[Senate Hearing 110-796]
[From the U.S. Government Publishing Office]
S. Hrg. 110-796
OVERSIGHT HEARING: VA OUTREACH TO MEMBERS OF THE NATIONAL GUARD AND
RESERVES
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
JULY 23, 2008
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Arlen Specter, Pennsylvania
Barack Obama, Illinois Larry E. Craig, Idaho
Bernard Sanders, (I) Vermont Kay Bailey Hutchison, Texas
Sherrod Brown, Ohio Lindsey O. Graham, South Carolina
Jim Webb, Virginia Johnny Isakson, Georgia
Jon Tester, Montana Roger F. Wicker, Mississippi
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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July 23, 2008
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Tester, Hon. Jon, U.S. Senator from Montana...................... 2
Murray, Hon. Patty, U.S. Senator from Washington................. 3
Sanders, Hon. Bernard, U.S. Senator from Vermont................. 3
WITNESSES
Mathewson-Chapman, MG Marianne, Ph.D., ARNP, U.S. Army (Ret.),
National Guard And Reserve Coordinator, Office Of Outreach To
Guard And Reserve Families, Veterans Health Administration,
Department of Veterans Affairs................................. 6
Prepared statement........................................... 8
Response to questions arising during the hearing from Hon.
Patty Murray............................................... 25
Mayes, Bradley G., Director, Compensation and Pension Service,
Veterans Benefits Administration, Department of Veterans
Affairs........................................................ 14
Prepared statement........................................... 16
Nelson, Donald L., Director, Yellow Ribbon Reintegration Program,
Department of Defense.......................................... 19
Prepared statement........................................... 21
Scotti, Joseph R., Ph.D., Professor of Psychology, West Virginia
University, Morgantown, WV..................................... 32
Prepared statement........................................... 34
Livingston, COL Bradley A., Director of the Joint Staff, Montana
National Guard................................................. 39
Prepared statement........................................... 41
Boyd, LTC John C., Deputy Chief of Staff for Personnel, Vermont
Army National Guard............................................ 44
Prepared statement........................................... 47
Meredith, SGT Roy Wayne, Team Leader, Maryland Army National
Guard.......................................................... 51
Prepared statement........................................... 53
Rasmussen, MAJ Cynthia M., RN, MSN, CANP, Combat Stress Officer,
Sexual Assault Response Coordinator, 88th Regional Readiness
Command........................................................ 54
Prepared statement........................................... 57
APPENDIX
Lucey, Kevin and Joyce, Parents of Cpl. Jeffrey Michael Lucey,
USMC Reservist; prepared statement............................. 73
Addendum..................................................... 74
Kerr, Pat Rowe, State Veterans Ombudsman, Missouri Veterans
Commission; prepared statement................................. 75
OVERSIGHT HEARING: VA OUTREACH TO MEMBERS OF THE NATIONAL GUARD AND
RESERVES
----------
WEDNESDAY, JULY 23, 2008
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:32 a.m., in
room SR-418, Russell Senate Office Building, Hon. Daniel K.
Akaka, Chairman of the Committee, presiding.
Present: Senators Akaka, Rockefeller, Murray, Tester, and
Sanders.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. The Committee on Veterans' Affairs will
come to order.
I want to welcome all of you here today, and particularly
our witnesses. Today, the Committee will look at the
effectiveness of VA's outreach to members of the National Guard
and the Reserves who have been mobilized and deployed to Iraq
and Afghanistan.
The Committee has held multiple hearings on VA benefits,
health care, and services. However, this is the first time we
are specifically focusing on the unique challenges confronting
members of the Guard and the Reserves.
In my own State of Hawaii, over 5,000 members of the Guard
and Reserve have been deployed. The Hawaii National Guard is
currently in the midst of its second deployment to Iraq, and
over 85 percent of those mobilized are already combat veterans.
It is important that these soldiers and all Reservists know
that VA will be there for them when they return.
After years of war, we appreciate that there are distinct
challenges facing the reintegration of these citizen
servicemembers. Unlike their active duty counterparts, Guard
and Reserve veterans must transition from their civilian life
and employment to active military service and back again.
Despite VA's best efforts to conduct outreach to this
population, it seems clear that some are still unaware of all
that VA has to offer, and how to access those services and
those benefits.
I am concerned about the results from a recent VA IG report
that shows that in 2006, VBA failed to send benefits packages
to over 36,000 Reservists. VA employees mistakenly thought
these Reservists were ineligible for these benefits. One would
have thought that, after years of war, this process would be
perfected.
I am also concerned about how VA reaches out to members of
the Individual Ready Reserve, and those who are discharged
after their deployment. These veterans may have the benefit of
a unit support during their reintegration.
I am pleased that, beginning this fall, VA will resume
using public service announcements and advertising. These
announcements will provide another means to reach an entire
veterans' population.
More work needs to be done without question. I hope that
both of our panels will shed some light on why we continue to
hear from veterans that they just did not know about their
eligibility for VA benefits and services. We need to know how
VA and Congress can help bridge this information gap. This is
particularly important for those who suffer from the invisible
wounds of this war and may need more help readjusting to their
civilian lives.
I hope today's witnesses will provide us with a real sense
of what the next steps are, so that no member of the Guard and
Reserves is unaware of their eligibility and the benefits
available to them.
Are there further statements? Senator Tester?
Senator Tester. Thank you, Mr. Chairman.
Chairman Akaka. Senator Tester.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman. I appreciate you
having this hearing. I also want to thank the witnesses for
being here today, especially those National Guardsmen who will
testify on the second panel. I want to thank you for being
here, and thank you for your service. I think it means a lot to
have you here today and to have you visit with us about what is
going on from a Guard perspective.
I particularly want to welcome Colonel Brad Livingston from
the Montana National Guard. I was just doing a little math this
morning in my head; I have known Brad for almost 35 years. It
is good to have you here; it is good to have you back in
Washington.
I look forward to a good discussion this morning with the
folks from the DOD and the VA about what Montana and other
States represented here have done to take care of their
Guardsmen. I hope we can get some agreement from the DOD and
the VA that some of these ideas can be standardized and
implemented in the Reserves and across State Guard units.
Members of the Guard and Reserve still face some pretty
unique challenges when it comes to demobilization. After
deployment that can last longer than a year, we give these
folks a new mission: getting back to their civilian lives in
just 1 week. That is 1 week to trade in a rifle for a civilian
job. That is 1 week to try to put aside patrols and convoys for
parenthood and car pools.
When the resumption of civilian life happens in a small
town hundreds of miles away from anybody else who knows what
that soldier is going through, that can make a mission every
bit as tough as the missions they have executed in Iraq or
Afghanistan.
The good news is that part of what makes our military so
strong is it is composed of citizen soldiers who find a way to
do anything that is asked of them, but we need to do a better
job of helping those folks accomplish the demobilization
mission. To do that, we need to use every tool in the toolbox,
and that is why I am so pleased that we have a number of State
Guard units represented today to talk about what has worked
and, quite frankly, what has not for their Guardsmen.
The Montana National Guard has done some pretty interesting
stuff when it comes to making the demobilization process work
better for its troops. They have been great leaders on this
issue, and there is a real credit given to Adjutant General
Randy Mosley and a credit given to Colonel Livingston and his
team.
I am proud that my State has been a leader on the issue,
but I do think we need to remember something about Montana's
experience. It took a tragic suicide in 2007 of a young
Guardsmen named Chris Dana for folks to understand the scope of
this problem. We must not forget about the death of Specialist
Dana, or the fact that we have lost far too many veterans to
suicide since the Afghanistan and Iraq wars were begun.
So, let me just say again how important this hearing is,
and how important it is that we get this issue right. Our
Reservists, our Guardsmen, and their families are counting on
us for some results. I want to thank you all.
Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Tester.
Senator Murray.
STATEMENT OF HON. PATTY MURRAY,
U.S. SENATOR FROM WASHINGTON
Senator Murray. Thank you very much, Chairman Akaka, for
holding today's hearing on how the VA is responding to the
needs of our members of the National Guard and Reserve when
they return.
Of the more than 800,000 Iraq and Afghani veterans that are
eligible for VA care since 2002, fully half of them are members
of the National Guard and Reserve. And unlike our active duty
troops who come home from battle to a military base and built-
in support network, many of our Guard and Reserve members leave
the battlefield and return home to family pressures and
civilian jobs almost immediately; and unfortunately, many of
them do have trouble making that transition.
The skills that helped them deal with the horrific
experiences they had on the battlefield often make it harder
for them to return to everyday life. And unlike active duty
troops, Guard and Reserve soldiers often live in remote rural
areas in our States, and it makes it even more difficult for
them to get access to the services and the benefits that they
have earned.
Now, the VA has targeted outreach programs in place to help
these servicemembers, but we still, I think, today, miss far
too many of our veterans who need help and really are not aware
of the services and benefits they earned.
The VA Inspector General issued a report late last week
that reaffirmed that problem. It found that the VA failed to
meet its statutory responsibility to inform new veterans of
their benefits. In fact, that IG report found that the VA
failed to send initial outreach letters to more than 65,000
Iraq and Afghanistan veterans--more than half of them Guard and
Reserve members.
But really, the challenges go beyond outreach. The
Department of Defense has found that members of the National
Guard who were deployed to Iraq and Afghanistan are 25 percent
more likely to suffer a combat-related psychological wound than
our active duty soldiers who have been deployed. And we all
know that members of the Guard and Reserve are twice as likely
to have their VA claim denied than active duty servicemembers.
This coming fall, I have 2,900 members of the Washington
State National Guard who are going to be deployed to Iraq. They
are in training right now, and I want to make sure that, as we
take care of these men and women while they are serving us
overseas it is equally important that we have the services in
place when they come home a little over a year from now.
So, this is an issue very important to me, Mr. Chairman,
and I really appreciate the work of this Committee as we focus
on this today.
Thank you.
Chairman Akaka. Thank you. Thank you very much, Senator
Murray.
Senator Sanders.
STATEMENT OF HON. BERNARD SANDERS,
U.S. SENATOR FROM VERMONT
Senator Sanders. Thank you very much, Mr. Chairman, for
holding this hearing. Let me just begin by saying that I concur
with your remarks and those of Senator Tester and Senator
Murray.
I am delighted that we are going to be hearing later on
from Colonel John Boyd who is the Deputy Chief of Staff for
Personnel for the Vermont Army National Guard, who is going to
testify about Vermont's veterans and family outreach program.
Let me also welcome Major Randy Gates, who is the State
Family Program Director--Family Readiness Program of the
Vermont National Guard, who has joined Colonel Boyd here today.
Mr. Chairman, as I think you have heard from other Members,
what we all understand is that if we have the best services
available, which we want, for those who are returning from Iraq
and Afghanistan, it does not mean anything if these people do
not know that the services are available. That is the bottom
line, and I think it is pretty clear that, up to now, we have
not done the kind of job on outreach to our veterans that we
should have.
And as I think you have heard from both Senator Tester and
Senator Murray, both who come from rural States, when you have
members of the National Guard who come from States as we do in
Vermont where there are 500 people or 1,000 people in a town,
sometimes you can get isolated. And the concern that we have is
that somebody goes over and serves in Iraq, serves in
Afghanistan, they come back home, they go to a small town, they
have a whole lot of problems. The nature of PTSD, the nature of
TBI, is not such that you jump up and say, hey, I have got a
problem. That is not the nature of that illness.
So how, in a dignified and respectful way, do you reach out
to men and women in isolated areas, in rural areas, make them
aware of the programs that we are developing, make sure that
these programs are effective as they can be? How do you bring
those people in?
A couple of years ago, working with the Vermont National
Guard and the Veterans Administration, we developed what we
think is a pretty good program in the State of Vermont by which
we are reaching out now to veterans and their families. We are
knocking on doors, we are calling our people all over the State
of Vermont. We are trying to make sure that nobody is left
behind.
And I think what is good about this hearing--and I will be
jumping in and out, Mr. Chairman; I have got another hearing
simultaneously, but I will be back--is it is important for us
to learn what different States are doing. We can all learn from
each other. There is good work going on around the country, I
know, in Montana, Minnesota, elsewhere. We are doing good stuff
in Vermont. Let's see what works; let's see what does not work.
The current military situation presents some unique
problems with TBI, with the number of cases of PTSD. I think
everybody here is increasingly aware that we need better
cooperation between the VA and National Guard. You cannot have
these walls.
The other thing, I think, we are also increasingly aware of
is, that if a soldier goes over and leaves a wife or a kid
home, you cannot ignore the wife and the kid. This is not just
a soldier problem, this is a family problem. We have got
hundreds of thousands of kids who have seen their parents go
over, and we have got to deal with this as a family unit, and
if it means making changes in the rules--things are different
today than they were 30 years ago. We have got to deal with the
whole family.
So, there is a lot to learn. I think we are making some
progress. We have got a long way to go. And I thank you very
much, Mr. Chairman, for holding this hearing.
Chairman Akaka. Thank you very much, Senator Sanders.
I would like to invite the first panel to please come up:
General Chapman, Mr. Mayes, and Mr. Nelson.
We have two excellent panels. I would like to thank all of
our witnesses again for being here today.
In our first panel, I would like to welcome Major General
Marianne Mathewson-Chapman, United States Army, Retired. Major
General Chapman is the National Guard and Reserve Coordinator
in the Office of Outreach to Guard and Reserve Families for the
Veterans Health Administration, Department of Veterans'
Affairs.
I would also like to welcome Mr. Brad Mayes, the Director
of the Compensation and Pension Services for the Veterans
Benefits Administration in the Department of Veterans' Affairs.
Finally, I want to welcome Mr. Donald Nelson, the Deputy
Assistant Secretary for Reserve Affairs in the Department of
Defense.
We look forward to hearing from each of you, and your full
statements will appear in the record.
Major General Mathewson-Chapman, we will begin with you. If
you would please give your statement.
STATEMENT OF MARIANNE MATHEWSON-CHAPMAN, Ph.D., ARNP, MAJOR
GENERAL, U.S. ARMY (RET.), NATIONAL GUARD AND RESERVE
COORDINATOR, OFFICE OF OUTREACH TO GUARD AND RESERVE FAMILIES,
VETERANS HEALTH ADMINISTRATION, DEPARTMENT OF VETERANS AFFAIRS
Major General Mathewson-Chapman. Good morning, Mr. Chairman
and Members of the Committee. Thank you for inviting me to
speak about outreach and the cooperation between the Department
of Veterans Affairs, Department of Defense, the National Guard,
and the Reserves.
I am joined today, as you just mentioned, by Mr. Bradley
Mayes, Director of C&P Service for the Veterans' Benefits
Administration. My written statement, which I request be
submitted for the record, discusses VA's four major outreach
efforts throughout the deployment cycle for members of the
National Guard and Reserve, from pre-deployment to lifelong
contact for health care and benefits.
This statement, along with Mr. Mayes' testimony, are
replete with descriptions of proactive VA outreach initiatives
executed to meet the complex challenges of the National Guard
and Reserves reintegrating home to their communities. War
changes us all, and that includes the families; and VA has
stepped up to meet this challenge.
The following are four critical outreach initiatives and
their stories that demonstrate the immediate impact on the
Guard and Reserve as they transition from active duty to
veterans. These initiatives demonstrate VA's critical outreach
support in four areas: enrollment in health care during the
mandatory briefings at the demobilization process; enrollment
and referrals during the post-deployment health reassessment
for Guard and Reserve members; and then reaching out to Guard
and Reserve members through the combat veteran initiative; and
finally, our partnership with the National Guard with the use
of the transition assistance advisors.
I would first like to illustrate the impact of VA outreach
and enrollment at the demobilization sites. Since May 2008, VA
has contacted over 4,000 Army soldiers at 12 Army
demobilization sites to provide not only enrollment, but health
care briefings and benefits briefings. We have been able to
enroll 83 percent of them in VHA health care.
At a recent event a female soldier was sitting in the
audience otherwise composed entirely of men. VA staff members
assisted all demobilizing soldiers in completing the 10-10EZ
enrollment form for health care as part of their standard
presentation. During the break, the female asked if VA really
had a women's clinic. After being assured we do, the woman
expressed her excitement that she would now be able to receive
all of her health care at VA, particularly sensitive issues
that require a female provider. She was also told that VBA has
female benefits counselors to help meet her needs.
The second major initiative exemplifies VA's partnership
with the DOD in providing support at the post-deployment health
reassessment, these PDHRA events are held at military units
throughout the country on weekends at 3 and 6 months' post-
deployment.
PDHRAs are a DOD program that provides education,
screening, and global health assessment to identify deployment-
related physical and mental health concerns. VA provides
support and appointments for follow-up evaluation of treatment,
and also they learn about their benefits at this time.
You might have recently read about the innovative program
in The Baltimore Sun. For the last 18 months, Baltimore's VA
Medical Center has been hosting PDHRAs in the hospital. VA
clinicians saw over 100 members of the Maryland National Guard
and screened them onsite at the hospital for everything from
common aches and pains to mental health conditions. As a result
of this in-hospital innovative program and screening, VA staff
were able to provide several soldiers with immediate
hospitalization and medical care.
Next, I would like to highlight the impact of the Combat
Veteran Initiative, which VA began in May. The call center
staff has contacted by phone over 17,000 OEF/OIF combat
veterans who have been injured and who may need the care and
coordination care of a Care Manager.
Presently, staff are contacting 510,000 National Guard and
Reserve members. They are being called and asked if they would
like to be enrolled, or for information about VA.
In one case, our call center staff called a National Guard
soldier and asked if he needed help or support. He said, I do
not need the help, but my brother sure does. He is a combat
Guard soldier and he is having trouble with readjustment issues
since his deployment. VA contacted both brothers and enrolled
them both in VA health care and assigned them to Care Manage to
coordinate VA health care services and benefits.
Another more dramatic example is a Guard soldier who was
told he was not a veteran, though he even served twice in Iraq.
When the program manager called him as a referral from the call
center, he said this call could not have come at a better time,
as he was having suicidal thoughts because he had no job and no
money, and he did not know where to turn. He was happy that VA
could coordinate the enrollment and appointments for him the
next day.
His mother called a social worker back and thanked the VA
for saving her son's life. He was also referred on then, to VBA
for C&P claim for his disabilities.
Finally, I would like to highlight the continued
partnership between the VA, the National Guard, VHA, and VBA
together who trained the first Transition Assistance Advisors,
or TAAs, in 2006. They were hired by the National Guard to
conduct VA outreach to Guardsmen and Reservists in the 50
States, the District of Columbia, and Guam, Virgin Islands, and
Puerto Rico. TAAs are the critical link to facilitate access to
VA information services, integrate the delivery of VA and
community services throughout the State coalitions, as well as
to notify VA staff when troops are returning.
Since February 2008, they have reached out to more than
85,000 Guard and Reserve members and family members in outreach
efforts, facilitating over 1,000 referrals to VHA, VBA, and Vet
Centers.
I would like to conclude with a story that shows quite
clearly the invaluable work of TAAs in performing outreach in
hometown America.
In one case, a deployed Guard soldier recently returned
home and suffered a stroke. His wife took him to a nearby
civilian hospital for care, but bills were mounting and the
family needed help. A TAA was called by our outreach staff to
assist the family and the Guard soldier with enrollment in
health care and assistance in applying for disability benefits.
The TAA was able to resolve the veteran's medical bills at the
civilian hospital by contacting community resources and members
of the State Coalition to assist them.
These few examples of four key initiatives only begin to
demonstrate the proactive joint efforts among VHA, VBA, and
DOD, as well as proactive efforts throughout the deployment
cycle that genuinely are impacting the lives of National Guard
and Reserve men and women who have truly borne the battle. I am
proud to participate in these efforts to meet the reintegration
and homecoming needs of our Guard and Reserve.
Mr. Chairman and Members of the Committee, this concludes
my statement. I would be happy to address any questions that
you may have on these initiatives.
[The prepared statement of Major General Mathewson-Chapman
follows:]
Prepared Statement of Marianne Mathewson-Chapman, Ph.D., ARNP, Major
General, U.S. Army (Ret.), National Guard and Reserve Coordinator,
Office of Outreach to Guard and Reserve Families, Veterans Health
Administration, Department of Veterans Affairs
Good morning, Mr. Chairman and Members of the Committee. Thank you
for inviting me to speak about the cooperation between the Department
of Veterans Affairs (VA), Department of Defense (DOD), the National
Guard and the military reserves. I am joined today by my colleague, Mr.
Bradley Mayes, Director, Compensation and Pension Services, Veterans
Benefits Administration.
From the start of Fiscal Year (FY) 2002 through the first quarter
of 2008, over 837,000 servicemembers have separated from active duty.
Slightly more than half of the returning servicemembers from Operation
Enduring Freedom and Operation Iraqi Freedom were members of the
National Guard and Reserves. I am pleased to report VA and DOD are
coordinating their efforts more closely than ever before to ensure our
newest veterans, including members of the National Guard and the
Reserves, reintegrating back into their communities are knowledgeable
about all of the VA benefits and services for which they are eligible
and know how to access the services they need.
VA has a long-standing commitment to serving this important reserve
component of our Armed Forces. We are dedicated to providing the
highest quality care and services to all who have worn the uniform in
any branch of service including our newest veterans who are members of
the National Guard and Reserve. We also recognize the importance of
timely contact, and that not all separating servicemembers, or members
of the National Guard and Reserve, will be interested in immediately
enrolling in VA for health care or benefits. As a result, VA has
developed a proactive multi-faceted strategy to provide key outreach at
critical stages throughout the deployment cycle.
Recently, DOD and VA have agreed to assign a VA Liaison to the DOD
Office of Reintegration Program Office (ORP). This position will assist
DOD in compliance with Section 582 of the FY 2008 National Defense
Authorization Act (NDAA). There will be continual and interdependent
collaboration between the ORP, VA and the Services' programs to further
develop policies to meet the needs of veterans and servicemembers. VA's
presence will bring specific expertise and knowledge to aid ORP in
developing best practices based on VA's experience. A crucial component
of this position will include supporting the field to better enable
consistent implementation of policy and program decisions through
coordination with the appropriate VA offices.
My testimony today will provide a detailed description of VA's
outreach efforts for non-severely injured National Guard and Reserve
members during four phases of this deployment cycle. These four phases
include: pre-deployment; during deployment and demobilization prior to
separation from active duty; immediately post-deployment; and finally,
life-long contact with the Guard or Reserve veteran. In each of these
phases, VA works closely with DOD, Guard and Reserve families,
communities, counties, state governments and community agencies to
ensure we inform them about VA and to facilitate their access to VA
services, benefits and health care.
pre-deployment
Since November 2004, VA has provided benefits brochures to everyone
inducted into the five military branches. This pamphlet delivers basic
information on VA benefits and services at the start of their military
career.
In addition, VA supports efforts for early contact with National
Guard and Reserve members and their families. Guard and Reserve members
and families learn about VA services and benefits during Soldier
Readiness Processing (SRP) events held prior to mobilization. These
benefits outreach briefings continue throughout the deployment phase as
VA collaborates with each of the services. VA provides outreach through
family programs, town hall meetings and family training events.
Families are a critical component in reaching veterans and providing
information about how to access VA health care and the importance of
seeking early assistance for needed health care services.
Our Vet Centers regularly conduct local outreach initiatives and
maintain strong working relationships with nearby Guard and Reserve
units. In addition to routine visits, Vet Center representatives will
sometimes host Open Houses onsite at Reserve units during the weekends
where they can answer questions from family members and Reservists. Vet
Center staff and GWOT counselors participate in pre-mobilization
educational briefings where they are able to establish contacts and
distribute information to family members.
during deployment and demobilization
Our latest efforts to expand services during the deployment phase
demonstrate further collaboration between VA and DOD as we establish a
comprehensive, standardized enrollment process at 12 Army
Demobilization sites. Since this pilot began on May 28, VA has
contacted more than 2,000 separating Army Guard and Reserve members and
offer them the opportunity to enroll in VA health care. VA has enrolled
more than 80 percent of these veterans and this month we are expanding
this program to the Navy at four sites. We will expand it further in
August to the Marines and to the Air Force Reserves later this fall.
DOD provides VA with dates, numbers of servicemembers demobilizing
and locations for Reserve Component units when demobilization events
occur. At these events, Veterans Health Administration (VHA) staff
representatives from the local VA medical center, benefits specialists
and Vet Center counselors are given 15 to 30 minutes during mandatory
demobilization briefings for a scripted presentation. During this time,
veterans receive information about recent changes in enrollment and
eligibility, including the extended period in which those who served in
combat may enroll for VA health care following their separation from
active duty. They are also educated about the period of eligibility for
dental benefits, which was recently extended from 90 days to 180 days
following separation from service, by the National Defense
Authorization Act for Fiscal Year 2008.
This enrollment process has been streamlined and veterans are also
shown how to complete the Application for Medical Benefits (the 10-
10EZ), which begins the enrollment process for VA health care. VHA
staff members also discuss how to make an appointment for an initial
examination for service-related conditions and answer questions about
the process. These completed forms are collected at the end of each
session. VA staff at the supporting facility match the 10-10EZ with a
copy of the veteran's DD-214, their discharge papers and separation
documents, scan them, and email or mail them to the VA medical center
where the veteran chooses to receive care. The receiving facility staff
enters this information into VA's electronic medical records; VA's
Health Eligibility Center staff will then complete the enrollment
process and send a letter to the veteran verifying their enrollment.
Guard and Reserve veterans receive a special letter at the
demobilization site identifying a toll-free number they can dial if
they need to seek medical care before they have received their official
enrollment letter in the mail. This is a process improvement strategy
to facilitate access for Guard and Reserve members for needed health
care prior to notification of official enrollment.
VA staff also makes a straightforward presentation regarding the
advantages of enrolling in VA care early, even though the
servicemember/veteran may not need health care services at this time.
Combat theatre veterans receive health care at no cost for any
condition that might be related to their combat service. Essentially,
VA reinforces a positive message that enrollment in VA health care,
will benefit them both now and in the future.
The Vet Center program is the VHA arm for community outreach to
returning combat veterans. The outreach to provide veterans and family
members with educational information about readjustment counseling
services is one of the legislatively mandated missions of the Vet
Center program. In response to the growing numbers of veterans
returning from combat in OEF/OIF, the Vet Centers initiated an
aggressive outreach campaign to welcome home and educate returning
servicemembers at military demobilization and National Guard and
Reserve sites. Through its community outreach and brokering efforts,
the Vet Center program also provides many veterans the means of access
to other VHA and Veterans Benefits Administration (VBA) programs. To
augment this effort, the Vet Center program recruited and hired 100
OEF/OIF veterans to provide the bulk of this outreach to their fellow
veterans. To improve the quality of its outreach services, in June
2005, the Vet Centers began documenting every OEF/OIF veteran provided
with outreach services. The program's focus on aggressive outreach
activities has resulted in the provision of timely Vet Center services
to significant numbers of OEF/OIF veterans and family members. Since
the beginnings of hostilities in Afghanistan and Iraq, the Vet Centers
have seen over 288,000 OEF/OIF veterans, of whom over 216,000 were
outreach contacts seen primarily at military demobilization and
National Guard and Reserve sites and more than 72,000 were provided
readjustment counseling at Vet Centers. The Vet Center Program has also
provided outreach services to the United States Marine Corp IRR
reservists across the Nation.
The approach builds on a prior outreach effort conducted during the
first Gulf War, which received the commendation of the President's
Advisory Committee on Gulf War Veterans' Illnesses. In its final report
of March 1997, the Committee cited the Vet Centers for providing
exemplary outreach to contact and inform this veteran cohort about VA
services. On October 2004, the U.S. Medicine Institute of Health
Studies and Association of Military Surgeons of the United States
reported that ``VHA's Vet Centers have proven a `best practice' model
in fostering peer-to-peer relationships for those with combat stress
disorders.''
immediately post-deployment
Following demobilization, DOD regularly holds post-deployment
health reassessments (PDHRA's) for returning combat Guard and
Reservists between three and six months after separation from active
duty. The PDHRA is a DOD health protection program designed to enhance
the deployment-related continuum of care. PDHRA's provide education,
screening, and a global health assessment to help facilitate care for
deployment-related physical and mental health concerns. Completion of
the PDHRA is mandatory for all members of the National Guard or Reserve
who complete the post-deployment health assessment at the
demobilization sites.
DOD provides VA a list of locations and times where these events
will take place--often at the Guard or Reserve unit. VA outreach staff
from local medical centers and Vet Centers participates at these
events. DOD clinicians conduct screening exams to veterans and VA staff
are available to coordinate referrals for any veteran interested in
seeking care from a VA facility. Vet Center staff members are also
present to assist veterans with enrollment in VA for health care or
counseling at a local Vet Center.
PDHRA's are typically held in person with mandatory attendance for
units of 30 or more servicemembers, while smaller units conduct their
PDHRA's by phone using DOD's call center staff to conduct the
screening. Almost 73 percent of all Reserve Component PDHRA referrals
were to VA--either a Vet Center or a VA medical facility. VA's PDHRA
mission is threefold: enroll eligible reserve component servicemembers,
into VA health care; provide information on VA benefits and services,
and; provide assistance in scheduling follow-up appointments. VA
medical center and Vet Center representatives provide post-event
support for all onsite and Call Center PDHRA events.
VA medical centers and Vet Centers accept direct PDHRA referrals
from DOD's 24/7 Contract Call Center. Between November 2005 and May
2008, VA staff supported over 1,050 onsite and 380 Call Center PDHRA
events. During that same period, DOD conducted 193,559 Reserve
Component PDHRA screenings, resulting in more than 41,100 referrals to
VA medical centers and 19,200 to Vet Centers.
