Thursday, March 22, 2012

Pray God there's no black dress in the wings







"Another concern I wanted to mention today and one I'm sure everyone in this room is concerned about is mental health," declared Senator Patty Murray this morning. "For service members who served in Iraq and Afghanistan, the VA has now projected an increased demand of over 200% for mental health care by Fiscal Year 2020. We have got to take a hard look at whether the department's proposed 5% budget increase is enough to meet the projected demand for mental health care. Not every veteran will be effected by the invisible wounds of war but when a veteran has the courage to stand up and ask for help the VA has to meet that need every single time. They have to be there not only with timely access to care but the right type of care. Challenges like PTSD or depression are natural responses to some of the most stressful events a person can experience and we must do everything we can to ensure those effected by these illnesses can get help, get better and get back to their lives."
She was speaking at the joint-hearing of the House and Senate Veterans Affairs Committee. She is the Chair of the Senate Veterans Affairs Committee, Senator Richard Burr is the Ranking Member. US House Rep Jeff Miller is the Chair of the House Veterans Affairs Committee and, while Rep Bob Filner is the Ranking Member, Rep Michael Michaud acted as the Ranking Member for the hearing. Appearing before them were Iraq and Afghanistan Veterans of America's Tom Tarantino, the Military Order of the Purple Heart's William R. Hutton, the National Association of State Directors of Veterans Affairs' David Fletcher, the Non-Commissioned Officers Association's H. Gene. Overstreet, the Retired Enlisted Association's John Rowan and Wounded Warrior Project's Dawn Halfaker.
Chair Patty Murray: Let me just say as I continue to sit down with veterans across my home state, I hear many of the same things that those of you who will testify hear from your members: veterans who are concerned that they can't get access to health care including mental health care when they need it, continue to wait for months on a decision claims and are unaware of the services that are available to them. Veterans tell me about the obstacles to employment that they continue to face and many tell me that they are afraid to write the word "veteran" on their resume. Last year's passage of our VOW To Hire Heroes Act was a great first step in tackling the high rate of unemployment among our veterans but there is a lot of work left to be done.
That's from Senate Committee Chair Murray's opening statements. House Committee Chair Jeff Miller had his statement entered into the record and briefly noted the following.
Chair Jeff Miller: The one thing I do want to draw attention to is that sequestration does in fact still loom over the VA. I, too, have asked not only the Secretary [of VA Eric Shinseki] but also the President as well. I have yet to receive a response and so because of that I have filed a piece of legislation that's very simple. It's a page-and-a-half and it codifies one of the areas that is concurrent law, one of the conflicting statues that says veterans programs -- especially health programs -- are, in fact, not going to be subject to sequestration. So I look forward to one of two things, either that bill passing and becoming law or secondly getting an answer from the administration as to whether or not we are going to be impacted by that.
Chair Murray had noted that in her statement, that she's repeatedly asked for an answer on this issue. Sequestration will most likely kick in due to budget issues. If it does, it will be automatic. (Automatic cuts to federal programs to lower the budget for the Fiscal Year 2013.) Is VA effected or not? This is a question that's been asked and asked again, over and over. Murray even asked Secretary Shinseki in a February 29th hearing (see the March 1st snapshot):
Chair Patty Murray: [. . .] let me begin the questions by getting this one off the table. It's on the issue of sequestration and cuts to spending. Like I said in my opening remarks I believe that all VA programs including medical care are exempt from cuts but there is some ambiguity between the budget act and the existing law. And when I asked the acting OMB director to adress this issue in a budget hearing two weeks ago, he said OMB had yet to make a final determination. So I am concerned that by not settling this issue now, we are failing to provide our veterans with the clarity they really deserve to have. And so while you're here, I wanted to ask you: Do you believe that all VA programs -- including medical care -- are exempt from any future cuts?
Secretary Eric Shinseki: I think, Madame Chairman, the answer that the OMB director provided you was the same one that I understand. They are still addressing the issue. For my purposes, I would tell you I'm not planning on sequestration. I'mI addressing my requirements and presenting my budget as you would expect me to do. I think sequestration in part or in whole is not necessarily good policy. And I think the President would argue the best approach here is a balanced deficit reduction and that the budget he has presented does that and I would ask that the Congress look at that budget and favorably consider it.
Chair Patty Murray: I think we all hope that is the outcome but we want to provide clarity to our veterans. They are very concerned about this issue.
That was 21 days ago. Murray, Miller, Filner and Burr (among others) had been asking repeatedly for an answer prior to the above exchange. However, when the Secretary is asked in an open session, with press present, and he doesn't know the answer, you think he would get on the ball to find out. It's very basic, or should be, for Eric Shinseki: Would sequestration effect my department or not?
It's very basic and you would assume it would be one he would want immediately answered since the budget is being hammered out.
There's no excuse for this non-response and, as Miller points out, he's asked for an answer from President Barack Obama as well and received nothing. So the point is, it's gone above Shinseki's head and if the administration had wanted the Congress (and the American people) to have an answer, the White House would have already provided one. There's no excuse for this. It is a concern to many veterans -- of more than just the current wars -- as to whether or not their benefits or the health care or an education program might be cut. While supposedly wanting to "honor" veterans of the Iraq War on Monday, Barack refused to do so by answering this very basic question: If sequestration kicks in, will the VA budget be targeted with automatic cuts?
