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+
+ - WOUNDED ARMY GUARD AND RESERVE FORCES: INCREASING THE CAPACITY TO CARE
+
+[House Hearing, 109 Congress]
+[From the U.S. Government Publishing Office]
+
+
+
+
+
+ WOUNDED ARMY GUARD AND RESERVE FORCES: INCREASING THE CAPACITY TO CARE
+
+=======================================================================
+
+ HEARING
+
+ before the
+
+ COMMITTEE ON
+ GOVERNMENT REFORM
+
+ HOUSE OF REPRESENTATIVES
+
+ ONE HUNDRED NINTH CONGRESS
+
+ FIRST SESSION
+
+ __________
+
+ FEBRUARY 17, 2005
+
+ __________
+
+ Serial No. 109-4
+
+ __________
+
+ Printed for the use of the Committee on Government Reform
+
+
+ Available via the World Wide Web: http://www.gpo.gov/congress/house
+ http://www.house.gov/reform
+
+
+ ______
+
+ U.S. GOVERNMENT PRINTING OFFICE
+20-085 WASHINGTON : 2005
+_____________________________________________________________________________
+For Sale by the Superintendent of Documents, U.S. Government Printing Office
+Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800
+Fax: (202) 512�092250 Mail: Stop SSOP, Washington, DC 20402�090001
+
+ COMMITTEE ON GOVERNMENT REFORM
+
+ TOM DAVIS, Virginia, Chairman
+CHRISTOPHER SHAYS, Connecticut HENRY A. WAXMAN, California
+DAN BURTON, Indiana TOM LANTOS, California
+ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
+JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
+JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania
+GIL GUTKNECHT, Minnesota CAROLYN B. MALONEY, New York
+MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
+STEVEN C. LaTOURETTE, Ohio DENNIS J. KUCINICH, Ohio
+TODD RUSSELL PLATTS, Pennsylvania DANNY K. DAVIS, Illinois
+CHRIS CANNON, Utah WM. LACY CLAY, Missouri
+JOHN J. DUNCAN, Jr., Tennessee DIANE E. WATSON, California
+CANDICE S. MILLER, Michigan STEPHEN F. LYNCH, Massachusetts
+MICHAEL R. TURNER, Ohio CHRIS VAN HOLLEN, Maryland
+DARRELL E. ISSA, California LINDA T. SANCHEZ, California
+GINNY BROWN-WAITE, Florida C.A. DUTCH RUPPERSBERGER, Maryland
+JON C. PORTER, Nevada BRIAN HIGGINS, New York
+KENNY MARCHANT, Texas ELEANOR HOLMES NORTON, District of
+LYNN A. WESTMORELAND, Georgia Columbia
+PATRICK T. McHENRY, North Carolina ------
+CHARLES W. DENT, Pennsylvania BERNARD SANDERS, Vermont
+VIRGINIA FOXX, North Carolina (Independent)
+------ ------
+
+ Melissa Wojciak, Staff Director
+ David Marin, Deputy Staff Director/Communications Director
+ Rob Borden, Parliamentarian
+ Teresa Austin, Chief Clerk
+ Phil Barnett, Minority Chief of Staff/Chief Counsel
+
+
+ C O N T E N T S
+
+ ----------
+ Page
+Hearing held on February 17, 2005................................ 1
+Statement of:
+ Embrey, Ellen, Deputy Assistant Secretary of Defense for
+ Employment Health, Department of Defense; Daniel Denning,
+ Acting Assistant Secretary of the Army, Manpower and
+ Reserve Affairs, accompanied by Lieutenant General Roger
+ Schultz, Director, Army National Guard; Lieutenant General
+ Franklin L. Hagenbeck, Deputy Chief of Staff, G-1, U.S.
+ Army; Lieutenant General Kevin C. Kiley, M.D., U.S. Army
+ Surgeon General; Major General Charles Wilson, Deputy
+ Commander, U.S. Army Reserve Command; and Philip E.
+ Sakowitz, Jr., Deputy Director, U.S. Army Installations
+ Management Agency.......................................... 144
+ Denning, Daniel.......................................... 160
+ Embrey, Ellen............................................ 144
+ Hagenbeck, Lieutenant General Franklin L................. 169
+ Kiley, Lieutenant General Kevin C., M.D.................. 181
+ Sakowitz, Philip E., Jr.................................. 194
+ Wilson, Major General Charles............................ 187
+ Kutz, Gregory D., Director, Financial Management and
+ Assurance, U.S. Government Accountability Office; Brigadier
+ General Raymond C. Byrne, Jr., Acting State Adjutant
+ General, State of Oregon, accompanied by Colonel Doug
+ Eliason, M.D.; Sergeant First Class John Allen, B/3/20th
+ Special Forces Group, North Carolina National Guard;
+ Sergeant Joseph Perez, 72nd Military Police Co., Nevada
+ National Guard; Chief Warrant Officer Rodger L.
+ Shuttleworth, Chief, Reserve Component Personnel Support
+ Services Branch, Army Human Resources Command, Maryland
+ National Guardsman, accompanied by Chief Warrant Officer
+ Laura Lindle; and Master Sergeant Daniel Forney, Reserve
+ Component liaison, Medical Hold, Walter Reed Medical
+ Center, U.S. Army Reservist, Pennsylvania.................. 35
+ Allen, Sergeant First Class John......................... 73
+ Byrne, Brigadier General Raymond C., Jr.................. 54
+ Forney, Master Sergeant Daniel........................... 123
+ Kutz, Gregory D.......................................... 35
+ Perez, Sergeant Joseph................................... 98
+ Shuttleworth, Chief Warrant Officer Rodger L............. 112
+Letters, statements, etc., submitted for the record by:
+ Allen, Sergeant First Class John, B/3/20th Special Forces
+ Group, North Carolina National Guard, prepared statement of 79
+ Byrne, Brigadier General Raymond C., Jr., Acting State
+ Adjutant General, State of Oregon, prepared statement of... 56
+ Cummings, Hon. Elijah E., a Representative in Congress from
+ the State of Maryland, prepared statement of............... 25
+ Davis, Chairman Tom, a Representative in Congress from the
+ State of Virginia, prepared statement of................... 4
+ Denning, Daniel, Acting Assistant Secretary of the Army,
+ Manpower and Reserve Affairs, prepared statement of........ 162
+ Embrey, Ellen, Deputy Assistant Secretary of Defense for
+ Employment Health, Department of Defense, prepared
+ statement of............................................... 146
+ Forney, Master Sergeant Daniel, Reserve Component liaison,
+ Medical Hold, Walter Reed Medical Center, U.S. Army
+ Reservist, Pennsylvania, prepared statement of............. 125
+ Hagenbeck, Lieutenant General Franklin L., Deputy Chief of
+ Staff, G-1, U.S. Army, prepared statement of............... 171
+ Higgins, Hon. Brian, a Representative in Congress from the
+ State of New York, prepared statement of................... 218
+ Kiley, Lieutenant General Kevin C., M.D., U.S. Army Surgeon
+ General, prepared statement of............................. 182
+ Kutz, Gregory D., Director, Financial Management and
+ Assurance, U.S. Government Accountability Office, prepared
+ statement of............................................... 37
+ Miller, Hon. Candice S., a Representative in Congress from
+ the State of Michigan, prepared statement of............... 216
+ Perez, Sergeant Joseph, 72nd Military Police Co., Nevada
+ National Guard, prepared statement of...................... 104
+ Ruppersberger, Hon. C.A. Dutch, a Representative in Congress
+ from the State of Maryland, prepared statement of.......... 31
+ Sakowitz, Philip E., Jr., Deputy Director, U.S. Army
+ Installations Management Agency, prepared statement of..... 196
+ Shuttleworth, Chief Warrant Officer Rodger L., Chief, Reserve
+ Component Personnel Support Services Branch, Army Human
+ Resources Command, Maryland National Guardsman, prepared
+ statement of............................................... 116
+ Waxman, Hon. Henry A., a Representative in Congress from the
+ State of California:
+ Minority report.......................................... 10
+ Prepared statement of.................................... 19
+ Wilson, Major General Charles, Deputy Commander, U.S. Army
+ Reserve Command, prepared statement of..................... 188
+
+
+ WOUNDED ARMY GUARD AND RESERVE FORCES: INCREASING THE CAPACITY TO CARE
+
+ ----------
+
+
+ THURSDAY, FEBRUARY 17, 2005
+
+ House of Representatives,
+ Committee on Government Reform,
+ Washington, DC.
+ The committee met, pursuant to notice, at 10:10 a.m., in
+room 2154, Rayburn House Office Building, Hon. Tom Davis
+(chairman of the committee) presiding.
+ Present: Representatives Tom Davis of Virginia, Shays,
+Gutknecht, Miller, Porter, Marchant, McHenry, Dent, Foxx,
+Waxman, Cummings, Davis of Illinois, Clay, Watson, Lynch, Van
+Hollen, Ruppersberger, Higgins, and Norton.
+ Staff present: Jennifer Safavian, chief counsel for
+oversight and investigations; Rob White, press secretary; Drew
+Crockett, deputy director of communications; Grace Washbourne
+and Brien Beattie, professional staff members; Teresa Austin,
+chief clerk; Sarah D'Orsie, deputy clerk; Kristina Sherry,
+legislative correspondent; Roody Cole, GAO detailee; Phil
+Barnett, minority staff director; Andrew Su, minority
+professional staff member; Earley Green, minority chief clerk;
+and Jean Gosa, minority assistant clerk.
+ Chairman Tom Davis. Good morning. A quorum being present,
+the committee will come to order.
+ I want to welcome everybody to today's hearings on the
+effectiveness and efficiency of Army medical administrative
+processes that affect the care of injured Army Guard and
+Reserve forces.
+ This hearing is the third in our continuing investigation
+into the Department of Defense's administrative and management
+challenges created by the largest mobilization of Reserve
+Component soldiers since World War II.
+ For the last year, along with the Government Accountability
+Office, our committee has been investigating the plight of
+injured Army Guard and Reserve soldiers seeking quality care,
+standardized medical and personnel assistance, and
+comprehensive service. We are here today to ask some basic but
+troubling questions.
+ How is it that so many injured and Reserve soldiers have
+been inappropriately removed from active duty status in the
+automated systems that control pay and access to medical care?
+ Why do soldiers languish for weeks or months in medical
+holding companies, not because of medical care but because of
+lags in efficient administrative processing?
+ Why do we all continue to hear from our Reserve Component
+constituents and their families still struggling under the
+convoluted current system?
+ Today the GAO will issue a report on their examination of
+two Army processes: active duty medical extensions [ADMEs], and
+medical retention processing [MRPs]. The committee, looking
+into the Medical Evaluation Board and Physical Evaluation Board
+processes, has reached similar findings that are, quite
+frankly, stunning in scope.
+ Current Army guidance for processing injured Guard and
+Reserve does not clearly define organizational responsibilities
+or performance standards. The Army has not adequately educated
+Reserve Component soldiers about Army medical and personnel
+processing or adequately trained Army personnel responsible for
+helping soldiers.
+ The Army lacks an integrated medical and personnel system
+to provide visibility over injured or ill Reserve Component
+soldiers, and as a result sometimes actually loses track of
+these soldiers and where they are in the process.
+ Last, and certainly not least, the Army lacks
+compassionate, customer friendly service. Frankly, I am
+appalled that these men and women not only have had to face the
+recovery from their war wounds, but are simultaneously forced
+to navigate a confusing and seemingly uncaring system of
+benefits.
+ What are the effects of these inadequacies? We will listen
+today to the individual experiences of two Guardsmen whose
+stories will be hard for us to hear. Sergeant John Allen of the
+North Carolina National Guard and Sergeant Joseph Perez of the
+Nevada National Guard will illustrate the price of an Army
+unprepared to handle their needs.
+ General Raymond Byrne, the State Adjutant General of
+Oregon, is also here on behalf of his injured and ill
+Guardsmen.
+ We are also pleased to have with us today two individuals
+who are on the front lines of caring for Reserve Component
+soldiers and who will explain the difficulties executing Army
+regulations and policies. An officer from U.S. Human Resource
+Command will relate the Army's growing pains as it attempts to
+improve its level of administrative service and care. One will
+tell about his experience as a Reserve liaison at Walter Reed
+Medical Center and the challenges he still faces as he tries to
+help injured Reserve soldiers. Both soldiers have been at their
+posts since the first return of injured Guard and Reserve
+soldiers from Operation Enduring Freedom, and both will
+describe urgent needs that are still unmet.
+ Certainly, the unprecedented number of Army Guard and
+Reserves mobilized in the war on terrorism has severely taxed
+the Army and its resources. We understand the pressures they
+are under. To their credit, Army leadership has accepted these
+challenges and has come a long way this past year in trying to
+repair some of the problems we are addressing today.
+ From our distinguished second panel we will hear of new
+management initiatives, increased personnel, enhanced training,
+and a new interconnectivity between medical and personnel
+tracking systems. We will hear of the hopes for vast
+improvement in Reserve Component administration and service
+under the community-based health care initiative. We hope to
+hear of a continued commitment to other major changes that
+address weaknesses that are still at hand.
+ Today when we ask who in the Army or the Department of
+Defense is ultimately responsible for the oversight of injured
+Army Guard and Reserve soldiers and the commands and agencies
+providing them care and service, I hope to get a clear answer.
+But the truth is we are all accountable to the men and the
+women who have been injured defending this country. I am sure
+we will listen closely to each witness this morning to better
+understand what we can do to assist in any way possible,
+including legislation, resources, and ongoing oversight.
+ We all look forward to the day when each and every injured
+Army Guard and Reserve soldier receives the care that they have
+earned and that they deserve. This distressing period where we
+have witnessed the equivalent of financial and medical friendly
+fire must end.
+ [The prepared statement of Chairman Tom Davis follows:]
+
+
+ [GRAPHIC] [TIFF OMITTED] T0085.001
+
+ [GRAPHIC] [TIFF OMITTED] T0085.002
+
+ [GRAPHIC] [TIFF OMITTED] T0085.003
+
+ [GRAPHIC] [TIFF OMITTED] T0085.004
+
+ [GRAPHIC] [TIFF OMITTED] T0085.005
+
+ Chairman Tom Davis. I now yield to our ranking member, Mr.
+Waxman, for his opening statement.
+ Mr. Waxman. Thank you very much, Mr. Chairman.
+ I want to thank you for holding this hearing. This is an
+important hearing, and I especially want to thank our witnesses
+who have come today.
+ What we are going to hear about and what this committee
+will shine a light on is the egregious mistreatment--it is
+inexcusable--that wounded National Guard and Army Reserve
+soldiers face. I want to mention the fact that the soldiers and
+their families who are here with us today deserve praise for
+their bravery, and especially for speaking out on behalf of
+their fellow soldiers. I thank you for being here.
+ Today we are going to hear about the inadequate care that
+wounded National Guard and Army Reserve receive. Tens of
+thousands of these Reservists have been called to duty with
+little notice. They have left their jobs, they have left their
+homes, they have served honorably far away from their family
+and loved ones, and, unfortunately for many Army Guard and Army
+Reserve soldiers wounded in action, the real battle begins when
+they arrive home.