Another essential element of VA's outreach during the post-
deployment stage are the 100 Global War on Terror (GWOT) counselors
employed by VA's Readjustment Counseling Service. Vet Center GWOT
Veteran Outreach Specialists conduct a focused campaign to inform their
fellow GWOT veterans about VA benefits and services. These GWOT
Counselors attend demobilization, PDHRA and other activities, including
``welcome home'' events in their hometown and community. These
Counselors are performing a vital service, and their personal
connection and dedication to the task at hand have helped countless
veterans and their families throughout the reintegration process.
life-long contact
While VA's participation at demobilization sites and in PDHRA
events represents critical elements of our outreach strategy, we are
well aware that not all veterans will enroll during this time and they
may return home with limited knowledge of VA services. As a result,
through a number of outreach initiatives, VA continues its efforts once
members of the National Guard and Reserves have returned to their
community. These measures range from nationwide to neighborhood
outreach events and leverage VA's relationships with state and local
partners, including a wide variety of organizations.
In May 2005, VA and the National Guard entered into a partnership
and signed a Memorandum of Understanding to enhance access to VA health
care for members of the National Guard in each of the 50 states,
District of Columbia, and territories of Puerto Rico, Guam, the U.S.
Virgin Islands. In early 2006, the National Guard hired and funded the
first 54 Transition Assistance Advisors (TAA's), while VA provided
specialized training for them at the VBA Academy in Baltimore about VA
benefits and health care services. In 2008, an additional six TAA's
were hired to provide further outreach support in states with large
pools of mobilizing National Guard members: Texas, Pennsylvania,
Georgia, Florida, California, and Minnesota. VA outreach staff
continues working closely with TAA's while they are in the field and
serving OEF/OIF veterans, through regularly scheduled conference calls,
newsletters, and annual training conferences that identify and
disseminate best practices in each state. TAA's serve two critical
missions: first, they perform local problem-solving for any specific
issues facing veterans; second, TAA's bring together key leaders and
organizations, such as State Directors of Veterans Affairs, Adjutants
General, and VA leadership at the Network and facility level. The VHA
OEF/OIF Office of Outreach also has strong ties with the Adjutants
General of the National Guard, TAA's, and with State Directors of VA,
all of whom can and do keep VA informed of any challenges in accessing
VA health care or other issues in the state.
TAA's have been the critical link in facilitating access to VA by
National Guard and Reserve members by providing VA with critical
information on numbers of returning troops, locations, and home coming
and reintegration events. TAA's also facilitate enrollment into VHA
care for returning troops.
Moreover, Network, Regional Office, and Medical Center staff have
signed a state Memorandum of Understanding with 47 states that define
the roles and responsibilities of VA and the state Departments of
Veterans Affairs. A few states prefer to operate under the national
agreement reached between the National Guard and VA in 2005. These
state partnerships are the foundation for the development of state
coalitions with participation by VA, State Adjutants General, State
Directors of VA, and community and state organizations to address the
coming home needs of the Guard and the Reserve members.
VA works with state governments to further our mutual goal of
enhanced benefits and access care for Guard and Reserve veterans in
multiple ways. Some examples include:
In Connecticut, the State has signed a Memorandum of
Understanding with VA allowing severely injured veterans to volunteer
to have their medical information shared with the state, and VA has an
active campaign to encourage wounded veterans in the state to contact
VA for enrollment and benefits.
In Delaware, the State signed a Memorandum of
Understanding in September 2007 with the Delaware National Guard, the
Delaware Department of Labor, VA, and other support agencies to
establish clarity of communication and synchronization of efforts
between each agency to provide veterans with transition assistance and
guidance.
In Florida, a pilot program was established to allow for
ease of transfer of information from VA to the state government for
wounded servicemembers who volunteer to have their information shared.
In Ohio, the National Guard and the regional VA office are
negotiating a Memorandum of Understanding to provide comprehensive
informational sessions for members of the Guard and their families
during different stages of deployment.
In South Carolina, the State has partnered with VA to
offer job and health fairs for returning servicemembers.
In South Dakota, the State has established a seven step
Reunion and Reintegration plan, a portion of which includes providing
information on Vet Centers and PDHRAs.
In Minnesota, during the ``Beyond the Yellow Ribbon
Reintegration Program'', VA participated in briefings to returning
troops and families, enrolled members of the National Guard in VA
health care, and supported family members in the Family Academy
classes, which provided information about VA benefits and health care
services for which the spouse or family of a veteran may be eligible.
Further Outreach Initiatives for Guard and Reserve Members:
VA also conducts direct outreach by telephone through several
initiatives, including the Secretary's recently announced call center
campaign to contact every OEF/OIF veteran and servicemember, including
members of the National Guard and Reserve, who have separated from
service but who have not yet enrolled in VA health care. On May 2,
2008, VA began contacting almost 510,000 combat OEF/OIF veterans to
ensure they know about VA medical services and other benefits. The
Department is reaching out to all OEF/OIF veterans to let them know VA
is here for them. The first of those calls went to an estimated 17,000
veterans who were sick or injured while serving in Iraq or Afghanistan.
If any of these 17,000 veterans did not already have a care manager to
work with them, VA offered to appoint one for them. The second phase of
the call initiative is to contact those discharged from active duty but
who are not yet receiving VA health care. Local VA facilities and
network representatives are sent referrals to provide follow-up contact
should the veteran want additional information or have unmet health
care and benefit needs.
In addition, the Secretary of Veterans Affairs sends a letter to
newly separated OEF/OIF veterans. These letters thank veterans for
their service, welcome them home, and provide basic information about
VA health care and other benefits. Through the first quarter of FY
2008, VA mailed more than 766,000 initial letters and 150,000 follow-up
letters to new veterans including members of the Guard and Reserve.
Families are a vital force in ensuring that veterans know how to
access care and services they need. They are often the first to notice
a change in behavior or any symptoms. VA works with National Guard
family programs and provides literature on readjustment counseling and
health care services to family program directors at annual training
conferences. Many families attend ``welcome home'' events sponsored by
the local VA Medical Center and Vet Centers identify other resources in
the community where families and veterans can establish contact to meet
their specific needs. VA is continuing its work with the Army's Warrior
Transition Units at active duty Army bases and the nine community based
health care organizations to ensure the leadership of these units is
linked to case managers at VA medical centers and vocational
rehabilitation services. VA also supports the Family Assistance Centers
at Army bases with VBA counselors and vocational rehabilitation
specialists who can support and extend VA's outreach efforts to help
servicemembers to enroll in VA health care prior to separation from
active duty, apply for a disability, or other VA benefits. Our Vet
Centers can also provide outreach services to family members while a
veteran is deployed. Many Vet Centers host family outreach events and
other activities, such as picnics or fishing expeditions, both while a
veteran is deployed and after he or she has returned. Vet Centers also
work closely with the Reserve's Family Readiness Units to collaborate
with them and support veterans and families through outreach, education
and referral services.
Outreach Programs for Severely Injured National Guard and Reservists:
For wounded warriors returning home, forty-three states currently
participate in the State Benefits Seamless Transition Program. To date,
350 severely injured veterans have signed the consent form authorizing
VA to notify their local State Department of Veterans Affairs of their
contact information when they return to their home state. The
initiative involves VA health care liaison staff located at the
following Department of Defense medical facilities:
Walter Reed Army Medical Center, Washington D.C.
National Naval Medical Center, Bethesda
Brooke Army Medical Center, San Antonio, TX
Darnall Army Medical Center, Ft. Hood, TX
Madigan Army Medical Center, Puget Sounds, WA
Eisenhower Army Medical Center, Augusta, GA
Evans Army Community Hospital, Ft. Carson, CO
Naval Medical Center, San Diego, CA
Womack Army Medical Center, Ft. Bragg, NC
Naval Hospital, Camp Pendleton, CA
Naval Hospital, Camp Lejeune, NC
Under the program, wounded veterans returning to their home states
can elect to be contacted by their local State Department of Veterans
Affairs about state benefits available to them and their families. VHA
Liaisons for Health Care identify injured military members who will be
transferred to VA facilities, inform them about the program, and obtain
a signed consent form from veterans electing to participate. These
forms are faxed directly to an identified point of contact in the
state's Department of Veterans Affairs. The state offices, in turn,
contact the veterans to inform them of available state benefits.
In order to participate in the program, State Departments of
Veterans Affairs must provide a point of contact and dedicate a fax
machine in a private, locked office to receive the release of
information forms. VA asked states to participate in the program in
February 2007 when it was expanded beyond the Florida pilot
program.
Moreover, the Federal Recovery Coordinator program has been created
within VA, with the cooperation of DOD, to assist the most seriously
injured servicemembers, whether they be members of the Guard and
Reserve or not. These Coordinators act as facilitators to ensure all
Federal benefits are made available to help the injured, ill, or
wounded servicemember transition out of the military and into civilian
life.
Media Campaigns
One important area recently opened to us will improve our outreach
efforts during all phases of a servicemember's career. On June 16, less
than a month ago, Secretary Peake lifted VA's restriction on
advertising. Our mission at the Department of Veterans Affairs is
clear: to do all within our authority and ability to help
servicemembers readjust successfully into civilian society after their
military experience ends and to make sure they know the VA is there to
provide health care, benefits and other services they have earned.
Secretary Peake's decision requires the Under Secretaries to
coordinate with the Assistant Secretary for Public and
Intergovernmental Affairs about outreach, media plans, education, and
awareness campaigns and initiatives, and for me to recommend to him
further steps to improve our ability to reach veterans and their
families. In the few weeks since the change, there have already been a
number of meetings with the three Administrations and staff offices
working together to move this effort forward. One of the key parts of
the rescission allows the Under Secretaries to purchase advertising in
media outlets for the purpose of promoting awareness of benefits and
services, after coordinating with the Department's public affairs
office.
The decision allows us to use proven modern advertising techniques
that will appeal to veterans of all ages and their family members. It
will give VA, with its variety and diversity of services and benefits,
the ability to provide the right message through the right medium to
reach veterans. Traditional advertising venues such as broadcast and
print are available to us. But we are also looking at social marketing
and internet based non-traditional media such as YouTube, MySpace and
Facebook, as well as podcasting. All can be considered and evaluated in
our outreach effort to veterans and their families.
Our goal is to reach veterans who have just returned from Iraq and
Afghanistan as well those who served in World War II, Korea, the cold
war, Vietnam, and the Persian Gulf War--we want to reach all veterans
of all eras of service with the messages of greatest concern to them
through the medium that is most effective.
On November 14, 2006 VA submitted to Congress a 5-year strategic
plan (2006-2011) which included an outreach component. At that time we
were still precluded from using paid outreach advertising. It is now
being revised to include a robust advertising approach. It is our goal
to provide the updated outreach strategic plan to you in December 2008
when we submit our scheduled Report of Outreach Activities to the
Congress. We also aim to include this fiscal year's accomplishments of
our current business plan objectives which will be linked to the
strategic plan goals in the report.
As we move forward we will work closely with you, and welcome your
suggestions. We believe the opportunities are vast and we will pursue
this new approach with vigor.
conclusion
VA's mission is ``to care for those who have borne the battle,''
and it is a mission we take seriously. Every day our clinicians and
staff are developing new methods for distributing outreach information
to those in need and facilitating access to VA health care and
benefits. I thank the Committee for your interest in this matter and,
on behalf of VA, I thank DOD for their cooperative efforts in granting
VA staff access to demobilizing servicemembers, veterans, and their
families.
Chairman Akaka. Thank you very much, General Chapman.
Mr. Mayes.
STATEMENT OF BRADLEY G. MAYES, DIRECTOR, COMPENSATION AND
PENSION SERVICE, VETERANS BENEFITS ADMINISTRATION, DEPARTMENT
OF VETERANS' AFFAIRS
Mr. Mayes. Mr. Chairman, Members of the Committee, I am
pleased to be here today to speak on initiatives and outreach
efforts undertaken by the Department of Veterans Affairs to
National Guard and Reserve members returning from theaters of
combat, operations, and demobilizing from active duty.
As was mentioned earlier, I am accompanied by Major General
Marianne Mathewson-Chapman.
We are committed in our efforts to see that the Nation's
citizen warriors and their families are honored for their
service to our country and receive the VA services and benefits
they have earned.
As the number of National Guard and Reserve members serving
on active duty has increased, VA has aggressively expanded its
outreach efforts to inform deactivating members of the many
services and benefits available to them.
From the beginning of fiscal year 2003 through the end of
June, 2008, we have conducted more than 8,600 briefings for
Guard and Reserve soldiers, and we have provided information to
approximately 510,000 combat OEF/OIF veterans.
VA initiates outreach to National Guard and Reserve members
at the beginning of their military career. Since November 2004,
everyone inducted into the five military branches receives a VA
benefits pamphlet at the military entrance processing station.
This pamphlet provides inductees with basic information on
VA benefits and services at the start of their military active
service, because we want servicemembers to know that the VA
will be there for them in the future.
Regarding briefings, outreach briefings to demobilizing
National Guard and Reserve components are generally one among a
series of presentations scheduled for our returning groups. The
briefings may be conducted at the military base where
administrative demobilization activities occur, or they may be
briefed later at the unit's home base, once the members have
returned to their local community.
Briefings at the demobe sites are generally abbreviated
because National Guard and Reserve units are there for only a
few days, with much out-processing to accomplish before
returning to their home locations.
Briefings to returning units at their home locations are
generally part of a welcome home or a family activities day or
job fairs at weekend drill sessions. Those might be TAP
briefings, but that is really where we need to reach them,
because we have time. The demobilization process--these
servicemembers, they are trying to get home, and we are
available for them when they come back to these drills.
At all briefings, the attendees are provided with written
informational materials that include the VA handbook, ``Federal
Benefits for Veterans and Dependents,'' and VA Pamphlet 20-00-
1, ``A Summary of VA Benefits,'' and an insurance information
folder. You have examples of those in the folders that we
provided to the Committee Members.
There are other outreach efforts. Along with face-to-face
outreach efforts, we seek to ensure that a welcome-home package
is sent to all returning National Guard and Reserve members.
DOD provides us with the names and addresses of these returnees
based on active duty separation records. The Veterans
Assistance and Discharge System then generates a welcome-home
package for recently separated veterans, including Reserve and
National Guard soldiers.
The mailing itself contains a letter from VA and a summary
and timetable of VA benefits. In addition to the VADS mailings,
a separate personal letter from the Secretary, along with
benefits information, is sent to each returning OEF/OIF
veteran.
VADS also sends separate packages that explain education,
loan guaranty and insurance benefits. A six-month follow-up
letter with the same general benefits information is also sent
to each returning member. And VA is currently working with DOD
to update this electronic transfer of information.
Partnerships in the past--outreach to Reserve and National
Guard soldiers--was generally accomplished on an on-call or as-
requested basis, but with the onset of Operations Enduring
Freedom and Iraqi Freedom, and the activation and deployment of
large numbers of Reserve and National Guard soldiers, VA's
outreach to this group has greatly expanded.
VA has made arrangements with Guard and Reserve officials
to schedule briefings for members who are being mobilized as
well as being demobilized. In order to facilitate these
outreach efforts, we have entered into joint agreements with
Department of Defense, and these agreements provide for the
sharing of information so that we know when there is going to
be an assembly of returning National Guard or Reserve soldiers.
VA and the National Guard Bureau, which represents National
Guard units nationwide, have entered into a memorandum of
agreement to establish the requirements, the expectations, and
obligations of each organization with respect to assisting
National Guard soldiers with demobilization issues.
Among its provisions, the agreement calls for the National
Guard Bureau to provide VA with timely and appropriate data on
when and where groups of demobilizing servicemembers will
return to their local communities. It also calls for the
National Guard Bureau to establish opportunities for VA
personnel to provide information to returning National Guard
soldiers and their families in all the States and territories.
And the agreement provides regional or local family
activity days, where VA represents or presents health and
benefits information to assembled groups within 3 to 6 months
of demobilization.
And finally, the handout entitled ``VHA/VBA Outreach for
Guard and Reserve'' depicts these and other initiatives
currently underway.
While we have done much, there is more still to do, and we
recognize that we must continually seek improvement and
innovation in the way we reach out to those we at VA have the
privilege of serving.
Mr. Chairman, Members of the Committee, that concludes my
testimony, and I would be happy to answer any questions that
you may have.
[The prepared statement of Mr. Mayes follows:]
Prepared Statement of Bradley G. Mayes, Director, Compensation and
Pension Service, Veterans Benefits Administration, Department of
Veterans Affairs
Mr. Chairman and Members of the Subcommittee, I am pleased to be
here today to speak on initiatives and outreach efforts undertaken by
the Department of Veterans Affairs (VA) to National Guard and Reserve
members returning from theaters of combat operations and demobilizing
from active duty. We are committed in our efforts to see that the
Nation's Citizen Warriors and their families are honored for their
service to our country and receive the VA services and benefits they
have earned.
As the number of National Guard and Reserve members serving on
active duty has increased, VA has aggressively expanded its outreach
efforts to inform deactivating members of the many services and
benefits available to them. From the beginning of fiscal year 2003,
through June 2008, VA has conducted more than 8,650 briefings and
provided information to approximately 510,000 combat OEF/OIF
veterans.
benefits information at time of induction into service
VA initiates outreach to National Guard and Reserve members at the
beginning of their military career. Since November 2004, everyone
inducted into the five military branches receives a VA benefits
pamphlet at the military entrance processing station. This pamphlet
provides inductees with basic information on VA benefits and services
at the start of their military active service. We want servicemembers
to know that VA will be there for them in the future.
transition assistance program (tap)
One of the formal pre-discharge outreach programs in which VA
participates is the Transition Assistance Program (TAP), which is
operated in conjunction with the Department of Labor. TAP is conducted
nationwide and in Europe and Asia to prepare retiring or separating
military personnel for return to civilian life, and VA provides
benefits briefings as a part of the program. At these briefings,
servicemembers are informed of the array of VA benefits and services
available, instructed on how to complete VA application forms, and
advised on what evidence is needed to support their claims. Following
the general instruction segment, personal interviews are conducted with
those servicemembers who would like assistance in preparing and
submitting their applications for compensation and/or vocational
rehabilitation and employment benefits.
disabled transition assistance program (dtap)
As a part of TAP, servicemembers leaving the military with a
service-connected disability, or those who think they may have a
service-connected disability, are offered the Disabled Transition
Assistance Program (DTAP). DTAP is an integral component of transition
assistance for servicemembers who may be released because of disability
incurred on active duty. Through VA's DTAP briefings, VA advises
transitioning servicemembers about the benefits available through the
Vocational Rehabilitation and Employment (VR&E) program. The goal of
DTAP is to encourage and assist potentially eligible servicemembers
with making informed decisions about the VR&E program and to expedite
delivery of these services to those who qualify.
other benefits briefings
In addition to TAP and DTAP briefings to separating and retiring
servicemembers, VA conducts other benefits briefings at the request of
DOD. One example is a presentation conducted at ``Commanders' Calls.''
Military commanders routinely have unit meetings with their assigned
personnel. These meetings are referred to as ``Commander's Call.''
During ``Commander's Call,'' the commander usually informs personnel of
on-going and future events, hot topics, and personnel issues. Sometimes
guest speakers are invited to provide informational briefings. VA is
typically asked to cover material on VA's Education and Loan Guaranty
Programs.
Outreach briefings to demobilizing National Guard and Reserve
components are generally one among a series of presentations scheduled
for a returning group. The briefings may be conducted at the military
base where administrative demobilization activities occur or later at
the unit's home base once the members have returned to their local
community. Briefings at the demobilization site are generally
abbreviated because National Guard and Reserve units are there for only
a few days, with much out-processing to accomplish before returning to
their home locations. Briefings to returning units at their home
locations are generally part of a ``Welcome Home,'' ``Family Activities
Day,'' or ``Job Fairs'' weekend drill session.
At all briefings, the attendees are provided with written
informational materials that include the VA handbook Federal Benefits
for Veterans and Dependents, VA Pamphlet 20-00-1, A Summary of VA
Benefits, and an insurance information folder.
other outreach efforts
Along with face-to-face outreach efforts, VA seeks to ensure that a
``Welcome Home Package'' is sent to all returning National Guard and
Reserve members. DOD provides the names and addresses of these
returnees based on active duty separation records. The Veterans
Assistance at Discharge System (VADS) then generates a ``Welcome Home
Package'' for recently separated veterans, including Reserve and
National Guard members. The mailing itself contains a letter from VA
and a summary and timetable of VA benefits. In addition to the VADS
mailings, a separate personal letter from the Secretary, along with
benefits information, is sent to each returning OEF/OIF veteran. VADS
also sends separate packages that explain education, loan guaranty, and
insurance benefits. A six-month follow-up letter with the same general
benefits information is also sent to each returning member. VA is
currently working with DOD to update the electronic transfer of this
information.
partnerships
In the past, outreach to Reserve and National Guard members is
generally accomplished on an ``on call'' or ``as requested'' basis.
With the onset of Operations Enduring Freedom and Iraqi Freedom (OEF/
OIF) and the activation and deployment of large numbers of Reserve and
National Guard members, VA's outreach to this group has greatly
expanded. VA has made arrangements with Guard and Reserve officials to
schedule briefings for members who are being mobilized and demobilized.
In order to facilitate these outreach efforts, VA entered into
joint agreements with the Department of Defense (DOD). These agreements
provide for the sharing of information so VA knows when and where a
presentation may be given to an assembly of returning National Guard or
Reserve members.
VA and the National Guard Bureau (NGB), which represents National
Guard units nationwide, have entered into a memorandum of agreement to
establish the requirements, expectations, and obligations of each
organization with respect to assisting National Guard members with
demobilization issues. Among its provisions, the agreement calls for
NGB to provide VA with timely and appropriate data on when and where
groups of demobilizing servicemembers will return to their local
communities. It also calls for NGB to establish opportunities for VA
personnel to provide information to returning National Guard members
and their families in all the states and territories. In addition, the
agreement promotes regional or local ``Family Activity Days,'' where VA
presents health and benefits information to assembled groups within
three to six months of demobilization.
VA has also reached agreements with individual National Guard state
military departments to facilitate outreach efforts. An initial
memorandum of understanding (MOU) was signed by VA and the Washington
State Military Department. This served as a model for 47 other state
and territorial military departments, which currently have an MOU with
VA. Agreements with other states have been initiated and will be
finalized in the near future. These agreements include the
participation of other organizations within the states, such as state
veterans organizations, state employment agencies, and state business
associations, which contribute to the transition of National Guard
members back into their local communities. Through the communication
place for presentations, and returnees are identified for informational
mailings. Communications are enhanced by VA military services
coordinators, who remain in contact with the state National Guard
headquarters.
As a part of this partnership, the National Guard Bureau employs 60
Transition Assistance Advisors (TAAs) for the 50 states and 4
territories. The TAAs' primary function is to serve as the statewide
point of contact and coordinator. They also provide information
regarding VA benefits and services to Guard members and their families
and assist in resolving any problems with VA healthcare, benefits, and
TRICARE. VA and the National Guard Bureau teamed up at the beginning of
the program in February 2006 to provide training to the TAAs on VA
services and benefits. VA has participated in subsequent annual
refresher training, as well as monthly TAA conference calls.
Procedures for outreach presentations to demobilizing Reserve
components are less formally established. Communications generally flow
between a Reserve unit liaison and the VA regional office military
service coordinator. There is currently an agreement pending between VA
and the Army Reserve Headquarters which, when completed, will serve as
the model for agreements with other military Reserve branches. It is
anticipated that the terms of these agreements and the lines of
communication established by them will be similar to those between VA
and the National Guard.
Another partnership between VA and DOD is designed to assist those
National Guard and Reserve members who are seriously wounded while on
active duty or develop a condition that causes them to be unfit for the
military. VA and DOD are working closely on efforts to evaluate the
disabilities of servicemembers still on active duty. Our goal in this
process is to smooth their reintegration back into civilian life, with
a focus on employment or independent living, should discharge from
service become necessary. These efforts include services and outreach
programs to regular military personnel, activated guard and reserve
personnel, and inactive but drilling reserve component military
personnel who may become unfit for duty. These efforts are coordinated
through a Senior Oversight Committee (SOC) comprised of both VA and DOD
representatives. One of the major projects being implemented is the
pilot of a new Disability Evaluation System (DES). This process
involves determining the extent of the servicemember's disability from
a wound or other condition causing unfitness and determining a course
of action based on medical examinations and an in-depth interview
conducted by an experienced military services coordinator, who also
assists the member in filing any claims. If the member is determined to
be unfit by the military, the military services coordinator provides
additional information and services to the member during his/her
transition. VA has supported the DES process by providing information
and assistance to DOD for the creation of a ``benefits book'' given to
servicemembers and their families involved with DES.
outreach improvement initiatives
VADS Process Improvements
In recent years, VA has made great strides in expanding and
improving the outreach programs. Because this is a critical component
of the VA mission, we continue to seek improvements in the delivery of
information on VA services and benefits to those separating from active
duty. One major improvement initiative involves the Welcome Home
Package sent to recently separated individuals. During fiscal year
2007, VADS generated approximately 188,000 outreach packages. The
current VADS method, traditionally used to generate and mail these
outreach packages, is scheduled to be replaced by a modern and more
efficient system referred to as the VA/DOD Identity Repository (VADIR).
One of the drivers for replacement of VADS is that deficiencies in the
system caused a number of individuals not to receive their outreach
package. When VA learned of this, a help team was immediately sent to
the VADS location in Austin, Texas. The system was analyzed and
corrective measures were taken. As a result of this, it became clear
that the newly developed VADIR system was superior and should replace
VADS. VADIR can provide VA with detailed electronic information
directly from DOD on separating servicemembers that will replace the
current paper-document-based method used by VADS. This interagency data
sharing will eliminate error and facilitate a timely mailing of the
outreach packages.
Relationship Building
VA also continues to develop a closer relationship with National
Guard and Reserve units in order to be available for in-person outreach
briefings. Regardless of whether a briefing is needed at the
demobilization site or the units home location, or whether it is a
complete TAP presentation or a condensed time sensitive presentation,
VA has made it known that we are always on call to help those who have
served our country.
conclusion
Mr. Chairman, VA outreach programs provide wide dissemination of
information on the array of benefits and services available to National
Guard and Reserve members. Our employees are dedicated to ensuring
veterans receive the benefits and services they have earned through
their service to our Nation, and we work diligently to provide
information and assistance in a timely, thorough, accurate,
understandable, and respectful manner.
This concludes my summary of the outreach efforts undertaken by VA
to provide returning National Guard and Reserve members with
information on the VA services and benefits available to them. I would
be pleased to answer any questions you may have.
Chairman Akaka. Thank you very much, Mr. Mayes, for your
statement.
Mr. Nelson.
STATEMENT OF DONALD L. NELSON, DEPUTY ASSISTANT SECRETARY FOR
RESERVE AFFAIRS, DEPARTMENT OF DEFENSE
Mr. Nelson. Good morning, Chairman Akaka and other
distinguished Members of the Committee. Thank you very much for
inviting me to appear and speak about the outreach actions
being taken by the Department of Defense, and the service
components to benefit Reserve and National Guard soldiers
ordered to active duty service.
Let me preface my remarks this morning by way of pointing
out that by way of personal background I served this great
Nation for 34\1/2\ years, both active and Reserve, as an
officer in the United States Navy. I am acutely aware that the
challenge to the freedom of this great Nation is being met
freely and wholly by the supreme commitment and unparalleled
personal sacrifice of our all-volunteer active, Reserve, and
National Guard forces.
There is no question that our soldiers, sailors, airmen,
Marines, and Coast Guardsmen deserve only the very best in
terms in every conceivable benefit that a grateful Nation can
bestow upon them for their service.
For that reason, I am especially appreciative of this
opportunity to appear before you and tell you what the
Department of Defense has done and is doing to implement the
Yellow Ribbon Reintegration Program mandated by Section 582 of
the 2008 National Defense Authorization Act.
Section 582 requires the Department of Defense to establish
a national combat veteran reintegration program for Reserve and
National Guard soldiers and their families. The program must
provide deployment support and reintegration activities during
all phases of deployment: pre-deployment, deployment,
demobilization, and reconstitution.
The Department of Defense established the Yellow Ribbon
Reintegration Program to oversee the activities and services
provided under this program on March 17, 2008, at 1401 Wilson
Boulevard in Rosslyn, Virginia. We now have 11 persons working
in that office on a full-time basis, including one Reserve
Officer from the Army, Navy, Air Force, and Marines,
respectively; a representative from the National Guard Bureau;
a liaison officer from the Department of Veterans' Affairs; the
Center for Excellence and Reintegration Director; and the
Deputy Director of the Reintegration Program Office; plus two
interns and a receptionist.
The Center for Excellence has been established within the
Reintegration Program Office to analyze and collect lessons
learned and assess suggestions on program improvements from
Reserve components and State National Guard organizations.
There are a variety of additional organizations that
provide services to assist Reserve and National Guard soldiers
and their families during the entire deployment cycle
including, but not limited to: the services and their
respective Reserve components; other Federal agencies, most
certainly including the Veterans' Administration; the National
Guard in each State; State Veterans' Affairs departments; and
other local offices and private sector organizations.
Let me offer an executive summary current as of July 17,
2008, of the deployment, support, and reintegration events that
the services have held and are planning during the period from
January 1, 2008, to September 30, 2008.
Noteworthy is the magnitude of the events that have already
been held and scheduled. Six components have conducted 338
reintegration activities since January 2008.
In addition, reintegration activities must be provided in
the fourth quarter of fiscal year 2008 for Reserve and National
Guard soldiers returning from deployment, with full
implementation of support programs for all phases of the
deployment cycle to be provided in fiscal year 2009.
