developing work tolerances and promoting effective social skills for the more seriously impaired, are set in an insulated 

environment. A work therapy program, expanded to other community settings, to 

accommodate patients like Ted, who are better served outside of a sheltered atmosphere, would be more effective. Volunteer or internship positions, or later, a parttime job that sparks his interest, would be more therapeutic. Not only would this 

help him acquire the confidence and independence he needs to someday become 

gainfully employed, but aid in his integration, by providing constructive, meaningful 

activities for him to participate in outside of the home. 

Counseling, Life Skills and Patient-Specific Case Management 

Although many basic therapies are offered, rarely do they include teaching socially appropriate behaviors, which are commonly an issue after a TBI. This task 

often falls on the veteran’s family member or spouse, increasing the responsibility 

of the caregiver, and causing conflict with the veteran, who feels he is being treated 

like a child. Ted has had the advantage of community peer support, but also a counselor at the private practice I have previously mentioned, to help him redevelop age 

appropriate social skills, allow me to be his spouse, and him to maintain his dignity. 

She has also worked with Ted to develop healthy coping skills, to manage cognitive 

deficits, improve mental health, and develop patient-centered treatment plans, 

which focus specifically on his unique challenges. Again, our situation is not typical 

though. This is something difficult to provide in an institutional care environment, 

like the Veterans Health Administration, without greater flexibility, and more resources to provide increased face time with the patient, and better injury-specific 

expertise. 

Conclusion 

The challenges we have faced are the same as countless other veterans, many of 

whom have not had the resources Ted has had available to him, or an advocate capable of negotiating the system. A veteran I often think about, who had a young 

wife with a newborn baby, and nothing more than a high school education, should 

have received the same world-class care as my husband, but sadly will not. Despite 

my best efforts to be a support to his spouse, who was overwhelmed by motherhood, 

while trying to negotiate a seemingly impossible system, she eventually left him, because it was more than she could handle. A veteran’s care should not depend on 

what family they were born into, who they married, or whether or not family obligations allow for their loved one to advocate for them, but sadly it does. Though we 

will never be able to fully compensate seriously wounded veterans for the sacrifice 


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they have made on our behalf, we can certainly do a better job of managing their 

care, rehabilitating them to their fullest potential in a timely manner, and providing 

the necessary resources to maximize their quality of life. I am pleased to see the 

Subcommittee is taking a look back to explore ways to learn from the past, and address the needs of the veteran injured yesterday. This will ultimately improve the 

care of the servicemember injured today, as well. Mr. Chairman, thank you again 

for the opportunity to share our story with you today. I look forward to answering 

any questions you may have for us. 

f 

Prepared Statement of Meredith Beck 

National Policy Director, Wounded Warrior Project 

Mr. Chairman, Ranking Member Brown-Waite, distinguished Members of the 

Subcommittee, thank you for the opportunity to testify before you regarding postacute care for the seriously injured. My name is Meredith Beck, and I am the National Policy Director for the Wounded Warrior Project (WWP), a non-profit, nonpartisan organization dedicated to assisting the men and women of the United 

States Armed Forces who have been injured during the current conflicts around the 

world. 

During the recent conflicts in Iraq and Afghanistan, there have been approximately 30,000 soldiers, sailors, airmen, and Marines wounded in action. Fortunately, due to advances in medical technology, the number of those killed in action 

is far lower. However, in many cases, as the wounded have suffered devastating injuries and require long-term outpatient care and rehabilitation, WWP is pleased 

that the Subcommittee has chosen to focus on this aspect. 

As a result of our direct, daily contact with these wounded warriors, we have a 

unique perspective on their needs and the obstacles they face as they attempt to 

transition, reintegrate, and live in their communities. As such, WWP has identified 

the following areas of concern: 

Options for Care: Specifically with respect to Traumatic Brain Injury, those suffering from TBI require individualized, comprehensive care, and while the VA has 

made progress in this area, the agency is still in the process of establishing an extensive, consistent, long-term continuum of care available throughout the Nation. As 

such, and due to the need for ongoing therapy and rehabilitation, many seriously 

injured veterans and families have indicated that their number one request is increased access to options for care, including access to private facilities previously 

available to them while on active duty. 

Discrepancies in Benefits: On a related topic, many veterans and families of 

the seriously injured have indicated confusion, frustration, and disappointment upon 

learning that they are not eligible for the same benefits and care as veterans as 

they were on active duty and vice versa. For example, consider that an active duty 

patient can be seen at a VA Polytrauma Center to treat his Traumatic Brain Injury. 

However, while at the VA facility, the servicemember, due to his duty status, cannot 

enjoy VA benefits such as Vocational Rehabilitation or Independent Living Services 

that can be helpful in his recovery. Alternately, as mentioned previously and unbeknownst to most families, a medically retired servicemember cannot use his/her 

TRICARE benefits to access private care as TRICARE does not cover cognitive therapy once retired. While there is an obvious need for an advantage to active duty 

service, those who are severely injured as a result of their service in an all-volunteer 

force deserve special consideration. 

The recently passed National Defense Authorization Act for FY2008 contained a 

provision intended to address these discrepancies. Specifically, section 1631 authorizes for a limited period of time the Secretary of Defense to provide any veteran 

with a serious injury or illness the same medical care and benefits as a member 

on active duty and entitles the severely injured still on active duty to receive veterans’ benefits, excluding compensation, to facilitate their long-term recovery and 

rehabilitation. While this provision recognizes the strengths of each agency and the 

necessity of basing an individual’s care and benefits on his/her medical condition 

rather than on military status, it is subject to regulation and will require significant 

oversight to ensure its success. 

Respite Care: For those who are seriously injured, one cannot discuss their care 

without discussing their caregiver. While the VA currently offers some respite care, 

the available options are often not entirely appropriate given the average age and 

types of injuries of those serving in Iraq and Afghanistan. For example, retired 

Army Sergeant Eric Edmundson suffered a severe brain injury in Iraq several years 

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ily and recently went fishing with his 3-year-old daughter Gracie. Eric’s family is 

unwilling to place him in a respite facility for fear that it could cause a regression 

in his rehabilitation and cause Eric distress. 

However, WWP has noted that similar to others, Eric’s family has used their personal funds to pay for an innovative type of individualized therapy that also provides a unique form of respite for the caregiver. In Eric’s case, rather than staying 

indoors all day, his family pays an individual to take him to the park to watch his 

daughter play. Eric thrives each time, and his progress and enjoyment are noticeable. 

As a result of Eric’s success as well as others in similar situations, WWP proposes 

that the Department of Veterans Affairs (VA) initiate a pilot program partnering 

with local universities to provide such a care/respite initiative for those with brain 

injury. As part of the veteran’s ongoing therapy, the program would draw graduate 

students from appropriate fields (i.e. social work, nursing, psychology, etc.), train 

them to interact with the veterans, and match them with eligible veterans in their 

local area so that an individualized program can be developed. In return for making 

the requisite reports to the veteran’s physician on his/her status, the graduate student would receive course credit. 

The creation of such a program would have several positive effects including: 

1. In recognition of the individual nature of Traumatic Brain Injury (TBI), the 

program would encourage an innovative means of providing age-appropriate 

maintenance therapy to those suffering from TBI. 

