[House Hearing, 112 Congress]
[From the U.S. Government Printing Office]
[H.A.S.C. No. 112-145]
=======================================================================
BACK FROM THE BATTLEFIELD: DOD AND
VA COLLABORATION TO ASSIST SERVICE MEMBERS RETURNING TO CIVILIAN LIFE
__________
JOINT HEARING
before the
COMMITTEE ON ARMED SERVICES
meeting jointly with
COMMITTEE ON VETERANS' AFFAIRS
[Serial No. 112-71]
HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
HEARING HELD
JULY 25, 2012
[GRAPHIC] [TIFF OMITTED]
U.S. GOVERNMENT PRINTING OFFICE
75-667 WASHINGTON : 2013
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Printing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC
area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC
20402-0001
HOUSE COMMITTEE ON ARMED SERVICES
One Hundred Twelfth Congress
HOWARD P. ``BUCK'' McKEON, California, Chairman
ROSCOE G. BARTLETT, Maryland ADAM SMITH, Washington
MAC THORNBERRY, Texas SILVESTRE REYES, Texas
WALTER B. JONES, North Carolina LORETTA SANCHEZ, California
W. TODD AKIN, Missouri MIKE McINTYRE, North Carolina
J. RANDY FORBES, Virginia ROBERT A. BRADY, Pennsylvania
JEFF MILLER, Florida ROBERT ANDREWS, New Jersey
JOE WILSON, South Carolina SUSAN A. DAVIS, California
FRANK A. LoBIONDO, New Jersey JAMES R. LANGEVIN, Rhode Island
MICHAEL TURNER, Ohio RICK LARSEN, Washington
JOHN KLINE, Minnesota JIM COOPER, Tennessee
MIKE ROGERS, Alabama MADELEINE Z. BORDALLO, Guam
TRENT FRANKS, Arizona JOE COURTNEY, Connecticut
BILL SHUSTER, Pennsylvania DAVE LOEBSACK, Iowa
K. MICHAEL CONAWAY, Texas NIKI TSONGAS, Massachusetts
DOUG LAMBORN, Colorado CHELLIE PINGREE, Maine
ROB WITTMAN, Virginia LARRY KISSELL, North Carolina
DUNCAN HUNTER, California MARTIN HEINRICH, New Mexico
JOHN C. FLEMING, M.D., Louisiana BILL OWENS, New York
MIKE COFFMAN, Colorado JOHN R. GARAMENDI, California
TOM ROONEY, Florida MARK S. CRITZ, Pennsylvania
TODD RUSSELL PLATTS, Pennsylvania TIM RYAN, Ohio
SCOTT RIGELL, Virginia C.A. DUTCH RUPPERSBERGER, Maryland
CHRIS GIBSON, New York HANK JOHNSON, Georgia
VICKY HARTZLER, Missouri BETTY SUTTON, Ohio
JOE HECK, Nevada COLLEEN HANABUSA, Hawaii
BOBBY SCHILLING, Illinois KATHLEEN C. HOCHUL, New York
JON RUNYAN, New Jersey JACKIE SPEIER, California
AUSTIN SCOTT, Georgia RON BARBER, Arizona
TIM GRIFFIN, Arkansas
STEVEN PALAZZO, Mississippi
ALLEN B. WEST, Florida
MARTHA ROBY, Alabama
MO BROOKS, Alabama
TODD YOUNG, Indiana
Robert L. Simmons II, Staff Director
Jeanette James, Professional Staff Member
Debra Wada, Professional Staff Member
James Weiss, Staff Assistant
------
COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
CLIFF STEARNS, Florida BOB FILNER, California, Ranking
DOUG LAMBORN, Colorado CORRINE BROWN, Florida
GUS M. BILIRAKIS, Florida SILVESTRE REYES, Texas
DAVID P. ROE, Tennessee MICHAEL H. MICHAUD, Maine
MARLIN A. STUTZMAN, Indiana LINDA T. SANCHEZ, California
BILL FLORES, Texas BRUCE L. BRALEY, Iowa
BILL JOHNSON, Ohio JERRY McNERNEY, California
JEFF DENHAM, California JOE DONNELLY, Indiana
JON RUNYAN, New Jersey TIMOTHY J. WALZ, Minnesota
DAN BENISHEK, Michigan JOHN BARROW, Georgia
ANN MARIE BUERKLE, New York RUSS CARNAHAN, Missouri
TIM HUELSKAMP, Kansas
MARK E. AMODEI, Nevada
ROBERT L. TURNER, New York
Helen W. Tolar, Staff Director and Chief Counsel
(II)
C O N T E N T S
----------
CHRONOLOGICAL LIST OF HEARINGS
2012
Page
Hearing:
Wednesday, July 25, 2012, Back from the Battlefield: DOD and VA
Collaboration to Assist Service Members Returning to Civilian
Life........................................................... 1
Appendix:
Wednesday, July 25, 2012......................................... 43
----------
WEDNESDAY, JULY 25, 2012
BACK FROM THE BATTLEFIELD: DOD AND VA COLLABORATION TO ASSIST SERVICE
MEMBERS RETURNING TO CIVILIAN LIFE
STATEMENTS PRESENTED BY MEMBERS OF CONGRESS
Filner, Hon. Bob, a Representative from California, Ranking
Member, Committee on Veterans' Affairs......................... 5
McKeon, Hon. Howard P. ``Buck,'' a Representative from
California, Chairman, Committee on Armed Services.............. 1
Miller, Hon. Jeff, a Representative from Florida, Chairman,
Committee on Veterans' Affairs................................. 3
Smith, Hon. Adam, a Representative from Washington, Ranking
Member, Committee on Armed Services............................ 4
WITNESSES
Panetta, Hon. Leon E., Secretary of Defense, U.S. Department of
Defense........................................................ 7
Shinseki, Hon. Eric K., Secretary of Veterans Affairs, U.S.
Department of Veterans Affairs................................. 12
APPENDIX
Prepared Statements:
Buerkle, Hon. Ann Marie...................................... 54
McKeon, Hon. Howard P. ``Buck''.............................. 47
Miller, Hon. Jeff............................................ 49
Panetta, Hon. Leon E......................................... 56
Shinseki, Hon. Eric K........................................ 64
Smith, Hon. Adam............................................. 51
Documents Submitted for the Record:
[There were no Documents submitted.]
Witness Responses to Questions Asked During the Hearing:
Mr. McKeon................................................... 84
Mr. McKeon and Mr. Miller.................................... 83
Questions Submitted by Members Post Hearing:
Mr. Barber................................................... 98
Ms. Bordallo................................................. 92
Mr. Cooper................................................... 88
Mr. Franks................................................... 93
Mr. Garamendi................................................ 97
Mr. Kissell.................................................. 96
Mr. Langevin................................................. 87
Mr. Loebsack................................................. 94
Mr. Schilling................................................ 97
BACK FROM THE BATTLEFIELD: DOD AND VA COLLABORATION TO ASSIST SERVICE
MEMBERS RETURNING TO CIVILIAN LIFE
----------
House of Representatives, Committee on Armed
Services, Meeting Jointly with Committee on
Veterans' Affairs, Washington, DC, Wednesday,
July 25, 2012.
The committees met, pursuant to call, at 10:00 a.m., in
room 2118, Rayburn House Office Building, Hon. Howard P.
``Buck'' McKeon (chairman of the Committee on Armed Services)
presiding.
OPENING STATEMENT OF HON. HOWARD P. ``BUCK'' MCKEON, A
REPRESENTATIVE FROM CALIFORNIA, CHAIRMAN, COMMITTEE ON ARMED
SERVICES
The Chairman. Good morning. The committee will come to
order. Good morning, I welcome everyone for this special joint
hearing with the Committee on Veterans' Affairs. Our focus is
the collaboration between the Department of Defense [DOD] and
the Department of Veterans Affairs [VA] to assist service
members transitioning to civilian life. We have two of
America's leaders with us, Secretary Panetta and Secretary
Shinseki, to discuss how we as a Nation can best serve those
who have served us in uniform.
I also welcome Chairman Jeff Miller and Ranking Member Bob
Filner and of course Ranking Member Adam Smith from our
committee. I thank them all for their significant efforts to
address a range of transition issues.
It is no secret that I oppose plans to reduce the size of
our military, especially when contingency operations are still
ongoing in Afghanistan. I find it strange that at a time when
we are still at war, the Department of Defense has announced it
will actually reduce the size of the Army and Marine Corps.
Such cuts put strain on our service members and their families.
Moreover, I have been very vocal regarding the threat
sequestration poses to the strength and integrity of our
military. Reductions in end strengths represent additional
service members that will be asked to leave the military on top
of the over 175,000 service members that separate every year. I
will continue to voice my staunch opposition to further cuts to
the Defense budget which, if they take effect, will not only
increase the damage to our national security, but also put
significant strains on the transition system that is already
working too slowly.
Today's hearing demonstrates our joint longstanding
commitment that there be no gap in services and support
provided to our service members and their families as they
transition from the Department of Defense to the Department of
Veterans Affairs.
The transition that service members experience from active
service into civilian life must be improved. Veterans of Iraq
and Afghanistan know that the hardships don't end when they
leave the war zone. We in Congress are painfully aware that at
this very moment 26,000 service members are in the midst of the
disability evaluation process and are forced to wait over 400
days on average before they can return home to their
communities.
To further assist this transition the Congress mandated
over a decade ago that the DOD and the VA create a joint
integrated Electronic Health Record [iEHR] to facilitate the
transfer of service members' personal health information
between the DOD and the VA health facilities. Unfortunately,
after continuing delays we are now told that it isn't expected
to be completed until 2017.
And finally we hear about the veteran unemployment numbers;
23.3 percent of veterans between the ages of 18 and 24 are
unemployed. This highlights the difficulty our younger veterans
are having to find employment. The idea that our service
members can go from the front lines to the unemployment lines
is unacceptable. These men and women whom I have called the
next greatest generation, and who with their families have
sacrificed so much for this country, deserve better than to
have to face the uncertainty of leaving the military in these
very hard economic times. We must never stop working on their
behalf, and there is much work still to be done.
During my meeting with Secretary Shinseki I came away
impressed by his commitment to improving the transition. He met
multiple times with Secretary Gates where a joint commitment to
action was born. That commitment has continued with Secretary
Panetta. I would like to hear from both of you today on the
progress that you have made and also what you believe to be the
critical next steps, and I would like to compliment both of you
for working so hard together to make these things happen.
Specifically, I want both of your views on the Transition
Assistance Program, TAP, which facilitates the transition from
Active Duty. With regard to objectives, do you both agree on
TAP's objectives? For example, is TAP designed to prepare
service members for entry into the job market or is the purpose
to actually get a service member a job? How do you measure
whether TAP is achieving its objectives?
Service members transitioning deserve a government-wide
approach that includes support from the Departments of Defense,
Veterans Affairs, Labor, Education, Small Business
Administration, among others. How is TAP providing such an
approach?
The unfortunate consequence of over a decade of war is that
service members return with serious life-changing injuries.
Even as the numbers of service members being deployed to combat
zones goes down, projections are that the numbers of service
members and veterans needing support will grow substantially
for the foreseeable future. What are both Departments doing to
help service members transition as quickly as possible while
providing this generation of veterans the treatment they need
to return to their families and live fulfilling, independent
and productive lives?
Given the significant evolution of medical science, service
members now survive horrific injuries that would have been
fatal even during the first Gulf War. Many of these wounded
veterans will need long-term, comprehensive services and
support that can only be provided by the military and by the
VA. How are the Departments resourced for this long-term
effort? What are the plans to maintain an equitable joint
venture in light of the fact the Department of Defense is
facing another half trillion dollar reduction due to
sequestration? But the Department of Veterans Affairs is
exempt.
I now recognize Chairman Jeff Miller for his opening
remarks to be followed by Ranking Member Adam Smith and Ranking
Member Bob Filner for their opening remarks.
[The prepared statement of Mr. McKeon can be found in the
Appendix on page 47.]
STATEMENT OF HON. JEFF MILLER, A REPRESENTATIVE FROM FLORIDA,
CHAIRMAN, COMMITTEE ON VETERANS' AFFAIRS
Mr. Miller. Thank you very much, Mr. Chairman, and to our
ranking members for helping set up this really truly historic
meeting today. According to a quick search, it appears that we
never had these two Secretaries simultaneously appearing before
our two committees. And I would suggest that we don't wait so
long before we do it again. And if we are going to ask the VA
and DOD to work together, I think our committees should be
doing exactly the same. Secretary Panetta, Secretary Shinseki,
it is a pleasure to have you both with us here today, and your
presence I think underscores the goal that we all share that
our separating service members have a seamless transition from
their military life to the civilian life.
Our committee, the Veterans' Affairs Committee, and the
Subcommittee on Oversight and Investigation have held at least
13 oversight hearings on transaction related issues. These
topics include improving the joint disability evaluation system
that your Departments administer, ensuring that the highest
quality of health care for the severely wounded who can no
longer continue on Active Duty and ensuring that our service
members leaving the military are equipped successfully to enter
today's workforce.
We have also focused on the tools that your Departments
must use effectively to deliver these 21st century services
such as the electronic health records and other IT [information
technology] solutions. The testimony that we have received so
far on matters that we talked about has been somewhat mixed.
Although we have heard a number of initiative plans and
processes and improvements from your testimony today, I see
that it echoes much of those improvements, but I think what we
all want to see is clear bottom-line results. Several examples
would include notwithstanding the resources that Congress has
provided over the last several years to improve Iraq and
Afghanistan veterans' access to mental health care, many, many
concerns remain.
A VA psychologist testified that, ``VA clinicians are
overrun with veterans in need. Mental health service lines are
pushing as many veterans into clinicians' schedules as possible
to meet their performance measures but those veterans are not
getting effective treatment.''
Secondly, 5 years ago Secretary Shalala and Senator Dole
called for the establishment of an effective Federal recovery
coordinator program for the seriously wounded and their
families. But rather than a single point of contact they called
for, VA and DOD created two separate programs. The GAO
[Government Accountability Office] testified that
``proliferation of these programs has resulted not only in
inefficiencies but also confusion for those being served. So
consequently the intended purpose, which is to better manage
and facilitate care and service, may actually have had the
opposite effect.''
Five years ago Senator Barack Obama said, ``All of us are
in agreement that we need to make the DOD disability review
process less complex and better coordinated with the VA
process.'' However, that process remains slow and continues to
be complex. GAO has reported that case processing times have
increased over time and measures of service member satisfaction
have shown shortcomings.
Finally, despite repeated assertions about the need for VA
and DOD to share medical and other information electronically,
it seems the goalpost continues to move over and over again on
when this is finally going to take place. GAO says VA and DOD
still don't fully agree on key planning and operational
elements that would ensure future success.
So it is my hope that raising these important issues to
both of you here today will serve as a benchmark going forward
by which all of us can hold you or your successors accountable.
I know that both of you and I sincerely believe that both of
you are committed to solving these problems. However, if what
we have been doing isn't working or isn't showing the
measurable results that we need, then let's work together to
get things back on track.
I look forward to your testimony and yield back my time.
[The prepared statement of Mr. Miller can be found in the
Appendix on page 49.]
The Chairman. Thank you. Mr. Smith.
STATEMENT OF HON. ADAM SMITH, A REPRESENTATIVE FROM WASHINGTON,
RANKING MEMBER, COMMITTEE ON ARMED SERVICES
Mr. Smith. Thank you, Mr Chairman. I thank both of our
chairmen for holding this hearing. The service member
transition is one of the most important issues that we face I
believe as a country. We are going to have a large number of
men and women who have served in the military transitioning
out. How we take care of them is going to be I think one of the
ultimate measures of how strong a society we are. I want to
thank Secretary Panetta and Secretary Shinseki for being here
today and also for your leadership. Having met with both of
you, I know how committed you are to this issue and I see it
with your DOD and Veterans Affairs personnel. They are
absolutely committed to tackling the problem and making changes
and making it better. And I think progress has been made in
terms of health care and in terms of finding jobs we've seen a
slight down-tick in the unemployment rate of service members.
But we all know that much more needs to be done. I won't repeat
everything that the two chairmen said except to say that I
agree with them on the challenges in this area and how much
more we need to do and how much better we need to get at
coordinating that service.
I think one of the things that really struck me about this
issue is how so many people in this country want to help.
Certainly it is true with your two Departments, it is true in
Congress, but business leaders, community leaders, and we have
so many people out there coming up with creative ideas every
day for how to help our service members and their families as
they transition out of the military. I think one of the great
challenges is how do you bring those resources together and
come up with the best practices approach? What works best and
how can you then use all of that enthusiasm for helping the
people who have served in the military make the most out of
those resources and best coordinate it. I think that is a
challenge you will have. There are folks outside of the
government who are anxious to help, we need to work them in as
well. But I agree with both of the chairmen and the challenges
that they have outlined. I look forward to your testimony and
the questions and answers about how we can best step up to this
critically important challenge for our Nation. And with that, I
yield back.
[The prepared statement of Mr. Smith can be found in the
Appendix on page 51.]
The Chairman. Thank you. Mr. Filner.
STATEMENT OF HON. BOB FILNER, A REPRESENTATIVE FROM CALIFORNIA,
RANKING MEMBER, COMMITTEE ON VETERANS' AFFAIRS
Mr. Filner. Thank you, Mr. Chairman, and thank you for
holding this hearing. I mean the picture of our two Secretaries
sitting there together says it all. I will tell you, Mr.
Chairman, when I was chairman of the Veterans' Committee I was
trying to work with our party to have such a joint session and
we never could accomplish it. So thank you for getting it done.
We appreciate that. Thank you, Mr. Secretaries. We are going to
use the word ``transition'' a lot here. I just want to thank--
can I say Leon here? When I first came to Congress the
Secretary was very helpful in me transitioning from local
government to the Congress. And I will never forget your
kindness in mentoring, so thank you, Leon, for all of your work
over the years with so many people. You have a legacy here of
course that we will never forget.
The issues that we have, we have been talking as a Congress
and with the executive branch for many, many years, decades in
fact, and we've got to break down the bureaucratic stuff that
keeps us from having a common, for example, health record
system. I mean it just, people die because that system is not
integrated closely enough. And it seems that this is not beyond
our capacity as a people to get those systems integrated.
I want to say one word, we want to thank the President for
announcing this reverse boot camp. I think it is a good start,
the recognition of that. But I think it is just a start. And I
have been talking for at least a decade about a deboot camp. I
don't think, Mr. Secretaries, that you ought to build it on the
TAP program. If any of you have attended those programs--what
shall I say kindly--they are a waste of time for most people.
The only people more bored than the service members actually
sitting there--they are just thinking about getting out, they
are not taking into account anything at these lectures--the
only thing more bored than them is the people giving the
lectures. It is not a very exciting time and to expand it to 5
days doesn't seem to get at the heart. I think you've got to
seriously look at--and I know there is cost factor and your
predecessors would not look at it seriously--a real deboot
camp. When we send our young men and women to military, they go
through 10, 12 weeks to get the military ethos; you need almost
as much time to transition.
And first and foremost, which the President's program I
don't think has, is adequate medical evaluation. You know we
have thousands, tens of thousands, probably hundreds of
thousands of young people leaving the military without adequate
diagnosis of either their mental health or their physical
health. We know PTSD [post-traumatic stress disorder] and TBI
[traumatic brain injury] could be undiagnosed, they are
unrecognized, people are in self-denial. And so they will
transition and then have enormous problems, as you know,
suicide, homelessness, whatever. We can stop that with an
adequate diagnosis.
If you did it in a setting where there was a transitional
setting on a campus or, I don't know, some base somewhere with
their families, with their company of soldiers, they get the
support they need, that they lack when they do a sudden
transition. Their families are with them, that is important.
You can do their medical stuff, you do the job counseling, you
do the educational counseling but in a relaxed atmosphere where
everybody is paying attention. It would be part of Active Duty,
8, 10, 12 weeks, whatever you think you can afford. But I tell
you 5 days is a start, it is not going to do it. As you know,
you know better than all of us, the rate of suicides, the
homelessness, the convictions for crimes of recent veterans are
symptoms of an incredible problem. It is an epidemic and we are
not focusing on--we really don't want to know about it, it
seems to me.
And yet if you look at a reverse or deboot camp, and take
it seriously, and deal with the medical and psychological and
economic and educational issues over a period of time, I think
you can greatly reduce this blot on our record after these
young men and women serve so professionally in Iraq and
Afghanistan or wherever they happen to serve and then come home
and have domestic violence, and suicide, and homelessness, and
joblessness.
We are not doing our country a service. And I think you
have the leadership skills, you have the ability, you work well
together that we can get this blot off of our country's record
and really do something seriously.
So thank you all for being here. We thank you for your
personal cooperation, your personal leadership. You can really
change the two biggest bureaucracies we have in the Nation. You
two can change them and we look forward to working with you to
do it. Thank you.