Moreover, the six components have also scheduled 141
additional reintegration events for the fourth quarter of
fiscal year 2008. The congressional mandate will continue to
drive coordinated efforts among the service components and the
Department of Veterans' Affairs and other organizations will
further improve and standardize existing individualized
programs.
As I have previously stated, there are a variety of
additional organizations that provide outreach services to
assist Reserve and National Guard soldiers and their families
throughout the deployment cycle, as described in the
legislation. Topping the list are our colleagues from the
Veterans Administration.
Additionally, the Joint Family Support Assistance, which
falls within the ambit of the Deputy Under Secretary of Defense
for military, community, and family policy currently provides
services in 15 pilot States, presently experiencing large
numbers of mobilizing and demobilizing Reserve and National
Guard soldiers, as well as those States with large numbers of
personnel alerted for mobilization.
The Department of Defense plans to expand beyond the pilot
phase to include all 54 States and territories during fiscal
year 2009. Specifically, the services offered by the Joint
Family Support Assistance Program include: financial
counseling, childcare, counseling on the effects of deployment
on children and the effects of reunification, volunteer
opportunities for spouses, support and assistance to
geographically dispersed youth, separation and grief and loss
issues, personal outreach visits by trained psychologists and
other professionals, including members of the Chaplain Corps.
In implementing the Yellow Ribbon Reintegration Program, I
cannot overemphasize the priority that we in the Department of
Defense give to family support programs, as well as to the
formation of partnerships among DOD and the Veterans
Administration and local mental health programs.
The Department of Defense has been working at flank speed
to establish and give shape to Yellow Ribbon Reintegration
Program activities all over the Nation, as required by the 2008
National Defense Authorization Act.
After a 6-month monumental effort by the Department of
Defense to ensure compliance with all rules, regulations,
national security requirements, and following coordination by
and through all service components, I am extremely pleased to
be able to report that on July 17, 2008, Secretary of Defense
Robert M. Gates signed the memorandum establishing the Under
Secretary of Defense for Personnel and Readiness as the
official executive agent for the Yellow Ribbon Reintegration
Program, as required by the legislation.
On the next day, July 18, 2008, just 5 days ago, the Under
Secretary signed the directive-type memorandum that requires
the services and their components to implement the
reintegration programs in the fourth quarter of fiscal year
2008. That memorandum also requires the service secretaries to
provide service-specific implementation instructions to fully
support robust, high-quality deployment support programs in the
first quarter of fiscal year 2009.
Finally, I am very pleased to report that the Department of
Defense has received funding for the fourth quarter of fiscal
year 2008, and is developing the program's funding requirements
for future years.
Let me conclude my remarks by stating that the Yellow
Ribbon Reintegration Program is all about our troops. Through
the implementation of this program, we must meet our sworn
responsibility to best serve our soldiers, sailors, airmen,
Marines, and Coast Guardsmen who serve this great Nation.
I am proud of the ongoing efforts of the Department of
Defense to fully implement this new program. What our troops
deserve is only the very best.
I very much appreciate the fact that you have invited me.
On behalf of the Department of Defense, I look forward to
working closely with all of you and your respective staffs to
ensure that the Yellow Ribbon Reintegration Program is a
smashing success. Thank you, again.
[The prepared statement of Mr. Nelson follows:]
Prepared Statement of Donald L. Nelson, Director, Yellow Ribbon
Reintegration Program, Department of Defense
Chairman Akaka and Members of the Committee: Thank you for your
invitation to discuss DOD and VA cooperation on the reintegration of
our National Guard and Reserve veterans. As you know, Section 582 of
the 2008 National Defense Authorization Act required the Department of
Defense to establish a national combat veterans reintegration program
to provide National Guard and Reserve members and their families with
sufficient information, services, referrals, and proactive outreach
opportunities throughout the entire deployment cycle. I'm pleased to
tell you that the DOD Yellow Ribbon Reintegration Program Office opened
on March 17, 2008, in Suite 401, at 1401 Wilson Boulevard, in
Arlington, VA. The office has a toll free number of 866-504-7092.
This office has liaison personnel from the National Guard, the Army
Reserve, the Navy Reserve, the Marine Corps Reserve and the Air Force
Reserve, serving as subject matter experts to assist in implementing
the program. Veterans Affairs Deputy Secretary Gordon Mansfield has
also committed to continuing and strengthening his Department's
partnership with the Department of Defense by placing a subject matter
expert from the VA on our staff. We are working closely with the VA
Veterans Health Administration and the Department of Defense Outreach
Office, which focus their efforts on outreach to National Guard and
Reserve members and their families. We also work with the National
Guard Transition Assistance Advisors, the National Association of State
Directors of Veterans Affairs, the Department of Defense Joint Family
Resource Center and their Joint Family Support Assistance Program, as
well as each of the National Guard and Reserve family program offices.
Our purpose in doing so is to ensure that the Department of Defense is
doing everything possible to make the best use of available resources
in meeting the deployment support requirements of our returning
military veterans, especially those that are geographically separated
from military installations and dispersed throughout all 54 states and
territories.
The Directive-Type Memorandum that implements the program requires
the Services and their Reserve components to provide 30-, 60-, and 90-
day reintegration programs for their returning members by the 4th
quarter of this fiscal year. It also requires them to implement robust
deployment support and reintegration programs beginning in the 1st
quarter of fiscal year 2009. Our office will monitor and manage these
programs at the strategic level and ensure that locally available
resources are used to the maximum extent possible, while also making
sure that the availability of these programs is shared between the
components to allow members and families to access them at the location
closest to where they reside.
The Department of Defense recognizes that support for families and
employers is vital to success. The Department has devoted substantial
resources and efforts toward expanding support for our families. The
challenge is particularly acute for widely dispersed reserve families,
many of whom do not live close to major military installations. Thus,
we have developed and promoted web sites and electronic support for our
military families, and the use of nearly 700 military family service
centers for all Active, Guard and Reserve members and their families to
provide personal reintegration contacts, and we have hosted and
attended numerous family support conferences and forums. Reintegration
training and efforts to support members and their families following
mobilization, particularly for service in the combat zones, are vital.
The reintegration program in Minnesota has proven to be an exceptional
success and forms the basis for the DOD Yellow Ribbon Reintegration
Program with its Yellow Ribbon Reintegration Center of Excellence for
all Guard and Reserve members. The Department is fully committed to
implementing this program, which will provide Guard and Reserve
members, and their families, the support that will help them during the
entire deployment cycle--from preparation for active service to
successful reintegration upon return to their community, and beyond. We
will continue to work with Veterans Affairs, State Governors and their
cabinet members, their Adjutants General, the State family program
directors as well as with the Military Services and their components to
ensure that an integrated support program is delivered to all Guard and
Reserve members and their families.
The support for employers over the past six years mirrors the
increased support and emphasis upon families. We doubled the budget of
the National Committee for Employer Support of the Guard and Reserve
(ESGR). We developed an employer database that identifies the employers
of Guard/Reserve members, and expanded the ESGR state committees and
their support structure (over 4,500 volunteers are now active on these
committees) and we are reaching out to thousands of additional
employers every year. The Freedom Awards Program and national ceremony
to recognize employers selected for this Award has become a capstone
event, in which the President, in each of the past two years,
recognized the annual Freedom Award winners in the Oval Office (15
recipients per year are selected from more than 2000 nominees from
small business, large business, and the public sector). Never in the
history of the Guard and Reserve have families and employers been
supported to this degree, and they appreciate it, as this effort is
critical to sustaining an Operational Reserve.
The Senate Committee on Veterans Affairs has always been very
supportive of our National Guard and Reserve Forces. On behalf of those
men and women, I want to publicly thank you for all your help in
providing for them as they have stepped up to answer the call to duty.
Secretary Gates and I are deeply grateful, our military personnel and
their families certainly appreciate it, and we know we can count on
your continued support. Thank you for this opportunity to discuss the
Yellow Ribbon Reintegration Program on behalf of our Guard and Reserve.
Chairman Akaka. Thank you very much, Mr. Nelson.
Major General Chapman and Mr. Nelson, I am concerned that
the efforts of commands to identify and help those who may be
suffering from emotional trauma may not be entirely focused.
The approach seems to be one of providing information to a
large gathering rather than working to identify those in need
and so as to reach them in a more appropriate setting.
I would add that sometimes these sweeping approaches can
hurt overall morale while still not reaching those in need. The
units' temporal and elements of the military culture create a
wall that is hard for servicemembers to breach.
My question to you is, what can VA do to create an open and
private environment in which servicemembers will be able to ask
for help?
Major General Mathewson-Chapman. I will begin on that
question.
First of all, what we have found very popular and very
comfortable to use is our readjustment counseling centers, or
Vet Centers, as they are known. Veterans learn about them at
the demobilization process, because they do have a 15-minute
briefing by a combat veteran. So, that is the first step, the
choke point, that we call it, as they are coming through.
If you have read in the newspaper recently, they are
getting 232 of those Vet Centers to be built in small
communities. They are storefront operations. They are not in
the hospital. And you know the stigma of coming into a hospital
and asking for mental health care. We are finding that they are
coming to the Vet Centers.
VA is getting ready to add another 39 centers in a lot of
small communities in America by 2009, then there will be a
total of 271 of those centers.
Again, VA is adding additional mental health resources at
community-based outpatient clinics that, again, are not in the
hospital. They are in small communities providing the outreach,
but also, mental health facilities have mental health
specialists there.
They are adding another 44 new community clinics, and also
in our rural health initiative in small communities--they do
not have the base to have a full-time large clinic. They have
outreach centers, again, to be able to provide mental health
services.
The family members--as we work with family programs, we
found the family is the key, the hook; because if we can
educate the family, the spouse, the mother, the sister of what
to look for when your spouse comes home, and where to go, how
to access those services, then we also are reaching out to
those with pamphlets and information. Our TAAs are out there
working with the family programs.
We are doing the outreach piece. It is more than just the
education, but it is how to access the system, and that is the
critical component--how to get in when I need it.
Chairman Akaka. Right.
Major General Mathewson-Chapman. And the call center,
again, will also call them, as I gave an example of an
individual--it was just at the right time that he was called.
And all of them will be called to make sure that they are
transitioning home successfully.
Chairman Akaka. Thank you.
Mr. Nelson, would you have any comment?
Mr. Nelson. I would just add, Mr. Chairman, that at the
reintegration activities--at the 30-, 60-, and 90-day
intervals, beginning with the 30-day reintegration activity--
servicemembers are required to fill out a post-deployment
health assessment. And at the 90-day level, they are required
to fill out a post-deployment health reassessment form.
OSD policy currently vests in unit commanders the
discretion to order members to active duty for a day or so--
whatever the period is to be required--so they must fill out
the post-deployment health reassessment form.
And when the forms are being executed, we have, on station,
professionals--fully trained psychologists, doctors, some
doctors who are psychiatrists, nurses, and other health care
professionals--whose job it is to review the answers and to
offer themselves as available to talk to anyone who may have
indicated that they do have a problem.
And those who are perceived to have a problem, even though
they do not profess on paper to have a problem--we are making
our very best efforts to deal with them, because we interview
family members.
For example, at the 30-day point, members have been home
with their families, the same at 60, the same at 90 days. So,
we have an opportunity to talk to family members, coworkers,
employers, friends, and other individuals who may have been
able to assess the behavior of the individual on an individual
basis following release from active duty.
The system certainly is not perfect, but we are making
every effort to work out the kinks. I could not agree more that
this is exceedingly important, and we are doing our level best
to make sure that no one gets through the system who has a
problem who is not completely treated by existing facilities
that are there to treat people.
Chairman Akaka. Thank you very much.
Senator Murray.
Senator Murray. Thank you, Mr. Chairman.
This past March, in my home State of Washington, a National
Guardsman and former Stryker Brigade soldier by the name of
Specialist Timothy Juneman tragically took his own life--a
story that we are hearing, you know, far too often.
Now, the Spokane VA psychiatrist who was treating that
young man wrote in his medical records that imminent
redeployment to Iraq with the National Guard was a major
stressor contributing to his condition. The week before he took
his own life, he received final notification that the National
Guard had rescinded a promise not to send him back to Iraq for
2 years.
So, despite the VA's assessment that redeployment was
causing him this serious mental hardship, the Spokane VA could
not contact the Washington Army National Guard to advise
officials of that diagnosis. And I am told that the VA cannot
inform the Department of Defense about the medical conditions
of active veterans such as Guard and Reserve members without a
patient's consent.
Now, I understand and have no doubt that there are good
reasons for that policy, but I am wondering if there should not
be an exception in extreme cases like this, like suicide; and I
wondered if all of you could comment on that for me this
morning.
Major General Mathewson-Chapman. I can comment on--I know
this case is under review, but I think what you are referring
to is, again, notifying DOD of high-risk individuals.
Senator Murray. That is correct.
Major General Mathewson-Chapman. And that is true--because
of the policy laws, we cannot tell a commander that someone is
high risk. It has to--the individual soldier has to sign out
his own medical records to get his records--to be able to give
to the commander--when being requested.
I do not have an answer for that.
Senator Murray. Is there any way to make an exception in
extreme circumstances?
Major General Mathewson-Chapman. On the VA side, I do not
know. It is something that I can certainly take for the record
and see if the VA has some answers for that and get back to
you.
Senator Murray. Anybody else? Anything we can do?
Mr. Nelson. We make every effort, Senator Murray, to make
sure that such tragedies do not occur, by virtue of the
professionals that we have to assess these situations, as I
indicated just a moment ago.
The privacy statutes to which my colleague referred do
place some restraints on the release of information. I would
also have to take that issue for the record, because I am not
personally familiar with the scope and extent of those privacy
regulations, but I do know that they are out there.
That said, I would be happy to take the issue for the
record and get together with my colleague on this.
[The response from VHA follows:]
Response to Question Arising During the Hearing by Hon. Patty Murray to
Veterans Health Administration, Department of Veterans Affairs
Question. Is there any way to VA can share medical records with DOD
in an extreme case, such as the risk of suicide?
Response. The Health Insurance Portability and Accountability Act
(HIPAA) prohibits the Department of Veterans Affairs (VA) from
disclosing protected health information without the patient's express,
signed, written authorization or pursuant to legal authority prescribed
in Federal laws and regulations. There are, however, exceptions which
permit, but do not require, the Department of Veterans Affairs (VA) to
disclose personal health information to other entities, including the
Department of Defense.
The intent of HIPAA is to protect the patient from unwanted
releases of information, thus helping to create an environment of trust
for patients and providers when discussing personal health information.
VA cites two relevant authorities under which VA may legally
disclose health information to the Department of Defense (DOD) without
obtaining the express authorization of the patient:
1. Serious Threat to Health or Safety: (HIPAA 45 CFR
164.512(j)(1)(i); 38 U.S.C. 5701(b)(3); and Privacy Act 5 U.S.C.
552a(b)(8)): Protected health information, including mental health
information, may be disclosed to DOD when a VA clinical provider
determines that such a disclosure would serve to avert a serious threat
to health or safety. VA clinicians are aware of and adhere to the duty
to warn, which exists if, in a clinical case, a patient presents a
clear danger to him or herself or others. Our health care professionals
provide immediate care to anyone in need. If the patient is competent,
VA requests a patient consent to a disclosure of information as needed.
If a patient refuses to accept treatment, VA works under state
authorities to provide treatment through involuntary commitment or
other means, as warranted.
VA may disclose information to DOD. Once DOD is notified of the
serious threat, the patient must be provided a written notification to
his or her last known address, indicating that a disclosure was made to
DOD.
2. To a DOD or Other Health Care Provider for Treatment of the
Individual: (HIPAA 45 CFR 164.502(a)(1)(ii); 38 U.S.C. 5701(b)(3); 38
U.S.C. 7332 (2)(A), and (3)(e)(2); and Routine Use #43 under Patient
Medical Records-VA (24VA19) Privacy Act system of records): Protected
health information may be disclosed to DOD or other health care
providers in order for them to provide treatment to the individual. If
a patient is being seen or needs to be seen by a DOD health care
provider, VA may disclose the patient's health information, including
mental health information, to the DOD health care provider in order for
DOD to provide care to the patient. VA must have knowledge of a
treatment relationship between the patient and the DOD health care
provider prior to disclosing the patient's health information to the
DOD health care provider.
Senator Murray. OK. I would really appreciate you taking a
look at that policy, because it seems to me, in those extreme
cases, when clearly that is the stressor, there should be
communication and work to make sure that situations like that
do not occur. So, I would really appreciate an answer back for
the record. Thank you.
On another topic, we know that Guard and Reserve veterans,
as I said earlier, are twice as likely to have their disability
compensation claim rejected by the VA.
Last year, I put an amendment on the Defense Authorization
Bill that requires the Secretary of Defense and the Secretary
of Veterans Affairs to present a plan to expand the Benefits
Delivery at Discharge Program to National Guard and Reserve
members in order to reduce that discrepancy.
Mr. Nelson and Mr. Mayes, perhaps you could give me a quick
synopsis of where that is and when we are going to see it.
Mr. Mayes. Senator Murray, I will try and take that.
We just--the Compensation and Pension Service within the
Veterans Benefits Administration--we just issued policy
guidance, I believe it was last month. Essentially, what we
have done is expanded the BDD program to any separating
servicemember who files a claim 60 to 180 days from separation.
So, before we changed our policy, the BDD program was
limited to places where we had formal agreements with the
Department of Defense. And if you count the Coast Guard, we had
153 of those agreements in place, actually.
And so, what we have done is said, if we can get that claim
within that window, then we will call it a BDD claim. In order
for it to be a BDD claim, we need some things, though, because
we want to expedite the delivery of the benefits. And what we
need is a signed application. So, we need to sit down with the
servicemember, find out what disabilities they have that they
are claiming.
We have to comply with our statutory requirement to fully
notify them of what it takes to successfully prosecute a claim
as a result of the Veterans' Claims Assistance Act of 2000. So,
we have to provide that notice, and then we get from them what
is called a notice response, essentially, which is telling us
we have everything that there is for us to review to make a
decision.
Senator Murray. So, it is a communication issue of going
back and forth when they are out in the States and regional
areas and you do not have face-to-face contact?
Mr. Mayes. Well, what we want to do and what we are doing
is having that face-to-face contact, and we are doing it--and
that is BDD.
If I might--we actually have expanded that even further and
created what we call Quick Start claims so that if you have a
servicemember that maybe is not able to file a claim in that
60- to 180-day window, but is pre-separation, then we will do
the same thing.
In order for this to be successful, we need to be able to
have those elements of the claim, and primarily, the service
treatment records. We are reaching out to Guard and Reserve
soldiers at the time we provide benefits briefings.
Now, it may not be TAP because, as I said in my statement,
when they are demobilizing, they want to get home.
Senator Murray. Right. We know that.
Mr. Mayes. But we are available, and we are there when they
come back to these family days or their first drill. And at
that time, we give them the briefing.
And we are also setting up claim workshops in instances
where the command allows us to be there for enough time to sit
down with the demobilized Guard and Reserve soldier, go ahead
and take the claim. Hopefully, we can get the notice response,
we can get the service treatment records, and then we feed it
right into the system. And because they are OEF/OIF claims, we
are expediting the processing of those claims.
Senator Murray. Should those TAP attendances be mandatory?
Would that help?
Mr. Mayes. Well, I get that question a lot.
I would say that TAP, really, in its original--as it was
originally created was designed for active duty component,
because you--when someone is getting ready to separate, they--
typically they are going to have some time.
Retirees, we can give that TAP briefing up to 2 years prior
to separation, for others a year prior to separation. We can do
it 180 days after separation.
But the Guard and Reserve soldier, I mean, they are coming
out of theater, they are going to the demobe site for 3 or 4
days, and then they go home. Whether you call it TAP or a claim
workshop or a family day when they come back to that first
drill, you know, I do not want to say that it should be
mandatory. I think what needs to be mandatory is VA have an
opportunity to present the benefits and services that are out
there for them.
Senator Murray. And today they do not have that?
Mr. Mayes. I think they do in most cases. I really think
that they do. And if there is a servicemember that is denied
that opportunity, I would suggest that DOD has to provide that
opportunity.
But I think they are getting the opportunity, and I would
defer to my colleague.
Senator Murray. Well, Mr. Nelson, should that be mandatory?
Mr. Nelson. The general program?
Senator Murray. Yeah.
Mr. Nelson. I would agree with my colleague that the
assistance program started off as a function of the Department
of Labor and primarily was, and is--a program directed toward
active duty personnel who are separating--thank you--who are
separating from the service as opposed to Reservists and
Guardsmen who are going back to their civilian jobs; and, more
likely than not, may be subject to being recalled--their
being--to be reconstituted to somewhere downstream.
They will remain in the Guard and Reserve program. The
people to whom the TAP program should be directed are those who
are separating, because they are the people who are the
potential beneficiaries of all the elements of the TAP program.
I would agree with Brad on that.
Senator Murray. Well, when we see a VA IG briefing that
says the TAP briefings did not meet the VA set goal of 53
percent, I think we still have work to do; and we have got to
figure this out.
Mr. Chairman.
Chairman Akaka. Thank you. We will have another round here.
Senator Tester.
Senator Tester. Yes, thank you, Mr. Chairman. I want to
thank the witnesses for testifying today. I do not really know
where to start, but will start here.
As for Mr. Nelson, some of the witnesses' testimony in the
next panel talk about requiring servicemembers to complete the
10-10EZ during demobilization. You say that you offer them a
chance to enroll in the VA through increasingly standardized
demobilization processes. What is wrong with an actual
requirement that the member fill out the form? Major General
Chapman, you can answer it, too.
Go ahead.
Major General Mathewson-Chapman. I am a little confused on
your question. This is the first time we have been allowed in
to the demobilization process, and we cannot mandate, requiring
that everyone fills it out; but we are certainly encouraging
them and teaching them how to fill out an abbreviated form
rather than the long, cumbersome form.
Senator Tester. So, why can't you require it?
Major General Mathewson-Chapman. Why can't we require them
to fill that out?
Senator Tester. Yes.
Major General Mathewson-Chapman. I have just been told that
we cannot mandate--VA cannot mandate to DOD because they are
still active duty soldiers--they are not veterans yet--that
they have to fill it out.
Now, in Montana, the Adjutant General has mandated that all
of his Guardsmen complete the forms. We do know about Montana's
program, and other States are doing the same thing.
So, whether it is at the demobilization station--we are
encouraging them, and we are actually counting the numbers of
those that are at the demobe site and how many forms we
actually collect. And what we are finding--many of them are
already enrolled. Many of them are going to stay on active
duty, so they are certainly not veterans.
So, we are getting 100 percent of those that are
demobilizing--going through the system, completing the forms,
and submitting them. And we have developed a standardized
process now so that paperwork goes to where your home of
record--where you want to receive your care, back to that field
site--and then they register them into the system, and then we
complete the final enrollment. It takes about--anywhere--two to
4 weeks.
Senator Tester. For those that fill it out?
Major General Mathewson-Chapman. For those that fill it
out.
But right now, we are finding across the board 100 percent
of them that are at the demobilization site are filling them
out.
Senator Tester. What----
Major General Mathewson-Chapman. At the 12 sites, soon to
be 15 sites.
Senator Tester. And does that include all of the returning
folks, the ones that----
Major General Mathewson-Chapman. Right. Well, we are asking
them to----
Senator Tester [continuing]. The demobilization, is that
everybody that returns from theater.
Major General Mathewson-Chapman. Yes, yes.
Senator Tester. So, everybody who returns fills out the 10-
10EZ form?
Major General Mathewson-Chapman. Yes. And if they feel they
are already enrolled, we encourage them to please fill out the
top part so we can verify their enrollment.
Senator Tester. OK.
Major General Mathewson-Chapman. So, we do have forms on
everyone.
Senator Tester. OK. One of the things that the Montana
Guard has also done is extend out the post-deployment health
assessment to 2 years instead of 90 to 180 days. Obviously, it
means tracking a servicemember's mental health status for
longer than what is currently done. I think it is a decent
idea, because mental health issues do not always manifest
themselves right away.
What is your sense about whether this is worth doing in
other States?
Major General Mathewson-Chapman. Well, this is--again, the
PDHRA is a DOD program, and I would probably refer----
Senator Tester. Mr. Nelson.
Major General Mathewson-Chapman [continuing]. To my
colleague.
Senator Tester. Mr. Nelson, I can repeat the question if
you want. If you heard it----
Mr. Nelson. I heard the question, which was--the post-
deployment health reassessment is a form that servicemembers
are required to fill out at the 90-day point.
As a matter of policy, we--let me back up. The Commission
on the National Guard and Reserve has met, and we expect to
have a final recommendation to Secretary Gates on August 29,
2008; and there are no less than 95 separate recommendations
that that Commission dealt with.
And one of them--in fact, several of them--touch upon a
concern the post-deployment health assessment and the post-
deployment health reassessment forms. And I believe that the
numerical sequence of those forms is, like, from 73 through 80.
The services have basically concurred--with the exception of
the Army--with all seven of those recommendations.
Senator Tester. Does one of the recommendations include the
reassessment out 2 years?
Mr. Nelson. Not to my knowledge. Not to my knowledge. I
cannot answer--not to my knowledge.
Senator Tester. So, just to get back on question, I mean,
the signature injury coming out of multiple deployments in Iraq
especially is mental health issues. They often do not crop up
immediately. They often crop up even longer than 2 years.
So, what would be wrong with extending that from 90 to 180
days to 24 months.
Mr. Nelson. I am not a health care professional. I do not
think I am qualified to answer that question. I am not a health
care professional. But I can assure you we will look into that
for you sir.
Senator Tester. Thank you very much. I appreciate that.
I got to have a question for Mr. Mayes, because I do not
want him to feel left out here.
The process for arranging VA briefings for a returning
Reserve unit is still fairly informal--meaning that it really
depends on the individual's commander's willingness and ability
to connect with the VA.
Do you anticipate the relationship becoming more formal
between the Reserve units and the VA?
Mr. Mayes. Yes, I do. I think you are familiar with the
relationship with the National Guard, and it is more
formalized. We have a national MOU, and then we have MOUs at
the State level. We have put those in place because it does lay
out expectations on both sides, and we are exploring a national
MOU with the Reserves.
Senator Tester. OK. When do you anticipate that occurring?
Mr. Mayes. It is well underway, but I cannot give you a
date at this time.
Senator Tester. OK. In your testimony you talked about a
lot of outreach you are doing, and it all sounded decent. It
sounded good.
One of the things that crossed my mind, your position is
compensation benefits for the VA.
Mr. Mayes. Yes, sir.
Senator Tester. And it deals with Guardsmen and
Reservists--probably among others--but Guardsmen and Reservists
who are returning from combat that are under special conditions
unlike active duty folks. And in rural areas, it becomes an
issue. In my opening statement, I talked about folks who go
into rural areas, and we are talking frontier areas where they
are kind of on their own to get back into society unless VA
reaches out.
You have talked about welcome-home packages and briefings.
Do you have folks on your staff that have been through the Iraq
conflict that can talk about things that will get the attention
of Guardsmen and Reservists who are coming back from theater?
What I am talking about is--I get a lot of information
everyday being a U.S. Senator, and some of it I look at and
some of it I do not. And my guess is that the folks coming back
from Iraq and Afghanistan probably are getting a lot of
information, whether it is written or verbal or whatever, and
some of it will catch their attention and some of it will not.
So, it would seem to me that the folks coming back would
have an idea on what catches people's attention and what does
not. So, do you have folks in your shop that have been through
the war?
Mr. Mayes. Yes, sir, we do. We have people who have been
through this conflict, been through Desert Storm, as well.
Senator Tester. Working for you?
Mr. Mayes. Working for me, yes, sir.
Senator Tester. OK. Well, that is good.
All right. Thank you, Mr. Chairman.
Mr. Mayes. You know, if I might----
Senator Tester. Yes.
Mr. Mayes [continuing]. Expound on that just briefly.
I met with a severely injured Captain--she was severely
injured in Iraq-- and we sat down and talked about that. And
you know, one of the things that she said is you have to look
at different ways of reaching these folks, and I think that is
where, maybe, you were going with that.
And I anticipated the question from the Committee, you
know, is there something you can do better? And I think we have
got to--in my oral statement, I said that we have got to be
innovative. And I think that is an area that we have got to
explore, because there are people out there using text
messaging and podcasts, and things out there, frankly, that I
do not know about. But we sat down with this individual, we got
those ideas, and we are exploring that so that we can sort of
communicate in the language of this modern warrior. It is a
little bit different than you would communicate with a veteran
who served in World War II, possibly, or Korea.
So, I appreciate the question.
Senator Tester. Yes. Just one more, if I might, Mr.
Chairman, because your answer brought some things to mind that
Major General Chapman talked about in her testimony.
You are dealing with folks who have been brought out of--
they are in the Guard and Reserve, which has been a part-time
job, and they are put into a full-time situation, and they
leave their normal full-time job, and it can result in
financial difficulties. And that, by the way, can translate
into mental difficulties. Is there anything that the VA can do
to help those folks that are in a situation--are there benefits
out there?
Let me give you an example. I was in Great Falls, Montana,
about a month ago. A guy walked up to me and said, I was going
to college--he was in the Reserves, I believe, maybe the
Guard--and I was in Iraq, did my time in Iraq; came back. He's
got student loans though, cannot go to college anymore. He has
got PTSD, cannot stay focused, and he has got these loans that
are available that have to be paid now that he is out of
college. Is there anything the VA can do to help folks like
that that are in that condition?
Mr. Mayes. Well, the situation that you described, it
sounds to me like this veteran--and this is a hypothetical--but
this veteran has disabilities that are related to their
military service.