In her opening remarks, one of the topics Dawn Halfaker noted was the Caregiver-Assistance program, the Caregivers and Veterans Omnibus Health Services Act of 2010. This allows caregivers access to support services, mental health services, eduaction sessions and counseling among other things. Although passed and signed into law, the VA, for some reason, decided, "We know what the law says, but let's instead do what we want to." Dropping back to the July 12, 2011 snapshot:
As Ranking Member Michael Michaud explained, the hearing was a follow up to the March 11th hearing by the Subcommittee. On the Senate side, the Senate Veterans Affairs Committee March 2nd hearing (covered in that day's snapshot and Kat covered it in "Burr promises VA 'one hell of a fight'" and Ava covered it at Trina's site with "The VA still can't get it together"). What both Senate and House Committees learned in the two March hearings was that they had passed legislation that was very different from what the VA was implementing. Senator Patty Murray, Chair of the Senate Veterans Affairs Committee, noted, "VA's plan on the caregivers issue was overdue and once submitted it hardly resembled the bill that unanimously cleared this Congress. Three weeks ago, my Committee staff requested information on how that plan was developed and to date no information has been provided. Rather than following the law, the administration set forth some overly stringent rules, bureaucratic hurdles, that would essentially deny help to caregivers."
Schulz explained she was now rated by the VA for providing 40 hours a week of caregiving. She probably does a great deal more than that but it's not recognized. She did want it understood that when a wounded veteran returns, there's nothing so simple as 40 hours a week of care. She reviewed how, in her case, a great deal of time was taken with reorienting and dealing with confusing on the part of her son as to where he was and what was going on. There were sleep and other issues that had to be addressed including bathroom issues and the first weeks contained a great deal of work on reorientation. It's an important point but it's sad that she had to underscore it. A veteran with no apparent disabilities or challenges will need time to reorient themselves and they may require help on that. That a wounded veteran would need it should have been obvious to the VA with no caregiver having to point it out.
"I couldn't understand that," Debbie Schulz told the Subcommittee of disparities for caregivers and gave an example of "another caregiver" in Texas who cares for her son suffering from TBI with a spinal cord injury and unable to transfer himself out of his wheel chair is judged of doing only 25 hours of care a week. "How can that be right?" Schulz wondered.
Schulz is Debbie Schulz, the mother of Iraq War veteran Steven K. Schulz who was severly injured in a Falluja attack on April 19, 2005. Halfaker called for the Committees to again review VA's performance to ensure that they are indeed following the law that the Congress passed (the law that they refused to follow until the House and Senate Veterans Affairs Committee hauled them in for hearings in 2011). We'll note this exchange from today's hearing.
Chair Jeff Miller: Captain, you talked in your testimony or made reference to VA's resistance to the caregiver law if I runderstood what I read. Can you kind of expand upon it a little bit for us and let us know what your thoughts are?
Dawn Halfaker: Sure. Thank you. Yeah, I think the biggest thing that we're focused on is one of the parts of the program projected, how many cases VA is going to have to address within this caregiver population and originally it was projected to be 3500 cases and we've already reached that caseload. So I mean in terms of the ability for VA to be prepared for the amount of cases that they're going to have to deal with, we feel that they need to start looking at that and, of course, how effective is the program being? We're very interested to do another survey within our population to start looking at how well the program's being set up and really how effective it's being. So those are two of the areas that we're highly focused on. And also looking for VA to kind of comprehensively address all facets of the program.
Chair Jeff Miller: Mr. Cooper, you alluded to something that actually I think everybody talks about, even those of us on the Committee have talked about in the past in regards to how you translate what you did in your time in the service to your civilian life as you transition across. And we tried in the VOW To Hire Heroes Act to begin to stimulate if you will the states to be able to waive some of their requirements that a truck driver or a combat medic or whatever it may be. What can the VA, what do you think the VA can do to help the veteran better market themselves or market their skills?
Arthur Cooper: I think if we were to say to the VA that you need to set up programs by which the service member returning is able to sit down with a counselor or counselors and do a resume that is specific to the job that he/she is trying to apply for. You have the qualifications from having done the job but you don't have the ability to put the job on paper as a resume. If we can do something to that effect, have that training process in place, that will do a lot toward helping us as far as getting employment -- meanful employment, I'll say it that way.
Chair Jeff Miller: Anybody else want to comment? Sgt Major?
Sgt Major H. Gene Oversight: Mr. Chairman, I would comment on that. Like I said, we put on forty job fairs around the countryside throughout the year and we counsel veterans, service members, young men and women getting out of the service how to write their resume. As a matter of fact, we have a guy who we used to bring in all the time and he wrote this book Does Your Resume Wear Combat Boots? And basically, we tell people how to make those transitional words from what they do in the military to civilian terminology. So when they build their resume and they put it together, the people that's doing the hiring do understand that and, matter of fact, the people that we bring understand that they're hiring a military person, they know what they get, they know they're going to get somebody that can read and write and that sounds very simple now days but it's not so simple because they can read and write and they can similate what they read -- in other words, they understand it and they can set it to music. They also realize that they get some leadership with that because they come early, they stay late, they're clean cut. They're good at all of those sorts of things when they hire a veteran. And that's the reason that when those companies that hire veterans continue to come back to us because they understand what they did in the military and what they're getting when they bring them on, sir.
Chair Jeff Miller: John?