The Chairman. Thank you. Given the interest in the hearing
today and it is a joint and that fact that it is a joint
hearing and, after consultation with Mr. Smith, Mr. Miller, and
Mr. Filner, I ask unanimous consent that each member shall have
not more than 2 minutes to question the panel of witnesses,
starting with me. Hearing no objection, so ordered.
In addition, we will follow our committee rules and
recognize members who arrived before the gavel in the order of
seniority, alternating between Armed Services Committee
majority and minority members followed by Veterans' Affairs
majority and minority members.
Lastly, I want to give special recognition to one of our
committee staff, John Johnson, better known as JJ, who is
responsible for artfully configuring this hearing room that
normally holds 64 members, but today had been expanded to
comfortably seat 82. You have my personal thanks, JJ.
Now, Mr. Secretary, Secretary Panetta, if you would please
begin.
STATEMENT OF HON. LEON E. PANETTA, SECRETARY OF DEFENSE, U.S.
DEPARTMENT OF DEFENSE
Secretary Panetta. Thank you, Mr. Chairman. I would ask
that my full statement be made part of the record, and I will
try to summarize it if I could.
The Chairman. Both of your statements will be fully entered
into the record. Hearing no objection, so ordered.
Secretary Panetta. Thank you very much, Chairman McKeon,
Chairman Miller, Ranking Member Smith, and Ranking Member
Filner, dear former colleagues of mine, and I appreciate the
opportunity to be here, and I also want to pay my respects to
the members of both committees. This is a unique event, it is
an important event. And first and foremost I want to thank all
of the members of both the Armed Services and Veterans'
Committee for the support that you provide the Department of
Defense, our men and women in uniform and our veterans. We
could simply not do the work that needs to be done in
protecting this country and in serving those that are warriors
and their families. We just could not do it without the
partnership that we have with all of you. And for that reason
let me just express my personal appreciation to all of you for
your dedication and for your commitment to those areas.
I also want to thank you for the opportunity to appear this
morning alongside Secretary Shinseki. He is a great friend, a
great public servant, a great military leader and a great
friend to me and to our Nation's veterans. I appreciate the
opportunity to appear alongside of him.
I am pleased to have this chance to discuss the ways that
the Department of Defense and the Department of Veterans
Affairs are working together to try to meet the needs of our
service members, our veterans, and their families. This hearing
comes at a very important time for our Nation and for
collaboration between our two Departments. DOD and VA are in
the process of building an integrated military and veterans
support system. It is something that should have been done a
long time ago, but we are in the process of trying to make that
happen, and develop a support system that is fundamentally
different and a lot more robust than it has been in the past.
Today, after a decade of war, a new generation of service
members, of veterans is coming home, our Nation has made a
lifetime commitment to them for their service and for their
sacrifice, for their willingness to put their lives on the line
for this country. These men and women have shouldered a very
heavy burden. They have been deployed, as you know, time and
time and time again. They fought battles in Iraq; they fought
battles in Afghanistan; they have been targeted by terrorists
and by IEDs [improvised explosive devices]; they have been
deployed from Kuwait to South Korea, from the Pacific to the
Middle East. Many are dealing with serious wounds, as well as
with complex and difficult problems, both seen and unseen. They
have fought and many have died to protect this country and we
need to fight to protect them. We owe it to those returning
service members and to the veterans to provide them with a
seamless support system so that they can put their lives back
together, so that they can pursue their goals, so that they can
not only go back to their communities but be able to give back
to their communities and to help strengthen our Nation in many
ways.
None of this, none of this is easy. It takes tremendous
commitment on the part of all Americans, those in government,
those in the military, it takes tremendous commitment on the
part of those in the private sector, our business leaders and,
frankly, all citizens across our country.
There is no doubt that DOD and VA are working more closely
together than we have before, but frankly we have much more to
do to try to reach a level of cooperation to better meet the
needs of those who have served our Nation in uniform,
especially our Wounded Warriors.
Since I became Secretary a little over a year ago,
Secretary Shinseki and I have met on a regular basis in order
to personally guide efforts to share resources and expand
cooperation between our Departments. Partnership between our
Departments extends to all levels led by a joint committee
cochaired by the Under Secretary of Defense for Personnel and
Readiness and the Deputy Secretary of Veterans Affairs. Senior
military leaders have been deeply committed to this effort.
This is about the care of their troops, but it is also about
recruiting and retaining the very best military force in the
world. When it comes down to it, caring for those who have
served and their families is not only a moral imperative, it is
a national security imperative as well.
For those who have fought for their Nation we need to
protect their care and their benefits, but we also need to
protect their integrity and their honor. It is for that reason
that before I discuss the specifics about DOD and VA
collaboration I want to announce an important step that my
Department is taking in order to help maintain the integrity of
the awards and honors that are earned by our service members
and their veterans. You are all aware of the Supreme Court
decision that determined that free speech allows someone to lie
about military awards and honors. Free speech is one thing, but
dishonoring those who have been honored on the battlefield is
something else. For that reason, today we are posting a new
page on the Defense Department's Web site that will list those
service members and veterans who have earned our Nation's
highest military awards for valor. Initially the Web site will
list the names of those who have earned the Medal of Honor
since 9/11. But in the near term it will include the recipients
of the services Crosses and the Silver Star since 9/11. We will
look at expanding that information available on the Web site
over time. This effort will help raise public awareness about
our Nation's heroes and help deter those who might falsely
claim military honors, which I know has been a source of great
concern for many veterans and members of these committees and
Members of the Congress. I want to thank you for your concerns
and for your leadership on this issue, and our hope is that
this will help protect the honor of those who serve the United
States in battle.
Now let me discuss the five priority areas that DOD and VA
are trying to work on to enhance collaboration. The first is
this transition program, Transition GPS program. At the
Department of Defense our goal is to provide a comprehensive
Transition Assistance Program that prepares those who are
leaving the service for the next step, whether that is pursuing
additional education, whether it is trying to find a job in the
public sector or the private sector, or whether it is starting
their own business.
On Monday the President announced the new Transition GPS
program that will extend transition preparation through the
entire span of each service member's military career. The
program will ensure that every service member develops their
own individual transition plan, meets new career readiness
standards, and is prepared to apply their valuable military
experience however and wherever they choose.
Second area that we focused on is trying to integrate the
disability evaluation system. We have overhauled the legacy
disability evaluation system and trying to make improvements
with regards to developing a new system. In the past, as you
know, service members with medical conditions preventing them
from doing their military jobs had to navigate separate
disability evaluation systems at both DOD and VA. We have
replaced that legacy system with a single Integrated Disability
Evaluation System [IDES] that enables our Departments to work
in tandem. Under the new system currently in use, service
members and veterans have to deal with fewer layers of
bureaucracy, and they are able to receive VA disability
compensation sooner after separating from the military.
But let's understand as we try to do this, this is a tough
challenge to try to make this work in a way that can respond to
our veterans effectively. After all, veterans have rights, they
have the right to ensure that their claims are carefully
adjudicated, but at the same time we need to expedite the
process and to ensure that as we do that we protect their
benefits, and that is what we are trying do with this system.
The third area is to try to integrate, as was pointed out,
a new electronic health record system. We are working on a
major initiative to try to do that. For too long efforts to
achieve a seamless transition between our health care systems
have been hamstrung by separate legacy health record systems.
In response to challenge that was issued by the President and
frankly Presidents in the past who have tried to address this
issue, DOD and VA is finally working steadily to build an
integrated Electronic Health Record system. When operational
that system will be the single source for service members and
veterans to access their medical history and for clinicians to
use that history at any DOD and VA facility. Again, this is not
easy, and so the way we are approaching it is to try to see if
we can complete this process at two places, San Antonio and
Hampton Roads, and then try to expand it to every other
hospital. It is tough, but if we can achieve this, it would be
a very significant achievement that I think could be a model
not only for the hospitals that we run, but for hospitals in
the private sector as well.
Fourthly, we need greater collaboration on mental and
behavioral health. Beyond these specific initiatives that I
mentioned, we are trying to focus on enhancing collaboration in
areas that involve some of the toughest challenges we face now
related to mental and behavioral health. Post-traumatic stress
has emerged as a signature unseen wound of this last decade of
war. Its impact will be felt for decades to come and both the
DOD and VA must therefore improve our ability to identify and
treat this condition, as well as all mental and behavioral
health conditions, and to better equip our system to deal with
the unique challenges these conditions can present. For
example, I have been very concerned about reports of problems
with modifying diagnosis for post-traumatic stress in the
military disability evaluation system. Many of these issues
were brought to my attention by Members of Congress, and I
appreciate their doing that, particularly the Senate Veterans'
Affairs Committee chairman, Patty Murray, who addressed this
issue because it happened in her own State in a particular way.
To address these concerns I have directed a review across all
of the uniformed services. This review led by the Under
Secretary of Defense for Personnel and Readiness Erin Conaton
will help ensure that we are delivering on our commitment to
care for our service members. The review will be analytically
sound, it will be action oriented, and it will provide
hopefully the least disruptive impact to behavioral health
services for service members. The effort here is to determine
where those diagnoses take place, why they were downgraded
downward, what took place so that we know exactly what has
happened. I hope that the entire review will be completed
within approximately 18 months.
The last area is an area that has really concerned me,
which is the area of trying to prevent military suicides. We
have strongly focused on doing what we can to try to deal with
this issue, which I have said is one of the most frustrating
problems that I have come across as Secretary of Defense.
Despite increased efforts and attention by both DOD and VA, the
suicide trends among service members and veterans continues to
move in a very troubling and tragic direction. And part of it
is reflected in larger society. The fact is numbers are
increasing now within the military. In close cooperation with
the VA, DOD is taking aggressive steps to try to address this
issue, including promoting a culture to try to get people to
seek help, seek the kind of help that they need to improve
access to mental and behavioral health care, to emphasize
mental fitness and to work to better understand the issue of
suicide with the help of other agencies, including the VA. One
of the things I am trying to stress is that we have got to
improve the ability of leadership within the military to see
these issues, to see them coming and to do something to try to
prevent it from happening.
Our efforts to deliver the best possible services depend on
the dedication of our DOD and VA professionals who work
extremely hard every day on behalf of those who have served in
uniform, and I extend my thanks to all who help support our men
and women in uniform today, to our veterans and to our
families.
Let me just say we are one family, we have to be one family
at the Department of Defense and the Department of Veterans
Affairs, a family that supports one another and all those who
have answered the call to defend our country. Together we will
do everything possible to ensure that the bond between our two
Departments and between our country and those who have defended
it only grows stronger in the future.
Let me also say this. As a former Congressman, now as
Secretary of Defense and someone who has spent over 40 years
involved in government in some capacity or another, I am well
aware that too often the very best intentions, very best
intentions for caring for our veterans can get trapped in
bureaucratic infighting, it gets trapped by conflicting rules
and regulations, it gets trapped by frustrating levels of
responsibility. This cannot be an excuse for not dealing with
these issues. It should be a challenge for both the VA and DOD,
for the Congress and for the administration to try to meet that
challenge together. Our warriors are trained not to fail on the
battlefield. We must be committed not to fail them on the home
front. I realize that there have been a lot of good words and a
lot of good will and a lot of good intentions, but I can assure
you that my interest is in results, not words. I am grateful
for the support of the Congress, particularly these two
committees, and I thank you and look forward to your questions.
[The prepared statement of Secretary Panetta can be found
in the Appendix on page 56.]
The Chairman. Thank you, Mr. Secretary. You know there have
been comments made about how unique this is to have this joint
hearing between these two committees. It resulted from Chairman
Miller coming to me with the idea and I want to thank him for
that, and I think it also happened because we have two such
outstanding Secretaries, both of whom are veterans, both of
whom have devoted their life to service of this country.
Secretary Panetta, many years in Congress, was here when I
first came here and a couple of others of us that are still
here, Mr. Barton and Mr. Filner. We are the old, old people on
this committee now. But you were taken from our midst over to
serve the President as Director of OMB [Office of Management
and Budget] and then as his Chief of Staff, and then later was
Director of Central Intelligence Agency and now as Secretary of
Defense. I think that is a lifetime to be commended.
And Secretary Shinseki, starting with entrance into the
United States Military Academy, lifetime of service in the
Army, culminating as Chief of Staff of the Army. No one could
have a better career, leading troops in battle and leading the
entire Army in the start of this war against terrorism. Thank
you both for your service.
Mr. Secretary.
STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY OF VETERANS
AFFAIRS, U.S. DEPARTMENT OF VETERANS AFFAIRS
Secretary Shinseki. Thank you, Mr. Chairman. Chairman
McKeon, Chairman Miller, Ranking Member Smith, Ranking Member
Filner, other distinguished members of both committees, the
House Armed Services and House Veterans' Affairs Committees,
thank you for your steadfast support of service members and
veterans and for this opportunity to testify before you.
I am honored to be here with my friend as well, Secretary
Leon Panetta. His leadership and close partnership on behalf of
those who wear and have worn the uniforms of our Nation has
been monumental.
I would also like to acknowledge I believe we have here and
other places veterans service organizations [VSOs] and veterans
who are here today. I acknowledge them because with the VSOs,
their insights have been helpful in developing, resourcing, and
improving the programs that we overwatch in the Department of
Veterans Affairs.
I have said it often enough and I will say it one more
time, little of what we do in VA originates in VA. Much of what
we work on originates in DOD. And so what this means is that we
in VA must be aware, must be agile and then must be fully
capable of caring for those who have, in Lincoln's words, borne
the battle. As a footnote, we still today in VA care for two
children of Civil War veterans. The promises of President
Abraham Lincoln are being delivered today by President Barack
Obama, this Congress, and the VA. And 100 years from now we
will still be fulfilling our commitment to the current
generation of veterans, their families, and our survivors.
History also shows, and this is VA's piece of history, also
shows that our requirements in VA continue to grow for about a
decade and maybe sometimes a little more after the last
combatant comes back from operation. And so in this case about
a decade or more after the last combatant leaves Afghanistan,
VA's requirements will continue to grow; the operation will be
over and budget will begin to reflect that, but at VA our
requirements will still be growing.
So for us it is important that we spend the time now to
better anticipate their needs for care, for benefits and for a
successful transition to civilian life for this current
generation, without losing sight of the needs of previous
generations that we also care for.
Collaboration and cooperation between VA and DOD have never
been more important and I think for the next two decades it
will be entirely important because this will be in large
measure the work of the Nation and focusing on how we care for
the less than 1 percent of Americans who serve in uniform today
and provide for us this way of life.
Most significantly, we are looking initially here at four
areas. Three of those areas will match up with what Secretary
Panetta just provided. That doesn't mean that in his five and
my four we are disconnected, but we describe them just a little
bit differently.
The integrated Electronic Health Record, the iEHR, which
you have remarked has been in the process of discussion for 10
years now, I think both Secretary Panetta and I have agreed on
what that will be and we are moving towards a solution.
The second point, more comprehensive sharing of data
through a virtual lifetime electronic record, of which
integrated Electronic Health Record is a key component.
The third area of focus, the Integrated Disability
Evaluation System, which is primarily a DOD enterprise with
significant VA support to ensure an efficient process.
And the fourth of our VA's areas of focus, the President's
initiative to redesign the transition process and the
implementation of the VOW [Veterans Opportunity to Work] to
Hire Heroes Act.
My testimony submitted to the committee expands on each of
these areas in some detail, and I thank the chairman for
accepting that written testimony into the record and I won't go
into them in detail at this time.
Well, let me briefly emphasize that it is especially
important that we assure the greatest collaboration between VA
and DOD in that critical phase before service members leave the
military. We simply must transition them better. And I speak as
one who has watched that process from a different vantage point
over time. We do this best with warm handoffs between the
Departments. That is key to assuring the success of
transitioning service members back to their communities in
productive ways. But it is also key in preventing the downward
spiral that some face in being challenged. Transitioning
doesn't work quite as well for them and in some cases
homelessness and sometimes suicide are what we have to deal
with.
So I echo Secretary Panetta's comments. While we are
pleased with the progress made to date on critical issues
common to both VA and DOD, we know we have a responsibility to
better harmonize our two large Departments in ways to better
serve service members, families, veterans, and our survivors.
Their well-being is the strongest justification of why we
should be working together more closely and more
collaboratively and we are today. There is more important work
to be done, and I am proud to move forward with Secretary
Panetta to make the most progress possible in our time on
behalf of those who wear and have worn the uniforms of our
Nation.
And with that, Mr. Chairman, thank you and to the members
of this committee for your unwavering support of our efforts,
and I look forward to your questions.
[The prepared statement of Secretary Shinseki can be found
in the Appendix on page 64.]
The Chairman. Thank you very much. I ask unanimous consent
to include the record of all member statements into the record.
Without objection, so ordered. We have already agreed that we
will have about 2-minute questions, so I would encourage
members to make their questions short so that we can have the
answers complete, and we will start with me.
As I have already said, we know that there is high
unemployment among our veterans, our young veterans. And we
know with the $487.0 billion cut in defense we will have
100,000 leaving the military. We will have another 100,000 if
the sequestration takes effect.
What plans do we have to ensure that these service members
will not go from the front lines to the unemployment lines? And
how do you see potential reduction in the defense workforce
resulting from the sequestration? What effect will that have on
what will you be able to do to try to move them into some
meaningful employment, Mr. Secretary?
Secretary Panetta. Well, I sure as hell hope that
sequestration doesn't happen.
The Chairman. I am with you.
Secretary Panetta. It would be, as I have said time and
time again, a disaster in terms of the Defense Department as
far as our budget is concerned and as far as our ability to
respond to the threats that are out there and it would have a
huge impact. It doubles the cuts in the military. It would
obviously add another 100,000 that would have to be reduced,
and the impact of that on top of the reductions that are
currently going to take place would place a huge burden on the
systems to be able to respond to that. I think it would be near
impossible to try to do the kind of work that we are trying to
do and make it work effectively.
I think we can handle what we have proposed in our budget
and the drawdown numbers that are coming now. We have tried to
do this pursuant to a rational strategy over these next 5
years. And I think the systems we are working on and what we
are trying to put in place I am confident can respond to that.
But if sequester should happen and if an additional burden is
suddenly put on top of it, I think it could really strain the
system.
The Chairman. Mr. Secretary, could you please give us that
input for the record?
Secretary Panetta. Absolutely.
[The information referred to can be found in the Appendix
on page 84.]
The Chairman. In keeping with it. My time has expired. Mr.
Miller.
Mr. Miller. Both Secretaries, in 1961 John F. Kennedy said
we would put a man on the Moon, 8 years later America was
there. We are talking about an integrated Electronic Health
Record by 2017. Why could we put a man on the Moon in 8 years
and we are not starting from ground zero with electronic health
record. Why is it taking so long? Because it so vital
especially, Secretary Shinseki, to solving the backlog issue
that exists out there today in regards to disability claims.
Secretary Shinseki. Mr. Chairman, I can't account for the
previous 10 years. I do know there is a history here. But let
me just suggest that two large Departments, each having their
own electronic health record, which happened to be two very
good, maybe the two best, electronic health records in the
country, and trying to bring that culture together to say we
are going to have one, and it is entirely possible. And I agree
with you it is not technology, it is leadership here. And
between Secretary Panetta and I, we have in the last year met
four times. We are going to meet again in September. We are
here today testifying together. I think this is a great signal
to both of our Departments. Prior to that I recall meeting with
Secretary Gates four or five times. So in 17 months, with two
Secretaries of these two large Departments have sat side by
side in direct communication on issues like this, with the
integrated Electronic Health Record being the primary topic of
discussion. It has taken us 17 months to get to an agreement
that both Secretary Panetta and I signed that describes the way
forward. And the way forward for us is a single joint common
integrated Electronic Health Record. Each of those words means
something. But key here is an agreement that it will be open in
architecture, nonproprietary in design. That is a significant
change from previous discussions which were wrapped around
which proprietary contractor were we going to be interested in
in establishing an arrangement with. I believe that was part of
the challenge. The fact that we have agreed on a concept I
think is groundbreaking here, and both Secretary Panetta and I
have agreed to move forward on this.
The Chairman. Thank you very much. The gentleman's time has
expired. Again if you could complete the record on those
questions that would be good.
Mr. Smith.
[The information referred to can be found in the Appendix
on page 83.]
Mr. Smith. Thank you, Mr Chairman. I have a question about
the TAP program, following up on some of the comments Mr.
Filner made. Exit interviews are notoriously difficult to get
people interested in and I think the problem is service members
are out, they are moving on. I met with some of your folks from
both your offices that showed me how they had refined the
program; they used to have a book this big, now they have a
book this big.
The bottom line is what are your thoughts on what you can
do to get the service members to pay attention to the two or
three most important things in that transition. It strikes me
like we are overwhelming them with information, eyes just glaze
over. If you had to explain it to them in 15 minutes, what are
the critical pieces of information that you want to give them?
How can we make that work better?