And so--I mean, the essence of the Disability Compensation
Program is that we provide a monetary benefit, compensation,
for someone who is suffering from a disability or disease that
was due to their service.
So, I would say yes. And if it is so severe that it
precludes employment, we have a provision in our rating
schedule that allows us to pay a total evaluation based on
individual unemployability. So, I would say that is available.
If they have a VA home loan, we can work with them to try
and prevent that loan going into foreclosure. So, there are
some things in our tool bucket, as you mentioned in your
opening statement, that we have that we can do.
Senator Tester. That is good to know. And this is it, but
with the caveat that a lot of these folks are not getting
through the door, which is a problem.
So, thank you.
Chairman Akaka. There are many things that we need to do in
policy to deal with the problems that are facing us at this
time, and we need to do this.
Major General Mathewson-Chapman. Thank you, Mr. Chairman.
Mr. Mayes. Thank you.
Chairman Akaka. I want to thank our first panel for your
responses and your presence here, as well.
Again, I repeat, I am so glad that we are holding this
hearing on the Guard as well as the Reserve. There are many
things that we need to do in policy to deal with the problems
that are facing us at this time. We need to do this, so, we
need to work together. So, I want to thank the first panel for
being here this morning.
Mr. Mayes. Thank you, Mr. Chairman.
Major General Mathewson-Chapman. Thank you.
Mr. Nelson. Thank you.
Chairman Akaka. I call up the second panel.
First, let me welcome Dr. Joseph R. Scotti, who is
Professor of Psychology in the Eberly College of Arts and
Sciences at West Virginia University--at West Virginia
University. You may be seated.
Next, I want to welcome Colonel Bradley E. Livingston,
Chief of the Joint Staff of the Montana National Guard.
Next, Lieutenant Colonel John Boyd, who is Deputy Chief of
Staff for Personnel from the Vermont National Guard.
Also, welcome to Sergeant Roy Wayne Meredith, an Infantry
Team Leader from the Army National Guard.
And finally, welcome to Major Cynthia Rasmussen, a Combat
Operational Stress Officer for the 88th Regional Readiness
Command, Surgeon General's Office, out of Fort Snelling,
Minnesota.
Your full statements will appear in the record, and we look
forward to hearing from all of you. We will start with Dr.
Scotti, if you will please begin with your statement.
Dr. Scotti.
STATEMENT OF JOSEPH R. SCOTTI, Ph.D., PROFESSOR OF PSYCHOLOGY,
EBERLY COLLEGE OF ARTS AND SCIENCES, WEST VIRGINIA UNIVERSITY
Mr. Scotti. Mr. Chairman and Members of the Committee,
thank you very much for having me today. This is really a great
honor and a super opportunity to present some findings from a
survey we did in West Virginia.
I am a licensed psychologist and a professor of clinical
psychology in West Virginia. I am not an ivory tower
psychologist who just runs out and does research. I want to
apply that research, I want to use it. I have many years of
experience working with the Morgantown Vet Center and the
Clarksburg VA and veterans of many eras. So, this is research
that I hope will lead to application.
I am going to summarize some of our results. The full
findings are in my report. Basically, we looked at 848 veterans
in West Virginia, 57 percent of whom were in the National Guard
or Reserve, and 52 percent of whom resided in rural areas of
our State. There were earlier comments about the importance of
looking at rural veterans. I would like to emphasize that.
It is no surprise to anyone here that being in combat leads
to Post Traumatic Stress Disorder, depression, and other mental
health problems. The present military conflict is particularly
unique, given that it involves the National Guard and many of
the issues that have already been stated here in terms of their
training and deployment back home.
The information I have here is also important because it is
not, as in many studies, just from veterans who seek treatment
at the VA. This is from a group of veterans who applied for
benefits from the State and that makes them a rather different
population.
I want to emphasize several points. One is that the
veterans in the National Guard and the Reserve were more likely
to be in the Army, were more likely to have combat exposure (as
opposed to active duty personnel), if they were from rural
areas of the State. In terms of Post Traumatic Stress Disorder
and depression, we found that a third of these veterans--more
so in rural areas of the State and more so if they were in the
National Guard--were experiencing Post Traumatic Stress
Disorder, and about 40 percent were experiencing depression.
Overall, between these two 47 percent--almost half--were
experiencing PTSD and/or depression. Again, more likely in the
Guard, more likely in rural areas.
We also looked at access or utilization of services. And in
this particular study, the veterans are reporting high
awareness of services from all levels, from informal contacts
all the way up to VA hospitals and Vet Centers. However, this,
again, is also already a group that sought monetary
compensation from the State. So, they may be a particularly
aware group.
This group, only about 50 percent have had some contact
with the VA, and only about 40 percent find that their services
are helpful. And I can elaborate on why that might be during
the question period.
One of the points that I want to make is that the VA and
the Department of Defense--although I think it does a wonderful
job, I have had the experience of working with the VA--they
need not be the sole source of help for these veterans. There
is a great civilian network available, and I think with
community mental health professionals, primary care
professionals, and private practice that we can go a long way
in supplementing VA services.
I wanted to make a couple of recommendations, and I was
glad to hear that funding for the post-deployment programs for
the National Guard is going to be forthcoming. That is sorely
needed, and I hope that it is funded at an adequate level. We
need to provide support and disseminate effective treatments at
many levels, including the VA and down all the way to private
care practitioners. I hope that we would have support and
funding for linking many of the local State and Federal
agencies in doing all this work.
I have many additional comments that I want to make,
especially in response to some of the prior testimony; so, I
will conclude my formal comments, but I am hoping to answer
many questions. Thank you.
[The prepared statement of Mr. Scotti follows:]
Prepared Statement of Joseph R. Scotti, Ph.D., Professor of Psychology,
West Virginia University, Morgantown
Chairman Akaka, Ranking Member Burr, and Members of the Senate
Committee on Veterans' Affairs: Thank you for the honor and the
opportunity to provide the following testimony.
I am Joseph R. Scotti, Ph.D., a West Virginia licensed clinical
psychologist and a professor of psychology at West Virginia University
(Morgantown, WV), where I have been employed for the past 18 years. I
have conducted service, teaching, and research in the area of Post
Traumatic Stress Disorder (PTSD) in a wide-range of populations (e.g.,
children, college students, adults) that have experienced a variety of
traumatic stressors (e.g., combat, motor vehicle accidents, sexual
assault, and technological/industrial accidents). I have worked with
combat Veterans of various eras (WW II, Korea, Vietnam, Desert Storm,
and the current conflicts) since 1989 in various capacities, including
over 12 years of consultation services (involving assessment,
diagnosis, and treatment) at the Morgantown Vet Center (a Center that
has distinguished itself as ``Best Vet Center in the Nation'' for
multiple years) and the Louis A. Johnson VAMC (Clarksburg, WV), and
through clinical services offered within the Department of Psychology
at West Virginia University. I have multiple publications in journals
and books, and dozens of conference presentations on PTSD in general,
and combat veterans in particular. Presently, I am conducting research
with my colleagues on Veterans of recent conflicts, and am
collaborating with the West Virginia National Guard Family Assistance
Center to provide services to military service personnel and their
families.
This testimony is provided to summarize key findings from a survey
research study conducted by my colleagues and myself with Veterans from
West Virginia who have been deployed in various areas of the Middle
East as part of Operation Enduring Freedom (OEF), Operation Iraqi
Freedom (OIF), and related military operations.
The testimony shall show that for military personnel from the State
of West Virginia:
1. Those who served as members of the National Guard and Reserves
experienced exposure to combat and related war zone stressors at a
level equal to that of Active Duty personnel.
(a) Those Veterans from Rural Counties of West Virginia experienced
greater combat exposure than those from Urban West Virginia
Counties.
2. Those Veterans who served as members of the National Guard and
Reserves are experiencing a greater negative impact on psychological
and daily functioning than are Active Duty personnel.
(a) Those Veterans from Rural Counties of West Virginia are
experiencing a greater negative impact than those from Urban West
Virginia Counties.
(b) The negative impact extends beyond the Veterans themselves and
includes significant others and children.
3. Awareness of a wide range of services and supports to address
the negative impact on the psychological and daily functioning of
Veterans is generally high (80% to 90%).
(a) Utilization of services and supports varies by level, but
typically, one-third to one-half or more of veterans in need are
not utilizing professional or VA-related services.
(b) Only about one-half of Veterans report that a service they have
utilized was ``helpful'' to them.
background
This survey research study was conducted by the Veterans Work Group
at West Virginia University (Project Coordinators: Virginia Majewski,
Ph.D., School of Social Work, and Joseph R. Scotti, Ph.D., Department
of Psychology; Key Contributing Members: Hilda R. Heady, M.S.W.,
Associate Vice President for Rural Health, and Roy Tunick, Ph.D.,
Department of Counseling and Rehabilitation Counseling). The survey was
requested and funded by the West Virginia State Legislature Select
Interim Committee on Veterans' Issues (Co-Chairs: Delegates Barbara E.
Fleischauer and Richard J. Iaquinta, and Senator Jon B. Hunter) in
response to that Committee's concerns regarding the need for and access
to mental and physical health services among West Virginia's military
personnel (particularly the National Guard and Reserve) who were
returning from OEF/OIF and related deployments.
The survey study was funded in October 2007, conducted during
November 2007 to April 2008, and the resulting data have since been in
various stages of analysis. The survey was an intentionally brief 108
questions in order to maximize response rate. The focus was on
demographics, deployment experiences, the impact of those deployment
experiences (in terms of symptoms of PTSD and depression, and changes
in various areas of basic functioning), and awareness and use of a wide
range of services. The staff of the WV State Division of Veterans
Affairs mailed the survey to 6,400 WV Veterans from their mailing list
of Veterans who had applied for the WV State Bonus ($600) for having
served overseas. Approximately 1,000 surveys were undeliverable;
approximately 1,100 completed surveys have been returned (a 20%
response rate: 1,100/5,400). This testimony is based on 848 surveys
presently entered into the survey database and which represent those
Veterans who have served in the present conflicts of interest.
It is well established that there is an association between
exposure to combat and other war zone stressors and the occurrence of
mental health problems such as PTSD, depression, and substance abuse.
Such research has almost exclusively been conducted with military
Veterans who had enlisted or were drafted directly to active duty, and
primarily with Veterans who were identified through VA patient roles.
The present military conflicts (i.e., beginning with Operations Desert
Shield and Desert Storm to OEF and OIF) are unique in the inclusion of
members of the National Guard in military conflicts outside the borders
of the United States. Given the differences in the intensity,
regularity, and type of training between active military and National
Guard units, the impact of combat and related war zone stressors on
members of the National Guard who have served in the conflicts overseas
is a relative unknown. Thus, a portion of this testimony is dedicated
to establishing the differential impact of war zone stressors on
members of the National Guard, as compared to Active Duty personnel.
Further, the Veterans in this survey were not accessed through VA
patient roles, but rather through the WV State Division of Veterans
Affairs. Thus, the information presented here represents both Veterans
who have and have not sought VA services.
survey research findings
General Demographics and Combat Exposure
Overall, the 848 persons (9% Female) in the study averaged 38 years
of age (20-64 years) and were primarily white (96%, as reflects the
demographics of WV). They came from all 55 counties in WV, with 57%
reporting service in the National Guard or Reserves and all currently
residing in WV. Of the 43% reporting Active Duty service, 56% were
still out-of-state and primarily at a military base. Furthermore, of
the 621 personnel residing in WV, 48% resided in the 13 urban counties
of the State; 52% in the other 42 rural counties. All respondents
indicated at least a high school degree and 30% reported some college.
Active Duty personnel were younger, on average, than members of the
Guard/Reserves (35 vs. 40 years), and were somewhat more ethnically/
racially diverse (93% vs. 97% white). (We note an overwhelmingly
positive response to this survey, with 87% or respondents reporting
that the survey was ``Worth the Time to Do.'')
All respondents had been deployed at least once to the Persian Gulf
Region since 1990 (97% since the year 2000) in--or in support of--
various operations: Iraq (71%), Afghanistan (16%), the Persian Gulf
Region (32%; e.g., Kuwait, Oman, Qatar, Saudi Arabia, Turkey), KFOR/
SFOR (the Kosovo Force/Stabilization Force in the Balkans region; 14%),
and Operations Desert Shield/Desert Storm (10%). Prior duty in
Operation Restore Hope (Somalia, 1%) and Vietnam (2%), among other
conflicts and operations, was additionally reported. Multiple duty
stations and or deployments were reported by 43% of the respondents.
All branches of military service were represented; however, members
of the Guard/Reserves were more likely to be in the Army (78%) than
were Active Duty personnel (48%), and were more likely to report Combat
Support Duty (70% vs. 60%) and less likely to report direct Combat Duty
(43% vs. 52%).
The Combat Exposure Scale (CES) was utilized to quantify the level
of exposure to combat and war zone stressors, including engagement in
patrols and dangerous duties; firing rounds at enemy forces; seeing
someone hit by rounds or explosive devices; and the percentage of unit
personnel who were wounded, killed, or missing. The CES score can be
quantified as indicating Light, Light-Moderate, Moderate, Moderate-
Heavy, and Heavy levels of combat exposure. The average score for both
Guard/Reserve and Active Duty personnel was in the Moderate range;
however, over 20% of Guard/Reserve and Active Duty personnel
experienced Moderate-Heavy to Heavy levels of combat exposure.
Urban-Rural Differences. Veterans from Rural Counties of WV
differed from those residing in Urban Counties in several ways. Rural
Veterans were: (a) more likely than Urban Veterans to have been in the
Army (83% vs. 60%), (b) to report Combat Duty (71% vs. 39%), and, (c)
to report more exposure to a Moderate Level of combat (based on the
Combat Exposure Scale; 33% vs. 23%) and less exposure to a Light Level
of combat (16% vs. 28%).
Impact on Mental Health
Commonly used and well-validated self-report measures of PTSD and
depression symptoms were utilized (PTSD Checklist, Center for
Epidemiological Studies--Depression Scale) to evaluate the possible
impact of combat exposure on the respondents.
[Symptoms of PTSD include reexperiencing the traumatic event, such
as nightmares and intrusive thoughts; avoiding reminders of the event,
including people, places, and activities; and hyperarousal, which
includes exaggerated startle response, irritability, sleep disturbance,
and concentration problems. Symptoms of depression include prolonged
sadness, low self-worth, sleep and appetite disturbances, self-blame,
and suicidal ideation.]
Using the recommended cutoff scores for these two measures (greater
than 43 on the PTSD Checklist and greater than 15 on the CES-Depression
Scale), 35% of the Veterans had scores suggesting clinical levels of
PTSD, and 43% had scores suggesting clinical levels of Depression.
Given the high concordance of depression with PTSD (a correlation of
.85 in this study), Veterans were classified as having PTSD and/or
Depression (PTSD/Depression Group: 47% of the respondents) or as not
meeting criteria for either (Other Veterans Group: 53%).
[NOTE: It should not be assumed that the Other Veterans Group was free
of mental health problems. The Other Veterans did not meet criteria for
PTSD or Depression, but may well exhibit other anxiety disorders,
substance use/abuse problems, sleep disturbances, and a range of sub-
clinical symptoms. Further, we did not directly evaluate Traumatic
Brain Injury in this study.]
By point of comparison, the 35% rate of PTSD in the present study
is similar to the 31% lifetime rate for PTSD reported in the National
Vietnam Veterans Recovery Study (NVVRS). Further, the recent Rand
Corporation Report (The Invisible Wounds of War, 2008) summarizes some
22 prior studies of OEF/OIF Veterans, giving a typical range of 5-15%
for the occurrence of PTSD, but with some studies reporting rates as
high as 30%. As if often seen in the trauma literature, rates vary by
assessment measure and criteria, sample characteristics, and time since
event, among other factors.
In this case, we note that members of the Guard/Reserves were more
likely than Active Duty personnel to meet the criteria for PTSD/
Depression (51% vs. 40%), despite having similar demographic
backgrounds and combat experiences. This result may reflect the impact
of pre-deployment preparation and training, support of families during
deployment, and post-deployment debriefing and support resources.
Urban-Rural Differences. One characteristic that is related to
mental health outcome in this study is whether the Veteran lived in an
Urban or Rural County (a factor not investigated in the research
summarized in the Rand Report). Veterans residing in West Virginia
(primarily Guard and Reserves) were more likely to meet criteria for
PTSD/Depression if they lived in a Rural County (58%) versus an Urban
County (44%). Note, however, that county of origin may be a proxy for
multiple other variables, including that persons in rural counties may
have a lower income, lower employment levels, lower quality of
education, dispersed support systems, greater transportation problems
(roads, gas prices, reliable vehicles, and public services), and
general availability and access to mental and physical health agencies
and other support services.
Suicide Risk
Due to growing concerns about the increased rates of suicide among
OEF/OIF Veterans, we reviewed the data for three factors that have been
shown to be associated with increased suicide risk: high levels of
symptoms of depression and PTSD, and high levels of combat exposure
(Rand Corporation, 2008). In this sample, 8% of the Veterans had scores
consistent with this ``risk profile,'' suggesting high risk for
suicide.
Impact on Daily Functioning and Family
We asked participating Veterans to report both how they currently
were functioning in daily life, and how their level of functioning had
changed from prior to their most recent deployment. Overall, veterans
did not differ in their reported level of functioning by their type of
service (Guard/Reserves vs. Active Duty), and time since last
deployment was not related to impact (i.e., functioning did not improve
over time).
As would be expected, Veterans with PTSD/Depression reported
greater declines in pre- to post-deployment functioning on a 10-point
scale (1 = extremely poor, 10 = extremely good), averaging less than a
1-point decline in rated functioning for Other Veterans, and averaging
over a 3-point decline for those with PTSD Depression in the areas of:
(a) Physical Health (-1.4 vs. -3.7), (b) Mental Health (-0.8 vs. -4.1),
(c) Family Relationships (-0.6 vs. -3.8), (d) Social Support (-0.2 vs.
-2.5), and (e) the Behavior and Academic Progress of Children (-0.2 vs.
-1.5). Further, when rating overall current functioning, 60% of
Veterans with PTSD/Depression rated at least one area of functioning
(Work/School, Military Duties, Home/Family, Social/Friends) as Poor or
Extremely Poor, as compared to only 7% of Other Veterans. It is
critical to note here that the impact of PTSD/Depression goes beyond
the mental and physical health of the Veteran; it also negatively
impacts significant others, children, friends, and work.
Urban-Rural Differences. Those Veterans residing in Rural Counties
were differentially impacted as compared to the Urban cohort. First,
Rural versus Urban Veterans reported a more negative impact on Mental
Health (-3.0 vs. -2.1) and Family Relationships (-2.7 vs. -1.8).
Second, 43% of Rural Veterans rated at least one area of functioning
(Work/School, Military Duties, Home/Family, Social/Friends) as Poor or
Extremely Poor, as compared to 25% of Urban Veterans. Finally, and most
telling, only 7% of both Urban and Rural Veterans without PTSD/
Depression rated at least one area of functioning as Poor or Extremely
Poor, as compared to 48% of Urban Veterans with PTSD/Depression. Over
two-thirds (69%) of Rural Veterans with PTSD/Depression rated at least
one area of functioning as Poor or Extremely Poor.
Service Awareness and Utilization
The above statistics establish that, as a group, members of the
West Virginia National Guard and Reserves who served in the recent
conflicts are experiencing a differentially greater mental health
impact than Active Duty Veterans from West Virginia. Furthermore,
Veterans residing in the Rural Counties of West Virginia are
experiencing both a greater mental health impact and greater declines
in functioning. It is then important to know if either Guard/Reserve
Veterans or Veterans from Rural Counties are differentially aware of
and seeking services.
To address this issue, the survey included a series of questions
asking whether the Veterans were aware of a wide range of support and
service options, whether they had used those services and support, and
whether the services and supports had been helpful or not. The
intentional brevity of the survey only allowed the respondents to
indicate use of a service, such as a VAMC. They were not able to
indicate the specific services accessed, such as the medical,
psychiatric, or benefits services at a VAMC. Further, use of a service
could have been by phone, mail, or in person. Thus, these results only
indicate some contact with a service, not the method of contact,
specific aspect of the service utilized, nor the duration of service
utilization. With these caveats, the general findings are next
presented.
Awareness of Services. Overall, West Virginia Veterans reported
being aware of the availability of a wide-range of services and
supports at each of five levels: (a) 92% reported the availability of
Informal Supports (e.g., family, friends, other veterans), (b) 87%
reported the availability of Formal Supports (e.g., Veterans
organizations and other support groups), (c) 84% reported the
availability of Emergency Medical Services (e.g., crisis line,
emergency room), (d) 91% indicated being aware that services from
Mental Health Professionals were available (e.g., clergy, counselors,
psychologists, social workers, etc.), and, (e) 88% were aware that they
could receive services from Center-Based Facilities (e.g., VAMC, Vet
Center, community mental health center). These rates of awareness of
availability did not differ by type of duty (Guard/Reserves versus
Active Duty). Urban Veterans without PTSD/Depression were somewhat more
aware of the availability of Emergency Medical Services than were Rural
Veterans with PTSD/Depression (89% vs. 79%).
Use of Services. It would appear that awareness of services is
quite high, although there is some room for improvement. Whether those
services have been utilized or not is the next question. Regardless of
status, 72% of Veterans in the survey reported use of Informal
Supports. Use of Formal Supports (53% overall) was more likely to be
reported by Veterans with PTSD/Depression (62%) than Other Veterans
(44%), as was the use of Emergency Medical Services (29% vs. 43%; 36%
overall). Mental Health Professionals (62% overall) were used by 54% of
Other Veterans and 70% of those with PTSD/Depression. Within the
variety of Mental Health Professionals, Veterans with PTSD/Depression
who lived in Rural Counties were the most likely group to use physician
services (67%). Services at Center-Based Facilities (54% utilization,
overall; including Vet Centers and VAMCs) were used more by Veterans
with PTSD/Depression (65%) than Other Veterans (43%); within this set
of services, hardly any use of community mental health centers was
reported (5%).
Overall, the utilization of a wide range of supports and services
is rather high, although clearly one-third or more of Veterans who are
potentially in need of services are not accessing them. Further, the
focus here is on a limited set of mental health issues, and not
physical health and other areas of concern (including TBI and substance
use/abuse). Nationally, about 39% of Veterans have at least one contact
with the VA system. The overall 37% utilization rate for Vet Centers
and 58% for VAMCs by West Virginia Veterans is apparently higher than
the national figures, and is likely due to the density of services in
West Virginia, with coverage by four different VISNs (4, 5, 6, 9) and
including four VAMCs, eight Vet Centers, and multiple CBOCs and
contract clinics in the most rural counties. The utilization rate
reported here may also be higher due to the very broad definition of
``service use'' in this survey.
Helpfulness of Supports and Services. Overall, 65% of the
respondents indicated that use of Informal Supports was helpful to
them; 53% indicated that services of Mental Health Professionals were
helpful. Formal Supports were helpful to 45% overall, but more so to
Veterans with PTSD/Depression (50%) than Other Veterans (39%).
Emergency Medical Services were helpful to 32% of the respondents who
used them (36% of Veterans with PTSD/Depression, 26% of Other
Veterans). Finally, while 45% found the Center-Based Facilities to be
helpful, again Veterans with PTSD/Depression (52%) found the services
more helpful than did Other Veterans (36%). Although we cannot
determine from this survey if Veterans were seeking or receiving those
services most appropriate to their individual situations, it is
disheartening to see that less than half of Veterans (including those
with mental health issues and declines in functioning) are reporting
the receipt of helpful
services.
conclusions and concerns
The prior sections support the initial statements concerning the:
(a) high level of combat exposure experienced by members of the West
Virginia National Guard and Reserves, with higher exposure by Rural
than Urban Veterans; (b) greater negative impact on the psychological
and daily functioning (of Veterans and their significant others and
children) experienced by members of the National Guard and Reserves,
with greater negative impact on Rural as compared to Urban Veterans;
and, (c) apparent under-utilization of various levels of support and
services, and the much less than complete satisfaction with the
``helpfulness'' of those services, despite generally high rates of
awareness of service availability among Veterans.
These findings point to significant concerns regarding the
provision of adequate services to all Veterans, but especially members
of the National Guard and Reserves, and those from rural areas of Our
Nation. These findings, coupled with the fact that the respondents in
WV seek out individuals in their informal helping systems first, and
given that there are multiple levels of services and supports that
Veterans utilize, we need not depend solely on the VA and DOD for the
provision of those services and supports. Further, as the need for
services goes well beyond Veteran themselves, but includes their
children and immediate and extended families, the need for a wide range
of family support services is evident--this being an area well beyond
typical VA services. In West Virginia, for example, the Council of
Churches has developed CARE-Net, a grassroots network of houses of
worship and their local communities to provide support, services, and
referrals to Veterans and their families. Further, the West Virginia
National Guard Family Assistance Center is consulting with other States
(such as Minnesota) about the development of a full circle of programs
and supports that run from pre-deployment, during deployment, and
following deployment. Although the Guard is now mandated to provide
homecoming and follow-up programs, States are left to develop and fund
those programs.
In West Virginia, we are also collaborating with the VA, AHEC (Area
Health Education Centers), and the Citizen-Soldier Program to bring to
our State a model program for disseminating information, providing
continuing education to community providers, and linking agencies.
These sorts of efforts are arising at all levels due to the
overwhelming need to support and serve Veterans and their families, and
to reintegrate Veterans back into their families and communities. It is
recognized that the VA and DOD need not--and perhaps should not be
expected to--do it all, even if such were possible. We recognize that
it takes a community--not an agency--to welcome a Veteran home.
In our work, we have thus formulated a number of questions that
will need to be addressed, including:
1. How will we network the multiple levels of service, from
informal/grassroots groups to state programs and facilities to Federal
programs and facilities?
2. How will we identify and follow Veterans over years to decades,
from initial return from deployment to resolution of identified
problems?
3. How will we identify and follow those Veterans in most immediate
need and those at greatest risk for suicide?
4. How will we ensure that all Veterans have equal access to
services, including rural and minority Veterans, those who have been
other than honorably discharged, and those who commonly do not seek
treatment or experience significant barriers to service access?
5. How will we ensure that Veterans are able to return--as soon as
possible--to a productive life?
6. How will we ensure that the Families of Veterans receive the
support and services that they need at all stages of their Veteran's
deployment?
7. How will we ensure adequate funding for services and related
research?
8. How can we do our best, as a Nation, to fully honor the
commitments and sacrifices of Veterans and their Families?
recommendations
In response to these data, the above questions and concerns, and
our personal experiences working with Veterans, families, communities,
agencies, and committed professionals, we have formulated three key
recommendations:
I. Fully fund and support homecoming programs to enable the
National Guard to adequately prepare their personnel and families for
upcoming deployment; provide support and services during deployment;
and offer support, services and referrals post-deployment (such as at
the required 30-, 60-, 90-, and 180-day reunions).
II. Support and fund the dissemination and evaluation of best
practices in a broad array of areas, including: (a) group and
individual treatment of combat-related PTSD (and comorbid depression,
substance abuse, family violence, etc.); (b) identification of suicide
risk and provision of related risk reduction services; (c)
reintegration to community, work, and educational settings; and (d)
child and family support and therapy services. Such dissemination
should occur with a range of professionals (e.g., clergy, social
workers, psychologists, vocational counselors, physicians and other
primary care professionals, psychiatrists, teachers), and in a range of
settings (e.g., from private mental and physical health practitioners;
to local grade schools, technical schools, and colleges; houses of
worship; community mental health centers; community health centers,
hospitals, and rural health clinics; to state agencies, military units,
and AHECs; to Federal agencies, such as Vet Centers, CBOCs, and VAMCs).
III. Support and fund the linking of local, state, and Federal
agencies in a coordinated effort of overlapping lay, volunteer,
paraprofessional, and professional services and resources in order to
meet the tremendous mental health, physical health, and quality-of-life
needs of our Military Personnel.
Chairman Akaka. Thank you very much, Dr. Scotti.
Colonel Livingston.
STATEMENT OF COLONEL BRADLEY A. LIVINGSTON, CHIEF, JOINT STAFF,
MONTANA NATIONAL GUARD
Colonel Livingston. Mr. Chairman and Members of the
Committee, thank you for the opportunity to provide testimony
on the Montana National Guard's efforts to strengthen our post-
deployment and reintegration process.
My testimony today reflects my personal views, and does not
necessarily reflect the views of the Air Force, the Department
of Defense, or the Administration.
Again, I am Colonel Brad Livingston, the Director of the
Joint Staff for the Montana National Guard. As previously
identified, in March 2007, the Montana National Guard lost a
soldier to a suicide linked to PTSD. That action prompted
Montana's Governor Brian Schweitzer and the Adjutant General
Randy Mosley to form a post-deployment health reassessment
program task force to evaluate the post-deployment process used
by the Montana National Guard.
We asked the task force, comprised of non-DOD subject
matter representatives from a variety of areas--for example,
mental health experts, Veterans Administration, local
ministers, and State government officials to evaluate our
current process, and to recommend actions for program
improvements.
After nearly 3 months of meeting, the PDHRA task force
reported--confirmed that the Montana National Guard was
following and, in many cases, exceeding established Department
of Defense and National Guard Bureau program guidelines, yet
the task force made fourteen recommendations in an effort to
improve our program. Due to the time, I will not go through all
14 of them, as they are in my written testimony.
As previously identified, all returning soldiers and airmen
now complete the VA form 10-10EZ to enroll for VA benefits.
This expedites follow-on care through the VA in the event that
it becomes necessary.
