[Congressional Record Volume 153, Number 95 (Wednesday, June 13, 2007)]
[Senate]
[Pages S7643-S7645]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. LEVIN (for himself, Mr. Akaka, Mr. McCain, Mr. Warner, 
        Mrs. Murray, Mr. Graham, Mr.  Kennedy, Mr. Sessions, Mr. 
        Rockefeller, Ms. Collins, Mr. Byrd, Mr. Chambliss, Mr. Obama, 
        Mrs. Dole, Mr. Lieberman, Mr. Cornyn, Mr. Sanders, Mr. Thune, 
        Mr. Reed, Mr. Martinez, Mr. Brown, Mr. Nelson of Florida, Mr. 
        Tester, Mr. Nelson of Nebraska, Mr. Bayh, Mrs. Clinton, Mr. 
        Pryor, Mr. Webb, Mrs. McCaskill, Mr. Durbin, Ms. Stabenow):
  S. 1606. A bill to provide for the establishment of a comprehensive 
policy on the care and management of wounded warriors in order to 
facilitate and enhance their care, rehabilitation, physical evaluation, 
transition from care by the Department of Defense to care by the 
Department of Veterans Affairs, and transition from military service to 
civilian life, and for other purposes; to the Committee on Armed 
Services.
  Mr. LEVIN. Mr. President in February, a series of articles in the 
Washington Post highlighted shortfalls in the care and treatment of our 
wounded warriors at the Walter Reed Army Hospital. These articles 
described deplorable living conditions for some service members in an 
outpatient status; a bungled, bureaucratic process for assigning 
disability ratings that determine whether a service member will be 
medically retired with health and other benefits for himself and for 
his family; and a clumsy handoff between the Department of Defense and 
the Department of Veterans Affairs as the military member transitions 
from one department to the other. The Nation's shock and dismay 
reflected the American people's support, respect, and gratitude for the 
men and women who put on our Nation's uniform. They deserve the best, 
not shoddy medical care and bureaucratic snafus.
  The Armed Services Committee and the Veterans' Affairs Committee held 
a rare joint hearing to identify the problems our wounded soldiers are 
facing. These committees continue to work together to address these 
issues, culminating in the bill we introduce today, the Dignified 
Treatment for Wounded Warriors Act. Our bill addresses the issues of 
substandard facilities, inconsistent disability ratings, lack of 
seamless transition from DOD to the VA, inadequacy of severance pay, 
care and treatment for traumatic brain injury and post-traumatic stress 
disorder, medical care for caregivers not eligible for TRICARE, and the 
sharing of medical records between the Department of Defense and the 
Department of Veterans Affairs.
  The Dignified Treatment for Wounded Warriors Act requires the 
Secretary of Defense to establish standards for the treatment of and 
housing for military outpatients. These standards will require 
compliance with Federal and other standards for hospital facilities and 
operations and will be uniform and consistent throughout the Department 
of Defense.
  Another shortfall identified in the aftermath of the Washington Post 
articles is the inconsistency in disability ratings for the same and 
similar disabilities. In many instances, disability ratings assigned by 
the Veterans' Administration are higher than the disability ratings 
assigned by the military services for the same injuries. The military 
services are not even consistent among themselves in assigning 
disabilities. The Dignified Treatment for Wounded Warriors Act 
addresses the issue of disparate disability ratings in several ways.
  First, it requires the military departments to use VA standards for 
rating disabilities, allowing the military to deviate from these 
standards only when the deviation will result in a higher disability 
rating for the service member. In our view, requiring all of the 
military departments and the VA to use the same standards should result 
in identical disability ratings for the same or similar disabilities.

  Second, the act will change the statutory presumption used by the 
military departments for determining whether a disability is incurred 
incident to military service or existed prior to military service to 
mirror the statutory presumption used by the VA. Currently, the 
military rule is that a disability is presumed to be incident to 
service if a member has been in the military for 8 or more years. That 
leaves out a high percentage of our troops. Under the revised rule, a 
disability will be presumed to be incident to service when the member 
has 6 months or more of active military service and the disability was 
not noted at the time the member entered active duty, unless compelling 
evidence or medical judgement warrant a finding that the disability 
existed before the member entered active duty. This should avoid the 
situation where the military assigns a disability rating of zero 
percent on the basis that a disability existed prior to service and the 
VA later awards a higher disability rating and disability compensation 
by using the VA presumption to conclude that the very same disability 
is service connected.
  Third, the act will require two pilot programs to test the viability 
of using the VA to assess disability ratings for the Department of 
Defense. One pilot program will require the Veterans' Administration to 
assign the disability ratings for the Department of Defense, based on 
all medical conditions that render the service member medically unfit 
for military service. The other pilot program will require the military 
department and the VA to jointly assign the disability rating, also 
based on all medical conditions that render the service member 
medically unfit for military service.
