    [House Hearing, 110 Congress]
    [From the U.S. Government Publishing Office]

                   THE RESULTS OF THE PRESIDENT'S TASK FORCE
                    ON RETURNING GLOBAL WAR ON TERROR HEROES

    =======================================================================

                                    HEARING

                                   before the

                         COMMITTEE ON VETERANS' AFFAIRS
                         U.S. HOUSE OF REPRESENTATIVES

                           ONE HUNDRED TENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                  MAY 9, 2007

                                   __________

                               Serial No. 110-22

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

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                         COMMITTEE ON VETERANS' AFFAIRS

                        BOB FILNER, California, Chairman

    CORRINE BROWN, Florida               STEVE BUYER, Indiana, Ranking
    VIC SNYDER, Arkansas                 CLIFF STEARNS, Florida
    MICHAEL H. MICHAUD, Maine            JERRY MORAN, Kansas
    STEPHANIE HERSETH SANDLIN, South     RICHARD H. BAKER, Louisiana
    Dakota                               HENRY E. BROWN, Jr., South
    HARRY E. MITCHELL, Arizona           Carolina
    JOHN J. HALL, New York               JEFF MILLER, Florida
    PHIL HARE, Illinois                  JOHN BOOZMAN, Arkansas
    MICHAEL F. DOYLE, Pennsylvania       GINNY BROWN-WAITE, Florida
    SHELLEY BERKLEY, Nevada              MICHAEL R. TURNER, Ohio
    JOHN T. SALAZAR, Colorado            BRIAN P. BILBRAY, California
    CIRO D. RODRIGUEZ, Texas             DOUG LAMBORN, Colorado
    JOE DONNELLY, Indiana                GUS M. BILIRAKIS, Florida
    JERRY McNERNEY, California           VERN BUCHANAN, Florida
    ZACHARY T. SPACE, Ohio
    TIMOTHY J. WALZ, Minnesota

                       Malcom A. Shorter, Staff Director

    Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
    hearing records of the Committee on Veterans' Affairs are also
    published in electronic form. The printed hearing record remains the
    official version. Because electronic submissions are used to prepare
    both printed and electronic versions of the hearing record, the process
    of converting between various electronic formats may introduce
    unintentional errors or omissions. Such occurrences are inherent in the
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                                C O N T E N T S

                                   __________

                                  May 9, 2007

                                                                       Page
    The Results of the President's Task Force on Returning Global War
      on Terror Heroes...............................................     1

                               OPENING STATEMENTS

    Chairman Bob Filner..............................................     1
        Prepared statement of Chairman Filner........................    33
    Hon. Steve Buyer, Ranking Republican Member......................     2
        Prepared statement of Congressman Buyer......................    34
    Hon. Ginny Brown-Waite, prepared statement of....................    35

                                    WITNESS

    U.S. Department of Veterans Affairs, Hon. R. James Nicholson,
      Secretary......................................................     5
        Prepared statement of Secretary Nicholson....................    35

                           SUBMISSION FOR THE RECORD

    Miller, Hon. Jeff, a Representative in Congress from the State of
      Florida, statement.............................................    38

                       MATERIAL SUBMITTED FOR THE RECORD

    Report of the Task Force on Returning Global War on Terror
      Heroes, April 19, 2007.........................................    40

                         THE RESULTS OF THE PRESIDENT'S
                            TASK FORCE ON RETURNING
                          GLOBAL WAR ON TERROR HEROES

                                  ----------

                             WEDNESDAY, MAY 9, 2007

                         U.S. House of Representatives,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.

        The Committee met, pursuant to notice, at 2:03 p.m., in
    Room 334, Cannon House Office Building, Hon. Bob Filner
    [Chairman of the Committee] presiding.

        Present: Representatives Filner, Michaud, Herseth Sandlin,
    Mitchell, Hall, Hare, Berkley, Salazar, Donnelly, McNerney,
    Space, Walz, Buyer, Stearns, Baker, Brown of South Carolina,
    Boozman, Brown-Waite, Lamborn, Bilirakis, Buchanan.

                  OPENING STATEMENT OF CHAIRMAN FILNER

        The Chairman. The House Committee on Veterans' Affairs is
    called to order. We thank the members for their attendance.
        Mr. Secretary, we thank you for being here. We thank you
    for chairing the President's Task Force on the Returning Global
    War on Terror Heroes and for the Task Force's report to the
    President.
        Mr. Secretary, we will hear from you on the Task Force
    recommendations. I think that you know, and I know you feel it
    personally, the frustration amongst us all as to making sure
    that we clearly and professionally deal with the returning
    veterans from Iraq and Afghanistan and that while we are doing
    that keep services up for our older veterans. That is a
    challenge that you have, and that we all have, in working
    together to do that. We want it done today or yesterday or last
    week and I know you do too. So we are looking forward to your
    report and the implementation of the recommendations. I was
    disappointed at the charge that you got in that you had to stay
    within certain constraints, no new programs, no new money.
        I hope that you might give our Committee a report that does
    not have those constraints, that details what we have to do to
    make sure that we meet the needs, and we meet them urgently.
        Every one of us has had the experience, and I know you have
    because we have done it together, of talking to veterans around
    the country and looking into the faces of the spouses of
    troops, returning troops who have brain injury and knowing that
    they are going to have to spend 24 hours a day with them and
    lose their jobs. What is their future going to be? We meet
    people, young people with Post Traumatic Stress Disorder (PTSD)
    trying to cope with this and trying to deal with a bureaucracy
    that sometimes seems unresponsive to them.
        So we have a job to do as a Committee and as a Congress and
    your agency is right at the frontiers of that. Everybody is
    looking to the VA to do its job correctly. So we hope that
    these recommendations do not sit around like so many other
    recommendations have done.
        There are other reports on the table. I know that there was
    a President's Task Force to Improve Health Care Delivery for
    Our Nation's Veterans in 2003. There was a report from the
    Congressional Commission on Servicemembers and Veterans
    Transition Assistance in 1999. And of all those
    recommendations, not all of them have ever been implemented.
        We want a timeframe for the implementation of your
    recommendations, who is going to be responsible for
    implementation; how will we be informed on the progress because
    we, as we have talked about, want to have accountability for
    all of this. So we are interested in time lines and
    implementation and we want to know what else we can do if we
    provide more resources.
        I think you know that in the first three budget bills that
    went through the House, only one of them signed by the
    President so far, that we were able to add close to $13 billion
    to the budget from last year, the highest increase in history.
    This is almost a 30-percent increase in healthcare revenues.
        So we think we are giving you the resources that you need,
    but we want to make sure that they are spent the right way and
    that our returning heroes do, in fact, get the kind of care and
    love and attention that we all want.
        I will say one more thing before I turn to Mr. Buyer for an
    opening statement, that we are discussing the war and the
    funding of that now. I just want to assure you, and the
    American people, that wherever we are on the war, wherever we
    stand, we are united in saying that every young person that
    comes back from that war gets all the care and attention, love,
    honor, and dignity that this Nation can bestow.
        I think many of us may have made mistakes in greeting
    heroes from Vietnam. We, as a country, are not going to make
    those mistakes again, and we look forward to working with you
    to make sure that that occurs.
        Mr. Buyer, you are recognized for an opening statement.
        [The prepared statement of Chairman Filner appears on p.
    33.]

                 OPENING STATEMENT OF HON. STEVE BUYER

        Mr. Buyer. Thank you very much, Mr. Chairman. I want to
    thank you for being responsive to my request to have the
    Secretary come up here today. This is a very good hearing. I
    appreciate your cooperating to make this happen.
        Mr. Secretary, thank you for being here today and for
    chairing this Task Force on behalf of the President and the
    country.
        The President has made clear his intent to establish a
    truly seamless transition for servicemembers between the
    military and the VA, as well as other agencies providing
    services to our veterans. You and your colleagues on the Task
    Force have produced a thorough review of factors affecting
    seamless transition and you are to be commended.
        I must inform you, though, Mr. Secretary, over the past 15
    years, I have seen, whether it is from the reports from the
    U.S. Government Accountability Office (GAO), the Inspector
    General (IG), commissions, task force reports, and reports on
    this issue, from my personal experience with seamless
    transition on this Committee, I know that at this point, there
    are few new discoveries.
        What we have regrettably seen and what I believe has
    compelled the President to directly intervene is a general lack
    of implementation. So to be fair, I believe the U.S. Department
    of Veterans Affairs (VA) has made most of the progress. It has,
    in fact, led the Federal effort, but the VA cannot do it alone.
    You need to have the cooperation and leadership from your
    counterparts at the Departments of Defense (DoD), Health and
    Human Services (HHS), Homeland Security (DHS), Labor (DoL),
    Education (DoE), and other agencies.
        So, Mr. Secretary, with the Task Force work behind us and
    this report now before us and the President's intent made clear
    to you as the leader of this Task Force, we must now have
    implementation.
        Now, when I ask about implementation, you and I both
    recognize that there are some other things that are still out
    there. We still have the Dole-Shalala report that will be due
    later on in the summer and we have the Claims Commission. So
    while we have some overlap, we want to avoid duplication and
    redundancies, but there are things that we can do now.
        So in a few short weeks, the President I believe is due to
    receive a progress report on the implementation of
    recommendations from the report. We in turn will look to you
    and other agency heads, in particular Defense Secretary Gates,
    to work directly with you and your respective departments as
    you move forward.
        So in your statement, I am hopeful that you will touch on
    these relationships and how you foresee them as you proceed.
        So what happens is we want to talk about real progress.
    This report is nonetheless, I believe, encouraging. And among
    the Task Force's 25 recommendations, a handful alone would
    dramatically improve transition and must become a high priority
    within the Administration.
        These include the development of a system of co-management
    and case management for returning servicemembers to facilitate
    transition between the Department of Defense and the VA.
        Second, the screening of all Global War on Terror veterans
    seen in VA healthcare facilities for mild to moderate traumatic
    brain injury (TBI). Now, it is often said about TBI being the
    signature injury of this war, yet the actual numbers that are
    actually being treated for TBI are relatively small. You will
    have to tell me what the exact number is.
        But there are individuals who are survivors of these
    improvised explosive device (IED) explosions that are excited
    that they survived, but they, in fact, may have some effects
    that they are not aware of. And that screening, I think, would
    be pretty important. And I know it is an issue that the
    Chairman is also pretty concerned about.
        Expanding VA access to DoD records to coordinate improved
    transfer of servicemembers' medical care through the patient
    handoff is a need that you and I witnessed as we went through
    the theater into Germany and saw those medical records taped to
    their chests. I know that is something vivid in your mind.
        Another goal is the development of the joint DoD/VA process
    for disability benefit determinations by establishing our
    cooperative Medical and Physical Evaluation Board process
    within the military service branches and the VA care system.
    Also among my goals here on the Committee is to ensure that the
    veterans have every opportunity to live full and healthy lives,
    that they can take advantage of the economic opportunities
    their service helped preserve.
        Among key recommendations, the Task Force report would help
    veterans transition to civilian life. As you mentioned, this
    would include increasing attendance at Transition Assistance
    and Disabled Transition Assistance Programs for active duty
    Guard and Reserve, requiring the Department of Education in
    cooperation with the Department of Labor to participate in DoD
    job fairs to provide returning servicemembers and their
    families with awareness of postsecondary education benefits,
    requiring the Department of Labor through the Veterans'
    Employment and Training Service to participate in the Workforce
    Investment System in every State and territory, and partnering
    with private-public sector job fairs to expand the number of
    employers involved in active veteran recruitment.
        The accomplishment of these recommendations as well as
    others is critically important. Since 2003, this Committee held
    more than ten hearings and conducted fifteen site visits
    focusing on seamless transition. Our experiences collaborate
    the value offered by these recommendations. And that is why I
    compliment you.
        Mr. Chairman, there are two other things I would like to
    address, and that is, one, there were statements, Mr.
    Secretary, made by members of this Committee that have ended up
    in the press as of late, some of which concerned me and I would
    thus probably label them as freshman over-exuberance. And so
    let me address each of them.
        The Chairman. Mr. Buyer, we are here to hear the Secretary.
    I would prefer if we have time at the end that you go over
    those.
        Mr. Buyer. That would be fine.
        The Chairman. But as a prosecuting attorney once said, once
    you open that door, anybody else can walk through it. So I
    would like to get to the Secretary.
        Mr. Buyer. I will restrain myself and close with this: Mr.
    Secretary, we are pleased to have you here. We look forward to
    your report.
        The Chairman. Wait a minute. Please, Mr. Secretary, you are
    on.
        Mr. Buyer. So you have cut off my statement?
        The Chairman. You told me you finished your statement.
        Mr. Buyer. No. I said I will not refer to what I was about
    to discuss and just let me complete the statement. It is just a
    minute, Mr. Chairman.
        The Chairman. You have one more minute.
        Mr. Buyer. Thank you.
        Mr. Secretary, I want to compliment your initiatives out
    there, not only coupled with this report, but you have doctors
    in Pittsburgh right now in your efforts to reduce the staph
    infection rates and you are about to leverage that across the
    VA system. I extend great compliments to you.
        Your diabetes initiative, you know, is doing over 8,000
    amputations a year. A lot of people do not realize why you are
    so good in that business.
        And you just announced a new formal Advisory Committee
    yesterday. So at some point, if you could let us know about
    what that is about.
        And thank you, Mr. Chairman, for your courtesy.
        [The prepared statement of Congressman Buyer appears on p.
    34.]
        The Chairman. Thank you, Mr. Buyer.
        Mr. Secretary, welcome, and we look forward to your report.

