May 25, 2007

The Iraq Accountability Project: A Wrap-Up of This Week's Senate Oversight on Iraq

This week Senate Democrats continued to conduct oversight of the President's conduct of the war. Senate Democrats are united in their determination to hold the President accountable for his failed strategy in Iraq and guarantee American veterans have the support they deserve.

Wednesday, May 23rd

Senate Committee on Veterans Affairs "Hearing on Pending Health Care Legislation"

Benefit timelines should to be modified to address the growing needs to treat mental illnesses, suicide, and traumatic brain injury.

SEN. AKAKA: Two years is often insufficient time for symptoms related to PTSD and other mental illnesses to manifest. In many cases, it takes years for such symptoms to present themselves, and many service members do not immediately seek care...

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DR. GERALD M. CROSS, ACTING PRINCIPAL DEPUTY UNDER SECRETARY FOR HEALTH: [Through S. 117] veterans would be eligible for hospital care, medical services, nursing home care, and family and marital counseling for any mental health condition identified during that examination, notwithstanding that the medical evidence is insufficient to conclude that the mental health condition is attributable to the veteran's combat service. Eligibility for medical services needed to treat the veteran's identified mental health condition would continue for two years, beginning on the date VA begins to provide such services. The bill would not, however, cover any mental health disability found by the Under Secretary for Health to have resulted from a cause other than the veteran's combat service....

Section 202 [of S.117] would require VA to establish an information system designed to provide an elaborate and comprehensive record of the veterans of the Global War on Terrorism (GWOT) who seek VA benefits and the benefits they receive. Section 203 would mandate that VA submit a quarterly report to Congress on the effects of participation in GWOT on both veterans and the Department. The first of these reports would be due not later than 90 days after this Act's enactment. Each quarterly report would include aggregated information on VA health, counseling, and related benefits to GWOT veterans, including information on the enrollment status of GWOT veterans; the number of inpatient stays they experienced and the related cost of that care (by both enrollment status and condition); the number of outpatient visits they experienced and the related cost of such services (again by enrollment status and by condition); and the number of visits to Vet Centers and the related cost of providing them readjustment counseling and services. As we testified on May 9, 2007, this bill's requirements to compile and frequently report to Congress massive amounts of data, much of which are not currently available, in the detail and manner specified, would force VA to divert considerable resources from our primary responsibilities... collection and tracking the individual-specific data mandated by the bill would require considerably expanded administrative personnel and resources....

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CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR, PARALYZED VETERANS OF AMERICA: [W]e support [S. 117] the requirement that post-deployment medical and mental health screening be conducted within 30 days. We would suggest that it should be done even sooner. PVA has expressed concerns repeatedly that pre-deployment and post-deployment screenings are not being handled properly. In fact, we believe that it should not be a screening, but instead, a full medical evaluation and physical.... PVA also supports the intent of Section 103 of the legislation that requires every service member released from active duty to be given an electronic copy of his or her military records, to include military service, medical, and any other relevant records. We have long felt that electronic transfer of all military service and medical records from the Department of Defense to VA would expedite the claims process....

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DENNIS M. CULLINAN, DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES: This is important because it gives the benefit of the doubt to these veterans for their illnesses and mental health problems they may suffer, and provides them access to these essential services without having to endure the VA disability claims process for access to care beyond their initial two years of eligibility. The bottom line is that if veterans are having problems, under this legislation, they would be cared for....

For those suffering from mental health issues - such as PTSD - the symptoms they show might not immediately manifest themselves, or they may need time to come to terms with the knowledge that they need treatment. If they fall outside the two-year window and qualify for health care under category 8, they cannot access VA health care unless they can demonstrate a service connection - a process that takes, on average, six months or more....

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JOY J. ILEM, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS: [B]ased on our review of VA's general efforts to meet its workload requirements within those constraints, it is doubtful VA could routinely meet [the requirements of S. 117] within available resources. With respect to the data gathering and reporting requirements of the bill, we believe thousands of staff hours and millions of dollars for other support likely would be necessary to enable VA and DoD to comply with these requirements, assuming they would be able to comply....

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SHANNON MIDDLETON, DEPUTY DIRECTOR FOR HEALTH, VETERANS AFFAIRS, AND REHABILITATION COMMISSION, THE AMERICAN LEGION: [S.117] addresses the need to differentiate veterans who served in OIF and OEF, those who served in both and those who served in neither. The environmental exposures may differ and the combat experiences may differ....

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DR. CROSS: VA supports S.383.... many OEF/OIF veterans are non-career military members who are unfamiliar with veterans' benefits and the procedures for obtaining them. For that reason many fail to enroll in a timely fashion. Providing combat-theater veterans with an additional three years within which to access VA's health care system would help to ensure that none of them is penalized because of reasons beyond their control or because they have been unable to navigate through VA's claims system in time. VA estimates the costs associated with enactment of S. 383 to be $14.1 million in FY 2008 and $289 million over a 10-year period. These estimates include both expenditures and lost co-payment revenue....