2. While the veteran is benefiting from the therapy aspects of the program, the 

family caregiver would be offered much needed respite. 

3. Interaction with the graduate students would increase general community 

awareness of the sacrifices of our Nation’s veterans and the needs of those suffering from TBI. 

Caregiver Compensation: Traumatic Brain Injury (TBI) has been widely identified as the ‘‘signature wound’’ of the Global War on Terror. While many organizations appropriately focus on the needs of the affected servicemember, the Wounded 

Warrior Project (WWP) has also identified the family caregiver as an individual in 

need of assistance. For example, in many circumstances, the spouse or parent is 

forced to leave his/her job to provide the necessary care for their loved one, leaving 

the entire family to suffer from an adverse economic situation. In these cases, the 

VA relies on the family member to assist in the servicemember’s care, but has been 

denied financial compensation for such labor. 

In recognition of this reality, WWP developed and endorsed legislation introduced 

by Representatives Salazar and Pascrell requiring the VA to train, certify, and 

make eligible for compensation the personal care attendants of severely injured TBI 

patients. This program would expand on one already in existence at the San Diego 

VA Medical Center for Spinal Cord Injury patients and would help alleviate some 

of the financial burden incurred by these families. WWP encourages the Subcommittee to review the program and help to ensure its implementation. 

Oversight: Finally, consistent with the recommendation of the Veterans Disability Benefits Commission and to ensure the best care and benefits for those who 

have sacrificed so much for our Nation, it is imperative that a joint, permanent 

structure be in place to evaluate changes, monitor systems, and make further recommendations for process improvement. This office must be structured to minimize 

bureaucracy and must have a clearly defined mission with the appropriate authority 

to make necessary changes or recommendations as warranted. With the passage of 

time, as veterans issues fade from the national spotlight, it will be necessary to 

have such a joint structure in place to ensure future inter- and intra-agency coordination. 

Mr. Chairman, thank you again for the opportunity to testify today, and I look 

forward to answering any questions you may have. 

f 

Prepared Statement of Todd Bowers 

Director of Government Affairs, Iraq and Afghanistan Veterans of America 

Mr. Chairman, Ranking Member and distinguished Members of the Committee, 

on behalf of Iraq and Afghanistan Veterans of America, and our tens of thousands 

of members nationwide, I thank you for the opportunity to testify today regarding 

this important subject. I would also like to point out that my testimony today is as 

the Director of Government Affairs for the Iraq and Afghanistan Veterans of America and does not reflect the views and opinions of the United States Marine Corps. 


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The tremendous advancements in frontline medical care have made many combat 

injuries more survivable. In Vietnam, the mortality rate for combat injuries was 1 

in 4, while the mortality rate in Iraq is 1 in 10. That means today’s battlefield medicine has saved approximately 6,000 American lives that would have been lost if we 

were still using Vietnam-era medical techniques. This is a tremendous success story 

for the DoD medical system. 

But the corollary of the improved survival rate is an increase in the number of 

severely wounded troops returning home. As the Independent Budget states, ‘‘We 

are seeing extraordinarily disabled veterans coming home from Iraq and Afghanistan with levels of disability unheard of in past wars.’’ Many of these young, wounded veterans will require long-term care, not just at Walter Reed and Bethesda, but 

in their communities across this country. At the VA, these veterans with Traumatic 

Brain Injury and blast injuries are confronting a system designed to treat diabetes 

and Alzheimer’s. 

The DoD and the VA have already taken some crucial steps to improve inpatient 

care for these young, severely wounded patients. There are four major Polytrauma 

Rehabilitation Centers, in Tampa, FL, Richmond, VA, Minneapolis, MN, and Palo 

Alto, CA, which use teams of physicians and specialists that administer individually 

tailored rehabilitation plans, including full-spectrum care for Traumatic Brain Injuries. These centers are also part of the Defense and Veterans Brain Injury Center 

network. 

These key centers offer cutting-edge treatment for the severely wounded troops 

who are receiving inpatient care. But what is available to troops near their homes? 

As of 2003, according to the GAO, ‘‘more than 25 percent of veterans enrolled in 

VA health care—over 1.7 million—live over 60 minutes driving time from a VA hospital.’’ This number is likely higher today, because the mission in Iraq has relied 

heavily on recruits from rural areas often underserved by VA hospitals and clinics. 

This places a tremendous burden on the families and also the veteran. With the current gasoline prices and many treatment centers hours away, treatment is often impossible to facilitate. Imagine if you will that your loved one has returned from combat wounded and it is your responsibility to make sure they are receiving the proper 

treatment. This is too much to ask of our servicemembers and veterans’ families. 

In response, the VA has created regional network sites that work with the major 

polytrauma centers to cater to patients closer to their homes. The VA is also planning to add new Polytrauma Support Clinics to provide followup services for those 

who no longer require inpatient care but still need rehabilitation. The 75 

Polytrauma Support Clinic Teams help veterans get access to specialized rehabilitation services closer to their home communities, and also are responsible for ensuring 

that these patients don’t ‘‘fall through the cracks’’ after leaving full-time care. For 

hospitals without a Polytrauma Support Clinic, a single person has been designated 

as the ‘‘point of contact’’ to coordinate care for local veterans with polytraumas. 

These are good first steps, but much more must be done to get these wounded 

veterans the care they need. A ‘‘point of contact’’ that can offer referrals to distant 


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1President’s Commission on Care for America’s Returning Wounded Warriors. ‘‘Serve, Support, and Simplify: Subcommittee Reports and Findings.’’ p. 20–21. Available online: http:// 

www.pccww.gov/docs/TOC%20Subcommittee%20Reports.pdf. 

hospitals and clinics is simply not an adequate response to a wounded veteran’s 

health care needs. IAVA joins the other IB–VSOs in calling for increased funding 

for home and community-based care, and a detailed plan from the VA regarding 

their long-term response to the needs of today’s veterans. 

Respectfully submitted. 

f 

Prepared Statement of Mahdulika Agarwal, M.D., MPH 

Chief Officer, Patient Care Services, Veterans Health Administration 

U.S. Department of Veterans Affairs 

Good morning, Mr. Chairman and Members of the Subcommittee. Thank you for 

the opportunity to discuss the Department of Veterans Affairs’ (VA’s) care for seriously wounded veterans after they complete their inpatient care. I am accompanied 

by Dr. Lucille Beck, Chief Consultant for Rehabilitation Services and Ms. Kristin 

Day, Chief Consultant Care Management & Social Work Service, Veterans Health 

Administration (VHA). 

VHA has long emphasized the importance of a personalized continuum of care for 

servicemembers. Our commitment extends beyond the initial transition across systems of care to ensure services continue to be provided to these individuals as veterans, and to their family members, who are essential to the recovery and rehabilitation of these injured warriors. 