+ Let me be blunt. The way the administration is treating
+wounded soldiers and veterans is a disgrace. As my staff has
+found in a series of reports, veterans across the country are
+routinely forced to wait months just to schedule a medical
+appointment. And when a veteran is severely injured, he or she
+has to wait months without any income before the Veterans
+Administration will process his or her disability claim.
+ While we looked into the complaints that my office was
+receiving, we found that there were 10,000 veterans in Los
+Angeles, alone, waiting to have their disability claims
+processed last year. This was a huge increase from just the
+year before.
+ And the problems are only going to get worse. The number of
+veterans who will need medical care will increase 5 percent
+next year, but the President's latest budget actually proposes
+a decrease in real funding for VA health care. To make up the
+difference, the President proposes large increases in
+copayments and deductibles that will force hundreds of
+thousands of veterans to lose their VA health care.
+ Over the last year, I have released several reports
+documenting these problems. I would like, Mr. Chairman, to have
+the report made part of the hearing record.
+ Chairman Tom Davis. Without objection, the report will be
+put in the record.
+ [The information referred to follows:]
+
+ [GRAPHIC] [TIFF OMITTED] T0085.006
+
+ [GRAPHIC] [TIFF OMITTED] T0085.007
+
+ [GRAPHIC] [TIFF OMITTED] T0085.008
+
+ [GRAPHIC] [TIFF OMITTED] T0085.009
+
+ [GRAPHIC] [TIFF OMITTED] T0085.010
+
+ [GRAPHIC] [TIFF OMITTED] T0085.011
+
+ [GRAPHIC] [TIFF OMITTED] T0085.012
+
+ [GRAPHIC] [TIFF OMITTED] T0085.013
+
+ Mr. Waxman. Today we are going to learn about the plight
+that wounded National Guard and Army Reserve soldiers face when
+they return home. Wounded regular duty troops are sent to
+medical facilities at their home bases when they leave Iraq or
+Afghanistan, but many wounded National Guard soldiers are
+placed in what is called medical hold status. As we will learn,
+these soldiers are sent to shoddy, dilapidated bunkers far from
+their home bases where they face long delays to receive medical
+appointments and treatment, and they confront a labyrinth of
+forms to fill out and offices to visit just to receive the care
+and benefits due them.
+ These soldiers have risked their lives for us, and they are
+returning home with severe and sometimes incapacitating
+injuries, yet the administration continues to neglect their
+health care and delay their benefits.
+ Mr. Chairman, I hope this hearing will be a step toward
+doing right by our veterans. Guardsmen and Reserve soldiers
+will be sorely needed for the foreseeable future. Let's give
+them the respect and care that they all so rightly deserve.
+ [The prepared statement of Hon. Henry A. Waxman follows:]
+
+ [GRAPHIC] [TIFF OMITTED] T0085.014
+
+ [GRAPHIC] [TIFF OMITTED] T0085.015
+
+ [GRAPHIC] [TIFF OMITTED] T0085.157
+
+ Chairman Tom Davis. Mr. Waxman, thank you very much.
+ Are there any other Members who wish to make statements?
+The gentleman from Nevada, Mr. Porter.
+ Mr. Porter. Thank you, Mr. Chairman. I appreciate your
+taking the time to hold this hearing today. I would also like
+to thank our witnesses for coming here to testify. Sergeant
+Perez is here today, a constituent of mine, from Logandale, NV.
+I would like to especially thank him and his wife Elena for
+traveling this long way to be with us today.
+ Our country is at war in a war against terrorism.
+Throughout this war, thousands of our brave men and women have
+volunteered to wear military uniforms and fight for the
+freedoms that many of us take for granted. Unfortunately, this
+war has had its casualties, but it is our job as Members of
+Congress to make sure that our injured and returning soldiers
+are cared for in the best possible manner.
+ The purpose of this hearing today is to examine the
+effectiveness and the efficiency of Army medical administrative
+processes and procedures that govern injured Army Guard and
+Reserve soldiers. Although the majority of these men and women
+are treated appropriately and above and beyond, we are now
+aware that many returning soldiers are experiencing
+difficulties associated with active duty medical extensions,
+medical retention processing, Medical Evaluation Boards, and
+Physical Evaluation Boards. With these programs, many returning
+soldiers are finding that they will have to deal with numerous
+layers of bureaucratic red tape, significant paperwork, and in
+some situations problems associated with their pay and
+benefits.
+ I have two constituents who have submitted their testimony
+to the committee regarding this problem. One of my
+constituents, Brian Robinson, was not able to be here today.
+Brian was a specialist in the Nevada Army National Guard.
+During his time in Nevada Army National Guard he was deployed
+to Iraq, where a vehicle he was riding in was struck by a hand-
+detonated land mine. As a result of this attack, Specialist
+Robinson suffered damage to both of his ears, cuts and bruises
+over his left eye, fractures to his left elbow and left wrist,
+a crushed index finger, severe head and back pain, whiplash,
+shrapnel damage, as well as swelling and bruising.
+ After this attack, Specialist Robinson was flown from Iraq
+to Kuwait, and then from Kuwait to Germany for additional care.
+But after about a week in Germany, Specialist Robinson was
+cleared to return to the United States. Specialist Robinson was
+then admitted for care at Madigan Hospital and was granted 30
+days leave for convalescent care. It was during this time that
+the U.S. military contacted his parents to notify them that he
+had been injured and that he was in a hospital in Germany.
+ Finally, while Specialist Robinson was being cared for by
+the Air Force physicians at Nellis Air Force Base in Las Vegas
+while on convalescent leave, the Army decided that Sergeant
+Robinson would have to return to Madigan for care by Army
+physicians as opposed to Air Force physicians.
+ Sadly, Mr. Chairman, Specialist Robinson's story is not
+unique. Another one of my constituents, Sergeant Joseph Perez,
+who is here today, is going to tell a similar story about the
+difficulties he encountered after being injured in the line of
+duty in Iraq.
+ Sergeant Perez is an exemplary American who served this
+country both since 1988 in the U.S. Marine Corps and later in
+Nevada Army National Guard, and is certainly someone that we
+should be proud of, since he received the Naval Commendation
+Medal, Sergeant of the Year for Western Region, and Recruiter
+of the Year.
+ I, of course, will let Sergeant Perez tell his story in
+person, but I will point out that both Specialist Robinson and
+Sergeant Perez proudly served our country during the global war
+on terror, and both have submitted testimony not to bash the
+Army, but rather to help find a solution to this longstanding
+problem.
+ Mr. Chairman, I am hopeful that our Army witnesses will
+help us look toward an effective, long-term solution, and I
+firmly believe that our Reserve soldiers who were injured or
+became ill in the line of duty should be given the pay and the
+benefits they deserve in an accurate and timely manner.
+ Again, thank you, Mr. Chairman.
+ Chairman Tom Davis. Thank you very much. Any other Members
+wish to make statements? Ms. Norton.
+ Ms. Norton. Mr. Chairman, I think you do a service for
+members of our military and for Congress, alike, in holding
+this hearing, and I appreciate that you have done so. I want to
+thank the members of the military who have agreed to step
+forward to help educate the Congress and to help us better
+prepare for what we should be doing for our members of the
+military, and especially the Reserve and the National Guard.
+ Walter Reed Hospital is, of course, located in my District
+here in the District of Columbia, and I have visited Walter
+Reed and seen world class treatment of the most seriously
+injured. I have also seen television reports of state-of-the-
+art treatment moving people from the battlefield to where they
+can be treated. So it looks like there are some places in the
+military where people do get first-class treatment.
+ Members of Congress are particularly close to the Reserve
+and National Guard. They are citizen soldiers and we have been
+hearing complaints now for years, particularly since the Iraqi
+war. I am concerned on two levels: first and foremost, at the
+health care that returning soldiers are receiving or not
+receiving; and, second, with the future of the volunteer Army,
+itself. We will hear about that. I believe there have been some
+improvements. There are still complaints. We need to know what
+the status is today and what we can do about it.
+ As to the volunteer Army, we are dealing with an unpopular
+war at home that has already taken its toll on recruitment for
+the Army Reserve and National Guard. We need to do all we can
+if we want to have a volunteer Army to make sure that people
+want to join that Army, particularly at a time when we are
+engaged and they see it every day on television in a guerilla
+war on the ground. At the very least they need to know that if
+they are wounded they are going to get the best health care
+that the United States has to offer. Every member of this panel
+I am sure is committed to seeing that happens.
+ I thank you again, Mr. Chairman.
+ Chairman Tom Davis. Thank you.
+ Any other Members wish recognition? Mr. Cummings.
+ Mr. Cummings. Thank you very much, Mr. Chairman, for
+holding this hearing on medical treatment of injured Army
+National Guard and Army Reserve personnel.
+ As I stated at the committee's hearing last year, it is
+deeply troubling to learn of the pervasive problems associated
+with pay and medical treatment of Guard and Reserve personnel.
+I believe--and I am sure that many other members of this
+committee believe, as well--that this situation is simply
+unacceptable. While I am comforted to learn of new efforts to
+help address these important issues, such as the community-
+based health care initiative, I am equally unhappy with the
+fact that there are soldiers who shed blood, sweat, and tears
+in the service of this country experiencing pay disruptions or
+medical care that is as much a burden as it is a blessing.
+ Insufficient planning and poor management controls by the
+Army made it ill equipped to meet the needs of the Guard and
+Reserve soldiers recently activated and deployed in Iraq,
+Afghanistan, and elsewhere around the world in the war on
+terror.
+ A central focus of this hearing is to examine the quandary
+many Guard and Reserve soldiers find themselves in when they
+are classified in a medical hold status while injured or ill.
+While approximately 5,000 Reservists are in medical hold, too
+many of our Nation's bravest have to endure long delays in
+diagnosis and medical treatment in austere facilities far away
+from friends and family. The consequences of this problem often
+manifest themselves in pay disruptions, stress, and undermined
+morale at a period of time when injured Guard and Reserve
+soldiers should be primarily focused on recuperation.
+ The GAO has indicated in its report entitled, ``Military
+Pay: Gaps in Pay and Benefits, Etc.,'' that sensible guarantees
+could not be given that Guard and Reserve soldiers would
+receive undisrupted pay and benefits in the event that they
+became wounded or sick. The study also indicated a startling
+finding that a designation of ``falling off orders'' lead to 24
+of 38 Reservists having their pay disrupted while they were
+undergoing medical care.
+ Additionally, the GAO cites numerous obstacles to
+inefficient management in the medical treatment of Guard and
+Reserve soldiers ranging from poor dissemination of information
+to soldiers about the active duty medical extension to lack of
+an integrated personnel system that is updated at all times.
+ Mr. Chairman, finally I believe that we honor the service
+and sacrifice of those who risk their lives for our Nation in
+the Armed Forces by eliminating inefficient, ineffective
+bureaucracies that undermine their ability to receive the pay
+that they are entitled to and the benefits that they are
+entitled to.
+ I am eager to hear from the witnesses today about what has
+been done and what is being done to address the pay and benefit
+problems Guard and Reserve soldiers are experiencing, and I
+hope, in the words of one of my constituents, that we don't
+have motion, commotion, and emotion and no results.
+ Thank you very much, Mr. Chairman. I yield back.
+ [The prepared statement of Hon. Elijah E. Cummings
+follows:]
+
+[GRAPHIC] [TIFF OMITTED] T0085.016
+
+[GRAPHIC] [TIFF OMITTED] T0085.017
+
+[GRAPHIC] [TIFF OMITTED] T0085.018
+
+[GRAPHIC] [TIFF OMITTED] T0085.019
+
+ Chairman Tom Davis. Mr. Ruppersberger.
+ Mr. Ruppersberger. Thank you, Mr. Chairman.
+ First, I would like to begin this opening statement by
+thanking our brave soldiers for their courage and bravery, not
+only on the battlefield but for being here today on behalf of
+your comrades. I was struck to the core when reading your
+stories. You are quite right in stating you are sadly not alone
+in this poor treatment. The Nation, the Pentagon, and this
+Congress owes you better.
+ Sergeant Allen, you spoke of the responsibility leadership
+carries, and I commend you for that. Soldiers, particularly
+disabled soldiers, should not be further burdened by
+disconnected bureaucracies. As members of this committee and in
+this legislative body, we must take responsibility and lead
+better in this area.
+ This is not a new issue for me. In August 2004 the problems
+severely disabled soldiers were facing came to my attention and
+on September 1st I introduced H.R. 5057--and this is a
+bipartisan bill--with Congressman Jones and Congressman Hoyer
+to expand the DS3 program in the Pentagon. That bill envisioned
+a joint command center with an executive agent to be a one-
+call-fits-all helpline for soldiers, Marines, Sailors, Airmen,
+and Coast Guardsmen.
+ It was intended to help with all sorts of problems severely
+disabled servicemen and women face when they return home,
+including pay, medical appointments, caseworker management,
+transportation, employment-related issues, and many other
+problems. Senators Bond and Kennedy introduced companion
+legislation in their chamber, and we came very close to passing
+that legislation before the close of the 108th Congress.
+ Now, I know we were onto something when Paul Wolfowitz,
+Secretary Wolfowitz, held a ribbon-cutting ceremony on February
+1st of this year to launch the Military Severely Injured Joint
+Support Operations Center. This center draws heavily from H.R.
+5057, and I congratulate the Pentagon on this effort.
+ We are working with our colleagues in the House and Senate
+to monitor this program and its progress and to see if it is
+working and if we can help.
+ The issue before us today is not just about processing
+paperwork; it is about the most basic promise we make to all
+men and women who put a uniform on and take the oath to serve
+our Nation. As leaders we have the responsibility to take care
+of these men and women and to leave no one behind and to not
+ignore them once we bring them home.
+ One great lesson from today's testimony and the GAO report
+is that our Federal Government needs to get much smarter in the
+way we do business. We have spent millions and millions of
+dollars creating joint weapon systems, open architecture
+platforms, and other integrated systems to create a more
+seamless battlefield between our military branches. Certainly
+we can do the same for our payroll and other processing systems
+for the Army, Navy, Air Force, and Marines. I fear the stories
+we hear today are just the
+tip of the iceberg and we should draw from the courage of these
+soldiers to fix this system and to help those who will follow.
+ Thank you, Mr. Chairman.
+ [The prepared statement of Hon. C.A. Dutch Ruppersberger
+follows:]
+
+[GRAPHIC] [TIFF OMITTED] T0085.020
+
+[GRAPHIC] [TIFF OMITTED] T0085.021
+
+[GRAPHIC] [TIFF OMITTED] T0085.022
+
+ Chairman Tom Davis. Thank you very much.
+ Any other opening statements?
+ [No response.]