  Fourth, the act will require the Secretary of Defense to establish a 
board to review and, where appropriate, correct disability 
determinations of 20 percent or less for those service members 
separated from service because they were medically unfit for duty after 
September 11, 2001. This will give our service members an opportunity 
to correct unwarranted low disability ratings and ensure that 
disability ratings are uniform and equitable.
  The Institute of Medicine has just completed a study for the 
Veterans' Disability Benefits Commission, concluding that current VA 
standards are out of step with modern medical advances in conditions 
such as traumatic brain injury and modern concepts of disability. The 
Disability Commission is due to report to Congress on its findings and 
recommendations in October. The Dignified Treatment for Wounded 
Warriors Act will require the Department of Defense to use any updated 
standards as soon as the Veterans' Administration adopts them.
  Our bill addresses the lack of a seamless transition from the 
military to the Veterans' Administration by requiring the Secretary of 
Defense and the Secretary of Veterans Affairs to jointly develop a 
comprehensive policy on the care and management of service members who 
will transition from DOD to the VA. This policy will address the care 
and management of service members in a medical hold or medical holdover 
status, the medical evaluation and disability evaluation of disabled 
service members, the return of disabled service members to active duty 
when appropriate, and the transition of disabled service members from 
receipt of care and services from the Department of Defense to receipt 
of care and services from the VA.
  Another problem identified by the committees is the inadequacy of 
separation pay for junior service members. Those separated with a 
disability rating of 30 percent or higher are medically retired with 
health care and additional benefits for the service members and their 
families. Those separated with a disability rating of less than 30 
percent are discharged and given a severance pay that is based on how 
long they were in the military. For example, a service member with 2 
years of service will receive the equivalent of only 4 months basic pay 
as severance pay. This bill increases the minimum severance pay to 
1 year's basic pay for those separated for disabilities incurred in a 
combat zone and 6 months' basic pay for all others. Furthermore, under 
current law, severance pay is deducted from any VA disability 
compensation these service members receive. Our bill changes that by 
eliminating the requirement that severance

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pay be deducted from disability compensation for disabilities incurred 
in a combat zone.

  The signature injuries of the current conflicts are post-traumatic 
stress disorder, commonly referred to as PTSD, and traumatic brain 
injury, referred to as TBI. We still have a lot to do to adequately 
respond to these injuries. To address this, the Dignified Treatment of 
Wounded Warriors Act authorizes $50 million for improved diagnosis, 
treatment, and rehabilitation of members with TBI or PTSD. The act also 
requires the Secretary of Defense to establish Centers of Excellence 
for PTSD and for TBI. These centers will conduct research, train health 
care professionals, and provide guidance throughout the Department of 
Defense in the prevention, diagnosis, mitigation, treatment, and 
rehabilitation of these injuries. Finally, the act requires the 
Secretary of Defense, in consultation with the Secretary of Veterans 
Affairs, to report to Congress with comprehensive plans to prevent, 
diagnose, mitigate, treat, and otherwise respond to TBI and PTSD. These 
plans will address improvements of personnel protective equipment in 
addition to addressing the medical aspects of diagnosing and treating 
TBI and PTSD.
  We are also addressing the problem that exists because medically 
retired service members, who are eligible for TRICARE as retirees, do 
not have access to some of the cutting-edge treatments that are 
available to members still on active duty. To address this shortfall, 
the act authorizes medically retired service members with disability 
ratings of 50 percent or higher to receive the active duty medical 
benefit for 3 years after the member leaves active duty.
  We are also beginning to address the problem created when parents, 
siblings, and others who are not normally authorized to receive 
military health care leave their homes to serve as caregivers to 
military personnel with severe injuries while the members are 
undergoing extensive medical treatment. In many cases, these family 
members leave their jobs and lose their job-related health care. Even 
though these family members are in a military hospital, they are not 
authorized to receive medical care from the doctors at that facility 
when they need it. To address this, the act authorizes military and VA 
health care providers to provide urgent and emergency medical care and 
counseling to family members on invitational travel orders.
  One of the significant shortfalls in the smooth transition from 
military health care to VA health care is the inability to share health 
records between the two Departments. Our bill will establish a 
Department of Defense and Department of Veterans Affairs Interagency 
Program Office to develop and implement a joint electronic health 
record.
  The Dignified Treatment of Wounded Warriors Act is a comprehensive 
bill that lays out a path for the Department of Defense and the 
Department of Veterans Affairs to address shortfalls in the care and 
management of our wounded warriors. They deserve the best care and 
support we can muster. The American people rightly insist on no less.
