Hello, everyone! Mike was great at the forum on Wednesday, but the forum was a little bit of a love fest and everyone patting each other on the back except for Mike who kept trying to bring up the real issues facing all of us today-- incompetent MEB/PEB boards, long time delays, not using VASRD ratings, etc. The moderator cut him off at one point, but Mike still let everyone know that there are still major problems even though some progress has been made. Some of us expressed to the panel that we were tired of funding for new initiatives when they cannot even staff and execute the initiatives that VA and DOD already have. Lots of volunteer agencies spoke up that they have tried to work with VA to provide items and services (Segways, free med. flights, etc.) but working with the VA is impossible because of the red tape, and that they have a hard time letting people know about their services. There is a website that is going to offer a state by state list of all the local, state, and national charities and government offices set up to provide assistance to families, soldiers, and vets. Maybe Mike can provide the email address as I couldn't hear all of it.
We, hubby and I, were told that the AW2 program is in contact with all its soldiers. After the speech, I let Col. Jim Rice know that this was incorrect as Hubby registered online with AW2 in January, and he registered again in person at our local program office in June, and we had not had any contact with our case manager since that day. We were not the only ones to call him on this. Needless to say, today we have gotten three phone calls from our local AW2 office. Apparently when you fill out the paperwork, the computer then assigns you to a case worker. The explanation so far is that BOTH times he registered, the computer never assigned him to a case worker. If you have not had contact with an AW2 case manager, they are supposed to contact you at least once a month, but the ideal is more frequently than that.
I have a call into Dr. Davis' office, she is heading up a new DOD/Va task force to ease the process. I asked if according to Sec. Peake's statement that those diagnosed with PTSD on active duty are not supposed to have to fill out the paperwork that VA sends to prove that you have PTSD, then why is VA still saying it needs to be filled out. I'll get back to you on that.
The other good speaker in my opinion was Sec. Peake of the VA. He seemed very realistic about the shortcomings of VA and seemed committed to fixing them. There are lots of good programs out there that I had never heard of and still haven't figured out how to access them. VA is trying to remedy this. Supposedly, they are creating a link page to services.
Look for upcoming articles in the different military times papers and the Baltimore Sun. Hope this helps!
Wounded Warrior Forum Cites Progress Amid Continued Shortcomings
By David Wood
WASHINGTON—Better, but nowhere near good enough.
That was the consensus on the current continuum of care for wounded servicemembers and their families among the hundreds of military caregivers, Defense Department, and Veterans Affairs officials, family members, and veterans gathered 17 September for a day of high-powered panels, discussions, and networking.
The U.S. Naval Institute (USNI) and the Military Officers Association of America (MOAA) sponsored the one-day forum, titled "Measuring Success: Keeping Faith with Wounded Warriors and Their Families."
Even as progress is being made, the problems are becoming more acute as greater numbers of severely injured service members return from Operation Enduring Freedom and Operation Iraqi Freedom. Many of them, observed retired Army Colonel Jack Jacobs, who earned the Medal of Honor in Vietnam, would not have survived in previous wars.
"These young Americans have written a blank check that includes giving their life if necessary," said Thomas L. Wilkerson, chief executive officer of the U.S. Naval Institute and a retired Marine Corps major general. "And Americans write a blank check that we will care for them and their families for the balance of their lives."
"That is a moral obligation but also a practical one: if we allow the perception to go forward that veterans cannot return to a meaningful life that they can sustain, when we next ring the bell we might not find the volunteers we need to defend this democracy," Wilkerson said.
With the passage of the Wounded Warrior Act, part of the FY 2008 Defense Authorization bill, much has been done toward that goal, said Senator Carl Levin, Democrat of Michigan and chairman of the Senate Armed Services Committee. The legislation mandated reforms of the DOD and VA disability rating standards and required an increase in severance pay for members injured in combat or combat-related activity. It required the Defense Department to establish "centers of excellence" for traumatic brain injuries (TBI) and post-traumatic stress disorders (PTSD) and that DOD and the VA jointly develop comprehensive policies on case management to achieve a "seamless transition" from military to veterans care.
But as Levin observed, "when it comes to implementation, there have been shortfalls."
"We can pass all the laws that we possibly can and should, but unless they are implemented fully, then we have not carried out our missions and we have not done our duty," he said.
The Pentagon has acted on many of these requirements and others, officials said. Army Brig. Gen. Loree K. Sutton directs the Defense Center of Excellence for Psychological Health and TBI. Among its initiatives, she said, are the establishment of a Defense and Veterans Brain Injury Center, a Center for Deployment Psychology, the Deployment Health Clinical Center, a Center for the Study of Traumatic Stress, a Center for Tele-Health and Technology to reach National Guard and reserve troops in remote locations, and the National Intrepid Center of Excellence, due to open next fall.