+ Chairman Tom Davis. Well, if not we will proceed to our
+first panel of witnesses. We are very honored and grateful that
+you are here today to share your personal experiences with the
+committee. I understand that some of you appear with a little
+apprehension about how your candor today might affect your
+future careers in the military. Let me just say that we
+appreciate the opportunity to receive your testimony under
+oath, and you have our assurances that you will not pay a
+professional price for sharing your stories with us. In fact,
+Congress is deeply gratified for your willingness to step
+forward.
+ We welcome today Mr. Gregory Kutz, the Director of
+Financial Management and Assurance at the U.S. Government
+Accountability Office; Brigadier General Raymond C. Byrne, the
+acting State Adjutant General of Oregon; Sergeant First Class
+John Allen, B/3/20th Special Forces Group, North Carolina
+National Guard.
+ Sergeant Allen, it is nice to see you again and have the
+opportunity to publicly thank you for all that you have done to
+bring the plight of injured Guard and Reserve soldiers to the
+attention of this committee.
+ We also have with us Sergeant Joseph Perez, the 72nd
+Military Police Co., Nevada National Guard; Chief Warrant
+Officer Rodger L. Shuttleworth, Chief, Reserve Component
+Personnel Support Services Branch, Army Human Services Command,
+Maryland National Guard. Chief Shuttleworth is accompanied by
+Chief Warrant Officer Laura Lindle, who is here to support
+Chief Shuttleworth's testimony--so when we swear everyone in,
+if you could rise and raise your right hands--and Master
+Sergeant Daniel Forney. He is a Reserve Component liaison,
+Medical Holding Co., Walter Reed Medical Center, an Army
+Reservist from Pennsylvania.
+ Sergeant Forney, it is also good to see you again and I
+want to thank you for your commitment to those soldiers and
+their families. Give my best to your fellow Reserve liaison
+soldiers at Walter Reed.
+ Before we begin, I want to recognize and thank a few more
+people who are here accompanying our first panel. Along with
+Mr. Kutz, I want to recognize John Ryan, Gary Bianchi, and
+Diane Handley of the GAO Special Investigations Office, who
+over the last 2 years have gone beyond the call of duty to
+assist this committee with its investigation.
+ I also want to welcome and thank Mrs. John Allen and Mrs.
+Joseph Perez for coming here today with your husbands. As we
+salute your husbands' service and the sacrifices, we salute
+yours, as well.
+ There is another husband and wife team I want to recognize
+and thank who have provided separate written statements today
+about their experiences: Specialist Brian Robinson of the
+Nevada National Guard, and his wife, Mrs. Nicole Robinson,
+whose stories I encourage everyone to read. I think Mr. Porter
+referred to it in his opening remarks.
+ I want to thank everybody for taking part in this very,
+very important hearing. It is our policy that all witnesses be
+sworn before their testimony, so if you would rise with me and
+raise your right hands.
+ [Witnesses sworn.]
+ Chairman Tom Davis. Thank you very much.
+ Your entire written testimony is in the record. Questions
+will be based on that. That is in the public record. There is a
+light in front of you that will be green when you start. It
+will turn orange after 4 minutes, and at the end of 5 minutes
+it turns red. We would appreciate it if you could move to
+summary after that, but we are not going to gavel you shut if
+you feel you just need to add something. This is an important
+issue, and we want to give you time to adequately explain to
+live Members what we are about today in your experiences.
+ Mr. Kutz, we will start with you and we will move straight
+on down the line. Thanks for being with us and thanks for the
+work that you and your team have done on this.
+
+ STATEMENTS OF GREGORY D. KUTZ, DIRECTOR, FINANCIAL MANAGEMENT
+AND ASSURANCE, U.S. GOVERNMENT ACCOUNTABILITY OFFICE; BRIGADIER
+ GENERAL RAYMOND C. BYRNE, JR., ACTING STATE ADJUTANT GENERAL,
+ STATE OF OREGON, ACCOMPANIED BY COLONEL DOUG ELIASON, M.D.;
+SERGEANT FIRST CLASS JOHN ALLEN, B/3/20TH SPECIAL FORCES GROUP,
+ NORTH CAROLINA NATIONAL GUARD; SERGEANT JOSEPH PEREZ, 72ND
+ MILITARY POLICE CO., NEVADA NATIONAL GUARD; CHIEF WARRANT
+ OFFICER RODGER L. SHUTTLEWORTH, CHIEF, RESERVE COMPONENT
+ PERSONNEL SUPPORT SERVICES BRANCH, ARMY HUMAN RESOURCES
+ COMMAND, MARYLAND NATIONAL GUARDSMAN, ACCOMPANIED BY CHIEF
+ WARRANT OFFICER LAURA LINDLE; AND MASTER SERGEANT DANIEL
+ FORNEY, RESERVE COMPONENT LIAISON, MEDICAL HOLD, WALTER REED
+ MEDICAL CENTER, U.S. ARMY RESERVIST, PENNSYLVANIA
+
+ STATEMENT OF GREGORY D. KUTZ
+
+ Mr. Kutz. Mr. Chairman and members of the committee, thank
+you for the opportunity to discuss pay problems for mobilized
+Army National Guard and Reserve soldiers. I previously
+testified that 94 percent of the soldiers that we investigated
+had pay problems. My bottom line today is that gaps in pay and
+benefits cause significant stress and financial hardship for
+injured soldiers and their families.
+ My testimony has two parts. First, pay problems for injured
+soldiers, and second, Army's new process for soldiers injured
+fighting the global war on terrorism.
+ First, we found that the Army does not know how many
+injured soldiers have experienced pay problems. Injured Reserve
+Component soldiers can request to have their active duty orders
+extended and their pay and benefits continued. When soldiers
+fall off of orders, pay and benefits generally stop. Based on
+our analysis of Army data for 2 months in 2004, 34 percent of
+the 867 soldiers who applied for extensions fell off their
+orders before their requests were granted.
+ We found the following examples of the impact of these
+problems: soldiers and their families denied medical and dental
+care, loss of access to the post exchange and commissary,
+negative impact on credit due to late payment of bills,
+soldiers borrowing money from friends and family to pay bills,
+added stress for soldiers that already had serious medical
+conditions, and injured soldiers spending incredible amounts of
+time to obtain entitled pay and benefits.
+ Of our 10 case study, 2 soldiers are here today, Sergeant
+First Class John Allen and Sergeant Joseph Perez. They will
+tell you their own stories.
+ The key causes of these problems included a weak control
+environment, a broken process, and non-integrated pay and
+personnel systems. For example, one Special Forces soldier who
+lost his leg when a roadside bomb destroyed his vehicle in
+Afghanistan missed three pay periods totaling $5,000. Why?
+Because this soldier's application did not contain adequate
+information to justify his qualification for an extension.
+ The financial hardships experienced would be far worse if
+not for the heroic efforts of people like Master Sergeant
+Forney and Chief Warrant Officer Shuttleworth, who will also
+tell you their stories.
+ Second, there is some good news. The Army's new process for
+soldiers injured fighting the global war on terrorism appears
+to have significantly improved the front-end application
+process. According to Army officials at each of the 10
+installations that we visited, they have experienced few delays
+in obtaining initial orders for injured soldiers. However,
+several key issues remain, including the Army's lack of
+visibility over injured soldiers. This problem reflects DOD's
+many stovepiped personnel systems. For example, the Army
+contacted one soldier's parents to inform them that their son
+was injured in Baghdad and was at a hospital in Germany;
+however, this soldier had been back in the States for 20 days.
+ In conclusion, this pay issue is another example of the
+ineffective and wasteful business practices processes that
+plague virtually every aspect of DOD's high-risk business
+operations. To its credit, the Army's new streamlined process
+has significantly reduced the initial delays extending orders;
+however, many problems remain and must be addressed in a more
+comprehensive manner with clear leadership and accountability
+for results. There should be zero tolerance for the poor
+treatment of our injured heroes.
+ Mr. Chairman, I look forward to continuing to work with
+this committee to help soldiers. I am also honored to be at the
+table with the other witnesses who have each played a
+significant role helping injured soldiers, and I look forward
+to their testimony.
+ [The prepared statement of Mr. Kutz follows:]
+
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+
+ Chairman Tom Davis. Thank you very much.
+ General Byrne, thank you for being with us today.
+
+ STATEMENT OF BRIGADIER GENERAL RAYMOND C. BYRNE, JR.
+
+ General Byrne. Mr. Chairman, members of the committee, I
+would like to thank the Committee on Government Reform for the
+opportunity to speak today.
+ Over 3,000 Oregon soldiers have served their country as
+part of the Operation Iraqi Freedom and Operation Enduring
+Freedom. These citizen soldiers have served bravely with the
+expectation of returning to home, family, and employer.
+Currently, over 100 of them have paid a much larger price
+through injury or illness, and 10 have made the ultimate
+sacrifice in the service of their Nation.
+ I am currently serving as the Acting Adjutant General of
+Oregon and work directly for the Governor of the State of
+Oregon, the Honorable Ted Kulongoski. This point is important
+because it highlights where my loyalty and duty reside: to the
+Governor and the soldiers and airmen of the Oregon National
+Guard.
+ Additionally, I have been questioned by some individuals as
+to my interest in Oregon National Guard soldiers currently in
+Title 10, active duty status. I have been told they are no
+concern of mine. The answer I give is that Oregon National
+Guard is a force provider and has a duty to ensure that the
+soldiers and airmen on active duty are well taken care of.
+Their employers, families, friends at ``Fort Oregon'' all have
+an interest in their care and well-being. All my soldiers and
+airmen will come home to Oregon one way or another.
+ In visiting my soldiers who have returned wounded or
+injured, I have a few observations which I would like to share
+with this committee.
+ First, I applaud the community based health care
+organizations [CBHCO], which is the single greatest improvement
+in care for Reserve Component soldiers I have seen in my
+military career. For the first time we have placed the needs of
+the soldiers and the Reserve Component on par with the active
+duty soldiers. This program is critical and should be
+supported, continued, and, in fact, expanded to allow soldiers
+to return home, yet receive the care they need and deserve.
+ Second, we must look at the administrative processes that
+hold up wounded or injured soldiers at power projection
+platforms. The soldier whose medical decisionmaking process is
+complete, a determination has been made, should never have to
+wait up to 30 days for an order releasing him or her from
+active duty.
+ Third, we must provide advocacy for Reserve Component
+soldiers in helping them through a foreign and often
+frightening process of determining disability. The Army Medical
+Department provides first-class care on par with any health
+care organization in the Nation, but our Reserve Component
+soldiers are accustomed to a far different system, a much more
+consumer friendly system with choices, especially when it comes
+to getting second opinions on procedures that may provide to be
+life-changing, and the feeling on their part that your health
+care provider works for you. We need advocates other than the
+Inspector General for our Reserve Component soldiers who can
+break down the perceived and real barriers.
+ The reality many of our soldiers are faced with after a
+wound or injury is that they may not be able to return to their
+civilian occupation, and the financial support that is
+available through the disability ratings determination may be
+inadequate to sustain them and their families while they are in
+the retraining environment.
+ Their lives and the lives of their families are forever
+changed. Soldiers that go through the MEB process and are
+discharged with 0 percent disability receive no disability
+payment, cannot join a Reserve unit, and in some cases may not
+be able to return to their previous job.
+ It is the experience of one VA counselor I talked to in
+Oregon that it is not uncommon for VA to double the disability
+rating received by service members going through the MEB/PEB
+process.
+ The stress and turmoil a Reserve Component soldier faces
+not knowing if they will be able to support their family or
+return to their jobs is a clear impediment to the healing
+process. We must do a much better job of bridging the gap from
+AC to RC or to VA when our soldiers are injured or wounded.
+ Finally, we need to help heal the hidden wounds of post
+traumatic stress disorder [PTSD], and post deployment
+readjustment. A recent New England Journal of Medicine study on
+four battalions of active duty soldiers and Marines provides a
+valuable insight into future problems and issues. Again, this
+study was done on active duty personnel, and I would urge a
+study be conducted on Reserve Component personnel who face far
+different circumstances as they return to their communities and
+not active duty posts that contain services and support not
+found in many remote areas of Oregon.
+ I have with me today Colonel Doug Eliason, senior medical
+officer of Oregon and a family practice physician in Salem, OR.
+ Thank you for your time and your support.
+ [The prepared statement of Brigadier General Byrne
+follows:]
+
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+
+ Chairman Tom Davis. Thank you very much.
+ Sergeant Allen, thank you for being with us. I just want to
+urge the committee members to listen to his testimony.
+ This is the equivalent of financial and medical friendly
+fire from armed services. We met before over at Walter Reed,
+and I asked you to come forward, and I very much appreciate you
+and Sergeant Perez being here to share your personal stories,
+because this puts a personal face on the problems that our
+troops face when they come back from battle.
+ Thank you very much.
+
+ STATEMENT OF SERGEANT FIRST CLASS JOHN ALLEN
+
+ Sergeant Allen. Yes, sir.
+ Mr. Chairman, members of the committee, it is a distinct
+honor to be here to discuss the important issues affecting
+National Guard soldiers.
+ I would like to start by saying that I am definitely out of
+my element, so I am a little nervous today, so bear with me.
+ My name is Sergeant First Class John Allen. I am a National
+Guard soldier from Blairstown, NJ. In my civilian occupation, I
+am a police officer. In the Army I am a member of Bravo Co.
+Third Battalion 20th Special Forces Group. I am a U.S. Army
+Special Forces weapon sergeant responsible for weapons,
+tactics, and security.
+ I have been a soldier for 14 years, and while in
+Afghanistan I was asked to extend my deployment, and I happily
+did. If medically able to, I would rejoin my brothers in arms,
+who did some wonderful things to free an oppressed people from
+a reign of tyranny. It was and is well worth every personal
+sacrifice I have made.
+ I tell you my story in hope that after you hear my
+testimony I will motivate you all to make the necessary
+changes.
+ Over a year ago when the GAO investigators first approached
+me, I was asked what can we do to make things better. My
+statement then is exactly the same as it is today: to bring to
+light a broken, dysfunctional system in order to correct it so
+not one more of my comrades will have to go through what I went
+through.
+ I am retiring later this month, and nothing I say or
+anything you may elect to do as a result of my testimony will
+personally benefit me.
+ In the summer of 2002, while deployed in Afghanistan, I
+sustained multiple injuries from a helicopter accident and a
+grenade blast. I am currently receiving medical treatment at
+Walter Reed. After being wounded, I was placed in the Army's
+active duty medical extension program [ADME]. I have
+experienced significant problems from ADME program, and by Army
+regulation it is a 90-day extension. When my orders expire, it
+creates a multitude of problems for me and my family--no pay,
+no access to the base, no medical coverage for my family, and
+the cancellation of all my scheduled medical appointments.
+ Our wounded soldiers have our share of champions, to
+include the President, the Secretary of Defense, the Deputy
+Secretary, and, of course, this committee. I want to personally
+thank all of you. In regards to what I call the day-to-day
+survival people who I have been blessed with meeting, such as
+Gary Bianchi of the GAO, Grace Washbourne of Chairman Davis'
+staff, I can never thank you enough for what you have done for
+me and my family. Most important of all, I want to thank all
+the doctors and health care professionals at Walter Reed
+Medical Center for their excellent health care.