Secretary Panetta. I will yield to Secretary Shinseki as
well on this. You know, I remember when I got out of the
service I couldn't wait to get the hell out of there and I
didn't really want to spend a lot of time having people tell me
what I was or was not going to do. In this instance I think the
best way to try to bring these opportunities to attention of
members is the counselors. We are assigning individual
counselors as part of the transition program. They are going to
sit down individually with them. I think that is the best way
to get their attention and try to get them moving with regards
to the potential benefits that are available to them.
Secretary Shinseki. Just very quickly, I would echo
Secretary Panetta here. I know that when I got ready to get out
of the military I couldn't wait to get the hell out of there
either. I would just say if we look at this as a transition
assistance program, and the focus is on assistance, I think we
come at it with a different attitude. If we look at this as an
education responsibility of preparing folks for at least the
next phase of their lives to make the right decisions, whether
it is education, whether it is a work choice and certainly from
the VA's point of view we are entirely interested in getting as
many departing service members enrolled with us. Whether or not
they have a requirement for health care today, having them
enrolled 5 or 10 years down the road when issues crop up we
have the evidence necessary to be able to deal with it. So we
need to look at this as more than just assistance, but this is
really preparing them, making them career-ready for the next
phase of their lives.
Mr. Smith. Thank you very much, Mr. Chairman.
The Chairman. Thank you.
Mr. Filner.
Mr. Filner. You know, in a democracy where you need
obviously the support and vote of people to go to war, the cost
of war is a pretty important item to understand. And treating
our veterans is obviously a part of the cost of war or should
be considered that. I have tried on several occasions to add an
amendment to any war appropriations, I don't know 15 to 20
percent surcharge, because that is the difference in your
budgets for veterans. And of course since we have been
borrowing money for war and nobody wants to borrow the money
for veterans. So it is not looked on kindly.
But part of the cost of war, you know, we have the
statistics, so about 6,000 killed in action--I am sorry, 5,000
killed in action since 9/11, and almost 50,000 wounded. And
yet, those who have showed up at the VA for help, and I know
there are different definitions and different circumstances, I
think it is close to, or could be over a million. Why is there
such a disparity between--and it is important for the public to
understand, what is the cost of war? How do you account for 1
million veterans seeking help for problems in war, and only
50,000 considered casualties?
Mr. Panetta, I will go to you first. Since you know how to
manipulate the 2 minutes, you are looking to him, I know, so
you don't have to answer.
Secretary Panetta. No. I mean, it clearly is the impact of
war over the last 10 years and how it has affected those who
have served. And when they do return, when they come back, the
reality is that, you know, that not all of them, not all of
them are getting the kind of care and benefits that they should
get. And it is our responsibility to try to respond to those
needs as they return.
Look, this system is going to be overwhelmed. I mean, you
know, let's not kid anybody. We are looking at a system that is
already overwhelmed. The likelihood is as we draw down further
troops and, you know, over these next 5 years, assuming
sequester doesn't happen, we are still going to--you know, we
are going to be adding another 100,000 per year. And the
ability to be able to respond to that in a way that effectively
deals with the health care issues, with the benefits issues,
with all of the other challenges, that is not going to be an
easy challenge. And you talk about the cost of war, this is
inherently part of the cost of war. It is not just dealing with
the fighting, it is also dealing with the veterans who return.
And that is going to be a big ticket item if we are going to do
this right.
Mr. Filner. I just hope you look at that boot camp idea as
a way to really get at that issue.
The Chairman. Thank you. Mr. Bartlett.
Mr. Bartlett. Thank you. By almost every account, we are
failing our veterans. More of them are killing themselves than
are killed by the enemy in Afghanistan, and the suicide rate is
increasing. Homelessness is approaching the percentage of
Vietnam veterans, and that is increasing. Unemployment is more
than twice the unemployment percentage of the general
population. The in-service disability evaluation delays are
unacceptable. And after they are out, it may take more than a
year. They are unemployable because of a disability, it may
take more than a year for them to get that disability.
Secretary Panetta, you mentioned that you hope that an 18-
month review could be completed on time. I would suggest, sir,
that that does not reflect the sense of urgency that this
challenge requires. What do we need to do in the Congress to
address this problem?
Secretary Panetta. You know, I think that the one thing I
have seen is that all of us share the same concern with regards
to our ability to respond to these issues. The challenge is
that as we try to make these systems work, there is a lot of
built in resistance to adapting and changing the way we do
things. And to the extent that we can work together, to try to
make sure that we push for these changes to take place, and do
it in a way that effectively responds to the challenges, that
is something I think both the Congress as well as the
administration have to push.
We cannot accept the old way of doing things. Things are
going to have to change. Things are going to have to be
modified. People are going to have to respond differently. If
we expect the same old responses to the problems we are having,
then we are going to have the same old problems. We have got to
change the way people respond to these issues.
The Chairman. Thank you. Mr. Reyes.
Mr. Reyes. Thank you, Mr. Chairman. And thank you,
Secretaries, for being here. First of all, I wanted to thank
both of you because you have put your personal leadership in
areas that have never been done before. The issue of women have
been very important to both of you in the military, both in
terms of sexual harassment and attacks and those kinds of
things.
Secretary Panetta, you have been a stalwart there. And
Secretary Shinseki, your leadership in prioritizing
homelessness among veterans, especially among women veterans,
is very much appreciated. I can tell you because veterans very
much appreciate those priorities and your personal leadership
in that. So I know both of you face immense challenges. But
reflecting on what Chairman Miller said, I hope we continue to
do these kinds of joint hearings because this truly is an
important--I think one of the most important things that both
of these committees can focus on. Just echoing what my
chairman, Chairman Bartlett said, can each of you comment
briefly on where we can be most helpful in terms as a Congress,
especially from these two committees?
Secretary Shinseki. I can speak on the VA piece of this.
Actually, the Congress has already provided some significant
assistance to VA. I would recall in 2008 and 2009, our budgets
were enhanced by Congress. Since then, you have provided us
advanced appropriations. Now, not all agree that it was a good
move, but for VA, it provided us an opportunity to have a 2-
year look at our budgets. And what it assured is that for the
health care piece of our budget, every year on 1 October,
whether or not there is a continuing resolution, we are able to
fund our health care requirements so that veterans--there isn't
a gap in care for veterans. In those ways, meaningful support
has been provided.
I would also say that we are dealing with issues that grow
over time, and some of them very quickly, mental health, PTSD.
The budgeting process is based on knowing requirements well
out, and methodically reacting to growth in trend. When you
have large growth in a short period of time, the budget process
is not quite as agile, and it is a bit reactive. And so our
efforts to try to harmonize, the reason that we are here is so
that VA has some good ideas on what to expect and be able to
put that into our budgeting process.
The Chairman. Thank you. Mr. Bilirakis.
Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it
very much. Thank you, Secretary Panetta and Secretary Shinseki.
You both mentioned in your testimony the prevalence of PTSD and
TBI. And I believe we certainly need more research to establish
better diagnostic tools and treatments. Through what channels
are the DOD, VA, and the private sector sharing the research
findings and collaborating on the direction of future research?
Secretary Shinseki. I would just offer in 2009, the DOD and
VA held its first mental health summit, a joint effort to bring
our mental health programs to the same table and have a
discussion. Twenty-eight strategic findings that came out of
that, those findings we continue to execute today. While it was
a broad look, inside that discussion were issues on PTSD, TBI.
We spent about $30 million in the VA budget on research for
PTSD. We learned a lot from DOD because they have extensive
experience in this area in terms of diagnosis and dealing with
PTSD, with formations, with people in formations, in combat,
going back to combat.
So there is much that we learn from our collaboration with
DOD, through our research. More to be done, to be sure.
Secretary Panetta. Let me add, what we try to do is to do
mental health assessments both before and after deployments, so
that we can identify and try to treat somebody who might have a
problem, specifically with a PTSD. We have done about 600,000
of these assessments. Our greatest limitation, our greatest
limitation is the number of care providers is simply not
sufficient for the demand. And we are competing with VA and
with private health care systems to hire these people. But that
is a real--that is an area of tremendous need in order to
address the amount of problems we are facing.
The Chairman. Thank you. Mr. Michaud.
Mr. Michaud. Thank you very much. I want to thank you both
for your service and for your both being here this morning. A
quick question, and I want to read from a veterans service
organization letter that they actually sent to Senator Webb
just last week, and just part of it that says: ``The only
branch of the military to show a marked improvement decreasing
the number of persons taking their own lives is the United
States Marines. They should also be praised for their active
leadership from the very top in addressing the problem and
implementing the solutions. The remaining services have yet to
be motivated to take any substantive action.''
Secretary Panetta, I have been to Iraq and Afghanistan
several times, and I looked the generals in the eye and I asked
them what are they doing personally to help destigmatize TBI,
PTSD. And the second question is do they need any help? I get
the same answer over there as I do here in DC, everything is
okay. We have all the resources we need, we don't need any
help. But the interesting thing is someone of much lesser rank
came up to me after I asked the general that question outside
and said we need a lot more help. And he suggested I talk to
the clergy to find out what they are seeing happening.
And I did, that trip, and every trip since then. And I am
finding that our service members are not getting the help that
they need. And my questions, particularly after looking at this
letter that was sent to Senator Webb, it appears the Marines
are doing a good job. So why is it so different between the
Marines, the Army, and other branches? And can you address
that?
Secretary Panetta. You know, obviously there is no silver
bullet here, I wish there were, to try to deal with suicide
prevention. We have a new Suicide Prevention Office that is
trying to look at programs to try to address this terrible
epidemic. I mean, we are looking just--if you look at the
numbers, recent totals are, we have got about 104 confirmed,
and 102 pending investigations in 2012. The total is as high as
206, almost one a day that we are seeing. That is an epidemic.
Something is wrong.
I think one of the areas--I mean, look, part of this is
people are inhibited because they don't want to get the care
that they probably need. So that is part of the problem is
trying to get the help that is necessary. Two, to give them
access to the kind of care that they need. But three, and
again, I stress this because I see this in a number of other
areas dealing with good discipline and good order and trying to
make sure that our troops are responding to the challenges, it
is the leadership in the field, it is the platoon commander, it
is the platoon sergeant, it is the company commander, it is the
company sergeant. The ability to look at their people to see
these problems, to get ahead of it, and to be able to ensure
that when you spot the problems, you are moving that individual
to the kind of assistance that they need in order to prevent
it. The Marines stay in close touch with their people. That is
probably one of the reasons that, you know, the Marines are
doing a good job. But what we are stressing in the other
services is to try to develop that training of the command so
that they, too, are able to respond to these kinds of
challenges.
The Chairman. Thank you. Mr. Thornberry.
Mr. Thornberry. Secretary Panetta, there was a cover story
on military suicides in Time Magazine within the past couple
weeks. And some statistics really jumped out at me. One fact
they said is that 33 percent of military suicides had never
deployed overseas at all, and 43 percent had been deployed
once. That is 76 percent, if you add it together. I am
wondering, number one, are those statistics accurate? And
number two, what does that tell us about the problem if a third
of all the suicides--we are focused so much on the PTSD and so
forth, if they have never deployed at all and a third of the
suicides, maybe we are not looking at all the factors.
Secretary Panetta. Those numbers are accurate as far as we
know. And I think what you are seeing is that it reflects the
larger problem in the society. Because the fact is that
suicides are on the increase in the rest of society as well.
So, problems with drinking, problems with finances, problems
within the family, problems, you know, of trying to deal with
conflicts that they are confronting, problems of dealing with
just the general pressures that we are seeing in a society that
is dealing, obviously, with economic pressures, at the same
time is dealing with social pressures.
All of that is impacting on families. And that is true in
the military as well. And that is why we are seeing this occur
not just from those that are deployed to the battlefield, but
we are seeing it with regards to families that are here.
Mr. Thornberry. It just seems to me that puts a little
different perspective on the scope of the issues that both you
gentlemen have to deal with if it is not just combat, but the
entire gamut of those problems. Thank you, I yield back.
The Chairman. Thank you. Mr. Secretary, do you know if
there is any correlation between this age group in the military
committing suicide and those not in the military, but of the
same age group committing suicide?
Secretary Shinseki. Mr. Chairman, an important question.
The CDC [Centers for Disease Control] publishes every year the
top 10 leading causes of death amongst Americans. And as I
recall, the last report--and it is a continuous track in the
age group 15 to 24, suicides is the third leading cause of
death in the top 10 of Americans. In the age group 25 to 34, it
is the second leading cause of death.
So suicides, it is a national discussion here. And when you
recruit out of that population and put youngsters through the
stresses we all are familiar with in combat, very small
percentage serve in uniform, yes, suicides become a matter of
great focus, interest, and importance to both Secretaries. I
guess the follow-on question is how do we try to decide who are
best suited to serve in the recruiting effort? But I no longer
have those responsibilities. I used to at one time.
The Chairman. Thank you. Ms. Sanchez.
Ms. Loretta Sanchez. Thank you, Mr. Chairman. And thank
you, gentlemen, again, for being before us today. In preparing
for this hearing, I asked my staff back in Orange County to go
through the casework we have with respect to veterans in
transition. And although we have a great relationship with our
VA Hospital in Long Beach, and we have two clinics, one in
Santa Ana and one in Anaheim in our district, the reality is
that the most troublesome area with respect to these cases
involve the quality and the lack of health care for our service
members who are transitioning from active, or having been
called up and are now out into the veterans world, if you will.
And in fact, I have a lot of veterans who come to my office and
they express real concern about not receiving treatment or
having a long time to wait for a specialty doctor, for example.
In Long Beach, it would be oncology, where we must be
short-staffed or something of the sort. And the other really
big concern for them is the issue of being prepped up for a
surgery and then somebody on the surgery team doesn't show up
out of whatever, and the surgery is then postponed. And it
isn't until these people come to my office and we call in
directly that we are able to get that rescheduled.
So my question is, how are you addressing these types of
concerns with respect to health care? And why, if a surgery is
scheduled, why aren't people showing up to be on that surgery
team? And more importantly, why does it take a congressional
office to call to ask that it be rescheduled?
Secretary Shinseki. All fair questions, Congresswoman. If
you would give me the details, I am more than happy to research
both your frustration and mine. We owe veterans better. And I
agree with you.
Ms. Loretta Sanchez. My second question is with respect to
homelessness. We have a lot of great organizations helping us
with that, but they are low on funds. Is there any grant
program coming up for something like that for local 501(c)(3)s
to help?
Secretary Shinseki. We have provided grants for the past 2
years. Two years ago, about $60 million worth of grants were
provided under the Supportive Services to Veterans' Families
Fund. Just recently announced this year's investment of $100
million. And in the 2013 budget we have a request for an
increase to that investment as well.
Ms. Loretta Sanchez. Thank you so much, Mr. Secretary.
Mr. Thornberry [presiding]. Mr. Stutzman.
Mr. Stutzman. Thank you, Mr. Chairman. Thank you to both
you gentlemen for being here today. The President has announced
a new model of the TAP program. As we understand it, everyone
will be required to attend a 1-day DOD pre-separation class,
followed by a 3-day employment workshop, and a 1-day VA
benefits briefing.
Other training in non-job seeking, such as determining
readiness for postsecondary education and entrepreneurship,
will be offered as voluntary, and not subject to the mandatory
provisions of law. This is hardly a tailored approach that
would meet the needs of those whose post-discharge intentions
are to attend school or to start a business. Offering
nonemployment-related instruction as voluntary ignores the fact
that it is difficult enough to get supervisors to allow service
members to attend the current 3\1/2\-day course, much less 7 or
8 days away from the unit, especially if that unit is preparing
to deploy. Will you make all 8 days of TAP, including the
voluntary nonemployment, mandatory?
Secretary Panetta. I think we have got to move in that
direction. You know, we are doing nine pilots that are
basically going to test this out. And we are hoping to complete
those pilots by November and learn, you know, just exactly what
we have to require, how do we have to mandate it, how do we
have to revise it. But, you know, my sense is the only way it
works is if you make it mandatory.
Mr. Stutzman. The model that the Marine Corps is using in
giving the options to those who are about to discharge, is that
a model that is worth looking at as well?
Secretary Panetta. I would think so.
Mr. Stutzman. It seems like that would give a lot of
flexibility, because not every service member is going to be
coming out planning on just going into the workforce.
Secretary Panetta. That is right. Some will want to stay.
Mr. Stutzman. Absolutely. Yes. Thank you. I yield back.
Mr. Thornberry. Mr. Walz.
Mr. Walz. Thank you, Mr. Chairman. I would like to thank
both chairmen and the ranking members for making this happen. I
have talked seamless transition for most of my adult life, and
it appears like it is happening. So I thank you. And to both of
you, you have my deepest gratitude, and the people of the First
District, for the defense of this Nation and the care of our
veterans. I have got kind of a tough one here, it is a
troubling one, I know it troubles both of you. The issue that
came out in the GAO report of the 26,000 soldiers discharged
under personality disorders. My question is, and it is brought
to the fact by the Vietnam Veterans Commission to study at Yale
Law School about what are we doing about that? And my question
to you, probably to you, Secretary Panetta, is what are we
doing to review and correct the records of those veterans who
may have been improperly discharged with a personality disorder
diagnosis?
Secretary Panetta. We are conducting a complete review of
those areas. We have responded to the situation that took place
up in Washington. That was the focus of the GAO report. And
that is what concerned us a great deal. And as a result of
that, we are not only running a review there, we are running a
review elsewhere to make sure that the same kind of problems
have not occurred elsewhere. You know, it is important that we
determine why someone would get this diagnosis and then it
would be downgraded. I mean, there may be some legitimate
reasons for it. But in this instance, it happened to too many
people. And that raised tremendous concerns.
Mr. Walz. I appreciate that sentiment. Because my concern,
I am sure like yours and now Secretary Shinseki's, is that one
of the biggest problems here is it is not benefits
compensation, it is the inability to get care for existing, and
that could have been whether it was existing or exacerbated by
their combat experiences, their time in the military, they are
not getting that care through our wonderful folks at the VA,
and how do we fix that? I would add, too, that as these have
decreased, personality order discharges, adjustment disorder
have increased. And so I thank you both for paying close
attention to this. I yield back.
Mr. Miller [presiding]. Mr. Jones.
Mr. Jones. Thank you, Mr. Chairman. Mr. Secretary Panetta,
2 years ago in the NDAA [National Defense Authorization Act]
bill, the House had a provision that said if you have served
this country at war and you come back home and you are in the
process of a medical review of your condition, but in that
period of time, you self-medicate and get yourself in trouble,
so therefore you have been given less than an honorable
discharge before the Medical Review Board finalized their
decision, the House position basically said to that individual,
if you are given less than an honorable discharge, you can go
back to the Department of Defense and ask the Department of
Defense to review your medical records and maybe change your
discharge.
And I would like to know how you all are handling this
issue, how you are contacting those who maybe were given less
than an honorable discharge?
Secretary Panetta. Congressman, let me respond to you
directly through the Department. Because this is the first time
I am familiar with the issues you just presented. And I want to
give you an accurate answer. And let me give you that answer
through the Department, if I could.
[The information referred to was not available at the time
of printing.]
Mr. Jones. Thank you, Mr. Secretary. That would be very
satisfactory. And thank you very much. I yield back.
Mr. Miller. Ms. Davis.
Mrs. Davis. Thank you, Mr. Chairman. And thank you both for
your really unparalleled leadership in trying to work and
coordinate these programs. I wanted to ask you about
coordination, about resolving the misalignment between the two
care coordination programs between the DOD and the VA. You
talked about traps and trying to get over those. What is it
that is causing these problems? I know one of my colleagues
mentioned earlier that it seems to be creating more confusion
than anything else.
Secretary Panetta. You know, the biggest problem here is
these things have developed on separate tracks. And as a
result, you know, you got two bureaucracies that basically
developed their own approach to dealing with these systems. And
they get familiar with them, that is what they use, they resist
change, they resist coordination, they resist trying to work
together. And that is the fundamental problem we have.
Mrs. Davis. Have we tried to switch off occasionally? I
think one of the other issues I really wanted to ask about was
counseling, because the coordination programs as well as the
Transition GPS program that the President has proposed and we
are moving forward on, call for counselors. And we know the
problems in mental health, but how are we planning for the kind
of counselors that are going to be needed for this? Because
clearly, they are going to have to be cross-trained in many
ways, understanding both systems as well as small business, et
cetera. How are we planning for the immersion of these kinds of
folks who are really going to be critical to this, yet we
really don't have them in any great number?
Secretary Panetta. That, I think, is the fundamental key to
making this transition work, is to have counselors that are
familiar both with veterans and defense areas. What are the
benefits? What are the opportunities that are available? And be
able to present that. So it is going to take some training of
the people that are going to be part of this effort so that
they provide good counseling to those that are involved.
Mrs. Davis. Is there a cost factor involved in that as well
that we need to address?
Secretary Panetta. There is going to be a cost factor
involved here. And, you know, we will have to discuss it.
Mrs. Davis. May I just suggest as well that there may be
some great models around the country? We think we have one in
San Diego. And if we could look at some of those models, that
would be helpful. Thank you. Thank you, both.