      STATEMENT OF HONORABLE R. JAMES NICHOLSON, SECRETARY, U.S.
       DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY HONORABLE
    PATRICK W. DUNNE, RADM, (RET.), ASSISTANT SECRETARY FOR POLICY,
     PLANNING AND PREPAREDNESS, U.S. DEPARTMENT OF VETERANS AFFAIRS

        Secretary Nicholson. Thank you, Mr. Chairman and members of
    the Committee. I welcome the opportunity to come here to give a
    report on the work of the President's Task Force on the Global
    War on Terror Heroes.
        The recent series of articles in the news media highlighted
    significant problems at the Army's Walter Reed Medical Center.
    Many people have misconstrued this to relate to the VA
    healthcare system which is an entirely different entity.
        Servicemembers maintained on active duty for care were
    being housed in a former motel at Walter Reed that had not been
    properly maintained for some time. Conditions in what everyone
    now knows as Building 18 were deplorable. That our
    servicemembers would be expected to live in those conditions
    elicited outrage. This situation was unfortunate on many
    levels.
        My wife, Suzanne, and I have visited Walter Reed Hospital
    many, many times in the two plus years that I have been the
    Secretary. We continue to be impressed by the character of our
    young, injured servicemembers. We are as well impressed with
    the quality and the compassion of the medical care that they
    receive there, but that is a focus on the critically injured
    inpatients, not on those who are in the Army's medical hold
    status.
        Upon learning of the Army's situation in Building 18, I
    immediately did two things. First, I directed that a survey be
    conducted at all points of access to the VA healthcare system,
    our 155 hospitals and nearly 900 outpatient clinics, to ensure
    that we did not have situations comparable to those encountered
    in Building 18.
        Although the findings in large part were positive, those
    areas of concern identified were addressed immediately under my
    orders that the VA non-recurrent maintenance funds be used to
    rectify them.
        I also wrote to every member of the United States Congress
    and reiterated my own commitment to assure that our veterans
    receive the very best care possible in an environment of care
    that is appropriate to that care.
        So I also asked them, you, to visit a VA medical center in
    your State or district at your earliest convenience. And to
    date, I am pleased to say that 305 members have done so and
    almost universally they have expressed their high regard for
    the quality of care being provided, the commitment of the
    caregivers, and the cleanliness of the environment in which
    that care is given.
        The President also took decisive, aggressive action. By
    Executive Order, he established two groups, the President's
    Commission on Care for America's Returning Wounded Warriors and
    the Task Force on Returning Global War on Terror Heroes, which
    he asked me to Chair.
        The President's Bipartisan Commission is chaired by former
    Senator Bob Dole and former Secretary of Health and Human
    Services, Donna Shalala. That Commission is to report to him by
    the end of July.
        Our Task Force was to develop recommendations and report
    back to him in 45 days with an assessment of gaps that may
    exist in services needed by our servicemembers that could be
    addressed without additional legislative authority or
    appropriations. Those were the two constraints.
        The Task Force which I chaired included the Secretary of
    Defense, Robert Gates; Secretary of Labor, Elaine Chao;
    Secretary of Health and Human Services, Michael Leavitt;
    Secretary of Housing and Urban Development, Alphonso Jackson;
    Secretary of Education, Margaret Spellings; the Director of the
    Office of Management and Budget, Rob Portman; the head of the
    Small Business Administration, Steven Preston; and the Director
    of the Office of Personnel Management, Linda Springer.
        And I am proud of the work of this Task Force. There is a
    new era of cooperation and what we can do here can make a
    substantial difference. The recommendations of the Task Force
    focus on ways that we can immediately improve the services for
    those returning servicemembers from the war and how we can
    better reach out to them and their families to make them aware
    of what services exist.
        We developed 25 recommendations and I want to note here
    what I consider some of the most significant.
        In the context of healthcare, DoD and VA have agreed to a
    new system of co-management and case management for these
    combatants who are seriously injured as they move from one
    system to another. We have the most advanced polytrauma centers
    in the world bar none. Our patients' transition from the
    military medicine arena to ours will be seamless for them and
    their families.
        We are going to work with DoD to develop a joint process
    for disability determinations which will provide consistency
    and speed for our veterans.
        We are now going to screen every Global War on Terror
    veteran who comes to us for any form of brain injury looking
    for the mild or moderate form of brain injury as a result of
    the environment they are in over there and the concussive
    blasts that are so prevalent. We want to identify it as early
    as possible and begin treatment.
        We are going to simplify the enrollment process for
    veterans to enroll for healthcare whether they enroll online or
    in person. And we will continue to develop our world standard
    of electronic medical records.
        The DoD is taking action to increase the attendance at the
    Transition Assistance Programs known to you probably as the TAP
    briefings. The more our veterans understand about their
    benefits, the more successful their transition to civilian life
    will become.
        A few other areas I want to briefly highlight for you today
    include the VA and HHS collaborating to improve access to care
    for returning servicemembers in remote or rural areas.
        The SBA is expanding eligibility of the Patriot Express
    Loan Program to provide a full range of lending, business
    counseling, and procurement programs to veterans, service-
    disabled veterans, Reservists, and families if the desire for a
    returning servicemember or family is to obtain self-employment.
        The DoD and the Department of Labor are improving civilian
    workforce credentialing and certification allowing for greater
    exposure of a servicemember's military experience to civilian
    job opportunities.
        The Department of Housing and Urban Development is
    expanding access to the national housing locator for
    servicemembers. By expanding its use, returning servicemembers
    will have a resource that provides safe, disability accessible,
    if needed, and affordable housing to ease in potential
    relocation to a new geographic area.
        The Department of Education in cooperation with the
    Department of Labor will participate in DoD job fairs to
    provide returning servicemembers and their families with more
    awareness of the postsecondary education benefits available to
    them.
        The Department of Education will provide education benefits
    training to the 211 Transition Assistance Programs and those
    sites would service more than 150,000 transitioning
    servicemembers every year.
        The Office of Personnel Management is expanding their
    military treatment facility outreach to promote the
    availability of Federal employment and veterans' preference
    rights.
        So all in all, our focus, I think, really is very simple.
    It is to make the existing services that are there of the
    Federal Government the very best they can be for our veterans
    and for their families and for the survivors of those who paid
    the ultimate price.
        Thank you very much, Mr. Chairman.
        [The statement of Secretary Nicholson appears on p. 35 and
    the Task Force on Returning Global War on Terror Heroes report
    appears on page 40.]
        The Chairman. Thank you, Mr. Secretary.
        I will be calling on colleagues in just a second after one
    short question I have.
        Let me just give you an example of the frustration many of
    us feel when we see reports like this. You said we will screen
    every veteran that comes to us for TBI. Now, that is the
    recommendation of the Task Force. What I would like to hear you
    say is only X percent, it is fairly small, of returning
    veterans come to us. We should be screening them
    comprehensively and mandatorily for both TBI and PTSD before
    they are discharged or before they enter the civilian life.
        We all have heard from experts that the sooner we catch
    this, as you mentioned, the better off the veteran is. Some
    symptoms are hidden until months later, so maybe we need a six-
    month screening and then a twelve-month screening and a twenty-
    four-month screening. That is our obligation. Part of the cost
    of war is dealing with the cost of caring for our veterans.
        And so we applaud that screening, but it is just a small
    part of what we really should be doing. And we need you to
    show--I know you know this--but tell us so we have a context in
    which we view these recommendations, as I said, on the one hand
    under the constraint of no new money, but on the other hand,
    what do you really want to meet the needs of our returning
    heroes. That is the kind of thing that I hope we can work
    together to solve.
        Mr. Michaud, who is Chairman of our Health Subcommittee,
    will start off the questioning.
        Mr. Michaud. Thank you very much, Mr. Chairman.
        And thank you, Mr. Secretary, for coming here today and for
    presenting this report to us.
        Looking at the report and having had a chance to read it
    when it first came out, I appreciate the fact that you are
    assigning a lead agency to look over some of these
    recommendations along with a target date for implementation so
    we can see where you are throughout the process.
        My concern, however, is, even though the Task Force did a
    great job, back at my office I have the Presidential Task Force
    for a Seamless Transition recommendations that came out in 2003
    that currently is sitting there and it is the implementation
    which is extremely important. I compared those Task Force
    recommendations for a seamless transition to these Task Force
    recommendations to see how many are the same. These reports are
    not going to do any good unless we act upon them.
        I can tell you that I will definitely be keeping a close
    eye on the target dates when these recommendations are supposed
    to be implemented and, if they are not, see why the
    implementation has not moved forward.
        You heard the Chairman talk about how you were directed to
    do this with existing resources and existing authority. Do you
    feel you can do all these recommendations without any
    additional resources for your agency?
        Secretary Nicholson. Yes, I do, because we abided that
    constraint of the action items that we are taking pretty
    carefully. That was our mandate.
        Mr. Michaud. Okay. Are there any recommendations when you
    went through looking at the seamless transition and what was
    needed out there, are there any recommendations that actually
    might have cost funding that you could not do that are out
    there that we should look at?
        Secretary Nicholson. There is a possibility, Congressman
    Michaud, as some of these things would, you know, as they
    mature.
        For example, I think the very enlightened idea of
    simplifying and streamlining this discharge procedure. The way
    it works now is that if a servicemember is injured, the Army
    makes a determination or the Marine Corps or the services that
    they are either fit or unfit to be retained on active duty. And
    if they are fit, in theory they go back to their unit. If they
    are unfit, they go into a category for determination of that
    degree of unfitness prior to their separation.
        And what we know is that if they are not happy with that,
    they have appeal rights within the Armed Services, but further
    they then can come to the VA and make a claim at the VA. And
    many, many of them do. And that entails months, if not years of
    time that they are sort of in limbo. In fact, that was the case
    at Walter Reed. I think some 600 people were in that medical
    hold category.
        What we are talking about is slicing through some of that.
    If they are fit, put their boots back on and go back to duty.
    If they are unfit, come in an expedited way to the VA and we
    then evaluate and process that degree of disability and work it
    into our compensation system. That could entail additional
    resources upon its full maturation.
        Mr. Michaud. It would be helpful if you can provide any
    other recommendations that came out of the Task Force or
    thoughts, but because it did not meet that criteria of within
    existing resources, it would be helpful if you could provide
    that to the Committee because I think we are very interested to
    make sure we do take care of our men and women who wear the
    uniform and those who become veterans.
        My last question is, what will happen, and I think the VA
    has done an excellent job when you look at medical records and
    what have you, and I think the Department of Defense has been
    slack in that area, what happens if there is a disagreement
    between DoD and the VA? How do you resolve those differences?
    How do you deal with that issue?
        Secretary Nicholson. Well, first, let me tell you a very
    encouraging note that the first meeting was held yesterday in
    Deputy Secretary England's office over in the Pentagon with my
    Deputy and all three of the service Secretaries and the Deputy
    Chiefs of those services to discuss these very issues.
        And, further, there is an agreement for such a meeting to
    take place now every Tuesday afternoon. That is significant
    movement because there is, I think, a new awareness and there
    is a new command emphasis that comes from the President, and
    people are getting it, that we are just going to have to do a
    better job in getting these two big organizations to talk to
    each other, particularly with respect to medical records.
        Mr. Michaud. Thank you very much, Mr. Secretary.
        The Chairman. Thank you very much.
        I will yield to Mr. Buyer and also Mr. Stearns for his
    time.
        Mr. Buyer. Mr. Chairman, I will exercise the same courtesy
    that you did.
        But in my opening statement to the Secretary, I had asked
    him in his opening statement to comment on this reduction of
    the infectious disease of our hospitals because we are talking
    about, you know, our soldiers coming home and transitioning to
    what. And, Mr. Secretary, you are getting out in front of the
    reduction of the infectious disease rate and it is a good
    story.
        Can you tell us about what happened at Pittsburgh, the
    reductions, and how you are trying to leverage that?
        Secretary Nicholson. Yes, I can. I can tell you, and maybe
    some of you have seen, there is a graphic out there that
    graphically portrays some of the things you do in life that are
    on a scale of very dangerous to very safe. And on the very
    dangerous thing that you can do in the United States today is--
    --
        The Chairman. Being a Cabinet Secretary?
        Secretary Nicholson. Pardon?
        The Chairman. Cabinet Secretary is right up there, right?
        Secretary Nicholson [continuing]. Is to go into a hospital.
    One of the very safe things you can do today is fly on a
    commercial airliner. And there are some things in between.
        So it is a fact that far more people are being killed today
    in today's hospitals by mistakes than are dying on the
    highways. One of the problems are staph infections. There is a
    technical name for it which is called methicillin staph
    resistant aureus and the acronym is MRSA. And we at the VA, I
    think we have established an exemplary record for patient
    safety and performance measures and so forth, but we have had
    that problem as well. So we instituted a pilot project at our
    VA hospital in Pittsburgh to go after the MRSA.
        And in one year, we reduced staph infections by 70 percent.
    And it is not space science how we did it. It is a disciplined
    approach, sanitation, culturing patients when they come in. It
    is usually a swab in the nasal passage. It used to take two
    days to read the culture. We now have a new technology. We can
    read them in two hours.
        If they are a MRSA carrier, they are treated accordingly.
    The staff will scrub afterwards, regarb if they have close
    contact with that patient. We cut those infections 70 percent.
        So we had a discussion about taking this pilot to ten or
    fifteen hospitals. I said, no, let us take this to 155
    hospitals. And I say I am very proud like I am in many ways of
    the leadership and the medical corps of the VA. They have
    embraced this and it is underway in our system. And I think we
    are going to see some just tremendous results from it.
        The Chairman. Mr. Stearns, you have five minutes.
        Mr. Stearns. Thank you, Mr. Chairman, and thank you for
    having this hearing.
        I want to thank the Secretary for the job he is doing and
    the sacrifice he is making at this critical time. We appreciate
    your efforts.
        Yesterday we had an Oversight Subcommittee hearing in which