+ We have come a long way since I was wounded, and some
+significant changes have been made. By working together with my
+champions, we have already made some significant
+accomplishments. We brought Walter Reed up to the handicapped
+access standards, the Reserve Component pay and finance system
+is being reworked, we have done away with the active duty
+medical extension program for injured warriors, and we have
+opened the severely disabled veterans clinic. However,
+significant problems continue to exist that will require all of
+our assistance in completing the task.
+ The problems as I see them are a combination of the system
+and some of the personnel. Commanders at all levels must be the
+engines for change, and the subordinates must follow that
+commander's intent. Unfortunately, there is no overall good guy
+wearing a white hat and no overall one bad guy wearing a black
+hat. I wish it were that easy.
+ I have certainly encountered some lazy, non-caring, even
+prejudicial individuals along the way, but had an adequate
+system been in place to take care of Reserve Component disabled
+veterans, it would have made my situation almost impossible to
+occur. As long as I have been around the Army, I could not have
+taken care of my family had I not met some of the prominent
+people that I have. I shudder to think what would have happened
+to me and my family without all of you that have helped me.
+ So what happens to the lower enlisted soldier that knows no
+one of importance, the young soldiers who don't have any rank?
+Who are their champions? How does that leave a Reserve
+Component soldier that gets wounded today? Exactly where I was
+2 years ago--left to figure it out on his own.
+ In my written testimony I have included a detailed timeline
+of the events related to my ADME issues that clearly
+demonstrate a broken system. When the people in my life hear my
+story, they look at me like I am crazy. Even Gary Bianchi of
+the GAO, when I first met him, looked at me like it was an
+unbelievable story until I provided him the supporting
+documentation and proof.
+ As I was writing my testimony on what happened to me over
+the last 3 years, I have to agree with them that I must be
+crazy to put myself and my family through this. A lot of guys
+can't deal with this, and somewhere along the process they just
+quit and they go home. I would like to be able to say the
+problems are fixed; however, this is not the case.
+ Currently, I still have problems with my orders, and up to
+last month having pay problems. The system is still broken, and
+the only way I have been able to get anything done is by
+knowing the people that I know. What happens if you don't know
+those people?
+ My first order I would like to address is the commander's
+intent and the willingness of the mid-level command personnel
+to make logistical effective changes.
+ The President of the United States declared war on the
+terrorists, and the fact is we are at war. I have met many
+leaders, to include the current administration, senior
+representatives of the Department of Defense, senior leaders of
+the Army, and some of this great Nation's Congressmen. I
+personally feel that they all do genuinely care about me and my
+family. I have seen them get involved in matters and get them
+fixed. I believe that the breakdown is clearly in the mid-level
+command.
+ The hospital administrators are also doctors. What
+surprises me is their own motto: cause no further harm. How can
+you allow Reserve Component soldiers to go months without pay,
+nowhere to live, their medical appointments canceled, and not
+even being paid? The result is a massive stress and mental pain
+causing further harm, violating their own creed.
+ In the Special Forces we have our own motto: free the
+oppressed. In this case, the oppressed are the Reserve
+Component disabled veterans that I am here to free today.
+ I have personally talked to and seen many Marines being
+treated at Bethesda Naval Station. I was amazed how their
+stories and care treatment are the complete opposite of my own.
+Examples of this are contained in my written report and are in
+detail for your support.
+ We are at war and Walter Reed is the receiving center for
+our wounded warriors. I would like to invite each one of you to
+come to Walter Reed for an unannounced visit and see for
+yourself. It would be very easy to correct the situation if the
+command element climate supported it. The command staff at
+Walter Reed needs to show their care. After what our soldiers
+have done and sacrificed for our Nation, don't they deserve
+better?
+ When a Marine is wounded and can no longer support the
+team, they are idolized and treated as the heroes they are.
+When someone asked me about joining the service, I always used
+to recommend the Army. Now, after what I have lived, if one of
+my own sons came to me I think I would tell him to join the
+Marines. After thinking about that, I thought of what my father
+used to tell me--you were either part of the problem or you are
+part of the solution. I was wrong to think that. I am part of
+and I have felt proud to be part of the Army, and I should not
+let a broken system taint my overall experience. Rather than
+being part of the problem, I am here today to be part of the
+solution. We need to fix our Army, my Army.
+ Case worker confusion--the saying ``too many cooks in the
+kitchen spoils the soup'' holds entirely true here. There are
+too many people involved. Each one thinks that what they do is
+the most important. The most important thing is what my doctor
+tells me, not spending my time chasing my tail for their
+accountability and their paperwork. I only need the U.S. Army
+Special Operation Command liaisons. These individuals are more
+than willing and capable of handling all of my needs. Each
+branch should have their own people helping their own people.
+If someone is needed, it should go to my liaison and he can
+schedule it. If there is an argument between my ombudsman and
+whoever it is, I as the patient can go on about getting better
+and not being stressed and harassed.
+ Reserve Component versus active duty--I do not know of any
+Reserve Component units that have liaisons. Until the U.S. Army
+Special Operations Command commander sent their liaisons on a
+permanent basis to Walter Reed, life was very difficult for me.
+But what about the Reserve Component soldier that is in
+transportation company? Who represents him and who is his
+ombudsman?
+ I thank God I joined the Special Forces, because the
+Special Forces are taking care of me. But that shouldn't make
+me special in terms of care and representation. In combat, I
+was considered a member of the active duty. Once I was wounded,
+I was considered a Reserve Component soldier. As a Reserve
+Component soldier, my family is not authorized on my orders to
+relocate with me. I am not entitled to use my leave as terminal
+leave. I am not entitled to have open-ended orders.
+ My wife and three sons are still living in New Jersey. My
+oldest son, who was 10 years old when I was mobilized, is going
+to be 14 in July. I have missed a large part of his life and I
+can never get it back. When I asked to go home, I was told
+active service members have to go to a medical treatment
+facility. I am not an active service member. I am a Reserve
+Component soldier and my family is at home, a fact that is
+causing me significant hardship. However, when I tried to get
+any of the active duty entitlements I am told I am a Reserve
+Component soldier. I have no problem with either scenario, but
+make a command decision on which one I am and allow me the
+benefits of that system.
+ If I need to come back, do so at the Government's expense,
+instead of causing me, the soldier, more harm by separating me
+from my family and having the soldier assume the financial
+burden of paying to go see his family.
+ The medical hold company I am sure has some kind of
+function. To those members of the company that are here today
+who have given your all, I thank you and I apologize to you for
+putting you in this category with the rest. If they are
+supposed to keep our accountability, my liaison does that. If
+it is handling and processing my orders and ensuring that I am
+paid, then they are not doing their job. It is to this end that
+I boldly state there is no reason for the existence of the
+medical hold company. They are simply another cook in the
+kitchen just spoiling the soup.
+ They also need to understand they are not dealing with
+basic training recruits, but rather our wounded warriors.
+Requiring amputees to attend formations, demanding you to come
+any time they need something, and the general lack of caring
+they have clearly demonstrated by allowing Reserve Component
+soldiers to go off orders is wrong. The overall attitude toward
+our Nation's finest is disgusting, and at best they should be
+ashamed of themselves. This goes on with the full knowledge of
+the mid-level command philosophy.
+ Point five, confusion about the system: everything in the
+Army has some kind of standard. I have not ever seen a standard
+for medical treatment for Reserve Component soldiers. The
+overall board process is confusing. Add in the Reserve
+Component factor and it is even more confusing and complicated.
+Records for Reserve Component soldiers are kept at their units
+and their command are not readily available.
+ Once mobilized, I was assigned to Third Group Special
+Forces. The day I was ordered to ADME my problems started. From
+the first day to the present, there is not one set of standards
+that I have been provided, and I have not ever submitted the
+same supporting documentation. Had I been provided a manual for
+injured National Guard or Reserve soldiers, I could have
+avoided the majority of the problems that I had.
+ The Medical Board for Reserve Component versus active
+duty--the Medical Board for all soldiers should be the same,
+but it is not. Bullets don't discriminate between Reserve
+Component and active duty soldiers, and neither should the
+Army. Once I was identified as an injured soldier, I should
+have stayed on OEF/OIF orders. The pot of money to run the war
+should include the price tag for taking care of the wounded for
+that war.
+ I was left on open-ended OEF/OIF orders. There would be
+only two amendments to my orders, instead of the eight or nine
+I think I have had. My orders would not run out in 90 days or,
+under the new system, every 179 days. If my doctor knows that
+my treatment is going to take 14 months, then my orders should
+be for 14 months, plus processing time. Why is the decision
+left up to some personnel person to determine how long if my
+treatment is going to be shorter than the order? If the
+treatment is longer, there is no problem because it is an open-
+ended order.
+ The burden should not be on me every 90 days to get all my
+paperwork done and turned in, keeping following up on the
+status of those orders, getting new ID card, a new window
+sticker for my vehicle, my family have to travel all the way
+down to get new ID cards at their expense and re-register for
+Tri-Care. I should be focusing on my medical treatment, the
+reason that my orders were extended in the first place.
+ The Board is supposed to be the same for active duty and
+Reserve Component soldiers, but there is one huge difference
+that I have contained in my written testimony.
+ Wounded soldiers are not quitting the team, they are
+getting out because their disabilities force them to. There is
+a big, big difference. They should still be considered part of
+the team.
+ While talking to a U.S. Army Special Operations commander
+recently, he told me of an idea of his of tracking soldiers
+once they are out. This is a great idea, and I think the Army
+should be helping the disabled veterans after they are out with
+their employment, getting into the Veterans Affairs system, and
+their reentry into civilian life.
+ My conclusion--I believe in utilizing my chain of command.
+In my case, my chain of command went through military channels
+and made no progress. I did not start this investigation; my
+chain of command did on my behalf. I have been cooperative in
+hopes of fixing a broken, dysfunctional system, and I have been
+persecuted for my actions.
+ Mr. Chairman, I am retiring this month and I am not afraid
+to speak my mind, but for some of the guys still receiving
+medical treatment and guys that are going to be at Walter Reed
+testifying today, to quote my father one last time, ``Tell the
+truth and let the chips fall where they may. That way you can
+always look at the man in the mirror in the eye.'' I know my
+father would be proud of me today standing here letting the
+chips fall by fighting for my
+disabled veterans. I am grateful for the opportunity to tell my
+story. I thank you for all your support and effort. God bless
+you and the greatest Nation on this planet, the United States
+of America.
+ [The prepared statement of Sergeant Allen follows:]
+
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+ Chairman Tom Davis. Thank you very much, Sergeant Allen.
+Thank you.
+ Sergeant Perez.
+
+ STATEMENT OF SERGEANT JOSEPH PEREZ
+
+ Sergeant Perez. I would like to begin by conveying my
+sincere appreciation to all the committee members today for
+this opportunity to help my fellow soldiers.
+ It is my belief that everyone here today is ultimately here
+for the same reason: for love of country and for the heart of
+the armed forces. It is my hope that what is conveyed here
+today is taken in a positive force, and the steps to improve
+the policies and/or administration issues that have been found
+lacking, which applies to all U.S. soldiers and their families.
+ I am a 38-year-old Nevada National Guard. I was on active
+duty ever since the Twin Towers fell. I wanted to serve and
+defend my country. I was deployed with the 77nd Military Police
+Co. in September 2001 for Operation Noble Eagle in Monterey,
+CA. During this deployment, two Army stop loss orders affected
+my enlistment. My second stop loss regarding specific MOS
+extended my service again for 12 months, but after revision put
+my ETS to April 2003.
+ Shortly after our 13-month deployment ended, I took a
+position as a Federal fire fighter at the Department of Air
+Force, Hill Air Force Base, Layton, UT. However, I was ordered
+to come back to Nevada to redeploy for Operation Enduring
+Freedom. I was notified that I was to be placed on a third
+involuntary stop loss order that extended me to full length of
+the deployment plus an additional 3 months. Our deployment
+orders sent us to Fort Lewis, WA, to prepare, be evaluated, and
+deploy to Iraq.
+ In late April I was deployed to serve my country as a 95
+Bravo military police sergeant. My unit provided critical
+support in theater operations in criminal and security
+detention missions. We worked endless hours in weather
+conditions exceeding 130 degrees in order to build and
+establish confinement operations in an area which is well known
+as extremely hostile to coalition forces. We endured over 22
+days of rocket-propelled grenades, mortar attacks, and with
+performing MP missions in Iraq under the most dangerous and
+hostile conditions such as several vehicle escort missions to
+various locations in downtown Baghdad and nearby cities.
+ I was also selected to play a vital role in transporting
+detainees to and from the courthouse in downtown Baghdad and
+was subject to daily threats of ambush and attacks during these
+convoys.
+ On July 13, shortly after returning from the convoy with my
+squad releasing detainees in the Baghdad area, we were alerted
+to rush to the prison compound area. An uprising within the
+insurgent detainees led to a prison riot. The insurgents were
+armed with sharpened tent poles, tent spikes, and rocks. They
+had already injured one soldier, and there was another pinned
+down. We led a group of soldiers into the compound as a quick
+reactionary force. While under fire, we helped the downed
+soldier and quelled the prison riot with physical force. During
+these actions I injured my left knee while taking down a
+combative. I also received a strong hit to my head.
+ That night again, just like so many other nights, we
+continued to be RPGed and mortar attacked. On occasions, these
+mortars entered the confined areas, killing and wounding
+numerous detainees. They also took the lives of two MI soldiers
+working with us. I remember the day working on the tower and
+witnessing part of our own company of 11 soldiers, many of them
+being close friends, load onto a military deuce truck. They
+were struck by an IUD just outside the prison walls. It blew
+them all out of the vehicle, causing many injuries. I still to
+this day relive these moments and feel helpless and have rage.
+ While on a family related emergency leave, I reported to
+Nellis Air Force Base to have my knee examined and x-rayed.
+They found my knee injury causing me to be unfit for deployment
+and in need of medical attention. I notified the Army National
+Guard. I was informed that because the physical profile was
+conducted by the U.S. Air Force, I could not receive care until
+I returned back to Baghdad, Iraq to be examined by an Army
+medical doctor. Not wanting to get into trouble, I returned
+back to my unit without delay.
+ On September 2, 2003, I finally had a chance to be seen by
+the 28th CSH unit--combat support hospital--in Baghdad, Iraq.
+Because of the injuries to my knee, I was placed on medical
+evacuation orders to Landstuhl, Germany. After further
+examination and x-rays in Germany, they put me on a plane to
+Fort Lewis, WA, to be attached to the 2122 GTSB Medical Hold
+Co. for treatment. I was put in the Reserve platoon under
+National Guard sergeant on orders. He stated his unit was on
+orders to work with injured soldiers of the National Guard and
+Reserves. He also stated that they were overwhelmed with the
+amount of soldiers and the host of medical and personal
+problems they were coming home with. I was given old sheets and
+led to an old World War I barrack with insufficient water,
+heating, limited access for injured soldiers, and with mold
+growing on the walls. I was given a bus schedule and told to
+find a case manager at Madigan Hospital.
