
STATEMENT
BY
MICHAEL J. KUSSMAN, M.D.
DEPUTY CHIEF PATIENT CARE SERVICES OFFICER
DEPARTMENT OF VETERANS AFFAIRS
AND
SUSAN H. MATHER, M.D.
CHIEF OFFICER
PUBLIC HEALTH AND ENVIRONMENTAL HAZARDS
DEPARTMENT OF VETERANS AFFAIRS
AND
LAURENT S. LEHMANN, M.D.
CHIEF, MENTAL HEALTH STRATEGIC HEALTH CARE
GROUP
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE SUBCOMMITTEE ON TOTAL FORCE
COMMITTEE ON ARMED SERVICES
U.S. HOUSE OF REPRESENTATIVES
HEARING ON FORCE HEALTH
PROTECTION AND SURVEILLANCE
FEBRUARY 25,
2004
Mr. Chairman and Members of
the Committee, I appreciate the opportunity
to appear before you today to discuss
efforts of the Department of Veterans
Affairs (VA) toward a seamless transition
for separating service members from the
Department of Defense (DoD) health care
system to the VA health care system.
We have been working hard both internally
and with DoD to identify the men and women
returning from combat theaters and to
provide those separated from active duty,
particularly those injured or with
deployment related illnesses, with
world-class VA service. Anyone who has been
wounded or injured or has become ill while
in defense of our country deserves the
highest quality and most timely service
possible from their Government.
Working with DoD, VA has accomplished and
put into place a number of strategies,
policies, and procedures to provide timely,
appropriate services to our returning
service members.
Seamless Transition Activities
Last August, VA's Under Secretary for
Benefits and Under Secretary for Health
created a new VA Taskforce for the Seamless
Transition of Returning Service Members to
reduce red tape and streamline access to all
VA benefits. This taskforce, composed of VA
senior leadership from key program offices
and the VA/DoD Executive Council structure,
focused initially on internal coordination
efforts to ensure that VA approaches this
mission in a comprehensive manner. In the
process, we have improved dialogue and
collaboration between our two Departments.
Points of Contact
Through the leadership of the Taskforce,
each Veterans Health Administration (VHA)
facility and each VA regional office has
identified a point of contact to coordinate
activities locally and to assure that the
needs of returning service members and
veterans are met and that additional contact
is made should the veteran relocate. VA has
distributed guidance on case management
services to VHA and VBA field staff to
ensure proper coordination processes and
that our expectations are communicated and
followed. The guidance also addresses the
roles and functions of the points of contact
and case managers. VHA has recently revised
its guidance to reflect recent experiences
at field stations. The revised guidance
will be distributed this month.
Working in collaboration with the military Surgeons General, the Veterans Benefits Administration (VBA) has detailed two full-time Veterans Service Representatives and VHA has detailed two full-time social workers to the Walter Reed Army Medical Center, the military treatment facility (MTF) receiving the largest numbers of casualties. Beginning in late August 2003, full-time and part-time VHA social workers and VBA Veterans Service Representatives have also been assigned as VA/DoD liaisons to the Brooke, Eisenhower, and Madigan Army Medical Centers, Darnall Army Community Hospital at Fort Hood, and the National Naval Medical Center in Bethesda. They work closely with military medical providers and DoD social workers to assure that returning service members receive information and counseling about VA benefits and programs, as well as assistance in filing benefit claims. They also coordinate the transfer of active duty service members and recently discharged veterans to appropriate VA health care facilities. Through this collaboration, we have improved our ability to identify and serve returning service members that sustained serious injuries or illnesses while serving our country. Over 1,100 hospitalized soldiers have received assistance from VA social workers.
Outreach Activities
VA actively participates in discharge
planning and orientation sessions for
returning service members, and we have
expanded our collaboration with DoD to
enhance outreach to returning members of the
Reserves and National Guard. Working with
DoD Health Affairs and DoD Reserve Affairs,
we developed a new brochure, "A Summary of
VA Benefits for National Guard and Reserve
Personnel." The brochure summarizes the
benefits available to this group of veterans
upon their return to civilian life. We have
distributed over a million copies of the
brochure to ensure the widest possible
dissemination through VA and DoD channels.
It is also available online at
http://www.va.gov/environagents/docs/SVABENEFITS.pdf
and http://www.defenselink.mil/r2/mobile/pdf/va_benefits_rs.pdf.
During FY 2003, VBA conducted over 800
briefings attended by almost 47,000 reserve
and guard members. During the 1st
quarter of FY 2004, 317 briefings were
conducted and were attended by more than
18,000 reserve and guard members.