The assistance we have received from the Fort Harrison
Veterans Administration team has been key in our improved
program. The current PDHRA program conducted within 90 and 180
days after redeployment has been extended to 2 years.
Redeploying soldiers and airmen receive a behavioral health
review either through a post-deployment health reassessment or
a periodic health assessment conducted every 6 months for 2
years.
Montana implemented the periodic health assessment in June
2007. This new program replaced the formal annual medical
certificate and the 5-year physical program with an annual
medical review. The new review is required every year, and
includes a self-assessment by medical examination and a face-
to-face meeting with a physician or a physician assistant.
Montana Senators Max Baucus and John Tester met with Dr.
Chu, Under Secretary for Defense for Personnel and Readiness,
DOD, and secured an additional PDHRA cycle for Montana. This,
again, allowed us to expand our current review out to the 2-
year mark.
The Montana National Guard formed a pilot program with
TriWest Health care Alliance to place behavioral health care
specialists at both the Joint Force Headquarters in Helena,
Montana, and the 120th Fighter Wing Headquarters in Great
Falls. This program incorporates a face-to-face with a
behavioral health specialist into our annual periodic health
assessment program. The pilot began in June 2008, and will
continue through December 2008. At that time, we will evaluate
the effectiveness, along with the options for future
participation.
The Montana National Guard Public Affairs office developed
a comprehensive marketing plan for our outreach efforts. A
large part of the plan included development of a PTSD outreach
video and brochures that have been used as an educational tool
to help Montana build a stronger community partnership with
medical behavioral health providers, churches, Veterans service
organizations, and both the State and Federal--and employees
throughout the State of Montana.
Additionally, we conducted community presentations and a
presentation of Picking up the Pieces, a DVD that we produced,
along with a short presentation on PTSD in 20 Montana
communities that host a National Guard Armory. Our goal was to
provide education on the Guard's progress in addressing PTSD,
elevate the public's awareness, and involve Montana
communities' efforts to address the issues of PTSD within the
Montana National Guard and other service components.
The Montana National Guard continues to move forward in its
implementation of the task force recommendations and our new
development cycle support beyond the Yellow Ribbon Program. We
appreciate the assistance received from our congressional team,
the Governor, the National Guard Bureau, the Department of
Defense, and our many community partners who have contributed
their assistance and support in our efforts. We believe it
takes a community to return a veteran from combat.
On behalf of Governor Schweitzer, Major General Mosley, and
more than 3,700 men and women of the Montana National Guard,
thank you for your continued support and commitment to
Montana's veterans and their family. Thank you.
[The prepared statement of Colonel Livingston follows:]
Prepared Statement of Colonel Bradley A. Livingston, Director of the
Joint Staff, Montana National Guard
Mr. Chairman and Members of the Committee: Thank you for the
opportunity to provide testimony on the Montana National Guard's
efforts to strengthen our post-deployment and reintegration processes.
``My testimony today reflects my personal views and does not
necessarily reflect the views of the Air Force, the Department of
Defense, or the Administration.''
I am Col. Brad Livingston, the Director of the Joint Staff for the
Montana National Guard. In March 2007, the Montana National Guard lost
an Army Soldier to a suicide linked to Post Traumatic Stress Disorder
(PTSD). That action prompted Montana's Governor, Brian Schweitzer, and
Adjutant General, Randy Mosley, to form a Post-Deployment Health
Reassessment Program (PDHRA) Task Force to evaluate the post-deployment
processes used by the Montana National Guard.
We asked the PDHRA Task Force, comprised of ten community subject-
matter representatives from a variety of areas--for example: mental
health experts; Veterans Administration employees; local ministers; and
state government officials--to evaluate our current processes and to
recommend actions for program improvements.
Although the PDHRA Task Force report confirmed the Montana National
Guard was following and, in many cases, exceeding established
Department of Defense and National Guard Bureau program guidelines, the
Task Force made 14 recommendations in an effort to help improve our
program.
The recommendations are as follows:
1. Evaluate medical status before discharge
2. Allow Guardsmen to request honorable discharge
3. Thoroughly review all Guard PDHRA personnel files for
completeness
4. Expand the PDHRA Process
5. Mandate Enrollment in the VA Healthcare System
6. Guardsmen receive awards and medals within 90 days of return
7. Send badge information to DOD within 90 days
8. Include mental health focus in training
9. Increase awareness of available resources
10. Create Crisis Response Team (CRT)
11. Allow drill attendance upon return home
12. Increase informal support systems--Vet2Vet
13. Enhance Family Readiness Program
14. Form partnerships with State Veteran's Groups
pdhra campaign plan summary of accomplishments
Modified Discharge Process
Montana modified the discharge process to incorporate an additional
series of reviews prior to approval of a discharge. In addition to the
current command assessment, reviews were added for medical, legal, and
senior leadership. This serves the purpose of confirming that a
discharge request for an OEF/OIF/ONE member is not related to a PTSD or
other combat issue.
Developed Crisis Response Teams
In response to the recommendation, we created two Crisis Response
Teams, with one team located in Helena, Montana and the other in Great
Falls, Montana. The purpose of the Crisis Response Team is to evaluate,
analyze, and advise unit representatives, Guardsmen, and/or their
families on situations that involve National Guard members affected by
Post Traumatic Stress Disorder (PTSD), Mild Traumatic Brain Injury
(mTBI), or other traumatic life events.
Mandated Enrollment into VA System
All returning Soldiers and Airmen now complete the VA Form 10-10EZ
to enroll for VA benefits. This expedites follow-on care through the VA
in the event it becomes necessary.
Modified PDHRA Process
The current PDHRA process, conducted within 90-180 days after
redeployment, has been extended to two years. Redeploying Soldiers and
Airmen receive a behavioral health review through either a Post
Deployment Health Reassessment or a Periodic Health Assessment,
conducted every six months for two years.
Suicide Prevention and PTSD/mTBI Training
Increased training on suicide prevention, PTSD, and mTBI was
conducted. All units have received suicide training and this is now an
annual requirement. Trained Montana counselors conducted PTSD/mTBI
Outreach Training in all units. We distributed focused resource/benefit
information (to include a copy of the book, Down Range to Iraq and
Back) and conducted outreach to increase awareness of the National
Guard Transition Assistance Advisor (TAA). We continue our efforts
through Web site modifications, ongoing unit training, and partnerships
with community organizations.
Reaffirmed Drill Attendance Policy
The Adjutant General published a policy letter to reaffirm a
Soldier's (ARNG only) ability to drill immediately upon redeployment
for the first 90 days previously identified as a ``no drill'' period).
Hired a PDHRA Program Manager
A full-time PDHRA Program Manager was hired. This position manages
the PDHRA process and our ongoing efforts in implementing the actions
of the PDHRA Campaign Plan.
Redesigned MTNG Website--Yellow Ribbon
The Montana National Guard Web site, located at
www.montanaguard.com, is updated to include information on the Beyond
the Yellow Ribbon program. The Web site consolidates related
information to help minimize confusion when benefits are needed. As we
move forward, we will develop a separate PDHRA Web site to continue
enhancing this effort.
Implemented Periodic Health Assessment
Montana implemented The Periodic Health Assessment (PHA) in June
2007. This new program replaced the former Annual Medical Certificate
and the five-year physical program with an annual medical review. The
new review is required every year. It includes a self-assessment
complimented by a medical examination and face-to-face meeting with a
physician or physician's assistant.
Redesigned Individual Mobilization Process
Soldiers and Airmen who volunteer to mobilize as individual
augmentees now receive the same redeployment information as units who
redeploy. A comprehensive checklist ensures all necessary stations are
completed before a Soldier or Airman is released.
Honorable Discharge Policy Request
We published a policy memorandum to allow Guardsmen to request an
honorable discharge based on deployment-related PTSD or mTBI
difficulties.
Expanded Family Resource Centers
Through additional funding resources, the Montana National Guard
Family Program was able to hire two contracted part-time Family
Assistant Coordinators, located in Billings and Kalispell, Montana.
Increased Family Communications
The Family Program has expanded its efforts to provide information
and additional focus on PTSD/mTBI signs and symptoms, along with
providing resource information for families. The family program is also
developing a consolidated resource guide to further enhance information
access and availability.
State Veteran's Affairs--MT Mental Health Association
The State Department of Veteran's Affairs partnered with the
Montana Mental Health Association to air a variety of statewide Public
Service Announcement radio spots from 9 Jan 2008 through 19 March 2008.
Received Additional PDHRA Cycle from OSD
Montana Senators Max Baucus and Jon Tester met with Dr. Chu,
Undersecretary of Defense for Personnel and Readiness, DOD, and secured
an additional PDHRA cycle for Montana. This allows us to expand our
current review out to the two-year mark.
Invitational Travel Authorizations for Family Members
National Guard Bureau extended funding to the Montana National
Guard to place family members on invitational orders to attend
Deployment Cycle Support (DCS) events. This helps us in involving all
families in the redeployment training.
TRIWEST Healthcare Pilot Program
The Montana National Guard formed a pilot program with TRIWEST
Healthcare Alliance to place a behavioral healthcare specialist at both
the Joint Force Headquarters in Helena and at the 120th Fighter Wing
Headquarters in Great Falls. This program incorporates a face-to-face
with a behavioral health specialist into the annual Periodic Health
Assessment program. The pilot began in June 2008 and will continue
through December 2008. At that time, we will evaluate the
effectiveness, along with options for future participation.
Joint Family Support Assistance Program (JFSAP)
National Guard Bureau selected Montana to participate in the Joint
Family Support Assistance Program. This program extends three new
positions to our Family Programs to assist with family and youth
outreach. These positions include a Child and Youth Specialist and two
Military Family Benefits Specialists. Program contractors have already
begun the recruitment process.
Community Partnership Program--Picking up the Pieces DVD
The Montana National Guard Public Affairs Office developed a
comprehensive marketing plan for our outreach efforts. A large part of
the plan included the development of a PTSD Outreach Video and
brochures that have been used as educational tools to help the MTNG
build stronger community partnerships with Medical (behavioral health
care providers), Ministerial (area churches), Veteran Services
Organizations (American Legion, VFW, and DAV), State (DPHHS), Federal
(OSD, NGB), and Employers located throughout the state. Montana sent a
direct mailing that included a copy of the DVD and informational
brochures, along with a letter of partnership request, to all
behavioral health care providers, ministerial groups, and Veteran
Services Organizations in early May 2008. Additionally, we conducted
community presentations of our Picking up the Pieces DVD, along with a
short presentation on Post Traumatic Stress Disorder (PTSD), in 20
communities that host a National Guard Armory. Our goal was to provide
education on the Guard's progress in addressing PTSD, elevate public
awareness, and involve Montana communities with our efforts to address
the issues of PTSD within the Montana National Guard and other service
components. This was a community event conducted during the weeks of 19
May and 26 May 2008. Nearly 400 Montana residents attended one of these
meetings.
Radio Public Service Announcements
Montana Veteran's Affairs Division and the Montana Mental Health
Association teamed up to produce and air 30 second awareness radio
spots across Montana in the months of January, February, and March
2008. These spots focused on PTSD and the VA resources available to
assist those in need.
Television Public Service Announcements
The Montana Veteran's Affairs Division and Montana Mental Health
Association produced 30-second television public service announcements
to again highlight and raise awareness of PTSD. The spots use footage
from the recently completed Picking up the Pieces DVD, produced by the
MTNG Public Affairs Office.
Published National Guard Resource Guide
The Montana National Guard developed a Resource Guide that
consolidates many of the most commonly used resources to treat PTSD and
mTBI into one convenient booklet. We mailed the booklet to all members
of the Montana National Guard and their families in July 2008.
Closing Remarks
The Montana National Guard continues to move forward in its
implementation of the Task Force recommendations and our new Deployment
Cycle Support, Beyond the Yellow Ribbon program. We appreciate the
assistance received from our Congressional TEAM, the Governor, National
Guard Bureau, Department of Defense, and our many community partners
who have contributed their assistance and support in our efforts.
On behalf of Governor Schweitzer, MG Mosley, and the more than
3,700 men and women of the Montana National Guard, thank you for your
continued support and commitment to our Montana veterans and their
families.
Thank You.
Chairman Akaka. Thank you very much, Colonel Livingston
from Montana National Guard.
And now we will hear from Colonel Boyd from Vermont Army
National Guard.
Colonel Boyd.
STATEMENT OF LIEUTENANT COLONEL JOHN C. BOYD, DEPUTY CHIEF OF
STAFF FOR PERSONNEL, VERMONT ARMY NATIONAL GUARD
Lieutenant Colonel Boyd. Good morning, Chairman Akaka and
Members of the Committee. Thank you for the invitation to
discuss the Vermont National Guard Veterans and Family Outreach
Program.
My name is Lieutenant Colonel John Boyd, and I serve as the
Deputy Chief of Staff for Personnel for the Vermont Army
National Guard, and I have direct oversight over our outreach
program for returning servicemembers and their families.
My testimony today reflects my personal views and does not
necessarily reflect the views of the Army, the Department of
Defense, or the Administration.
Since September 11, 2001, 2,581 Vermont National Guardsmen
and 268 Reservists who reside in Vermont have deployed in
support of OIF and OEF.
Early in the mobilization process, the Vermont National
Guard recognized that soldiers and airmen deserve the very best
post-deployment support available. It became increasingly
apparent that Post Traumatic Stress Disorder was developing
into a significant issue. While the many degrees of this
affliction were diagnosed in some soldiers, the instate
infrastructure to match this emerging need had yet to be
created.
As the Committee knows, National Guard and Reserve
servicemembers, particularly in States such as Vermont, which
are rural and do not have any active duty military
installations, can experience challenges with awareness of and
access to mental health and other benefits when they return
from deployment.
In 2005, the State of Vermont recognized the need for
greater assistance for the National Guard soldiers and their
families, which led our Legislature to allocating $250,000.
These funds were used to establish the first ever sharing
agreement between the Veterans Administration and the Vermont
National Guard.
Seeing a continued and growing need for mental health
services for veterans and their families, the Vermont National
Guard, in partnership with others, designed an innovative
outreach readjustment and reintegration program targeted at our
returning OIF and OEF veterans and their families throughout
the State.
This program, which was started in 2007 with $1 million in
Federal funding, employs trained outreach specialists, a
majority of which are combat veterans, to reach out directly to
our returning OIF and OEF veterans and their families to ensure
that they are receiving the medical mental health and other
assistance that they need. One of the main goals of this
program is to personally contact each and every one of these
veterans to check in on them and connect them to relevant
services.
In order to develop the goals for the outreach program, the
Vermont National Guard and VA officials from the White River
Junction Medical Facility met to discuss existing services in
the State on the Federal and local level, and how congressional
resources could be used most effectively to provide
servicemembers and their families with the best possible care.
Up to this time, Vermont had lost 11 Guardsmen: nine in
Iraq, one in Kuwait, and one in Afghanistan. In addition,
another 16 soldiers and Marines with Vermont-related
connections were killed in action. This number continued to
elevate Vermont into the unfortunate circumstance of having one
of the highest per capita casualty rates in the war. This
cumulative loss and the effect it has had on several
deployments, became a driving force to develop a robust program
focused on helping returning soldiers with PTSD, other medical
conditions, TBI, and other needs.
The Vermont Veterans and Family Outreach Program goal was
to construct a Vermont National Guard managed outreach program
developed and sustained to help identify and refer
servicemembers and their families to the appropriate clinical
care to serve their readjustment needs.
This program was designed so that each of the five outreach
specialists worked out of five existing Vermont National Guard
family assistance centers. These centers are located in
different areas of the State, and it was linking our work with
the Guard's family programs that allowed us to have a full
wraparound with the family and the soldier.
At the same time that this outreach team was working across
the State, Federal resources were used to fulfill the Adjutant
General's outreach program's goal to help all soldiers
suffering from mental health difficulties. The resources were
used to enter into a sharing agreement with the Veterans
Administration, allowing them to hire two additional qualified
and certified clinicians, serving under the supervision of the
Mental Health Services Director at the White River VA. And in
addition, $259,000 was shared with the VA to support clinical
mental health outreach throughout Vermont. These services
included basic and advanced mental health service for our
servicemembers and their families.
Initially, a simple survey was developed to capture basic
soldier data such as name and gender. In addition, among other
questions, each respondent was asked to answer which deployment
they were on, which component they deployed with, the length of
tour, et cetera. This initial survey has since been revised
twice with the assistance of the Veterans' Affairs hospital,
and we subsequently have begun using a TBI survey, which is
providing some significant results.
The program has set its goal in contacting all of our OIF
and OEF Reserve members, airmen, sailors, and Marines in the
State. To do this, we use a number of different strategies
reaching out, such as public service announcements, mailings,
posters, just to name a few.
I would like to highlight the importance of using combat
veterans on an outreach team. I believe these members are able
to focus down on a direct, person-to-person peer outreach
approach. Our program has observed that using fellow veterans
help allay anxiety some soldiers felt when they were first
contacted.
All of our outreach specialists focused on ensuring
veterans were receiving their benefits, including early
diagnosis and treatment of PTSD and TBI, ensuring that mental
health counseling could be extended to family members and that,
as much as possible, could take place in the communities where
the veteran lived.
In doing this detail-oriented work, our staff observed that
making personal contact with the veterans is a time-intensive
process. When we list a servicemember as being contacted, that
means we have actually opened a case with the individual, made
a serious attempt to complete the survey with them. For many
cases, this is just the first phase of our work. Often,
establishing a relationship with a contacted veteran--the next
step is a referral to VA.
In order to make sure that our outreach staff is of the
highest quality, we spend a significant amount of time in
training so as to ensure professionalism on the job. That
included training with the VA as well as private parties.
Towards the end of 2007, Senator Sanders convened a meeting
of the Vermont veteran and military community stakeholders
(including the Vermont Guard, Federal and State Veterans Affair
leadership) to discuss the lessons learned from our first year
of the program, and to establish how new resources could best
be used to strengthen and expand the program.
We believe that Vermont's outreach program strength is its
use of mostly veteran outreach specialists to focus on
personally meeting soldiers on their own turf, where anecdotal
evidence suggests they are much more prone to reveal the
challenges they are experiencing in their lives than if they
are being interviewed at a military facility or in a group
setting.
Our program also does a strong job of leveraging the
resources of entities in the State that already provide
important services for our servicemembers, especially Vermont
Department of Veterans Affairs. We have formed strong
partnerships with all of these agencies with the State, and we
also have strong partnerships in the public, private, and
nonprofit stakeholders through our military family and
community network.
As our program continues to mature, it serves as an example
of an effective and cost-efficient rural delivery model for
other States. As earlier testimony today has discussed, the
Department of Defense is now in the process of implementing the
new Yellow Ribbon Reintegration Program, created in Fiscal Year
2008 Defense Authorization Act.
We are pleased that through Senator Sanders' efforts, the
Yellow Ribbon Program included a provision based on our Vermont
model, which allows Yellow Ribbon to fund outreach initiatives
in the various States.
We are proud of the role that Vermont took in developing an
effective response to the invisible wounds suffered by our
soldiers which also impacts their families and communities. We
believe this commitment to our veterans is our obligation, and
an important way to ensure that they are able to remain a part
of the Guard and Reserve, while also living a productive and
normal life.
As you can see from my PowerPoint slides in your packet, as
of 18 July 2008, we have contacted nearly 1,000 of our
soldiers, sailors, airmen, and Marines. Of them, 85 percent are
enrolled in the VA for some level of care or assistance. Our
hope is to continue this work until every servicemember and
their family that needs help gets help.
Thank you for this opportunity to discuss Vermont's
outreach program, and I look forward to answering any questions
that you may have.
[The prepared statement of Lieutenant Colonel Boyd
follows:]
Prepared Statement of Lieutenant Colonel John C. Boyd, Deputy Chief of
Staff for Personnel, Vermont Army National Guard
Chairman Akaka and Members of the Committee, Thank you for your
invitation to discuss the Vermont National Guard Veterans and Family
Outreach Program. My name is Lieutenant Colonel John Boyd and I serve
as the Deputy Chief of Staff for Personnel of the Vermont Army National
Guard and have direct oversight over the outreach program for returning
servicemembers and their families.
``My testimony today reflects my personal views and does not
necessarily reflect the views of the Army, the Department of Defense,
or the Administration.''
Since September 11, 2001, 2581 Vermont National Guardsmen (1968
Army Guard and 613 Air Guard) and 268 Reservists (159 Army Reserve, 22
Air Force Reserve, 59 Marine Corps Reserve and 28 Naval Reserve) have
deployed in support of Operation Iraqi Freedom and Operation Enduring
Freedom. I believe it is worthwhile to note that Vermont is a Guard and
Reserve state with no active duty installation in the state. The
closest active duty installations are over five hours travel from
anywhere in the state. As we all know, the reserve component's role
since 9/11 has transformed from a strategic reserve force to an
operational reserve force. This transformation has led to greater
frequency in mobilizations and deployments since 2001.
Early in the mobilization process of our very first deployments
after September 11th, the Vermont National Guard recognized that
Soldiers and Airmen deserved the very best post-deployment support
available. As Operation Enduring Freedom and Operation Iraqi Freedom
continued, it became increasingly apparent that Post Traumatic Stress
Disorder was developing into a significant issue. While the many
degrees of this affliction were diagnosed in some soldiers, the in-
state infrastructure to match this emerging need had yet to be created.
As the Committee knows, National Guard and Reserve servicemembers,
particularly in states such as Vermont which are rural and do not have
any active duty military installations, can experience challenges with
awareness of and access to mental health and other benefits when they
return from deployment. In 2005, the State of Vermont recognized the
need for greater assistance for National Guard Soldiers and their
families, which led to the legislature allocating $250,000. These funds
were used to establish the first ever, sharing agreement between the VA
and the Vermont National Guard. This agreement allowed the VA to screen
and treat veterans outside their eligibility window and more
importantly provide mental health counseling for the family members of
our OIF and OEF veterans. This paradigm shift has produced amazing
results for the veteran and his or her family and strengthened the ties
between the Vermont National Guard and the VA.
Seeing a continued and growing need for mental health services for
veterans and their families, the Vermont National Guard, in partnership
with the Department of Veterans Affairs Medical Center in White River
Junction, Vermont, our Congressional delegation, and other state
stakeholders designed an innovative outreach, readjustment, and
reintegration program targeted at returning Iraq and Afghanistan
veterans and their families throughout the State of Vermont.
This program, which was started in 2007 with $1 million in Federal
funding, employs trained outreach specialists, a majority of which are
combat veterans, to reach out directly to returning OEF/OIF
servicemembers and their families to ensure that they are receiving the
medical, mental health, and other assistance that they may need. That
may mean assistance with general health problems; TBI screening and
treatment; mental health, marriage, and/or financial counseling;
employment issues; services for children; and substance abuse awareness
and treatment or other areas. One of the main goals of the program is
to personally contact each and every one of these veterans to check in
on them and connect them to relevant services.
In order to develop the goals for the outreach program the Vermont
National Guard stakeholders (Family Readiness Leadership, Chaplains,
State Medical Command representatives, and the United States Property
and Fiscal Office in Vermont) and VA officials from the White River
Junction Medical Facility met to discuss existing services in the state
on the Federal and local level and how Congressional resources could be
used most effectively to provide servicemembers and their families with
the best care possible.
Up to this time, Vermont has lost eleven Guardsmen; nine in Iraq,
one in Kuwait and one in Afghanistan. In addition, another sixteen
Soldiers and Marines with Vermont-related connections were killed in
action. This number continued to elevate Vermont into the unfortunate
circumstance of having the highest per capita casualty rate in the Iraq
war. This cumulative loss and the effect it had on several deployments,
especially Task Force Saber (Ar Ramadi, Iraq, June 2005-June 2006),
became a driving force to develop a robust program focused on helping
returning soldiers with PTSD, other mental health conditions, TBI and
other needs.
The Vermont Veterans and Family Outreach Program first launched in
January 2007. Its goal was to ``construct a Vermont National Guard
managed outreach program, developed and sustained to help identify and
refer Service Members and their families to appropriate clinical care
to serve their readjustment needs.''
More specifically the first phase of the program included:
Interviewing, hiring, and training five Outreach
Specialists and one supervisor in skills to contact post-deployed
Reservists and their families, ascertain their individual health
situation, and then refer them to qualified clinical and pastoral help
as needed;
Entering into a sharing agreement with the VA to use DOD
dollars to pay for VA care for servicemembers and their families; and
Resources were also used to reimburse outreach specialists
who drove servicemembers to VA facilities to get clinical help.
The program was designed so that each of the five outreach
specialists worked out of five existing Vermont National Guard Family
Assistance Centers (FACs) in five different areas of the state where
there was significant in-state Guard membership. Linking our work with
the Guard's Family Assistance Centers made sense for a number of
reasons:
The new outreach staff was able to capitalize on the
existing networks used by the FAC Specialists which gave them immediate
access to servicemembers and their families that had strong and trusted
relationships with the FAC staff;
We leveraged the resources of the Family Assistance
Centers allowing us to use Federal dollars more efficiently by reducing
the need for new office space; and
Referrals to the Outreach Program came through the FACs by
concerned family members, employers, and commanders. Conversely, family
related issues identified during Outreach Specialist/Soldier
discussions were given to the FACs for immediate attention.
This full ``wrap-around'' method continues to work extremely well.
The program began in earnest in the late spring of 2007 with Outreach
Team members traveling around the state to conduct direct outreach to
veterans.
At the same time that this Outreach Team was working across the
state, Federal resources were also used to fulfill the Adjutant
General's and the Outreach Program's goal to help all soldiers
suffering from mental health difficulties. The resources were used to
enter into a sharing agreement with the VA, allowing them to hire two
additional qualified and certified clinicians serving under the
supervision of the Mental Health Services Director at the White River
Junction VA Medical Center. In addition, $259,000 was shared with the
VA to support the clinical mental health outreach throughout Vermont.
These services included basic and advanced mental health services for
our servicemembers and their families.
We also realized early on, the strong need to track our work so
that we could follow the trends in the health or other challenges our
returning servicemembers and their families were experiencing, and to
evaluate and improve our efforts. Initially a simple survey was
developed to capture basic solder data such as name, age, and gender.
In addition, among other questions, each respondent was asked to answer
which deployment they were on, which Component they deployed with,
length of tour, and whether or not they were receiving any disability
benefits. This initial survey has been revised twice with the
assistance of the Mental Health Services Director of the VA Medical
Center and a copy is included as an attachment to this testimony.
Subsequently, in concert with the VA we also introduced a TBI survey
that has greatly improved our efficiency at determining those veterans
who require a more formal TBI screening.
The program has set as its goal contacting all OEF/OIF Reserve
Soldiers, Airmen, Sailors, and Marines in the state. To do this we used
a number of different strategies for reaching out to these
servicemembers. Each Reserve Center in Vermont was contacted with
information about the Outreach program and its features were explained
to unit commanders. Additional help came from the State of Vermont's
Office of Veterans' Affairs, which had Reserve soldier contact
information not available to the National Guard. Information from the
Department of Defense Form 214 was shared with the Guard and that
proved immensely useful in figuring out how to contact these
servicemembers. In addition, the Outreach Team placed information about
the program at each rest stop on Interstate Highways 89 and 91. These
highly visible posters resulted in some of the first referrals to the
program.
I also want to highlight the importance of using combat veterans as
Outreach Team members and focusing on direct person-to-person or peer
outreach. Our program has observed that using fellow veterans helped
allay anxiety some soldiers felt when first contacted. Two of the team
members are OIF Task Force Saber veterans, further strengthening ties
to servicemembers from this deployment. All of our Outreach specialists
focused on ensuring veterans were receiving benefits including early
diagnosis and treatment of PTSD and TBI, and also assuring that mental
health counseling could be extended to family members, and that as much
as possible treatment could take place in the communities where the
veterans lived.
In doing this detailed oriented work our staff have observed that
making personal contact with veterans is a time intensive process. When
we list a servicemember as being ``contacted,'' that means that we have
actually opened a case with the individual and made a serious attempt
at completing a survey with them. For many cases, this is just the
first phase of work. Often, after establishing a relationship with a
contacted Veteran, referral to the VA takes place. In many cases the
Outreach Specialist drives the servicemember to the White River
Junction VA Medical Center, or the CBOC clinic in Colchester, Vermont,
for their first couple of visits. While this ``windshield time''
reduced the time available to contact other veterans, Outreach Team
members have noted that this drive time is, in reality, a short
decompression period for the servicemember. This time helps many
soldiers prior to their arrival at either of the two VA facilities.
Faced with the decision between helping a soldier right in front of
them and those yet to be contacted, the Outreach Specialist always
tends to the more immediate need. The person-to-person time spent by
our Outreach Specialists with each individual servicemember and/or
their family is a very important component of the program.
In order to make sure that our Outreach staff was of the highest
quality we also spent a significant amount of time in training so as to
ensure professionalism on the job. Training opportunities were
explored, designed, and scheduled using existing VA and State
Department of Human Services expertise. Each team member went through a
series of VA benefit classes so as to best understand the system they
were bringing referrals to. In addition, each Outreach Specialist
graduated from a Critical Incident Stress Management (CISM) course
taught by the International Critical Incident Stress Foundation. This
coursework included ``what-if'' scenario training and dovetailed well
with additional training on anger management, sexual assault, active
listening skill development, suicide prevention, and reintegration
coping skills.
Towards the end of 2007 the Vermont Congressional delegation
secured follow-on year resources of $3 million to continue the program.
In order to make sure the resources were used most effectively, Senator
Sanders convened a meeting of the Vermont veteran and military
community stakeholders (including the Vermont National Guard and
Federal and state VA leadership) to discuss the lessons learned from
the first year of the program and establish how the new resources could
best be used to strengthen and expand the program.