+ I found and reported to my case manager. I was set up to
+see medical staff within a few days. I was told they wanted to
+start my medical process with physical therapy, which was set 3
+weeks away. During this time many of the medical hold soldiers
+felt like they were lost and thrown away.
+ When you come back to the States, you figure that
+flashbacks and nightmares were a normal stress that you go
+through when you come out of a war zone. Soldiers still say,
+however, that, despite the Army's efforts, languishing in
+medical hold compounds one's medical and psychological issues.
+Everything is uncertain. You are denied care, and you feel that
+they don't give a damn whether you get better or not.
+ During the month of November 2003, my National Guard unit
+was REFRAD and returned home for Thanksgiving. They were given
+a hero's welcome. The ones in medical hold watched it on TV.
+ On December 8, 2003, I was finally allowed to take
+convalescent leave. At this point my wife had to care for me,
+and I couldn't see any hope of getting my position back as a
+fire fighter at Hill Air Force Base. My wife was beginning to
+see signs of change in me and she was worried about my mental
+health because of the nightmares and always wanting to be
+alone. I couldn't even enjoy the time with my children and
+visit family without putting up a front. It was my case
+manager, Captain Boardman at Madigan, who promised to get me
+remote care through the VA so I could heal and start physical
+therapy near my family.
+ I reported to the VA in Las Vegas in January 2003. I met
+with my primary care provider and began medical treatment. That
+care I received at the VA was outstanding. Most of my care and
+surgery was contracted through a VA fee base program. I was
+able to get x-rays, MRIs, physical therapy, surgeries to my
+knees and my neck. My appointments were handled quickly and
+with the best of care. I also started a veterans PTSD focus
+group at the vet center in Las Vegas. My wife and I do believe
+that they saved my life. For the first time I felt that my
+medical and psychological issues were finally being handled
+properly.
+ During my stay in medical holdover, I received little to no
+counseling regarding traumatic events I experienced during war.
+Why didn't I or others ask for help? The culture here is that
+unless your leg has been torpedoed off or your arm shot off,
+then it is not a combat-related injury. Many servicemen here
+fear to be stigmatized for being able to deal with their
+problems on their own. I did the same thing that everyone else
+does in the military--you suck it up. You don't whine. But I am
+sure during the course of treatment a soldier will display
+signs that will suggest that an individual is in need of mental
+health counseling of some kind.
+ My National Guard unit was demobilized February 10, 2004.
+Because of this, my family and I fell off the Army records.
+After many calls to the National Guard and hearing that,
+because I was still on Title 10 orders, it was an active Army
+problem, I started to call Fort Lewis. I was told the exact
+opposite. I was finally told that there was confusion about how
+to handle the ADME orders and line of duty packages. I asked to
+speak to my case manager, to find out he was replaced by a new
+case manager who didn't have a clue who I was or what my
+situation was. My family went 3 months without military IDs,
+Tri-Care health, pay, and even denied entrance onto Nellis Air
+Force Base to shop.
+ Not being able to work, I had to borrow money from family
+members to make ends meet. At the same time, I was still
+receiving phone calls from the 2122nd medical hold company
+saying they couldn't fix anything unless I came back, or I had
+to come back or I would be placed on AWOL. This caused more
+stress because I had just had surgery to my cervical spine.
+ I was low on funds, didn't have orders, or even a military
+ID card. My wife and family members couldn't believe all the
+problems, and started to think that maybe I did something wrong
+and I was being punished. All this made me feel worthless, and
+I ended up on April 22nd in a mental health unit at Mike
+O'Callaghan Hospital for PTSD and again suicidal thoughts.
+ After two extension orders and a back-dated ADME to report
+back to Fort Lewis to be attached to the Madigan Medical Hold,
+I finally was able to get my family updated in DEERS and have
+military ID again. I was finally able to show proof of
+employment and get a rental house for my family. I reported
+back to Madigan Medical Hold on July 8, 2004. I was glad to see
+that the troops did not have to stay in the old barracks any
+more, but a lot of the same problems still remained. Many of
+the soldiers were still having pay and order problems. I
+started to try to help as much as I could.
+ I have been involuntarily medically separated because of
+the injuries I accrued for my country in Iraq in combat. I have
+gone through a major life change, and within the next month I
+am having to endure another. I have always had pain in my
+knees, and if I walk long distances or lift anything the pain
+is greater. Pain in my knees is from the injuries and the past
+two knee surgeries for tears, damaged cartilage, micro
+fractions, and lateral release.
+ I also had cervical fusion. I have lost some range of
+motion in my neck. I sometimes can't turn my head to the left
+and if I look down for a long time, such as reading a
+newspaper, my neck locks up. I have chronic neck pain which
+starts in my neck and ends in my lower back. I have taken large
+doses of hydrocodone throughout the day and the night for
+relief. This prevents me from performing tasks that I feel that
+I need to be sharp mentally. This medication, along with other
+medication, keeps me balanced. I have to take the medication
+for the rest of my life.
+ I can't get to sleep most nights, and I must sleep with a
+CPAP machine strapped to my face because of severe obstructive
+sleep apnea. I also sleep with a hard mouth brace because of
+the TMJ surgeries to my jaw. I still do my therapy with the VA
+in Las Vegas.
+ I continue to take my PTSD group meetings every week at the
+Las Vegas Vet Center because it works for me. It helps keep me
+strong and centered. I and many of my colleagues say such
+problems are particularly acute among the National Guard and
+Reserve soldiers, who make up 40 percent of the deployed
+troops. I don't think it has been budgeted for the Reserve and
+Guard components, and now they want us to suck it up. An
+injured soldier shouldn't be thought of less because he is a
+Guard member or a Reserve. I am very displeased how my family
+has been treated during my medical holdover. But the issues
+that are mostly directly affecting my future is my dispute with
+the Army over disability ratings.
+ Most of my conditions are chronic and I can't perform many
+of my functions as a fire fighter nor law enforcement. These
+were my chosen fields I have strived to be proficient and
+professional at. I am told to look forward to a VE rehab
+program to help with education and training into a new field
+starting me over again. My family and I live in a rural city
+outside of north Las Vegas. Our closest health care, hospital,
+major food shopping, fitness center, and largest gas station
+has always been Nellis Air Force Base, Las Vegas, NV. My first
+daughter was even born here when I served with the U.S. Marine
+Corps. It is very hard knowing that this has been taken away
+from us.
+ As a Nation, we should note the special contributions of
+our National Guard and Reserves. Since the attacks of September
+11th, and extended into the Iraq conflict, demands placed on
+citizen soldiers and their families have been extraordinary.
+ I make this statement today not to complain or look for
+pity, but to finally have my chance to tell my story. I don't
+believe or want to presume that I have a well-rounded knowledge
+of military procedures. I do believe this committee has a
+vigilant desire to make provisions to the adjustment and
+strengthening of these programs.
+ I would like to make the following considerations: National
+Guard and Reserve forces face challenges that their active duty
+avoid. When part-time soldiers do return home, they have little
+interaction with other soldiers and sometimes feel that they
+are the only ones going through these emotional adjustments. I
+feel a bit isolated, like the rest of the world has just gone
+by me for the past 3 years. For these reasons, I feel that
+remote care would benefit and aid the recovery of individual
+soldiers and their families. I would recommend the Veteran
+Association in ways of medical care.
+ The medical holding companies have full control over the
+soldiers to be able to utilize them in tasks that don't hinder
+their care as soldiers. This could help the soldiers progress
+in the military and have an active duty component to handle
+problems that arise. Many of these soldiers fall through the
+cracks when it comes to promotions, educational benefits, and
+awards.
+ The wounds of the battle frequently do not require hospital
+attention. There are severe long-term physical and
+psychological disabilities that prevent veterans from attaining
+positions in our Nation's work force. When a soldier returns,
+they have to go through a complex workman's comp type paperwork
+to prove that there is something that they did in war, which is
+the reason that they are sick. That can take from 4 to 16
+months. They come home injured, and rather than being
+integrated into society they are stuck in medical limbo waiting
+for their disability ratings and then being diagnosed with pre-
+existing conditions that imply that they shouldn't have been
+sent overseas in the first place.
+ For these reasons, I believe there should be a seamless
+transition from going from medical hold status to veteran
+status. I feel that the veterans service organizations should
+have more access to bases to help the injured soldiers deal
+with the MEB and PEB issues. Families would be free to focus on
+physical and emotional recovery progress in lieu of following
+up on paperwork, policies, and medical care on their own
+financial and emotional expense.
+ I have found that many of the problems occurred during my
+medical care because the DOD and the VA create an independent
+patient record. Records are hand carried to and from agencies.
+I also found, unfortunately, that the current VA/DOD process
+for sharing information about eligible service members does not
+facilitate quickly and there is not a smooth transition into
+enrollment into the VA programs.
+ There seems to be a great deal of difference in the
+policies regarding the medical care and treatment of soldiers
+between the branches of the military. I feel that the treatment
+to an injured should be written and maintained as one standard.
+A medical doctor's opinion shouldn't change based off of the
+uniform that they wear.
+ Last, I would like to see more progress and emphasis on
+mental health services available in post traumatic stress and
+depression. It has made a difference in my life, and I feel
+that the programs such as at the vet center will give a great
+deal of comfort to many of the returning veterans as they
+undergo their personal struggles.
+ It is because I have a great deal of love for my country
+and family that I write this statement. I have cherished much
+of my life in the armed services. I have taken pride in wearing
+the uniform. I have made great friends and I have seen and
+accomplished many things throughout my deployments. There can
+be no doubt of the commitment of those in uniform, whether
+active, National Guard, or Reserve. When we speak words of
+sacrifice, courage, and conviction it touches my heart as a
+former Marine and a soldier, as they do for those who are
+serving in uniform today in the defense of our safety and
+liberty.
+ I thank you again.
+ [The prepared statement of Sergeant Perez follows:]
+
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+
+ Chairman Tom Davis. Sergeant Perez, thank you very much for
+sharing that with us. Mr. Shuttleworth, thank you.
+
+ STATEMENT OF CHIEF WARRANT OFFICER RODGER L. SHUTTLEWORTH
+
+ CWO Shuttleworth. Mr. Chairman, members of the committee,
+it is a distinct honor to be here to discuss important issues
+affecting injured Reserve Component soldiers, including those
+injured as a result of the global war on terrorism. Our Reserve
+Component soldiers have born the brunt of growing pains
+necessary to change a system that was not designed to support
+Reserve Component soldiers.
+ My name is Chief Warrant Officer Rodger Shuttleworth. My
+military career began in 1973, where I served in the active
+Army until 1981. I then joined the Maryland Army National Guard
+and became a full-time employee of the National Guard Bureau of
+1988. I was assigned to my current position as Chief, Reserve
+Component Support Services Branch, Army Human Resources
+Command, in February 2003. My responsibilities include all
+aspects of personnel for Reserve Component soldiers ordered to
+active duty under Title 10.
+ Prior to September 11th, there were only two programs that
+dealt with injured Reserve Component soldiers--active duty
+medical extensions and incapacitation pay. Incapacitation pay
+and allowances are paid to soldiers without them being on
+active duty. There are a lot of soldiers on incapacitation pay.
+Over $3 million monthly is spent on their care. Without proper
+oversight, questions to the best use of the money remains. If
+these soldiers were placed on active duty medical extension,
+they would be better managed and the Army would spend less
+money getting them returned to duty or placed in the physical
+disability system.
+ The numbers of injured soldiers in these programs prior to
+2001 was manageable, but due to the largest mobilization of
+Guard and Reserve since World War II in the global war on
+terrorism, the amount of injured needing assistance grew beyond
+the capacity to assist.
+ For example, I started with a staff of six. At the time,
+the Adjutant General of the Army gave me a mission: to do all I
+could to increase the capacity to care of our injured Reserve
+Component soldiers. At that time, the only process was active
+duty medical extension and incapacitation pay. An active duty
+medical extension prior to September 11, 2001 was used to order
+drilling soldiers injured during training to active duty for
+medical care. Because we were not prepared for the disaster of
+September 11, ADME had to be used to support GWOT soldiers
+injured in the line of duty. Because ADME was not specifically
+designed for GWOT, soldiers were being denied eligibility, fell
+off pay systems, and lost benefits for their families.
+ ADME was supposed to be a 179-day program, longer than the
+30 days given, but the Army G-1 who was responsible for
+establishing and interpreting ADME policy also chose to execute
+it, and they became a major stumbling block, shortening
+extensions as we tried to ensure GWOT soldiers were treated
+equally to their active component counterparts.
+ These problems continued until the creation of medical
+retention process in March 2003. This was an improvement,
+better because the application process was easier, the
+requirements were streamlined, and all extensions were
+automatic for 179 days. We also directly submit the soldiers'
+orders to the Defense Finance and Accounting Service so pay
+problems and benefits will end.
+ In January 2004, I established the Medical Services Section
+of my branch to facilitate MRP processing, Medical Board
+process, and other RC personnel functions for medical reasons.
+During this time, we began to realize that we were also
+responsible to train and assist Reserve Component and active
+Army personnel in medical care facilities who had any questions
+at all on Reserve Component processing.
+ Some calls are from the medical holdover companies who do
+not always know how to process or help Reserve or Guard
+soldiers being treated in their facilities, but most of the
+callers are Guard and Reserve soldiers who have not gotten any
+answers from their chain of command at the facilities and have
+exhausted all other avenues in health and service.
+ One of the major problems is that Army medical personnel do
+not interface with Army personnel specialists. This continues
+to cause serious misunderstandings, delays, and holdups in
+personnel services.
+ Another of the major problems is that we have a medical
+command telling an injured Guard or Reserve soldier one thing
+and we tell him another.
+ Another continuing source of inter-Army command
+difficulties for us involves our relationship with the Army G-
+1. The Army G-1 is by definition supposed to be a source of
+policy decisions, innovation that the Army Human Resources
+Command are executors of, but this is not always the case. This
+causes the following problems: great delays in the approval in
+each soldier's paperwork, causing increased days in treatment;
+pay problems and benefits; and great family stress. We have
+spent far too much time debating between our offices on the
+most effective way to support injured Reserve Component
+soldiers.
+ In regards to these difficulties, I am happy to report that
+2 days ago the Army G-1 transferred functional responsibility
+for all types of Reserve Component personnel management in
+regards to medical processing to my branch.
+ I want to bring forward another problem that my staff and I
+encounter every day. Reserve Component soldiers are remaining
+on active duty for long periods of time without being injured
+into the physical disability process and remain in a medical
+board process for long periods of time. Of the paperwork we
+review, approximately 80 percent of ADME and MRPE Reserve
+Component soldiers will end up in a physical disability system.
+Part of the problem is the shortage of trained manpower, both
+at medical command and the U.S. Army Physical Disability
+Agency. Injured Reserve Component soldiers have paid the price
+for this, but we are trying to improve manning and training.