Mr. Miller. Mr. Flores.
Mr. Flores. Thank you, Mr. Chairman. Thank you, Secretary
Panetta and Secretary Shinseki for being here today. Also
Secretary Panetta, thank you for protecting valor for those
that have earned it. My question is a little bit more
theoretical. And what prompts this is the claims processing
time at the Waco Claims Regional Center in Texas, which is the
worst in the country when it comes to adjudicating disability
claims. What can we do if the IDES doesn't work? I mean, what
are you thinking about in terms of a new paradigm to fix this
issue? And both of you can answer, either one of you. It seems
to me like we have got cultural issues that cannot be fixed by
having new systems. So how do you make--I mean, you are doing
your best to get the systems right, but what are we doing to
fix the culture so that we do what we promised our military men
and women, our veterans that we would do in terms of providing
benefits to them for their service?
It just seems to me like, you know, we have spent all our
time on systems, we are not spending any time on culture. So
can you help me with that? And let me interrupt before you
answer. One other thing. Are you thinking about a pilot program
so that if IDES doesn't work, what are you going to do? Where
is the clean sheet of paper? Where is the whiteboard that has
the big ideas to fix this?
Secretary Shinseki. Congressman, I just want to be sure I
am answering the right question here. Waco and claims would
sound to me like disability claims that we normally handle.
IDES is a joint program that DOD and VA. So it is the IDES
question that you have here. We have piloted IDES. We started
off with 27 sites. These are a DOD initiative with VA in
support. We are at 139 sites now, fully operational across the
Nation. And I think we both have put in place controls that
will drive this to the target, which is 295 days for
processing. Now, that sounds like a lot of time. On the one
hand, when we did our systems independently, sequentially, DOD
first and then VA, it was like 540 days. Right now, with an
Integrated Disability Evaluation System, that is down below 400
days, and we are targeted on 295.
When we get to 295, which is going to be a bit of work, and
it sounds like a long time, but involved in the 295 days is
care and surgical procedures that veterans who have been
injured are still going through. And there is leave associated
with that. Whenever a surgery occurs, an individual is provided
X amount of days for recuperation leave, so to speak. All of
that is factored into this 295. So when the 295, while it
sounds large, it is a treatment and transition program. I think
we have a right model here. What is incumbent on us is to get
to the targets we have described. In the 295, VA's piece of
that is about 100 days. Right now we are at 145 days. We have
been as low as 103, and then we get a surge from our friends in
DOD and we adjust. But we know we can get to 100 days. And we
are proceeding.
Mr. Miller. Mr. Forbes.
Mr. Forbes. Thank you, Mr. Chairman. Secretary Shinseki, we
know right now that VA topped out in May at about 904,000
claims. And as you just mentioned, we have got about 65 percent
of them are over 125 days, and 1.25 million is projected for
2013. My question is, can the current system handle the
expected reductions in end strength projected in the
President's budget and under sequestration? And if you could
give me a yes or no answer on that, and then elaborate any way
you want to to clarify it?
Secretary Shinseki. Your number is a little higher than
mine, but I will accept it. It is a big number, nearly 900,000
by my count. Let me explain why the inventory, that is the
total number of claims in processing, and the backlog portion
of that, 65 percent or so, 550,000 of those are backlogged, why
these numbers result. In the last 3 years, the VA has made
three significant decisions. We awarded Agent Orange service
connection for Vietnam veterans, three new diseases; we awarded
Gulf War illness, nine new diseases for veterans who had been
waiting in the case of Gulf War veterans 20 years since the
conclusion of that conflict; for Vietnam veterans, 50 years.
We also granted, the third decision was combat verifiable
PTSD service connection for anyone who served in combat and has
been diagnosed with verifiable PTSD.
Mr. Forbes. Mr. Secretary, my time is running out. How will
sequestration and these end strength reductions impact these
claims going forward?
Secretary Shinseki. Well, I would say that in the case of
VA, we have been informed that VA is exempt from sequestration
except for administrative costs. I don't have a definition of
administrative costs right now. But what I would, Congressman,
say, that I am with Secretary Panetta, the reason you have the
two of us here, whatever impacts him is going to have some
effect here, even though I have been exempted. And it has my
attention.
Mr. Forbes. Thank you, Mr. Chairman.
Mr. Miller. Mr. Secretary, you just said that possibly
administrative costs would be affected by sequestration. The
President the other day at the VFW [Veterans of Foreign Wars]
said no veteran issues would be touched by sequestration. Could
you explain to this committee? Because there is still some
conflicting information that is out there from the acting OMB
[Office of Budget and Management] director letter that I got
back in June. How much is VA going to be affected by
sequestration?
Secretary Shinseki. I will go back to I believe what you
received in that letter, is that VA is exempt from
sequestration. And I don't have the letter in front of me, Mr.
Chairman. I think administrative costs were listed in that.
Mr. Miller. So it is your understanding no benefit,
function, program, account would be subject to, only
administrative costs? And again, if you would like to take it
for the record because of time.
Secretary Shinseki. I think this would be one that I best
provide to you a response for the record.
[The information referred to was not available at the time
of printing.]
Mr. Miller. Thank you, Mr. Secretary. Ms. Bordallo.
Ms. Bordallo. Thank you, Mr. Chairman. Secretary Panetta
and Secretary Shinseki, thank you very much for being with us
this morning.
Secretary Shinseki, we talked about suicides quite a bit.
But can you provide us with an update on your efforts to end
veterans' homelessness? Can you give an estimated number? Is it
as serious as suicides? And what programs do you have in place?
Secretary Shinseki. Congresswoman, I think you may be
familiar with the fact that we in the Department of Veterans
Affairs have established 2015 as the point in time where we
intend to end veterans' homelessness. And when I say end
veterans' homelessness, there are two pieces to veterans'
homelessness: One is the rescue. That is getting everyone on
the street off the street, into housing, into programs that get
them treatment for substance abuse or depression, training for
employment, and moving on with their lives.
What won't end in 2015 is prevention. Prevention will be
ongoing. What do I mean by ``prevention''? Right now we have
about 900,000 veterans in the GI Bill programs. And that is
colleges, universities, community colleges, tech trade schools.
Any youngster who fails out of that program right now in this
economy is at high risk of homelessness. And so our prevention
effort here is to make sure youngsters get into school, stay in
a school, graduate, and have an opportunity to go on and work.
Our housing mortgage program, last year about 90,000
veteran mortgage holders who had defaulted on their home loans,
we were able to defer roughly 75 percent of them from being
evicted from their homes. And that is with VA's financial
counselors getting in there, helping them get control of their
finances, lowering the monthly payments, extending the payment
period. The return to us is that we are able to then share
stability. We will deal with these veterans as homeless
veterans otherwise. And our records indicate that a homeless
veteran's health care costs is about 3\1/2\ times what the
health care costs are for veterans who are not homeless. So
there is a--it is an important aspect of this. And while I say
we were able to save 75 percent, there is still 25 percent we
did not save. And we have got to just do better at it.
Ms. Bordallo. Thank you. Thank you, Mr. Secretary.
Mr. Miller. Mr. Johnson.
Mr. Johnson of Ohio. Thank you, Mr. Chairman. And both of
you, General Shinseki and Secretary Panetta, I have come to
respect greatly both of your commitments and your heart for our
veterans. I will tell you, though, that I am not convinced that
all the members of your organizations, your Departments share
that commitment and will follow through with the commitments
that you two are making. I understand that you can't account
for the last 10 years, Mr. Secretary. And I understand that
you've got two bureaucracies that don't necessarily like to be
told what to do and get along all the time. But I will submit
to you that another 5 years is unacceptable. It is unacceptable
to me, and gentlemen, it ought to be unacceptable to you. This
is not a matter of can do or should do. This is a matter of
want to and will do. This is 2012. And one of the underlying
issues, Mr. Secretary, quite honestly, is the VA's lack of an
overall information technology architecture.
You and I have talked about this before. And it still
doesn't exist today, as far as I know. I have pointed that out.
My committee has pointed that out. Organizations outside that
have looked at the VA's IT department have pointed that out.
You know, I am just not convinced that 5 years from now, given
that I don't know where you two will be, but my fear is that we
are going to be sitting right here talking about this same
issue again because we are not going about it with the
discipline that is needed.
I come from an information technology career of over 30
years. I worked at U.S. Special Operations Command as the
director of the CIO [Chief Information Officer] staff. I know
what it takes to get this stuff done. And 5 years, gentlemen,
is totally unacceptable. And I don't really have a question for
you. I just want you to fix this, for crying out loud.
Secretary Shinseki. May I respond? Congressman, you and I,
but more primarily Roger Baker and you have had this
discussion. I will work with you. And we believe we have a good
mark on an architecture. Obviously, we haven't satisfied you.
We will come back and work it again.
Mr. Miller. Mr. Turner.
Mr. Turner of Ohio. Thank you, Mr. Chairman. To both of our
Secretaries, thank you for being here. I appreciate your
leadership. And Secretary Panetta, I want to particularly thank
you also for your work on sexual assault, which I know that you
are working on in coordination with the Secretary of the VA,
and your efforts to try to change the culture throughout DOD to
both prevent sexual assault and to assist the victims. And
thank you for your leadership there.
Many of the questions that you have received from members
have been about service members and their families
transitioning out of the military. Secretary Panetta, one of
the most important things for the service members in
transitioning with their family is obviously to keep their
family together. And that raises the issue of custody. I want
to thank Chairman Miller, Chairman McKeon, Subcommittee
Chairman Wilson, and also I want to acknowledge Chairman
Skelton, former Chairman Skelton, and of course, Erin Conaton
and her work on the issue of custody in this committee.
The House, as you are aware, has passed eight times
legislation that would protect the custody rights of service
members, the VA Committee twice, HASC six times. Secretary
Gates had endorsed the provisions that the committee had
passed. You had sent a letter suggesting a compromise that
Senator Boozman is going to be drafting in the Senate. I just
want to ask for your support for that, and also, to tell you
that we are going to need your additional assistance.
The Uniform Laws Commission just brought out a draft
uniform bill that would change the State laws, actually
reversing all the progress that we have made actually in favor
of taking service members' custody rights away. We hope to have
your support for Senator Boozman's legislation. Secretary.
Secretary Panetta. I appreciate that. As I indicated to you
in my letter, I support the efforts that you have made. You
have provided tremendous leadership on this issue. And I will
do the same with regards to the amendments on the Senate side.
Mr. Miller. Ms. Tsongas.
Ms. Tsongas. Thank you, Mr. Chairman. And thank you both
for being here today. Like others before me, Congressman
Turner, I want to thank you, Secretary Panetta. I appreciate
very much your efforts that you have made over the last several
months to improve the treatment of survivors of military sexual
assault. And Secretary Shinseki, I was so heartened to learn of
your recent interest in the documentary film, ``The Invisible
War.'' As you say, that which starts during military service
ends up in the VA. And that movie so painfully highlights the
multiple bureaucratic hurdles survivors of such assaults, which
are all too frequent across all the services, must endure to
prove that their physical or their psychiatric symptoms are
connected to an incident of military sexual trauma.
And it shows that too often, victims are unsuccessful in
pursuing their claims for assistance. To address one aspect of
this problem, the fiscal year 2012 Defense Authorization Act
included language that required the Secretary of Defense, in
consultation with the Secretary of Veterans Affairs, to develop
a comprehensive policy for the Department of Defense on the
retention of and access to evidence and records relating to
sexual assaults involving members of the armed services.
This policy is to be in place by October 1, 2012. Can you
both comment on the status of this policy? I would also welcome
any further thoughts you may have on how these claims can be
processed faster and more accurately.
Secretary Panetta. Well, it is a very important issue for
me. I am not going to wait for the legislation in trying to put
that policy in place, because I think it ought to take place in
providing that kind of guidance and assistance to those that
have been the victims of sexual assault so that they get the
kind of support that they need in order to not only get the
care they need, but if they want to continue in their career,
to get the support system that would allow them to continue
their career. And I think it is fair to say that Secretary
Shinseki and I are going to work together on this issue to make
sure that we can deal with this on both sides, not only the
Defense side, but on the Veterans side for those that
ultimately move in that direction.
Ms. Tsongas. Thank you both. I look forward to seeing that
policy in effect. Thanks.
Mr. Miller. Mr. Denham.
Mr. Denham. Thank you, Mr. Chair. Mr. Panetta, Mr.
Shinseki, great to see you both here. Mr. Panetta, I have been
working on these veterans issues for quite some time with you
in our area of central California. By the way, thank you for
support on the Veterans Skills to Jobs Act that was signed this
week into law. A good bipartisan effort that Mr. Walz and I
worked on after our Afghanistan trip. Another issue that came
up during that same trip was working with our veterans on
Active Duty that were transitioning back that had disabilities.
And further conversations with General Bostick afterwards. You
know, he had said that this is the number one issue, the
evaluation process of those disabled before they get
discharged, making sure that not a day goes by that they are
having to wait for disability, or the issue of 20,000
nondeployable men and women that are disabled on Active Duty.
So he said it was the number one issue dealing with--
legislative issue that needs to be fixed back from 1940. The
question I would have for you, is what can we get done? What
would be your recommendation? What is the legislative fix that
you need us to pass that would help with this overall
disability evaluation system?
Secretary Panetta. My view is that one of the most
important things we can do is address the needs of our Wounded
Warriors and the ability of those individuals. If they want to
stay in the service, we ought to do everything we can to help
them stay in the service. If they want to move on, then it
becomes something where we have got--we and the VA have to work
together to make sure that that transition is as smooth as
possible. We have a tremendous amount of focus on this. I guess
probably the one key is, again, helping us in terms of funding
to make sure that we have the funds necessary to complete these
evaluations and give them the assistance they are going to need
once they move on. That is a key area for me.
Mr. Denham. Outside of funding, is there a legislative fix
that you are looking for?
Secretary Panetta. At this point, I have to tell you, I
mean, I think we have the pieces we need. I mean, we have got
large numbers that we have to deal with. But the programs are
in place. The assistance is in place. We have just got to make
sure that we provide the resources necessary so that we can do
what we have to do to help them. That is the key.
Mr. Denham. Thank you.
Mr. Miller. Mr. Wittman.
Mr. Wittman. Thank you, Mr. Chairman. Secretary Panetta,
Secretary Shinseki, thank you so much for joining us. Secretary
Panetta, I want to ask you about how we can better align
military to civilian jobs in transition, especially as it
relates to licenses and certifications. Give you a great
example. You take a highly trained combat medic, comes back
home, wants to go into the civilian side, wants to become an
emergency medical technician. Unfortunately, as you know,
certifications there prevent him or her from doing that. Has to
go through lengthy schooling, take on lots of debt. Many times,
they could probably be teaching the class. How can we better
align the skills that are obtained in the military to parallel
what they could be pursuing in jobs on the civilian side? That
is one of many categories that I know that you are aware of.
And it is really a matter of taking that military job
description and figuring out how do we align that, or how do we
get some paralleling with what they are doing in the military
versus outside?
Secretary Panetta. Well, it is a great point. It is
something actually the First Lady has dedicated a lot of time
to. We have got to push States to try to develop some common
standards here with regards to accreditation in these various
jobs. These guys come out and they have got great skills, they
have worked in these areas, they have done tremendous work in
their particular skill area. And to come out and then have to
drag them through a whole process in order to be able to take
those skills and make them applicable, that is something that--
there are a number of States that are willing to basically take
these individuals and take the accreditation that we provide
and incorporate that at the State level. We have got to get all
of the States to recognize that kind of credentialing.
Mr. Wittman. Mr. Secretary, is it something we could do
within DOD so as these individuals come out, if they become a
trained medic, they would also, at the same time, that they get
that certification would get something within the military to
say by the way, now you have a credential that is an EMT
[emergency medical technician] within that particular State,
say where they are based or they have some kind of way that
there is an equivalency there? Because they are obtaining the
same skills there as they would outside.
Secretary Panetta. I think that is a good point. One of the
things I am looking at is can we develop some kind of
certification within the military that would then be
transferable in terms of their getting a job within the State.
Mr. Wittman. It seems like if you just align things that
align with outside, there could be some reciprocity.
Secretary Panetta. That is right. Good point.
Mr. Wittman. Thank you. Thank you, Mr. Chairman. I yield
back.
Mr. Miller. Mr. Courtney.
Mr. Courtney. Thank you, Mr. Chairman, and thank both
witnesses for your attendance here today. Secretary Shinseki,
you know, I am wondering if you could talk for a minute about
an initiative that I think falls under today's hearing, which I
think is a very exciting example of the work the VA has been
doing with health IT, which is the Blue Button program, which,
again, is something that again, I think you have surpassed even
the private sector in terms of really trying to give patients
control over their own medical situation, as well as make a
smarter system in our health care delivery.
Secretary Shinseki. I will just say it is one of several IT
initiatives, but Blue Button is the one that has received a lot
of attention. And there are civilian health care systems now
that are adopting the concept. And that is with a single stroke
of a mouse on the Internet, you are able to access your data,
personal data regarding health care. And you can download your
records, you can take those records and use them as you would
with your own private physician. It has tremendously grown in
size, into the millions. And we think this is also helpful for
the private sector in having that kind of concept capability.
Mr. Courtney. And the nice thing about it is it gives the
patient control in terms of being able to move, go from one
provider to another. And again, just congratulations to you and
your team for really leading the way for the whole health care
sector really in terms of that initiative. And I know comments
have come up, and I am running out of time, the issue of
regionalizing claims is emerging as an issue in Connecticut as
well. And again, I look forward to working with your Department
in terms of trying to solve that problem.
Secretary Shinseki. We will do that.
Mr. Miller. Ms. Buerkle.
Ms. Buerkle. Thank you, Mr. Chairman. And thank you both
for being here this morning and for your service to our Nation.
It is an honor to have you both here. My question has to do
with, and you have heard some references to it, the Dole-
Shalala Commission, and the fact that now 5 years later, after
they issued this urgent call to streamline, to make sure we
have a single point of reference for the care and the services
and the benefits of our military, we have two very distinct
entities. We have had multiple hearings trying to get assurance
from DOD and from the VA as to how you are going to get this
together so that we can make sure our veterans get the services
without being overwhelmed by an extremely complex system.
So I would ask both of you today, please, how specifically,
what are the goals, what is the plan to get these two entities
under one roof so that you are complying with the Dole-Shalala
Commission and their recommendations for our veterans? I thank
you both.
Secretary Shinseki. The program, the Federal Recovery
Coordination Program, in existence since 2007. And I think as
Secretary Panetta indicated earlier, two good Departments
launched and essentially developed good programs that don't
quite harmonize. We have a task force with the specific
direction to study and bring harmony to these programs. Where
are we being--duplicating one another? Where are we not doing
things that we should be doing? So it is going to get a good
look here, and I say in the next couple of months. And I would
be happy, and I think Secretary Panetta would be as well, to
make our people available to provide the results of that.
Secretary Panetta. You know, look, Secretary Shinseki and I
share the same frustration. I mean, we have been working on
this, and, frankly, we have been pushing to try to say why
can't we get faster results? Why can't we get this done on a
faster track? And, you know, bottom line is, frankly, we just
have got to kick ass and try to make it happen. And that is
what we are going to do.
Ms. Buerkle. I would suggest in your opening statement, Mr.
Panetta, you mentioned commitment, and that we look to our
military as an example, their commitment to our country. We
should be that committed to them to make sure we get this job
done. I thank you both very much.
Mr. Miller. Dr. Heck.
Dr. Heck. Thank you, Mr. Chairman, and thank both of you
for being here today. Likewise for your long and distinguished
service to our country. Secretary Panetta, I am happy to hear
about your initiative on the Stolen Valor Web site, realizing
that any Web site will probably have limitations. As you may
know, myself and Senator Brown have introduced legislation to
reinstitute the Stolen Valor that will meet constitutional
scrutiny. So hopefully, we will be able to gain your support on
that. We have heard a lot about the Integrated Disability
Evaluation System, something that after spending over 20 years
in the Army Medical Department I think was far too long in
coming. And I am encouraged by the pilot results. In fact, I
have two down-trace units that are getting set to mobilize in
October to support those efforts, CONUS [continental United
States]. But we have seen over time the processing times start
to creep back up.
And even though there has been--customer service has
increased over the legacy system, that was really a low bar to
overcome. And we are hearing a lot of the fact that the program
is somewhat complicated and convoluted. Other than volume
driving the creep in processing times going back up, what other
issues are there that are causing that processing time to
increase, and what can we do to help you decrease those times?
Secretary Shinseki. Well, I think I indicated earlier that
we have a target of 295 days. Within, I would say, the DOD's
portion of that is the medical care of seriously wounded and
injured individuals who still have their care to be completed,
and also recuperation leave as part of that. So it is a little
bit--individuals have some control here. And also, I think
Secretary Panetta alluded to this, these youngsters know the
military health care system. They know it very well. They are
very comfortable with it. It is world class. They know VA's
health care system less. And there is a point in time where a
decision has to be made to make that psychological commitment
you are going to leave the military.