It is important to emphasize, however, that neither the transfer between health 

care systems, nor the transfer to veterans’ status is a linear path. To ensure every 

veteran or servicemember receives the care and benefits they deserve, VA has created a Case Management Program for Operation Enduring Freedom/Operation Iraqi 

Freedom (OEF/OIF) veterans. The VA/DoD Federal Recovery Coordination Program 

(FRCP) further provides needed assistance and support for veterans and servicemembers with serious injuries or illnesses. VA’s provision of both inpatient and outpatient rehabilitation services in locations across the country is designed to meet 

the short- and long-term needs of veterans with serious injuries, including 

Polytrauma, Traumatic Brain Injury (TBI), Spinal Cord Injury (SCI), and mental 

health needs. These overlapping strategies of case management and coordination of 

rehabilitative care allow me to state with confidence that VA is adapting to the 

needs of our returning veterans and operating a system capable of providing lifelong 

care to them. These programs provide little net value if veterans are unaware of 

the services available to them; consequently, VA has pursued outreach on multiple 

levels to see that our veterans, particularly those with severe injuries or illnesses, 

can access our system and receive the care they have so bravely earned. 

OEF/OIF Case Management Program and Federal Recovery Coordination 

Program 

We deeply appreciate the recommendations of The President’s Commission on 

Care for America’s Returning Wounded Warriors, chaired by Senator Dole and 

Former Secretary Shalala. Specifically, we echo their description of the importance 

of integrated care management, which they describe as providing, ‘‘. . . patients with 

the right care and benefits at the right time in the right place by leveraging all resources appropriate to their needs. For injured servicemembers—particularly the severely injured—integrated care management would build bridges across health care 

services in a single facility and across health care services and benefits provided by 

DoD and VA.’’ 1

VHA and VBA published a joint handbook (VHA Handbook 1010.01) in May 2007 

establishing procedures for the transition of care, coordination of services and case 

management of OEF/OIF veterans. This joint Case Management Program represents a fully integrated team approach, and includes a Program Manager, Clinical 

Case Managers, a VBA Veterans Service Representative, and a Transition Patient 

Advocate. These teams are active at every VA Medical Center (VAMC). The Program Manager, who is either a nurse or social worker, has overall administrative 

and clinical responsibility for the team, and must ensure all OEF/OIF veterans are 

screened for case management needs. OEF/OIF veterans with severe injuries are 

automatically provided a case manager; all other OEF/OIF veterans are assigned a 

case manager upon request. Clinical Case managers, who are either nurses or social 

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viding care to the patient in a cohesive, integrated manner. VBA team members assist veterans by educating them on VA benefits and assisting them with the benefit 

application process. 

The Transition Patient Advocates (TPAs) serve as liaisons between the VAMC, 

the Veterans Integrated Service Network (VISN), VBA, and the patient. The TPA 

acts as a communicator, facilitator and problem solver. The team documents their 

activities in the Veterans Tracking Application (VTA), a Web-based tool designed to 

track injured and ill servicemembers and veterans as they transition to VA. VHA 

is also using the Primary Care Management Module (PCMM), an application within 

VHA’s VistA Health Information system, to track patients assigned to an OEF/OIF 

Case Management team. 

VA has developed a rigorous training schedule for this new program to ensure it 

is operating fully and effectively for all veterans requesting assistance. TPAs and 

VISN Points of Contact attended a training conference in Washington, D.C. in June 

2007, and Program Managers received training in September 2007. VA held a weeklong training conference in San Diego in January 2008 for Case Managers, and two 

regional training conferences for the entire OEF/OIF Case Management Team are 

planned for May and June 2008. 

As a part of this effort, VHA and VBA are jointly developing a comprehensive list 

of severely injured OEF/OIF veterans. The two administrations are defining the requirements and definitions for this list, and will establish a single record to track 

VHA or VBA contact each month with severely injured veterans and servicemembers. 

VA and DoD are working on jointly developing and implementing a comprehensive policy on improvements to the care, management, and transition of recovering 

servicemembers, pursuant to the National Defense Authorization Act of 2008. 

In October 2007, VA partnered with DoD to establish the Joint VA/DoD Federal 

Recovery Coordination Program (FRCP). The FRCP will identify and integrate care 

and services for the seriously wounded, ill, and injured servicemember, veteran, and 

their families through recovery, rehabilitation, and community reintegration. VA 

hired an FRCP Director, an FRCP Supervisor, and eight Federal Recovery Coordinators (FRCs) in December 2007. The FRCs are currently deployed to Walter Reed and 

Brooke Army Medical Centers, as well as National Naval Medical Center at Bethesda. Two additional FRCs are currently being recruited and will be stationed at 

Brooke Army Medical Center and Balboa Naval Medical Center in San Diego. The 

FRCP is intended to serve all seriously injured servicemembers and veterans, regardless of where they receive their care. The central tenet of this program is close 

coordination of clinical and non-clinical care management for severely injured 

servicemembers, veterans, and their families across the lifetime continuum of care. 

Caregiver Assistance 

The Caregiver Pilot Task Force was formed in response to a provision of the ‘‘Veterans Benefits, Health Care, and Information Technology Act of 2006’’. Eight Caregiver Assistance Pilot Programs were awarded grants beginning in October 2007, at 

a total cost of approximately $5 million. The goal is to explore options for providing 

support services for caregivers in areas across the country where such services are 

needed for families of disabled or aging veterans, and where there are few other options available. These programs will also increase the caregiver support services 

available to OEF/OIF veterans in the immediate future and the long term. Examples of these pilots include: 

• Home Based Primary Care programs, in Memphis and Palo Alto, are implementing interventions from the evidence-based REACH II National Institutes 

of Health Initiative to train and support caregivers in managing patient behaviors and their own stress. • Caregivers in Gainesville, Florida will participate in a Transition Assistance 

Program using videophone technology to provide skills training, education and 

supportive problem solving. • In Ohio, Caregiver Advocates will be available via telephone 24 hours a day 

to coordinate between VA and community services. • VA will work with a community coalition to provide education, skills, training, 

and support for caregivers of veterans with TBI in California, using telehealth 

technology. 

• The VA Pacific Islands Healthcare System will develop a Medical Foster Home 

program to provide overnight respite care for veterans. 

• In Miami and Tampa, funding will be used to expand respite care, train home 

companions, and develop an emergency response system. 

• Atlanta will use a model telehealth program to provide instrumental help and 

emotions support to caregivers who live in remote areas. 


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VA is committed to providing key services to assist caregivers with case management, service coordination, and support for the veteran, as well as education on how 

to obtain community resources such as legal assistance, financial support, housing 

assistance, and spiritual support. 

Medical Foster Homes and Volunteer Respite Services 

In February 2008, VA’s Under Secretary for Health approved funding for programs to facilitate the transition and support of seriously injured veterans with 

Polytrauma, TBI, and/or SCI by providing specialized support and care in their 

homes and communities. This program will aid both veterans living in their homes 

and those who are no longer able to live independently but prefer an in-home alternative within their community. The Volunteer Respite program will create access 

to needed home respite services for family caregivers, while giving members of the 

community an opportunity to volunteer with VA closer to home, regardless of distance from a VA facility. VA Voluntary Service would recruit, train, and coordinate 

community volunteers to provide respite care in the homes of OEF/OIF veterans. 

