[Congressional Record Volume 153, Number 44 (Wednesday, March 14, 2007)]
[Senate]
[Pages S3136-S3138]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. MENENDEZ (for himself, Mr. Lautenberg, Ms. Mikulski, and 
        Mr. Casey):
  S. 882. 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 24,042 members of our Nation's armed forces have been 
injured, more than 10,685 of them too severely to be returned to 
action.
  I have visited these soldiers at Walter Reed, at Fort Dix, and at the 
East Orange Veterans Hospital. I have heard stories consistently from 
our veterans about fighting against DoD and VA bureaucracy for months 
and even years simply to receive the basic benefits they are owed by a 
grateful Nation.
  The controversy at Walter Reed again brings to light the shortcomings 
in the process our returning veterans must deal with in their difficult 
transition from soldier to civilian. Just as

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the deplorable conditions that have come to light are unacceptable, so 
too are the countless stories detailing the maze of forms, hearings, 
and medical evaluations that prevent so many of our veterans from 
getting the health care and benefits they need.
  Too often, it seems that rather than thanking the soldier for their 
sacrifice, this system sets up yet another battle of bureaucracy. Too 
often, it seems that the system is stacked against the very soldiers it 
is designed to help. Too often, veterans must seek out their own 
treatment options and benefits or risk missing deadlines and losing 
benefits. It doesn't have to be this way. We have an obligation not 
only to fulfill the promises we make to America's fighting men and 
women, but to do so in a manner that ensures the benefits we owe them 
are made readily available.
  At the East Orange VA hospital in my State of New Jersey, for 
instance, we have a modern War-Related Illness and Injury Study Center 
that stands underutilized because many veterans aren't even informed 
that it's there. Patients whose quality of life could be drastically 
improved by the technology the center provides miss the opportunity 
simply because they are not aware the option is available. This country 
can do better; the will of the American people is to do better; now 
this government must do better.
  That's 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 servicemen 
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 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 healthcare 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 recommend whether or not 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.
  While all veterans will benefit, 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, is different 
from previous conflicts we've undertaken.
  During the Iraq and Afghanistan campaigns, we have the largest 
activation of National Guard and reservists since World War II. As of 
March 12, according to DoD, the United States had 141,000 military 
personnel deployed in Iraq. Of these, 119,005 were active component 
personnel and 21,995 were National Guard and Reserves. These numbers 
are set to increase due to the recent announcement by President Bush to 
send at least 20,000 more troops to Iraq by May.

  The GAG released a report in February 2005 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've been hearing a lot more about post-traumatic 
stress disorder, or PTSD in veterans and those returning from conflict. 
The GAO report 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 a recent study commissioned by the Department of 
Veterans Affairs, roughly 13 percent of service men and women returning 
from Iraq suffer from PTSD. GAO has concluded that roughly 78 percent 
of those service members 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 re-
experiences an event, has a flashback or is somehow reminded of a 
battlefield event. That may not happen until after a service member 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

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tactical intelligence analysts, and serve in artillery units.''
  This would have been unheard of a decade ago, but it's 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.
  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 re-enter 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.
  As we have seen with the situation at Walter Reed, DoD and VA simply 
do not have the manpower to effectively handle the influx of veterans 
cases coming into the system. With a backlog of over half a million 
claims, the VA can not adequately address the individual needs of 
America's warriors. Our service members didn't have to wait to sign up 
to serve their country; they shouldn't have to wait and fight to get 
the benefits they are seriously entitled to.
  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, 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.
                                 ______