We in VA can do a lot to help educate folks to make them
comfortable about being able to let go of--you know, like wing
walking, one hand hold before taking the next one. And I think
that will help streamline the process. But as I say, we have
both agreed to this 295-day target, and we are moving to that
point.
Mr. Miller. Mr. Johnson.
Mr. Johnson of Georgia. Thank you, Mr. Chairman. Thank you,
gentlemen, for being here. Secretary Panetta knows how much I
appreciate his service to the Nation over the years. And I
certainly thank you again, sir, in public. And General
Shinseki, I have not had the opportunity to spread my love for
you publicly, but you are a true gentleman.
You served admirably in the United States Army, became a
four-star general, became the Secretary of the Army--or
chairman of the Army. Army Chief of Staff. That is what it was.
And in that capacity, you put in place strategies, very
innovative, that have held us in good stead up to this point.
You are a forward-thinking leader. And you are also a
courageous and honest leader. I would be remiss not to point
out the fact that during the run-up to the war in Iraq, you
took a public bashing from high-level members of the previous
administration for your assessment as to the number of troops
we would need to effectively occupy Iraq in the aftermath of
the war going in. And you paid the price for that in being it
said that you were perhaps forced to resign early. But
nevertheless, the underdog is now on top.
And you bring the same innovative, strategic thinking to
your new post that you had in the old post. And it is
definitely needed. And I think it is going to pay off. And I am
glad that your Department and the Department of Defense have
both become more integrated in how we address the needs of our
service men and women as they make the transition from military
force--has my time expired already? Okay. I keep hearing a--you
want me to move on from what I am saying, or what?
Mr. Miller. Your time has expired, Mr. Johnson.
Mr. Johnson of Georgia. Has my time already expired?
Mr. Miller. A minute ago.
Mr. Johnson of Georgia. Oh, 2 minutes. I am sorry. All
right. But thank you, sir, for your service. And I yield back.
Secretary Shinseki. Mr. Chairman, may I just a small point
here. I thank the Congressman for his compliments. I would just
say there are more than this one individual who held that
opinion. And I was not forced to resign. I served a full and
complete tour as the Army Chief, and I was very proud do that.
Thank you.
Mr. Johnson of Georgia. Thank you. I stand corrected.
Mr. Miller. Mr. Johnson, I am trying to save you from
yourself because the next person up is Mr. Runyan.
Mr. Johnson of Georgia. Oh, I don't think I need to be
saved from myself.
Mr. Miller. You haven't seen Mr. Runyan.
Mr. Runyan. Thank you, Mr. Chairman, and, gentlemen, thank
you for being here. I want to touch on the IDES process. I know
in Secretary Panetta's opening statement the last sentence of
that particular paragraph or the end of the IDES statement says
you are going to have a senior level working group in
coordination with the VA and provide recommendations on how to
move forward. I know Secretary Shinseki knows that I happen to
chair the DAMA [Disability Assistance and Memorial Affairs]
Subcommittee in the House VA Committee. We just had a hearing
on this back in March, and I asked the DOD to acknowledge the
specific roles the VA has in the process and distinguish the
roles that the VA and DOD carry out. And I have also been
briefed by the GAO that they have great concern of the
overlapping responsibilities in the two.
There is a couple of issues and time running out that I
just want to bring to both of your attention you can have here,
specifically dealing too with the medical evaluation narrative
summaries, is that clear, and they lack clear and complete
diagnosis of the service member which a lot of times renders an
unfair decision. And the arbitrary time date of 7 days to
challenge that, refuting that decision. I sometimes think to
get the complete medical evaluation you need I don't think that
is possible. Dealing with the PEBLOs [Physical Evaluation Board
Liaison Officers] and their ability or lack of--I don't know--I
know quality control has been used a couple of times by some
VSOs [veteran service organizations] but not so much they are
not reaching out to the veteran. And I know some of the VSOs
brought up instances where JAGs [Judge Advocate Generals] have
been involved and the process went a lot smoother because they
understand the process a lot better. There are some points I
wanted to bring to both of your attention that I hope would
come up in those discussions and I yield back.
Mr. Miller. Mr. Scott.
Mr. Scott. Thank you. Thank you, Mr. Chairman. Secretary
Panetta, you mentioned earlier one the problems was the
limitation of the number of health care providers. I have got
some information I would like to share with you. I represent
Georgia, which has a tremendous number of veterans, a proud
military history. And one of the medical providers gave me this
list and it is actually a list of reimbursements versus
Medicare reimbursements. And I will just give you a couple of
examples. For the exact same code, Medicare reimburses about
$2,000 and TRICARE reimbursement is somewhere in the $630
range. That is one of the reasons that many of the private
sector providers out there are having to limit the number of
our veterans that they are seeing; they are covered under
TRICARE. So I will just share this with you, and it is not that
they don't want to see them, it is that if they are the only
person that is signed up in that area, then it becomes a huge
portion of their practice. And quite honestly the practices
have to be revenue positive. But I will leave this for you and
we will go from there.
Mr. Shinseki, if I had a second copy I would give it to you
and I can get copy for you as well. We kind of beat around this
a little bit. I trust both of you as great leaders. We beat
around this issue of having two bureaucracies that resist
change. And so my question, open-ended to either one of you
that wants to take it, is would the men and women that are
serving this country be better served if the health care
benefits were handled under either one of the agencies instead
of both of the agencies in having to make that transition?
Secretary Panetta. Well, you know, I thought about that a
lot. But I think the reality is we have got these systems in
place. The veterans are very tied to their health care system
and, you know, the benefits that they receive there, and
obviously DOD is very tied to our system. But the key--I don't
think that ought to inhibit our ability to bring these two
systems together, let me put it that way. I don't think we have
to create another monster. I think all we have to do is be able
to get both of these two systems to work together and get it
done.
Secretary Shinseki. Mr. Chairman, might I add a little bit
here. Two huge Departments, we are already collaborating, both
bringing together in a number of locations joint and integrated
activities; North Chicago, a Federal health care center, the
director is a VA person, the second in command is a Navy
captain. And we are learning a lot from that and we look for
other areas where we can do this and there are several other
examples of that. We look at bundling acquisition, large
acquisition decisions. We are working on right now trying to
see whether there is a benefit to bringing our pharmacy
programs together.
So I think there is great opportunity from efficiencies and
a business standpoint. I would be cautious about saying we are
going to create one system here. He has a to-go-to-war
requirement and the go-to-war requirement has with it a whole
list of preparations that you have to have competent leadership
who have been trained how to do this in combat from the top of
the organization all the way down to the youngest medic in that
formation. That is an enormous responsibility, and that is a
culture we don't want to change. We have the best go-to-war
medical capability anywhere, and that has got to be a primary
function here.
Mr. Miller. Ms. Hanabusa.
Ms. Hanabusa. Thank you, Mr. Chairman. Thank you both for
being here. A special aloha to General Shinseki. My questions
are for you, General. On page 7 of your testimony you talked
about of course the VOW to Hire Heroes Act of 2011 which
Congress and the President signed into law. Do you have any
statistics or any report you can give us as to how that is
coming along? And in that same light also on page 7 you talked
about removing the impediments to credentialing with of course
the DOD and I would like to know where we are in that as well.
Thank you.
Secretary Shinseki. On the VOW to Hire Heroes Act
implementation, there are various pieces of that. I would say
one piece, VRAP [Veterans Retraining Assistance Program], is up
and running. We have veterans who are signing--this is between
veterans between the age of 35 and 60 who have exhausted their
unemployment benefits, have a capability for 1 year of training
in a high priority work area. That is up and running, in the
tens of thousands people have signed up. In the transition
arena both Secretary Panetta and I are working this very hard.
We think we have a good plan being put together, but in our
case we are still looking at the details of that.
I am not sure I have addressed all of your questions,
Congresswoman, but--was there something I missed.
Ms. Hanabusa. No, I will follow up with any specific
questions that I may have for the record. Thank you very much.
I yield back.
Mr. Miller. Dr. Roe.
Mr. Roe. Thank both of you all for being here today and
your service to our Nation. Yesterday we had a hearing, just a
briefing with Dr. David Rudd on the suicide problem and I would
like to share with you, both of you all, I won't do it today
because of time, with his data which was very impressive about
multiple deployments and how that affected soldiers.
Number two, I know I have been to Great Lakes twice and it
is clear when you are a freshman Congressman as I was two terms
ago when your CODEL [congressional delegation] is to Great
Lakes in January when it was 4 below zero. So I have been there
and the question is how is that interconnect interactivity
between DOD and VA doing now, General Shinseki? Is that working
better? I was there about a year ago. I know it is up and
running but how is that working?
Secretary Shinseki. It just gets better over time,
Congressman. New concept, bringing two good teams together,
integrating them. I would say that the area of challenge is the
single electronic health record. And for the most part there
are great workarounds but when you get to some places like
pharmacy, because of the sensitivity to the safety aspects of
that there are a lot of checks and rechecks. I don't think we
have solved all of those issues and won't until we get this
integrated Electronic Health Record. So one team, veteran or an
active service family member walks in a front door, they go
wherever. So in terms of the provision of care and access to
care I think it is first rate. It is the business aspects of
this that still require more work and the integrated Electronic
Health Record will go a long way to solving that.
Mr. Roe. Mr. Chairman, I had a Wounded Warrior in my office
yesterday lost a leg above the knee, and I personally cannot do
enough for these Wounded Warriors. I know that you all feel
exactly the same way, and I certainly appreciate your service.
Mr. Secretary, I will ask you any further questions at the
Harris Teeter. I see you there shopping from time to time.
Mr. Miller. Mr. Coffman.
Mr. Coffman. Thank you, both of you, for your long and
distinguished service to our country. Secretary Panetta, I just
want to commend you and the Secretary and the Department of
Defense for your work in dealing with combat stress. I have
served in the Marine Corps in the first Gulf War, in the Iraq
War. I remember the out-briefings I received in 1991 before I
left the theater and they were excellent, 2006 they were
excellent as well. I tracked the improvements in the Department
of Defense in terms of on the Active Duty side in working with
our military personnel and those new programs and I think we
are doing the best we can.
And you see, the Department of Defense sees post-traumatic
stress disorder as a wound. However, Secretary Shinseki, the VA
sees it as a disability. And the signature wound of this war is
post-traumatic stress disorder and it seems that we have a
disability-centric approach and not a treatment-centric
approach in the Veterans Administration. And wouldn't it be
wise if we invested dollars in treatment and reform the current
system that was both compassionate, more compassionate I think
to those who served our country and fair to the taxpayers and
saving money in the long run by again investing in treatment in
the short run and being able to allow veterans to see mental
health practitioners within their private ones, within their
own communities and not be relying upon the VA. And I would
love it if you could respond to me now but also respond to me
on the record because of our limited time.
Secretary Shinseki. I would be happy to provide a more
detailed response for the record.
[The information referred to was not available at the time
of printing.]
Secretary Shinseki. Congressman, let me just say I am not
sure when the decision to treat this as a wound occurred, but I
think we have all used PTSD disorder as the descriptor for
many, many years. We are closely linked with DOD on all things,
we will go back and look at this. So on the one hand I don't
disagree with what you are suggesting, but I would offer that
we treat PTSD, we screen every veteran who comes to VA for
PTSD, TBI, substance abuse, sexual assaults. And so we have a
pretty comprehensive record of who to treat and then we set
about treating them.
Mr. Coffman. There is no requirement for treatment once
that disability determination is made and I think we need to
really rethink that and take a look at that again. All the
mental health professionals that I talk to feel that it is
treatable down to a level to where it is no longer
debilitating. And so we need to rethink and potentially reform
this again to be more compassionate for those who have served
our country in repairing their lives, and also I think in the
long run certainly being fair to the taxpayers of this country.
Secretary Shinseki. I don't disagree. But I do say we
treat, it is not just a disability.
Mr. Coffman. Thank you, Mr. Chairman. I yield back.
Mr. Miller. Ms. Speier.
Ms. Speier. Thank you, Mr. Chairman. To each of you, we are
in awe of the extraordinary contributions you have made to this
country. Thank you for being here today.
I am going to try to cram three questions into my two
minutes so I am going to move fairly quickly. On Schedule II
drugs there is an addiction that often occurs while members are
still in the military that also continues once they are in the
VA system. What are we doing to try and deal with this
addiction problem?
The for-profit colleges that many of our GIs are accessing,
there are some bad actors. I want to know if you are sharing
the bad actors with each other, both from the Department of
Defense and the VA.
And finally, I want to tell you about a 24-year-old Iraqi
veteran who started community college, is starting community
college next month, he wants to go to law school. His present
worry is that his foot operation will make it difficult for him
to get to class in this hilly community college campus. He and
other injured veterans in my district all would like more time
to complete their studies under the post-9/11 GI bill. I would
argue that a 1-year extension would be in order for veterans
with service-connected disabilities.
I would like your opinions, both of your opinions on that.
Secretary Shinseki. Let me just very quick try to take all
three of them on. On addiction, I myself have asked our people
whether or not we have medication policies that lead to
addiction, and we are looking at it; I know that both DOD and
VA look at this. I was speaking publicly at one point and I
asked the question are we courageous enough to ask the question
of whether or not our medication policies create other
problems. It got a response out of the audience and so I think
there is something here and we are looking at it.
On the for-profits, we do share that information. In our
case we found three bad actors and we have cut them off, and we
will continue to look at that. But I would just say there are
bad actors. It is just not for-profits, there are others that
we need to be sensitive to.
More time for individuals who are severely injured, you
indicated. VA has a program for rehabilitating seriously
injured folks that is a little more liberal and very capable.
And I would like to ensure that the individuals you are talking
to are aware of the voc rehab, we call it, vocational
rehabilitation.
Ms. Speier. I think you misunderstood my question, Mr.
Secretary. Whether or not we can extend the GI bill for
severely disabled veterans so that it does not elapse in the 4
or 5 years that it is presently the time limit in which they
have to access those benefits.
Secretary Shinseki. I would say on the voc rehab--let me
come back to you on the record to see the amount of time on voc
rehab is enough. For the GI bill, it is stipulated in law how
much time is available.
[The information referred to was not available at the time
of printing.]
Secretary Panetta. I think it should be modified because it
would give us that additional time in the event that they are
dealing with the kind of serious wounds that your veteran is
dealing with.
Ms. Speier. Thank you.
Mr. Miller. Mr. Gibson.
Mr. Gibson. Thanks, Mr. Chairman. I thank the gentlemen for
being here, for their distinguished careers and their
leadership. And what they are doing is so important right now
in terms of bringing us better transition.
I would like to make a couple comments here just based on
my experience initially as a private in the New York Army
National Guard and over the course of 24 years rising to the
rank of colonel, including brigade command where I had troopers
that made the transition from Active Duty back home and now in
the vantage point of serving in these responsibilities, that I
think over time the Department of Defense has really done
incredible work before service men and women, before they
separate in terms of education and training, understanding what
is out there. And now all these efforts to integrate the DOD
and the VA, but what I think is missing is that back home, just
when we think we are making a difference we learn of a new
case, somebody in a village or a town that I was not even aware
was struggling and they are spiraling down and we are looking
to make a difference and get them into a community of caring,
including the VA, VFW, American Legion.
So Peter Welch and I, my colleague from Vermont, we have
been working on a program that is actually doing very well for
the National Guard, the Yellow Ribbon Program, and seeing if
are there ways we can learn from that that we can provide
better situational awareness to State officials that are
actually working this issue. In New York, for example, we have
it to the county level. And many times they just don't have the
information knowing a veteran is coming home. Sometimes they
get it a year of that after they get home but they don't have
it before they get home; that is to say, the service man or
woman is coming home and then when they get home. So we are
very enthused about what you are doing. We don't want to
duplicate what you are doing. What we are looking to do is to
sort of evaluate it and see if there aren't ways that we can
have in the framework, DOD, VA, and then the transition in the
framework to the State apparatus. So I wanted to mention that
and just make you aware. I know we have been working with your
offices and they are doing great work on this.
And then finally thank you for your work on Agent Orange. I
will tell you we are not done, we still have Navy veterans from
Vietnam that don't have the presumed coverage and we are
working on that effort as well.
Thank you, gentlemen.
Mr. Miller. Mr. Larsen.
Mr. Larsen. Thank you, Mr. Chairman. General, continue to
support HUD-VASH [Department of Housing and Urban Development
Veterans Affairs Supportive Housing]. HUD-VASH program is well
used in Washington State, especially in my district, the
housing authorities are partnering very well with others to
make that happen.
Second, we started a program in my office to assist some of
our community and technical colleges to translate the skills
and abilities that veterans bring into the private sector
language of what they need, especially as it applies to
aerospace manufacturing and aerospace skills needed. What we
found is that some of our community and technical colleges did
not even know there actually was a translator available online.
It is sad enough we have to translate that language from
military to private sector, but we do. So there is a fellow in
my office we hired who is a 30-year chief, retired after 30
years out of the Navy as a command master chief. And so his job
now is doing some outreach to community colleges all over the
State because they come to this one research or aerospace
training center and let them know how this works. You might
want to use that with the DOL [Department of Labor] and the
Department of Education.
But finally, where does this one kid fit? He comes home, he
is discharged from the military, he goes home to a rural town,
he is not enrolled in VA, has trouble adjusting, commits
suicide, an actual story in my district. So he doesn't fit the
military, he doesn't fit the VA. I am not asking you to solve
that problem from 3 years ago, but I am asking you what is
being done to reduce the likelihood of that kind of thing
happening again?
Secretary Shinseki. This is part of the reason you have two
Secretaries sitting here, and our efforts are to create a warm
handoff by and large across the board anyone departing the
military, but especially for those that have indicated while
they are serving in uniform that they have some mental health
challenges. We need not to discover that the hard way. This
handoff would give us the opportunity to bring to bear VA's
significant mental health treatment capability so that there is
a smooth transition for this.
Secretary Panetta. I would agree with that. In these
situations you have got to ring the bell, you have got to say
there is a problem here, and the key right now is to be able to
pick up that there are those problems, to make sure that that
individual gets into the health care system and then to alert
the VA so that they pick it up when we try to make this
handoff, but that is one the keys we are focusing on.
Secretary Shinseki. Mr. Chairman, just for one second, the
translator that you were talking about, Congressman, we in VA
have created one called VA for Vets. I am pretty sure your
master chief is familiar with it, but there are about five
others that touch on various aspects of translating skills.
Mr. Miller. Mr. Stearns.
Mr. Stearns. Thank you, Mr. Chairman, and let me compliment
you for bringing these two committees together. I think this is
fabulous. I have served on the Veterans Committee for 24 years,
so I think this is a first and I just think it is a very good
idea.
Mr. Panetta and Mr. Shinseki, welcome. I am going to ask
you sort of a basic question that the GAO has reported that
basically it takes 200 days with a 68 percent accuracy to
address the current backlog. And we are hoping that--I mean
think the timeline is in 2015 to get to 100 days with 98
percent accuracy. But the question would become how could you
do this if roughly almost 700,000 new service members are
coming in? I mean, come on now. How are you going to do this
with 700,000 new members, new veterans coming in? How are you
going to cut the backlog in half and increase the accuracy by
almost 30, 40 percent?
I will start with you Mr. Veteran Secretary.
Secretary Shinseki. We are in the process of piloting now,
you are familiar with VBMS, it is Veterans Benefit Management
System, first automation tool we have had in VA. We are still
paperbound today all these many years later.
Mr. Stearns. I just don't want to interrupt you but Steve
Buyer was chairman of the committee, he had a bill that was
going to solve that problem, and this is many moons ago. So
when you indicate you had this for the first time--I am just
saying I thought that was implemented some time ago, but you
are saying it wasn't.
Secretary Shinseki. I would have to go back and refresh
myself on what Chairman Buyer's initiative was. But clearly in
the testimony I presented before the committee there was no
automation tool ever discussed in the last 3\1/2\ years. In
fact, the testimony was that we were building this and it was
going to require close collaboration with DOD. We get paper
from DOD, we are a paperbound process. And so in order to go
paperless in VA, it is going to take coordination between both
Departments and we are piloting that automation tool today and
we intend to have 16 regional offices automation on VBMS by the
end of this year. And by the end of 2013, VBMS on all of our 56
regional offices, 14 and 15 to take down the backlog.
Now Mr. Stearns, we created the backlog in large measure.
We made an Agent Orange decision that added a quarter of a
million claims to the existing inventory. We made a decision on
combat PTSD that added half a million claims to that inventory.
Some would say, why would you do that. It was the right
decision to do for veterans had been waiting for many, many
years. We are going to work the backlog now. Automation is the
key piece here we are after.