At a higher level, the Wounded, Ill and Injured Senior Oversight Committee, chaired by the deputy secretaries of Defense and Veterans Affairs, is working to streamline coordination between the two agencies and to improve case management, said Dr, Lynda Davis, deputy assistant secretary of the Navy who supervises joint DOD-VA case management. The committee oversees the work of the services' Wounded Warrior programs with its own recovery coordinators who work at Walter Reed Army Medical Center, Brooke Army Medical Center, the National Naval Medical Center at Bethesda, and elsewhere.
Although many of these programs and initiatives had their genesis before 9/11 and the wars in Afghanistan and Iraq, there has been impressive progress since then.
"There are double amputees on active duty. That's profound," said Lieutenant General Ronald Coleman, deputy commandant of the Marine Corps for manpower and reserve affairs.
But even with these achievements came acknowledgements of shortcomings.
Many community-based organizations want to help wounded troops, but cannot find a way to do it. "We have an awful lot of families who call and want to help,'' an Army officer said. Individuals and non-profit organizations call to offer help, she said, but are bewildered by the number of acronymed offices within DOD and the VA. State agencies often have trouble integrating their services with military and VA programs.
One problem is a DOD ethics regulation that forbids the gift of more than $1,000 to any active-duty service member. Jerry Kerr is a 53-year-old disabled civilian who runs a nonprofit organization that provides the two-wheeled mobility platforms called Segways to injured service members. His organization, Segs4Vets, obtained a blanket waiver from the Pentagon allowing it to donate the Segways, which cost about $5,000 each.
If the ethics rule was amended to allow gifts to wounded troops, he said, "people would come out of the woodwork to help."
"There's a lot of guys out there who want to assist," said Marine Colonel Gregory A.D. Boyle, who commands the Marine Corps Wounded Warrior Regiment, but there is no organized way to include them. "There is a lack of command and control," he said.
Meredith Beck, a senior VA adviser on community reintegration, acknowledged that the VA had been "somewhat insular" in not reaching out to community organizations and individuals. She agreed that reforming ethics and other regulations is needed "not because the government is not doing its job, in many cases, but because these communities want to help."
There is a shortage of caregivers, acknowledged Army Colonel Jim S. Rice, director of the Army's Wounded Warrior program. His goal is to provide one case manager for every 30 patients, but currently he can only manage one for every 37 patients. One reason for the shortfall is high turnover among case managers, he said, and there is competition among Pentagon and VA agencies for experienced case managers. And the workload is growing: His program is absorbing 91 new soldiers per week and is currently caring for over 3,200 soldiers.
Among those not receiving help are tens of thousands of former service members who are not in contact with their former service or the VA. Colonel Boyle said there are an estimated 8,000 former Marines in this category, and his office is making an effort to reach each one of them by phone.
Families of wounded service members were not hesitant to speak up.
"I have to pester the VA" to get assistance, said Cynthia A. Lefever, whose son, Army Specialist Rory Dunn, was badly wounded by an IED blast in Iraq. "You have got to get rid of your big roll of red tape," she told a VA official. She said she and her son had not had any contact from their VA case manager since February, 2007. She said it took 18 months to arrange for automatic deposit of her son's checks.
"As far as getting contact with the VA, it's always, 'we're understaffed, we're understaffed!' All these programs sound great, but we don't get access to them because of understaffing,'' she said.
She said VA staff, including receptionists, should be trained to handle patients with TBI or PTSD. "We need your staff to know how to de-escalate a confrontation, how to treat patients with dignity and respect—just those two things—please! Sometimes when I come into the VA, I want to hit somebody I get so frustrated!''
Andrea Sawyer, the wife of a soldier who served in Iraq in mortuary affairs, also sounded bitter about the VA. Her husband, Sergeant Loyd Sawyer, waited at Fort Lee, Virginia, for eight months to get a referral from the base psychologist for help with PTSD, which he says he developed after handling 40 to 50 bodies a day and "being mortared constantly." He is now being treated at the Portsmouth Naval Medical Center. The psychologist at Fort Lee, he said, "couldn't care whether I was alive or dead."
"There are so many people working so hard on these problems—and not talking to each other," said Beck, who has served as national director of the Wounded Warrior Project and who has a brother deployed as a Marine in Iraq.
"A lot of progress has been made but there is a long way to go," she said. "I know the worst thing you can say to the family of an injured member is to be patient. They have been patient!''
David Wood is the national security correspondent for the Baltimore Sun.
Here is the MOAA report on the forum. Note, I am a retired Army LTC, not a retired Air Force Lt Col.
