[Congressional Record Volume 152, Number 104 (Tuesday, August 1, 2006)]
[Senate]
[Pages S8541-S8543]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. MENENDEZ (for himself and Mr. Lautenberg):
  S. 3770. A bill to require a pilot program on the facilitation of the 
transition of members of the Armed Forces to receipt of veterans health 
care benefits upon completion of military service, and for other 
purposes; to the Committee on Veterans' Affairs.
  Mr. MENENDEZ. Mr. President, since the March 2003 start of the Iraq 
war, more than 19,157 members of our Nation's Armed Forces have been 
injured, more than 18,777 of them wounded in action.
  Imagine that you are one of those wounded. You are an enlisted marine 
serving your country in Iraq. Your convoy is attacked by Iraqi gunmen 
and your transport explodes, killing several of your fellow soldiers 
and wounding many more. You are seriously wounded, so you're medevaced 
to Landstuhl Regional Medical Center and then transported to an 
appropriate medical facility in the U.S. for further stabilization and 
treatment.
  As you begin the long road to recovery in the hospital, you may be 
approached by a Department of Veterans Affairs, VA, counselor who 
provides you with information about VA medical benefits and vocational 
rehabilitation and employment services. You may or may not meet with 
someone from the VA. But you're not ready to think about those things 
yet. You just want to get better and rejoin your fellow marines in 
Iraq.
  Several months later, as you convalesce, Department of Defense, DOD, 
determines that you should be discharged due to the seriousness of your 
injuries. But, the discharge process won't become official for at least 
nine months, and you can't access VA services until it does. This 
leaves you in limbo, caught somewhere between the DOD and VA systems.
  You finally return home, still convalescing from your injuries and 
while there, you finally receive your discharge papers. This 
development means no more access to the support you received during 
active duty, including health care. In order to receive medical care, 
you need to begin enrollment in the VA system to access medical 
services. Enrollment is a slow and difficult process, and, in your 
seriously wounded state, you come up against a blizzard of paperwork, 
Byzantine procedures, and a number of overworked VA caseworkers.
  Your family has no idea how to get you into the system quickly and 
without having to pay more money for interim care until the VA benefits 
kick in.
  As the conflicts in Iraq and Afghanistan grind on, these stories are 
all too frequent. Many wounded soldiers, service men and women are 
faced with the prospect of a premature end to their military service 
and are struggling to reenter civilian life, often with permanent 
disabilities. And they now have to find their way to the VA. They need 
help finding their way so they can get the care they deserve. They have 
served their country and now their country, their military, owes them 
our best in return.
  That is why I am proud to introduce the Veterans Navigator Act, a 
bill that would expand and enhance the important work done by VSOs and 
other non-governmental organizations to guide our Nation's service men 
and women to and through the VA healthcare system. It would, in fact, 
acknowledge the work of these organizations by providing $25 million in 
grants over 5 years to augment their capabilities.
  The ``navigator'' concept is not new. It is similar to the Patient 
Navigator demonstration program I introduced and which was subsequently 
enacted

[[Page S8542]]