We appreciate the purpose of [S.479]; however, we do not support this bill. It is unnecessary because it duplicates many efforts already underway by the Department. Indeed, many of the bill's requirements are already being addressed and implemented through VA's current Mental Health Strategic Plan. The use of adult veterans as peer-counselors in caring for other veterans who suffer from mental health issues is simply not advisable. Data on the efficacy of these types of programs do not reflect favorable results. Although well-intended, we believe such an approach to clinical care lacks scientific support. We strongly believe that VA mental health care services, including counseling, should continue to be provided by our capable, experienced, and appropriately-trained cadre of mental health care professionals. In addition, we do not think the bill's requirement that we encourage every veteran seeking any type of VA benefit to obtain a mental health assessment is justified, and it may cause veterans to believe they have been stigmatized.

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MR. BLAKE : PVA fully supports S. 479.... Every PVA chapter designates individual members to pair up with newly injured veterans to help them get through the early stages of their recovery. I know firsthand that being able to talk to someone who has experienced what you have experienced and has dealt with the same problems you are dealing with can help you overcome bouts of depression, sadness, and anger as you first come to grips with your condition. The peer counselor serves as a motivator to get you moving in the right direction....

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MS. MIDDLETON: [In suicide prevention f]amily Education and Outreach is significantly important, since family and friends may notice changes in the veteran's mental health first. The American Legion receives contact from veterans themselves who openly admit they need immediate help because of thoughts of harming themselves. When the family and the veteran know what services are available, it is easier to seek assistance.

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BERNARD EDELMAN, DEPUTY DIRECTOR FOR POLICY AND GOVERNMENT AFFAIRS, VIETNAM VETERNS OF AMERICA: S. 479... attempts to grapple with one of the unfortunate consequences of war. Too many of our young men and women whom we've sent off to fight halfway around the globe return markedly different. The lingering trauma of things they've experienced haunts them. These memories affect their daily living, and too many succumb to the emotional numbing and hurt. To not support this bill would do a grave injustice to those troops still fighting their demons.

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JERRY REED, EXECUTIVE DIRECTOR, SUICIDE PREVENTION ACTION NETWORK USA: A majority of veterans who complete suicide are not currently receiving medical care through the VHA. Therefore, family members and friends of veterans need to recognize the warning signs for suicide and learn about services for their loved ones before it is too late. The VA's awareness and outreach program must be focused not just on veterans who seek care at the VA, but also on veterans who have returned to their home communities, family members of veterans, and veteran service organizations (VSO).... While there is no substitute for licensed mental health professionals with respect to diagnosis and treatment of PTSD, depression, and anxiety, it is often fellow veterans who provide the support needed to convince a veteran to visit a licensed professional.

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MR. BLAKE: PVA is concerned about the authority provided by Section 4 [S. 1233] of the legislation. We understand that outside facilities and programs can bring some level of expertise to this population of veterans. However, we would hope that the VA would see fit to invest the majority of its resources in improving its own TBI programs, even as it taps into outside expertise.... [W]e think that the legislation also unnecessarily rewrites contracting authority that already currently exists in the fee basis statute. The legislation seems to explain medically unfeasible and geographic inaccessibility in new language, when the VA already has authority to follow these guidelines under fee basis. VA's non-institutional long-term care programs will be required to assist these younger severely injured veterans who need a wide range of support services such as: personal attendant services, programs to train attendants, peer support programs, assistive technology, hospital-based home care teams that are trained to treat and monitor specific disabilities, and transportation services. These younger veterans need expedited access to VA benefits such as VA's Home Improvement/Structural Alteration (HISA) grant, and VA's adaptive housing and auto programs so they can leave institutional settings and go home as soon as possible. PVA also believes that linking these assisted living programs to the poly-trauma centers and possibly the proposed research, education, and clinical care program is a must.

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MR. CULLINAN: Improvements in body armor and more rapid and effective medical interventions are resulting in individuals surviving bomb blasts and other concussive injuries that would not have been possible in previous conflicts. Tragically, though, along with amputations many of these survivors now suffer from TBI resulting in varying degrees of cognitive impairment, reduced concentration and ability to focus on more than one thing at a time and emotional distress. This has profoundly negative implications for these injured warriors as well as their families and dependents.