The Medical Foster Home component provides an in-home alternative to nursing 

home care, merging personal care in a private home with medical and rehabilitation 

support from specialized VA home care programs. 

Through these programs and others, VA will expand the availability of Medical 

Foster Homes (MFH) to seriously injured OEF/OIF veterans near specialized facilities within the communities in which they live. We will also expand the number of 

MFH sites and modify them to meet the needs of younger, seriously injured veterans with Polytrauma, TBI, and/or SCI, and strengthen the rehabilitation expertise 

of the VA home care teams who will serve them. Veterans with disabling injuries 

or conditions may need the support of a non-familial caregiver as they work toward 

independent living in the community, or may have long term care needs that initially, or eventually, exceed the capabilities their family can sustain. MFH may be 

a favorable alternative to nursing homes for these veterans as we facilitate their return to homes and communities. 

Rehabilitative Services 

VA provides clinical rehabilitative services in several specialized areas that employ the latest technology and procedures to provide our veterans with the best 

available care and access to rehabilitation for polytrauma and traumatic brain injury, spinal cord injury, visual impairment, and other areas. VA’s Under Secretary 

for Health directed our facilities to seek a second opinion from civilian physicians 

upon request. Whenever an OEF/OIF veteran requires specialized rehabilitative 

services, the assigned OEF/OIF case manager engages with the clinical case manager that is appropriate for that area of rehabilitation; e.g., polytrauma, spinal cord 

injury, blindness. Throughout the rehabilitative process, the OEF/OIF case manager 

coordinates with the appropriate clinical case manager regarding the veteran’s 

progress and rehabilitation. 

Polytrauma System of Care 

Over the past 2 years, VA has implemented an integrated system of specialized 

care for veterans sustaining traumatic brain injury (TBI) and other polytraumatic 

injuries. The Polytrauma System of Care consists of four regional TBI/Polytrauma 

Rehabilitation Centers (PRC) located in Richmond, VA; Tampa, FL; Minneapolis, 

MN; and Palo Alto, CA. A fifth PRC is currently under design for construction in 

San Antonio, TX, and is expected to open in 2011. The four regional PRCs provide 

the most intensive specialized care and comprehensive rehabilitation for combat injured patients transferred from military treatment facilities. As veterans recover 

and transition closer to their homes, the Polytrauma System of Care provides a continuum of integrated care through 21 Polytrauma Network Sites, 76 Polytrauma 

Support Clinic Teams and 54 Polytrauma Points of Contact, located at VAMCs 

across the country. Throughout the Polytrauma System of Care, we have established 

a comprehensive process for coordinating support efforts and providing information 

for each patient and family member. On February 27, 2006, VA established a national Polytrauma Call Center available 24 hours a day, 7 days a week, for families 

and patients with questions. This Center is staffed by health care professionals 

trained specifically in Polytrauma care and case management issues and can be 

reached by calling 1–888–827–4824. 

The care coordination process between the referring DoD military treatment facility and the PRC begins weeks before the active duty servicemember is transferred 

to VA for health care. The PRC physician monitors the medical course of recovery 

and is in contact with the MTF treating physician to ensure a smooth transition 

of clinical care. The admissions nurse case manager maintains close communication 


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with the referring facility, obtaining current and updated medical records. A social 

work case manager is in contact with the family to address their needs for psychosocial and logistical support. Prior to transfer, the PRC interdisciplinary team meets 

with the DoD treatment team and family by teleconference as another measure to 

ensure a smooth transition. The PRCs provide a continuum of rehabilitative care including a program for emerging consciousness, comprehensive acute rehabilitation, 

and transitional rehabilitation. Each of the PRCs is accredited by the Commission 

on Accreditation of Rehabilitation Facilities (CARF). Intensive case management is 

provided by the PRCs at a ratio of 1 case manager per 6 patients, and families have 

access to assistance 24 hours a day, 7 days a week. The interdisciplinary rehabilitation treatment plan of care reflects the goals and objectives of the patient and/or 

family. 

From March 2003 through December 2007, the PRCs provided inpatient rehabilitation to 507 military servicemembers injured in combat theaters. The transition 

plan from the PRCs to the next care setting evolves as the active duty servicemember progresses in the rehabilitation program. Families are integral to the team 

and are active participants in therapies, learning about any residual impairments 

and ongoing care needs. The team collaborates with the family to identify the next 

care setting, and determine what will be needed to accommodate the transition of 

rehabilitative care. The consultation process includes a teleconference between the 

PRC team, the consulting team, the family, and the patient. These conferences allow 

for a coordinated transfer of the plan of care, and an opportunity to address specific 

questions. 

Prior to discharge, each family and patient is trained in medical and nursing care 

appropriate for the patient. Once a discharge plan is coordinated with the family, 

VA initiates contact with necessary resources near the veteran’s home community. 

Based upon location, an agreement is reached with one of the 21 VA Polytrauma 

Network Sites or an appropriate local provider within the patient’s community. As 

veterans and servicemembers transition to their home communities, ongoing clinical 

and psychosocial case management is provided by a rehabilitation nurse and social 

worker from one of 76 Polytrauma Support Clinic Teams. VA social work case managers follow each patient within the Polytrauma System of Care at prescribed intervals contingent upon need. For example, there are four levels of case management: 

intensive case management, where contact is made daily or weekly; progressive case 

management, where VA contacts the patient monthly; supportive case management, 

quarterly; and lifetime case management, annually. For the many patients who are 

still active duty servicemembers, the military case managers are responsible for obtaining authorizations from DoD regarding orders and followup care based upon VA 

medical team recommendations. 

VA is committed to ongoing review and improvement of our provision of care for 

these wounded or injured warriors. In this spirit, VA assembled a national research 

task force last summer to review and evaluate the long term care needs of our most 

seriously wounded or injured returning OEF/OIF veterans. This taskforce recently 

completed its work and identified several recommendations, which are being submitted to the Secretary for his review. Moreover, in compliance with the 2008 National Defense Authorization Act, VA is collaborating with the Defense and Veterans 

Brain Injury Center to design and execute a 5-year pilot program to assess the effectiveness of providing assisted living services to eligible veterans to enhance their rehabilitation, quality of life, and community integration. 

Spinal Cord Injury and Disorders 

For Spinal Cord Injury and Disorders (SCI/D), VA has the largest single network 

of care in the Nation. VA facilities nationwide provided a full range of services to 

26,191 veterans with SCI/D in 2007; 12,789 of these veterans received specialized 

care within the Spinal Cord Injury Centers and Spinal Cord Injury Support Clinics. 

For veterans with SCI/D, VA provides health care, maintains their medical equipment, and provides supplies, education and preventive health services. Since 2003, 

364 active duty servicemembers have been treated in VA SCI units; of these, 116 

acquired spinal cord injury in an OEF/OIF theater of operations. Each of these patients received care from a VA facility accredited by CARF. A national, multi-site 

vocational improvement research project identifies evidence-based vocational rehabilitation programs for veterans with SCI/D. 

VA is improving and expanding our SCI/D nationally, with plans for a ribbon-cutting ceremony for a new facility in Minneapolis in February 2009. Our Denver, CO 

facility’s design was funded in 2004 and land was acquired in 2006, while our Jackson, MS facility’s funding is still being determined. Tampa’s LTC facility (30 beds) 

is under construction and planning is underway for the VISN 3 SCI LTC facility. 

