Thursday, May 24, 2012

That hard working Barry






Chair Patty Murray:  Almost a year ago today, this Committee held a hearing on VA and DoD efforts to improve transition.  We explored a number of issues including the Integrated Disability Evaluation System. At the hearing, we had an opportunity to hear from both departments about the state of the joint program.  The Departments' testimony that day spoke to how the Departments had created a more transparent and consistent  and expeditious disability evaluation process.  There testimony also states that IDES is a fair, faster process. Well now that the joint system has been implemented nationwide, I have to say that I am far from convinced the Departments have implemented a disability evaluation process that is truly transparent, consistent or expeditious.  There are now over 27,000 service members involved in the disability evaluation system.  As more and more men and women return from Afghanistan and as the military downsizes, we're going to continue to see an even larger group of service members transition from the military through the disability evaluation process.  This process impacts every aspect of a service member's life while they transition out of the military.  But it doesn't stop there.  If the system doesn't work right, it can also negatively affect a service member and their family well after they have left active duty.
This morning the Senate Veterans Affairs Committee held a hearing entitled "Seamless Transition: Review of the Integrated Disability Evaluation System." Senator Patty Murray is the Chair of the Committee, Senator Richard Burr is the Ranking Member.  There was one panel of witnesses: DoD's Dr. Jo Ann Rooney, GAO's Daniel Bertoni and the VA's John Gingrich.  The hearing was prompted by, among other things, the Interim Committee Staff Report: Investigation of Joint Disability Evaluation System
Research for the report resulted in many discoveries including basic errors not being caught such as, "A servicemember with a lung condition who was being treated with steroids and immunosuppressive drugs was incorrectly rated at 0% rather than 100%."  The report found many problems regarding the VA recognizing TBI (Traumatic Brain Injury):
Some VA medical examinations involving TBI failed to address findings on detailed neuropsychological testing conducted during service.  TBI facets such as memory are reported as "normal" based on "general conversation" without repeating or referencing prior tests, which identified the type and severity of the servicemember's TBI deficits.   In a number of cases, TBI and PTSD conditions were rated together when the evidence suggested that some of the TBI conditions should have been considered separately.  For example:   
• Testing that would help to differentiate between TBI and mental health conditions was not  conducted despite indications of deficits, such as visual-spatial orientation and memory loss due to organic injuries (such as trauma to a specific part of the brain associated with certain deficits). 
• VA claims for TBI residuals were denied or received a lower rating based on the absence of objective testing.  If testing had been conducted, objective evidence of TBI for symptoms complained of by the servicemember, might have changed the result.
• Conclusions by VA examiners were inconsistent with the medical evidence, such as an examination for TBI which found no TBI to support a diagnosis of post-traumatic headaches, but indicated that the same veteran's dizziness following an IED blast injury was due to his TBI.
• A servicemember diagnosed with anxiety disorder prior to separation was erroneously denied service-connection for PTSD when the disability had been diagnosed as anxiety disorder due to combat.
Chair Murray noted the case of Sgt 1st Class Stephen Davis who is a veteran of both the Iraq War and the Afghanistan War and was receiving treatment for Post Traumatic Stress for about a year before he was accused of "making up his ailments" and he was part of a group at Joint Base Lewis-McChord: "All of these men and women had been diagnosed with, and in many cases were receiving treatment for, PTSD during service.  But then, during the disability evaluation process they were told that they were exaggerating their symptoms, they were labeled as malingerers and their behavioral health diagnoses were changed. "  She noted that a re-evaluation process  of examining 196 service members who were diagnosed with PTSD and then told they did not have it.  The re-evaluation process has already found that, yes, 108 of those service members do have PTSD (as originally diagnosed). 
Chair Patty Murray: Dr. Rooney, let me start with you.  We have had in the past regarding this joint disability rating system and the number of challenges service members faced while they were going through this process.  Recently, it has come to my attention that some of our service members involved with the disability evaluation process are facing retribution and unsupportive behavior from their chains of command while on limited duty and waiting for a disability decision.  I've heard from service members who were forced to participate in activities in direct violation of doctors' orders, who've been disciplined while struggling with behavioral health conditions and who have struggled to get access to care because their leadership would not cooperate with their treatment requirements.  I think you agree with me, that is completely unacceptable.  Whether in a warrior transition unit or not, leaders have to understand these medical issues and the difficult process that these service members are going through and they have to provide the leadership and support that these men and women need. So I'm going to begin with you by asking you, Dr. Rooney, what needs to be done to provide supportive and compassionate leadership for these injured service members that are forced to wait for a disability decision.