Outreach activities include the distribution
of flyers, posters, and information
brochures to VA medical centers, regional
offices, and Vet Centers. All of these
publications explain VA services available
to veterans. As VA becomes aware of service
members who are separated from the military,
VA contacts them to welcome them home and
explain what local VA services are
available. Furthermore, in order to make a
wide selection of general information
available to Operation Iraqi Freedom (OIF)
and Operation Enduring Freedom (OEF)
veterans online, we have created a direct
"Iraqi Freedom" link from VA's Internet page
(www.vba.va.gov/EFIF).
This new site provides information on VA
benefits, including health and mental health
services, DoD benefits, and community
resources available to regular active duty
service members, activated members of the
Reserves and National Guard, veterans, and
veterans' family members.
A critical concern for veterans and their
families is the potential for adverse health
effects related to military deployments. VA
has produced a brochure that addresses the
main health concerns for military service in
Afghanistan, another brochure for the
current conflict in Iraq, and one recently
distributed on health care for women
veterans returning from the Gulf region.
These brochures answer health-related
questions that veterans, their families, and
health care providers have about these
hazardous military deployments. They also
describe relevant medical care programs that
VA has developed in anticipation of the
health needs of veterans returning from
combat and peacekeeping missions abroad.
These are widely distributed to military
contacts and veterans service
representatives; they can also be found on
VA's website.
Another concern is the
potential health impact of environmental
exposures during deployment. Veterans often
have questions about their symptoms and
illnesses following deployment. VA
generally addresses these concerns through
such media as newsletters and fact-sheets,
regular briefings to veterans' service
organizations, national meetings on health
and research issues, media interviews,
educational materials, and websites, like
www.va.gov/environagents.
As a new initiative recently requested by
Secretary Principi, VA will
shortly begin to send "thank-you" letters
together with information brochures to each
OIF and OEF veteran. These letters will
provide information on health care and other
VA benefits, toll-free information numbers,
and appropriate VA web sites for accessing
additional information.
Training and Education
To ensure that our commitment is understood
and shared at every level of the Department,
the Taskforce developed a number of training
materials and other tools for front line
staff to ensure that they can identify
veterans who have served in a theater of
combat operations and take the steps
necessary to ensure the veterans receive
appropriate care.
To further aid VA employees
in their efforts to assist OIF/OEF veterans,
we have recently distributed a video
entitled "Our Turn to Serve" to all VHA and
VBA field facilities. The video helps VA
staff better understand the experiences of
military personnel serving in Operations
Iraqi Freedom and Enduring Freedom and
explains how they can provide the best
possible service to these newest combat
veterans. We have also provided copies of
this video to Military Treatment
Facilities. Additionally, we have created a
web page for VA employees on the activities
of the VA Seamless Transition Task Force.
Included are lists of points of contact for
all VHA health care facilities and VBA
regional offices, copies of all applicable
directives and policies, press releases,
brochures, posters, Task Force minutes, and
resource information.
The Veterans Health Initiative (VHI) is a
program designed to increase recognition of
the connection between military service and
certain health effects; better document
veterans' military and exposure histories;
improve patient care; and establish a
database for further study. The education
component of VHI prepares VA healthcare
providers to better serve their patients. A
module was created on "Treating War
Wounded," adapted from VHA satellite
broadcasts in April 2003 and designed to
assist VA clinicians in managing the
clinical needs of returning wounded from the
war in Iraq. Modules on spinal cord injury,
cold injury, traumatic amputation, Agent
Orange, the Gulf War, PTSD, POW,
blindness/visual impairment and hearing
loss, and radiation are also available.
Training modules on infectious disease risks
in Southwest Asia and on Weapons of Mass
Destruction were released in January 2004.
We are developing additional modules on
military sexual trauma, traumatic brain
injury, and pulmonary diseases of military
occupational significance.
In addition to the VHA
training modules on PTSD, VA's National
Center for PTSD has developed the Iraq War
Clinician's Guide for use across VA. The
website version, which can be found at
WWW.NCPTSD.ORG, contains the
latest fact sheets and available medical
literature and is updated regularly. The
first version of the Iraq War Guide was
published in June 2003. It is now being
revised in collaboration with DoD based on
our experience with returning casualties.
These important tools are integrated
with other VA educational efforts to enable
VA practitioners to arrive at a diagnosis
more quickly and accurately and to provide
more effective treatment.
VA Health Care
Mr. Chairman, veterans who have served or
are now serving in Afghanistan and Iraq may
enroll in the VA health care system and, for
a two-year period following the date of
their separation from active duty, would
receive VA health care without co-payment
requirements for conditions that are or may
be related to their combat service.
Following this initial two-year period, they
may continue their enrollment in the VA
health care system but may become subject to
any applicable co-payment requirements.
Based on lists of separated OIF and OEF
veterans received from DoD, we estimate that
as of December 2003, 9,753 OIF veterans and
1,798 OEF veterans
had received health care from VA for a wide
variety of health problems.