On Sept. 17, MOAA, in conjunction with the U.S. Naval Institute, sponsored a day-long symposium highlighting progress and continuing challenges in meeting the needs of severely wounded warriors and their families.
Senate Armed Services Committee Carl Levin (D-MI) kicked off the day, recapping the Committee’s long list of initiatives to address the problems exposed at Walter Reed last year, when the “sprawling overlap of bureaucracies left the wounded and their families confused, overwhelmed, and too often without adequate care…There has been some progress,” he said, “but a lot more needs to be made, because we’ve seen some implementation shortfalls. The wounded troops aren’t complainers, so that makes your involvement [in measuring progress] all the more critical.”
“Problem, Progress, and Prescription” discussion panel highlights
- COL Jim Rice, Director of the Army Wounded Warrior Program, said his chief challenges are the rising numbers of returning wounded and finding and training new case managers, as those high-demand specialists have many other opportunities.
- Col Greg Boyle, Commander of the HQ USMC Wounded Warrior Regiment, said his job is to ensure regular, caring leadership contact and personal assistance to every wounded Marine, and his people also are in the process of reaching out to contact the 8,000 who left active service before his program came into being.
- Sam Retherford, head of the DoD/VA disability evaluation system pilot project, focused on “adding transparency, advocacy, and speed to the process. There’s still too much passing of paper and files and we’re working to resolve conflicts in DoD vs. VA regulations, but we’re working to expand the pilot to 13 DoD sites.”
- Lt Col Mike Parker (USAF-Ret), a disabled advocate, said the services aren’t following DoD guidance in all cases, and DoD doesn’t always follow the VA rating guidelines, which still leads to inappropriately low disability evaluations. He also emphasized the obligation to review cases of those separated or retired before the new rules took effect.
- Meredith Beck, Special Assistant to the VA Secretary and former policy director for the Wounded Warrior Project, emphasized that the intent has to be to ensure the wounded are able to live their lives to the fullest possible, and that the VA needs to make more use of civilian and community-based programs to do that. “An ongoing problem,” she said, “is that so many people are working so hard, they sometimes don’t take time to talk to each other.”
“How Can Leadership Institutionalize the Seamless Transition Process?” discussion panel highlights
- Moderator Geoff Deutsch of the Veterans Innovation Center emphasized that the wounded warrior problem “won’t go away. We will find continually evolving problems and technological capabilities. And those who have disabilities today at age 25 are still going to have disabilities when they’re age 75.”
- Melinda Darby, Executive Director of the DoD/VA Senior Oversight Committee (SOC)Office, emphasized the intensity of commitment of the leaders of both departments, highlighting that they worked out a joint interagency agreement in only 30 days. She also said the committee is planning a transition to a permanent structure this fall (the statutory authority for the SOC expires at the end of the year).
- Dr. Lynda Davis, a Deputy Assistant Secretary of the Navy who co-chairs the DoD/VA case management effort, said an essential part of helping the wounded not just survive, but thrive, is ensuring their families are included as a key part of their recovery team. Her group is about to produce a national resource directory of all benefits, compensation, health care, family support, education/training, and other support, searchable by geographic area, military service, and diagnosis.
- Keith Pedigo, Associate Deputy Under Secretary for the VA, expressed confidence that the joint efforts of the new departments will continue into the new Administration, citing the statutory requirements and memorandums of understanding signed by both departments. “As long as the conflict continues,” he said, “we have a built-in stimulus.”
- LtGen Ronald Coleman, USMC, Deputy Commandant for Manpower and Reserve Affairs, highlighted top military leadership’s commitment to addressing the problems, emphasizing that only the best leaders are being assigned to the Wounded Warrior Regiment.
Challenges and Handling of PTSD, TBI, and Depression discussion panel highlights
- Moderator Col Jack Jacobs, USA-Ret, Congressional Medal of Honor recipient and NBC/MSNBC analyst, noted that brain and nerve tissue aren’t so easy to heal. “People who have nothing wrong today are going to show up needing treatment years from now, and we need to be ready to care for them.”
- Terri Tanielian of RAND Corporation, co-director of a major study on the topic, cited institution barriers such as the fear that revealing these conditions will affect military careers and a shortage of health care providers. “We need to incentivize and reimburse providers to show we value quality care. Our study documented there’s a price tag for inaction. If we don’t provide specific kinds of care now to all who need it, it will cost the country billions more later on.”
- BG Loree Sutton, USA, Director of the Defense Center of Excellence for Psychological Health & TBI, said this is the time to use lessons from the past to transform for the future – that there are wonderful things being done in all kinds of institutions across the country that give great hope if we can bring them to bear.