  Mr. AKAKA Mr. President, as chairman of the Veterans' Affairs 
Committee and as a member of the Armed Services Committee, I was 
delighted to work with Senator Levin, chairman of the Armed Services 
Committee, and others on this important legislation, the Dignified 
Treatment of Wounded Warriors Act of 2007. I really appreciated the 
willingness of the Armed Services Committee staff to work in close 
cooperation with the Veterans' Affairs Committee staff on its drafting. 
This legislation would improve the policies which govern the care and 
management of all servicemembers with a serious illness or injury that 
might render them unfit for duty in order to facilitate and enhance 
their care, rehabilitation, and physical evaluation, as well as improve 
their transition from the Department of Defense to the Department of 
Veterans Affairs.
  This measure is a direct outcome of an unprecedented joint hearing 
held on April 12, 2007, by the Senate Armed Services and Veterans' 
Affairs Committees during which we heard testimony on the transition of 
servicemembers from DoD to VA. This measure will go a long way toward 
addressing the problems that first gained public attention with the 
stories about Walter Reed Army Medical Center and will help achieve the 
goal of providing optimal care and a truly seamless transition for the 
nation's wounded warriors.
  I view issues relating to those servicemembers who may be rendered 
unfit as a result of an illness or injury from two different 
perspectives, both as chairman of the Veterans' Affairs Committee and 
as a member of the Armed Services Committee. As I said at the joint 
hearing, this is not solely a DoD or a VA problem. While DoD and VA are 
separate organizations, they both deal with the same servicemembers. A 
key element of this proposed legislation is the requirement that DoD 
and VA develop a comprehensive policy for transitioning those with 
serious illnesses or injuries from Active Duty military status to 
veteran status. As part of this effort, the two Departments will be 
required to conduct a comprehensive review of all regulations, 
policies, and procedures that impact these servicemembers and to 
identify best practices when developing joint policy. If we are going 
to fix the problems identified at Walter Reed, there must be uniform 
standards for the transition process that are understood by all parties 
and that are consistently applied by the military services.
  I am delighted that the Dignified Treatment of Wounded Warriors Act 
embraces the reforms to the DoD Disability Evaluation System contained 
in S. 1252, legislation I introduced on April 30, 2007. For the 
Disability Evaluation System to work fairly and consistently, there 
must be uniform use by the military services of VA's disability rating 
schedule. The services must take into account all conditions which 
render a servicemember unfit when making a disability rating, as well 
as develop a program for the uniform training of Medical Evaluation 
Board and Physical Evaluation Board personnel. It is also essential 
that DoD develop a system of accountability to ensure that the military 
services comply with disability rating regulations and policies.
  I am pleased to note that on June 27 the Veterans' Affairs Committee 
will conduct a markup of legislation that will complement the efforts 
of the Armed Services Committee to make sure that VA appropriately 
addresses problems confronting seriously wounded and injured 
servicemembers once they become veterans.
  I commend Chairman Levin and the staff of the Armed Services 
Committee for crafting this comprehensive legislation. It will go a 
long way toward providing DoD and VA with a roadmap for improving the 
transition processes and ensuring that seriously ill and injured 
servicemembers and veterans get the benefits and services they need and 
deserve, the benefits and services these courageous men and women have 
earned by their service.
  I urge all of our colleagues to support this proposed legislation.
  Mr. McCAIN. Mr. President, as ranking member of the Senate Armed 
Services Committee I am pleased to co-sponsor the Dignified Treatment 
of Wounded Warriors Act, which would ensure that wounded and injured 
members of the Armed Forces receive the care and benefits that they 
deserve.
  We were all surprised and deeply disappointed by the conditions at 
Walter Reed and the problems that our wounded warriors faced after 
their inpatient care was complete, living in substandard conditions at 
Building 18, being treated poorly, battling a Cold War-era disability 
evaluation process, and for some, simply falling through the cracks.
  Since February of 2007, many encouraging changes have been initiated 
by the Department of Defense. First and foremost, Secretary Gates 
established and enforced a culture of accountability for the leadership 
failures that lead to the tragedy at Walter Reed. Medical facilities 
have now been inspected by all three military departments, and 
improvements are underway. Additional counselors and support has been 
provided to families. On April 25, 2007, a new Warrior Transition 
Brigade stood up at Walter Reed to manage all the needs of wounded and 
ill soldiers, both Active and Reserve. DOD has begun to exert greater 
management responsibility for the disability

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evaluation systems of the military departments. We are on the right 
track to address the problems at Walter Reed and at other hospitals. We 
need to ensure that the effort is sustained. This legislation will 
ensure that these efforts continue.
