Buyer delegation visits troops, inspects U.S. military health care in Middle East theater

Washington, DC — Leading a congressional delegation to U.S. military facilities in Kuwait, Iraq and Germany, House Committee on Veterans’ Affairs Chairman Steve Buyer (R-Ind.) and delegation members found the morale of troops and commanders high. The delegation also saw profound strengths and troubling weaknesses in the military’s provision of seamless medical and dental care for servicemembers returning from combat.

“We are here to show appreciation for your service to our nation,” Buyer, a veteran of Operation Desert Storm, said to U.S. troops at Camp Arifjan, Kuwait. “What you are doing here is important and we in Congress must give you the resources to finish the job.”

Accompanying Buyer on the five-day trip were committee members John Boozman (R-Ark.) and Rep. John Salazar (D-Colo.), as well as Secretary of Veterans Affairs R. James Nicholson. The delegation met with Multi-National Forces-Iraq commander, General George Casey; Lt. Gen. Steven Whitcomb, commander of 3rd U.S. Army, headquartered in Kuwait; as well as Iraq’s president and members of his cabinet; and the U.S. ambassador to Iraq, Dr. Zalmay M. Khalilzad.

The delegation observed the full continuum of medical care, from “level 1” care provided by a combat medic and “dustoff” air ambulances, through the second and third levels of care in combat support hospitals -- such as those in Kuwait and Iraq -- to level 4 care at the military’s Landstuhl Regional Medical Center in Germany. Buyer called this continuum of health care, which culminates for many at VA, “the unbreakable link in the medical chain of mercy.”

“These individuals are all heroes and I am in awe at their selflessness and dedication,” Buyer said of the medical personnel he had encountered. Every facility showed evidence of inter-service cooperation. The U.S. Military Hospital Kuwait for example is run by the Navy and with mixed Navy, Army and Air Force staff, treats mostly Army soldiers.

The delegation arrived at Landstuhl Regional Medical Center in Germany minutes before casualties, some in critical condition, arrived from the combat support hospital at Balad, Iraq, where the delegation had been the day before. Seeing first-hand the quality of care and seamless transfer from battlefield to level-4 hospital was a powerful experience.

“The military has done an exceptional job of integrating the services and the reserves and National Guard into a total-force team of amazing skill, caring and efficiency,” Buyer said. “It is absolutely extraordinary and America has every reason to be proud of the commitment and the investment of these people the care of our injured and wounded.”

Buyer has questioned the frequency with which the military refers separating servicemembers with dental problems to the Department of Veterans Affairs (VA) for eventual treatment, rather than correcting problems earlier. Troops undergo pre-deployment physicals and corrective care before they go overseas. Buyer however suspects that troops experience deterioration during the deployment and are sometimes released and encouraged to get treatment from VA.

Referring treatment to VA is less efficient and more costly than treating problems or performing routine dental maintenance before separation, sends troops and families the wrong message. Military dentists in Kuwait said that while troops must pass rigorous pre-deployment physicals and arrive in good health, some may indeed depart needing care. They acknowledged that VA has been used for this purpose, especially for reservists and members of the National Guard, not all of whom ultimately seek that treatment, creating long-term dental problems.

“The earlier we get treatment done, by the Army, by the service, the better,” Buyer, an officer in the Army Reserve, told hospital commanders and staff. “The military must take care of its own.”

Pointing up the need for the Pentagon to transition to electronic health records, at Landstuhl Regional Medical Center, wounded soldiers arrived with their medical records in files on their chests. Buyer has long demanded that DoD and VA, which has an excellent electronic medical records system, develop an interoperable system that can share records, reducing delays and risks.

“The types of serious trauma we are seeing, such as traumatic brain injuries caused by roadside bombs, demand the best in health care. Our military doctors and nurses are superb, but DoD must move decisively to give them a comprehensive electronic records system that enables their work,” Buyer said, noting that the Joint Patient Tracking Application DoD uses is not enough.

Buyer has worked with the Marines to develop an improved helmet, which vents out some of the blast that travels up the torso from IED detonations and contributes to brain and other cranial injuries. At Camp Fallujah, the delegation was shown equipment used by the Marines to reduce their vulnerability to IEDs; V-bottom vehicles that deflect and survive blasts, and experimental armored suits are two promising innovations.

In Baghdad, Iraq’s president, Jalal Talabani, took advantage of the delegation, with its representation of both the U.S. executive and legislative branches, to gather his newly formed cabinet for a meeting at his home. Talabani expressed the appreciation of the Iraqi people for the role of America in their liberation. He urged his guests to convey to Congress the importance of continued support of his unity government and Iraq’s struggle for democracy.

“Fifteen years ago, I was an Army captain, serving in the United States Army and Coalition forces in the first gulf war. Little did I ever dream, Mr. President, that 15 years later I would stand here as a guest in a free Iraq,” Buyer told the president. “I believe the United States needs to have the resolve to stand behind this unity government. There are challenges in front of them, but Iraq has a very proud people and they have a country of vast and great resources, and they can be a leader in this region.”

The delegation was encouraged at the growth of Iraqi security forces, which now number about 275,000, including police and border guards. In Fallujah, Maj. Gen. Richard Zilmer, commander of the I Marine Expeditionary Force in Iraq, had briefed the delegation on the successes experienced by Marine training teams embedded in Iraqi units. Commending the Marines, Buyer called this effort the key to the Coalition’s ultimate withdrawal.

“There is a resolve for victory in this war against radical Islam, a will to see this through. Americans also recognize that in addition to defeating the enemy, victory means training Iraqis and Afghans to stand on their own, with capable, well-equipped combat units and the logistics to sustain them,” Buyer said.
While Buyer was in Iraq, staff from the committee’s Subcommittee on Economic Opportunity assessed the Transition Assistance Program (TAP) run by the Department of Labor and VA to help separating and retiring service members find work. Staff members visited TAP classes at Ramstein and Spangdahlem air bases in Germany. The committee remains concerned that program staffing limits the impact of TAP and that people separating from remote sites with high operations tempo, such as Afghanistan, have the opportunity to participate in TAP.

Concluding the trip, the delegation visited the American Military Cemetery in Luxembourg, the resting place for 5,076 American dead, most of whom lost their lives in the Battle of the Bulge and the advance to the Rhine River the following spring. “If we permit the eyes of our mind to see, we see them. If we permit the ears of our heart to listen, we can hear them; and we celebrate their lives. What these men and women lived for and fought for, their heritage is carried on by those we visited in Kuwait and Iraq and in the wards at Landstuhl. They have earned our best efforts and strongest support,” Buyer said.

“I will encourage my colleagues in the Congress to travel with representatives of the Executive Branch,” Buyer said, referring to the presence on this trip of VA Secretary Nicholson. “It is very meaningful and sends a great signal of cooperation to our visited countries.” 

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