Secretary Panetta. Congressman, what you pointed out is a
hell of a challenge. I mean, we are not kidding anybody. What
you pointed out is exactly the concern because we are going to
be adding more and more to that list. I think the key for us is
if we can develop the systems to deal with what we are dealing
with now and make those work, it is going to make it much
easier as additional individuals come on board. If we don't get
through this, if we don't deal with it and make it more
efficient now, then it will become an even worse problem in the
future.
Mr. Stearns. Thank you, Mr. Chairman.
Mr. Miller. Our final questioner today will be Dr.
Benishek. You are recognized for 2 minutes.
Mr. Benishek. Thank you, Mr. Chairman. I have a question as
to the nature of the collaboration between the Department of
Defense and the VA on reducing the backlog. Can you tell me
more about that? How much--are you working together for this or
can you just comment on that?
Secretary Panetta. That is one of the fundamental
challenges that we have taken on in both Departments is to
address that backlog and try to make sure that both of us are
trying to work in a way that reduces those numbers. I think the
Secretary has done a great job at the Veterans side to try to
reduce the number of days there. We are working to try to
reduce the number of days on our side and to be able to try to
provide this kind of seamless relationship so that overall we
can deal with this huge backlog. It is a problem, we have
recognized it as a problem, and I can tell you we are doing
everything possible to try to see if we can confront it.
Mr. Benishek. Are your staff talking every day then?
Secretary Shinseki. Yes, they are. They are. When we say
backlog here, there are about two or three transition programs
from DOD to VA. We have IDES that most of us are familiar with,
which is primarily a transitioning of seriously wounded and
injured folks out of uniform and then to veteran status with
us. That is only about 7 percent of the people leaving the
military. We have two other programs called Benefits Delivery
at Discharge and Quick Start, again transitioning individuals
out of the military to us. Together those two programs account
for maybe 6 percent of the number of folks leaving the
military. So the vast majority is this large discussion of
backlog that I was responding to Mr. Stearns on. And part of
that backlog is created by decisions we have made and that we
have testified to. Agent Orange, combat PTSD, Gulf War illness,
all the right decisions. But understand that that creates a
volume of claims. We are going to be better able to deal with
it as we get automation in place. So that is an important step.
We need to get that program funded and hold onto IT funding
dollars that we have testified to.
The second piece of this is this collaboration of DOD and
VA sitting side by side making sure we have warm handoffs. It
is one thing to know that there are 100,000 people coming out
next year, but if they all come out on 1 October that is a
different problem than this being scheduled out over 12 months
or if they all come out at one location that is different than
being spread across the country. We will match up, VA will
match up with whatever the plan is in DOD and that is why this
collaboration is important.
Mr. Benishek. Thank you, gentlemen. I see my time is up.
Mr. Miller. Thank you very much, gentlemen. Thank you for
being here today, spending 2\1/2\ hours with our two
committees. We appreciate you being so generous with your time
to answer some very important questions. I would ask unanimous
consent that all members would have 5 legislative days to
revise and extend their remarks. Without objection, so ordered.
With that, the committee is adjourned.
[Whereupon, at 12:35 p.m., the committees were adjourned.]
=======================================================================
A P P E N D I X
July 25, 2012
=======================================================================
=======================================================================
PREPARED STATEMENTS SUBMITTED FOR THE RECORD
July 25, 2012
=======================================================================
[GRAPHIC] [TIFF OMITTED
[GRAPHIC] [TIFF OMITTED] 75667.002
[GRAPHIC] [TIFF OMITTED] 75667.003
[GRAPHIC] [TIFF OMITTED] 75667.004
[GRAPHIC] [TIFF OMITTED] 75667.005
[GRAPHIC] [TIFF OMITTED] 75667.006
[GRAPHIC] [TIFF OMITTED] 75667.007
[GRAPHIC] [TIFF OMITTED] 75667.008
[GRAPHIC] [TIFF OMITTED] 75667.009
[GRAPHIC] [TIFF OMITTED] 75667.010
[GRAPHIC] [TIFF OMITTED] 75667.011
[GRAPHIC] [TIFF OMITTED] 75667.012
[GRAPHIC] [TIFF OMITTED] 75667.013
[GRAPHIC] [TIFF OMITTED] 75667.014
[GRAPHIC] [TIFF OMITTED] 75667.015
[GRAPHIC] [TIFF OMITTED] 75667.016
[GRAPHIC] [TIFF OMITTED] 75667.017
[GRAPHIC] [TIFF OMITTED] 75667.018
[GRAPHIC] [TIFF OMITTED] 75667.019
[GRAPHIC] [TIFF OMITTED] 75667.020
[GRAPHIC] [TIFF OMITTED] 75667.021
[GRAPHIC] [TIFF OMITTED] 75667.022
[GRAPHIC] [TIFF OMITTED] 75667.023
[GRAPHIC] [TIFF OMITTED] 75667.024
[GRAPHIC] [TIFF OMITTED] 75667.025
[GRAPHIC] [TIFF OMITTED] 75667.026
[GRAPHIC] [TIFF OMITTED] 75667.027
[GRAPHIC] [TIFF OMITTED] 75667.028
[GRAPHIC] [TIFF OMITTED] 75667.029
[GRAPHIC] [TIFF OMITTED] 75667.030
[GRAPHIC] [TIFF OMITTED] 75667.031
[GRAPHIC] [TIFF OMITTED] 75667.032
[GRAPHIC] [TIFF OMITTED] 75667.033
=============================================================
WITNESS RESPONSES TO QUESTIONS ASKED DURING
THE HEARING
July 25, 2012
===============================================================
RESPONSE TO QUESTION SUBMITTED BY MR. MCKEON AND MR. MILLER
Secretary Panetta. DOD and VA currently share more clinical data
than any other two healthcare organizations in the world. However,
healthcare operations between the Departments are not integrated. The
DOD and VA have multiple healthcare legacy systems and data stores,
developed over decades, that must be modernized to enable the
sustainability, flexibility and interoperability required to improve
continuity of care. The integrated Electronic Health Record (iEHR) will
employ a joint platform and service-oriented architecture that is
standards-based; this will give the Departments the ability to
integrate healthcare capabilities for streamlined care and benefits
delivery and an architecture that supports rapid delivery and
enhancement of new capabilities as needed. The agreements between the
Departments associated with iEHR have been widely publicized. The
Departments must balance the need to conduct proper planning for the
overall effort with a strong desire to field new systems and
applications as rapidly as possible.
Effective governance has been established and put in place to
assist the DOD/VA Interagency Program Office (IPO) in navigating
Department-specific processes for acquiring IT solutions to ensure iEHR
does not incur unnecessary delays. Given the need to merge two
acquisition life cycles, the Departments have acknowledged the need to
optimally align their processes to ensure agile and cost efficient
delivery of capabilities to the clinical community. The iEHR is subject
to the programmatic requirements of both the DOD Business Capability
Lifecycle (BCL) and the VA Program Management Accountability System
(PMAS). The IPO, DOD, and VA identified areas where process differences
may exist, and are collaboratively engaging in efforts to ensure that
any impediment that may arise is resolved in an efficient manner. The
IPO leveraged BCL and PMAS to create a Capability Development Life
Cycle Framework which captures the required documentation and milestone
decisions for each phase, to include funding and investment decisions.
The IPO has appropriately placed its initial focus on putting
critical iEHR infrastructure and services in place. The iEHR requires
significant work to create a technical framework in which clinical
capabilities can be incrementally incorporated. Key steps have been
taken toward achieving the infrastructure upon which the iEHR will be
built and a master schedule is in place to guide iEHR progress: A
Service Oriented Architecture (SOA) and Enterprise Service Bus (ESB)
contract that has been let and those programs are meeting their
milestones. Use of SOA reduces dependence on proprietary technologies
and enables the Departments to avoid being ``locked-in'' to a specific
vendor for a long term, which would hamper ongoing competition and
stifle innovation.
Ultimately, the iEHR will unify the two Departments' EHR systems
into a common system that will ensure that DOD and VA health facilities
have Service members' and Veterans' health information available
throughout their lifetime. We anticipate joint use of the iEHR will
help contain healthcare costs and provide higher value based healthcare
delivery systems. By implementing a single, common health record for
DOD and VA medical facilities, the iEHR will ensure that information
about injuries and illnesses incurred during military service remain
available for health and benefits purposes throughout a person's
lifetime, supporting patient safety and continuity of care and
facilitating access to and delivery of benefits. Seamless information
sharing is expected to support the expeditious processing of disability
claims in the future. Further, the iEHR will support the objectives of
the HIPAA Privacy and Security Rules to ensure that when protected
health information (PHI) is collected, maintained, used, disclosed or
transmitted, reasonable and appropriate administrative, physical and
technical safeguards have been implemented to ensure integrity,
availability and confidentiality.
The initial iEHR capabilities, laboratory and immunizations, will
be delivered to two sites (San Antonio, Texas and Hampton Roads,
Virginia) by the end of 2014. The capabilities of the iEHR will be
increased incrementally through the end of 2017. [See page 15.]
______
RESPONSE TO QUESTION SUBMITTED BY MR. MCKEON
Secretary Panetta. The President's budget makes the necessary
budget constrictions to avoid devastating the Department through
sequestration. If sequestration becomes an inevitability, the
Department will evaluate all options available to comply with the law.
[See page 14.]
?
=======================================================================
QUESTIONS SUBMITTED BY MEMBERS POST HEARING
July 25, 2012
=======================================================================
QUESTIONS SUBMITTED BY MR. LANGEVIN
Mr. Langevin. Both DOD and the VA receive funding for spinal cord
injury treatment, research, and education--the VA through the Office of
Research and Development, and the DOD specifically through the
Congressionally Directed Medical Research Program.
While the programs share a common goal, there are important
differences. To what extent are spinal cord injury research efforts
coordinated and shared across Departments?
Secretary Panetta. Spinal cord injury (SCI) research efforts are
coordinated and shared across the Departments of Defense and Veterans
Affairs at several levels. First, DOD and VA jointly sponsor research
portfolio reviews and analyses (R&A) of major research efforts in
Traumatic Brain Injury and Psychological Health; Clinical,
Rehabilitative, and Regenerative Medicine; Combat Casualty Care;
Military Operational Medicine; Military Infectious Diseases; and Health
Information Technology and Medical Training. SCI research is covered in
the Traumatic Brain Injury and Psychological Health, and Clinical,
Rehabilitative, and Regenerative Medicine R&As. Through this review,
research gaps are identified for future research investment and
collaborative DOD/VA research opportunities.
Second, VA participates in the CDMRP research planning efforts.
Specifically, VA has co-chaired the SCI Research Program Integration
Panel for the past two years. Other Panel members are from the VA the
military Services (Army, Navy, and Air Force), the National Institutes
of Health (NIH), and academic institutions, the Department of
Education's National Institute on Disability and Rehabilitation
Research, and consumer advocacy organizations (Paralyzed Veterans
Association, United Spinal Association). The SCI panel provides
strategic direction, screens pre-proposals, recommends proposals for
funding, identifies research gaps and sets the vision for the coming
year.
Mr. Langevin. Secretary Panetta, in today's tepid economy, the DOD
cannot downsize our forces without ensuring we provide mechanisms and
programs for the service members to utilize before, during and after
their transition from the military. In your words, what is the single
most important role the DOD can play to assist these warriors in
transition?
Secretary Panetta. The Department's most important role is to
prepare our Service members to become successful civilian citizens in
their communities. We do this through a re-designed transition
assistance program that focuses on providing all Service members with
the appropriate tools needed to succeed. These tools include a
crosswalk between military service and civilian experience; financial
planning seminar; information about Department of Veterans Affairs (VA)
benefits, and the Department of Labor employment workshop. The
transition assistance program provides a transitioning Service member
with a tangible product such as a budget, resume, listing of civilian
careers that match military service experience and the practical
application of how to apply for education benefits, home loans,
disability (benefits, as appropriate) and experience in interviewing
and searching for jobs. Using these tools along with the support from
our interagency partners will result in the smooth transition from
Service member to civilian.
Mr. Langevin. Both DOD and the VA receive funding for spinal cord
injury treatment, research, and education--the VA through the Office of
Research and Development, and the DOD specifically through the
Congressionally Directed Medical Research Program.
While the programs share a common goal, there are important
differences. To what extent are spinal cord injury research efforts
coordinated and shared across Departments?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Langevin. The suicide rate for both service members and
veterans is rising at an alarming rate, what is the VA doing to address
this tragic rise today and what are your plans to address this trend in
the future?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
______
QUESTIONS SUBMITTED BY MR. COOPER
Mr. Cooper. Has VA measured how effective the VA National PTSD
Center's numerous webinars and training sessions are for promoting
among providers safer drug treatments for veterans experience PTSD? How
many providers use those webinars and training sessions? Is this a
number of providers that is satisfactory to VA and DOD? Has VA and DOD
seen a change yet in PTSD treatment plans following these webinars and
trainings? Are DOD and VA prepared to measure how effective the
sessions are?
Secretary Panetta. The Under Secretary for Health of the Department
of Veterans Affairs and the Assistant Secretary of Defense for Health
Affairs signed a formal Memorandum of Understanding (MOU) in March 2012
to facilitate collaboration, coordination, and evaluation of training
courses and programs in both Departments. DOD encourages providers to
utilize all government resources when meeting continuing education
requirements for medical professionals.
Although DOD has not specified a target number of providers to
participate in VA webinars, the new MOU can be used to further develop
methods to increase DOD and VA webinar participation as well as efforts
to develop a formalized method to assess the impact on provider
practice.
DOD has also partnered with VA via the Integrated Mental Health
Strategy (IMHS) to improve collaboration related to provider training
and webinars. In addition, DOD has begun to develop processes to
measure effectiveness and changes in PH treatment outcomes after best
practice implementation across the Military Health System.
Mr. Cooper. A July 13, 2012, IOM study noted that PTSD screening,
treatment, and rehabilitation services should be done ``in different
populations of active-duty personnel and veterans.'' Does VA and DOD
know of PTSD studies performed on active-duty service men and women,
and/or military veterans? How numerous and how comprehensive have those
studies been? That recent IOM study goes on to recommend that ``the DOD
and the VA should coordinate, evaluate, and review these [active-duty
personnel and veteran study] efforts continually and routinely and
should disseminate the findings widely.'' How is the VA and DOD
disseminating treatment findings now? How can they disseminate best
practice treatment findings now? Would the EHR or drug formulary be
helpful in doing this? Is there any incentive in place for VA and DOD
providers to share, consult with, and use best practices found in other
VA facilities?
Secretary Panetta. There have been over 1,500 studies related to
Active Duty military with PTSD, and 3,000 studies related to veterans
with PTSD, completed since 1980. DOD has allocated significant
resources dedicated to fund ongoing comprehensive PTSD research focused
on the effectiveness of prevention, screening, treatment, and
rehabilitation programs for Service members. PTSD research is also in
progress through multiple military research institutions, to include
the Armed Forces Health Surveillance Center, the Army Medical and
Materiel Research Command, the Walter Reed Army Institute of Medicine,
the Deployment Health Clinical Center, the Center for the Study of
Traumatic Stress, and the Naval Health Research Center. These entities
share their findings through annual reports posted on websites,
publications in scientific journals, presentations at professional
conferences, and various public forums. The VA/DOD Integrated Mental
Health Strategy (IMHS) has specific task groups working to develop
processes to rapidly translate research and move innovative programs
into practice.
DOD findings are translated into clinical practice via formal and
informal PTSD training programs as well as clinical practice
guidelines, recommendations, and support tools. For example, the Center
for Deployment Psychology (CDP) is a DOD resource that trains mental
health providers in evidence-based psychotherapies for PTSD. To date,
CDP has trained approximately 6,700 mental health providers to deliver
evidence-based psychotherapies for PTSD. There are also provider on-
line training courses that are hosted through DOD, such as the Military
Health System Learning Portal and the Center for Deployment Psychology.
The Army Medical Command's Office of Quality Management provides tools
to assist providers to follow the VA DOD Clinical Practice Guideline
for Management of Post-traumatic Stress.
DOD's National Center for Telehealth and Technology (T2), a
Component Center of the Defense Center of Excellence for Psychological
Health and Traumatic Brain Injury (DCoE), has developed products to
inform providers, Service members, and their families about evidence-
based practices for the treatment of PTSD, to include smart phone
applications that assist patients and providers to follow evidence-
based practices. T2 also designed innovative, state-of-the-art virtual
delivery systems to increase the availability of evidence-based PTSD
treatment. Further, DOD has multiple postgraduate education,
internship, and fellowship behavioral health training programs for new
accessions that require students to be trained in evidence-based
Psychological Health (PH) practices.
The electronic health record (EHR) will continue to be an important
dissemination tool for PH treatment best practices, and DOD is
positioned to further leverage the EHR to develop and implement
standard PH practice guidelines, to include PTSD guidelines. For
example, DOD currently uses an application in the EHR to inform primary
care providers about medication best practices related to PTSD; the
application has been used to treat over 30,000 patients. DOD recognizes
that pharmacists in the Military Health System can help further improve
psychiatric medication standard of care, and created a policy
memorandum from February 22, 2012 entitled ``Guidance for Providers
Prescribing Atypical Antipsychotic Medication.'' This memorandum
suggests that Military Treatment Commanders work with their Pharmacy
and Therapeutics Committee to monitor providers and their compliance
with best practices related to use of medication for PTSD treatment.
DOD ensures evidence-based and best practice treatment skills are
integrated into care as part of the health care appraisal system,
including a peer review process to ensure the highest standard of care
is met. In addition, hospitals are motivated to use best practices that
decrease care costs and maximize treatment outcomes through various
means.
Mr. Cooper. Do DOD and VA plan to create ``an evidence base to
guide the integration of treatment for comorbidities with treatment for
PTSD?'' How do you plan to encourage that kind of research?
Secretary Panetta. DOD has already provided an evidence-based guide
that helps providers manage co-occurring conditions, the ``Co-occurring
Conditions Toolkit: Mild Traumatic Brain Injury and Psychological
Health.'' This toolkit, based on scientific evidence, was developed to
help primary care providers better assess and manage patients with
psychological health and TBI conditions. In formulating these guides,
knowledge gaps were identified to inform future research. In addition,
DOD has funded over 30 studies related to treatment of PTSD and
comorbid diagnoses (TBI, sleep disorders, alcohol and substance use
disorders, anxiety, depression, and suicide). The results from these
studies will further our knowledge in improving diagnosis and treatment
of these conditions.
In addition, DOD partners with other research institutes. For
example, STRONG STAR (The South Texas Research Organizational Network
Guiding Trauma and Resilience) is a multidisciplinary, multi-
institutional research consortium funded by the DOD's Psychological
Health and TBI Research Program. Their research includes the
investigation of PTSD treatment with co-occurring disorders that
include chronic pain, alcohol use, and insomnia.
DOD creates research opportunities annually in the areas of
traumatic brain injury and psychological health through the release of
Program Announcements that describe the program of interest and the
research need, the purpose and objectives, submission information,
application review procedures, award administrative information, agency
contacts, and time lines for submission and reviews. Program
Announcements are posted on grants.gov for open and fair competition
and submissions are received electronically.
Mr. Cooper. Have DOD and VA identified PTSD treatment practices
that are usually ineffective in active-duty service men and women and
veterans?
Secretary Panetta. DOD and VA published the VA DOD Clinical
Practice Guideline for the Management of Post-Traumatic Stress in 2010.
This guideline is based on thorough reviews of scientifically published
evidence of Posttraumatic Stress Disorder treatments, including
psychotherapy, medication, and complementary and alternative medicine
interventions. This guideline includes an extensive discussion about
treatments that have been found to be effective, found to be
ineffective, have yet to be established as either effective or
ineffective, or have found to be potentially harmful. A copy of the
guideline is available at:
http://www.healthquality.va.gov/
Post_Traumatic_Stress_Disorder_PTSD.asp
Mr. Cooper. Approximately what percentage of the experts who put
together the VA/DOD Clinical Practice Guideline for Management of Post-
Traumatic Stress have first-hand experience with treating veterans or
active-duty personnel with prescription drugs? How much are those
guidelines based on studies done in active-duty personnel and veterans?
Secretary Panetta. Twenty one of the thirty-two DOD and VHA members
of the Working Group for the 2010 revision of the VA/DOD Clinical
Practice Guideline for the Management of Post-Traumatic have first-hand
experience as prescribers. All of the members have experience treating
veterans and active-duty personnel. A full list of members of this
working group is found on page 10 of the Guideline (see below footnote
for link).
The Guidelines were based on literature and empirical findings
specific to--and most relevant to--treatment of active duty Service
members and veterans. The Introduction section of the Guideline
provides an excellent overview of the criteria and standards used in
the review of literature.
Mr. Cooper. A July 13, 2012, Institute of Medicine study
recommended that ``to study the efficacy of treatment and to move
toward measurement-based PTSD care in the DOD and the VA, assessment
data should be collected before, during, and after treatment and should
be entered into patients' medical records. This information should be
made accessible to researchers with appropriate safeguards to ensure
patient confidentiality.'' How quickly can the VA and DOD put this
recommendation into practice? What are the barriers to beginning to do
this and how substantial are those barriers if they exist?