  The legislation requires that the Secretaries of Defense and Veterans 
Affairs work together to develop new policy to better manage the care 
and transition of our wounded soldiers. This policy would address many 
of the concerns that have been raised by wounded soldiers and their 
families, conditions while in a medical hold status, the need to 
streamline and make more transparent the medical and physical 
evaluation board processes, policies that facilitate the return to duty 
for soldiers who are able, and a policy governing the smooth transition 
of separating service members from the Department of Defense to the 
Department of Veterans Affairs which focuses on the needs of patients.
  This legislation would improve health care benefits to severely 
wounded soldiers by extending their health care benefits as if the 
member were on active duty for a period of up to 5 years. This approach 
ensures that our most severely wounded have as many health care options 
as possible, especially for treatment of traumatic brain injury and 
other long term serious conditions.
  This legislation authorizes additional funding for traumatic brain 
injury and post-traumatic stress disorder and requires the 
establishment of two centers of excellence for the prevention, research 
and treatment on these consequences of war. This legislation would also 
require DOD to develop a comprehensive plan for research, prevention 
and treatment of traumatic brain injury, which is long overdue in 
addressing the so-called signature injury of this war.
  The administration requested, and this bill would provide, additional 
authorities to the Department of Defense to hire health care 
professionals to care for our service members and their families. It 
would also require the Department of Defense and Department of Veterans 
Affairs to jointly develop an electronic health record that can easily 
be shared between the two departments.
  With respect to disability determinations for wounded warriors who 
leave military service, this legislation would require the Secretary of 
Defense to establish a special review board to independently review the 
findings and decisions of the Physical Evaluation Boards of the 
military departments since 2001, in cases in which the disability rates 
of 20 percent or less were awarded and members were not medically 
retired. We must act, in light of data showing that some members, 
particularly junior enlisted soldiers, may have unfairly been denied 
medical retirement. This legislation empowers the special board to 
correct military records and, if appropriate, restore to a wounded 
soldier a higher disability rating or retired status.
  The bill would also end the requirement that disabled service members 
pay back severance pay if they obtain a higher disability rating from 
the VA, and increase the amount of severance pay that separating 
members receive.
  To address the need for fundamental change in the way that the DOD 
and VA disability evaluation systems are structured, a belief shared by 
many of my colleagues, this legislation would require the Secretary of 
Defense to immediately implement pilot projects to test new 
improvements to the disability evaluation system. Such pilot programs 
will help expedite implementation of needed changes to the disability 
evaluation system.
  This legislation would also require the Secretary of Defense to 
establish uniform standards for medical treatment facilities and 
medical residential housing facilities, and a DOD investment strategy 
to remedy all medical facility deficiencies. It would also require the 
Secretary of Defense to study the feasibility of accelerated 
construction of state-of-the art facilities and consolidation of 
patient care services at the new National Medical Center at Bethesda. 
As a condition for the closure of Walter Reed Army Medical Center, it 
would require the Secretary of Defense to certify that health care 
services would remain available in their totality until the new 
facility and staff are in place to effect a seamless transfer of care. 
The current facilities at Walter Reed have served the Nation well, but 
we can and must do better.
  This legislation is a start on the journey to restore trust for 
America's wounded and her veterans, but it is not our final 
destination. It will take time to understand fully the complexities of 
the DOD and VA disability systems and to reconcile them in the best 
interests of our wounded veterans.
  We must also look to the Department of Veterans Affairs to improve 
access to care for wounded veterans and improvements in its handling of 
veterans claims for disabilities. We must ensure that the VA maintains 
a robust medical infrastructure for quality health care, teaching and 
research, but one that also supports veterans beyond the limits of 
bricks and mortar in communities throughout the nation. I am developing 
legislation which would require the Secretary of Veterans Affairs to 
establish health care access standards for veterans with a service-
connected disability throughout the VA health care delivery system, 
and, similar to DOD's TRICARE system, when services cannot be provided 
by the VA, authorize that care to be purchased from civilian providers. 
Civilian health care specialists are eager to do their part for 
America's veterans. Given the strain on the veterans health system, and 
the limits to our resources, we should give them that chance, and make 
certain that our Nation's veterans get the care that they need, when 
they need it.
  There is no more important responsibility than to act on our moral 
obligation as a Nation to those who are willing to give their blood for 
its freedom. Let us continue to be guided by the words of President 
George Washington in 1789, who said, ``the willingness with which our 
young people are likely to serve in any war, no matter how justified, 
shall be directly proportional as to how they perceive the Veterans of 
earlier wars were treated and appreciated by their country.''
  I hope that my colleagues will join Senator Levin and me in a 
bipartisan effort to make a difference in the lives of our service 
members who have given so much in support of our Nation.
                                 ______