    we had a lot of the DoD and Veterans Affairs up here. And it
    was clear to us that the whole idea of inter-operability
    between DoD and Veterans Affairs is a long way off.
        And as you know, we have been working on this. There has
    been legislation. There has been studies and this has been
    going on for some time unsuccessfully. And we found yesterday
    that it could be as late as 2012 when they possibly will have
    inter-operability.
        And this goes to your policy directive, your Veterans
    Health Administration (VHA) directive of April 13th in which
    you said it will be the policy of the VHA that all Operation
    Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF)
    veterans receiving medical care within VHA must be screened for
    possible TBI. Those who on the basis of the screening might
    have TBI must be offered further evaluation and treatment by
    clinicians with expertise in the area of TBI.
        I guess my question is to you, is it not crucial and
    important that the Department of Defense provide you the
    medical information that they have so that the seamless
    transition when they move from active duty to veteran, that all
    that information, particularly dealing with traumatic brain
    injury, is available to the veterans?
        And I was just disappointed last night that it is still not
    being done and I just would like your opinion.
        Secretary Nicholson. Yes, it is. It is extremely important.
    It is critically important that we get what is available on the
    medical history of that servicemember since being injured.
        And as Congressman Buyer mentioned earlier, he and I had
    been in Iraq with other members. Two people were injured where
    we were one day near Fallujah and we happened to be going into
    the hospital in Landsthul the same time as they were coming in
    on gurneys and their medical records were taped to them with
    duct tape to their bodies----
        Mr. Stearns. Yeah.
        Secretary Nicholson [continuing]. Bespeaking, I think, the
    anomaly that there exists between how highly technical our
    Armed Services are with the state-of-the-art target
    acquisition, night vision optical equipment and, yet, still
    very rudimentary with paper records which are fraught with
    being illegible, things getting lost. It is not a lack of bad
    faith on their part.
        Mr. Stearns. No. I think it is just getting all these
    departments together.
        Secretary Nicholson. It is problematic.
        Mr. Stearns. You know, in my congressional district, I have
    a company called Banyan Biomarker and they are trying to
    determine through diagnostic blood samplings whether traumatic
    brain injury is--what category of seriousness it is.
        Now, when you say you are going to do this screening, I
    assume in addition to questions and answers, you are also going
    to do MRIs and things like that. I am asking you for the
    technical aspect.
        But these scientists have pointed out that you really
    cannot fully detect traumatic brain injury or, for that matter,
    posttraumatic stress disorders. You have to do it
    diagnostically through blood. And we are not at that point, so
    there is going to be a lot of debate of a person who comes
    through and you say, no, you do not have TBI and, yet, the
    person says there is something wrong.
        And so I think you and your staff should be aware of that,
    that there is another state-of-the-art for this testing that
    through blood diagnostic you can find this.
        But I think the thing that I think is extremely important,
    and you have sort of confirmed it, is this inter-operability.
    In this age of information, we should be able to have that
    those records are not affixed, attached to a person, but should
    be electronically transmitted automatically. And I think that
    part of your whole Task Force is to continue to push on that
    effort.
        And I thank you, Mr. Chairman.
        The Chairman. Thank you.
        Mrs. Herseth Sandlin----
        Ms. Herseth Sandlin. Takes some getting used to.
        The Chairman [continuing]. The Chairperson of our Economic
    Opportunity Subcommittee.
        Ms. Herseth Sandlin. Thank you, Mr. Chairman.
        The Chairman. Congratulations on your recent marriage.
        Ms. Herseth Sandlin. Thank you. Thank you and the Ranking
    Member for having this hearing today.
        Mr. Secretary, thank you for your testimony. I would like
    to start out with the recommendation that you cited and that is
    in the materials from the Task Force work product to expedite
    adaptive housing and special home adaptation grants claims.
        I could not agree with that recommendation more and I am
    wondering if the Task Force looks specifically at the change in
    the law that we made in 2003 where active duty servicemembers
    could apply for these specially adapted homes because I have a
    constituent that has run into a lot of hurdles and was
    initially told that you cannot apply for the specially adapted
    housing grants until you have a DD-214 and a VA disability
    rating, but he is still on active duty. And we have more and
    more active duty status servicemembers who have suffered
    serious brain injuries.
        If you could elaborate as to whether or not the Task Force
    did look into that specifically in terms of implementing that
    legal change and what recommendations you might have.
        Secretary Nicholson. I am aware of that issue,
    Congresswoman. The answer, though, our Task Force did not look
    at that because, again, that would require legislation. And
    within the ground rules that we were operating and this
    expedited timeframe we had, we did not look at those things.
        Ms. Herseth Sandlin. Okay. Well, I just want to bring it to
    your attention so that you know that the Subcommittee may very
    well be interested in looking at what is needed to make sure
    that the implementation of the change that was made in 2003 for
    active duty and what VA needs to more quickly process these
    claims with the authority, I think, was given in 2003.
        But I think this is again an area where DoD, when a soldier
    is still active duty and under the way that the claims
    processing has always worked, you need to be discharged and
    have a VA disability rating. And we have got some folks out
    there that are either in polytrauma centers or they are in
    private rehabilitation facilities that are trying to apply and
    getting misinformation.
        The other area I wanted to explore was the specific
    recommendations in the health area for traumatic brain injured
    servicemembers. I know that you mentioned at the outset that
    one of the most significant recommendations in your opinion is
    developing that system of co-management and case management
    more broadly, but then specifically the polytrauma identifier
    as well as the traumatic brain injury database to track
    patients.
        And I am wondering, well, I would just make the comment
    that as you move forward in implementing these, a
    recommendation, suggestion again by the mother of one of my
    constituents in talking with the mother of another brain
    injured soldier is that the case management, managers could be
    trained specifically for TBI patients because untrained people
    may not be fully aware of what seriously injured, brain injured
    servicemembers may require. If we had this subset of trained
    case managers, it might help these families substantially.
        One last question. Did the Task Force specifically evaluate
    the suitability of existing programs and the restrictions on
    those programs in the Vocational Rehabilitation Employment
    Service for brain injured soldiers?
        Secretary Nicholson. I am sorry. Of the what programs?
        Ms. Herseth Sandlin. The existing programs under vocational
    rehabilitation and the restrictions on the participation of
    those programs and their suitability for brain injured
    servicemembers.
        Secretary Nicholson. Yes, we did. Looked at that quite
    carefully and have stepped up the efforts for awareness of
    those programs.
        Ms. Herseth Sandlin. I understand. I appreciate that and I
    appreciate the recommendation of extending the period of time
    because over two years or more we see cognitive functions
    continuing to come back and develop for these servicemembers.
        And so, again, the Subcommittee will work more closely with
    you and those that work with you to more closely evaluate the
    suitability and the need to maybe modify these programs to work
    best for these servicemembers and their families. Thank you,
    Mr. Secretary.
        And thank you, Mr. Chairman.
        The Chairman. Thank you.
        Mr. Baker, you have five minutes.
        Mr. Baker. Thank you, Mr. Chairman. I appreciate your
    courtesy.
        Mr. Secretary, I commend you and the Task Force for
    identifying promptly the problems at Walter Reed and taking
    prompt corrective action. It is highly commendable.
        My observation today is we have a similar problem in
    Louisiana as a result of Katrina. Due to the destruction of the
    VA hospital there, veterans now may travel as much as eight
    hours to receive appropriate healthcare.
        It was February 23rd, 2006, that is for the Committee 15
    months ago, when the VA and the State entered into an MOU to
    explore the feasibility of VA-State partnership for delivery of
    innovative care in the New Orleans area.
        Only recently, as in the last couple of weeks, has the
    State forwarded its proposal which I thought was rather
    unexpected in that its $1.2 billion scope and bed count was
    above earlier anticipated numbers.
        In the interim, since that report has initially been
    issued, there have been two statements for the record, one by
    Governor Blanco, one by the Chairman of the LRA, the Recovery
    Authority, indicating several points of consideration, the need
    of economic recovery, the need of an economic engine, financial
    necessity. It went on and on in the letter. I found it of
    interest in the three pages of correspondence the word veteran
    was not mentioned once.
        On April 10th, the Chairman and myself, the Ranking Member,
    Mr. Jefferson of New Orleans forwarded correspondence to your
    office requesting establishment of a date certain. We are not
    trying to tell anybody how to do it. We are only requesting
    that it get done. I am awaiting that determination. The problem
    is clear in Louisiana just like it was at Walter Reed. You see
    it, you decide what to do, and you went and fixed it.
        My reason for being here today is after 15 months is to say
    it is time for us to do something. We do not have to describe a
    plan. We do not have to tell the State what to do. We merely
    should say by a date certain. Whatever that date is, you are
    certainly free to make that determination. As I understand the
    MOU, either party can unilaterally withdraw for any cause
    whatsoever.
        But the plan now under consideration will require the
    acquisition of considerable private property interest. In one
    plan as few as 200 parcels. In another plan as much as 37
    acres, some of which is in downtown Orleans which has generated
    considerable discussion among those homeowners.
        The original plan contemplated to have begun planning and
    feasibility studies for the structure itself would have been
    engaged already, would not have allowed a ribbon cutting and
    service of veterans until 2012.
        With the added curve of the acquisition of new private
    property in order to facilitate a 60-acre site above the
    initial 37 proposed by the State, it would seem logical to me
    that control of the site for development may take not months
    but years.
        If I were to tell veterans they were to wait until 2012,
    which was plan A, they were not happy. To be honest, I cannot
    represent that to them anymore because I cannot tell them when
    it will be.
        My question, Mr. Secretary, is not how long I am going to
    have to wait. I am not important. But it is extremely important
    for me to be able to tell the veterans how long are they going
    to wait. When are we going to set a date, Mr. Secretary?
        Secretary Nicholson. Well, you do not have any more
    frustration there than I, Congressman. We did enter into the
    memorandum of agreement, making a lot of good sense to
    collaborate and share facilities such as parking, laundry
    facilities, certain other infrastructure, utilities, and did it
    in good faith with high expectations.
        And while we do not have all of the money that we need to
    build the hospital, you need to give us about another $300
    million of authorization, we do have $300 million appropriated
    and authorized, plenty to start all the design work,
    engineering, site planning. But we have not been able to count
    on a site.
        So as you know, about two months ago, I said we cannot wait
    any longer for LSU. And I put out an RFP for alternative sites
    which we are now looking at with a view toward possibly having
    to build this hospital independent of a collocation with LSU.
    And we are going to be vetting out those sites soon.
        But as I sit here today, I could not give you a date
    certain. I just could not be honest about it if I did because
    we do not yet have enough----
        Mr. Baker. Will we likely wait another year, another two
    years? I mean, is there an outside limit? There has got to be.
    I mean, at this point, we have no plan. The State does not have
    the money. There are alternative private interests who are
    willing to make their facilities available within the region.
        I am just asking for a business decision and I am not going
    to ask for it today, but I think it highly inappropriate to
    have such uncertainty over something that is so important to
    the region. There is not any reason in the world to have
    someone have to drive to Houston or Biloxi.
        These are Louisiana veterans coming home and they have
    every right to expect care in their community because it used
    to be there. And all I am suggesting is a decision. I will be
    happy with a bad one, just we need a decision.
        I yield back.
        The Chairman. Thank you.
        Mr. Buyer and I have joined you and Mr. Jefferson in trying
    to do this and we share the frustration of Mr. Baker.
        The Chairman of our Investigations and Oversight Committee,
    Mr. Mitchell.
        Mr. Mitchell. Thank you, Mr. Chairman.
        And thank you, Mr. Secretary, for being here today to
    report on the findings of the Task Force.
        You know, the Global War on Terror has been the reality for
    our Nation since 2001 and I am glad the President created this
    Task Force. But I have to admit I am disappointed that it took
    until 2007 to do it. It seems to me that the Department of
    Veterans Affairs should have been prepared many years ago.
        Mr. Secretary, I visited the Carl T. Hayden Medical Center.
    That is the VA medical center in Phoenix. I have tremendous
    respect for the staff, but what they told me is that they are
    strained, that they are under-staffed and in some cases do not
    have the equipment they need.
        Aside from the Administration's delay in addressing this
    issue, I am concerned that the VA may not have the resources it
    needs to get the job done.
        Veterans tell me and VA officials tell me that the VA is
    under-staffed and lacking the equipment it needs. Do you
    believe that the VA is under-resourced and do you regret your
    decision not to ask for funds to allow the VA to handle the
    strain of the new veterans' population?
        Secretary Nicholson. I think, Congressman Mitchell, the VA
    is adequately staffed to take care of this mission that we
    have. It is a dynamic and the VA is a very large organization
    with facilities from Maine to Manila. And overall, it is
    adequately staffed.
        The President, since he has been in office, has requested
    increases in spending for the VA that now are nearly 80 percent
    from when he came into office.
        And I think that while there may be exceptions because it
    is dynamic and patient demand is not static and sometimes it
    will cue up in certain places and we have an obligation to
    adjust to that, the VA healthcare system is, I think, doing an
    extraordinary job. And that is not just me, a proud Secretary,
    proud of the people out there doing it, but that is what others
    say about us.
        I was just sent a copy of a book here. It is written by a
    guy named Phillip Longman, whom I have never met, but I noted
    his credentials, and it said VA is the best healthcare
    anywhere. And it says why VA healthcare is better than yours.
        Mr. Mitchell. Mr. Secretary, I understand that. And it
    sounds like what you are saying is you have all the resources
    and all the staffing you need. And I am not too surprised that
    you are saying that because it almost sounds like you have
    plenty of money.
        And as a result, I think, last week, the Associated Press
    reported that your top officials were paid the most lucrative
    bonuses in Government.
        Now, it kind of begs the question, but I think it is
    appropriate. I am going to ask you, do you think it is
    appropriate with all these political appointees receiving
    bonuses of $30,000 plus, and these are not salaries, these are
    bonuses, while veterans are waiting an average of 90 days for
    PTSD followup appointments, the backlog for claims range from
    400,000 to more than 600,000 with delays averaging 177 days,