into law. There, we also took a successful small-scale program being 
used at select medical facilities around the country and expanded it by 
providing grants for a scaled-up demonstration program to serve those 
with cancer and other chronic diseases, and in particular, to provide 
support to medically underserved populations.
  With the veterans navigator bill, I propose to do something similar, 
capitalizing on the successes of the Patient navigator concept, to help 
our troops. The $25 million over 5 years in the bill would allow VSOs 
and other organizations to apply for grants so that they could hire and 
train navigators to provide assistance, on an individualized basis, to 
members of the Armed Forces as they transition from military service to 
the VA health care system. They would do so in coordination with DOD 
and the VA. Right now, many VSOs rely principally on donations to 
perform these services.
  At the end of the 5 years, the VA Secretary would submit a report to 
Congress on the effectiveness of the veterans navigator demonstration 
program and to recommend whether it should be made permanent.
  Often called national service officers or counselors, a navigator is 
a ``sherpa,'' a guide through the maze of paper and people and 
specialists and benefits. A navigator is an advocate for those no 
longer able to go it alone. A navigator is a facilitator, someone who 
will be with you through the process, to provide the expertise you will 
need to transition between active duty and veterans status and to get 
the urgent care you need.
  Let me be clear: a navigator does not supplant the role of the DOD or 
the VA. A navigator is meant to complement the work done by these 
organizations, particularly at a time when those systems are struggling 
to meet the needs of the soldiers returning from war and will continue 
to do so long after the conflicts in Iraq and Afghanistan have ended.
  The bill focuses particular attention on four underserved groups in 
the military community: the seriously injured or wounded soldiers, 
female soldiers, those suffering from psychological problems like post-
traumatic stress disorder, PTSD, and members of the activated National 
Guard and Reserves.
  These underserved groups have not been sufficiently served in 
existing VA and DOD transition programs and activities. It is these 
underserved groups who especially need continuity of care as they enter 
and wind their way through the VA medical system. Part of the reason 
they have not been adequately cared for is that the nature of the 
current wars we are fighting, in Iraq, in Afghanistan, are different 
from previous conflicts we have undertaken.
  During the Iraq and Afghanistan campaigns, we have the largest 
activation of National Guard and reservists since World War II. As of 
June 1, according to DOD, the United States had 128,789 military 
personnel deployed in Iraq. Of these, 102,709 were active component 
personnel and 26,080 were National Guard and Reserves. The recent 
announcement by President Bush to send additional troops to Baghdad in 
the face of increasing sectarian violence will likely only mean that 
those numbers will increase.
  The GAO released a report last February citing deficiencies in 
benefits for these soldiers. The report concluded that National Guard 
and Reserve soldiers ``are given little help navigating a thicket of 
regulations and procedures necessary to gain access to military 
doctors.''

  To complicate matters, members of our National Guard who seek medical 
care must file for an extension of their active duty status in order to 
continue to access military bases and hospitals.
  In its report, GAG also concluded that, and I quote, ``the Army has 
not consistently provided the infrastructure needed to accommodate the 
needs of soldiers trying to navigate their way through the' active duty 
medical extension' ADME--process . . . this has resulted in injured and 
ill soldiers carrying a disproportionate share of the burden for 
ensuring that they do not fall off their active duty orders.''
  The Veterans Navigator Act would help minimize such occurrences by 
providing National Guardsmen and Reservists someone to help bring them 
through the ADME process and to help correct any discrepancies before 
they cause a delay in accessing VA medical care.
  Veterans with psychological problems also need help. In the last 
several years, we have been hearing a lot more about post-traumatic 
stress disorder, or PTSD, in veterans and those returning from 
conflict. A recent GAO report has concluded that almost four out of 
five service members returning from Iraq and Afghanistan who were found 
to be at risk for PTSD, were not provided appropriate medical 
assistance. All of these factors mean that now, more than ever, our 
Nation's soldiers need help moving between the DOD and VA realms.
  According to the chief of psychology at Walter Reed Army Institute of 
Research, roughly 20 percent of those service men and women returning 
from Iraq suffer from PTSD. In its recently released report, GAO 
concluded that roughly 78 percent of those servicemembers at risk for 
PTSD do not get further evaluation. That means they return to active 
duty or are discharged without receiving the appropriate care.
  It is the nature of this disorder to appear not right after the 
traumatic event is experienced, but often not until an individual 
reexperiences an event, has a flashback or is somehow reminded of a 
battlefield event. That may not happen until after a servicemember has 
been discharged from service. Once PTSD does emerge, the veteran may 
not know how to access VA medical assistance, or he or she may not have 
yet enrolled into the VA medical system.
  Again, as in the case of the severely wounded, time is of the 
essence. PTSD can manifest itself so severely as to incapacitate a 
soldier, making medical care more urgent. In the case of returning 
National Guardsmen and Reservists, the problem is made more complex 
because of the 2 year time limit on filing for VA benefits.
  Since 1991, opportunities for women in our Nation's Armed Forces have 
grown. For the first time, the military is placing women in support 
units at the front line. This has come partly as the result of more 
than 10 years of policy changes making 91 percent of the career fields 
gender neutral.
  The Navy and the Air Force have begun to allow female soldiers to fly 
fighters and bombers. The Army has expanded the role of women in 
ground-combat operations. Right now, ``women command combat military 
police companies, fly Apache helicopters, work as tactical intelligence 
analysts, and serve in artillery units.
  This would have been unheard of a decade ago, but it is happening 
right now. Right now, record numbers of female soldiers are fighting on 
the front lines and, as a result, more are being seriously wounded or 
killed. A Baltimore reporter profiling women soldiers' participation in 
Iraq observed that ``the war in Iraq has been an equal opportunity 
employer, by killing and injuring a historic number of female soldiers 
in combat situations.''
  Therefore, a VA medical system designed to treat wounded male 
soldiers must now ensure that female soldiers get the right kind of 
medical care. They will need help finding that care and getting access 
to that care. A veteran navigator can help them do that.
  Because of the length and size of the deployment, many more soldiers 
are being seriously wounded. According to the GAO, roughly 30 percent 
of U.S. soldiers wounded in combat during World War II later died. 
Today, that number has dropped to 3 percent for those serving in Iraq 
and Afghanistan due to advances in technology and protective gear.
  While this is clearly a positive development, it also means that many 
of these injured soldiers are returning home with severe disabilities, 
including traumatic brain injuries and missing limbs that require 
comprehensive inpatient rehabilitation services.
  But, severe injuries often mean a lengthy transition from active duty 
to veteran status. As my story earlier indicates the physical 
evaluation of a seriously wounded service member to determine whether 
he or she can return to active duty can take months to complete. In the 
interim, the VA has to be able to identify these soldiers so that they 
can perform early outreach, provided that they have the information to 
do so.