Each VA Spinal Cord Injury Center will be provided with state-of-the-art technology 


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and equipment to better support home-based therapies, provide closer management 

and monitoring of function and complications in the home, and offer closer attention 

to health promotion and prevention. 

Blind Rehabilitation 

For veterans and active duty personnel with visual impairment, VA provides comprehensive Blind Rehabilitation services that have demonstrated significantly greater success in increasing independent functioning than any other blind rehabilitation 

program. Currently, 164 Visual Impairment Service Team (VIST) Coordinators provide lifetime case management for all legally blind veterans, and all OEF/OIF patients with visual impairments. Additionally, 38 Blind Rehabilitation Outpatient 

Specialists (BROS) provide blind rehabilitation training to patients who are unable 

to travel to a blind center. 

The VA Blind Rehabilitation Continuum of Care, announced January 2007, further extends a comprehensive, national rehabilitation system for all veterans and 

active duty personnel with visual impairments. Program expansion during 2008 will 

add 55 outpatient vision rehabilitation clinics, 35 additional BROS at VAMCs currently lacking those services, and 11 new VIST positions. The continuum of care will 

provide the full scope of vision services—from basic, low vision services to blind rehabilitation training—across all Veteran Integrated Service Networks (VISNs). 

Outreach 

VA has always been committed to outreach, and all the more so during periods 

of armed conflict. Given the importance of outreach to servicemembers and veterans 

of OEF/OIF, VA promotes and conducts activities at both national and local levels. 

VA has developed an array of training materials, directives, publications, and established points of contact at each VA facility. VA also partners with Federal agencies, 

Veterans Service Organization (VSOs), and State, county, and local agencies and 

governments. Our outreach to OEF/OIF participants begins when the servicemember returns home and continues through the transition period from servicemember to veteran and beyond. 

Outreach to active duty personnel is a major part of VA’s Outreach program and 

is generally accomplished through the Transition Assistance Program (TAP) sponsored in cooperation with the Departments of Defense and Labor. All VA benefits 

and services are included in TAP briefings. All returning OEF/OIF servicemembers 

are given a copy of VA Pamphlet 80–06–01, Federal Benefits for Veterans and Dependents. 

Special outreach to Reserve/Guard members is an integral part of VA’s outreach 

efforts. VA provides briefings on benefits and health care services at townhall meetings, family readiness groups, and during unit drills near the homes of returning 

Reserve/Guard members. 

Since 2003, VA’s outreach to those severely injured in OEF/OIF includes placing 

VA/DoD Social Work and Registered Nurse Liaisons and Benefits Counselors at 

Walter Reed Army Medical Center, the National Naval Medical Center and nine 

other military treatment facilities across the country. 

In November 2005, VA began partnering with DoD in implementing the Post-Deployment Health Reassessment (PDHRA) among National Guard and Reserve Component (RC). The PDHRA is a DoD global health-screening tool that includes specific questions covering PTSD, alcohol misuse and Traumatic Brain Injury (TBI). 

VA’s role in this partnership is fourfold: provide information on VA benefits among 

Reserve and Guard personnel; enroll eligible veteran in VA health care; provide assistance in scheduling followup appointments at VAMCs and Vet Centers; and develop ongoing referral and training relationships with Reserve and Guard Commanders. As of January 31, 2008, VA has supported PDHRA referrals from DoD’s 

24/7 Call Center, 283 Unit Call Center PDHRA events and 888 Unit On-Site 

PDHRA events. The RC PDHRA initiative has generated over 75,000 referrals, including 36,199 referrals to VAMCs and 17,214 referrals to Vet Centers representing 

71% of total referrals. 

Vet Center staff regularly participates in DoD-sponsored PDHRA events. Vet Centers provide information on VA benefits and care to servicemembers as they transition from military to civilian life at National Guard and Reserve demobilization 

sites, active duty transition briefings, and community events involving returning 

combat veterans such as homecoming events. Outreach is also performed with local 

VSOs and community agencies. Vet Center outreach is designed to provide information, minimize stigma, and help veterans obtain needed services as early as possible. 

More than 200,000 servicemembers have been provided outreach services, primarily 

at military demobilization sites, including National Guard and Reserve units. Vet 


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Centers initiate outreach efforts to area military installations and closely coordinate 

their efforts with military family support services at various military bases. 

In October 2005, DoD Health Affairs began providing VA with a list of servicemembers entering the Physical Evaluation Board (PEB) process. These servicemembers sustained an injury or developed an illness that may preclude them from 

continuing on active duty and result in medical separation or retirement. This list 

will enable VHA to send outreach letters encouraging them to contact the nearest 

VA medical facility for future assistance in enrolling in VA health care and addressing their health care needs as they transition from active duty to veteran status. 

As of January 31, 2008, the VA has mailed 16,905 PEB outreach letters to servicemembers. 

The Veterans Assistance at Discharge System process mails a ‘‘Welcome Home 

Package,’’ including a letter from the Secretary, ‘‘A Summary of VA Benefits’’ (VA 

Pamphlet 21–00–1), and ‘‘Veterans Benefits Timetable’’ (VA Form 21–0501), to veterans recently separated or retired from active duty (including Guard/Reserve members). We re-send this information 6 months later to these veterans. 

The Secretary of Veterans Affairs sends a letter to newly separated OEF/OIF veterans. The letters thank veterans for their service, welcome them home, and provide 

basic information about health care and other benefits provided by VA. To date, VA 

has mailed over 766,000 initial letters and 150,000 followup letters to veterans. 

VA Regional Offices assist and support seriously injured OEF/OlF servicemembers 

and veterans by conducting case management activities, including outreach, coordinating services, and streamlining claims processing procedures. 

In collaboration with DoD, VA published and distributed one million copies of a 

new brochure called, ‘‘A Summary of VA Benefits for National Guard and Reservists 

Personnel.’’ The new brochure summarizes health care and other benefits available 

to this special population of combat veterans upon their return to civilian life. 

As part of VA’s ‘‘Coming Home to Work’’ program, participants work with a Vocational Rehabilitation and Employment Counselor (VRC) to obtain unpaid work experiences at government facilities. This represents an early outreach effort with special emphasis on OEF/OlF servicemembers pending medical separation from active 

duty at military treatment facilities. 

VA also continues its Benefits Delivery at Discharge program, where servicemembers can apply for service-connected compensation, vocational rehabilitation, 

and employment services before discharge. Normally, prior to discharge, required 

physical examinations are conducted, service medical records are reviewed, and rating decisions are made. 

Access to Care 

VA has identified access to outpatient care as a priority in our effort to provide 

care for seriously wounded veterans after inpatient care is complete. VHA’s strategic 

direction is to enhance non-institutional care with less dependence on large institutions. Our comprehensive care management plans offer guidance for providing care 

to veterans in their homes and communities. For those veterans who prefer to visit 

in person, VA issued a directive last June instructing our medical centers to explore 

offering extended hours for veterans unable to schedule appointments during the 

day. Similarly, our Vet Centers are available to veterans on nights and weekends 

for readjustment counseling needs. 