+ Guard and Reserve soldiers have so many difficulties
+because the active Army tries to treat them like active Army
+soldiers in all cases, and in some instances they cannot. An
+example is when an active Army soldier is med-evac'ed from a
+theater of operation to a Stateside medical facility and
+determined to be an outpatient, they are returned to their home
+unit for a period of recovery. The Reserve Component soldier
+may not have a home station because his unit has been mobilized
+and there may be no one left at home station to assist them.
+This causes us to lose accountability for these soldiers. All
+of them are authorized to receive medical care and treatment
+and should be reported through active Army organizations prior
+to returning to their home of record.
+ To alleviate this problem, the Army has created the
+community based health care initiative. This initiative will
+allow some Reserve Component soldiers, after being processed
+through an active Army organization, to return to their home of
+records and their families, remain on active duty, and receive
+medical care. Each community based health care organization is
+responsible for the care and accountability of the soldiers
+assigned them. My office assists in training the staff
+personnel of these newly created facilities. In addition to
+that, I have placed over 80 NCOs at Army treatment facilities
+in the United States and Germany to assist in patient tracking
+and Medical Board processing. Because of the placement of these
+NCOs, completed Medical Board ratios have now improved. Over
+400 are being done annually.
+ We have also placed personnel at the U.S. Army Physical
+Disability Agency, the DOD Defense Finance and Accounting
+Service, and at the CBHCOs. We were also asked very recently by
+the Army Installation Management Agency to provide experienced
+Reserve Component command and control staff onsites at the
+installation because there is a shortage of permanent staff at
+the installation medical readiness processing units and CBHCOs.
+ There is still a need to sustain this staff currently and
+at least 2 years after the current contingency operations end.
+As of last week, the Director of the Army staff has approved my
+office to fill these leadership voids with the Army extended
+active duty program.
+ I hope from my testimony you understand how important it is
+to me that my staff and the Army continues to resource and
+improve policies aimed at supporting injured Guard and Reserve
+soldiers.
+ There are four things I want to bring to your attention.
+ One involves a needed change to Title 10. Under the current
+law, Reserve Component soldiers not injured in the line of duty
+are entitled to a retirement benefit that soldiers that are
+injured in the line of duty are not entitled to. That bothers
+all of us. I respectfully ask that Congress change this unfair
+law. Right now, if you are injured prior to entering the armed
+forces and have 15 years of credible service and are found to
+be non-retainable, you are eligible to retire and obtain
+benefits at age 60. But if you agree to come to active duty and
+fight for your country and are injured in the line of duty, you
+are not entitled to this benefit.
+ Second, I have deep concerns about current Army procedures
+for injured Reserve Component soldiers at certain Army
+installations, including Walter Reed, Fort Bragg, Fort Bliss,
+Fort Lewis, Fort Dix, and Fort Drum. These installations do not
+provide timely and accurate medical personnel records or line
+of duty investigations that are vital to Reserve Component
+soldiers who are leaving active duty and will need future
+medical care. At these installations there is no standard for
+consistency in who is responsible for providing us timely and
+accurate records or applications for MRP extensions so that the
+soldier is entered into the system. If this doesn't change,
+Army case managers will not have access to the records they
+need, orders will be cut too late and pay and benefits will be
+affected.
+ I ask the Army Installation Management Agency to help
+create standards for installations so that we will have the
+same policies in place to assist these soldiers.
+ Third, even with the new influx of medical case workers
+assigned to assist injured Guard Reserve soldiers, the ratio
+between patient and care manager is still too high at at least
+50 to 1 at each hospital and now 30 to 1 at the CBHCO. These
+people are crucial to making appointments, liaisoning with
+families, liaisoning with doctors on treatment time tables, and
+also entering correct information into the mod system, one of
+the many data bases tracking medical data, timely and
+accurately. If you can, please help us with this.
+ Last, my office needs more resources. I have space issues,
+funding issues to visit facilities for training and assistance,
+and equipment shortages. I have time and again asked my budget
+office for the ability to use reimbursable GWOT funds to cover
+these expenses and am denied. I don't understand the reluctance
+to use already dedicated funds. I look to Congress to consider
+line item appropriations to help us in the Guard and Reserve.
+ Thank you, Mr. Chairman.
+ [The prepared statement of CWO Shuttleworth follows:]
+
+ [GRAPHIC] [TIFF OMITTED] T0085.084
+
+ [GRAPHIC] [TIFF OMITTED] T0085.085
+
+ [GRAPHIC] [TIFF OMITTED] T0085.086
+
+ [GRAPHIC] [TIFF OMITTED] T0085.087
+
+ [GRAPHIC] [TIFF OMITTED] T0085.088
+
+ [GRAPHIC] [TIFF OMITTED] T0085.089
+
+ [GRAPHIC] [TIFF OMITTED] T0085.090
+
+ Chairman Tom Davis. Thank you very much.
+ Sergeant Forney, thank you.
+
+ STATEMENT OF MASTER SERGEANT DANIEL FORNEY
+
+ Sergeant Forney. Mr. Chairman and members of the committee,
+it is a distinct honor to be here to discuss active duty
+medical extension, the medical retention process, and life at
+medical hold at Walter Reed for injured Guard and Reserve
+soldiers.
+ I am Master Sergeant Forney, an Army Reservist from
+Pennsylvania with almost 25 years of proud service. I arrived
+at Walter Reed Army Medical Center in July 2002, after I
+volunteered and received orders from Chief Warrant Officer
+Shuttleworth of the Human Resources Command. Chief Shuttleworth
+saw the need for someone to help the administrative process for
+Guard and Reserve soldiers because the active duty medical hold
+company did not know how to help these soldiers.
+ I was the first Reservist liaison to be sent to Walter Reed
+to help soldiers. I was the only one there in that capacity for
+over 1 year. When I first arrived, there were only about 10
+injured Army Reserve and National Guard soldiers on ground. I
+assessed the situation and determined that the process was
+broken. Soldiers fell off orders and had delayed pay and lost
+medical care. The soldiers' families also lost Tri-Care
+benefits.
+ Then came the task of keeping them on orders. This is where
+the real trouble started. Because I had to send their packets
+to the Army G-1 at the Pentagon to be signed and approved,
+sometimes it would take up to 4 months to get their orders.
+Although doctors had requested extensions for soldiers for up
+to 179 days and we submitted those requests, G-1 sometimes did
+not grant this much time, instead approving 90-day extensions.
+This caused more workload for us and put the soldiers at risk
+of falling off orders. This caused great hardship for the
+soldiers and their families, not only monetarily but because
+medical care for soldiers and their families stop when soldiers
+are not on orders.
+ G-1 requirements for valid support for an extension often
+changed, sometimes without notice. For example, at first a form
+46-2-R was acceptable for doctors to sign off, and this worked
+well. However, after about 6 months this form was no longer
+taken. Now a letter from a doctor was needed that included
+significantly more information, such as the diagnosis,
+prognosis, and medical treatment plan. This then slowed down
+the process even more, because a soldier would have to get his
+or her doctor to take time and write the letter.
+ In April 2004 the medical retention process was
+implemented. This was a great step forward, reducing the
+process of getting orders down to an average of 7 days.
+ There are still stipulations for getting MRP orders. They
+have to be on 12301 orders. These are the mobilization orders.
+There are still some bugs in the system and we are working with
+the Human Resources Command to fine tune the process.
+ In addition to the problem with extending orders for
+soldiers and lost pay and benefits, there are other issues I
+want to bring to the committee's attention. For example, during
+all this we encountered even more problems with the active
+duty, as they did not know how to deal with the Reserves and
+National Guard soldiers.
+ When I first arrived at Walter Reed in 2002 I found a
+soldier from California that was living in the hotel on ground.
+He had been living there for 3 months paying out of his own
+pocket. He had fallen off orders 2 months before. When he went
+to active duty, he was told that there was nothing they could
+do for him because he was National Guard. I did get him his
+back pay, and that took 2 months because it took a month to get
+him back on orders. As far as I know, he has never been
+reimbursed the total cost for his out-of-pocket expenses,
+approximately $5,000.
+ Mr. Chairman, my staff and I do whatever it takes to make
+sure that soldiers are taken care of. The motto for the medical
+hold company at Walter Reed is soldiers first. My staff and I
+have spent approximately $2,000 of our own money in the past 2
+years and are continuing to pay out of our own pockets for a
+lot of the supplies we use to uphold the motto. The medical
+hold company only gets so much money a year, and my office is
+at the bottom of the list for funding. What makes this so bad
+is the Reserves and Guard are fighting next to the active duty,
+and still we treat them like second class citizens. We do not
+want to be treated special, just equal.
+ Thank you, sir.
+ [The prepared statement of Sergeant Forney follows:]
+
+ [GRAPHIC] [TIFF OMITTED] T0085.091
+
+ [GRAPHIC] [TIFF OMITTED] T0085.092
+
+ [GRAPHIC] [TIFF OMITTED] T0085.093
+
+ [GRAPHIC] [TIFF OMITTED] T0085.094
+
+ [GRAPHIC] [TIFF OMITTED] T0085.095
+
+ Chairman Tom Davis. Thank you very much. That was very
+compelling testimony. It shows what happens when you don't get
+information sharing between the Guard and the Reserves and
+military and we are not interconnected and we are just letting
+regulations drive this whole process and we are forgetting
+about the people.
+ I am going to start the questions with Mr. Porter.
+ Mr. Porter. Thank you, Mr. Chairman. Again, thank you to
+the panelists for pretty compelling testimony.
+ I have a specific question for Sergeant Allen. You had
+mentioned in your testimony and your backup regarding being
+persecuted for actions, vindictive medical hold personnel, and
+have been labeled as a troublemaker. Can you give me a little
+more details about that? How are you being labeled, and what
+are they doing to cause you additional pain and suffering right
+now?
+ Sergeant Allen. At the time, sir, when the original GAO
+investigation was started with Mary Ellen Tribanic--she is a
+great help--my chain of command started the investigation. They
+came to me. I was forthcoming, provided the information that
+was asked of me.
+ Shortly thereafter the first GAO report came out. The
+information that was contained in that report was very
+specific. It stated something to the effect, if my memory
+recalls correctly, ``A Virginia Special Forces National Guard
+police officer from New Jersey--'' something to that effect--
+``receiving medical treatment at Fort Bragg,'' which I was the
+only one of. When that happened I had on different occasions be
+called late at night, 8:30, 9 p.m., be told that I had a 4:30
+or 4 a.m. appointment, medical appointment that is, sir.
+ And on more than one occasion I went to the appointment,
+documented when, where I was told to go. On one occasion at
+4:30 a.m. I was told to have an MRI done. I went there. The
+NCOIC, the non-commissioned officer in charge, told me that he
+had told my medical administrator that they would not do my
+appointment at 4:30 a.m. and that I should come back Friday
+when my original appointment was scheduled.
+ I had the NCOIC write a letter, memorandum for record,
+stating that, turned it over to GAO, and continued to have
+those type of problems. I do have them documented. I have filed
+them all with the GAO. It is very unfortunate. I consider
+myself a big boy. I can take care of myself, and I have taken
+care of myself. But my concern has been and will be for the
+lower enlisted guy that can't take care of themselves. That is
+one of the examples.
+ Mr. Porter. Thank you.
+ Mr. Chairman, if I could ask an additional question. Mr.
+Perez, again, thank you for being here. I know that you are a
+long way from home. I appreciate it very much. Very compelling
+testimony.
+ Can you kind of explain the difference between when you
+were in the Marines and your most recent service? Was there
+different treatment? Was there substantial difference in
+culture and procedures?
+ Sergeant Perez. Yes, I would go ahead and answer that. I
+enjoyed both the services, but I did feel that the care and the
+commitment that I received while in the Marine Corps, even like
+it was stated, your mid-level sergeant positions, a gunnery
+sergeant or an E-6 or an E-7 took great pride in taking care of
+their under-enlistment soldiers. They didn't try to pass it up
+the chain of command for the next level to try to take care of
+it. I found when I got into the Army once again that, even
+though we were serving side by side with the active, when we
+got back it was just--there seemed to be a complete discomfort
+on how we were treated as National Guard and Reserves.
+ Many of our command, when they come back to the States,
+they are coming back--when they come back to the States they
+are getting demobilized. They are going back to their job,
+going back to 1 weekend out of the month, 2 weeks out of the
+summer time. So when you are trying to get in contact with the
+same command that you are serving active duty with, a lot of
+times you can't get in contact with them, not even e-mails or
+replies back. That is real discomforting, because this is the
+command group that you are hoping would be there for you the
+same way you were there for them.
+ Mr. Porter. Thank you.
+ Chairman Tom Davis. Ms. Norton.
+ Ms. Norton. Thank you, Mr. Chairman.
+ Mr. Kutz, in trying to get our arms around this process,
+your own work has been important to us. We recognize that part
+of what has happened with the medical hold has to do with the
+planning connected with the overall war effort. But when we
+hear this testimony and we read your report, it has all the
+appearance of a startup effort. Can I ask you whether or not
+medical holds have been used? Is it because we have such a
+large--in other wars? I mean, it is as if we haven't done this
+before. Does this have to do with the fact that we are using
+such a large Reserve and Guard component to fight this war in
+the first place?
+ Mr. Kutz. Yes. Under the old active duty medical extension
+program that was really not designed for the kind of
+operational tempo we have today. The medical retention process
+that they have in place now is probably more equipped with what
+is going on, although that has risks also.
+ But really what you are talking about here is that they
+have a process, not a program that is being managed. There is
+no one really in charge, no one responsible. There is a lot of
+organizations, but there is no one that you can go to and say
+that you are accountable for this.
+ So the kinds of stories that you have heard from the
+witnesses here, you can't go hold anyone accountable at this
+point, and so I think someone does need to be put in charge,
+made responsible. Put a general in charge of this, an
+ombudsman, or someone, because this is clearly reflective of
+not being prepared to handle the kind of operational tempo that
+you have today.
+ Ms. Norton. In that regard I would like to get a
+clarification from Chief Warrant Officer Shuttleworth who said
+in one section of his testimony he was happy to report that G-1
+transferred functionally ``responsibility for all types of
+Reserve Component personnel management with regard to medical
+readiness processing to my branch.'' I wonder if you are saying
+that you are in charge. What are the specific effects you
+expect from the transfer you describe in your testimony?
+ CWO Shuttleworth. The G-1 has transferred all orders
+processing and for the most part the approval process except
+for those cases that may be in question or may have some
+specific things that doctors and medical professionals need to
+look at. But what that does is what we had before we did this
+was that we had several different agencies within the Army
+publishing orders, depending on the kind of active duty that
+you were going to place that soldier on.
+ As of this month, we now own all the orders, ADME, medical
+readiness processing both one and two, and all the other
+processes that keep these global war on terrorism soldiers on
+active duty. Therefore, the soldier now has one place to go and
+one place to get those orders from and doesn't have to go
+wondering where they are going to get their next order from.
+ Ms. Norton. Do you believe, for example, if you would just
+take me through a scenario--you have heard them here--that this
+would solve the problems we have heard and the testimony we
+have received here this morning?