Dr. Jo Ann Rooney: Clearly the information you just shared is troubling on many levels and I would be very interested in speaking with you or your staff so that we can actually determine where those issues are occurring and make sure that, in fact, the leadership does know -- which is the department's decision and the leadership that I'm familiar with -- that that cannot be tolerated, that we must understand what is necessary for the care, that there are no stigmas with being able to address behavioral health or mental health issues and that really is the department's position.  So in those cases, if there are those substantive issues that you mentioned, not only do we need to find out where those are so we can work directly with that leadership and correct that situation, but we will continue with our ongoing work at all levels of command -- not just at the senior level of the department.  But we understand that it needs to go right through the command level of every installation to ensure, in fact, that the situations you described are not occurring.
Chair Patty Murray: Well we need to make sure that's happening because, as we all know, these are very challenging situations for these soldiers and any kind of retribution shouldn't be tolerated whether it's one case or many.  But I will share those with you but I want to make sure that system wide, that leaders throughout the chain of command all the way to the bottom are clearly understanding what these soldiers are going through and are not having any kind of repercussions on those individuals.
Dr. Jo Ann Rooney:  Absolutely.
Chair Patty Murray: Mr. Gingrich, from the perspective of someone who has served in many leadership positions within the military, what can we do to educate our military leaders on not only this process but really on the  medical issues facing so many of these young men and women?
John Gingrich: Madam Chairman, I see a lot of things that the Army's doing and I know that because I've been in their VCTs.  They started, as we're told by GAO, they're now bringing in in layers all the way up to the Vice Chief of Staff so they've involved current level discussion groups -- Brigadier General, Major General, all the way up and they included VA in every one of those discussion groups.  So I think getting the information is the biggest key that we've got and the biggest challenge that we have.  The Secretary right now, yesterday, spoke to the Sergeant Major Academy in the Army and the Sergeant Majors are now understanding that this is a problem that we have to take on as two departments and not just one. And I think that education is happening.
Chair Patty Murray: Well we still have a lot of work to do --
John Gingrich: Yes, sir -- Yes, ma'am, we do.
Chair Patty Murray:  Okay.  Dr. Rooney, there is no doubt that the events at Madigan have shaken the trust and confidence of service members who are in the Disability Evaluation System. I believe that transparency and sharing information about the ongoing re-evaluations that are happening today and actions the Army and DoD are taking to remedy this situation will go along ways towards restoring some trust in this system. I wanted to ask you today what we have learned from the investigations that the army is conducting into the forensic science unit at Madigan?
Dr. Jo Ann Rooney:  Well as you pointed out earlier, there have been 196 re-evaluations completed to date.  Of which, 108 of those have been diagnosed as having PTSD where before they had not.  We also --
Chair Patty Murray: Let me just say that they had been diagnosed with PTSD.  When they went through the evaluation system they were told they did not.  Now going back and re-evaluating them once they've gone out, we're saying, "Yes, you did --
Dr. Jo Ann Rooney: Yes.
Chair Patty Murray:  --  indeed have PTSD."
Dr. Jo Ann Rooney:  Correct.  108 of those 196.
Chair Patty Murray: More than half.
Dr. Jo Ann Rooney:  Correct. There are 419 that have been determined to be eligible for re-evaluation.  287 from the original  group that was looked at and as you know the Army actually opened the aperture up to see anybody else who would have gone through the process while forensic psychiatrists were being used.  So that was 419 totally eligible for re-evaluation. And at this point, there are three in progress and twelve being scheduled.  So what we have learned from that is clearly that the process that was put into place at that time did not function as originally designed.  Evidence did not show that there was a mean spirited attempt but really to create similar diagnoses.  Obviously, that was not something that occurred.  So the Army has taken the lessons from here and it's actually going back to 2001 to re-evaluate all of the cases where we might have a similar situation.  What we're doing from that point is not only learning from what Army is doing and looking at these re-evaluations where we're using the new standards in many ways advances in the medical and behavioral health areas to better diagnose PTSD but also then we'll be taking those lessons learned across the other services as well. So since Army has the greatest majority of people going through -- currently about 68% of the people in the Disability Evaluation Process are from Army -- we will take the lessons learned from there and apply those across to all the services.