    and while the Phoenix VA facilities do not even have an MRI
    device? It seems to me that they are under-equipped and they
    are under-staffed.
        Secretary Nicholson. I will respond to that, Congressman. I
    want to adjust your paraphrasal of my statement when I said I
    think the VA is adequately staffed and then you said, or it
    sounds like, you think the VA has all the money it needs.
        I would say given the size of the VA and the expanse of our
    capital system and its age, we can probably always make good
    use of more money at the VA. So I wanted to clarify that.
        Mr. Mitchell. Okay. So let me ask this then. You say it is
    adequately staffed, but, yet, we find claims for PTSD to be an
    average of 90 days, the backlog of claims for disabilities are
    over 177 days, and you think you have enough people to handle
    all of these claims and all these appointments that are
    necessary, and you think this 90 days for a followup
    appointment is adequate, and you think that the average of 177
    days is also adequate? And that does not take equipment. That
    takes manpower. And you say that you are adequately staffed; is
    that right?
        Secretary Nicholson. I would say I cannot respond to your
    90-day assertion about PTSD. I will have to look at that and
    get back to you. I am not aware that it is taking that long. If
    it is in Phoenix, I am not aware of that. It is not systemwide,
    I am sure.
        You are correct about the claims and that is exactly right.
    It is taking about 177 days and that is too long in my opinion.
    We have in the 2008 budget a request and so when I say we are
    adequately staffed, I incorporate our request for personnel in
    that budget request for 450 additional claims evaluators which
    we project will be able to bring that time down by at least 18
    percent.
        Mr. Mitchell. I yield my time. My time is up.
        The Chairman. Thank you, Mr. Mitchell.
        Mr. Buchanan, you are recognized for five minutes if you--
    --
        Mr. Buchanan. No.
        The Chairman. Mr. Lamborn.
        Mr. Lamborn. Thank you, Mr. Chairman, but I have no
    statement or questions at this point.
        The Chairman. Mr. Hall, who is Chairman of our Disability
    Assistance and Memorial Affairs Subcommittee.
        Mr. Hall. Thank you, Mr. Chairman.
        Mr. Secretary, first of all, thank you for your service in
    the service and since then in your continuing work for our
    country.
        And congratulations on your progress on the methicillin
    resistant staph infections. I know firsthand how difficult they
    can be and have family members who have suffered from drug-
    resistant bacterial infections and that is a really dangerous
    thing that is happening in our hospitals. And you are to be
    commended to be spreading your program to all 155 hospitals.
        I want to say that I share Congressman Baker's frustration
    and I do not know if I was the freshman who was overly
    exuberant or not, but, what I reflect, I believe, is what I
    hear from the veterans in my district.
        And I am also one of the 305, I think you said, members of
    Congress who have visited VA facilities in my district and I do
    find them, the nurses, the doctors, the therapists, the
    caregivers in the hospitals, to be doing their very best as far
    as I can tell. And there are many things that our veterans are
    happy about with the VA system.
        However, our job, as you know, is not just to, and since we
    only have five minutes, it is not even mainly to pat you on the
    back for the things that are going well.
        I just want to ask, following up on Congressman Michaud's
    question, with the revelation that the Army and the Marines
    appear to be providing ratings under 30 percent in an effort to
    prevent wounded members of the military from receiving benefits
    from the DoD, I am concerned about efforts to develop a joint
    process for disability benefit determinations.
        How will the VA ensure that ratings reflect the nature of a
    servicemember's disability and not a bureaucratic need to
    minimize payments to the veteran?
        Secretary Nicholson. The VA makes its evaluation totally
    independent of the military's. And, in fact, the military, they
    have a different set of criteria and they are guided by the
    specific disabling condition that would make one unfit for
    continuing military service.
        To illustrate, if they had a very seriously injured
    arthritic knee or they were immobilized, that would be the
    central claim because that is the question of whether they can
    remain in active duty. And if they had a hearing loss or other
    problems, that would not be considered as I understand it.
        At the VA, when they come to us, we consider all of those
    disablements that are service connected. And part of that
    process is to authenticate whether or not they are service-
    connected and we do that independent of what has gone on at
    DoD.
        Mr. Hall. Thank you. And on another topic regarding
    Congressman Mitchell's question, what would you consider to be
    a reasonable time period for veterans to wait for a claim to be
    heard? If not 177 days, what would be reasonable to you?
        Secretary Nicholson. There is a marker out there that was
    there when I came in. Just less than four years ago, it was
    taking about 220 days for these claims. But there is a marker
    that says it ought to be 125 days.
        I have asked Chairman Filner and he has consented that
    sometime, if we can ever all find the time, to just have a
    working session or roundtable and give us the opportunity to
    come over here and brief you on what is involved in making
    these claim evaluations because there is both law and case law.
    And I will just use one point to illustrate.
        If we must go back to a veteran for an additional piece of
    information to authenticate that he made a parachute jump in
    1988 at Fort Bragg and was in the 82nd, he or she, the
    claimant, has 60 days from the time we request that within
    which to respond to us. And those are linear, so that----
        Mr. Hall. I understand.
        Secretary Nicholson [continuing]. It is difficult. There
    are other things about it too. But my goal is to get it soon
    down to 145 days.
        Mr. Hall. Thank you, Mr. Secretary. Excuse me for
    interrupting you, but I am about to run out of time. And I just
    wanted to ask you last, what is the evaluation process for
    determining the level of bonuses for officers in the VA or the
    Veterans Benefits Administration (VBA)?
        Secretary Nicholson. First of all, I want to clarify
    something that Congressman Mitchell also raised. These bonuses
    were not given to any political employees. They are all given
    to career SES, Senior Executive Service, professional
    Government employees.
        And there is a very detailed prescribed set of criteria
    that we get from the Office of Personnel Management of the
    Federal Government to use in determining who should be
    considered for these bonuses. And they are based on their
    performance in our organization and in the Government,
    including our organization.
        Mr. Hall. Thank you. Maybe you can supply that to the
    Committee, if you will, or we will write and ask for it.
        Secretary Nicholson. I would be happy to.
        Mr. Hall. Thank you very much.
        Thank you, Mr. Chairman.
        The Chairman. Thank you.
        We have scheduled that roundtable on claims for May 23rd
    and your staff, Admiral Cooper and Mr. Aument, are scheduled to
    join us for that. So thank you.
        Mr. Brown, you are recognized.
        Mr. Brown of South Carolina. Thank you, Mr. Chairman.
        Mr. Secretary, I understand yesterday that you formed a new
    Advisory Committee consisting of OIF and OEF combatants and it
    was led by Lieutenant General Barno.
        Could you kind of give us a little bit about the mission of
    this Task Force?
        Secretary Nicholson. Yes, sir. Since coming into this job
    and moving around and meeting with wounded servicemembers and
    their families, it is no secret to me that they have suffered
    frustrations, anxiety. I mean, it is a tough state, first of
    all, when they get seriously injured.
        And both DoD and VA have incorporated the families very
    much into the holistic effort of recovery and rehabilitation.
    And that is a positive thing.
        But there have been cases I have known of. So I started
    going around and gathering when possible servicemembers and
    family members and just having discussion sessions with them.
    And I got a lot of good and I got some that was not very good.
        Things like I remember one young mother telling me the time
    it took to get a new pad for her son's wheelchair and that just
    should not happen. And that showed a need for better case
    management.
        And so what I decided to do is within the framework that I
    have of having advisory committees to formalize an Advisory
    Committee for OIF/OEF returnees, why family members, spouses,
    VSOs, certain Veteran Service Organizations are very involved
    with some of these, and survivors, of those who have been
    killed. They are not only to be a source of information to me,
    but for them to be out there meeting with other members that
    are similarly situated so that we know what is going on. They
    report directly to me, not through a bureaucratic screen, of
    what it is like, because then we can cut through and take
    better action.
        Mr. Brown of South Carolina. Thank you. I just applaud you
    for putting that Committee together.
        And I have no further questions, Mr. Chairman.
        The Chairman. Thank you, Mr. Brown.
        Ms. Berkley.
        Ms. Berkley. Thank you very much for your courtesy. I have
    been called down to the floor and I was very anxious to ask you
    a couple of questions. And it is lovely to see you again. I
    have three issues very, very quickly.
        There was a person from the State of Nevada, Lance Corporal
    Justin Bailey. His parents have testified in front of the
    Senate VA Committee. He returned from Iraq a few years ago. He
    sustained some injuries, but his primary problem was PTSD. He
    developed a serious drug problem. His parents encouraged him to
    get help and he eventually decided to seek help with the VA.
    And he was admitted into the West LA VA facility.
        He had a serious drug problem going in, but apparently
    nobody read his records closely enough. He was over-medicated
    by the VA when he died while he was at the VA facility trying
    to get clean. The VA gave him five different drugs at the same
    time, antidepressants, including Methadone, and he ultimately
    died of an overdose in our care.
        And I was hoping that you could look into this. His parents
    are absolutely beside themselves because they encouraged him to
    seek help with the VA and it seems as though we did not do our
    job.
        Now, I know that we cannot save everybody and mistakes
    happen, but this seemed to have been a tragedy that could have
    been avoided.
        The other thing that his parents were heartbroken about is
    it seemed that they felt they were treated with a tremendous
    disregard and apathy. When they went to collect his remains,
    they handed them their only son's remains in a trash bag. And
    it was just the culmination of treatment that they felt was
    totally inappropriate.
        That is number one. I need to continue to communicate with
    this family and ease their pain, but they are very concerned
    that their son is not an isolated incident, that it is
    unfortunately widespread. I need a report back to me.
        The other thing, and this just happened two days ago in Las
    Vegas, you know my concern because we are in the process of
    building our VA medical complex, that I have got my veterans
    waiting to be picked up by a shuttle that takes them to ten
    different locations.
        Apparently there is a Mr. Key that contracted with the VA
    as a small disadvantaged business to provide the shuttle
    service. There was a problem between the VA and the bank and
    Mr. Key, and the VA was $600,000 in arrears to pay this man.
        The local VA administrator, John Bright, had no idea this
    was going on because Mr. Key was dealing with people above him
    in the VA system to get paid. He had been talking to them for
    months because he had not gotten paid. What he eventually did
    is he pulled the plug and he called the VA in Las Vegas and
    said I am not doing your shuttle service anymore.
        All my veterans were standing there stranded with no
    shuttle service because we did not pay this guy $600,000 that
    we owed him. Can you imagine how long it must have taken to
    accumulate $600,000? I really need a report on this and we need
    to fix this quickly.
        Now, I understand that Mr. Bright is all hands on deck and
    they have got some sort of shuttle service, but this is no way
    to run a business or a Government or a VA system either.
        And as long as I am on the subject of my VA medical
    complex, I know that there is a lot of dirt being moved and
    there is some vertical construction, but I would love somebody
    that you designate to come to my office and give me a briefing
    of where we are and how we are doing.
        I have been out to the site a number of times and I see
    progress, but I want to make sure that when I report back to my
    veterans' groups, and they are asking me all the time what is
    going on out there, that I can give them an honest assessment
    and a true assessment of the progress.
        Secretary Nicholson. Thank you, Congresswoman Berkley.
        I am aware of the Bailey case and we are looking into that.
    I am not aware of the shuttle issue and we will look into that.
    Of course, we would be happy to brief you on the status of the
    construction of the new Las Vegas hospital.
        Ms. Berkley. Now, let me just mention this. This
    disadvantaged small businessman says he is now having to file
    bankruptcy. That should not be if they are dealing with a
    Government agency, that a disadvantaged small business has to
    file bankruptcy because we did not pay him.
        But that is a concern of mine. But the bigger concern is,
    it is going to be 110 degrees in Las Vegas a month from now and
    I just cannot have my veterans standing outside in the heat
    waiting for some shuttle that may or may not show up.
        Thank you.
        Secretary Nicholson. Thank you.
        The Chairman. Thank you, Ms. Berkley.
        Apparently what happens in Vegas does not stay in Vegas.
        Mr. Bilirakis, you are recognized.
        Mr. Bilirakis. Thank you, Mr. Chairman.
        Good afternoon, Mr. Secretary. I have one question. One of
    the Task Force recommendations included enhanced capacity for
    servicemembers to receive dental care in the private sector as
    the VA works to improve its capacity to provide these services
    at the VA facilities. Can you give us an update on that? Has
    any action been taken?
        Secretary Nicholson. Well, the action that is being taken,
    Congressman Bilirakis, is that we are expanding the
    availability of contracting out fee-for-service dental care,
    the result of more need for it.
        Mr. Bilirakis. Okay. Thank you.
        The Chairman. Thank you, Mr. Bilirakis.
        Mr. Walz, you are recognized.
        Mr. Walz. Thank you, Mr. Chairman.
        And thank you, Mr. Secretary, for what you are doing and
    taking the time to come see us today. And I do think it is
    important as many of the members here have mentioned for us to
    stress the positives of what we are doing with the VA and with
    our veterans.
        Out in my district and out in Minneapolis at our polytrauma
    center there, which I would consider to be probably one of the
    more premier facilities in the world, and they are doing great
    work.
        And I sat up there in the polytrauma ward with mothers from
    Michigan and their sons who have multiple amputations and have
    TBI. And they will stress that the only thing keeping them
    going is the angels on that floor that are serving them.
        So I do think it is important that we are here because the
    bottom line on this is this is an outcome-based proposition
    that is zero sum. We will never rest until everyone is taken
    care of to the best of our ability. I know you share that with
    me and that is our responsibility. So I am not here with joyful
    enthusiasm. I am a new member, but I am not joyfully
    enthusiastic. I am here with a deep sense of solemn duty and a
    responsibility to get this right. So I thank you for being
    here.
        I also in my time prior to coming here, my postgraduate
    work was in organizational analysis, so I am looking at it when
    you are talking the gap analysis. I know it is one of many
    tools. I think it is very important for us not to forget words
    like optimal allocations of inputs and things like that. It is
    a way you have to use it as a management tool, but these are
    veterans, these are people, and we can never forget that.
        So when I heard things that everything is fine, we are
    reducing numbers, one is too many, and it gets frustrating.
    When my veterans see, they will see a document and they will
    see it is well done and they see great things in here and they
    will ask me the question, so what, I still cannot get in. And
    so that is why we are here and that is where we are coming.
        I want to ask one particular question. I noticed, and I am
    glad this was listed as P1, the recommendation and the process