John Rowan: The other issue and the problem is that this is spread across the different states and they all have different laws and applications. But it would be interesting I think if the DoD people looked at training manuals and things to see that often times they're just missing a little something extra that would give them the certification they need for that particular job. It's not really analogous but I was a linguist in the military and when I went back to college they gave me some credit for my college but told me I didn't take any reading courses so I couldn't get credit for the whole language. I mean, it was just something as simple as that. Now that's a bizarre thing but I'm sure that in some of the medics and things, there's probably just something not quite right that would equate to the equivalent of an education in the private sector and they need to figure that out and add it in.
Chair Jeff Miller: It's interesting that you would bring up the item of not taking reading courses. I visited a college that shall remain unnamed and was talking with them about the VOW To Hire Heroes Act and saying, "How in the world can a person who has been in a field hospital, doing all of the things that they do, day in and day out, not transfer those skills into a nursing program or something along those lines?" And the first response? "Well they haven't had the humanities, they haven't had the English" -- and I'm like, "We have got to change the culture out there to help put these folks to work." And, as the Sgt Major said, we have people who know what it's like to get up early, work late, do it when they don't want to do it, do it with a smile on their face and you don't find that a lot of times out in the civilian workforce and we've got to find a way to expand that if we can.
What they need to do is for DoD to offer classes -- along with medic training, I'm sorry but I don't find, for example US history to be a joke or something to laugh at. LVNs getting a BSN from a university (as opposed to a diploma mill) are required to have certain courses and US history and US government are part of those requirements. DoD should be training in those areas and they should be offering humanities courses (one is generally needed in most LVN-BSN programs). The point of education is to make you a well rounded citizen. Is that not a goal the military has for veterans? They can easily put together courses -- courses which could utilize the training and the mission within the course work. This should be done for every service member. The military owes it to them. In most cases, there is a degree of training that already qualifies it's just not structured so that a college will recognize it. This is a DoD issue that needs to be addressed immediately.
Due to floor votes starting on the Senate floor, the Senate members had to leave the hearing after the witnesses delivered their opening remarks. We'll note the following exchange.
Ranking Member Michael Michaud: You'd mentioned the stateveterans nursing home and the great job that they do. I really appreciate Mr. Miller's efforts on addressing the issue on reimbursment rates which is extremely important for a lot of veterans around the country -- each one a little differently. My question is -- because we addressed it back in October, the Senate hasn't dealt with the legislation as of yet -- what effect is it having for veterans who are 70% or higher in their disabilies throughout some of the nursing homes around the country?
David Fletcher: In cases where we have a large number of -- 70% or higher of veterans in a home, uhm, the cost -- the reimbursement does not give the homes what they -- it doesn't pay for the full cost of care. So the homes actually have to come up with the difference or the veteran. And then the veteran obviously suffers from that. I believe in the case especially of a few of the states and in one state in particular, it happened to be Maine, there's a large number of veterans there and the more veterans that you have that are 70% and above that are -- [handed a piece of paper] And of course, the comment I just got is that homes are turning veterans away because they can't match their cost of care.
Ranking Member Michael Michaud: Thank you and that was the concern that I have. I know from Maine, you mentioned Maine, Maine veterans nursing homes are going to lose anywhere from $8 to 16 million a year and they can't take that sustainable loss. I was kind of curious on other states and thank you for that answer. My next question is for Mr. Tarantino, you talked about education for soldiers coming back from Iraq and Afghanistan. And have you found problems there in different states as far as higher ed being willing to take into consideration the experience that a soldier might have had whether it's a medic or working on heavy equipment, whereas the higher ed might at ground zero and work up? Have you found that to be a problem or is it, have most higher eds been taking that into consideration?