Chair Patty Murray: Well I really appreciate the Army's announcement that they are now going to do a comprehensive review of PTSD and behavioral health systemwide throughout the Army.  I believe that is a first and important major step for the Army to be doing.  But I did want to ask you, Dr. Rooney, I have been told by Secretary [of the Army] McHugh about the issues we were seeing at Madigan were not systemwide.  And then the Secretary announced a comprehensive review across all systems.  So if we didn't believe this was a system wide problem, what led the Army to look into a system wide review?
Dr. Jo Ann Rooney:  Secretary McHugh and I have had numerous conversations and I believe the use of the forensic psychiatrists was primarily isolated to Madigan and that's where I believe that comment of it wasn't system wide because that type of additional process --
Chair Patty Murray:  So the forensic system wasn't system wide.  But system wide, we have issues with people who are not being diagnosed correctly?
Dr. Jo Ann Rooney:  What we want to do is look across the system and ensure that if we do have issues we identify those and we're able to get those individuals back into the system.  So I believe at this point, it was very much a forward leaning approach to say  we need to look across the system, not that we're convinced similar problems existed, but that it's the right thing to do for the individuals since, as you pointed out, we saw a number of these re-evaluations ended up with diagnoses changed.  So it's the right thing to do for people to look across.
Chair Patty Murray:  Okay and I think it's extremely important that we find anybody who was misdiagnosed and get them care.  So we'll be continuing to focus on this.
Later during Senator Jon Tester's questioning, Dr. Jo Ann Rooney would insist to him that most of the changed diagnoses "were before 2008"  and Chair Murray would have to step and offer, "Let me just clarify a large number of the ones who were misdiagnosed or had their diagnoses changed inaccurately were after the 2008 -- after the forensic psychology system was put in place."
Ava will cover Tester at Trina's site tonight, as always Kat will grab Ranking Member Richard Burr as the topic for her site and Wally will offer some thoughts on the financial at Rebecca's site.
Still on the subject of the US Senate, we'll note this from Senator Ron Wyden's office:
Wednesday, May 23, 2012
Washington, D.C. – In a letter to Secretary of Defense Leon Panetta, U.S. Senator Ron Wyden (D-Ore.) called on the DoD to investigate the excessive expenses racked up by the legal team of Kellogg, Brown and Root (KBR) – a defense contractor that operated in Iraq with the contractual ability to pass all of their legal costs to American taxpayers. A lawsuit against KBR brought by a group of Oregon National Guard members assigned to provide security for KBR personnel claims that KBR management knew that the soldiers were being exposed to toxic chemicals while working at the Qarmat Ali water treatment plant.
A newly declassified indemnification provision in the KBR contract with the U.S. military releases the contractors from all financial liability for misconduct and allows KBR to pass the on all of their legal costs to the U.S. government. Recent investigations into the conduct of KBR's legal team have uncovered excessive legal costs including senior attorneys billing at $750 per hour, taking numerous international and domestic first class flights and paying one expert more than $500,000 for testimony and consultation who has admitted to billing KBR for time spent sleeping.
"Essentially, KBR was handed a blank check with the Pentagon's signature, and it seems clear to me that they intend to run up the bill as much as possible before cashing that check," Wyden wrote in the letter. "What has DoD done to ensure that KBR is not taking advantage of taxpayers?  Has DoD done a detailed audit of KBR's legal expenses so far?  Has anyone at DoD checked to see if the legal expenses are excessive?  Has any kind of cost-benefit been done to determine if it would be cheaper to direct KBR to settle the lawsuit?"
Kellogg, Brown and Root were contracted in 2003 to perform clean-up work at the Qarmat Ali water treatment facility in Iraq. Members of the Oregon National Guard were assigned to provide security for the KBR contractors and were exposed to dangerous levels of toxic chemicals including sodium dichromate, a carcinogen that contains hexavalent chromium – one of the most dangerous chemicals on Earth.  A group of exposed soldiers have brought a lawsuit against KBR based on evidence indicating that KBR managers "were aware of the presence of dangerous chemicals, but failed to warn the soldiers working in and around the plant," Wyden wrote in the letter.
Under KBR's contract, the government has the ability to direct KBR's legal defense and require the company to settle with Oregon Guard Members. 

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