    for disability determinations, which is obviously the big
    issue, and I see in here that we went through the gap, we did
    the recommendations for the gap and then we did the
    implementation and action target date.
        We have met those apparently and we had the joint meeting
    on May 3rd. What next? What do I tell my people? And what I see
    in here, Mr. Secretary, you said, and I appreciate you saying
    this, that you take personal responsibility to make sure these
    things get done. I appreciate you saying that, but I also state
    that you took that on when you took the job. Tell me now how
    this P1 is going to be implemented.
        Secretary Nicholson. Well, I mentioned, and I think you
    were here, that things are moving on that. And there was a big
    meeting yesterday in the Deputy Secretary of Defense's office,
    Secretary England. Secretary Gates served on my Task Force. He
    attended the meetings. He is up to speed on those issues and
    has delegated to Secretary England to head up their endeavor.
        So this is really getting serious and I would say
    unprecedented command focus. And as I said they have agreed to
    meet every Tuesday and there is an energy, there is a force
    behind this.
        There are, like there are in almost everything always at
    least two sides to everything and this is a complicated issue
    with the welfare and the future of a lot of people involved,
    including members of the active force who have a stake in this,
    in how this comes out. And they, of course, are going to be
    heard and represented by their service secretaries and chiefs.
        But there is a real action going on that I have never seen
    before and I do not think ever existed before.
        Mr. Walz. If we are sitting here in two years, will we
    expect to see disability determinations be made at a quicker
    pace? Would that be the outcome we are looking for? Is that
    something we cannot say can happen?
        Secretary Nicholson. I can safely say that, yes.
        Mr. Walz. All right. So if you and I are here in two years,
    we are going to take responsibility between the two of us to
    reduce that backlog and making sure that that is going to
    happen and this recommendation can help us get there?
        Secretary Nicholson. Yes. You know, I cannot wave a wand
    over all these different agencies. I chaired this Task Force. I
    reported it to the President. The President has taken it on
    board. It will be taken very seriously. And I also am in charge
    of the followup and----
        Mr. Walz. I am encouraged by that. I am encouraged that we
    are going to get this done. But you and I both know that if
    that does not translate into our veterans getting there
    quicker, it is not going to be for anything. And we have a deep
    responsibility to do that. So thank you.
        Secretary Nicholson. You are totally correct. And we have a
    lot of other things to do than to just go through another
    bureaucratic morass here. That is not my mindset on this at
    all, believe me.
        Mr. Walz. Great. Thank you, Mr. Secretary.
        And I yield back.
        The Chairman. Thank you, sir.
        Mr. Boozman, you are recognized.
        Mr. Boozman. Thank you, Mr. Chairman.
        I really do not have any questions. I appreciate the work
    of the Commission in coming up with this and really look
    forward to working with Ms. Herseth Sandlin in her capacity as
    Chairman of the Economic Opportunity Subcommittee and my
    capacity as Ranking Member of the Subcommittee and really
    looking at this and trying to see what we can do through our
    Subcommittee working with the full Committee to implement
    recommendations.
        So I appreciate your hard work. Thank you very much.
        The Chairman. Thank you, Mr. Boozman.
        Mr. Hare?
        Mr. Hare. Mr. Secretary, since part of this is also called
    returning Global War on Terror heroes that we are doing, many
    wounded War on Terror heroes seek care in our Nation's
    outpatient centers, vet centers.
        Were you in receipt of a letter that was signed by 53
    members, a bipartisan letter sent to you asking you to get back
    to us? It says we urge you to address these issues immediately.
    In addition, we would like you to know what actions are planned
    to meet the staffing crisis at the VA centers. How much Federal
    resources would be required to fully staff the vet centers over
    the next five years. I was just wondering if you were in
    receipt of that letter.
        Secretary Nicholson. Could you tell me the date on that,
    Congressman.
        Mr. Hare. April 27th of this year.
        Secretary Nicholson. I do not know the answer.
        Mr. Hare. Well, I share Mr. Baker's comments about not
    getting a response. Here is the genuine concern that I have. We
    sent this letter out and I know we are going to have a hearing
    on this later.
        And you will probably get a little of my freshman
    exuberance here, but with the shortage that we have at our vet
    centers across this Nation, I cannot for the life of me imagine
    why $3.8 million is being sent out in bonuses.
        We have 600,000 backed up claims and, yet, when you came to
    us and asked on the General Operating Expense account, you
    asked for less money than 2007 which was a cut of nearly $9
    million. So your comments about the VA having all the money it
    needs must be reflective.
        And let me just say this to you. It would seem to me that I
    do not know why our veterans have to err on the side of having
    to wait 177 days to get a claim adjusted. If these things are
    adjusted because, as you said, ``they were based on
    performance,'' I would suggest to you, Mr. Secretary, that the
    person in charge of that is doing a miserable job and did not
    deserve a $33,000 bonus.
        That said, I think our veterans are the ones that should
    have--the burden of proof should not be put on them. It should
    be put on us. If you file your income tax and you send it in,
    you are audited, you are not assumed to be a cheater. Our
    veterans are sitting here waiting for benefits that they want.
        I listened to Mr. Baker talk. Fifteen months for Gulf War
    veterans, 15 months, and the answer to him is, well, we do not
    know. Maybe another year, maybe another year and a half.
        My point is this. I may be new here, but I have listened to
    VSOs come here. I have listened to our Filipino veterans come.
    I have listened to vet after vet come and spouses of veterans
    come. I will tell you this. One hundred and seventy-seven days
    is inexcusable. To get it down to 145 days is not doing these
    veterans what I would consider to be a big favor. I think it is
    disingenuous.
        I also just want to say candidly from my perspective, we do
    not have enough money for our veterans in our budget and you do
    not have enough staff. You do not have enough polytrauma units.
    Your doctors have testified that you do not. We do not have
    enough people that are working in these clinics.
        I have four outpatient clinics in my district. I have a vet
    center one block from my district office in Moline. I worked
    for a member for 23 and a half years. I know post traumatic
    stresses. The VA is woefully unprepared for the number of post
    traumatic stress veterans that they are going to have coming
    back.
        So you will have to pardon me if I do not share your
    opinion that you have all the money that you need and that you
    are completely staffed up to what you desire.
        The fact of the matter remains, if we make a promise to
    veterans, and it makes no difference to me whether I am a
    freshman on this Committee or whether I have been here for 25
    years, as long as I sit in this chair, my responsibility is to
    those men and women who gave everything they had for this
    country and they come back and we do not even have the DoD
    talking to the VA. You have the Walter Reed scandal that goes
    on. Our records are sent out left and right.
        I think that what we need is an overhaul here. I am not
    happy with the way our veterans have been treated. I have made
    that very clear. And let me suggest to you that I think we
    really need to get down to business here. We have really got to
    put our veterans first.
        And that to me, with all due respect, Mr. Secretary, from
    my perspective of sitting here in the four months that I have
    been here, just has not been the case. I have listened to the
    DAV. I have listened to the Paralyzed Veterans of America. I
    have listened to the VFW and the American Legion come before
    this Committee. Someone told them they were too late to come. I
    do not think it is ever too late for a VSO to come to this
    Committee and ask for money that we need in the budget.
        And if the answer is the money, and the Chairman has said
    before, all we are asking for is for the VA to tell this
    Committee what it is that you need to be able to clear up the
    backlog, what is it that we can do to quit erring on the side
    of the bureaucrats and start erring on the side of our
    veterans. That to me is very disturbing and I just do not think
    our veterans have gotten a fair shake, with all due respect.
        And I would yield back.
        The Chairman. Thank you, Mr. Hare.
        Mr. Space?
        Mr. Space. Thank you, Mr. Chairman.
        Mr. Secretary, my district, like so many other members of
    this Committee, is comprised of small towns and villages, very
    rural in nature. And I am interested in the Task Force
    recommendations regarding how the VA will work together with
    HHS to provide access to those members who come from rural or
    remote areas.
        Can you give us some insight as to what the VA and the HHS
    or the Department of HHS plan to do in this regard?
        Secretary Nicholson. Yes, Congressman. First, I will say
    that we have been mandated by law to develop a new rural health
    initiative and our response in that to you is September. And we
    are heavily underway in that. That is a concern of ours. It is
    a challenge of ours at the VA.
        And at the Task Force, we had discussions with HHS about
    the ways that we could collaborate and use our facilities or
    theirs, the community mental health facilities in ways that,
    you know, we can augment and supplement each other in the
    rural, remote areas of the United States where we know it is
    difficult for veterans, some who have to travel two, three
    hours to get to a community-based outpatient clinic, longer
    than that to get to a referred acute care facility, or
    hospital. That is essentially what we are looking at there.
        Mr. Space. And you say we can expect that to be completed
    in September of this year?
        Secretary Nicholson. I mentioned that just to make you
    aware that Congress mandated us with a law to develop a new
    rural healthcare initiative in the VA. And that is underway.
    This Task Force took a tangent from that in working with HHS to
    see ways that we could supplement our gaps using existing
    facilities that are in these remote areas.
        Mr. Space. I certainly trust that the situation will be
    taken very seriously. We have veterans who are in an
    impoverished area, many of whom have no means whatsoever of
    public transportation. Private transportation in many cases is
    limited. Compound that with the price of gas now at $3 a gallon
    and going up, it represents a considerable hardship for these
    folks. And I trust that the VA will, in fact, take their
    responsibility very seriously in that regard.
        Secretary Nicholson. We do. We are. I can also tell you
    that we have made some good advances using existing technology
    for rural health in telehealth and telemedicine and including
    telemental health. And we are finding pretty good results with
    that.
        Mr. Space. I yield back, Mr. Chairman.
        The Chairman. Thank you, Mr. Space.
        Mr. McNerney?
        Mr. McNerney. Thank you, Mr. Chairman.
        And thank you, Mr. Secretary, for testifying before us
    today. Like Mr. Walz, I understand and I recognize a lot of
    good work being done by the VA and by the people that are
    employed by Veterans Affairs throughout the country.
        However, I am concerned about two issues which could, with
    a little creative thinking, have a joint solution. First, I am
    concerned about the possibility of closing an excellent
    facility in Livermore, California, that serves a number of my
    constituents and is currently under reviews with the Capital
    Asset Review for Enhanced Services (CARES) Project.
        First, I would like you to shed some light on the VA's
    rationale here. Why would we be closing an excellent facility
    at a time of large-scale military action, at a time when large
    numbers of veterans from the Vietnam, Korea, and World War II
    are needing additional care?
        Secretary Nicholson. I am going to have to get back to you
    on the Livermore facility, Congressman, because I am not
    familiar with an action that we are taking there. I know we are
    not closing a hospital. And it is not on my radar, on the CARES
    screen that we have, the Capital Asset Review for Enhanced
    Services.
        So are you talking about a clinic; do you know?
        Mr. McNerney. The Livermore facility has a hospital and a
    clinic and there is also one in French Camp and there is a
    nursing home.
        But what is the rationale for considering closing
    facilities anyway? I mean, I do not understand that at this
    particular point in time.
        Secretary Nicholson. Well, I can address that point. That
    comes to us from you, the Congress, pursuant to a GAO report
    that was done on the VA some several years ago and found that
    it was inefficient, in fact maybe wasting over a million
    dollars a day with maintaining unused or under-utilized
    facilities, and told to do something about that.
        And the response was the establishment of this system
    called CARES, which is the review of all the existing plant and
    equipment to see if it is being properly used.
        And it was found that veterans like all other Americans
    have made some demographic shifts from certain locales to the
    south and the west and the southwest and that there are more VA
    facilities needed where there are higher densities of veterans
    and less needed where they left from or used to live.
        Mr. McNerney. Let me continue then. As Ranking Member Buyer
    suggested, the relatively low number of TBI and PTSD cases the
    VA is currently treating relative to the number that are
    estimated to have been exposed to conditions that might lead to
    such injuries.
        My question is this or my suggestion is this: If we
    disregard the assumption that no new funding or programs will
    be introduced, would the VA be interested in reprogramming some
    of the existing facilities currently under CARES review
    providing treatment for PTSD and TBI?
        Secretary Nicholson. Yes, indeed, if the need was shown. I
    can cite to you a couple of examples.
        We were looking at the Waco, Texas, facility, for example.
    The veteran population count was down from what it used to be.
    Many of these facilities were put in place right after World
    War II. That facility has been established as a Center of
    Excellence. Similarly in Canandaigua, New York, the same sort
    of demographic experience. It has been made a Center of
    Excellence and these will be for mental health facilities,
    mental healthcare.
        So the answer is yes. I mean, we will have the facilities
    that, you know, are needed. And this is a high priority.
        And I would like to correct something that, again,
    Congressman Hare said. I did not say here today that we have
    all the money that we need. We are big and we are dynamic and
    there are other things that we could do both program-wise and
    facility-wise.
        We have an excellent team of people, however, on board to
    treat posttraumatic stress disorder. I think we are the
    preeminent experts on that in the world and we have the
    preeminent research facility on that at White River Junction,
    Vermont. And we are now screening diligently for that and
    treating veterans for that. If we need additional facilities to
    do that, we will indeed come forth and request those.
        Mr. McNerney. Well, it seems like we are going to be
    overwhelmed by that sort of injury fairly soon if we are not
    already. So thank you.
        I yield.
        The Chairman. Thank you, Mr. McNerney.
        As a part of housekeeping, I ask unanimous consent that all
    written statements be made part of the record. Without
    objection, so ordered.
        I ask unanimous consent that all members be allowed five
    legislative days to revise and extend their remarks. Without
    objection, so ordered.
        Mr. Buyer, you are recognized for five minutes.
        Mr. Buyer. Thank you.
        Let me pick up on Mr. McNerney's point. The actual number
    of TBI cases that you treated in the VA is what, how many that
    you know of?
        Secretary Nicholson. I think that we are treating in the
    vicinity of 220,000 veterans for PTSD.
        Mr. Buyer. No. I am talking about at your polytrauma
    centers for traumatic brain injury inpatients.
        Secretary Nicholson. Oh, I am sorry. Yes. In our polytrauma
    centers, we have so far treated 369 veterans.
        Mr. Buyer. Three hundred and sixty-nine. An allegation has
    been made that you do not have the bed space at the polytrauma
    centers to care for all of them. Would you respond to that
    because I believe you have empty beds at the polytrauma