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MS. ILEM: The neurological, cognitive, and behavioral changes due to TBI are complex, varied, and diverse and may change in severity or develop over time. Longer-term neurological problems often include movement disorders, seizures, headaches, and sleep disorders. Common residual cognitive problems include memory, attention and concentration impairments. Depending on the area of the brain injured, judgment, planning, problem-solving and other executive functioning skills may also be impaired. Visual perception problems and language impairments are usual but often go undiagnosed. Prevalent behavioral issues include personality changes, aggression, agitation, learning difficulties, shallow self-awareness, altered sexual functioning, impulsivity, and social dis-inhibition. Many individuals self-medicate with alcohol to deal with the dis-inhibitory symptoms and disruption to their sleep cycle.

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MEREDITH BECK, NATIONAL POLICY DIRECTOR, WOUNDED WARRIOR PROJECT: We are also extremely concerned with the method by which the legislation [S. 1233] determines the TBI patient's eligibility for such a health care benefit. According to the provision as currently written, the Secretary would have the discretion to enter into individual agreements with facilities to provide care based on in part on geographic location, but no care criteria for the participating private facilities are enumerated. Even more importantly, by determining eligibility based on geographic proximity to a VA facility and the discretion of the Secretary for the Department's ability to provide the necessary services, the legislation will limit the range of patients who can qualify for placement in a private facility and thus not provide the options for care that our warriors and their families are seeking.

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DR. JOHN BOOSS, ON BEHALF OF THE AMERICAN ACADEMY OF NEUROLOGY: Each veteran who suffers a TBI should receive ongoing individualized, comprehensive and multidisciplinary rehabilitation after inpatient services. Rehabilitation plans that are based upon a comprehensive assessment of the veteran's physical, cognitive, vocational, and psychosocial impairments, using a multidisciplinary team that includes neurologists (as required by S. 1233), are essential to rehabilitative success. We support the provision in section 3 which requires involving the family and veteran in the development and review of the rehabilitation plan. TBI is a devastating and life-altering event which affects the veteran and his or her family. Families of veterans with TBI need support and education, and should be part of the rehabilitative team to the greatest extent possible.

Additional efforts to help veterans transition to civilian life and avoid homelessness are needed.

MR. CROSS: S. 882 would require the Secretary, in consultation with the Secretary of Defense, to establish and carry out a five-year pilot grant program to assess the feasibility and advisability of using eligible entities to assist members of the Armed Forces in applying for, and receiving, VA health care benefits and services after completion of military service.... VA does not support S. 882 because it is unnecessary and duplicative of ongoing outreach services and seamless transition efforts currently underway by VA and DoD....

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MR. CULLINAN: [S. 882] would award grants to organizations who help veterans, especially those with serious wounds, women and members of the Guard and Reserves with applying for benefits and services within VA. Expanding outreach efforts so that all our veterans understand the benefits that they are entitled to....

The VFW supports S. 1205. The effectiveness of peer support has been well documented in the wake of the Vietnam conflict. Specifically, for mental health disorders like PTSD and depression, peer-support programs have shown that participation yields improvement in psychiatric symptoms and decreased hospitalizations, the development of larger social support networks, enhanced self-esteem and social functioning, as well as lower services costs.

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MR. EDELMAN: {S. 1205 should be rejected because] assisting veterans' reintegration with peer-support groups is and should be a function of VSOs; organizations should not have to compete for funding for providing veterans' services....

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MS. BECK: [S.882 and S. 1205] would create programs redundant to those already provided by the government or non-profit groups.... WWP would suggest improved coordination and integration among existing organizations and agencies before adding more layers and a review of current services, both governmental and non-profit to determine the best use of limited funds.

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MR. CROSS: S. 874 would require the Secretary to provide financial assistance in the form of per diem payments to eligible entities to provide and coordinate the provision of supportive services for very low-income veteran-families occupying permanent housing or transitioning from homelessness to permanent housing.... VA opposes S. 874 as currently configured. We understand there is a high demand for supportive services for these vulnerable low-income veterans and their families who are at risk of becoming homeless. However, it is inappropriate to provide such assistance in the form of per diem payments. We recommend that the bill be modified so that financial assistance is furnished in the form of grants, similar to all other Federal programs that provide financial assistance to entities providing supportive services to homeless persons.

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MS. ILEM: we would strongly oppose offsetting the costs associated with S. 874 against other vital VA health care programs. Also, with regard to the health care and counseling services this bill would provide, we are concerned that as well-intentioned as it may be, that a grant under which health care services would be provided by private providers versus VA providers raises questions about cost, quality, continuity and safety.

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MR. EDELMAN: Per Diem dollars received by service centers [helping homeless veterans] are not capable of supporting the "special needs" of the veterans seeking assistance. Currently they are receiving less than $3.50 per hour per veteran that the veteran is on site. The work of assisting the homeless veterans who utilize these services goes on long after they have left the service center, a center that is providing a full array of services and case management.

Tuesday, May 22nd

Senate Select Committee on Intelligence Hearing on Iraq (CLOSED)

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