Community Based Outpatient Clinics (CBOCs) have been the anchor for VA’s efforts to expand access for veterans. CBOCs are complemented through partnerships, 

such as contracts in the community for physician specialty services or referrals to 

local VA medical centers, depending on the location of the CBOC and the availability of specialists in the area. In addition, we provide rural outreach clinics that 

are operated by a parent CBOC to meet the needs of rural veterans. 

Telehealth provides veterans with access to care in their homes and local communities where possible and appropriate. It is a new modality of care requiring robust 

clinical practices, technology infrastructure and business processes to maintain and 

sustain the modality. Telehealth capabilities in VA have expanded in all clinical 

areas since FY 2004. There are telehealth programs within all VISNs and many programs have grown from point-to-point connections to inter-hospital and VISN-based 

networks. VA continues to evaluate the effectiveness of telehealth and to work with 

clinical leadership in the VISNs and VA facilities to introduce new clinical processes 

based on information technologies to assist clinicians in meeting the health care 

needs of older veterans. This reduces the barriers of distance and time that may 

restrict the availability of care. Currently, VA is piloting applications to create national tele-consultation networks to expand the provision of specialty care to rural 

and remote areas. 


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Conclusion 

We are honored to provide care and service to America’s veterans. For those who 

return from combat with serious injuries or illness, we work closely with DoD to 

ensure a swift and seamless transition to VA, but we also work with those who do 

not need immediate care to make it as accessible as possible. Thank you again for 

you the opportunity to meet with you today. I would be happy to address any questions that you have at this time. 

Memorandum 

Department of Veterans Affairs 

Date: February 22, 2007 

From: Deputy USH for Operations and Management (10N) 

Subj: Acceptance Requirements for VA Volunteers 

To: All VISN Directors (10N1–23) 

All Medical Center Directors (00) 

1. Effective immediately, all VISNs and VA facilities will accept and process volunteers according to the standardized process outlined in this memorandum 

and attachment. 

2. This process is necessary to reduce barriers to volunteering at VA facilities, 

while complying with current laws and VA regulations. It enables VA to establish reasonable expectations for managing our ability to accept new volunteers 

while enhancing our volunteer recruitment activities. 

3. For the purpose of accepting new volunteers, and determining the level of 

cyber security and privacy training they will require, four specific groups of 

volunteers have been established. Each group has specific requirements that 

correlate with the level of cyber security risk involved in their volunteer assignment. Every volunteer assignment will be categorized in one or more of the 

groups listed below. 

Group A 

VA employees who have volunteer assignments will require: 

• A completed and signed application • A general orientation • An assignment-specific orientation • A physical examination if driving is their volunteer assignment 

Type of 10 Badge Required: Standard employee 10 badge 

Group B 

Volunteers with recreation, cemetery, book cart, or similar assignments 

will require: 

• A completed and signed application 

• A general orientation 

• An assignment-specific orientation 

• Privacy Policy Training 

• A PPD Inoculation 

• A photo 10 badge 

• A physical examination if driving is their volunteer assignment 

• A List of Excluded Individuals & Entities (LEIE) Health and Human Services (HHS) database check. The LEIE database check is performed automatically between databases. 

• A Healthcare Integrity and Protection Data Bank (HIPDB) HHS database 

check. The HIPDB database check is completed by facility personnel. 

Type of 10 Badge Required: FLASH 

Group C 

Volunteers who have assignments in any of the seven categories outlined 

in VHA Directives 0710 and VHA Handbook 1620.1 will require: 

• All Group B requirements plus: 

• A Special Agreement Check (SAC) for Fingerprint Only 

Type of 10 Badge Required: NON–PIV 


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The seven categories for Group C are volunteers who have: 

• Assignments associated with home health care; 

• Assignments involving the provision of patient care or working alone with 

patients; 

• Assignments involving contact with pharmaceuticals or other biological 

agents; 

• Assignments that provide access to patient records; 

• Assignments involving clinical research; 

• Assignments that provide access to any VA computer system; or 

• Access to any sensitive information not identified above (e.g., Privacy Act 

Protected Information) 

Group D 

Volunteers who have computer access or access to the LAN will require: 

• All Group B & C requirements plus: 

• A National Agreement Check Inquiry (NACl) Investigation 

• Cyber Security Training 

• A signature that the volunteer has read the VA’s Rules of Behavior 

Type of 10 Badge Required: PIV 

4. These volunteer categories will standardize the acceptance process for all VA 

volunteers, regardless of the facility where they volunteer their time. This process will enable members of the community to serve those who have served, 

while safeguarding veteran private information. 

5. The process outlined in this memorandum will be included as policy in VHA 

Handbook 1620.1, ’Voluntary Service Procedures’’. All VISN Directors and 

Medical Center Directors will ensure the implementation of this standardized 

process for acceptance of volunteers. 

William F. Feeley, MSW, FACHE 

Attachment: Volunteer Acceptance Requirements 

VA Employees 

as Volunteers 

(already have 

necessary training and checks) 

Volunteers with No Access 

to Veterans Records or VA 

IT Systems 

Volunteers 

with Access 

to Veterans 

Volunteers with 

Access to VA 

IT Systems 

• Completed • Completed and signed All Group B All Group B & C 

and signed application requirements requirements plus: 

application • General orientation plus: 

• General • Assignment–specific • NACI 

Orientation orientation • Special Investigation 

• Assignment– • Privacy Policy Training Agreement • Completed 

specific • PPD Inoculation Checks • Returned 

orientation • Photo ID (SAC) for • Cyber Security 

• Physical • Physical exmination Fingerprint Training 

exmination (for volunteer drivers) Only • Sign VA’s Rules 

(if driving • LEIE database check of Behavior 

is their (List of Excluded 

volunteer Individual/Entities, 

assignment) Health and Human 

Services database, not 

completed by the 

volunteer) 

• Health Integrity and 

Protection Data Bank 

Check 

Ongoing Requirement—Annual Supervisor Evaluation. 

f 


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Committee on Veterans’ Affairs 

Subcommittee on Oversight and Investigations 

Washington, DC. 

April 17, 2008 

Hon. James B. Peake 

Secretary 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20420 

Dear Secretary Peake: 

On Thursday, March 13, 2008, the Subcommittee on Oversight and Investigations 

of the House Committee on Veterans’ Affairs held a hearing on Care of Seriously 

Wounded After Inpatient Care. 

During the hearing, the Subcommittee heard testimony from Dr. Madhulika 

Agarwal, Chief Patient Care Services Officer for the Veterans Health Administration. Dr. Agarwal was accompanied by Dr. Lucille Beck, Chief Consultant for Rehabilitation Services in the Veterans Health Administration; and Kristin Day, Chief 

Consultant for Care Management and Social Work. As a followup to that hearing, 

the Subcommittee is requesting that the following questions be answered for the 

record: 

1. Please provide the Committee with a timeline for full implementation of the 

Federal Individual Recovery Plan (FIRP), and include in the timeline dates 

for each stage of implementation. 