    centers?
        Secretary Nicholson. Yes. That is not the case. We have
    four level-one polytrauma centers and we have 17 level-two
    polytrauma centers. So we have one in every medical region of
    the country and----
        Mr. Buyer. When you say that is not the case, what does
    that mean? What is not the case?
        Secretary Nicholson. If someone asserts that we do not have
    capacity, that is not the case. We have capacity. I might add
    that many of our patients in our polytrauma centers are active
    duty military because they are acutely brain injured. They come
    to us very soon not worrying about their status.
        The Chairman. Would you yield to me for one second----
        Mr. Buyer. Yes.
        The Chairman [continuing]. Because this issue is very
    important. As I understand it, Mr. Buyer, Mr. Secretary, the
    centers are treating severe TBI, whereas so-called moderate or
    mild TBI, which I would rather call hidden because it is going
    to really influence people, are not being treated there. And
    that is where I am told we are going to have thousands of
    cases.
        Mr. Buyer. You are going right into where I was asking
    questions.
        The Chairman. Okay. I am sorry. I yield back.
        Mr. Buyer. No, no, no.
        The Chairman. But that is where the issue is.
        Mr. Buyer. Right.
        The Chairman. And that is what we want the preparation for.
        Mr. Buyer. But I wanted to set the baseline.
        The Chairman. Okay.
        Mr. Buyer. The baseline is a relatively small number with
    regard to your treatment of these traumatic brain injured. It
    is traumatic. This is tremendous trauma.
        But we have a really strong concern. We have done well with
    regard to up-armored Humvees, some of the other vehicles, the
    Buffalo, the V shape that we are going to, and the soldiers,
    they get out, they are in awe, they are in shock that they have
    survived. They are photographing, my God, I have just survived
    this and it is later on that they are having some difficulties,
    memory loss, in brushing their teeth, you know, weird things
    are happening to them.
        And these are the cases that Mr. Filner and I are pretty
    concerned about. So how do we discover them, track them, bring
    them into the systems, and that kind of thing? But I was just
    trying to establish the baseline.
        So we want to work with you on making sure that you have
    the capacity and you work inter-operably with DoD. Do you agree
    with that?
        The Chairman. Yes.
        Mr. Buyer. Okay. I also want to share my feelings with Mr.
    Filner in his opening with regard to the report, but you also
    had some restraints. You had to make some decisions inside the
    box with regard to what can you do without new resources. And I
    do want to have a follow on discussion.
        Maybe you can meet with Mr. Filner and me or other
    interested members about beyond that because even when we did
    Wounded Warrior, Mr. Filner and I worked together to do the
    electronic medical records and actually mandated them. Sure, it
    was in the Wounded Warrior legislation, but then when we put it
    in the DoD authorization bill, the Congressional Budget Office
    (CBO) came back and gave this huge number, billions that this
    would cost, so we had to scale it back to basically say Joint
    Patient Tracking Application (JPTA). And we could do that and
    make it inter-operable, bi-directional, and share the
    information and add no cost.
        So we also then were thrown back in the box, but there are
    some big things that we have to do and I think that sort of is
    the emotional flow of Mr. Hare. There are some big things out
    there that kind of need to be done. So I would like to do that
    with you, Mr. Secretary.
        Now I am going to jump really deep in the weeds. When I got
    to your to improve IT inter-operability, it is on page 72 of
    the report, HHS is going to be the lead agency on this. You are
    going to sign an MOU.
        And, Admiral, maybe you can help me here. When you
    establish this inter-operability with HHS, is this being done
    in the arena of risk management?
        In your reporting requirements in all of your hospitals and
    your outpatient clinics with regard to the adverse events
    because of the Prescription Drug User Fee Act (PDUFA) and
    Medical Device User Fee and Modernization Act (MDUFA), so you
    have adverse events reporting requirements under the post-
    marker reviews, and if you can electronically move this to HHS,
    we are reducing a tremendous amount of paperwork and burden.
    And this is part of the goal? I cannot get this from what you
    have here.
        Secretary Nicholson. Well, that is an important question, I
    think. What we are going to do is to have this joint group that
    is working on that. I mean, the President has thrown down a
    marker on trying to both standardize and universalize
    electronic health records in the movement and communication of
    it.
        And the Secretary of HHS, for example, has the
    responsibility to develop the protocols so that different
    organizations of the government and the private sector can
    establish their systems and their proprietary prerogatives. But
    they need to communicate. And this joint group has taken on
    this responsibility right now of working that.
        Mr. Buyer. Please place that into consideration in the
    interface with HHS on risk management----
        Secretary Nicholson. All right.
        Mr. Buyer [continuing]. And post-marker review. The last
    thing I have, Mr. Chairman, is on this page 70 through page 74,
    you lay out all of these target dates for implementation.
        And so, Mr. Secretary, what assurances can you give the
    Chairman and the Committee that--what assurances do you have
    that other Federal agencies involved in this process, notably
    DoD--will take implementation of the Task Force recommendations
    seriously as you have? I mean, who is going to be the person?
    Has the President tasked you to turn to your counterparts and
    say this is the date, you have not implemented? I mean, who is
    the task master with regard to implementation?
        Secretary Nicholson. Well, they have signed on. They have
    signed an agreement to participate and to abide. I mean, these
    schedules were not developed by us in a vacuum. They were
    collegial. And I am happy to say that, you know, so far, so
    good on compliance, very encouraging.
        These things are considered extremely important to the
    mission which is serving these current combatants and so they
    have a sense of urgency about them and that was established
    early in this process. And we want that to remain there.
        You know, if they go slack, I will try to motivate them or
    indeed the Commander in Chief might get involved because he has
    a real interest in this.
        Mr. Buyer. In closing, Mr. Secretary, what you have proven
    to Mr. Filner and me is when you were faced with a tremendous
    challenge, you told us you will take ownership of that issue
    and you did. So whether it is IT or this, you have proven
    yourself to this Committee.
        Now we have a tremendous responsibility being in charge for
    the President with regard to these initiatives. And I suppose
    Mr. Filner and I are--I want to make sure we are touching the
    right person.
        Are you saying to us that each of them, your other
    Secretary counterparts, they are the ones who are now
    responsible for the implementation? I see a nod from the back
    of the room. That is what we are to assume and that you are
    going to be responsible for your piece of this. You are going
    to have to turn to Duncan Hunter or somebody else with regard
    to the other Committees with regard to implementation. So we do
    not come back six or eight months from now and go after you and
    say how come so and so missed their targets. In other words,
    when you step away, you are no longer the guy in charge of the
    Task Force?
        Secretary Nicholson. Well, I am coordinating it as the
    Chairman. I am coordinating it. I do not have command
    responsibility over those other service sectors, but I am
    coordinating it in this role that I have been given.
        Mr. Buyer. Okay. Thank you.
        The Chairman. Thank you, Mr. Buyer.
        Thank you, Mr. Secretary.
        Let me try to summarize what I think a lot of my colleagues
    have said and some of the frustration we have. We agree with
    you that there is a tremendous number of good things happening
    in the VA in the medical area and committed people everywhere
    you go who want to serve veterans. I know medical directors
    could probably earn twice as much outside the VA and they are
    committed to veterans. So we agree with you on that.
        On the other hand, I think what the American people want
    and I think what we want and I think what you want, and if
    there is a silver lining in the cloud that Walter Reed
    represented, it is that people are ready for bold action.
        You said there is a sense of urgency among everybody and
    yet what we see is a process. It seems to me that we are
    allowing the bureaucratic needs of not only your agency but
    every agency to set the pace rather than the needs of our
    veterans.
        Look at this report. This is stuff that you did not need
    any new money or any new authority I do and it goes on for a
    year, year and a half. We could do it today.
        The claims backlog that several people have brought up, I
    think we have to, and we have talked about it, cut through the
    whole mess. Give veterans the benefit of the doubt. Either work
    it like the IRS and send them the check and audit later, start
    some minimal check when we receive their claim. We are going to
    talk about all these things when we have this roundtable on May
    23rd. But we cannot keep saying we have this backlog and we are
    going to solve it. We have got to cut through it.
        The health records interoperability, how many years have
    you been talking about this? This is not rocket science, as you
    pointed out. It takes somebody to say, ``do it tomorrow.'' We
    worked together at Chicago where they have, it looks like to
    me, made significant progress in this.
        If the VA has the better health records system, which I am
    told, the VistA System, order the DoD tomorrow to use that
    system. We cannot wait years and years and years and years and
    years, as everybody seems to suggest.
        These are kids. We have all been to see these kids with
    brain injuries and amputations and even World War II veterans
    are still very frustrated and Vietnam vets are frustrated. We
    cannot wait. We want bolder action.
        Take PTSD for instance, since everybody seems to have a
    greater appreciation of it. I do not think we have adequate
    staffing. And if you made that statement in a townhall meeting
    that any of us led with you, they would boo you off the stage.
    They have made calls. I have talked to people who have said you
    are either on a waiting list and then when I got mad at waiting
    lists, they stopped doing waiting lists and just said call back
    in three or four weeks.
        We know the story of the Minnesota Marine who was told that
    he would be 26th on a waiting list, so he committed suicide. We
    cannot wait. We have got to have the staffing there.
        And we have, I think, resources, Mr. Secretary, outside the
    VA that we need to welcome in and bring in. There are experts,
    and we are going to have a symposium on PTSD on May 16th,
    experts around the country on brain injury, trying to tell the
    bureaucracy ``we want to help'' and, yet, bureaucratic needs
    outweigh the need for urgency.
        I have visited with dozens of people who have programs that
    they think could help veterans with PTSD. And I am sure that
    all of them work. And we talked about setting aside a certain
    part of the money to help these community groups.
        There is a young man named Sean Hughes in Los Angeles, came
    back as a Marine with severe PTSD. He did not think he was
    making much progress in normal treatment, so he started writing
    his own feelings down in the form of a play. His play was
    produced. It was called Sandstorm. Some of you may have seen
    it. To try to work out his feelings. And he felt so healed by
    that that he set up a group called Vet Stage that he invited
    his comrades in to write and act, do such things as lighting
    and directing plays.
        And I saw a play of his in Los Angeles called The Wolf. And
    it had a very powerful statement of what people feel when they
    get out of a combat situation. And he is running this program
    on a shoestring. Thirty people can see the play at once.
        I go a few minutes later over to the West LA complex where
    there are two theaters run, I think, by UCLA. Surely Mr. Hughes
    might use that theater when it is not being used by UCLA.
        Regarding the Livermore situation that Mr. McNerney brought
    up; I have not been there, but I am told it is a very beautiful
    site, very conducive to relaxing rehabilitation for PTSD
    victims.
        So, we have talked about being creative, being bold. People
    do not want to wait for this stuff. We will never respond as
    quickly as someone needs, but we have got to have a quick
    response as a goal. We cannot allow ourselves to be victims of
    processes to say, okay, it is going to take a year before we do
    this stuff. That is not an answer for the people we are calling
    heroes. We know they are heroes. We want to treat them as
    heroes. But, telling someone they are 26th on a waiting list,
    that is not treating them heroically.
        So as Mr. Buyer said, we look forward to working with you.
    People want bolder action. They do not want this process stuff.
    Let us announce some bold actions, whether it is targeting
    several hundred million dollars to the kind of thing that Sean
    Hughes is doing and people are doing all across the country,
    whether it is setting aside some of these facilities that have
    outlived their usefulness in the context that they were built
    but can serve other functions now.
        People have offered brain injury beds in their clinics. Let
    us do it and not just study it and set up a process. I think
    that is our frustration. I know it is yours too. But I think we
    have to have some evidence that we are cutting through it.
        Mr. Secretary you have listened to all of us all day. I
    would be happy to give you as much time as you want either to
    conclude or respond to anything anybody here has said.
        Secretary Nicholson. Well, thank you, Mr. Chairman and
    members of the Committee. I genuinely appreciate the chance to
    come over here, present the work of this Task Force so far, and
    to respond to your questions because I know they are sincere.
        We are a big organization. Last night we got this letter
    from AARP, a bulletin called Vetting the VA and it is just
    extremely complimentary of the VA and the job it is doing.
        I have in my files letters from the heads of three Veteran
    Service Organizations complimenting the job that the VA is
    doing.
        So I say that because we are a big organization populated
    with people that I find to be very committed to the mission
    which is to serve veterans. And many of them, including many if
    not all of these Senior Executive Service people, working in
    this medical field could be making tremendously more money on
    the outside. I know what those people are making. Yet, they are
    staying there.
        So it is important, I think, that we recognize our
    shortcomings and we have some. We see over a million patients a
    week now. And as somebody said to me in St. Louis yesterday at
    the hospital, he said if we get it right 99.5 percent of the
    time, we are still going to have some problems. And we take
    those problems seriously, each of them, and see what we can
    learn from those and improve.
        But I have a real concern for the people who work at the
    VA, many, many of whom are veterans and their morale and their
    need to be, I think, shown some respect and gratitude as well.
    And I do that every chance I have. So I am doing it now as
    well.
        It is really a phenomenal organization with a clear mission
    to take care of what President Bush called last Veterans Day
    our Nation's finest citizens. And we are hard at it, but we
    welcome the oversight and the constructive inquiry and
    criticism that we get from you.
        And somebody told me today in preparing to come over here
    that there are, I think, 66 agencies, including the VSOs, that
    are licensed, accredited to come in and inspect VA facilities.
    So we do have quite a lot of oversight. And I think that as I
    move around and visit with veterans as I do continually and ask
    them how we are doing, they are generally extremely grateful
    and complimentary of the care that they are getting.
        There is a frustration in the time it takes to adjudicate a
    claim. That is a top priority of mine. And we are working on
    that. We are looking at some of these creative ways of
    reversing the assumption about the validity of the claim. But
    that is in motion.
        But in summary, Mr. Chairman, I appreciate the chance for
    us to be here and I appreciate your leadership of the Committee
    and that of the Ranking Member, Congressman Buyer, because I
    know how much you care. Thank you.
        The Chairman. Thank you, Mr. Secretary.
        This hearing is adjourned.
        [Whereupon, at 3:58 p.m., the Committee was adjourned.]