Secretary Panetta. Assessment data is already collected before,
during, and after treatment and entered into patients' medical records.
The administration of standardized and validated PTSD clinical
screening tools that are often used in research (e.g., the PTSD
Checklist) is endorsed by the DOD for use when a Service member might
benefit from further clinical evaluation or in monitoring treatment
response. No standardized screening or assessment tool is available
that can replace a comprehensive clinical interview that assesses the
full spectrum of both PTSD and non-PTSD symptoms within broader social
and occupational contexts. The DOD standard of care is that all data,
inclusive of clinical assessment measures, becomes a part of the
Service member's healthcare record.
There are no inherent barriers to access of these records for
research. Access to the use of TRICARE Management Activity (TMA) owned
or managed data is subject to patient protections, privacy safeguards,
and other research protocols mandated by law and implemented by
institutional review boards and obtained through a formal agreement
with TMA for sharing and use of data elements. The TMA Privacy and
Civil Liberties Office (TMA Privacy Office) manages the data sharing
agreement program and research protection program.
The Department of Defense (DOD), Office of the Assistant Secretary
of Defense (Health Affairs) (OASD[HA]) and the TRICARE Management
Activity (TMA) support and encourage research, including human subject
research. The Department of Defense (DOD) invests in Psychological
Health (PH) research and the largest portion of the PH portfolio is
directed toward PTSD. Out of the 225 current research projects in the
PH portfolio, 162 focus on PTSD including studies specific to examining
efficacy of treatment for PTSD and studies that focus on evidence-based
long-term recovery protocols to decrease recurrence of PTSD symptoms.
Recently, the Department in collaboration with the VA announced the
creation of two research consortia one of which is focused on PTSD. The
Consortium to Alleviate PTSD (CAP) Award will consist of a Coordinating
Center and multiple Study Sites, and will be supported through this
DOD/VA collaborative research effort. The primary purpose of the
collaborative DOD/VA Consortium will be to improve the health and well-
being of Service Members (Active Duty, National Guard, and Reservist)
and Veterans, with the most effective diagnostics, prognostics, novel
treatments, and rehabilitative strategies to treat acute PTSD and to
prevent chronic PTSD. Key priorities of this Consortium are elucidation
of factors that influence the different trajectories (onset/
progression/duration) of PTSD and associated chronic mental and
physical sequelae (including depression, anger/aggression, and
substance use/abuse, etc.) and identification of measures for
determining who is likely to go on to develop chronic PTSD. The
Consortium will therefore work to improve prognostics, advance
treatments, and mitigate negative long-term consequences associated
with traumatic exposure.
Mr. Cooper. In general, how does VA and DOD get evidence based
medical information out to be used systematically throughout the
systems? Is there a good example of a best practice being widely
disseminated and used?
Secretary Panetta. There are many points for wide dissemination of
evidence-based medical information. A few are listed below:
The DOD has central website for wellness resources for
the military community at http://www.afterdeployment.org/. An adjunct
program to this website has just been opened as a centralized
information mart for providers at http://www.afterdeployment.org/
providers/home. It includes continuing education materials, mobile
applications, patient educational resources, libraries, briefings and
quick links to the DOD/VA Clinical Practice guidelines.
The DOD/VA Clinical Practice Guidelines are available at
http://www.
healthquality.va.gov/index.asp.
PDHealth.mil at http://www.pdhealth.mil/main.asp provides
a gateway to information on deployment health and healthcare for
healthcare providers, service members, veterans, and families. It was
designed to assist clinicians in the delivery of post-deployment
healthcare by fostering a partnership between service members,
veterans, families, and healthcare providers.
Up-to-date and current information pertaining to research
and best practices is available through the Combat & Operational Stress
Research Quarterly published by the Navy (www.nccosc.navy.mil or direct
link @ http://bit.ly/wnadBm) and the Deployment Health Clinical Center
newsletter dispatched daily by email.
The Department of Defense also disseminates evidence
based information pertaining to practice, responsibilities, and
requirements through the publication of Directives, Instructions and
Guidance Memorandums.
The clinical practice guideline titled ``Management of Post-
Traumatic Stress Disorder and Acute Stress Reaction (2010)'' posted on
the DOD/VA Clinical Practice Guidelines home page is an excellent
example of a best practice that is widely disseminated and used.
Mr. Cooper. Has evidence based psychotherapy been evaluated in
active-duty service men and women with PTSD?
Secretary Panetta. There are many points for wide dissemination of
evidence-based medical information. A few are listed below:
The DOD has central website for wellness resources for
the military community at http://www.afterdeployment.org/. An adjunct
program to this website has just been opened as a centralized
information mart for providers at http://www.afterdeployment.org/
providers/home. It includes continuing education materials, mobile
applications, patient educational resources, libraries, briefings and
quick links to the DOD/VA Clinical Practice guidelines.
The DOD/VA Clinical Practice Guidelines are available at
http://www.
healthquality.va.gov/index.asp.
PDHealth.mil at http://www.pdhealth.mil/main.asp provides
a gateway to information on deployment health and healthcare for
healthcare providers, service members, veterans, and families. It was
designed to assist clinicians in the delivery of post-deployment
healthcare by fostering a partnership between service members,
veterans, families, and healthcare providers.
Up-to-date and current information pertaining to research
and best practices is available through the Combat & Operational Stress
Research Quarterly published by the Navy (www.nccosc.navy.mil or direct
link @ http://bit.ly/wnadBm) and the Deployment Health Clinical Center
newsletter dispatched daily by email.
The Department of Defense also disseminates evidence
based information pertaining to practice, responsibilities, and
requirements through the publication of Directives, Instructions and
Guidance Memorandums.
The clinical practice guideline titled ``Management of Post-
Traumatic Stress Disorder and Acute Stress Reaction (2010)'' posted on
the DOD/VA Clinical Practice Guidelines home page is an excellent
example of a best practice that is widely disseminated and used.
Mr. Cooper. Has VA measured how effective the VA National PTSD
Center's numerous webinars and training sessions are for promoting
safer drug treatments for veterans experience PTSD? How many providers
use those webinars and training sessions? Is this a number of providers
that is satisfactory to VA and DOD? Has VA and DOD seen yet a change in
treatments following these webinars and trainings? Are they prepared to
measure how effective the sessions are?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Cooper. A July 13, 2012, IOM study noted that PTSD screening,
treatment, and rehabilitation services should be done ``in different
populations of active-duty personnel and veterans.'' Does VA and DOD
know of PTSD studies performed on active-duty service men and women,
and/or military veterans? How numerous and how comprehensive have those
studies been? That recent IOM study goes on to recommend that ``the DOD
and the VA should coordinate, evaluate, and review these [active-duty
personnel and veteran study] efforts continually and routinely and
should disseminate the findings widely.'' How is the VA and DOD
disseminating treatment findings now? How can they disseminate best
practice treatment findings now? Would the EHR or drug formulary be
helpful in doing this? Is there any incentive in place for VA and DOD
providers to share, consult with, and use best practices found in other
VA facilities?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Cooper. Do DOD and VA plan to create ``an evidence base to
guide the integration of treatment for comorbidities with treatment for
PTSD?'' How do you plan to encourage that kind of research?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Cooper. Have DOD and VA identified PTSD treatment practices
that are usually ineffective in active-duty service men and women and
veterans?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Cooper. Approximately what percentage of the experts who put
together the VA/DOD Clinical Practice Guideline for Management of Post-
Traumatic Stress have first-hand experience with treating veterans or
active-duty personnel with prescription drugs? How much are those
guidelines based on studies done in active-duty personnel and veterans?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Cooper. As Secretary Shinseki mentioned, the VA has ``a pretty
comprehensive record of who to treat [for PTSD, TBI, substance abuse,
sexual assaults] and then [the VA] sets about treating them.'' If this
is the case, is how these veterans are treated for PTSD, tracked at
all? Does the VA know for a fact which treatments are given most
frequently to veterans with PTSD and in what combination? Do these
treatments match up with what evidence there is for the most effective
way to treat these veterans? Has either the VA or DOD studied patterns
in treatment of PTSD in active-duty personnel and veterans?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Cooper. A July 13, 2012, Institute of Medicine study
recommended that ``to study the efficacy of treatment and to move
toward measurement-based PTSD care in the DOD and the VA, assessment
data should be collected before, during, and after treatment and should
be entered into patients' medical records. This information should be
made accessible to researchers with appropriate safeguards to ensure
patient confidentiality.'' How quickly can the VA and DOD put this
recommendation into practice? What are the barriers to beginning to do
this and how substantial are those barriers if they exist?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Cooper. In general, how does VA and DOD get evidence based
medical information out to be used systematically throughout the
systems? Is there a good example of a best practice being widely
disseminated and used?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
______
QUESTIONS SUBMITTED BY MS. BORDALLO
Ms. Bordallo. If we are to create a joint medical electronic
records system, where all services including the VA will be using it at
the same time, what will be different about this system that will
prevent the system from running slow during peak hours or crashing in
the middle of a heavy patient appointment schedule?
Secretary Panetta. Systems Engineering and Testing will be
conducted throughout the development and deployment of the integrated
Electronic Health Record (iEHR) to ensure the system is stable and
reliable in production environments. Network capacity planning will be
performed and performance measures will be validated. The Development
and Test Center/Environment (DTC/DTE), which consists of a set of
systems, software, network, and test tools will be utilized throughout
the system life cycle for continuous test and evaluation of system
performance.
Ms. Bordallo. Aside from the efficiencies a joint electronic
medical record system will create, could you share some of the other
benefits this system will produce as a byproduct?
Secretary Panetta. The ultimate benefit the integrated Electronic
Health Record (iEHR) will be improved quality of healthcare for our
Service members and Veterans. The iEHR's close coupling with the VLER
Health information exchange initiatives will accelerate the ability for
DOD and VA healthcare providers to exchange information with other
federal and private industry partners about patients they collectively
care for.
Patient-Centered Care: Patients will have a comprehensive
and transportable medical profile that will support seamless transition
of care between DOD and VA treatment facilities--as well as private
providers. The iEHR will promote and facilitate an empowered patient,
healthcare staff, and patient-centric approach, that will support
healthcare information technology (HIT) systems that foster the
delivery of effective, efficient, safe, and quality patient care.
Precision of Care: Enhanced Clinical Decision Support
(CDS) tools enabled by the iEHR will increase the precision of care
delivered/received by providing access to comprehensive patient data
and increased information exchange capabilities among providers that
would otherwise not be available.
More Time with Patients: Healthcare providers will be
able to spend more time with their patients instead of searching for
their data and signing on to multiple systems.
Personal Health Records: Promoting partnership between
healthcare team members and patients through an empowered patient care
model for delivery of high quality medical care that engages patients
in the healthcare process.
Improve Quality of Care per Dollar Spent: Improving
clinical outcomes while creating cost efficiencies in both workforce
and IT life cycle costs.
Population Health: Access to quality population health
data and analytic tools will result in cost efficiencies and improved
preventative healthcare. For example, insight into the number of
diabetics who have not had their H1Cs done could inform a patient
outreach program that have been shown to result in a reduction in
amputations.
Innovation: Promote innovations in technology and product
research that support the delivery of quality healthcare and improved
patient outcomes.
Maturity of International HIT Standards: As the largest
healthcare network in the world encouraging open solutions, the iEHR
will be a driving force in the maturation of HIT standards improving
the quality and landscape of HIT solutions available in the market.
Interagency Collaboration Center of Excellence: The scale
and scope of this effort provides the opportunity set the standard and
influence policy for large scale interagency collaboration activities
moving forward.
Ms. Bordallo. What efforts are underway to improve the electronic
delivery of information from DOD to VA and vice versa to improve
benefits and health care delivery to service members and veterans?
Additionally, can either witness discuss what is being done to develop
a joint electronic medical records system. It's my understanding that
each service including the VA currently operates a separate system and
there is very little cross service functionality between any of the
systems so how will you achieve cross-functionality and how do we
improve the slow processing of the systems currently in place?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Ms. Bordallo. If we are to create a joint medical electronic
records system, where all services including the VA will be using it at
the same time, what will be different about this system that will
prevent the system from running slow during peak hours or crashing in
the middle of a heavy patient appointment schedule?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Ms. Bordallo. Aside from the efficiencies a joint electronic
medical record system will create, could you share some of the other
benefits this system will produce as a byproduct?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
______
QUESTIONS SUBMITTED BY MR. FRANKS
Mr. Franks. Reports show that suicide rates among veterans,
especially combat veterans, have increased over the past several years.
Furthermore, studies have shown a correlation between people of faith
and lower rates of suicide. Therefore, I'm concerned by reports
indicating that the military is censoring religious references and
symbols beyond Constitutional requirements. How is religion being
incorporated into suicide prevention, and does the military's extra-
Constitutional censorship of religion support your departments' suicide
prevention efforts?
Secretary Panetta. Suicide and the prevention thereof is one of the
most vexing and important challenges the Department faces and we are
committed to using every means available to assist our Service members
and their families. Progress on this crucial issue will require a
multi-functional and multi-faceted approach and our Chaplains fulfill a
vital role in lending assistance to commanders, troops, and families in
need. The Chaplaincies of the Military Departments are established to
advise and assist commanders, troops, and families in the free exercise
of religion in the context of military service as guaranteed by the
Constitution. Our Chaplains serve a religiously diverse population and
provide comprehensive religious support to all who seek it.
The Department does not censure religious support. Indeed, all of
the Military Departments have, over the course of the last several
years, placed increased emphasis upon holistic efforts aimed at
improving every aspect of fitness. This emphasis with a view toward the
total comprehensive fitness of the force recognizes the vital component
faith serves in the lives of many of our military families.
Mr. Franks. Reports show that suicide rates among veterans,
especially combat veterans, have increased over the past several years.
Furthermore, studies have shown a correlation between people of faith
and lower rates of suicide. Therefore, I'm concerned by reports
indicating that the military is censoring religious references and
symbols beyond Constitutional requirements. How is religion being
incorporated into suicide prevention, and does the military's extra-
Constitutional censorship of religion support your departments' suicide
prevention efforts?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
______
QUESTIONS SUBMITTED BY MR. LOEBSACK
Mr. Loebsack. What specific steps are the Department of Defense and
the Department of Veterans Affairs taking to coordinate transition
assistance and benefits for members of the National Guard and Reserve
transitioning from Active Duty service back to civilian jobs and
civilian life? How are the Departments coordinating to ensure members
of the Reserve Component are aware of the DOD and VA benefits available
to them?
Secretary Panetta. In order to coordinate transition assistance and
benefits for members of National Guard and Reserve transitioning from
active duty to civilian life, DOD has worked with thje Department of
Veterans Affairs, Department of Homeland Security, Department of
Education and Office of Personnel Management over the last year to
redesign the Transition Assistance Program (includes eligible National
Guard and Reserve Service members).
All eligible National Guard and Reserve Service members will
receive transition assistance, which includes Pre-separation Counseling
and VA Benefits Briefing. They will also be afforded the opportunity to
register for their eBenefits account as well as the opportunity to
either sign up for VA benefits to which they may be entitled and/or
schedule a one-on-one appointment with a VA representative to submit
applications for benefits.
In addition, the VOW to Hire Heroes Act requires all eligible
National Guard and Reserve members to participate in the re-designed
Department of Labor Employment Workshop (except those with exemptions).
Finally, the Transition GPS (Goals, Plans, Success) includes a CORE
Curriculum which consists of the following modules and topics:
Transition Overview, Considerations for Families, Special Issue, Value
of a Mentor, Military Occupational Code (MOC) Crosswalk, and a
Financial Management Seminar. The Transition GPS also includes three
tracks (Education, Career Technical Training, and Entrepreneurship)
which are in addition to the CORE curriculum. The track they select is
based on their personal needs and goals.
Furthermore, the DOD's Yellow Ribbon Reintegration Program (YRRP)
provides National Guard and Reserve Service members and their families
with critical support throughout the entire deployment cycle (pre-
during and post-), easing transitions as Service members move between
their military and civilian roles. Post-deployment activities are
specially focused on reintegration into the family, community and
workforce, providing information and resources through local and state
agencies, military transition assistance, and other military-related
non-profit organizations. On-site assistance with enrollment and other
benefits is included in all YRRP activities, with follow-up
capabilities offered for those Service members with more long-term
needs.
Mr. Loebsack. What specific steps are the Department of Defense and
the Department of Veterans Affairs taking to identify service members
transitioning to civilian life who require Post Traumatic Stress,
Traumatic Brain Injury, or mental health care? How are the Departments
ensuring that these service members do not fall through the cracks as
they transition between the DOD and VA health systems? What steps are
being taken to ensure that transitioning service members and their
families are aware of the suicide prevention resources available to
them?
Secretary Panetta. For those Service members transitioning to
civilian life who require Post Traumatic Stress Disorder (PTSD),
Traumatic Brain Injury (TBI), or mental health care for other
identified mental health conditions, the DOD ensures proper treatment
and successful transition to civilian life through care coordination
and transition assistance services through the following policies and
practices:
The Military Departments have engineered clinical case
management services and practices for aspects of care within the
Military Health System (MHS), particularly as it relates to the care of
the wounded, ill or injured (WII) Service members. Directive-Type
Memorandum (DTM) 08-033, ``Interim Guidance for Clinical Case
Management for the Wounded, Ill, and Injured Service Member in the
Military Health System'' was initially published in 2009 and updated in
2012. This guidance delineates the requirements for the implementation
of clinical case management in the MHS and established MHS medical and
clinical policies and procedures for WII care.
In 2011, DOD published policy, ``Continuity of Behavioral
Health Care for Transferring and Transitioning Service Members,'' which
prescribes guidelines that ensure continuity of care for Service
members transferring to a new duty station or transitioning out of the
Service. This policy directs the Military Services to develop policies
for transfer of behavioral health care from military to civilian
providers, including VA providers. When a separating Service member
provides consent for sharing information with a follow-on behavioral
health provider, DOD shares all relevant clinical information. This
includes diagnoses, medications, treatment history including suicide
risk, test results, treatment plans and prognosis. Service members'
treatment record information is available to VA providers via the
Bidirectional Health Information Exchange.
DOD's inTransition program provides a telephonic coach
for transitioning Service members with behavioral health issues,
whether that is in the VA health care system, the Military Health
System, TRICARE, or the community. The inTransition program has opened
thousands of coaching cases since its inception in February 2010. The
acceptance rate for service members referred to the program since
inception exceeds 95%.
The VA Liaison for Healthcare, a social worker or nurse
strategically placed at an MTF with recovering service members
returning from Afghanistan, is another asset. 33 Liaisons for
Healthcare are stationed at 18 MTFs, helping transition ill and injured
Service members from DOD to the VA system of care. Thousands of health
care transitions have been coordinated.
For individuals who have suffered a traumatic brain injury:
The Defense Veterans Brain Injury Center (DVBIC) Regional
Care Coordinator (RCC) program provides a nationwide care coordination
network for Service members with TBI. This program facilitates
transition from the DOD to VA care by working with VA case management
teams.
For Service members with more severe brain injuries, a
DOD-VA Polytrauma Telehealth Network connects the current DOD treating
team with the accepting treating team in the VA. This facilitates
transfer planning, affords families an opportunity to meet care teams
and ensures that medical records are transferred between facilities.
DOD and VA work together on a Congressionally-mandated
five year pilot program which assesses the effectiveness of providing
assisted living services to Service members and Veterans with TBI who
require ongoing care in the community. VA collaborated with the DVBIC
on a family caregiver panel to develop a uniform training curriculum
for family members in providing care and assistance.
TRICARE Regional Offices have VA Liaisons who serve as
intermediaries between VA facilities and the TRICARE regional
contractors. VA Liaisons actively assist with authorizations and
claims, and TRICARE contractors hold monthly calls with the VA's
Medical Sharing Office to review the cases of active duty Service
members who are receiving joint VA/DOD care.
At each point of contact in these chain of transition events and
post-active duty follow-on (e.g., the periodic health assessments,
post-deployment screening, and yellow ribbon events), assessment for
the potential for suicide occurs and information regarding suicide
prevention and other helping resources are made available. In addition,
Service and VA Mental Health and suicide prevention coordinators,
suicide hotlines (VA and DOD), we have Military OneSource are available
resources.
The DOD-VA Integrated Mental Health Strategy includes actions
specifically focused on transition and continuity of behavioral health
care. DOD will continue to work with VA in implementation of our
policies regarding transition and continuity of behavioral health and
TBI care. We will ensure our providers address transition of behavioral
health care for wounded warriors to VA and other civilian providers,
and will continue to manage the important issues of suicide risk,
occupational impairment, and PTSD.
Mr. Loebsack. I have held multiple veterans forums across my
District and have heard time and again from Iowa veterans that they are
deeply frustrated by the time it takes to process their disability
claims. The Integrated Disability System was meant to integrate the DOD
and VA disability evaluation processes. What steps are being taken to
improve IDES? Do additional steps need to be taken to standardize and
streamline the disability evaluation process and improve DOD and VA
collaboration?