2. When will VA go back through the medical records and other sources of information for those seriously wounded veterans who have already been discharged into the civilian community (like Corporal Owens and Sergeant 

Wade) and bring these veterans into the FIRP with their own assigned Federal Recovery Coordinator (FRC), or otherwise provide those veterans with effective case management services? 

3. Does the VA currently have sufficient staffing to handle the number of 

servicemembers and veterans who will need to rely on a Federal Recovery Coordinator (FRC) to assist them with their FIRP? 

4. Are the FRCs in the current pilot assigned to newly injured servicemembers, 

to previously injured servicemembers (i.e., servicemembers who were injured 

prior to the creation of the FRC pilot), or a combination thereof? If a combination, please provide the relative percentages of the two groups. If the pilot 

FRCs are being assigned primarily to newly injured servicemembers, please 

explain why this scare resource—FRCs—is being assigned to newly injured 

inpatients who have multiple case managers instead of previously injured 

servicemembers who may not have adequate case management? 

5. Many of the most seriously injured OEF and OIF vets are treated in the VA’s 

four Polytrauma Rehabilitation Centers (PRC). Has the VA tracked PRC patients after they leave the PRCs? If not, why not? How is VA ensuring that 

they receive everything they need? 

6. Apart from PRC patients, what steps has VA taken to identify severely injured separated servicemembers who need ongoing care coordination? 

7. What are VA’s criteria to decide when a servicemember who has been treated 

at a PRC is no longer the responsibility of PRC case managers? In other 

words, what are the criteria for deciding to transition a servicemember from 

PRC case management to OIF/OEF care coordinator case management or 

something else? 

8. What is the average caseload of a OIF/OEF care coordinator? Is this considered manageable? Is there a health care standard for this issue? 

9. Have the special needs of severely injured rural vets been identified? 

10. Please explain how VETSNET is being used to support the FRC pilot and the 

OIF/OEF care coordination program. 

11. The testimony of Dr. Agarwal on page 3 states: 

As a part of this effort, VHA and VBA are jointly developing a comprehensive list of severely injured OEF/OIF veterans. The two administrations are defining the requirements and definitions for this list, and 

will establish a single record to track VHA or VBA contact each month 

with severely injured veterans and servicemembers. 

Describe in detail how this list is being constructed and what the timeline is 

for completion of a comprehensive list. 


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We request you provide responses to the Subcommittee no later than close of business on June 11, 2008. If you have any questions concerning these questions, please 

contact Subcommittee on Oversight and Investigations Staff Director, Geoffrey 

Bestor, Esq., at (202) 225–3569 or the Subcommittee Republican Staff Director, Arthur Wu, at (202) 225–3527. 

Sincerely, 

HARRY E. MITCHELL 

Chairman 

GINNY BROWN–WAITE 

Ranking Republican Member 

Questions for the Record 

The Honorable Harry E. Mitchell, Chairman 

The Honorable Ginny Brown-Waite, Ranking Republican Member 

Oversight and Investigations Subcommittee 

House Veterans’ Affairs Committee 

March 13, 2008 

Care of Seriously Wounded After Inpatient Care 

Question 1: Please provide the Committee with a timeline for full implementation of the Federal Individual Recovery Plan (FIRP), and include in the timeline 

dates for each stage of implementation. 

Response: A memorandum of understanding (MOU) between the Department of 

Veterans Affairs (VA) and the Department of Defense (DoD) was signed on October 

30, 2007, for the joint oversight of the Federal recovery coordination program 

(FRCP). In December 2007, VA hired the program’s director and supervisor. In January 2008, VA hired Federal recovery coordinators (FRCs) who were placed at the 

following military treatment facilities (MTF): 

Number of 

FRCs Location Status of Recruitment 

3 Walter Reed Army Medical 

Center, Washington DC 

• All on site and serving patients 

2 National Naval Medical Center, 

Bethesda, MD 

(1) On site and serving patients 

(1) Starts 5/19/08 

3 Brooke Army Medical Center, 

San Antonio, TX 

(2) On site and serving patients 

(1) In boarding process 

2 Naval Medical Center, San 

Diego, CA 

(1) In final selection stage 

(1) In boarding process 

The FRCs started working with patients January 28, 2008. FRCs developed Federal individualized recovery plans (FIRP) for severely wounded, ill and injured 

servicemembers or veterans who meet the FRCP criteria. Phase One of the FRC 

program targeted those catastrophically wounded, ill or injured arriving from theatre to the MTF and is scheduled to be completed in May 2008. Phase Two, which 

will begin immediately after Phase One is complete, will expand the program’s scope 

to include those servicemembers and veterans who were discharged from an MTF 

prior to January 2008. 

Question 2: When will VA go back through the medical records and other sources 

of information for those seriously wounded veterans who have already been discharged into the civilian community (like Corporal Owens and Sergeant Wade) and 

bring these veterans into the FRCP with their own assigned Federal Recovery Coordinator (FRC), or otherwise provide those veterans with effective case management 

services? 

Response: At this time, FRCs are accepting servicemembers/veterans injured 

prior to January 2008 into the FRCP on a referral basis. As mentioned above, Phase 

Two will start in June 2008, and will expand the program’s scope to include those 

servicemembers and veterans who were discharged from a MTF prior to January 


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2008. Identification of this population will be conducted through a review of VA rehabilitation databases, to include spinal cord and blind rehabilitation, along with 

the polytrauma centers. In tandem, DoD will work through TRICARE in an effort 

to identify the same population for potential inclusion into the FRCP. Recruitment 

of staff to support this expansion effort has begun. An additional registered nurse 

is being recruited to champion this effort along with additional FRCs whose geographic placement will be based on identified patient needs. 

Question 3: Does the VA currently have sufficient staffing to handle the number 

of servicemembers and veterans who will need to rely on the Federal Recovery Coordination Program to assist them with their FIRP? 

Response: VA and DoD continue to closely monitor workload and geographic distribution of cases as the program matures. As of now the number of FRCs is adequate, but we expect that number to increase as we continue to identify servicemembers in need of their services. 

Question 4: Are the FRCs in the current pilot assigned to newly injured servicemembers, to previously injured servicemembers, (i.e. servicemembers who were injured prior to the creation of the FRCP), or a combination thereof? If a combination, 

please provide the relative percentages of the two groups. If the pilot FRCs are 

being assigned primarily to newly injured servicemembers, please explain why this 

scarce resource—FRCs—is being assigned to newly inured inpatients who have multiple case managers instead of previously injured servicemembers who may not have 

adequate case management? 

Response: Almost 25 percent of the patients in the FRCP were admitted to a 

MTF prior to the implementation of the program January 21, 2008. Phase One of 

the program is targeting catastrophically wounded, ill or injured arriving from theatre to a MTF. Phase Two will expand the program’s scope to include those servicemembers and veterans who were discharged from a MTF prior to January 2008. The 

rationale behind this decision was that it allowed the FRCs to establish working relationships with the multidisciplinary teams, the MTF leadership, and those programs that support the severely ill/injured servicemembers. 