Beyond continuing the existing program the stakeholders agreed to:
Deliver a joint letter from the Adjutant General and the
Director of the White River Junction VA Medical Center to all returning
Vermont veterans letting them and their families know about the
program;
Craft a series of public service announcements about the
program;
Create a 24-hour 1-800 number staffed by Vermont National
Guard Veterans and Family Outreach personnel that servicemembers and
families could access for immediate information;
Enhance VA services for servicemembers and families;
Hire more outreach workers to extend the reach and
coverage area of our program;
Provide expanded mental health services to treat Post
Traumatic Stress Disorder and other health issues;
Screen servicemembers for possible Traumatic Brain
Injuries that have gone undetected or untreated; and
Produce more publications for posting, mailing and
delivery to increase awareness of the program.
We are currently implementing all of these initiatives.
In the last number of years, many states including Minnesota,
Maryland, Missouri, Montana, Maine, New Hampshire, and California have
developed a wide range of innovative programs to help servicemembers
transition back home. Each of these programs has important lessons to
offer that other states can learn from and use as appropriate to their
state and military population. We believe that Vermont's outreach
program's strength is its use of mostly veteran outreach specialists to
focus on personally meeting soldiers on their ``own turf'' where
anecdotal evidence suggests they are much more prone to reveal the
challenges they are experiencing in their lives than if they were being
interviewed at a military facility or in a group setting. Our program
also does a strong job of leveraging the resources of entities in the
state that already provide important services for our servicemembers,
especially the Vermont Department of Veterans Affairs. We have formed a
strong partnership with the Federal VA in Vermont and have used DOD
resources to enhance the VA's ability to provide care to our
servicemembers and their families. We also have strong partnerships
with public, private, and non-profit stakeholders in our state through
our Military, Family, and Community Network.
Since 2007, there has been a great deal of attention on the
national level regarding reintegration programs for the Guard and
Reserves, their proper structure, and the amount and source of funding
needed to support them. The Vermont National Guard program, as it
continues to mature, serves as an example of an effective and cost
efficient rural delivery model for other states. As earlier testimony
today has discussed, the Department of Defense is now in the process of
implementing the new Yellow Ribbon Reintegration Program created in the
FY08 Defense Authorization bill. We are pleased that through Senator
Sanders' efforts that the Yellow Ribbon program includes a provision
based on our Vermont model, which allows Yellow Ribbon to fund outreach
initiatives in the various states.
We are proud of the role Vermont took in developing an effective
response to the ``invisible wounds'' suffered by our soldiers, which
also impacts their families and communities. We believe this commitment
to our veterans is our obligation and an important way to ensure that
they are able to remain a part of the Guard and Reserve while also
living a productive and normal life. As you can see from the Power
Point slide presentation attached at the end of my testimony, as of 18
July 2008 a total of 977 Vermont Veterans out of approximately 3700 had
been contacted and had a case opened for them by our Outreach
Specialist. Our goal is to contact each and every OEF/OIF veteran in
our state. Of those contacted to date, 93% are male, 7% female and 85%
enrolled in the VA for some level of care and assistance. 27% have been
referred to the VA after a TBI screening tool was administered; 21% are
currently on disability; and 19% are experiencing significant personal
issues. Our hope is to continue this work until every servicemember and
their family that needs help gets help. Thank you for this opportunity
to discuss Vermont's outreach program and I look forward to answering
any questions you may have.
Chairman Akaka. Thank you very much, Colonel Boyd, for your
statement.
Now we will hear from Sergeant Meredith.
STATEMENT OF SERGEANT ROY WAYNE MEREDITH, TEAM LEADER, 1/158
CALVARY, MARYLAND ARMY NATIONAL GUARD
Sergeant Meredith. Chairman Akaka and distinguished Members
of the Committee, thank you for the opportunity to speak with
you today regarding my experience with the VA's post-deployment
outreach program.
Having served two tours of duty in Iraq over the last 3
years, my testimony will reflect my personal experience, and
does not necessarily reflect the views of the Army, the
Department of Defense, or the Administration. However, I am
grateful for this opportunity to speak.
Mr. Chairman, I would qualify my testimony by first stating
that, when I returned from Iraq in 2005, a formal reintegration
such as the program we have now did not exist.
When I returned to Fort Stewart, Georgia, I underwent some
briefs from military personnel. The experienced counselors we
have from the VA today were not at my reintegration training
then. I was given some pamphlets and told to report to my local
VA clinic if anything was wrong with me. I was told I could
follow up for treatment for my wounds, but military staff
thought everything that could be done for me was already done.
I still was given an in-the-line-of-duty entry in my
medical records. This means I can walk in and should not have
to worry about processing a claim or restarting treatment. The
doctors in any VA hospital or military hospital should be able
to access my records and do a continuation of treatment for me
at no cost because my injury was in the line of duty.
However, when I reported to the VA clinic at Perry Point,
Maryland, to receive follow-up care from battle injuries caused
by an improvised explosive device while patrolling Samarra,
Iraq, the VA tried to say my treatment would not be covered and
I would have to pay for my medical expenses.
I was billed, and when I went back for more treatment, I
took copies of my medical records from the treatment I received
after I was hit on July 30, 2005, on Camp Taji, Iraq. Even when
I showed them my medical records, the VA still billed me.
Finally, after several months of late notices and
collection letters, the VA backed off and paid for the
treatment and apologized for the way my case was handled. I had
to file a claim in order not to be charged for treatment. This
was a very stressful time upon my family, myself; and was
rectified only because a social worker heard what I was going
through and immediately started to help me. This was the first
time any VA representative tried to explain my benefits
associated with my 2005 tour.
Comparatively, Mr. Chairman, after returning from Operation
Iraqi Freedom in 2008, I was pleasantly surprised at the
maturity of the post-deployment process being implemented by
the State of Maryland. Sir, there are a number of areas in
which my second experience was much better.
First, there was a program outlining three phases of
reintegration training--30 days, 60 days, and 90 days after
returning home from my deployment. My family could participate
in every phase, and to make it easier on us, the State of
Maryland paid for hotel rooms for us over the course of the
training. Having our wives or significant others interact was a
huge success, and helped make the homecoming much easier.
The VA had experienced counselors and claims workers at our
disposal. They actually had two supervisors who gave a very
informative class on how to file for claims, apply for
benefits, guidance on seeking medical care; and not only did
they give out many forms of literature about the VA, but also
gave me their cards with all their contact information on it. I
received email addresses, clinics, and hospital addresses
countrywide; office faxes, office phone numbers, and even
personal cell phone numbers of theirs, in case I needed to talk
to them. I have also had these supervisors call me to see how I
was coming along.
There was also a fourth phase which consisted of a follow-
up at the VA hospital in Baltimore, Maryland. This has helped
me a great deal, for I had a head injury from this tour, and
the doctors have already set up appointments for me to be
reevaluated for this recent injury, but also to recheck my
previous injuries from my last tour, as well.
Mr. Chairman, I would like to say as a Gulf War vet, and a
two-time Iraqi Freedom vet, and the father of a Marine--my son,
Mike, who has a combat tour in Iraq, as well--that I am not
only concerned for myself and my troops, but am concerned for
my children, as they one day will need the VA. And as a father,
I want the best treatment for my children, and will help the VA
to improve the care of our warriors.
That being said, the difference in where we are today
compared to where we were during my first two deployments is a
180-degree difference in the quality of care given to those of
us who have answered the call to defend our Nation.
No longer do I wonder if I will be taken care of by my
nation for wounds both seen and unseen, but rather I feel
confident that I may be treated with respect and dignity that
befits a proud warrior who is grateful to serve and will so
again stand up and put my heart, body, and soul to the test.
I humbly thank you once again for the opportunity to speak
here today, and I look forward to answering any questions that
you may have.
[The prepared statement of Sergeant Meredith follows:]
Prepared Statement of Sergeant Roy W. Meredith, Team Leader,
Maryland Army National Guard
Chairman Akaka, Senator Burr and distinguished Members of the
Committee, thank you for the opportunity to speak with you today. I am
grateful for the chance to testify regarding my experience with post-
deployment outreach to members of the National Guard and Reserve.
My testimony today reflects my personal views and does not
necessarily reflect the views of the Army, the Department of Defense,
or the Administration.
I come before this Committee as a proud soldier; proud of the
support we have received from our elected and military leaders. I also
come before you as a soldier concerned about the welfare and post-
deployment services of members of my team and others throughout this
country. There is no country better or more capable of matching our
country's ability to efficiently and effectively mass a large number of
soldiers, sailors, airman, and equipment and deploy anywhere in world
to protect, defend and secure peace. Equally so, is our ability to
bring everyone home.
As a member of the Reserve Component, my access to medical services
is not the same as that of a member of the active duty. As some
individuals are now completing their second, in some cases third tours
of duty, it is extremely important that the level of emphasis given
toward deployment of forces; also be placed on providing post-
deployment support. The goal should include a well defined process
which facilitates the transition from a military service to civilian
life with the intent of identifying medical and emotional conditions to
support follow-on medical requirements. I must say, there has been a
significant improvement between the procedures and services received
after returning from my second in 2007 and my most recent return from
Iraq in March of this year.
post-deployment health assessment
The first opportunity to address the medical needs of returning
soldiers is during the Post-Deployment Health Assessment (PDHA). From
January 2005 through January 2006, I was deployed in support of
Operation Iraqi Freedom (OIF) and deployed again in June 2007 through
March 2008. After each deployment, I had to undergo a PDHA. The timing
of the PDHA during the demobilization process is perfect; where the
soldiers remain in a formal and controlled status. The PDHA provides an
early opportunity to assess the physical condition of soldiers. This is
great because the goal should be to identify and capture any condition
as soon as possible. However, unlike the pre-mobilization physical
assessment, the PDHA is not a complete physical but based on self
identification of ailments. I think it would be proper and re-assuring
to soldiers if members received a similar level of assessment as the
pre-mobilization. Second, based on my experience, the information
captured in the PDHA should somehow be connected to the claims process.
During my second deployment I received several injuries to include
shrapnel which is still embedded in my right arm. This information was
well documented and identified during the PDHA. However, my Post-
Deployment Health Reassessment (PDHRA) stage, after receiving medical
care from the local veterans hospital, I received a bill and was told I
had to file a claim. The PDHA should be a seamlessly connected to post
mobilization medical services.
post-deployment health reassessment
Along with being seamless connection to medical care, the Post-
Deployment Heath Reassessment (PDHRA) lacks one of the key strengths
that support an effective PDHA; control and access to the soldiers.
From what I have seen, as soldiers return to their homes, it is
difficult to communicate and require them to attend PDHRA events. I
think the primary reason for this breakdown relates to the fact that
members are not provided military orders requiring them to report. As
individuals began to assimilate into their normal lives and return and/
or to work, competing requirements will overshadow the PDHRA without
proper directives requiring member to report to duty. In my opinion,
providing members with military orders prior to finalizing
demobilization could improve the effectiveness of PDHRA.
Since my first deployment to Iraq in 2006, the reintegration
program has made strides but there are a number of areas in which the
program can be improved. As Team Leader, it is my additional duty to
manage and insure soldiers participate in the reintegration process. To
be effective there needs to be a formal and defined program with proper
oversight at the state level. A formal program will ensure soldiers,
regardless of which state they may live, receives services and medical
treatment. Additionally, soldiers should be allowed to receive
treatment and services at the local level without requiring them to
travel unnecessary distances.
Mr. Chairman, thanks for this opportunity to come before your
Committee. I look forward to your questions.
Chairman Akaka. Thank you very much, Sergeant Meredith.
Our final witness, Major Rasmussen, will be testifying on
the unique challenges confronting Reservists.
Will you please begin.
STATEMENT OF MAJOR CYNTHIA RASMUSSEN, RN, MSN, CANP, COMBAT
OPERATIONAL STRESS CONTROL OFFICER, 88th REGIONAL READINESS
COMMAND, SURGEON'S OFFICE, FT. SNELLING, MN
Major Rasmussen. Thank you, Chairman Akaka, distinguished
Members of this Committee, and all others attending. Thank you
for the opportunity to talk today on behalf of servicemembers,
veterans, and their families who are experiencing reintegration
or coming home from deployment.
My testimony today reflects my personal views, and does not
necessarily reflect the views of the Army, Department of
Defense, or the Administration. I have submitted testimony for
the record.
I would like to specifically thank James Monroe, Vietnam
veteran Chaplain of the Boston VA for some of the materials and
information that you are going to hear today.
I am a mobilized Reserve soldier, and I feel a little bit
like the only one here. I am a psychiatric nurse and an adult
nurse practitioner; and I am on military leave from the VA.
I have had the honor of working with hundreds of
servicemembers, families, and community members, including from
the Canadian Army during my 3\1/2\ years as a combat stress
officer mobilized for the 88th Regional Readiness Command,
which is an Army Reserve Command of six States. When we started
this program 5 years ago, we served 26,000 servicemembers and
their families in six States.
So, needless to say, it is a little bit different. We work
with the Guard in every State, because we could not do it
without them. But, our challenges, even for the Reserves, are a
little bit different than for the Guard.
I am honored to have the opportunity to share with you
their stories of what it is like for a warrior, especially
Guard and Reserve soldiers, to come home.
Warrior skills, what we learn in the uniform, are not the
skills that work when we take the uniform off. The military is
a culture of its own. As you can see, we dress differently, we
talk differently, we eat differently, sometimes we eat dirt
differently, and may I introduce you to some of these skills.
We are mission-oriented. Once a mission is assigned,
unrelated tasks are unimportant. And if I may share, as we
talked earlier before we came up here, he mentioned, ``ma'am,
that is like the most important thing. Everywhere I go, people
do not understand, we need to get it done right now. We need
to--you know. It is very frustrating,'' which is what we talk
about.
Decisions need to be quick, clear, and accurate or someone
could get hurt; the mission would not be completed and somebody
could get hurt.
Multiple competing tasks, when the servicemember gets home,
cause confusion. We do not know how to think that way. We know
how to be mission-oriented. We receive an op order, it tells us
who, what, when, where, why, and how, basically. We do not get
op orders when we get home 5 days after when we take the
uniform off.
Owen Rice, who is a Hennepin County Sheriff Deputy in
Hennepin County Jail, has been to Iraq, got a Traumatic Brain
Injury in Iraq. He says, ``Ma'am, it is like this. One person
talks in the military and everyone else listens. When you get
home, everyone talks, everyone listens, and nobody hears.''
What I hear from soldiers across the country,
servicemembers across the country is, ``Ma'am, it is too
chaotic here. Please send me back where I know how to survive,
I know how to function. I know how to do that.''
Safety and trust. When you are in a combat zone or in a
uniform for a long time, vigilance pays off. You learn to never
relax. You assume everyone is the enemy. You learn to be
suspicious of everyone and everything, including children,
family members, animals on the side of the road, boxes,
bridges, et cetera.
So, what does that look like when you get home and try to
take the uniform off? You avoid getting involved, because you
are still suspicious. You still do not trust anyone, including
your family and friends. They need to earn your trust, but they
do not understand this. So, what happens? You test people to
earn their trust. You are always on guard. You become
isolative. You become suspicious of others.
My Command Sergeant Major lost his son in Iraq after he
spent a year there. We went out to dinner one evening with him
and his wife, my husband, who is a Vietnam-era Navy vet, and
some other vets. We could not find a wall big enough in a
restaurant for all of the vets to sit against the wall so that
they could monitor everyone that came in and out.
The NCO who works with me is on mobilization with me right
now. He does Operation Purple Camp in the six States. A few
weeks ago, he spent a long time with the kids at Operation
Purple Camp, and the comments--he sent me many comments. One he
sent to me that was really poignant came from an 8-year-old boy
who said to him, ``You know, my dad, he used to do everything
with me. He used to take me golfing, he used to take me
fishing. Now, my dad does not do anything with me.'' I thought
that was amazing.
Emotions and anger. In war, we control our emotions.
Obviously, you would not want your warriors having their
emotions out in the open anywhere, plus, we cannot accomplish a
mission if we have different emotions going on. We numb out.
Anger is useful. Anger is not only useful, anger is an
awesome emotion. We want anger. We like anger. We encourage it
because it is the fight-or-flight response. It makes your body,
your mind, and everything about you be the best you can be and
accomplish the mission that you need to accomplish. We
encourage it. We live that way. We like to live that way.
But guess what? When the uniform comes off, the anger that
you have learned in practice and felt good about does not go
away.
It looks like this: Not talking about your emotions and
being angry in war is a strength. It only leads to--you cannot
talk about your emotions at home, which is considered a
weakness.
We look insensitive to others when we get home. It is not
that we are insensitive; it is that we have not practiced those
emotions for a long time. Emotions take practice.
We have a decreased ability to read other people's
emotions, not because we do not care, not because we are cold-
hearted warriors, but because we have not practiced that for a
long time. This can lead to increased irritability and
defensiveness, because if your spouse, your mom, dad, or
someone else in your family accuses you of not caring anymore
or not showing emotion, we are not going to say, oh, yes, you
are right. Thank you. I am sorry I was unable to articulate
that. Instead, we are going to say, what are you talking about?
That is not true. We are going to get defensive, as all of us
would if someone said that to us.
It leads to increased alcohol and drug use to cover up our
emotions. You know why? Not because we are warriors and we
learn to do that. It is more socially acceptable in our society
to go to the bar and have a few drinks or sit home and slam
down a case of beer with your friends or buddies than it is to
raise your hand and say, I need help. I need medication. I need
to talk to someone. Not just in the military, but across the
board.
In our program, we work with all branches of the service
and many VA and civilian organizations across the country.
Despite this amazing comprehensive program, servicemembers and
families are still falling through the cracks.
I had the honor and opportunity to speak to 150 Purple
Heart National Service Officers at their training in Phoenix a
few months ago. I received this note, handwritten, put it in my
pocket, and went back to the hotel room, and it read:
``Ma'am, for the last 3 years I have been treated for PTSD
by doctors, nurses, and others that have no clue over what it
is being a soldier and have this feeling inside''--this is a
quote, by the way--``I cannot thank you enough for coming
today. In the last 2 hours, you have done what nobody could
have done. You make me feel normal again. That is a feeling
that I thought I would never feel again since I was discharged
from the Army. Thank you and God bless.''
This was an Operation Iraqi Freedom vet from Puerto Rico,
approximately 24 years old.
One final point I want to make: Not all issues with
servicemembers are about PTSD. We need to deal with the combat
stress, the operational stress, the things I just talked about
that are normal habits for all servicemembers.
When I spoke to the purple heart recipients, a World War II
vet raised his hand and started sobbing and said, ``Where were
you when I came home?''
I had a Korean war wife say to me last week at the Battle
Creek VA, ``If you would have been around 40 years ago, I would
not be divorced from my husband who is a Korean vet, because
now I understand why we had all the problems we had.''
This is not PTSD, this is a warrior taking his uniform off
and trying to come home. We have operational stress. We have
grief issues. We have lost a year or more in whatever life it
was we thought we were going to have. We have depression. We
have anger issues. We have PTSD. We have all kinds of issues.
Please, please, please stop just calling it PTSD, because I do
not want to be called PTSD. I want to be called a combat vet
with some issues coming home. Thank you.
And may I end with this quote from General Colin Powell:
``The day soldiers stop bringing you their problems is the
day you have stopped leading them. They have either lost
confidence that you cannot help them, or concluded that you do
not care. Either case is a failure of leadership.''
Thank you for the attention to this very important topic.
Thank you for giving the opportunity to me to answer the call
to bring their stories to you, and I welcome any questions from
the Committee.
[The prepared statement of Major Rasmussen follows:]
Prepared Statement of Major Cynthia M. Rasmussen, RN, MSN, CANP, Combat
Stress Officer, Sexual Assault Response Coordinator, 88th Regional
Readiness Command
My Testimony today reflects my personal views and does not
necessarily reflect the views of the Army, the Department of the Army,
the Department of Defense or the Administration.
Chairman Akaka, Senator Burr, and Distinguished Members of this
Committee, and all others attending, thank you for the opportunity to
talk today on behalf of Servicemembers, Veterans and their families who
are experiencing Reintegration, or, coming home from Deployment. I
welcome any questions from this panel to fully detail what we offer.
I have been mobilized for 3 years as a member of the Combat Stress
Control Team at the 88th Regional Readiness Command (RRC). Following
the end of my tour, I will return to my civilian position at the
Minneapolis Veterans' Administration facility. The 88th is the Army
Reserve Command for Servicemembers in six Midwestern states (Minnesota,
Wisconsin, Michigan, Ohio, Indiana, and Illinois).
Shortly after 9/11, the RRC mobilized LTC Susan Whiteaker, a
Licensed Clinical Social Worker (LICSW) and LTC Mary Erickson,
Occupational Therapist (OT). They organized this team to care for the
mental health needs of the Servicemembers and Families in the region
during the entire deployment cycle to include Reintegration. Our
comprehensive program has served thousands of Servicemembers,
Commanders, Family members, Employers and Communities through
education, support, crisis intervention, and referrals.
The 88th RRC Surgeon's Office Combat Operational Stress Control
(COSC) Team provides a comprehensive program of education, assessment,
brief intervention and referral to meet the behavioral health needs of
Soldiers, Families, and the community.
Mild Traumatic Brain Injury (mTBI)/Post Traumatic Stress Disorder
(PTSD) are the signature injuries of the campaigns in Iraq and
Afghanistan. Most programs, while well constructed and resourced, are
passive in nature. This requires the injured Servicemember, or his/her
Family, to not only recognize the problem, but also to figure out where
to seek help, and to gain the knowledge to fight through the red tape
to get the help they need. Since 2003, the 88th RRC has a very
effective program in place that helps its units, Soldiers, and
Families, removing a good portion of the administrative, medical, and
financial burden these injuries can cause.
Education begins before a Soldier is deployed, with a variety of
briefings that establish rapport between the command and the Soldiers'
families. It is critical they know there is a place they can go to for
assistance, answers, and counseling. The education and support network
continue throughout the mobilization processing, the actual deployment,
and following deployment.
The period following deployment is critical. The majority of
Reserve Component (RC) Soldiers just want to go home. They are not
thinking too much about what occurred in the previous twelve to fifteen
months, they think they can ``forget it.'' That is what makes the Post
Deployment Health Assessment (within six months of their return)
invaluable.
Our various programs have made leaps and strides in terms of
delivery of care and resources. In 2005 alone, grief seminars for
families were initiated and conducted. We received a $10,000 Health
Promotions Programs Incorporated (HPPI) grant from the U.S. Army Center
for Health Promotion and Preventive Medicine (CHPPM) for Soldier/Family
Wellness Programs throughout the Command. We reached out to our
National Guard partners to assist in Anger Management classes and other
training for redeploying units, to name just a few accomplishments.
Our successes continued into 2008 including providing numerous
Mental Health First Responder courses, our continuing to provide
reintegration education and support for Veterans' Affairs staff
throughout the country, and received numerous awards for our various
programs and efforts.
There are several recommendations resulting from our work. Customer
care must be a number one priority. Success depends on inter-service,
joint programming across all government and civilian organizations that
have a stake in the health of the Servicemembers and Families. All of
us need to enhance the whole Family system, ensuring the entire Soldier
Family is taken care of and heard. Staffs across the medical spectrum
who work with Servicemembers and Veterans must be culturally competent.
They need to understand the Warrior mindset and how that translates
into Warriors as civilians and consumers and be able to design care
based on their unique needs. From this, it should be understood that
the same personnel in the spectrum must be held accountable for abuse
and/or inappropriate behavior toward a Servicemember or Veteran.
We recognize the need to work hand-in-hand with the Department of
Defense to provide ``seamless transition'' care for all Servicemembers/
Veterans and Families, not just those who are seriously wounded.
Medical providers must be able to recognize, articulate and care for
the Servicemember with Combat Operational Stress Reaction before the
sequences of events results in serious life-altering consequences.
Veterans have multiple and complex issues. Our legacy systems of
``stovepipe care'' are out-dated and ineffective. If the Servicemembers
are Reserve Soldiers or Guard Members, include their commands and
battle buddies, wingmen, shipmates, and so on, in their care. All of us
need to recognize that reintegration issues are a part of the challenge
of caring for Veterans and Families.
Again, I thank this Committee for the opportunity to explain, in
part, what we're doing at the ``Blue Devils'' Command, the 88th RRC,
and our efforts at reaching across component and service lines to
ensure no one is ``lost'' because of negligence or inattention.
Chairman Akaka. Thank you very much, Major Rasmussen.
Your dedication to the needs of returning servicemembers
from your statements, also, is amazing. Your tremendous
enthusiasm for your work--I have got to say, it shows.
Major Rasmussen. Thank you.
Chairman Akaka. Without giving us a name, can you tell us
about one of your most challenging cases? You have mentioned
some, but your most challenging case, and what was specifically
done to make a veteran as whole as possibility.
Major Rasmussen. Absolutely, sir. I could tell hundreds of
them, but--and I can also tell you a name.
Chairman Akaka. Just one.
[Laughter.]
Major Rasmussen. OK. You can tell I like to talk. Sorry.
OK. This is an Army Reservist--I received a call from a VA
social worker. The VA social worker stated to me, ma'am, you
need to help this servicemember. It turns out this
servicemember, still an Army Reserves soldier, also a vet, with
DD-213, 30 percent blind from a fuel IED, could not work.
At the time that I received the call, I immediately called
this servicemember and found out that they were at the door to
repossess his vehicle. A week later his house was going to be
taken away from him. He was self-medicating with alcohol and
because of that, his wife and four children had moved out of
the house.
What happened then--he owed $16,000 on his vehicle, as well
as his house and other bills through the VA, because he did not
realize that he did not have to pay his bills at the VA. It
turned out, after requesting a meeting with the VA team and
working very closely with the servicemember and his unit--his
military unit and Reserve unit--they were awesome. I mean, they
were right on it every time we ever needed anything. This
soldier had TBI, PTSD, serious blindness, pain, grief, and
significant family issues.
What we did was we pulled together VA staff, Vet Center
staff, luckily we called a Congressperson's aide, and within a
few days--as well as the family assistance center from the
National Guard and some other funds that are available that,
luckily, after you do this a while, you will learn what is
available--we pulled together $16,000 in less than a week to be
able to pay off all his bills so that at least that was one
stress off of his life.
Let's see. The main issues that still continue after quite
a while are that his family--him and his family--are back
together and they are doing better, but they have had no
counseling; or his wife has not been taught yet at all about
working with Traumatic Brain Injury or PTSD because he was in
an alcohol and drug track. So they were not--there was not a
concerted effort to make sure that all of the issues that he
had were being focused on at the same time.
Chairman Akaka. Thank you very much for that.
As you notice, we have all of you here from West Virginia,
Vermont, Maryland, and Minnesota. We were looking at the issue
from across the country.
I have one question to ask all of you. You can make it
brief. This question is for the entire panel. It is clear that,
if we cannot reach veterans, their needs will go unmet, without
question. What can VA do to improve the effectiveness of its
outreach efforts, especially for Guard and Reserve, whose
experience is so different from those in active duty? Nothing
is off the table, and what we are trying to do here is we are
looking for creative solutions.
So, I am asking you, what can VA do to improve the
effectiveness of its outreach efforts?
Let me start with Dr. Scotti.
Mr. Scotti. I have a number of ideas, and I have already
heard former panelists mention doing more through the media to
advertise these services, and I am interested in the video that
the Colonel has in terms of demonstrating that these are the
types of problems.
So, I think it is very important to have actual veterans
with actual difficulties to talk about their actual lives and
the help that is available to them. That has been shown in many
other fields to be very effective in getting people in for
treatment.
I am glad that the post-deployment health measures are
being used. The question was raised earlier about how long that
should continue. I will conservatively say 10 years. Mental
health problems wax and wane. People come back and are
overwhelmed. It is not just PTSD. Major Rasmussen is right, we
should not just focus on that issue. There are a whole range of
problems, and we need to evaluate, and reevaluate, and
reevaluate. I would like to do it for the rest of their lives.
The problem with these post-deployment forms, the
information goes into a computer. Some program somewhere pulls
that name, it may not get back to where they are stationed, and
there may not be resources to pull that veteran aside and
address their issues.
So, assessment and screening is one thing, getting that to
the point of actively getting treatments for the veteran is a
whole different issue. It needs to trickle down and it needs to
do so immediately.
Also, the Vet Centers are an excellent place for outreach,
and I am very proud to have worked at the Morgantown Vet Center
in West Virginia that has been awarded the best Vet Center in
the Nation three times. And they do a tremendous job, but they
are incredibly overwhelmed. They will not tell you this, but
when I go there and there is a room full of fifty veterans and
one counselor and they are calling that group therapy. It is
not. They need more help, they need more outreach. They are
still overwhelmed with Vietnam veterans, Desert Storm veterans
are coming in now at a greater rate, and we still have Korea
and World War II veterans coming out of the woodwork.
The focus at the Vet Center and the VA is not on OEF/OIF
and other conflicts, as they are still dealing with many other
prior conflicts, and new cases all the time. So, we need all
this outreach and we need greater resources, and we need to get
those measures back to the hands of the people who are going to
do something to help the veteran.
Chairman Akaka. Thank you, Dr. Scotti.
Colonel Livingston.
Colonel Livingston. Mr. Chairman. I guess for the VA, and
using the Fort Harrison VA as a model, is that, do not be
``active duty-centric'' in the standpoint that Montana, too,
only has one active duty facility, that is Malmstrom Air Force
Base, 90 miles from the VA hospital.
Partner with your National Guard and with your Reserve. But
specifically, the National Guard; you can leverage the State
relationship also. What Governor Schweitzer and the State
officials did for the Montana National Guard was phenomenal.