+ CWO Shuttleworth. Yes. ADME was never designed to be a 30
+or 60 or 90-day program. ADME was a program that was designed
+to be just what MRP is, but for a smaller number of people. It
+was designed to be a 179-day program, 6 months for each
+soldier, but because the individuals who managed the program
+chose to decide for themselves how much care a soldier really
+needed based on the number of days they wanted to put them on
+orders, those soldiers began to fall off orders, which was the
+wrong thing to do and that will be fixed. No order is cut for
+less than 179 days, and they are all directly fed to the
+finance accounting office so they will not drop off the system.
+ Ms. Norton. We are going to really be expecting real
+improvements here. You talk about debates back and forth over
+what to do. It seems a pretty simple remedy that somebody has
+come up with. I can't imagine why it took so long if this is,
+in fact, centralizing control that was the answer all along.
+ May I ask, because it looks like some progress was being
+made on the front end, that there were additional personnel
+that many on the front end were no longer falling off of their
+orders and pay, and there were housing standards. As a result
+of some of the work of this committee, it looks like some
+improvements have been made.
+ Now, given the improvement you spoke of, it seems to me a
+signal improvement in your testimony. You nevertheless have a
+real mop-up job to do here, and therefore I am really
+interested in corrective efforts. My question really goes to
+part of, I guess, Mr. Kutz' testimony where he says we need
+advocates. I am sorry, this is General Byrne's testimony. He
+says we need advocates other than the Inspector General for our
+RC soldiers who can break down the perceived and real barriers.
+ I wish you would explain what you mean. It certainly is
+true that you have to go all the way to that high level, a
+pretty nuclear level to get problems dealt with. I wonder what
+you have in mind, what kind of--are you talking about some kind
+of ombudsman, some kind of better troubleshooting? Does what we
+have heard from Mr. Shuttleworth take care of it in terms of
+the support you would need other than the advocate general in
+order to get these problems dealt with?
+ General Byrne. Ms. Norton, I will go ahead and start it,
+and then I would like Dr. Eliason. Essentially, what I would be
+looking at is some sort of form of an ombudsman, someone who
+knows the system, who can take the part of the soldier. For
+example, in the process each of the soldiers is given a case
+worker, but the case worker doesn't necessarily work for the
+soldier, it works for the system in working through getting the
+soldiers to the end of the process, the medical process. So
+they are not neutral necessarily or for the soldier, and so as
+a soldier does go through the process they are not familiar
+with the process.
+ Now, what we have done in Oregon is periodically we send
+our medical personnel plus our administrative personnel papers
+now up to the various places we have soldiers all across the
+Nation, and they go through and they assist them in any pay,
+personnel actions, and in some cases any medical actions that
+they can assist in.
+ Let me turn it over to Colonel Eliason. He can better
+explain.
+ Colonel Eliason. The uncertainty of medicine causes concern
+for our soldiers. When I as a private physician am asked by a
+soldier for my medical opinion, there is a relationship built
+on trust that has happened because they have selected me. They
+have come to me to be their doctor. They know that they have
+choices, that they can go and get second opinions, they can ask
+other physicians. Our soldiers, when they become injured----
+ Ms. Norton. You said they can get second opinions, although
+that was one of the areas that Mr. Kutz' testimony said raised
+issues for members of the Reserve and Guard.
+ Colonel Eliason. Yes, ma'am. I guess what I was trying to
+highlight is that the uncertainty happens frequently because of
+the fact that you will hear two separate stories, not because
+one system has better medicine than the other, but because of
+the fact that there is uncertainty and that different treatment
+plans vary based on different physicians.
+ The problem is our soldiers are looked at. When they arrive
+at a medical facility they see a green-suit doctor who is the
+company doctor, the Army doctor. They don't always see this as
+their physician, a person they can trust and establish that
+kind of relationship. What advocacy is about is somebody who
+can help break down those barriers and explain the uncertainty
+in medicine, explain and advocate for the soldier, maybe even
+attend an appointment with them to settle a misunderstanding
+about their treatment plan.
+ As General Byrne has said earlier, the Sergeant General has
+wonderful indicators of the quality of care that he provides in
+the system. The problem is our soldiers often begin with an
+element of distrust or at least concern about what health care
+they can receive, and this is their physician telling them that
+they need surgery or that it is better not to have surgery and
+maybe physical therapy first.
+ Chairman Tom Davis. Thank you very much. I am going to
+take----
+ Ms. Norton. Mr. Shuttleworth had----
+ Chairman Tom Davis. Did you want to say anything, Mr.
+Shuttleworth, on that?
+ CWO Shuttleworth. No, sir.
+ Chairman Tom Davis. OK. I will take my 5 minutes. It looks
+to me like what we have, gentlemen, is a breakdown in the chain
+of command. I mean, it is very clear here that this is
+absolutely broken, and when people who are in the system tried
+to move forward and tried to be advocates they were ostracized,
+they were slapped down. We heard this from Sergeant Forney's
+testimony.
+ Maybe a designated ombudsman whose job it is to get to the
+bottom of this and that is their job and nobody questions them
+is something that you need. We had people who tried to step up
+to that role, but the system tended to swallow them.
+ You have so many different stovepipes in the military right
+now, so many chair fights, so we are not getting the
+information sharing back and forth. This has taken 30, 40 years
+to get it this way. Everybody wants to do it their own way.
+They want their own legacy system. They want this or that. We
+come into a war at this point and we can't put it together, and
+these people, these soldiers who are on the front lines taking
+fire, some of them killed, some of them injured coming back, we
+have a system that has been so turf driven that it is beyond
+the power of one or two people to fix.
+ One of the purposes of this committee is to try to get
+Government to work as a unit. We don't have the jurisdiction of
+a lot of the other authorizing committees. We try to work
+across those lines to make it work. This is just an indication
+with some very sad consequences, and I think, from the
+perspective from the Department of Defense, some very
+embarrassing consequences of what has happened with years and
+years and years of these systems that are jealously guarded,
+that are stovepipes, that are not communicating with other
+systems, and the people that fall through the cracks.
+ It gets so regulation driven at this point we forget about
+the mission, which is getting these people back on their feet,
+getting them the health care that they have earned, that they
+deserve, and getting them back out in society. It is
+embarrassing for all of us.
+ Yes, I think there will be some appropriate followup action
+on this. The Armed Services Committee is also very, very
+concerned about this. But if these gentlemen hadn't taken their
+initiative to come forward--and we asked them to come. We asked
+them to come here. We begged them to come here. Nobody wants to
+embarrass anybody, but it wouldn't get fixed. We have more and
+more people in queue. I think people are trying to make it
+better, but I am not sure this isn't so stovepipe driven at
+this point it becomes more and more difficult all the time.
+ General Byrne, can you give me some examples of some
+specific problems soldiers encountered during their time at
+Fort Lewis? And also you made the statement about these
+soldiers were of no concern of yours, which is a typical
+stovepipe answer that now they are under Army care and you guys
+back out. It is the typical turf fight. Who said that?
+ General Byrne. I would rather not say.
+ Chairman Tom Davis. I know you wouldn't, but I am asking
+you who said it at this point. Do you want to get with the
+committee later on? You know, it is not what ought to be
+happening. You agree with that, don't you?
+ General Byrne. Yes, sir.
+ Chairman Tom Davis. I mean, somebody has to be accountable
+somewhere when they are saying this kind of stuff, so I am not
+going to ask you to say anything but we are going to ask you
+afterwards. Will you help us? Because this should not be
+allowed to continue, and the person who said that needs an
+attitude adjustment.
+ Go ahead, though. Tell me some of the problems.
+ General Byrne. What concerned me, just to followup on that,
+the conversation I had with the individual, what concerned me
+most in the conversation was the fact that nowhere in our
+conversation did taking care of soldiers come up. It was the
+fact that there was a newspaper article that had been
+published, the fact that potentially I was not following
+procedures as far as how we went and did business. As a result
+of maybe a news article that came out, my intent was not to
+raise major issues, was not to----
+ Chairman Tom Davis. Of course not.
+ General Byrne [continuing]. Embarrass anybody, was not to
+create major problems. My whole purpose in going to Fort Lewis
+in this case was to take care of soldiers. The way I run things
+in Oregon, and I hold my subordinates accountable for this, is
+I don't place blame. What is the problem? Let's put our effort
+and energy into taking care of the problem, the issue. That is
+the way I do business. And so I sometimes, when things get
+sidetracked, I get real excited and it bothers me.
+ Chairman Tom Davis. I think the statement is less
+reflective of the individual, I am afraid, and more reflective
+of the system.
+ General Byrne. I would agree.
+ Chairman Tom Davis. That is why I understand you don't want
+to come forward.
+ General Byrne. Yes.
+ Chairman Tom Davis. It probably is reflective of the
+system.
+ General Byrne. I can't speak to it. I can only speak to
+individuals.
+ Chairman Tom Davis. Yes.
+ General Byrne. Very similar to what the soldiers here today
+have talked about, very similar things related: pay issues,
+promotion issues. I own some of that, and part of the reason
+why I went to Fort Lewis was to find out what is--after I
+finished the visit I divided up my findings what I had. I
+divided it up into three parts: what is it that I owned? What
+is it that maybe the medical folks owned? And what is it that
+maybe the post owned? Then I sent that off to Fort Lewis, and
+then I sent my folks the piece that I had.
+ I deal with families, so any issues that were related to
+families and families not being taken care of I worked at.
+ Chairman Tom Davis. That is fine. I am glad somebody was
+looking after them at this point.
+ General Byrne. Well, I do.
+ Chairman Tom Davis. Right.
+ General Byrne. That is my job.
+ The second piece that I worked on was there are pay issues.
+Again, we need one system, one pay system, and at this point in
+time that is not there, but strides are being made, and so I
+own some of the pay issues that the soldiers have. I also own
+some of the personnel issues, for example, promotions and
+things like that, so I own those, too. But as services and
+similar instances that these soldiers have testified toward,
+those are things that I had concerns of, and then I turned
+those back over to Madigan Hospital.
+ Chairman Tom Davis. Right.
+ General Byrne. I would like to compliment Dr. Dunn, who is
+the commander at Madigan Hospital. When he knows the
+information, he works it hard.
+ Chairman Tom Davis. Thank you. My time is up, but let me
+just ask for Sergeant Allen and for Sergeant Perez and also to
+Mr. Shuttleworth and Forney, I mean, the two individual cases
+we heard about are not isolated cases, are they? Is that
+correct, Sergeant Forney?
+ Sergeant Forney. Right.
+ Chairman Tom Davis. Unfortunately, these are just two
+people. One, we had a long talk with Sergeant Allen, but he had
+a half dozen other people with him that had similar problems
+just over at Walter Reed, and this is just 1 day going through.
+Unfortunately, we are not taking one or two nit-picky
+instances. This is a problem that has been endemic throughout
+the system. Would you agree with that, Sergeant Allen?
+ Sergeant Allen. Yes, sir, I would. From the six injured
+soldiers from my unit, all six of us had significant pay
+problems, significant problems with our orders not being
+renewed in a timely manner. And from the other National Guard
+and Reserve soldiers that are at Walter Reed with me, they were
+having significant problems.
+ One of the caveats that I do want to add is there is a
+couple really good guys that were trying hard that were getting
+squashed, like Sergeant Forney.
+ Chairman Tom Davis. Yes.
+ Sergeant Allen. And Chief Shuttleworth and Chief Laura
+Lindle that was in my testimony, last month when I talked to
+you and I was having the pay problems and you read my testimony
+about the 23rd, well, that was due to Chief Shuttleworth and
+Laura Lindle. Hopefully now that he has gotten command of that
+structure, it is going to make a change for all these guys and
+we are not going to have what we have had.
+ Mr. Kutz. Mr. Chairman, I would say that we looked at this
+overall. We are talking about hundreds, possibly over 1,000
+soldiers that have had this type of problem, based on our
+overall look.
+ Chairman Tom Davis. Yes. And you don't think that is going
+to help recruiting and retention, do you, Mr. Kutz?
+ Mr. Kutz. That is an issue, because the soldiers that
+aren't injured are very well aware of what is happening to the
+injured soldiers.
+ Chairman Tom Davis. And they should be, frankly. I mean,
+this is just something that we weren't ready for.
+ Mr. Ruppersberger, 5 minutes.
+ Mr. Ruppersberger. Thank you, Mr. Chairman.
+ I have a whole list of questions, Mr. Chairman, I would
+like to leave with GAO and have written answers given back, but
+I have another hearing I have to go to at 12.
+ The one issue that I would like to talk about right now
+with respect to Walter Reed, I had one of my staff people go to
+a briefing this past Monday for the care that wounded soldiers
+currently were receiving at Walter Reed, and she left with the
+impression that even though there are still a lot of issues out
+there that we have discussed here today with respect to the
+Army and DOD and the problems from pay to care, but she left
+with the impression that a lot of the issues that we talked
+about here today, that Walter Reed has really resolved some of
+those problems.
+ Now, when you go to a briefing sometimes you only hear what
+the top people want you to hear. I want to make sure, to hear
+from you all whether or not--I guess you, Chief Shuttleworth--
+are there problems that still exist at Walter Reed? What are
+they? We have heard these problems today. If they are, let's
+talk about them.
+ CWO Shuttleworth. Obviously I can't speak for the medical
+care. That is a medical professionals' issue, but from the
+administration----
+ Mr. Ruppersberger. I am talking about paperwork issues,
+which is what you testified to.
+ CWO Shuttleworth. From a personnel/administrative
+standpoint----
+ Mr. Ruppersberger. Right.
+ CWO Shuttleworth [continuing]. As far as soldiers dropping
+off orders and dropping out of pay, I believe that we have
+fixed that problem. There are still some accountability issues
+within the system that we are still trying to get our hands
+wrapped around, but I believe that we have about a 99 percent
+accountability of those Reserve Component soldiers that we
+didn't have before. So we are improving the process. We may not
+be there yet, but we are about 90 percent there.
+ Mr. Ruppersberger. OK. Well, in my opening statement I
+talked about a bill that we are still attempting to work. I
+really would like to meet with you and maybe Sergeant Forney to
+get further information.
+ Just one question, though. You say the paperwork system
+seems to be doing better. That is why we are here. That is why
+we want to move forward. How about the system entirely, not
+just Walter Reed? Do you have any knowledge of other problems
+that are out there? Since Walter Reed has gone a long way in
+relation to paperwork, that should be a model for the other
+areas.
+ CWO Shuttleworth. Well, the good news is that when we fixed
+the system we didn't just fix Walter Reed. We looked at
+everybody. So when we started fixing the program, we fixed the
+entire program. When we developed the MRP process, it was for
+the entire Army and not because of what was happening at Walter
+Reed at the time. So we really have wrapped our arms around the
+whole thing, and the whole thing is being fixed at the same
+time, rather than one piece at a time.
+ Mr. Ruppersberger. You feel it is beyond just Walter Reed
+then?
+ CWO Shuttleworth. It was, yes.