                                A P P E N D I X

                                  ----------

            Opening Statement of the Honorable Bob Filner, Chairman,
         and a Representative in Congress from the State of California
        The Committee on Veterans' Affairs will come to order. I would like
    to thank the Members of the Committee for being here this afternoon.
        I would like to thank Secretary Nicholson, who chaired the Task
    Force, for appearing before us today to provide us with the results of
    the Task Force report, which was submitted to the President on April
    19, 2007.
        The Task Force was created, by Executive Order, on March 6, 2007.
    The mission of the Task Force was to:

          identify and examine Federal services and benefits
    currently provided for returning servicemembers;
          identify existing gaps in such services;
          seek recommendations from appropriate Federal agencies on
    ways to fill those gaps as effectively and expeditiously as possible
    using existing resources; and
          ensure that, in providing services to those
    servicemembers, appropriate Federal departments and agencies are
    communicating and cooperating effectively and facilitate the fostering
    of such agency communications and cooperation through informal and
    formal means, as appropriate.

        The Task Force report identified 15 ``process'' and 10 ``outreach''
    recommendations. Of these 25 recommendations, the report states that
    ``18 represent collaborative efforts among Federal entities.'' The Task
    Force will reconvene in approximately one month to provide updates on
    the progress of the Government-wide action plan. The Committee looks
    forward to the Secretary's report on these 25 recommendations.
        I know that I speak for many of my colleagues here today in
    expressing our fear that the recommendations of this Task Force report
    will meet the fate of so many other recommendations from other reports
    from the last decade--that there will be great fanfare and very little
    action.
        Many of these recommendations are not new. Many of these
    recommendations will face the same problems of implementation as so
    many recommendations of the past--the inability of the Department of
    Veterans Affairs and the Department of Defense to work together in an
    effective manner to address the problems and hurdles faced by our
    returning servicemembers.
        This Committee is sensitive to the difficulties involved in
    coordinating the activities of the Department of Defense and the
    Department of Veterans Affairs. These Departments do indeed have
    different missions and different requirements.
        But as we meet here this afternoon our servicemembers are in harms
    way. Many of these men and women will be killed or wounded. We have
    talked and talked about the necessity of providing a seamless
    transition for years. We no longer have the luxury of time, if we ever
    did--we simply must act today.
        It is my hope that Secretary Nicholson will provide us with
    concrete answers as to why this Task Force report will be different
    from the Report of the President's Task Force to Improve Health Care
    Delivery for Our Nation's Veterans, released in 2003, and the Report of
    the Congressional Commission on Servicemembers and Veterans Transition
    Assistance, released in 1999.
        We seek a detailed timeframe as to implementation, the officials
    who will be responsible for implementation, and how the Secretary will
    inform this Committee as to the progress of implementation. This
    Committee seeks accountability and will look to Secretary Nicholson to
    provide this personal accountability.
        I note that the ``Government Wide Action Plan'' in the report lists
    a number of actions that were targeted to be completed after the
    release of the report and before today. As of today, Mr. Secretary,
    have all of these deadlines for action been met?
        Finally, I am concerned that the mission of the Task Force was
    constrained by being forced to concentrate on solutions using existing
    resources and available authorities. This reliance begs the question as
    to why these steps were not taken earlier, if it was indeed only a
    matter of existing resources and available authorities. It also raises
    the larger question as to what resources and authorities the VA needs
    to provide the long-promised seamless transition between the VA and DoD
    once and for all.

                Opening Statement of the Honorable Steve Buyer,
     Ranking Republican Member, and a Representative in Congress from the
                                State of Indiana
        Good afternoon.
        Mr. Chairman, thank you for holding this hearing.
        Mr. Secretary, thank you for being here today and for chairing this
    Task Force. The President has made clear his intent that we once and
    for all establish a truly seamless transition for servicemembers
    between the military and the VA, as well as other agencies providing
    services to veterans. You and your colleagues on the Task Force have
    produced a thorough review of the factors affecting seamless
    transition, and are to be commended.
        However, over the past 15 years, I have seen one commission and
    task force report after another. From my own personal experience with
    seamless transition, I know there are few new discoveries. What we have
    regrettably seen, and what compelled the President to directly
    intervene, is a general lack of implementation. To be fair, VA has made
    much progress; it has in fact led the federal effort. But VA cannot do
    it alone.
        Mr. Secretary, with the Task Force's work behind us, this report
    before us, and the President's intent made clear, we now must have
    implementation. In a few short weeks, the President is due to receive a
    progress report on the implementation of the recommendations from the
    report. We in turn will look for department and agency heads, in
    particular you and Defense Secretary Gates, to work together to move
    your respective departments forward.
        When that happens, we can talk about real progress.
        This report is, nonetheless, encouraging. Among the Task Force's 25
    recommendations, a handful alone would dramatically improve transition
    and must become a high priority within the administration. These
    include:

          Development of a system of co-management and case
    management for returning servicemembers to facilitate transition
    between the Department of Defense and VA.
          Screening all Global War on Terror veterans seen in VA
    healthcare facilities for mild to moderate traumatic brain injury.
          Expanding VA access to DoD records to coordinate an
    improved transfer of a servicemember's medical care through patient
    ``hand-off.''
          Development of a joint DoD/VA process for disability
    benefit determinations by establishing a cooperative Medical and
    Physical Evaluation Board process within the military service branches
    and VA care system.

        Among my goals here on the Committee, is to ensure that veterans
    have every opportunity to live full and healthy lives--that they can
    take advantage of the economic opportunities their service helped
    preserve. Among key recommendations from the Task Force report that
    would help veterans transition into civilian life:

          Increasing attendance at the Transition Assistance and
    Disabled Transition Assistance Programs for active duty Guard and
    Reserve.
          Requiring the Department of Education, in cooperation
    with the Department of Labor, to participate in DoD job fairs to
    provide returning servicemembers and their families with an awareness
    of the postsecondary education benefits.
          Requiring the Department of Labor, through the Veterans'
    Employment and Training Service, to participate in the Workforce
    Investment System in every State and territory; and partnering with
    private and public sector job fairs to expand the number of employers
    involved in active veteran recruitment.

        The accomplishment of these recommendations, as well as others, is
    critically important. Since 2003, this Committee held more than 10
    hearings and conducted at least 15 site visits focusing on seamless
    transition. Our experiences corroborate the value offered by these
    recommendations.
        Yet, it already appears there is some reason for concern over
    implementation of the Task Force's 25 recommendations. The
    implementation target dates for 12 actions supporting the
    accomplishment of nearly half of those recommendations have already
    passed. At this point, we do not know if these actions have been
    completed.
        Of additional concern is the apparent lack of a single point of
    accountability short of the President to ensure interdepartmental
    action. It is unclear to me who in the Administration is responsible
    for monitoring and enforcing timelines and implementation. Our odyssey
    with this issue, as well as our experience with moving the Department
    to a centralized system of information technology management
    unequivocally attests to the supreme importance of accountability.
        I look forward to learning about the Departments' implementation of
    the Task Force's recommendations, and to learning what is being done to
    fulfill the President's intent in a timely fashion.
        Again, thank you, Mr. Chairman, and I yield back.

             Opening Statement of the Honorable Ginny Brown-Waite,
             a Representative in Congress from the State of Florida
        Thank you, Mr. Chairman.
        I also want to thank Secretary Nicholson for appearing before the
    Committee today.
        Responding to the problems at the Walter Reed Army Medical Center,
    President Bush took the appropriate step of creating the Task Force on
    Returning Global War on Terror Heroes. This panel worked tirelessly to
    identify recommendations on how Congress can improve the care and
    support for our returning soldiers. Their findings focused on several
    key areas, including healthcare services, employment assistance,
    benefits, and outreach efforts.
        Mr. Chairman, with thousands of wounded soldiers returning from the
    front lines in Iraq and Afghanistan, Congress has an obligation to
    ensure that these individuals receive the best healthcare in the world.
    Never again should we see a breakdown like what occurred at Walter
    Reed. Congress, the VA, and DoD need to work together to bring about
    the changes needed in caring for our veterans.
        I look forward to hearing from the Secretary about the panel's
    findings. Thank you.

                 Statement of the Honorable R. James Nicholson,
                 Secretary, U.S. Department of Veterans Affairs
        Mr. Chairman, Members of the Committee, good afternoon.
        Thank you for the opportunity to discuss the Task Force on
    Returning Global War on Terror Heroes and the steps which will be taken
    to ensure that the Nation's promises to those veterans and returning
    servicemembers are kept.
        In the past, Congress has demonstrated the value they placed on
    military service by creating programs to provide military personnel and
    eligible veterans with benefits and services to help them readjust to
    civilian life.
        Under President Bush, and at Congress' direction, there have been
    tremendous strides in addressing the needs of our Nation's veterans.
        As the War on Terror continues, however, it has become apparent
    that a government-wide approach which addresses all aspects of caring
    for our most recent heroes is necessary. Although VA's healthcare is
    noted nationally as one of excellence, there are always ways in which
    we can improve both our medical care as well as processes to better
    serve our veterans.
        While DoD has been praised for the life-saving medical care that it
    provides on or near the battlefield beginning minutes after injury, the
    condition of Building 18 of the Walter Reed Army Medical Center was a
    call to arms for those of us who took the oath to serve our returning
    servicemembers. The President, like the rest of the Nation, was
    infuriated by the conditions at Walter Reed's outpatient facility and
    wanted to ensure that our servicemembers and veterans' needs were being
    met and wanted to swiftly address any areas in which services to
    veterans could be improved.
        On a personal note, as you know I am a veteran of the Vietnam War.
    I am also the son of a veteran. I am the father of a veteran and the
    brother of a veteran. I am the uncle of four active duty colonels, one
    of whom is in his 14th month of service commanding a brigade in
    Afghanistan. In my capacity as the Secretary for the Department of
    Veterans Affairs, I have the ongoing privilege of meeting our Nation's
    heroes from across the country. The issue of their care and meeting
    their expectations upon their return home is a personal one to me and
    one in which I can emphatically state that I know and understand.
        To address the very real needs of returning servicemembers,
    President Bush created the Interagency Task Force on Returning Global
    War on Terror Heroes on March 6, 2007.  This Task Force was given 45
    days to review all government services upon which veterans and
    servicemembers rely when they return home. The membership of this Task
    Force consisted of the Secretaries of Defense, Labor, Health and Human
    Services, Housing and Urban Development, and Education, plus the
    Director of the Office of Management and Budget, the Administrator of
    the Small Business Administration, and the Director of the Office of
    Personnel Management.
        President Bush appointed me Task Force Chair. The Task Force's
    structure provided an opportunity to establish interagency cooperation
    in delivering benefits to our Global War on Terror [GWOT]
    servicemembers and veterans.
        The President's Executive Order directed the Task Force to:

          Identify and examine existing Federal services that
    currently are provided to returning GWOT servicemembers;
          Identify existing gaps in such services;
          Seek recommendations from appropriate Federal agencies on
    ways to fill those gaps;
          Ensure that appropriate Federal agencies are
    communicating and cooperating effectively; and
          Develop a government-wide action plan that ensures that
    in providing services to these servicemembers, appropriate Federal
    agencies are communicating and cooperating effectively.