- Dr. Steven Scott of the VA’s Tampa Polytrauma Center said TRICARE isn’t set up to deal with people with multiple injuries, and their doctors don’t have time to get multiple authorization numbers. Multiple tours in a long war dramatically increase exposures to trauma. He said even the severely wounded have high expectations and “want to stand, walk, think, and serve.” A crucial element is to get family members, including children, involved as part of their rehabilitation.
- BG Wayne Hoffman, AUS-Ret, former president of the Military Chaplains Association, emphasized the availability of military and civilian community faith leaders as experienced members of the rehabilitative team to help those who feel disconnected in any number of ways.
- Mrs. Jackie McMichael, spouse of a wounded warrior with TBI, reinforced the need for immediate and intensive involvement of family members in the treatment process, as they’re the only ones who see the member round-the-clock. She said TBI patients are often in denial in their communications with medical and other personnel, either because of their fears or their understandable wish to be as they were before.
Keynote speaker James Peake, Secretary of the VA (and a previous Surgeon General of the Army) was proud of the VA’s progress, noting that his department has added 4,000 mental health providers in the last 2 ½ years and will spend $4 billion on mental health in FY2009. But he acknowledged, “The VA needs to do a better job of communicating... We need to be ‘veteran-centric’. And you can’t make progress without change. 38% of veterans live in rural areas…and we have a 1945 disability system. We need to get to a paperless system, and we need to use technology to assist in adjudication of claims.”
Army Surgeon General LTG Eric Schoomaker graciously served as the event’s closing speaker on less than 24 hours’ notice when world events forced Joint Chiefs of Staff Chairman ADM Mike Mullen to extend his trip to Pakistan. He said the Army is working hard to standardize processes so that wounded and their families anywhere in the country get the same high level of care and support. One challenge is that the drawdown and facility reductions/closures of the 1990s meant “we’ve lost [a lot of] capacity to provide intermediate rehabilitation.” The bottom line, he said, is that “We want soldiers who aspire to serve and we want them to know they will get the very best care when they serve. Our commitment to this all volunteer force is that if you’re wounded in combat, we’ll take care of you.” One aspect of that commitment is that the Army has retained 20% of Iraq/Afghanistan-era amputees on active duty.
MOAA’s Bottom Line. Recurring themes we took from the day’s discussions include:
- The overriding need for a permanent, joint DoD/VA office, fully staffed by members of both departments with responsibility for oversight, implementation, and evolution of joint cooperation efforts by the services, DoD, VA, and civilian agencies.
- The overriding need for continuing personal involvement and attention by the most senior leaders in the two departments. That’s what it took to begin serious cooperation, and that’s what it will take to ensure it continues after the current leaders who got the ball rolling will depart – as many will in a very few months.
- The vital requirement for immediate and full involvement and education of family members in every aspect of the treatment, rehabilitation and transition process.
- Despite the continuing implementation and coordination problems that are inherent in changing the way these massive bureaucracies do business, there are thousands of leaders, administrators, and support staff at all levels who are sincerely doing their level best to provide our wounded and their families the kind of care and treatment they deserve. But it can be an overwhelming task, and continued oversight, reassessment, and constructive criticism is essential.
Wow, Mike thanks much for what you have done. I just found this ppt and read through it. The first thing that stood out to me is my situation. For some reason I'm assigned to Camp Atterbury but all titles in their emails say they are Fort Knox, and I have many issues with my PEB documents due to the MEB documents being mostly incorrect. Some of this is due to the C&P exam as that nurse practitioner verbally told me she was in a hurry and said this should take at least two days but finished in 4 hours. After fighting with my PEBLO to get a copy of the C&P Exam results I was amazed at things she wrote that was never discussed. Fast forward and my NARSUM looks good, then it's like the MEB didn't even read the NARSUM and I know they never looked at any of my medical documents that the VA has and what I have loaded into ebenefits/vets.org. The legal counsel at Camp Atterbury convinced me that I have no appeals and to sign the MEB document and that I would be able to fix this during the PEB stage. So I've requested thru my PEBLO for the PEB to send my packet back to the MEB to fix some misdiagnosis and other issues. Not sure if this is going to work but this system I think personally is pretty good but what fight I see is the people in the offices at Camp Atterbury not doing their jobs correctly. I've had many issues with the legal counsel trying to force me to accept current things even when telling him they are incorrect and a PEBLO that doesn't answer emails and will only talk on the phone. I finally have used the VA POC to force the MSC Coordinator to load up additional documents I received from a MTF after the MEB stage. He fought me hard on saying I could fix things after I'm discharged but I won as I used the regulations and VA POC stating out what his duties was.
Even now in 2017 there are still issues with the DES.