And the VA, partnering with the National Guard, ran public
service announcements that we were able to put out there, that
leveraged money of the State, leveraged money from the feds. It
was--it is, today, a great partnership. I think we have a great
team with the VA Administration that is on the same fort that
we are located. The Director was part of our task force, and I
think it is just very active. So, that would be my
encouragement--again, it sounds National Guard-centric--that is
not what I am saying here. But take a look at your National
Guard, because that Adjutant General connects to a Governor,
and a Governor is more than willing to leverage, I believe,
State resources also to help solve this issue.
Chairman Akaka. Thank you, Colonel Livingston.
Colonel Boyd.
Lieutenant Colonel Boyd. Mr. Chairman, I would concur with
Colonel Livingston's comments and add the other piece that, in
this modern day, we seem enamored with doing everything
electronically. There is something to be said about burning up
a little shoe leather and going to find these people.
It is not an excuse to say, well, I sent somebody an email.
It really--our experience has been, when you go and knock on a
door, 99 times out of 100 that veteran is going to talk to you,
and then you are going to find out what is going on. They may
not answer the phone call. They may not answer the email. So,
there has got be a component of that ``shoe leather'' patrol,
if you will. Thank you.
Chairman Akaka. Thank you, Colonel Boyd.
Sergeant Meredith.
Sergeant Meredith. Yes, sir. One thing that I noticed that
I have had trouble as a team leader is getting some of my men
to come to some of these reintegration training meetings.
We were not very familiar with the new regulations that
have come out April 2nd. We demobed May 20th, I believe it
was--or March 20th of this year. So, part of our problem was
that we had thought that there was a 90-day window of no
training. The majority of us did go to this reintegration
training, but there are still a handful that did not go; and we
thought that we could not do anything to get them in until
after the 90-day window.
In the last several days, I have been given a regulation
for the Yellow Ribbon, but we were--we had demobed before and
we did not fall underneath of that, from what our reintegration
officer and our command knew.
The one way that we could fix people not coming in is to
give us orders of the 30 days to 60 days, and then 90 days
before we demobe. That way, we know when, where, and what time
to report for this reintegration training. And team leaders and
the command would be able to say, every one of my men have been
accounted for, because each one of them has orders. And if they
do not show up, we can actually go to their homes, instead of
going through a lengthy process before we are allowed to do
that under the authority that we have now. If we all had
orders, we could go right down and say, you must come to this
training.
So, that would simplify and hold to account my men
underneath my command, and that is the single biggest thing,
sir. Because as a three-time vet, I know what it is, especially
being wounded--of how hard it is to want to come to these kinds
of things. When you come home, you just want to get done and
let it go, but having orders could make us accountable to come
in.
Thank you.
Chairman Akaka. Thank you, Sergeant.
Major Rasmussen.
Major Rasmussen. Thank you. I know this about Guard and
Reserve soldiers, but I want to just keep in mind that, when an
active duty servicemember ends his tour and gets a DD-214, they
may come home to your rural areas alone, also. And some of
the--in the past, the suicides that we have seen have been
related to that and not to Guard and Reservists.
Anyway, really quickly, success depends on inter-service
joint programming across all government and civilian
organizations that have a stake in the health of servicemembers
and families.
Treat the whole family system. All staff that work with
servicemembers and veterans must be culturally competent. You
do not have to wear the uniform, but you have to be able to
understand why we do what we do, why we think the way we do,
and to not judge that or not avoid it or anything because of
it.
Appointments must be made for the convenience of the
consumer and not the facility. You need to work hand-in-hand
with DOD to provide seamless transition care for all
servicemembers, veterans, and families.
VAs need to have good representatives in all Guard and
Reserve units. We do have--in most of our Reserve units, we
have arranged for Vet Center staff and VA staff to come on our
drill weekends to become--to get to know--just to hang out and
get to know folks so that when we are done--because we are not
going to be in this role much longer--that there will be
somebody there they know besides us to call and talk to.
If the servicemembers, our Reservists or Guard soldiers,
include their commands and battle buddies, wingmen, shipmates,
et cetera, in their care, especially since many of them will be
deployed again and need to prepare for this while getting care
and support for the current issues.
Thank you very much.
Chairman Akaka. Thank you very much.
Senator Rockefeller.
Senator Rockefeller. Thank you, Mr. Chairman.
My first question would appear to be hostile but is not.
Why is it that everybody but Dr. Scotti had to say, I am
speaking personally, not on behalf of the Reserve, the Guard,
or the Department of Defense?
I really want to know that. Does that mean that they are
afraid that you might tell the truth? Does that mean that they
are embarrassed by what you might say, because their culture is
that everything always works and always works right? I would
like to know why you have to say that.
Colonel Livingston. Sir, I might be able to address that
because my testimony had not been vetted----
Senator Rockefeller. You cannot correct it because you said
it.
Colonel Livingston. Correct.
Senator Rockefeller. You can explain it.
Colonel Livingston. OK, I can explain it then.
My testimony had not been vetted through DOD.
Senator Rockefeller. Isn't that a very good thing?
Colonel Livingston. So I was instructed that my testimony
had to have----
[Laughter.]
Colonel Livingston [continuing]. That statement put on it,
sir.
Senator Rockefeller. See, I can understand that. I have so
many questions I do not even know where to begin.
But I can understand that, if you are from the Department
of Transportation, if you have come back from the types of
experiences that you have all come back from, your testimony,
Major Rasmussen, is probably one of the best I have ever heard
here, and I have been on this Committee for 24 years.
But it just breeds a sense of suspicion, not in you, but in
them. They have to be right. You did not vet it with them;
therefore, you are dangerous. You are telling the truth. You
are telling the truth like few people ever do before this
Committee.
One of the problems is the fact that when the VA and other
people come before the Committee, we know that everything they
have said has been vetted, so, there is no real reason for us
to listen particularly carefully to them because we know that
it is not necessarily what they think.
You are telling us what you think, and therefore you are
real. You really help us. This is superb help to us, just at
the time that the whole care of veterans has become, along with
global warming, one of the two top issues for the entire
Congress, because it is like we have suddenly rediscovered
you--our own guilt, our own mistake, regardless of who--you
know, political party or anything else going back over many
years. And there are reasons for that and I will not go into
them.
But it annoys me that you have to say that, because it
implies that if you did not that you would get in trouble, and
that makes me angry. OK. I have got that off my chest. You see,
I have got my little thing done.
Dr. Scotti, I got--you know, you say that, in your
testimony, that about a third of the addresses are wrong for
all veterans. Now, the Veterans Administration is considered
the best health care system in the country, which maybe speaks
not so well about the rest of our health care system, or maybe
it speaks very well about the VA. I will not comment on that.
But it is all based upon data, the very thing which some of you
question, the very thing which some of you question. Boots on
the ground--just do not give me emails.
I would like you to take me through what happens when a
veteran comes back. I meet with veterans. And I will take a
Sunday afternoon, and I walk in. I do not take off my tie,
because I am who I am, and we will meet for 4 hours. They will
be mostly from the recent two ongoing wars, but they will be
from other wars also. And I am, I think, pretty well thought of
by veterans, so they open up more quickly. And the things they
tell me are some of the things that you were talking about,
Major Rasmussen. That is what educates me. That is what
motivates me. That is what makes me want to do more and better.
That is why we put $5 billion more into the VA.
Now, we are having to put $5 billion more into the VA--that
does not tell you a thing because it is a very large
battleship. It has more people working in it than the Pentagon,
and it takes a little while to turn things around.
But you know, I do not really know where to begin. Because
you have got to get the help. I love this concept of, do not
say PTSD.
What is it that you want us to call you? What phrase do you
want us to use?
Major Rasmussen. Are you asking me that question?
Senator Rockefeller. I am asking.
Major Rasmussen. I actually do not have PTSD from combat,
sir, but I think it is something that would be appropriate to
dialog with those of us that work on a regular basis.
``Combat operational stress responses,'' or ``operational
stress responses,'' for those of us that were not in combat but
still had to wear the uniform.
Senator Rockefeller. OK.
Dr. Scotti, you talk about when people come home to their
families. And you talk about 43 percent having suggested
clinical levels of depression (the dread word), 35 percent have
PTSD, and 8 percent of veterans have a high-risk profile
suggesting a real possibility of suicide. All that is
profoundly complex--if you push the wrong button--stuff.
Some of the veterans I talk with talk with me after an hour
or so about going down into their basements and digging a room
under their basement, so if it came to the point where they
could not handle it, they could go handle it in their own way.
People fleeing away.
One of the questions that I think you were hoping I would
ask you is about the difference between rural and urban in West
Virginia. And I have never been able to figure that out,
because we do not have any city over 50,000 people, and they
average--I would guess, like in Vermont, except maybe for
Burlington--around 8,000.
Mr. Scotti. Big cities.
Senator Rockefeller. Yes. [Laughter.]
But how do you dump this on families?
I mean, we have got VA centers scattered all over West
Virginia. You know that. And the reason was so--because they
did not want to go to the VA centers, because the VA centers of
a number of years ago were pretty bad, and they had not very
good people running them, and that makes all the difference in
the world, and their counselors were not trained--by
definition, they could not be trained for what you all have
been through; could not be trained. It is a whole new way of
fighting a war, and accepting stress and pain and all the
dangers that come from that.
But how can you take--how can families, other than being
there everyday--how can they really help? I mean, again, like
you said, Major, the soldiers I talked to frequently talked
about when a 6- or 7-year-old jumped in their lap wanting to be
hugged.
And I would say, ``So, what did you do?''
``I very gently pushed the child off of me so that I would
not hurt that child.''
This is not something that families can do. This is not
something that even outreach--I mean, outreach to do what?
Outreach to get them to go to the VA centers? Well--gas, all
the rest of it--I mean, it makes it very, very hard to do. So,
what is the pattern? What is the pattern that should be gone
through in a State like West Virginia, which has 6,800 Guard
and Reserve, many of whom greatly resent the regular military,
if I may say that--and that is an issue which I wish we could
talk about, because I heard endless amounts of--you know, we
are being treated like second-class citizens, et cetera.
But how can you train--how do you train family members?
Mr. Scotti. I think you asked and answered all your
questions.
Senator Rockefeller. Well, I apologize.
Mr. Scotti. You cannot----
Senator Rockefeller. I apologize.
Mr. Scotti [continuing]. You cannot train them; and I might
say that perhaps you should not train them.
You need to make them aware. You need to work with the
families while the veteran is deployed, for two reasons. One,
so the veteran knows that their family is being taken care of
while they are in a danger zone.
And two, so the family can continue along without someone
important, a mother or a father or an aunt or an uncle,
grandmother, grandfather, et cetera, someone who they have
depended on. You need to provide support services for them.
And while the active duty personnel is gone, we need to
educate them on what is likely to be the case--operational
stress response sounds like a great term--when they come back.
And be aware, when you gently push the child off of the lap
so you do not hurt them, they need to know that that is why
that is happening, not to be afraid of daddy, but that is why
that is happening. And then, we are going to move on and help
get treatment for everybody. It may not be what it is for PTSD,
for depression, for substance abuse--there are just general
stress issues, et cetera, but it is a whole program of
education.
I have been recently talking with the West Virginia
National Guard and we had a Governor's conference in West
Virginia on returning veterans. We had a Colonel from the
Minnesota National Guard come and talk with us about their
program, and I am hearing similar things going on with Vermont
and Montana. I am going to pick their brains before they leave
today. We need to do many things for the service personnel and
the family before they leave. We need a comprehensive program
while they are gone. We need to make sure that these 30-, 60-,
90-, 180-day, 5-year, 10-year programs are kept up and that
everybody--we are on top of what is happening in those
families, not just mental health, but physical health,
financial health.
I have heard a number of stories where the veteran--the
personnel is over in the combat zone. The combat pay is coming
home. It is twice the money the family ever had. And by the
time they get home, it is not only gone but they are in debt
because they are not used to spending that much money. We need
financial counseling for the families while they are gone.
Getting people to the centers. West Virginia is just rich
with VAs: four VAs, six Vet Centers, multiple CBOCs, and lots
of other outreach centers--and it is still hard to get people
to show up there. There is a great stigma associated with
mental health. People are worried about whether they are going
to be able to continue in their jobs or continue in the
military if they are diagnosed with Post Traumatic Stress or
depression. People also just do not recognize when they have
problems, which is why we need this great deal of education.
Again, I would like to reinforce that having these post-
deployment assessments is critical. But even more important is
that we attend to those data and, you know, the trigger gets
back down to the personnel on the ground that something is
going on for this particular veteran and they need assistance.
Education is incredibly important at all these levels. We
have got to take care of everyone, veterans and families.
Senator Rockefeller. I went way over my time. I apologize
to my esteemed colleagues.
Chairman Akaka. Senator Sanders.
Senator Sanders. Thank you, Mr. Chairman.
This has been an excellent panel. I think we all recognize
that and we appreciate all of the members, all of the
panelists, for being here.
Let me start off by asking Colonel Boyd a question. He and
I and the Vermont National Guard and the VA have worked
together to try to develop what we think is a very good
outreach program. One of the beauties of what is going on right
now is we are seeing different States doing different things.
So, let me start off by asking Colonel Boyd, what are we
doing in Vermont that you think other States can learn from?
What are other States doing that you think that we can learn
from?
Lieutenant Colonel Boyd. Senator, I think what we are doing
very well in Vermont--as you look at the Yellow Ribbon timeline
that is laid out in NDAA 2008, the bottom line is--from day 91
on, whether that is 180 days or 10 years, we are doing it
everyday with outreach counselors, correction specialists,
working with veterans, getting them what they need and
following up with them.
What the other States are doing that I think we will
improve on here shortly--Minnesota, for example, the 30, 60, 90
is very, very formalized, and they are doing it very, very
well. And so, I think that we can learn from them in that
aspect.
The other piece that I think we bring to the table is our
sharing agreements with the Veterans Administration. The VA,
under very limited circumstances, can assist family members.
With our sharing agreement, we can bring those kids who are
having a hard time with dad or mom's deployment, or the spouse
that is having a bout with depression can come into the VA.
Because when all the troops are gone from the State, the VA
might not be so busy.
In a place like Vermont, you take, 1,500, 1,600, 1,800,
2,000 troops out, you do not have a lot of business. And we
thought it was also good, because it wraps around our families,
something we did not have.
Senator Sanders. Let me pick up on Colonel Boyd's question
and ask it to Dr. Scotti or anybody else, Major Rasmussen.
I think we all understand that we are talking about family
problems, not just the individual. And I think the point that
Colonel Boyd has made out in Vermont--we are trying to reach
out to wives and kids, as well. And we are trying to develop a
new type of relationship between the VA and the National Guard.
Dr. Scotti, is that important?
Mr. Scotti. I think that is extremely important.
As has already been commented, the VA traditionally has not
dealt with families unless the veteran has requested it, and
even then I do not think effectively in my experience. They are
just not trained for that.
We need to have that outreach. We need to have more people
at the VA who are family specialists. But as I said earlier, I
do not think we need the VA to do it all. We have very good
mental health systems that are out there that are already
extremely well-trained in dealing with child behavior problems,
family problems, depression, and substance abuse, and other
issues in the spouse that is left behind. I think we should
take advantage of that, rather than just keep growing the VA
and keep adding these personnel. The people are out there, and
they are very, very, very willing to help.
Senator Sanders. Major Rasmussen.
Major Rasmussen. Is it OK for me to ask a question?
Senator Sanders. Sure.
Major Rasmussen. When you say the Vermont National Guard
and the Montana National Guard and the Minnesota National
Guard, are you really meaning that all there is--all the
soldiers in the State: the Reserve soldiers and active soldiers
or veterans that come home? Because I am kind of--that is
making me a little nervous, because I know that, as a
Reservist--I mean, I work really well with Guards all over the
country. I have no problems. You know, we work very well
together.
But my concern is that I very often hear from Marines,
Navy, active duty, Army----
Senator Sanders. That is a good question.
Major Rasmussen. That I will--I am sorry.
Senator Sanders. No, that is a very good question, and we
try to break down those barriers, as well. And we are reaching
out to--Colonel, we are reaching out to active duty people and
Marines and people who are not in the National Guard.
Lieutenant Colonel Boyd. That is correct, sir. Those who
have come off of active duty, those who have gotten a DD-214
and returned to civilian life, those from the Marine Corps
Reserve, Army Reserve, any component--we are not turning
anybody away, Senator.
Senator Sanders. Right.
Lieutenant Colonel Boyd. Regardless of who is funding it.
Senator Sanders. The bottom line is we are all in this
together and we are not trying to distinguish.
Any other comment about the need to reach out to the entire
family, above and beyond?
Colonel Livingston.
Colonel Livingston. Thank you, Senator.
I guess if you would take this and think about what we just
talked about. Sometimes we mask it with alcohol or drugs. It
was not created by government, but Alcoholics Anonymous, which
initially was designed to treat the individual, and in the
process they realized they needed an Al-Anon program to heal
the family.
I think initially we have been trying to treat the veteran,
and now I think we have come to the realization that the family
also needs to be treated.
So, whether it is an Al-Anon approach--and that is why,
again, in Montana, we felt that it was not just DOD's
responsibility, or the VA's responsibility; it was the Montana
National Guard's responsibility to take care of our soldiers
and airmen and their family and leverage State government,
local government, civilian organizations who have stepped
forward, including, again, TriWest, who has done a marvelous
partnership with us providing behavioral health experts for not
only our members but also our families also.
Senator Sanders. OK. Well, thank you, very, very much.
I am sorry. Sergeant Meredith, did you want to jump in?
Sergeant Meredith. Yes, sir. I can speak on this
personally.
I am currently going through counseling with my family. We
did not choose to go through the VA system because of some of
the past problems that we have and the magnitude of soldiers
that are going through the VA system. We chose to go another
route through the military. It is called Military OneSource. It
is a very good program.
It actually--instead of having you travel to a VA center,
which sometimes can take several hours, they have found
counselors right down the road or within the same city or just
a few minutes away, and that has been very, very helpful. And
it allows your spouse or significant other to go with you, and
your children, and instead of just talking about problems,
problems, problems, it is, OK, how is this soldier different?
How is your husband different? How is your boyfriend or fiance
different? What is going on? What do you think that you are
seeing where he is different, or she is different?
This has been a very good program, and I also encourage my
troops to go through this system as well. It is not just for
counseling; it is also with jobs and other areas, you know,
that we have trouble dealing with once we get back home.
Because, from being active duty--you know, when we are getting
ready to come out of the system, when I was in the Marine
Corps, we had time to go through the system and get ready to
come back home, as a rule.
With the Guard, within a matter of a few days, you are
done, and you are expected to assimilate right back into the
civilian style of life, and it is just not there, sir.
Senator Sanders. Thank you very much.
Chairman Akaka. Thank you, Senator Sanders.
I do have other questions for you, but I would like to ask
Senator Rockefeller whether you have any further questions.
Senator Rockefeller. About a hundred.
Dr. Scotti, you say--and you are right, because we both
come from the same State--that, in West Virginia, on a family
assistance program that the Guard has, we have four people
taking care of five thousand. That does not work.
Mr. Scotti. No, sir.
Senator Rockefeller. So, somewhere there has to be a
difference between the soft touch that you indicated, Sergeant,
when you can go into, you know, a member of the clergy or
somebody downtown who is sympathetic, and the fact that you go
with your family allows you to say what is on your mind to
another individual who is not a member of your family, but the
members of your family are hearing you say it in very real
terms so they come to understand you at least a little bit more
after you take the uniform off, as the Major said.
Sixty-five percent of veterans turned first to informal
supports, and that is terrific and that is natural, because
that is who is around you: your family, your friends, your
neighbors, this or that. But you are dealing here with some of
the most complex physical and mental, psychological, perceived,
real, unreal, dreaming, so that you go to sleep next to your
wife--and you do go to sleep and you wake up in the middle of
the night convinced that this is an Iraqi terrorist with a
knife who is about to slash your throat. That is not trivial
stuff, and it is not stuff that families can handle. So, there
has to be really professional training, other than if you are
just going to say, well, let them talk it out, and it will
help.
I mean, when I meet with those veterans, and I do it all
the time, I always leave with the feeling that I have--you
know, maybe encouraged them a little bit. But then they are
immediately let down because I am gone and the professionals
are not there.
You said, at one point in your testimony, that 50 percent
of veterans in West Virginia never even go to a VA hospital--
never even go. So, we can sort of count that one aside.
On your CBOCs and outreach centers and other kinds of
things which you and I have both worked on--you know, I am
thinking of the one up in Wheeling, with John Looney, a Vietnam
vet. It worked like a charm. He is just there--it is something
on the street. It is not a big building. It does not have a
long driveway. It does not have executive parking places; you
have got to find a place on the street; and you just walk in,
and you are with friends. That, however, is not the kind of
training, it seems to me, that is needed to deal with some of
these really severe problems and to individuals who may not
have the problems that I just talked about, but the problems
that they do have are as real to them as if they were those
problems.
So, what do we do about that? Now, we have got a whole
bunch of money so we can begin training. But the last I heard,
you are a psychologist, right? Well, to become a psychologist,
you have to take 7 years after you have finished college. Am I
correct about that?
Mr. Scotti. I did it in five, but, yes.
Senator Rockefeller. Well, you are smart. [Laughter.]
But I mean, I am just talking about, what are we going to
do, because this is here and now? And this is going to go on
for a long, long time, this War on Terror.
Mr. Scotti. And even if it does not go on for a long, long
time, the problems are.
Senator Rockefeller. The problem is----
Mr. Scotti. The problems are.
Senator Rockefeller. I agree with you, it is for life. It
is all for life.
Mr. Scotti. The Vet Centers do a tremendous job in
supportive therapy. My experience with people who work in Vet
Centers--tremendous care providers--but they are not trained in
some of the most empirically supported treatments that are
incredibly intensive and individualized.
Group therapy has its purposes and points. It is very
important for veterans to be talking about their experiences,
but it has to be done in a controlled and safe environment
where they feel that they can do that, and where somebody is
listening and understanding and is not going to run out of the
room screaming when they hear the horror stories. And they are
horror stories.
We need to get more people fully trained at many, many
levels. In our State, the Council on Churches has developed a
program called CARENET: Caring Beyond the Yellow Ribbon. They
are trying to train their clergy in how to recognize when
members of our congregation are having difficulties--and this
is of all sorts--but particularly our returning veterans. And
what are the limitations of what they can do? They know they
should not be doing therapy, but they want to know how much
they should listen without it going too far and opening up a
can of worms that cannot be easily shut.
And the same thing is the problem with large-group
therapies or intensive programs that are just about group
therapy. I have done many, many years of individual therapy for
trauma of all sorts. It is incredibly effective, but it is
incredibly intensive and long term. But there is hope. There
are people I have treated that I would say have been cured.
Senator Rockefeller. So, what you are basically saying is
that, at some point in this process there needs to be a
professional who is available; a trained professional in these
areas who is available.
Mr. Scotti. Yes.
Senator Rockefeller. And you cannot just rely on families.
They help----
Mr. Scotti. You certainly cannot rely on families.
Senator Rockefeller. But you cannot escape----
Mr. Scotti. You do not want the veteran telling the stories
that they need to tell to their family. They cannot and they
should not.
Senator Rockefeller. Yes.
Mr. Scotti. It is not fair to either party.
And we need training at the VA level. We need training in
the community. There are not enough community care providers
who know how to deal with trauma. And we need training at the
level of physicians to recognize when somebody is having mental
health problems.
It is fine to go to your local CBOC and get some medical
care, but physicians should be able to ask a couple of
questions or recognize a couple of signs and say, I think you
should see Dr. So-and-so down the hall who is a mental health
counselor, to get some initial screening and a contact going
there.
You mentioned our family program in West Virginia. We have
four staff, two are psychologists. They are not allowed to
treat more than three sessions. So, even if that----
Senator Rockefeller. You mean you have three sessions and
then that is it?
Mr. Scotti. That is it.
Senator Rockefeller. Well----
Mr. Scotti. And then vets have to get on elsewhere, if they
will go to the VA.
I would also--on a personal soapbox, if I can take a moment
to do that--I think in terms of compensation and pension, most
of the veterans that I have dealt with over the last 20 years
do not apply for compensation for the money. They apply to get
the treatment. The money is useful and helpful. They want the
treatment, because money does not solve the problems.
And I personally feel that the VA sets the bar too high as
to what qualifies for Post Traumatic Stress Disorder. In the
civilian world, any veteran who walked in with the problems
that most of the men and women I have talked with have would
get a diagnosis of PTSD in an instant.
In the military world, in the VA world, it is like, oh, you
are only having nightmares once a week? Yes, you and everyone
else. That is enough. You do not have to have them every night,
four times a night. Once a week, once a month is enough.
You think about it everyday? Well, so does everyone else.
That is way beyond the criteria needed to get PTSD. You are
avoiding people and bunkering down in your basement, as you
said? That is enough to meet criteria.
The bar is way to high. If it were up to me, if you served
in a war zone, you would get the money, and you would get the
treatment automatically. You do not have to jump through hoops.
That is my soapbox.
Senator Rockefeller. Well I have, again, gone way over my
time.
I just really mean it when I say that you are sort of an
ideal panel. You are the kind of panel that every Congressman
and Senator dreams about.
Major Rasmussen. Is that a nightmare, sir?
Senator Rockefeller. Huh?
Mr. Scotti. Is that a nightmare, sir?
[Laughter.]
Senator Rockefeller. No, no, no, no, no. Because you are
saying what you think, what you know, what you believe, what
hurts, what could help, and you are saying it free of any
vetting. The very though of vetting you is offensive to me, but
that is a matter I will leave for another day.
Mr. Chairman, I thank you, and I apologize for my length.
Chairman Akaka. Thank you very much, Senator Rockefeller.
Without question, he is a valued Member of this Committee,
and former Chairman of this Committee, as well. And you can
tell that Senator Rockefeller has a passion for trying to get
things right. So, we value him as a member of the U.S. Senate,
and I am so glad that he was here today. And I want to thank
you folks again.
As Senator Rockefeller pointed out, this is an ideal panel,
because you represent different parts of the country, the
Reservists as well as the National Guard, and the academic
sector as well.
So, once again, allow me to thank all of our witnesses for
the testimony that you have provided. This information will
undoubtedly be of great value to this Committee as we proceed
to consider the problems we have explored today, and ideas that
have been offered to address them.
We also can utilize the lessons learned from things that
are being done right, and find ways to incorporate those
methods in achieving our common goals.
We all work tirelessly to ensure that veterans receive the
best possible care and the greatest possible benefits in
recognition of their honorable service to our country, and our
country in time of need.
Historically, the members of the Guard and Reserves have
been somewhat under-served by our efforts. And we are
endeavoring to change that.
The National Guard and Reserve servicemembers face unique
challenges as they selflessly set aside their education, their
careers, to serve in harm's way. We have all learned more about
those obstacles today, and I look forward to working with my
friends and colleagues on the Committee, in this Senate, and
our friends in VA and DOD to remove as many of these obstacles
as we can. And these are the steps that we are looking forward
to taking.
Again, I want to thank all of you, and this hearing is now
adjourned----
Senator Rockefeller. Mr. Chairman, can I just add one more
little thing? This is, I promise, less than a minute.
It strikes me as an ultimate irony that we ask people, 18,
19, 20, 21, who are willing to take risks and are eager to do
so, and then, when they have been through their first
deployment, second deployment, they want to get back with their
buddies, and I really resonate--I think it was you who said
that, get me back--or maybe it was you, Sergeant--get me back
to the rules: how, when, where, why, what time.
That is a comfort zone developed over a period of time, but
then we take these very young people and we put them through a
type of hell that nobody else in the country can come anywhere
close to understanding and--which is one of the reasons,
frankly, that I have--maybe you do not agree with me, but I
have agreed with embedded journalism because it is what has
brought this thing home.
And now, it is--you know, the television is just full of
it. But then, when a youngster comes back--you are 22, which I
consider somebody a youngster--they come back and they are in
the very worst position to take the risk of what they then have
to go through in the immediate future and, really, for the rest
of their life.
So, we pick them for their youth, and then we, to this
point at least, have been too much dropping them at their most
vulnerable age.
Chairman Akaka. Thank you very much, Senator Rockefeller.
This hearing is now adjourned.
[Whereupon, at 12:03 p.m., the hearing was adjourned.]
A P P E N D I X
----------
Prepared Statement of Kevin and Joyce Lucey,
Parents of Cpl. Jeffrey Michael Lucey--USMC Reservist
We first want to thank you for allowing us to present our son's
story today.
We are the proud parents of Cpl. Jeffrey Michael Lucey--an USMC
reservist who signed in 1999; was activated in January, 2003; sent over
in Kuwait in February, 2003, participated in the invasion and then
returned physically unscathed in July, 2003. Initially, there were
minor adjustment problems. Then, on December 24, 2003, Jeffrey tossed
the dog tags to his youngest sister while standing in the kitchen,
intoxicated and with tears in his eyes, declaring himself to be no more
than a murderer. We encouraged him to get help but he refused due to
stigma. We finally brought him to the Veteran Administration Medical
Center on Friday, May 28, 2004--the Friday of the Memorial Day weekend.
After refusing to enter voluntarily, Jeffrey was involuntarily
committed due to being both homicidal and suicidal only to be
discharged three and a half days later--despite making very serious
statements while in their custody. During his stay there, staff had
advised us that we might want to consider 'kicking him out of the house
and letting him hit rock bottom or call the police and if necessary,
lie' to get Jeff to remain sober for a period of time so they could
assess him for PTSD. Thus, Jeffrey was never assessed for Post
Traumatic Stress Disorder--in fact, he only saw a psychiatrist on the
evening of the admission and the morning of discharge on June 1, 2004.