[[Page S8543]]

  Despite this, the GAO observed in a March 2005 report that the VA 
faces ``significant challenges in providing services to seriously 
injured service members.''
  In many cases, VA staff have reported that seriously injured service 
members are simply not ready to begin thinking about VA benefits or 
dealing with the VA system during the recovery process. The problem 
here, as GAO has pointed out, is that the VA has no policy for 
maintaining contact with these soldiers down the line, once they are 
discharged. Contact is often conducted on an ad hoc basis. Navigators 
can also help these seriously wounded soldiers.
  VSOs such as the Veterans of Foreign Wars, Disabled American 
Veterans, Jewish War Veterans and so many others have emphasized the 
importance of maintaining contact with seriously injured veterans who 
do not initially apply for VA health care benefits because it may be 
many months or even years before they are prepared to apply for them.
  The veterans navigator can help perform this function. Because this 
individual or individuals have reached out to the injured service 
member before his or her discharge, they can, in coordination with the 
VA caseworkers, remain in contact with them as they recover and prepare 
to reenter civilian life. The navigator can also help obtain 
information from DOD on seriously injured soldiers earlier on so that 
they can help ensure that all service members and veterans benefit from 
VA health care services at the right time.
  At a time when many active duty service people and veterans have 
fought and often made the ultimate sacrifice for their country, we 
cannot risk having any soldier fall through the cracks. We cannot take 
the risk that our female soldiers, who are fighting alongside their 
male colleagues, may not receive the medical care they need. We cannot 
risk the lives and health of soldiers with PTSD. We cannot risk the 
lives and the health of any service member who put their lives at risk 
for our country.
  Not so long ago we celebrated Memorial Day, a day when each and every 
American honors the service of our Nation's Armed Forces, both past and 
present and takes a moment to thank them for helping to keep America 
safe and secure. The very least that we can do is to ensure that all of 
these brave men and women are able to access the medical benefits to 
which they are entitled, particularly in their time of greatest need. 
At some point in each of our lives, we might need a guiding hand to 
help us find our way. Today, Mr. President, I am proposing to provide 
that helping hand to our troops in a time of their greatest need. It is 
the very least that we can do.
                                 ______