Question 5: Many of the most seriously injured OEF and OIF vets are treated 

in the VA’s four Polytrauma Rehabilitation Centers (PRC). Has the VA tracked PRC 

patients after they leave the PRCs? If not, why not? How is VA ensuring that they 

receive everything they need? 

Response: Follow-up case management is provided by the PRCs in accordance 

with Veterans Health Administration (VHA) Handbook 1172.1. The assigned case 

manager is involved in developing the discharge plan of care with the treatment 

team, patient and family. This includes, arranging and coordinating ongoing services, and communicating with DoD and/or the local VA case manager. 

While a patient is on active duty, DoD has authority over the servicemember’s 

medical care. The PRC case manager partners with the military case manager, and 

documents post-discharge recommendations in the medical record to provide to DoD 

for active duty patients. 

For patients who are veterans when they leave the PRC, the PRC case manager 

provides regular contact and followup with the patient, family, VA and any other 

service providers. The PRC case manager also tracks and monitors implementation 

of the care plan by the local VA by reviewing the electronic medical record. Video 

teleconferencing is often used to facilitate a smooth transition of care to the receiving VA care team and the polytrauma network site (PNS) responsible for monitoring 

the care plan and consulting with the local VA team. 

Question 6: Apart from PRC patients, what steps has VA taken to identify severely injured separated servicemembers who need ongoing care coordination? 

Response: VHA liaisons for health care and Veterans Benefit Administration 

(VBA) benefits counselors are stationed at 11 of the major MTFs receiving casualties 

from Afghanistan and Iraq. VHA liaisons, are either social workers or nurses. They 

facilitate the transfer of servicemembers and veterans from the MTF to a VA PRC 

or medical center closest to their home or most appropriate for the specialized services their medical condition requires. The benefits counselors brief servicemembers 

about VA benefits and assist them in applying for VA benefits and services. 

These teams ensure that a VA facility has a process in place for the care of all 

Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans and 

servicemembers. The care is coordinated. Each VA medical center has an OEF/OIF 


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team which includes a nurse or social worker program manager, and nurse or social 

worker case manager. Transition patient advocates also support severely injured or 

ill OEF/OIF veterans by acting as an advocate for the patient and family as they 

move through the VA system of care. Additionally, each VA medical center has a 

process in place to ensure that the care of all OEF/OIF veterans and servicemembers is well-coordinated and that those who are severely ill or injured receive 

case management services from a nurse or social worker case manager. 

The polytrauma system of care integrates services at regional centers, network 

sites, and at local VA medical centers to optimize resources and create points of access along a continuum of care. Specialized polytrauma care is provided at the VA 

facility closest to the veteran’s home with the expertise necessary to manage rehabilitation, medical or mental health needs, and facilitate the veteran’s re-integration 

into the home community. 

The polytrauma system of care is designed to provide smooth transition from one 

level of care to the next. The PRC case manager maintains contact and/or monitors 

the care of patients discharged from the PRC for the patient’s lifetime. The level 

of oversight, monitoring, or direct involvement of the PRC depends on the patient’s 

access to care and services that are being provided at the local level. 

Question 7: What are VA’s criteria to decide when a servicemember who has 

been treated at a PRC is no longer the responsibility of PRC case managers? In 

other words, what are the criteria for deciding to transition a servicemember from 

PRC case management to OIF/OEF care coordinator case management or something 

else? 

Response: The transition process may range from weekly or monthly contact for 

some, while monitoring on a quarterly or annual basis for others is appropriate. 

When direct PRC case management is no longer required, the PRC case manager 

will monitor the patient through the polytrauma case manager at a PNS, polytrauma support clinic team, or the OEF/OIF case manager. The PRC case manager 

continues to have ongoing responsibility to review the medical record and continue 

to followup with the primary case manager. The local VA continually has access to 

its PNS or PRC for consultation if new problems arise, or if the patient needs to 

be referred to a higher level for evaluation and treatment. 

Question 8: What is the average caseload of an OEF/OIF care coordinator? Is 

this considered manageable? Is there a health care standard for this issue? 

Response: Each OEF/OIF care manager follows approximately 24 patients as a 

national average. VHA Handbook 1010.01 states the caseload for nurse and social 

worker case managers will typically be no more than 25 to 30 patients per care 

manager. This ratio is consistent with DoD caseload as published in its medical 

management guide, DoD/TRICARE management activity, dated January 2006, 

which suggests a caseload of 25–35 acute and chronic cases per care manager. 

Recognizing the crucial role nurses and social workers provide in case management and the need for a more consistent approach to determining caseloads, two national organizations are currently studying caseload calculations for nurses and social workers. The Case Management Society of America and the National Association of Social Workers are developing a caseload matrix. 

Question 9: Have the special needs of severely injured rural vets been identified? 

Response: Severely injured veterans living in rural areas are provided the case 

management services and oversight available to each veteran seen throughout the 

VA polytrauma system of care as well as the OEF/OIF care management program 

located at each VA medical facility (e.g., a nurse or social worker clinical case manager, transition patient advocates, OEF/OIF case manager, VBA counselors). An 

interdisciplinary team of rehabilitation specialists assesses the needs of seriously injured patients to match the treatment plan and coordinate support services needed. 

If local VA care is not available to a patient due to their geographic location, feebased rehabilitation services are provided through the local community. The Office 

of Rural Health is working closely with the veterans integrated service networks to 

address access for all rural veterans, and has recently implemented initiatives to 

increase access to care to primary care. 

Question 10: Please explain how VETSNET is being used to support the FRC 

pilot and the OEF/OIF care coordination program. 

Response: Veterans services network (VETSNET) provides benefits counselors, 

OEF/OIF managers and coordinators with improved access to veteran and claims 


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data, on-time updates, and immediate status on pay. VETSNET is not directly available to the FRCs or the OEF/OIF team at the VA medical centers. 

VETSNET is primarily used at this time by benefits counselors at MTFs. The benefits counselors meet with servicemembers and their families to provide benefits information and assistance to servicemembers applying for VBA benefits and services. 

Counselors assist servicemembers in completing claims and in gathering supporting 

evidence. While servicemembers are hospitalized, they are routinely informed of the 

status of their pending claims and given their counselor’s name and contact information should they have followon questions or concerns. 

The OEF/OIF team at the VA medical centers collaborates with the benefits counselors at the closest VA regional office. 

Question 11: Dr. Agarwal’s testimony on page 3 states that VHA and VBA are 

jointly developing a comprehensive list of severely injured OEF/OIF veterans. Describe in detail how this list is being constructed and what the timeline is for completion of a comprehensive list. 

Response: VHA recently developed a new tool to track the care management of 

severely ill and injured OEF/OIF veterans. The new application is known as the 

care management tracking and reporting application (CMTRA). This robust tracking 

system allows OEF/OIF care managers to specify a care management schedule for 

each individual veteran and to identify specialty care managers such as polytrauma 

case managers and spinal cord injury case managers. The new application was implemented at VA medical centers on April 29, 2008. VHA mandated that all severely 

ill and injured OEF/OIF patients being case-managed need to be added to CMTRA. 

VBA is identifying a similar list of severely ill/injured patients. VA information technology staff will consolidate VHA and VBA information into a single, comprehensive 

database. 

Æ 


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