Secretary Panetta. The Departments collaborate closely on efforts
to jointly refine and improve the IDES. In FY 2012, major efforts in
this area included:
The Military Departments significantly increased IDES
staff levels in FY2012. DOD added authorizations for over 1,500 case
managers, administrative assistants, and lawyers over the next four
fiscal years to improve case processing timeliness and customer
service. Additionally, each of the Services is increasing efforts to
hire and retain physicians, particularly behavioral or mental health
professionals. We expect to see process improvements during FY2013.
In April 2012, the Secretary of Defense and Secretary of
Veterans Affairs directed their Departments to implement a paperless,
searchable claims file for the Integrated Disability Evaluation System
(IDES). The Departments created an electronic case file transfer
capability for IDES cases as an interim step towards that objective.
The Departments initiated a pilot test of that capability at 11
locations in September 2012. The Departments will decide whether to
field the electronic case file transfer capability in January 2013.
In June 2012, VA released version 2.0 of the Veterans
Tracking Application (VTA). This version incorporated operational
reports that improved IDES case oversight capabilities. Additionally,
DOD developed and fielded case tracking tools that enable installation-
level visibility of case duration and data errors.
A DOD IDES Task Force, comprised of senior leaders from
the Department, conducted an end-to-end business process review of the
IDES and, as of October 2012, is preparing recommendations for
additional improvements for the Secretary of Defense.
Mr. Loebsack. What specific steps are the Department of Defense and
the Department of Veterans Affairs taking to coordinate transition
assistance and benefits for members of the National Guard and Reserve
transitioning from Active Duty service back to civilian jobs and
civilian life? How are the Departments coordinating to ensure members
of the Reserve Component are aware of the DOD and VA benefits available
to them?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Loebsack. What specific steps are the Department of Defense and
the Department of Veterans Affairs taking to identify service members
transitioning to civilian life who require Post Traumatic Stress,
Traumatic Brain Injury, or mental health care? How are the Departments
ensuring that these service members do not fall through the cracks as
they transition between the DOD and VA health systems? What steps are
being taken to ensure that transitioning service members and their
families are aware of the suicide prevention resources available to
them?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Loebsack. I have held multiple veterans forums across my
District and have heard time and again from Iowa veterans that they are
deeply frustrated by the time it takes to process their disability
claims. The Integrated Disability System was meant to integrate the DOD
and VA disability evaluation processes. What steps are being taken to
improve IDES? Do additional steps need to be taken to standardize and
streamline the disability evaluation process and improve DOD and VA
collaboration?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
______
QUESTIONS SUBMITTED BY MR. KISSELL
Mr. Kissell. What is the possibility of getting VA and DOD medical
records electronically available for civilian medical venues? How and
when might this be implemented?
Secretary Panetta. One important goal of the integrated electronic
health record (iEHR) is to maximize the information exchanged among DOD
and VA health providers and private providers via bilateral
communications and health information sharing. Specifically, the IPO is
continuing to develop the Virtual Lifetime Electronic Record (VLER)
Health program that enables the exchange of electronic medical data
with the private sector. For example, under VLER Health, a private
sector provider or hospital can request electronic health data from the
DOD or VA, and the Departments can securely provide that information
back to the requesting party. This exchange is governed by the Data Use
and Reciprocal Support Agreement (DURSA) developed by the Office of the
National Coordinator (ONC) at Health and Human Services (HHS). ONC is
also responsible for the development of the infrastructure that
supports this exchange. This infrastructure is called the Nation-wide
Health Information Network (NwHIN), and the DOD and VA have been
actively engaged in its development. Through the DOD's and VA's
participation in the NwHIN, the departments will be able to exchange
electronic health data in a secure and trusted way with private
healthcare entities.
VLER Health capability has been demonstrated at 4 joint DOD/VA
sites, and at 11 other VA sites as part of the VLER Health
demonstrations. Recently, the Joint Executive Committee (JEC) has
approved the further deployment of VLER Health at sites that meet
criteria that ensures its effective implementation: where there are
large numbers of beneficiaries using private sector care, where the
state Health Information Exchanges (HIEs) are mature, where the private
sector has electronic medical records, and where the beneficiaries have
``opted-in'' to the program. These exchanges will continue to grow over
the life of the iEHR.
Mr. Kissell. What is the possibility of getting VA and DOD medical
records electronically available for civilian medical venues? How and
when might this be implemented?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
______
QUESTIONS SUBMITTED BY MR. GARAMENDI
Mr. Garamendi. Please advise of the contractor that developed and
currently maintain DOD's electronic health records system and the
contractor that developed and currently maintain the VA's electronic
health records system. Are either of these contractors developing the
Joint Electronic Health Record, iEHR? If not, has this attributed to
the delay of iEHR? What steps are being taken to ensure a seamless
transition between current contractors and new contractor?
Secretary Panetta. VistA was developed by the VA clinical
community, rather than contractors. The Composite Health Care System
(CHCS), DOD's predecessor system, was developed using the Veteran
Administration's Decentralized Hospital Computer Program (DHCP) as the
foundation and modifying modules when possible to meet the requirements
established by DOD. Additionally, CHCS has a long history and does not
have one specific contractor that can be singled out as responsible for
its development.
The current contractor support to iEHR was not involved in the
support provided to DOD and VA legacy electronic health record (EHR)
systems; however, this has not resulted in a delay. The DOD/VA IPO's
government staff has extensive technical knowledge of respective legacy
systems and/or reach back to the Departments for expertise as needed.
Mr. Garamendi. In your testimony, you stated that the iEHR is
expected to be fully operational no later than 2017. Considering the
immediate need for this system, will additional funding enable you to
provide the system sooner? If not, what steps can be taken to improve
your current schedule?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
______
QUESTIONS SUBMITTED BY MR. SCHILLING
Mr. Schilling. From casework, I've heard that veterans who have
been treated for PTSD have been overwhelmed by doctors and that they
have not made things better, but worse. In fact in one case a patient,
who later committed suicide, was over-medicated by multiple doctors who
did not check with each other, per his father. Is it common practice to
have multiple doctors for one patient with PTSD? Can this be fixed by
this new system?
Secretary Panetta. It is not common practice for one patient to be
treated for the sole condition of PTSD at the same time by multiple
doctors. However, conditions that lead to or co-occur with PTSD (e.g.
poly-trauma) may involve multiple providers and teams of care. The
current system implemented by the DOD has many safeguards and risk
mitigation strategies in place to prevent this type of incident from
occurring--especially in regard to the prescription of pharmaceuticals.
For example:
The Tricare Policy Manual mandates that coordination
between various medication providers must be evidenced in the treatment
plan.
Poly-pharmacy in the use of opiate medications has been
reduced in Warrior Transition Units, and other clinical settings owing
to leadership and case management interventions.
The Army has implemented the Sole Provider Program to
help identify patients who exhibit drug-seeking behavior by conducting
periodic reviews of all prescriptions for controlled substances,
identifying suspicious drug usage patterns.
Clinic procedures limit the number of pills dispensed to
potentially high-risk patients.
Warning flags appear in electronic drug dispensing menus
which require physician attention.
Military Treatment Facilities (MTFs) have prescription
restriction programs, and real-time monitoring and reconciliation of
prescriptions dispensed through MTFs, mail-order, and network
pharmacies.
The Department of Defense (DOD) PharmacoEconomic Center
(PEC) provides a single, comprehensive patient drug profile for DOD
beneficiaries across the Military Health System, allowing monitoring
and surveillance of drug contraindications or usage patterns of
concern.
When a prescription is filled within the U.S. Military
Health System, an online system, the Pharmacy Data Transaction System,
automatically checks the prescription against the patient's medication
history before the drug is dispensed. This process includes retail,
mail and military treatment facility pharmacies and has helped avoid
more than 171,000 potentially life-threatening drug interactions.
Pharmacists throughout the Military Health System provide
consumers with a medication information sheet on each new and renewed
prescription. DOD evaluates for drug-drug interactions on every
prescription prescribed by mail order, a retail pharmacy or MTF,
ensuring our patients receive medication that is safe and medically
indicated.
Mr. Schilling. From casework, I've heard that veterans who have
been treated for PTSD have been overwhelmed by doctors and that they
have not made things better, but worse. In fact in one case a patient,
who later committed suicide, was over-medicated by multiple doctors who
did not check with each other, per his father. Is it common practice to
have multiple doctors for one patient with PTSD? Can this be fixed by
this new system?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
______
QUESTIONS SUBMITTED BY MR. BARBER
Mr. Barber. Our armed service members are some of the best trained,
most disciplined, and most ambitious men and women in our country. How
can the Department of Defense work with our other agencies, including
the Department of Labor, to better educate employers and departing
service members about how military skill sets translate to civilian
skill sets? How Congress can be more helpful in conveying the skills
and attribute of our veterans?
Secretary Panetta. The Department very much appreciates Congress'
actions to improve the employability of our Veterans. Sections 558 and
551 of the National Defense Authorization Act for Fiscal Year 2012 are
assisting us in identifying critical training gaps and in beginning
skills training in sufficient time to facilitate a smooth transition to
civilian life. Authorities in the recently enacted Veterans Skills to
Jobs Act, Public Law 112-147 (H.R. 4155) will help with several aspects
of credentialing and licensing of Service members. These recent
Congressional initiatives are essential in the transition of our
Service members from Active Duty to civilian life.
The Department is working very closely with our federal partners to
better educate employers about translating military to civilian skills.
In May, we established the DOD Credentialing and Licensing Task Force
led by the Deputy Assistant Secretary of Defense for Readiness to
oversee all credentialing and licensing initiatives within the
Department. Our Federal partners from the Departments of Labor,
Veterans Affairs, Education and Transportation are represented on the
Task Force and are working with us to address the unique challenges
faced by Service members as they transition to civilian life. The
Department is also working with the National Council of State
Legislators, the American Legion, and several state governments to
facilitate civilian recognition of military skills.
Education and outreach by DOD and other Federal agencies are
critical to helping employers better understand military skills.
Meeting with employers on a regular, ongoing basis to address specific
issues, such as promoting the quality and transferability of military
education, training and experience, is important and may include
translation of military technical and leadership skills using a
nationally recognized badging system. Also, educating employers about
Service members unique needs in regard to domicile/residency
requirements, recognizing national certifications or other national
exams, and deployment experiences and why these are not detriments to
hiring Veterans would also be helpful.
Civilian companies can become more involved in the hiring process
by being encouraged to participate in job fairs where military members
can interview with their resumes and military records in hand.
DOD and other Federal agencies can also help business leaders
better understand how well military members perform using recently
added title 10 authorities that deal with apprenticeship and transition
training opportunities for separating Service members. This may involve
pilots with industry to hire military members at mid to senior levels
on a trial basis and not merely focusing on the unemployed or
sponsoring them at entry levels.
Mr. Barber. As service members return from deployment and
reintegrate, they experience a period of readjustment. Growing up in a
military family, I know that their families, too, go through an often
difficult transition. What are some of the efforts that DOD is working
on to engage military families in the transition process and encourage
spouses to take advantage of transition services?
Secretary Panetta. The Department of Defense provides a number of
services that support the transition of Service members and their
families throughout the military life cycle. The return of a Service
member from deployment is understandably an adjustment for the military
family and calls for targeted efforts.
Each Service branch sponsors information and support programs for
Service members and their families and begin with pre-deployment
preparation, like family care plans, and include deployed family events
that take place during the Service member's deployment. Current
programs also consist of reintegration briefings sponsored by the
installation Family Support, Community Support or Readiness center.
These reintegration briefings include family members and cover topics
like preparing for a reunion, updating administrative, legal,
financial, and employment affairs, and adjustments to be experienced by
a Service member, spouse, and children. For Guard and Reserve
personnel, Yellow Ribbon Reintegration events and the Joint Family
Support Assistance Program are integral to family support.
These centers also provide resources in the form of DVDs, books and
activities for children of Service members to assist with dealing with
the absence and return of the deployed family member.
The Family Support Centers and Chapels of most military
installations also offer Military Family Life Counselors (MFLCs),
marriage counseling and communication classes, free childcare and or
discounted activities for families.
Of course, the military lifecycle includes the transition into
civilian life. The re-designed Transition Assistance Program (TAP),
known as Goals, Plans, Success (GPS), prepares separating Service
members and their families by building career readiness skills and
self-confidence necessary to assist in successful reentry into the
civilian work force or student life. Spouses are encouraged to
participate in transition planning and curriculum to the maximum extent
possible alongside their spouses or attend on their own.
The TAP GPS core curriculum provides information and training on
financial management, teaches Service members how to translate their
individual military skills into civilian skills, provides a detailed
overview of potential veteran's benefits, and employment tools and
resources to aid in finding a career. The TAP GPS Career Track modules
are provided based on an individual's career choices and needs be those
higher education, technical training, or entrepreneurial aspirations.
Transition preparation cannot be a one size fits all approach and, just
as our military families don't fit one mold, the new TAP GPS can be
customized to meet their family needs.
Service members must also create an Individual Transition Plan
(ITP), a holistic tool that leads Service members through thoughtful
consideration of family issues like impact of the career change upon
children, elderly parents, and spouses. The changing financial
situation, due to separation from military careers, is specifically
highlighted and planned. Social support networks must be considered.
The ITP is competed in private during TAP GPS modules so that family
members can participate in its development at home and in classes.
Utilization of Transition GPS will improve the Service members'
effectiveness and their ability to be ``career ready.'' By creating an
ITP that starts early and considers the spouse, children and family
needs, the family can also be better prepared.
Mr. Barber. Post Traumatic Stress Disorder and Traumatic Brain
Injury have been called the signature injuries of the current wars
abroad, but they can be silent injuries that often go undiagnosed or
come with a stigma that cause them to go unreported. What steps is the
Department of Defense taking to identify these service members and
ensure their complete and successful transition into civilian life?
Secretary Panetta. The Department of Defense (DOD) has pre- and
post-deployment screening for symptoms of TBI, mental health issues and
substance use and abuse (which can signal unidentified problems). The
post-deployment screening occurs immediately following a deployment and
is repeated at 3, 6 and 12 month intervals thereafter. All deployment
health assessments incorporate both self-report questions for Service
members and specific questions that guide healthcare providers in
conducting mental health assessments for suicide risk, TBI, PTSD,
depression, and alcohol use.
National Guard and Reserve units partner with VA to conduct Yellow
Ribbon events 90 days post-deployment, increasing awareness of VA
benefits, programs and services. Military Services' demobilization
events provide a setting for post-deployment National Guard and
Reservist members to meet with VA staff to complete enrollment forms.
As well, referral recommendations for VA behavioral health care are
generated for National Guard and Reserve members during the 3-month
post deployment assessment.
For those who are injured and/or transitioning out of active duty
status, the DOD ensures proper treatment and successful transition to
civilian life through care coordination and transition assistance
services. This continuum of evaluation, assessment, treatment, and
coordination and transition services is carried out throughout the
lifecycle of a Service member's tenure.
In 2011, DOD published ``Continuity of Behavioral Health Care for
Transferring and Transitioning Service Members,'' which prescribes
guidelines that ensure continuity of care for Service members
transferring to a new duty station or transitioning out of the Service.
This policy directs the Military Services to develop policies for
transfer of behavioral health care from military to civilian providers,
including VA providers. When a separating Service member provides
consent for sharing information with a follow-on behavioral health
provider, DOD shares all relevant clinical information. This includes
diagnoses, medications, treatment history including suicide risk, test
results, treatment plans and prognosis. Service members' treatment
record information is available to VA providers via the Bidirectional
Health Information Exchange. DOD's inTransition program provides a
telephonic coach for transitioning Service members with behavioral
health issues, whether that is in the VA health care system, a Military
Treatment Facility, TRICARE, or the community. The inTransition program
has opened thousands of coaching cases since its inception in February
2010. The acceptance rate for service members referred to the program
since inception exceeds 95%.
For those who have suffered a traumatic brain injury, The Defense
Veterans Brain Injury Center (DVBIC) Regional Care Coordinator (RCC)
program provides a nationwide care coordination network to support
Service members with TBI. This program facilitates transition from the
DOD to VA care by working with VA case management teams. For Service
members with more severe brain injuries, a DOD-VA Polytrauma Telehealth
Network connects the current treating team with the accepting treating
team in the VA. This facilitates transfer planning, affords families an
opportunity to meet receiving care teams and ensures that medical
records are transferred between facilities. DOD and VA are working
together on a Congressionally-mandated five year pilot program which
assesses the effectiveness of providing assisted living services to
Service members and Veterans with TBI who require ongoing care in the
community. VA collaborated with the DVBIC on a family caregiver panel
to develop a uniform training curriculum for family members in
providing care and assistance.
TRICARE Regional Offices have VA Liaisons who serve as
intermediaries between VA facilities and the TRICARE regional
contractors. VA Liaisons actively assist with authorizations and
claims, and TRICARE contractors hold monthly calls with the VA's
Medical Sharing Office to review the cases of active duty Service
members who are receiving joint VA/DOD care.
The VA Liaison for Healthcare, a social worker or nurse
strategically placed at an MTF with recovering service members
returning from Afghanistan, is another asset. 33 Liaisons for
Healthcare are stationed at 18 MTFs, helping transition ill and injured
Service members from DOD to the VA system of care. Thousands of health
care transitions have been coordinated.
The DOD-VA Integrated Mental Health Strategy includes actions
specifically focused on transition and continuity of behavioral health
care. Data are being shared between the Departments on rates of follow-
up in at VA Medical Centers and Vet Centers for Service members
referred to VA for a behavioral health issue identified during the
PDHRA or the Post Deployment Health Assessment (PDHA). These data show
that among Service members whose behavioral health follow-up is
recommended during the PDHRA, 43% have a behavioral health encounter at
a VA facility within 90 days.
DOD will continue to work with VA in implementation of our policies
regarding transition and continuity of behavioral health and TBI care.
We will ensure our providers address transition of behavioral health
care for wounded warriors to VA and other civilian providers, and will
continue to manage the important issues of suicide risk and
occupational impairment and suffering from PTSD.
Mr. Barber. What is the Department of Defense doing to ensure close
access to health care services for service members who are stationed in
rural areas? Does DOD contract with exiting, private sector behavioral
health professionals and agencies to provide health care services close
to where service members are stationed?
Secretary Panetta. Active duty members, including activated
National Guard/Reserve members, who are stationed more than 50 miles or
more than one hours drive from a military treatment facility are
enrolled in TRICARE Prime Remote (TPR) to ensure most care is provided
in their local area. Members may select a primary care manager (PCM)
from the TRICARE network, or if one is not available, can select any
TRICARE-authorized, non-network provider as their PCM. The PCM refers
members to TRICARE network specialists in the local area if available
(or TRICARE-authorized, non-network specialists), and coordinates with
the regional contractor for authorizations and claims.
Mr. Barber. My district in Southern Arizona is home to more than
10,000 veterans. I appreciate the attention that VA and DOD are giving
to this issue of transition assistance--an issue of critical importance
to the service men and women I represent and their families. I hear
from service members frequently about the long lag time between the
time they file their VA claims at time of discharge, and the time the
claim is adjudicated. They frequently wait 6 months or more before they
receive compensation from the VA. For a service member transitioning
from Active Duty and looking for a job, that VA check could be their
only resource for buying food and paying rent. In addition to providing
additional transitional assistance to our service members, what more
can be done to fast track basic transition services and reduce the wait
time?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Barber. Unemployment among our veterans has reached historic
proportions. Nearly 780,000 veterans are unemployed, and as the numbers
of troops in the Middle East are reduced, about 100,000 more vets will
be looking for jobs. According to the Bureau of Labor Statistics the
average unemployment rate in the U.S. in 2011 was 8.9 percent, but the
rate of unemployment among anyone who was a member of the U.S. Armed
Services since September 2001 was 12.1 percent. As part of the new
Veterans Employment Initiative Task Force, what specifically will be
done to eliminate this disparity in current unemployment levels between
veterans and the general population? How will the Department of
Veterans Affairs work to accomplish that goal?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Barber. Post Traumatic Stress Disorder and Traumatic Brain
Injury have been called the signature injuries of the current wars
abroad, but they can be silent injuries that often go undiagnosed or
come with a stigma that cause them to go unreported. What steps is the
Department of Veterans Affairs taking to identify these service members
and ensure their complete and successful transition into civilian life?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
Mr. Barber. What is the Department of Veterans Affairs doing to
ensure close access to health care services for veterans who live in
rural areas far away from VA centers and clinics? Is the VA authorizing
VA centers to contract with exiting, private sector behavioral health
professionals and agencies to provide services close to where veterans
live?
Secretary Shinseki. [The information referred to was not available
at the time of printing.]
|
NEWSLETTER
|
|
Join the GlobalSecurity.org mailing list
|
|
|