For returning service members
who are experiencing emotional and
behavioral problems, VA has programs
specifically developed to assess and address
emotional and behavioral problems associated
with the military experience. The training
programs cited above will ensure that our
skilled clinicians will be better able to
identify and treat problems presented by the
newest generation of combat veterans. The
VHI module on PTSD in Primary Care mentioned
above is designed to increase recognition of
PTSD in medical primary care settings.
Within these mental health programs, VA
operates a comprehensive continuum of
clinical care for posttraumatic stress
disorder (PTSD) in its Medical Centers and
clinics. This is accomplished both through
special PTSD programs and through PTSD
specialists in general mental health
programs.
VA's Vet Centers also play an important role
complementing VA health care services. Our
mental health clinical activities are linked
to and supportive of Vet Center activities.
Vet Center staff members actively pursue
outreach to military installations and
family support centers to assist veterans
and their families in the veterans' return
to civilian life. Last year, Vet Centers
began extending readjustment counseling
services to all OEF and OIF veterans. As
of December 2003
Vet
centers had served 4,300 of these veterans.
Clinical Tools
Earlier I discussed the Veterans Health
Initiative (VHI) as a program designed to
increase recognition of the connection
between military service and certain health
effects. VA has also developed additional
tools to assist the clinician when treating
OIF and OEF veterans.
A screening instrument in the form of a
clinical reminder triggered by the veteran's
separation date is being implemented for
returning OIF and OEF veterans who come to
VA for health care. This assessment tool
will prompt the provider with specific
screening requirements to assure that
veterans are evaluated for medical and
psychological conditions that may be related
to recent combat deployment.
VA has also developed evidence-based
clinical approaches for treating veterans
following deployment. These clinical
practice guidelines (CPGs) give health care
providers the needed structure, clinical
tools, and educational resources that allow
them to diagnose and manage patients with
deployment-related health concerns. Two
post-deployment CPGs have been developed in
collaboration with DoD, a general purpose
post-deployment CPG and a CPG for
unexplained fatigue and pain. Our goal is
that all veterans will find their VA doctors
well informed about specific deployments and
related health hazards. The VA website
contains these CPGs as well as information
about unique deployment health risks and new
treatments.
VA and DoD will release a new CPG on the
management of traumatic stress by the end of
this month. This guideline pools DoD and VA
expertise to help build a joint assessment
and treatment infrastructure between the two
systems in order to coordinate primary care
and mental health care for the purpose of
managing, and, if possible, preventing acute
and chronic Post Traumatic Stress Disorder (PTSD).
Record Sharing between VA and DoD
VA and DoD are also collaborating to develop
the ability to share medical information
electronically. Since June 2002, the
Departments have successfully been sharing
electronic medical information. Key
initiatives in the Electronic Health Records
Plan are the Federal Health Information
Exchange (FHIE) and HealthePeople
(Federal). FHIE provides historical data on
separated and retired military personnel
from the DOD's Composite Health Care System
to the FHIE Data Repository for use in VA
clinical encounters and potential future use
in aggregate analysis. Patient data on
laboratory results, radiology reports,
outpatient pharmacy information, and patient
demographics are now being sent from DoD to
VA via secure messaging. This second phase
of FHIE has been deployed and is operational
at VA medical centers nationwide. It
includes admission, discharge, transfer
data, discharge summaries, allergies, and
consult tracking. Most recently, additional
enhancements were completed to provide
retail pharmacy data from the DoD Pharmacy
Data Transaction Service. Work on the final
release of FHIE is on target to provide
Standard Ambulatory Data Record information
to VA. FHIE is scheduled to go into
maintenance mode at the end of the second
quarter FY 2004. The next Phase of the Plan
will provide bi-directional exchange of
health data between Departments. VA and DoD
are developing prototype interoperable data
repositories using standardized data that
will demonstrate bi-directional data
exchange with pharmacy information in
October 2004. The Departments will achieve
health system interoperability by October
2005.
We are also working with DoD to develop
processes whereby pre- and post-deployment
health assessments will be available
electronically to VA physicians and claims
examiners. We are further analyzing the
HIPAA Privacy rule and its implications for
our health information sharing efforts.
Summary
A service member separating from military
service and seeking health care through VA
today will have the benefit of VA's
decade-long experience with Gulf War health
issues as well as the President's commitment
to improving collaboration between VA and
DoD. VA has successfully adapted many
existing programs, improved outreach,
improved clinical care through practice
guidelines and educational efforts, and
improved VA health provider's access to DoD
health records. Secretary Principi has
emphasized VA's commitment to returning
combat veterans. In his words, "We will
have failed to meet our very reason to exist
as a Department if a veteran is poorly
served."
This concludes my statement. My colleagues
and I will be happy to respond to any
questions that you or other members of the
Subcommittee might have.
2120 Rayburn House Office Building
Washington, D.C. 20515
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