Tom Tarantino: Thank you, Congressman, this is -- this is actually a problem over all. And this was largely what the VOW To Hire Heroes Act, one of the provisions, was meant to address. It's less that schools aren't using a veteran's military experience and crediting them for that, it's that professional licenses and certifications that are required to do a lot of vocational jobs -- medics, mechanics, truck drivers -- don't recognize military training experience. There have been a lot of sort of efforts where -- I know ACE has a great way to -- the American Counseling Education, forgive me -- has a great way to translate your military experience into college credit. But we've never done the math on what a military vocation and a civilian vocation is -- largely because we've never had a generation of business leaders that hadn't served in the military before. This is the first generation where you just don't have very many people who are running the business sector having military experience. And so now this is one of the things that Congress said last year we're going to need to ramp up quickly is to do the math on the gaps and overlaps between military jobs and vocations and their civilian equivalents so that we can actually have something that the professional sector can say, 'This is what we have, this is what we need.' And the higher ed sector can follow up with adapting their training to what they need.
Ranking Member Michael Michaud: My last question, probably quick yes or no answer since I'm running out of time, is the House, little over a month ago, passed legislation that sets up a Brack type process dealing with federal buildings and if you look at the VA facility, they already have a process within the VA facility and a utilization rate of VA facilities actually have increased dramatically. Unfortunately, VA is covered under this legislation that's over here on this Senate side that once it's in that Brach type process they get rid of the VA facility that money doesn't go back to the VA facility and we have a problem as it is with construction within the VA area. Has your organization looked at that legislation and do you support it or oppose it? Quick yes-or-no answer starting with Mr. Tarantino?
Tom Tarantino: We have looked at it. It hasn't been a priority but we do definitely support that concept. And are looking forward to seeing a lot of stuff passed by the Senate that's come out of the House.
Now we'll note another Congressional hearing. I was not at this hearing. Wally was and was ready to do a brief synopsis for this snapshot but we've got a press release from Senator Patty Murray's office that we can use instead (and spare Wally the trouble -- thank you, Wally):
Murray Presses Army Secretary on Handling of the Mental Wounds of War
At Hearing of Defense Appropriations Subcommittee, Veterans Chairman Murray pressed Army Secretary John McHugh on troubled PTSD unit at Joint Base Lewis-McChord and whether similar problems exist at other bases
(Washington, D.C.) -- Today, U.S. Senator Patty Murray (D-WA), Chairman of the Senate Veterans' Affairs Committee and a senior member of the Defense Appropriations Subcommittee, questioned Army Secretary John McHugh on recent shortcomings in the Army's efforts to properly diagnose and treat the invisible wounds of war. Specifically, Murray discussed the forensic psychiatry unit at Madigan Army Medical Center on Joint Base Lewis-McChord that is under investigation for changing mental health diagnoses based on the cost of providing care and benefits to servicemembers. The Army is currently reevaluating nearly 300 service members and veterans who have had their PTSD diagnoses changed by that unit since 2007.
Key excerpt of Sen. Murray's remarks:
"Secretary McHugh, as you and I have discussed, Joint Base Lewis McChord in my home state is facing some very real questions on the way they have diagnosed PTSD and the invisible wounds of war. And today, unfortunately, we are seeing more information on the extent of those problems.
"Mr. Secretary, this is a copy of today's Seattle Times. In it is an article based on the most recent review of the Forensice Psychiatry Department at JBLM which -- as you know -- is under investigation for taking the cost of mental health care into account in their decisions.

"And what it shows is that since that unit was stood up in 2007 over 40% of those service members who walked int he door with a PTSD diagnosis had their diagnosis changed to something else or overturned entirely.
"What is says is that over 4 in 10 of our service members -- many who were already being treated for PTSD -- and were due the benefits and care that comes with that diagnoses -- had it taken away by this unit. And that they were then sent back into the force or the local community.
"Now, in light of all the tragedies we have seen that stem from the untreated, invisible wounds of war -- I'm sure that you would agree that this is very concerning.
"Not only is it damaging for these soldiers, but it also furthers the stigma for others that are deciding whether to seek help for behavioral problems."

Meghan Roh

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The Seattle Times article referred to above is Hal Bernton's "40% of PTSD diagnoses at Madigan were reversed."

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