We, his family, were never informed that he had admitted to not only
having a plan to harm himself, but also a method. He would carry out
his plan using the hose he had told the admitting psychiatrist about
when he ended his life on June 22, 2004.
On June 3, 2004, Jeffrey was involved in a single car accident and
then resumed drinking heavily while being on medication. Becoming
further despondent, we contacted the VAMC and informed them of the
developments. They stated that he sounded to be worse and encouraged us
to return him. He reluctantly returned to the VAMC but refused to go in
voluntarily due to his first experience of being with so many older
veterans who were suffering from assorted mental health issues. They
never called anyone authorized to do an involuntary. Jeffrey came back
home despite his support system stating that we were being overwhelmed
by the issues. We called the civilian Emergency Crisis Services only to
be turned away again. All abandoned both Jeffrey and our family. We
were left totally alone.
Despite Jeffrey's halt in drinking for 5 days--Joyce calling the VA
and telling them that we were watching our son die slowly in front of
us (how prophetic!) and her emphasizing that we only have this small
window of time, we were put off for another 3 days and referred to the
Vet Center. Jeff's intake was done and a plan developed to get a bed
for Jeffrey for PTSD--in the meanwhile, the Vet Center therapist would
come to the house 3 days per week . . . except time ran out. (Further
details of Jeffrey's struggles and death can be found under his name on
the internet).
On June 21, 2004, late into the night, Jeffrey asked if he could
sit in my lap which he did--and we rocked for about forty-five minutes.
Then, the next time I held him in my lap was the next night as I took
the hose from around his neck and lowered him to the ground.
Jeffrey and our family are not alone. Regretfully, this travesty
has been repeated over and over again throughout this Nation.
While all talk and argue about this issue, there is probably
another putting a noose around their neck or loading a bullet into the
chamber.
In this country, to have this situation is completely unacceptable,
immoral, illegal, inexcusable and unconscionable--it is simply wrong.
We are here today on behalf of so many of our veterans who are
bearing wounds both seen and hidden who proudly wore the uniform for
their country and their families/loved ones--not only asking why but
also when . . . when will this Nation and her government give to those
who have sacrificed so much the Best of care and develop the healthcare
system second to none for our wounded warriors?
We stand totally bewildered as to how the veterans serving within
Congress, with the exception of so few voices, could abandon their less
fortunate brothers and sisters in uniform to suffer so horribly and
allow many of them to die from their negligence . . . such as our son
and so many more.
It is because of this negligence by both this administration and
the past Congresses that we suffered so many needless deaths off of the
battlefields.
Let not the Legacy of this Congress be of those of the recent past
Congresses and the present administration;
Let not this be another Congress which will just talk the talk and
allow the necessary funding for the treatment of our warriors inflicted
with the hidden wounds of Post Traumatic Stress Disorder to disappear
not only once, twice, but Three times in the darkness of conference
committee--at those times immersing our government and Nation into the
depths of shame, disgrace and dishonor;
Let this not be another Congress who abandons, turns its' back and
leaves the troops behind once they return home to a broken,
dysfunctional VA healthcare system which has shown that it will deceive
and minimize to Congress itself;
Rather, Let this Congress truly be the Congress which will support
the troops and veterans--supporting them in both word and deed;
Let this Congress be the Congress which will embrace those who
served and will keep this Nation's promises to our heroic men and
women;
Let us as a Nation be all that we can be to those who now are in
need of our help.
______
Addendum
recommendations based on our experiences:
Health Proxy for those deployed;
Community education of resources for troops, veterans and military
families as well as reciprocal education for the community based
services as to PTSD and other related mental health issues from combat
related experiences--this would include the medical field as well as
first responders, bartenders, package store employees, etc.
Developed in concert with communities, community based intervention
centers i.e. weekly Veterans Court in Buffalo; specialized correctional
centers for veterans afflicted with PTSD as well as developing
alternative innovative sentencing options for those who work the
program.
Development of SAVE teams as modeled on the SAVE team in
Massachusetts who not only assist but can also advocate for veterans /
families but for selected veterans--can also provide employment
opportunities to those who wish to help and work with their brothers
and sisters in arms.
To do follow-up on the Joshua Omvig law--to provide adequate
resources to house and treat those found to be in need.
If the VA system is to continue, then give it a rebirth--make it
responsive to the needs of the veterans; not forcing the veterans to
meet the needs of the system. Let the system not remain to be the slow,
lumbering, dispassionate bureaucracy--change it to be the active
outreach which it should have always been. The VA must develop programs
reaching beyond their walls.
If the VA is truly serious about self examination and challenging
itself to be the best that it can be, then it must appoint those who
will challenge it. Don't appoint the old traditional members--some or
all who may have a vested interest in maintaining the status quo--to
those committees charged with examining various issues; appoint members
such as veterans who know of its' lackings and failings so that they
can be addressed as well as some of their loved ones who will be able
to give different perspectives.
These are but a few of suggestions which we have. It may be the
time to call together various components of the systems including
veterans, military families, etc. to a multi-day conference to assist
in the creation of that which should have always been--the most
effective, efficient, responsive and comprehensive veteran healthcare
system on this planet.
We thank you for your time and patience.
Respectfully submitted,
Kevin and Joyce Lucey,
The proud parents of Cpl. Jeffrey Michael Lucey,
a 23-year-old USMC reservist forever
succumbed to the hidden wounds of PTSD.
03/18/1981-06/22/2004.
______
Prepared Statement of Pat Rowe Kerr, State Veterans Ombudsman,
Missouri Veterans Commission
Thank you for an opportunity to offer testimony outlining the
extensive and aggressive efforts the State of Missouri's Veterans
Commission has made since March 2003 to create programs to support
Guard, Reserve and injured Active Duty.
The program directed by the State Veterans Ombudsman, Operation
Outreach, has become a nationwide model for Best Business Practice.
Five States, one country (Canada) and the Department of the Army
(through their Army Community Covenant Program) are using this program
as an example of Best Business Practices in creation of their support
and outreach.
Missouri has 540-560,000 Veterans, with 51,100 deployments since
OEF, affecting over 225,000 family members. The Missouri National Guard
currently has 1100 members deployed in support of the KFOR 10 mission,
under the leadership of the Commanding General, Larry D. Kay, who also
is the Deputy Director of the Missouri Veterans Commission when not on
leave to support his military obligations.
The State agency is a Title III agency, which does not report to a
DOD agency and is a sister agency to the Missouri National Guard.
Representatives from the Missouri Veterans Commission work laterally as
well as drilling down in to the local communities and governments and
up through the State, to the Department of Defense and the Veterans
Administration.
The following outlines the extensive outreach created thus far.
Referrals between agencies occur daily, and over $2 million dollars
have been coordinated to support Guard, Reserve and injured Active
Duty.
To mention a few successes, 45 families have been kept from
homelessness, medical board cases have a 100% success rating in
achieving a minimum of a 30% DOD medical discharge, so as to minimize
the negative impact on receipt of VA benefits.
The VA and the State of Missouri Veterans Commission has been
working together on at least a bi-monthly basis to benefit Veterans and
families from the Global War on Terror since 2004 on several individual
issues facing America's newest Veterans. Weekly referrals are made via
agency relationships.
In 2003 a citizen in Missouri began a very recognized outreach
program to support the Guard and Reserve military and their families as
her Reservist daughter was deployed at a time when her husband was very
injured. The daughter left a 13-month-old and a husband and the family
recognized they were living what would be facing the injured returning
from war.
Missouri's Governor, Matt Blunt, and the legislature worked with
the Executive Director of the Missouri Veterans Commission and the
Missouri Association of Veterans Organizations to expand her efforts
and brought her to the Missouri Veterans Commission as the first State
Veterans Ombudsman in the United States.
At this point, the program they developed has a strong relationship
with all of the VA facilities in Missouri to support all components of
the military, focused on the Veterans, military and families serving in
the Global War on Terror. We are providing you a matrix defining the
outreach to all branches and components as well as community and
benevolent organizations.
Most recently, at the suggestion of the Office of the Secretary of
Defense, the Department of the Army has used this program as its
nationwide Best Business Practices example to create its newly
developed Army Community Covenant Program. Missouri's program is also
being mirrored by five States and one country, Canada.
In addition to the State Veterans Ombudsman working directly with
the injured at time of initial injury at the medical facilities where
she has had 100% success in advocating on behalf of the injured for at
least a minimum of a 30 percent Medical Board rating and identifying
gaps, the staff working in the Operation Outreach Program have now
coordinated over $2 million in private grants as well as kept 45
families from homelessness. The State Veterans Ombudsman and the
Missouri Veterans Commission has been integral in the development of
legislation and policy both nationally and statewide.
This aggressive program is the oldest in the Nation and staff have
assisted Troops, Veterans and families from over 30 States while
continually identifying gaps and proposing potential solutions.
VA OEF/OIF managers, social workers and PTSD clinics and polytrauma
staff work regularly to coordinate resources through Missouri's program
to benefit those at our facilities. Social Worker, Polytrauma Network
Site, St. Louis, Erin Hullinger wrote to State Veterans Ombudsman Pat
Rowe Kerr and said:
``I just wanted to write you to say thank you for all that you have
done for the veterans in our polytrauma program here in St. Louis.
The resources and financial assistance that you have connected my
patients with have been invaluable. We often see amazing
differences in our patients after severe financial stress is
relieved--it improves their stress/anxiety and allows them to
redirect their focus from dealing with financial problems to
dealing with their complex medical and psychological issues. Many
are even more compliant with treatments and recommendations after
this burden is lifted. I love to get the relieved and excited phone
calls from patients and spouses when the assistance comes in. These
injured young men and women have so much to deal with after they
come home, and finances often rise right to the top of the list.
The type of assistance you give also helps some of these patients
to be able to leave jobs that are grossly inappropriate for them
(physically and mentally), and pursue more appropriate, gainful
careers.
You are invaluable to me and to my veterans. I think I have told you
before that I would have to completely change the way I assist with
resource referral (finances, SSD, housing, utilities, etc.) if you
were not doing what you do. I feel so fortunate (especially when
compared to my counterparts in other regions) to have your
commitment and support to helping our veterans. Thank you so much
for all you do, and I look forward to continuing to work with you
in the future!''
State Missouri Veterans Commission (MVC)
Missouri State Veterans Ombudsman Program
comprehensive reintegration services
*Created a specific outreach through the Missouri Veterans
Commission called ``The State Veterans Ombudsman Program.''
The initial goals were to reach as many Guard, Reserve and their
families who deployed since 9/11 to (a) provide financial support in
crises situations, (b) to develop relationships that would ultimately
bring the injured in to the VA health, disability and pension system,
with assisted access to state and local benefits and resources, which
also provides an economic benefit to the communities of Missouri; (c)
to identify gaps and propose solutions with the systems supporting
Missouri's newest veterans; and (d) to raise awareness that the State
of Missouri Veterans Commission is the only neutral point of contact
for all branches and components.
**Five States and one Country (Canada) are mirroring this program
in some manner and the Department of the Army is using the Missouri
Veterans Commission ``State Veterans Ombudsman Program Operation
Outreach'' as the nationwide Best Business Practices in the creation of
its new Army Community Covenant Program.
Have developed outreach for over 3100 individual cases in 3 years,
coordinating over $2 million in grant resources as well as keeping 45
families from homelessness.
The State Veterans Ombudsman Program Operation Outreach advocates,
educates, coordinates resources and individually assists in navigating
the complex DOD, Federal, state and local systems.
To date, it has a 100% success rate in working DOD medical board
cases to increase ratings to a minimum of at least 30% at discharge
from the Department of Defense through the MEB/PEB system based upon
review of medical records.
to accomplish these outcomes, the program
Develops and utilizes resources and assists in navigating Service
Members, Veterans and Families toward optimal life solutions in
transitioning to civilian environment
Increased outreach to deploying and returning servicemembers and
their families through Reserve, NG and Family Readiness Programs/
Briefings (have briefed thousands of NG, Reserve, injured Active Duty
and families)
Developed outline explaining DOD/VA/TSGLI/MED/PEB/Social Security
Disability for educating injured.
Increased support and connectivity with Ft. Leonard Wood to support
Missouri's injured by:
Educating Medical Hold Commanders
Provide liaison support for injured/sick troops
transferred from Ft. Leonard Wood to civilian medical facilities
Provide transitioning assistance to Guard, Reserve and
injured Active Duty demobilizing through this facility and through the
WTU
At the request of Ft. Leonard Wood WTU the Ombudsman meets
almost monthly with the injured at the facility assessing needs,
assisting with life care plans and decisionmaking, reviewing MED/PEB
ratings, getting injured servicemembers in to additional Federal and
systems that can benefit their families.
The Ombudsman has developed a relationship between Ft.
Leonard Wood Medical Holdover and Rusk Rehabilitation Center to provide
specialized care for Missouri's traumatic brain injured.
Increased support and connectivity with Ft. Riley by:
Educating Medical Hold Commanders
Provide liaison support for injured/sick troops
transferred from Ft. Riley to civilian environment
Provide transitioning assistance to Guard, Reserve and
injured Active Duty demobilizing through this facility WTU
Increased support and connectivity with Whiteman Air Force Base by:
Educating Commanders, returned Airmen/women and Family
Readiness Groups
Provide liaison support for injured/sick/financially
strapped Airmen/women
Provide transitioning assistance to Guard and Reserve
demobilizing through this facility
Increased support and connectivity with Fayetteville CBHCO-AR to
support Missouri's injured.
Welcome Home letters are sent individually from the Executive
Director of the Missouri Veterans Commission as well as the Missouri
National Guard Adjutant General with specific points of contacts listed
as the respective agencies to National Guard servicemembers.
Additionally, the Missouri Veterans Commission sends Welcome Home
letters to all branches and components with POC information listed.
briefings
Weekend briefings
Briefings are provided to Guard and Reserve of all components that
can be scheduled relative to time, access and staff availability as
well as to family readiness groups
Demobilization Briefings
Presented to Reserve components prior to release from Active Duty
Status as available
Medical Hold Briefings
Given at regular intervals at WTU facilities, working specifically
with the Reserve Component injured initially. Now Active Duty injured
are referred to the State Veterans Ombudsman for advocacy, education
and assistance as well relative to transition to civilian life.
Financial Assistance
*Working with the Lt. Gov., created the Missouri Military Family
Relief Fund (MMFRF) where Guard and Reserve can receive up to a
$3000.00 grant as a result of financial difficulties relating to their
deployment. Over $286,000 has been raised, with 100% of private
donations or tax check-off contributions going to the Fund.
With the leadership and support of the Lt. Gov. the State Veterans
Ombudsman created and coordinates The Power of 11 Cents which is an
academic outreach in the schools to educate children on patriotism. The
program has been recognized in an article that appears in the National
Honor Society's Leadership Magazine. To date over 7,800,000 pennies
have been raised by children for the MMFRF through the school
presentations.
Created Trekking For Troops, along with a billboard campaign on the
tax check-off, all of which raise dollars for the Missouri Military
Family Relief Fund.
See (Comprehensive Reintegration Services) (Legislation)
(other State Programs) relative to additional financial assistance.
Community Outreach, Education and Advocacy
Developing support mechanisms within communities through events,
Supermarkets of Veterans Benefits, and Support Your Troops Events.
Working on coordinating a community and faith based conference as a
follow-up to the first Intra-Agency State Veterans Conference.
Freedom Walks
Will host the second Freedom Walk for the Capitol city of Jefferson
this September.
Benevolent and community/Veteran Service Organization
partnerships
Appointed to the Boards of Operation Military Kid, the Brain Injury
Association of Missouri. Serves as the ex officio member on behalf of
the Missouri Veterans Commission to the Missouri Military Preparedness
Enhancement Commission and on the advisory committee for the Missouri
Military Family Relief Fund.
Created an informal coalition of military donors that spans the
United States and includes such 501(c)(3) organizations as USA Cares
(www.usacares.us) out of Kentucky, Operation First Response
(www.operationfirstresponse.org) out of Washington, DC, Wounded Soldier
(www.woundedsoldier.org) out of Chicago, Operation Undergarment
(www.operationundergarment.com) St. Louis, and the Coalition to Salute
America's Heroes (www.saluteheroes.org) New York, OIF Family Fund
(www.oiffamilyfund.org), California, to name a few. Works regularly
with the VFW Unmet Needs Program (www.unmetneeds.org) located in Kansas
City, Mark Cuban's Fallen Patriot Fund (www.fallenpatriot.org) in
Dallas, Snowball Express (www.snowballexpress.org), California, Semper
Fi Fund (www.semperfifund.org) as well as the American Legion's
National Temporary Financial Assistance Program (TFA) grant, to name a
few.
As an example, The Ombudsman created Operation Save the Home,
Operation On Spirit's Wings, Operation Children's Hearts, to assist
with extreme extraordinary situations, raising over $30,000 in
resources for each outreach.
State Intra-Agency Veterans Summit
Coordinated to acquaint all state agencies with the Missouri
Veterans Commission as well as to facilitate collaborations amongst
agencies
Traumatic Brain Injury
Assisted with creating a State Action Plan for Traumatic Brain
Injury in Missouri at the direction of the Governor working with the
Missouri Head Injury Advisory Council, Governor's Council on
Disabilities, Missouri Department of Health and Senior Services, Brain
Injury Association of Missouri, Missouri Veterans Commission, Missouri
Planning Council for Developmental Disabilities, Rehabilitation
Institute of St. Louis, Missouri Protection and Advocacy Services,
University of Missouri-Columbia, the Center for Head Injury Services,
Missouri Association of Rehabilitation
National presentations/testimonies
89th RRC Battle Focus Conference, Kansas
Vietnam Veterans of America Winter Conference, Arizona
Brain Injury Association of Missouri Annual Conference,
Missouri Veterans Commission
Coalition to Salute America's Heroes Road to Recovery
Conferences, Texas, Florida--4 years--Life After War--It's About Making
A Plan
Coalition to Salute America's Heroes Troop Recognition,
Missouri
Wounded Soldiers Conference, Illinois
Congressional Subcommittee of the House of Representatives
on Small Business, Washington, DC
The Joint Committee of the Missouri House and Senate on
Veterans Affairs
Missouri State Veterans Commission's Accredited Veteran
Service Officer Training
The Missouri Department of Economic Development's Annual
training for Disabled Veterans Outreach Program (DVOPS) and Local
Veterans Employment Representatives (LVERS)
The National Head Injury Association Annual Conference,
Missouri
Naval Ombudsmen Family Programs, Missouri
Missouri Association for Social Welfare Conference,
Missouri
Various community, civic and veteran service organizations
statewide
Participated in the AMVET's National Symposium on the
Needs of Returning Veterans, Chicago, Illinois
Attended the 15th Annual International Conference on
Combat Stress at Camp Pendleton, California
Attended Department of Defense America Supports You Annual
Conference in Washington, DC
Keynote Speaker at Tri-State Veterans Conference in
Dubuque, IA
Keynote Speaker at Marine Parents Annual Conference in
Washington DC and Missouri
Presented to the Head Injury Associations of Idaho, Oregon
and Alaska by video conference
Presented at the Missouri Department of Mental Health
CLAIM Training
Keynote Speaker at Fort Leonard Medical Hold and Dental
Winter Ball
Presenter at Missouri Department of Mental Health Annual
Conference
Presenter and Coordinator of Fisher House Donator Luncheon
in St. Louis, MO
Presented at International Center for Psychosocial Trauma
``Multiple Faces of Trauma: An Integrative Approach to Preparing
communities--2008 14th Annual Conference, Missouri
NGB Family Readiness Summit (Washington, DC)--assist in
developing new policy formation
Special Forces (Florida)--profiled Missouri's Operation
Outreach Program and State Veterans Ombudsman position
National Guard Bureau--provided subject matter expert
advice at Family Readiness Symposium, Washington, DC
National Association of State Departments of Veterans
Affairs--presented Power Point and provided best business practices
regarding development of Operation Outreach Program and creation of a
State Veterans Ombudsman position at Mid-Winter Conference, Washington,
DC
Presented subject matter information at the Missouri State
Social Workers Conference in Columbia--The True Welcome Home
Presented subject matter information to the Department of
the Navy Ombudsmen at the regional ombudsmen training in St. Louis
Developed ``Life After War--It's About Making A Plan''
booklet
Coordinated ``A Grateful Nation Remembers'' legislative
recognition, ``75th Missouri Veterans Commission Anniversary
Celebration and the 9th Support Your Troops Event outreach
Provided support for the State Women Veterans National
Conference, Branson, Missouri, May 2007
State/national outreach/awareness
Prepared and submitted testimony to a VA Committee re GWOT gaps/
solutions
Prepared and submitted testimony to the Presidential Task Force on
OEF/OIF issues
Provided education support relative to GWOT legislation for the
Missouri Association of Veterans Organizations (MAVO)
Provided support to Missouri Military Preparedness Enhancement
Commission
Created a Power Point outlining development of Operation Outreach
Program which has then been used as a prototype for other programs
Created one-pager relative to Operation Outreach which was used as
prototype for other MVC programs
Prepared and supported grant proposal presented to Senator
McCaskill re GWOT/Veterans' needs
Participated in the development of a liaison between Mental Health,
MVC, and VA
Wrote the initial white papers that supported the Joint House and
Senate Committee on Veterans Affairs and the more recent Governor's
Advisory Council
The Ombudsman has been integral in providing information to support
the passage of several bills benefiting veterans and servicemembers to
include the Missouri Military Family Relief Fund. A bonus of the
efforts of the Ombudsman has been coordinating financial assistance for
prior service veterans.
Additionally, the Ombudsman has been asked to serve on the new
American Legion, Army Wounded Warrior 2 ``Hometown Heroes'' initiative
to assist the extremely injured transition back to their communities.
The State Veterans Ombudsman has been contacted by servicemembers,
new veterans or their families from some 30 states with questions
relative to programs created within Operation Outreach. She
participated in the development of the statewide Traumatic Brain Injury
plan with the Department of Health and Senior Services.
The Ombudsman creates programs that raise awareness not only of the
needs of GWOT veterans but increases the awareness of prior service
veterans about their Federal benefits along with benefits from the
Missouri Veterans Commission. She speaks to organizations representing
them as well and has been invited to speak to national organizations on
ways to assist prior service veterans.
Additional MVC Specialty Programs for Outreach
The Missouri Veterans Commission has also created: Women's Veterans
Program, Minority veterans program, Reintegration Program.
Additional Accredited Veterans Service Officers have been added
throughout the state as well as increased budget for Missouri Veterans
Commissions Veterans Homes.
The Veterans Service Grant Program funding has been increased to $1
million to provide additional support to Veterans Service Organizations
who have Accredited Veterans Service Officers.
Memorandum of Understanding
Created on how state agencies (MVC, DOL) and the National Guard can
provide services to returning Troops and their families
additional state programs
Education/Scholarships (Also see legislation and other programs)
Hero At Home Program (DED) Available to spouses of Guard and
Reserve who are deployed and extends the program to cover the first
year after discharge from deployment, to cover Reservists, and to cover
situations in which an individual cannot return to his or her previous
employment;
Missouri Returning Heroes Education Act (Higher Education) (creates
a $50 tuition per credit hour limit for combat veterans who have served
since September 11, 2001)
Injured and dependent Scholarships Allows the spouse and children
of a soldier who was killed in action after September 11, 2001, or who
became 80% disabled as the result of an injury sustained in combat
action after September 11, 2001, to receive an educational grant for
tuition at a public or private college or university in Missouri. The
Coordinating Board of Higher Education will award up to 25 grants
annually. If the waiting list of eligible survivors exceeds 50, the
board can ask the General Assembly to increase the number of grants it
is authorized to award. The tuition grant cannot exceed what is charged
for a resident by the University of Missouri-Columbia.
The Veteran must have been a Missouri resident when first entering
military service or at the time of death in order for his or her
survivors to receive this grant. In addition to the full cost of
tuition, the grant includes $2,000 per semester for room and board and
the actual cost of books up to $500 per semester. Children are eligible
to receive the scholarship until age 25. Spouses are eligible until age
45. No eligible student will receive a grant for more than 100% of the
tuition costs when combined with other similar funds given to the
student;
Employment
Veteran's preference for consideration in employment with the State
of Missouri and Federal agencies
(Also see Hero At Home Program)
Dept. of Mental Health/PTSD
Additional dollars have been added to the Department of Mental
Health's budget to provide counseling to families of GWOT Veterans at
provider networks throughout the state.
Additional general revenue dollars have been allocated for PTSD
outreach through St. Patrick's Center, St. Louis, Missouri.
Governors Advisory Council for Veterans Affairs which identifies
the needs of Missouri's aging Veteran population, develop strategies
for improving the delivery of services, increase services to and
awareness about the number of women veterans in Missouri and promote
Missouri as a ``military friendly state''
Missouri Military Preparedness Enhancement Commission
The Missouri Military Preparedness and Enhancement Commission was
established in 2005 when Governor Matt Blunt signed Senate Bill 252
into law.
The Commission is tasked with making recommendations regarding
community relations and interstate cooperation on military issues. The
Commission will also serve as a clearinghouse for information regarding
Federal actions affecting military installations and their potential
impact on the state and local communities.
Conservation
Free hunting and fishing permits for Veterans with 60% or more VA
disability rating
Reduced price hunting and fishing permits for Missouri Veterans who
mobilized in the previous 12 months.
Department of Revenue
Waiver of Missouri CDL driving examination requirement with
military CDL certification (other conditions apply)
Missouri Army and Air National Guard
Have created additional programs to support families and military
Legislation passed to Support GWOT Servicemembers, Veterans and their
families (highlights for GWOT)
SS HB 1687 (some of the provisions)
Allows a military dependent who has completed an accredited
prekindergarten or kindergarten program in another state to enter
kindergarten or first grade even if the child has not reached the
required age for Missouri schools by August 1;
Authorizes the State Board of Education to develop recommendations
regarding alternate assessments for military dependents who relocate to
Missouri during the school year;
Requires the state board to establish a rule to allow the issuance
of a provisional teacher's certificate before the completion of a
background check to the spouse of a military member who holds a
teacher's certificate in another state that requires a background check
and who has relocated within the last year;
Allows school districts to accept a course in government completed
in another state when a student transfers to a Missouri high school in
ninth to twelfth grade to satisfy the state's graduation requirement;
Allows the spouse and children of a soldier who was killed in
action after September 11, 2001, or who became 80% disabled as the
result of an injury sustained in combat action after September 11,
2001, to receive an educational grant for tuition at a public or
private college or university in Missouri. The Coordinating Board of
Higher Education will award up to 25 grants annually. If the waiting
list of eligible survivors exceeds 50, the board can ask the General
Assembly to increase the number of grants it is authorized to award.
The tuition grant cannot exceed what is charged for a resident by the
University of Missouri-Columbia.
The veteran must have been a Missouri resident when first entering
military service or at the time of death in order for his or her
survivors to receive this grant. In addition to the full cost of
tuition, the grant includes $2,000 per semester for room and board and
the actual cost of books up to $500 per semester. Children are eligible
to receive the scholarship until age 25. Spouses are eligible until age
45. No eligible student will receive a grant for more than 100% of the
tuition costs when combined with other similar funds given to the
student;
Renames the Guard at Home Program to the Hero at Home Program and
extends the program to cover the first year after discharge from
deployment, to cover reservists, and to cover situations in which an
individual cannot return to his or her previous employment;
Specifies that military service and out-of-state employment, by
itself, is not sufficient to justify a modification of a child custody
or visitation order; and authorizes Missouri to enter into the
Interstate Compact on Educational Opportunity for Military Children and
establishes the Interstate Commission on Educational Opportunity for
Military Children. The compact becomes effective upon its adoption by
10 states. Military children include the kindergarten through twelfth-
grade children of active duty members of the Armed Services including
the National Guard and the Reserve, as well as the children of members
who die while on active duty, retire, or are medically discharged for a
period of 1 year afterward. The compact covers issues including
facilitation of enrollment, both in classes and extracurricular
activities; placement; graduation; and information-sharing. The
commission is made up of one voting member from each participating
state. The duties of the commission include dispute resolution between
member states, enforcing the rules of the commission, and providing
training and other administrative functions. The bill contains
provisions for the formation of the commission's executive committee,
budget, liability, and legal status.
SB 830--tuition limitation bill for combat veterans serving since
September 11, 2001 to $50 per credit hour at state institutions
Secretary of State is to waive reinstatement fees and
procedures in the event a corporation was administratively dissolved
due to a failure to file an annual registration report when the failure
was due to the business owner's active military service. All late fees
are waived, and certificate of dissolution is canceled and corporation
is reinstated.
Enacted legislation allowing a homeless Veteran to use the
post office box or voice mail address of certain charitable or
religious organizations on applications for Federal or state assistance
by agreement.
Enacted legislation exempting a person who presents proof
of permanent disability from the United States Veterans Administration
from the 4-year certification requirement for renewal of disabled
license plates or placards.
Created the ``Veterans' Historical Education Fund''
Enacted legislation giving a preference in all state
purchasing contracts to certain disabled Veterans doing business as
Missouri companies when the quality of work is equal or better and the
price is the same or less
Enacted the ``Specialist Edward Lee Myers'' law to protect
families from funeral protests
Enacted legislation requiring all government buildings to
fly the U.S. and Missouri flags at half-staff when any Missouri
resident is killed in combat
Increased funding for Veterans Homes, Veterans Service
Grant Program, Dept of Mental Health outreach on PTSD
Created a ``Some Gave All'' license plate for family
members of KIA (see Dept of Rev)