        We sought input from stakeholders. We considered this essential if
    we were to be successful. Within 48 hours of the Executive Order, the
    Task Force had a functional website to seek input from veterans, active
    duty personnel, veterans' service organizations, federal employees, and
    other interested parties.
        We received over 2,400 communications by email, regular mail, and
    fax. Each was identified as raising either constituent casework and/or
    policy issues which needed further review by the Task Force. In
    addition, we met with Veterans Service Organizations (VSOs) to discuss
    their concerns and ideas as to how we could improve our service to
    veterans and servicemembers. Equally as important, Admiral Patrick
    Dunne, the Executive Secretary of the Task Force and my Assistant
    Secretary for Policy and Planning, and I met with servicemembers and
    their families to solicit their input for this Task Force.
        The Task Force utilized a ``gap analysis'' approach to determine
    the manner and extent to which services and benefits are provided to
    servicemembers and veterans. This approach defined what currently
    exists, identified what is needed or desirable, and determined the
    process to achieve the identified needs. It inventoried Federal
    services and benefits available to servicemembers and veterans. Work
    groups assessed and analyzed emerging themes related to the current
    delivery of services and benefits. The Task Force then developed
    recommendations that could be implemented within agency authority and
    existing resources.
        The Task Force's 25 recommendations involve collaborative efforts
    among several federal entities to improve the timeliness, ease of
    application, and delivery of services and benefits to those who earned
    them. The Task Force focused on Healthcare, Benefits, Jobs, Education,
    Housing and outreach to servicemembers and their families about
    available benefits and services. The Task Force also addressed
    information technology such as enhancing VA's Computerized Patient
    Record System, improving VA access to electronic medical records of
    servicemembers treated in VA healthcare facilities, and the improvement
    of the electronic enrollment process.
        I would like to highlight some of the recommendations in this
    report which improve services to veterans.
        One of the reports' recommendations pertains to evaluating an
    injured servicemember's disabilities. As part of this effort, DoD and
    VA will develop a joint process for disability benefit determinations
    by establishing a cooperative Medical and Physical Evaluation Board
    process within the military service branches and VA. Meetings have
    already occurred to begin this process.
        Another recommendation will develop a system of co-management and
    case management to ensure continuity of care, benefits, and services to
    injured military personnel and disabled veterans. Currently there is no
    formal policy that outlines the procedures to be used by VA and DoD
    when their case managers co-manage the care of a patient.
        In order to bridge the informational gap around the programs
    available, the Department of Education staff will participate in
    selected Department of Labor sponsored job fairs conducted for
    servicemembers and provide quarterly information for inclusion in VA's
    GWOT newsletter. Another cross-cutting recommendation is the ``Hire
    Vets First'' campaign. For this, the Department of Education will
    coordinate with other Federal partners to integrate a campaign with
    existing job/career fairs to promote awareness of the campaign to
    employers and servicemembers seeking employment.
        The Department of Labor (DoL), along with DoD, has been tasked to
    improve job qualification, certification, and credentialing
    opportunities for transitioning servicemembers by working with
    certifying entities to develop credentials for military training and
    experience.
        The Small Business Administration will work with DoD, DoL, VA and
    all federal agencies with procurement authority to implement the
    PatriotExpress Loan Initiative in order to better meet the needs of
    veterans, service-disabled veterans, activated Reserve Component
    members, discharging servicemembers, spouses, survivors, and dependents
    of servicemembers who died in service, or of a service connected
    disability.
        Another example of this Task Force's work is the recommendation to
    better educate transitioning servicemembers on the benefits available
    to them with regard to financial aid. For this, a financial aid
    information module will be developed for the Transition Assistance
    Program and Disabled Transition Assistance Program (TAP/DTAP). This
    module can be integrated into any presentations currently provided.
        The report was submitted to the President on April 19, 2007 and
    Admiral Dunne and I briefed him on the Task Force and its
    recommendations. The President welcomed the Task Force's
    recommendations and directed me to begin implementation and report back
    to him in 45 days on their progress. The action plan contained in the
    report specifies required steps for each recommendation and a timeline
    for those actions which we are tracking closely. In addition, there
    were Congressional Committees and VSO briefings on the final report.
        Although the report has been completed, the Task Forces' work is
    not done; only when the gaps noted in the report are successfully
    closed will we have fulfilled the President's charge as outlined in the
    Executive Order. I take personal responsibility in assuring Congress,
    veterans and servicemembers that this report will be accompanied by
    definitive and measured actions to achieve its goals.
        Toward that end, the President asked me to communicate directly
    with the Commission on Care for America's Returning Wounded Warriors
    led by former Senator Dole and former Secretary Shalala to ensure both
    groups exchange ideas, advance reform efforts, and, to the extent
    possible, provide assistance to their report so they can build upon the
    work of the Task Force. I have spoken to both Senator Dole and
    Secretary Shalala about our efforts and my staff has continued contact
    with the Commission as they proceed with their work.
        There is much work to be done but we can and must work together to
    ensure that our returning heroes receive the best healthcare and the
    full range of benefits and services they deserve.
        In addition to the recommendations identified by Interagency Task
    Force, VA is focusing on other areas in which we can improve services
    to veterans independent of this report such as information technology
    and data security. The VA leads the world in the use of electronic
    medical records. Every one of our nearly 8 million enrolled patients
    has an electronic medical record allowing a veteran to access his or
    her records anywhere in this vast system. Additionally, while Katrina
    required us to evacuate thousands of people, we didn't lose a patient
    or a medical record. The same cannot be said of the civilian sector.
        Secondly, we have a high rate of diabetes among veterans that we
    are treating. Nearly a quarter of the veterans we treat have been
    diagnosed with diabetes. In response, we have initiated educational
    programs, in collaboration with HHS, to ensure that individuals
    understand the causes of Type II diabetes and what they can do to
    control the disease, including weight control.
        Thirdly, in response to a U.S.-wide rise in methicillin resistant
    staph infections, we have begun an initiative in our Pittsburgh
    facility, which has cut staph infections by 70 percent. This program,
    which focuses on disciplined sanitation measures, will be enacted
    throughout our entire system.
        I should note that over the years, a number of commissions,
    advisory panels and government study groups have looked at similar
    issues and provided recommendations. In addition, numerous Government
    Accountability Office reviews have encouraged the Departments to pursue
    cost-effective resource sharing. Many of the recommendations of those
    studies and reports have been adopted in whole or in part. I would like
    to take a moment to highlight some of these successes.
        For example, past recommendations have suggested changes and
    improvements in our Education, VocRehab and Outreach efforts. In its
    1999 report, the Congressional Commission on Servicemembers and
    Veterans Transition Assistance, noted the evolution of the delivery of
    higher education--along with the increasing price tag--since the
    inception of the Montgomery GI Bill. In partnership with Congress and
    the Administration, the VA worked to implement the recommendations
    needed for a modern and enhanced benefits package for those completing
    honorable service. For example, VA worked with Congress to broaden the
    range of Montgomery GI Bill options to include entrepreneurial courses,
    licensing courses, and high technology certification courses. Benefits
    for tuition have been increased, including those for high-cost
    technology courses. An automated enrollment system has been fully
    operational since July 2001. That commission also pointed out the need
    for VA to improve the Vocational Rehabilitation and Employment (VR&E)
    Service and there now is a long-range strategy to emphasize employment
    outcomes. As for outreach, VA is expanding its outreach to National
    Guard and Reserve troops with a Post Deployment Health Reassessment and
    Readjustment Counseling at our Vet Centers with the hiring of an
    additional 100 OIF/OEF combat veterans as peer counselors.
        Past commissions have made healthcare recommendations as well, a
    number of which we have implemented. One notable example is the 1991
    Commission on the Future Structure of Veterans Healthcare's
    recommendation that VA continue to lead in specialized areas which will
    lead to VA's advancements in TBI and polytrauma care.
        And of course, we have initiated and responded to calls for action
    to enhance healthcare resource sharing. As you may be aware, VA and DoD
    created mechanisms to enhance healthcare resource sharing by forming
    the Joint Executive Council (JEC) in February 2002. The JEC mission
    seeks to enhance collaboration; ensure the efficient use of federal
    services and resources; remove barriers and address challenges that
    impede collaborative efforts; improve business practices; enhance
    sharing arrangements that ensure high-quality, cost-effective services
    for both VA and DoD beneficiaries; and develop a joint strategic
    planning process to guide the direction of joint sharing activities.
        On behalf of the Task Force agencies, I can pledge to you that we
    are all committed to this effort.
        Mr. Chairman, this concludes my remarks. I would be happy to answer
    any questions you may have.

                    Statement of the Honorable Jeff Miller,
             a Representative in Congress from the State of Florida
        Thank you, Mr. Chairman.
        I appreciate your holding this hearing to review the 25
    recommendations made by the President's Task Force on Returning Global
    War on Terror Heroes.
        We, as a grateful nation, depend on the members of our Armed Forces
    to defend our freedom. Similarly, these brave men and women and their
    families rely too on their government to deliver the benefits and
    services they have earned in an effective and forthright manner.
        I want to commend the President for his leadership in establishing
    this Task Force. I also want to thank Secretary Nicholson and the
    members of the Task Force for their swift and decisive action in
    undertaking this critical review of how we are providing services to
    our returning Global War on Terror (GWOT) servicemembers.
        As a Member of both the Committee on Armed Services and the
    Committee on Veterans' Affairs, we have been examining a number of the
    issues put forth by the recommendations of the Task Force for several
    years. As Ranking Member of this Committee's Subcommittee on Health, I
    am particularly interested in the 11 recommendations geared toward the
    provision of health services to those who serve and have served in the
    GWOT.
        In March, the Health Subcommittee held a hearing to review how the
    needs of the veterans suffering TBI are being met. Our review found
    that there are significant barriers between the care provided between
    the Department of Veterans Affairs (VA) and the Department of Defense
    (DoD). In response, I joined as an original cosponsor of H.R. 1944, the
    Veterans Traumatic Brain Injury Treatment Act of 2007. The bill, among
    other provisions, would require the screening of all veterans for TBI,
    establish a comprehensive program of long-term care for post-acute TBI
    in four geographic regions, and create TBI transition offices. It is
    encouraging to note that several of the Task Force recommendations
    support the requirements in this legislation.
        The Task Force also recommended that VA and DoD, in coordination
    with HHS expand collaboration and work with Community Health Centers to
    improve health services provided to Operation Iraqi Freedom (OIF) and
    Operation Enduring Freedom (OEF) servicemembers who live in rural
    areas, with about 41 percent of our returning OEF/OIF veterans hailing
    from rural settings.
        The target date provided by the Task Force for establishing a
    working group between VA, DoD, and the Department of Health and Human
    Services (HHS) was April 30, 2007. This recommendation included that
    VA, DoD, and HHS would formalize an agreement to determine the needs of
    OIF/OEF returnees to interact with the CHCs and other HHS supported
    providers. While I understand that this initiative was tasked to HHS, I
    hope VA and DoD are tracking these recommendations and encouraging
    timely action.
        VA and DoD are to develop a standard system of co-management and
    case management. VA and DoD were to have a draft Memorandum of
    Agreement and complete a charter to standardize processes between the
    two agencies in regards to case management by April 30, 2007.
        Additionally, the Task Force recommended that DoD improve VA access
    to health records of servicemembers treated in VA facilities. VA and
    DoD have had the authority to share since 1982, with the enactment of
    Public Law 97-174, the VA/DoD Health Resources Sharing and Emergency
    Operations Act. In 2003, Public Law 108-136 created the Joint Executive
    Committee, an interagency Committee to enhance the sharing between the
    two Departments. While some progress has been made, I am still
    disturbed by the sufficient lack of progress that remains.
        Both DoD and VA should take notice that we will no longer accept
    business as usual. Missed deadlines are simply unacceptable. We expect
    both Departments to own up to the problems and take immediate action to
    implement the recommendations of the Task Force. I intend, as I am sure
    everyone will agree, to continue monitoring both the actions of VA and
    DoD to ensure that no servicemember ``slips through a crack.''

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