+ Mr. Ruppersberger. Mr. Kutz, the questions that I am going
+to present to you are questions about solving the problem, I
+mean, our whole system, the priority of funding, our technology
+and how we are using it. One of the things, it seems to me, the
+problem is that it all starts at the top, and upper-level
+management has to hold middle-level management accountable for
+the follow-through and it just hasn't happened. That was your
+testimony all day through. We have to start at the top, see
+what the system is, make sure the resources are given, and hold
+the people accountable so that this will not happen.
+ Thank you all for being here to day.
+ Chairman Tom Davis. Thank you.
+ Mrs. Miller.
+ Mrs. Miller. Thank you, Mr. Chairman. First of all, Mr.
+Chairman, let me thank you for holding this hearing today and
+all of these witnesses for coming here. This is an unbelievable
+issue. I shouldn't say unbelievable. I suppose we should be
+shocked by some of the testimony, but unfortunately we are not.
+We do recognize that this is a problem, perhaps a manifestation
+of the high degree of the amount of people, Guard and Reserve,
+that we have as a component of the total force in today's world
+and today's military.
+ But, you know, at a time when our country is successfully
+prosecuting the war on terror, at a time I think when our
+country is needing to be so focused on recruitment and
+retention and these kinds of things, the testimony that we have
+heard today is certainly distressing. It does call for action
+by the Congress, by the DOD, and, as the chairman has said,
+that is something that our committee I think can very much be a
+conduit of as we investigate some of these different
+situations.
+ I have a question for General Byrne. Let me preface the
+question by telling you a bit. In my particular Congressional
+District we have what is known as Selfridge Air National Guard
+Base, which is a unique kind of facility in the inventory of
+the Guard, as you know. It is unusual, the exception rather
+than the rule, that the Guard would actually own a base, own
+the real estate. They do. Normally they are an appendage off of
+a commercial airport or something, and of course the armories.
+We have all of that also.
+ But we have at this particular base every facet of the
+military represented there, not only the Air Guard, but the Air
+Force Reserve, the Marines, the Navy. It is not only a critical
+component in the recruitment in an urban area, of course, but
+it has been a major deployment area as we are in theater here
+for the Guard and Reserve forces. In fact, my husband, after
+having served as a fighter pilot in Viet Nam in the Air Force,
+finished his military career as a Air Reserve, Michigan Air
+National Guard Reserve officer. He was the base commander
+there.
+ I will tell you one of my other committee assignments is
+also serving on the House Armed Services Committee, and so, as
+the chairman has said, our committee also has been looking at
+some of these kinds of problems.
+ To the extent that in our last Defense authorization,
+reauthorization bill, we actually titled it ``2004, the Year of
+the Troops.'' With all of the tremendous expenditures our
+country does make on armaments and various systems, there is no
+second, obviously, for our troops. So we were very pleased to
+have as a component of the Defense Reauthorization Act a real
+emphasis on creating parity for the Guard and Reserve to the
+active duty. As one of you mentioned, the bullet doesn't know
+if it is hitting an active duty or a Guard or Reserve. I think
+that was you, Sergeant Allen. That is so true.
+ We have had, I won't say huge strides, but we made a lot of
+improvements last year in having parity, I think, between the
+active duty and the Guard and Reserve, not only with pay, but
+with commissary privileges. One of you mentioned about
+commissary privileges. As you know, previously you could only
+go once a month, which is crazy. Actually having parity with
+all of this is so important, as well.
+ And, of course, as we mentioned, now if you go and look in
+theater, in the high 30 percentile is the component you will
+find of our Guard and Reserve, whether you are in Iraq,
+Afghanistan, Uzbekistan, what have you. Many of the Guard and
+Reserve, unfortunately perhaps maybe for them, have such a
+tremendous skill set that they are called for longer
+deployments, depending on what the mission is there. We are
+finding that those kinds of things are happening with extended
+tours.
+ That is a sort of long lead-up to the question, General,
+but I actually have a unit coming home to our base tomorrow, I
+believe, that has had some similar instances that you have
+articulated a little bit in your testimony, as well, to some of
+your Reserve units. It is a group that actually--there was also
+a newspaper article about them. They process through Fort
+Bliss.
+ We actually had called the processing personnel from our
+office and said we were going to send a person down there to
+make sure that these Guard and Reserve, as they were coming
+back home, that their needs were being met, etc., and that we
+weren't absolutely convinced because they had a bad experience
+as they began their deployment, quite frankly, not having--I
+won't go into all the details, but similar to what you have
+found with some of your units, perhaps, in Oregon there.
+ I would ask you, General, do you think that the respective
+adjutant generals--my adjutant general for Michigan is General
+Tom Cutler. Now, he is a blue-suiter. I hope you won't hold
+that against him. But is it possible for the adjutant generals,
+as we are calling on all of our Guard and Reserve forces in the
+universe or in the Nation to do more, is it possible for the
+adjutant generals to have a more forceful role perhaps as a
+fraternity in making sure that their units--and I also
+appreciate the chairman's comments, which you said you were
+told that your troops were no longer a concern of yours now
+that they weren't active duty and how outrageous that comment
+actually is.
+ How can the adjutant generals perhaps be a more effective
+conduit to making sure that as your units are called up, as
+they begin deployment, as they are processed into theater and
+then all the way through their deployment and coming home, is
+there something else that the AGs could do or that Congress
+could help you to do?
+ General Byrne. I am sure that each of the adjutant generals
+takes a very profound interest in deploying and redeploying
+their units, whether they are Army or National Guard, Air
+Force. I know that they advocate for their personnel. Also,
+there is an organization, the Adjutant General Association of
+the United States, which also collects commonalities and works
+through those. I know that organization works very hard to
+develop agendas and items related to deployment and re-
+deployment. So we do work it.
+ Mrs. Miller. I mean, I think you have to. I am sure that
+every AG across the Nation shares your consternation, if they
+are getting those kinds of answers. My adjutant general has
+never mentioned anything quite like that, but there is a
+different culture, I think, and so I wondered about that.
+ Thank you. And thank you, Mr. Chairman.
+ Chairman Tom Davis. Thank you very much.
+ Mr. Shays.
+ Mr. Shays. General Byrne, you provided a list of 84 of your
+soldiers that are now in medical hold status. Of the 84, 73
+have been in longer than the current reported Army standard of
+67 days, 35 of them have been in longer than 6 months. Is this
+the standard you have found?
+ General Byrne. I would like to let Dr. Eliason answer the
+question. This is his area. He follows a lot better.
+ Mr. Shays. Sure. I thought all you were going to say is no.
+ Colonel Eliason. Well, sir, I can't speak to the Army
+standard. When soldiers are put in medical holdover, under the
+MRP processing there is supposed to be a determination made
+relatively early whether they can eventually return to theater,
+which I suspect is where the 67-day rule is.
+ Our major concern is getting our soldiers home. What we
+would like and what we have asked and, quite frankly, what has
+improved markedly in the last year is getting them into
+programs like community based health care organizations. Their
+length of treatment is their length of treatment. People heal
+as they heal. But the sooner we get them home, we believe they
+are going to heal better, and so that is our push--as rapidly
+as possible getting them returned to their State for care,
+where they are living in their own home with their family and
+their support system around them.
+ Mr. Shays. That is your answer?
+ Colonel Eliason. Yes, sir.
+ Mr. Shays. Well, frankly, this is an old story, and it is
+shocking except it is an old story, which kind of makes it even
+more shocking. I am pretty convinced that in Congress we have
+tried to put enough focus on this to embarrass a solution, and
+yet that doesn't seem to work. So I am somewhat lost for why
+this continues to persist, and I am just wondering if any of
+you could suggest to me why it continues to persist.
+ I would like, Mr. Kutz, for you to tell me why you think it
+persists.
+ Mr. Kutz. You are talking about the Medical Board process?
+I am not familiar with that, so I can't really comment on that.
+I mean, we heard from the soldiers that we talked to that had
+the MRP problems and the medical extension problems that they
+were in hold waiting for the Medical Boards for hundreds of
+days in some cases, and that is about all the knowledge that I
+would have on that.
+ Sergeant Allen. Sergeant Allen, sir. I think it is a
+serious lack of leadership ability in the mid-level command.
+People aren't willing to step up to the plate and just do what
+is necessary. If something is identified that is wrong, then it
+needs to go away. What has perplexed me this whole time living
+this nightmare is how could something be so wrong and continue
+to go on and on and on and just keep perpetuating itself? It is
+generation after generation.
+ A perfect example, I just went to get my orders to out-
+process and they were wrong and they had me as a specialist in
+the Army. I talked to my friend that got out 2 months ago and I
+said, ``I can't believe this. I feel like I am the first guy to
+go through this.'' His name is Ryan Kelly, and he said, ``Well,
+that is funny, because I thought I was the first guy 2 months
+ago to go through it.'' And so I think it is a serious lack of
+people just stepping up to the plate and coming up with a
+solution. I think if somebody can come up with a solution, then
+it would be implemented and there wouldn't be the problem.
+ Mr. Shays. See, usually what happens in something like
+this, when Congress decides that we are going to conduct a
+hearing on it, it is such a shameful thing that people start to
+take action. Sometimes the problem is resolved before we even
+have a hearing. In this case, this is not the first hearing and
+the problem continues. That is what I find, frankly, a bit
+discouraging. It clearly has to be the stovepipe nature of it,
+and no one taking responsibility.
+ Sergeant Allen. To add to that, sir, some very senior high
+people in DOD and the Army have been trying to help us, the
+guys that aren't getting paid, aren't getting orders. I mean,
+the one-star, two-star, three-star generals, people over at
+DOD, and you would think that would encourage things to be
+changed, but there again, you know, it is got to be in the mid-
+command level of the philosophy, command philosophy as a whole,
+which is what I put in my testimony, that people, they don't
+take the time to care.
+ Mr. Shays. My conclusion is it is just not a priority of
+DOD. That is the only conclusion I can get.
+ If I told my Dad when I was young, ``Well, I forgot,'' he
+would say to me, ``If I gave you $100, you wouldn't have
+forgotten.'' It was a clear message to me. In other words, if
+it had been a priority, I wouldn't have forgotten. And in the
+case of DOD, this has been a longstanding problem. We have too
+many of our Reservists and National Guard risking their lives,
+and they get treated like dirt. That is the bottom line.
+ Thank you, Mr. Chairman.
+ Chairman Tom Davis. Yes. Thank you very much.
+ Ms. Norton.
+ Ms. Norton. I just have two short questions. My colleague
+from Connecticut is pressing toward a remedy when he says why
+has this gone on so long, and I just want to understand what
+the testimony here has been with respect to remedy. Do I
+understand--and perhaps it was General Byrne--that you endorse
+the notion of some form of ombudsman attached to these
+companies that would perhaps do some of what, or at least bring
+to earlier attention some of what we have heard about in these
+work-around procedures I think that GAO reported where people
+are in an ad hoc business running around trying to straighten
+these out.
+ I am asking would an ombudsman help that. And I am also
+asking Officer Shuttleworth whether he would endorse the
+notion, whether it would help his work now that he says this
+has been centralized with him, to have an ombudsman connected
+to these holding companies.
+ First General Byrne.
+ General Byrne. Ms. Norton, yes, a neutral party, someone
+who is educated in the process that can, one, explain and, two,
+be an advocate for the individual as they go through the
+process.
+ Ms. Norton. Do you endorse that notion, Officer
+Shuttleworth?
+ CWO Shuttleworth. We can use all the help we can get. I
+will tell you that as far as the comment on the Medical Board
+process a while ago, understand that prior to September 11th
+the amount of Medical Boards that were pushed through for
+Reserve Component soldiers in a year was very low, sometimes
+not even 100. If you look at the statistics from prior to that,
+what happened--and the liaison offices for those medical
+facilities are staffed with civilian employees, and not very
+many of them, I will tell you, to work with the active Army
+soldiers that get hurt.
+ So after September 11th trying to push 400 and 500 boards
+through every 3 months or 4 months on a Guard or Reserve
+soldier is just overburdening the system. That is why there are
+in my testimony 80 NCOs out there at treatment facilities who
+have Guard and Reserve experience to help these soldiers with
+that.
+ So to have someone else out there helping us? Absolutely.
+We can use anything that we can get in order to get these
+soldiers through the system timely and fairly.
+ Ms. Norton. Mr. Chairman, I wouldn't want it to go
+unnoticed, because I think this comes out of the hearings you
+have held, the GAO report you ordered, not only the notion this
+notion of ombudsman is endorsed here, but also I would not want
+to go unnoticed what, again, Officer Shuttleworth said here
+today. I believe that has come out of your work in this
+hearing, where he announced that 2 days ago they centralized
+these concerns for processing in his branch, and therefore we
+are going to look to that person in charge now for improvements
+on the theory that it will help the process.
+ One final question. It was very compelling testimony about
+what we in civilian life call post traumatic problems or
+syndrome, very, very disturbing. I wonder whether somebody
+could tell me whether or not in this war and other wars that
+qualifies for disability or if it should qualify for
+disability.
+ CWO Shuttleworth. I believe that on the next panel there is
+a colonel from the Physical Disability Agency.
+ Ms. Norton. Thank you. I will ask them.
+ Chairman Tom Davis. Can I just say thank you to all of you.
+Sergeant Allen and Sergeant Perez, very, very compelling
+testimony. I think the Members were very moved by it. Let me
+thank your wives, who have had to stick through this thing.
+This has been a family issue for a long time, and we appreciate
+your loyalty. You are all heroes and heroines in my book.
+ To Mr. Shuttleworth and Sergeant Forney, you tried to be
+ombudsmen, but we have a system right now that just really
+doesn't embrace that concept. Maybe we ought to formalize it a
+little bit.
+ General Byrne, thank you for your continued concern for
+your troops there. I think what you have shown is that it is a
+systematic problem, just in terms of the troops go from you to
+the Federal system, the Federal system says, ``It is not your
+concern, it is ours,'' and then they don't take care of them. I
+mean, what are you supposed to do?
+ And Mr. Kutz, you laid the groundwork in your report, you
+and your team. We want to thank you for that. Hopefully we can
+limit the damage in the future because of what people have been
+able to come forward with today and testify to, so this is not
+in vain. It is important, and we appreciate it.
+ I will dismiss this panel and move on. We will take a 1-
+minute recess and move on to the next panel. Thank you very
+much.
+ [Recess.]
+ Chairman Tom Davis. We welcome our second panel. I want to
+thank them for taking the time from their schedules to come
+today.
+ We have Ms. Ellen Embrey, the Deputy Assistant Secretary of
+Defense for Employment Health from the U.S. Department of
+Defense; Daniel Denning, Principal Deputy Assistant Secretary
+of the Army for Manpower and Reserve; Lieutenant General
+Franklin Hagenbeck, the Deputy Chief of Staff, G-1, U.S. Army;
+Lieutenant General Kevin Kiley, M.D., U.S. Army Surgeon
+General; Major General Charles Wilson, Deputy Commander, U.S.
+Army Reserve Command; and Mr. Philip Sakowitz, who is the
+Deputy Director, U.S. Army Installation Management Agency.
+ It is our policy that all witnesses be sworn, so please
+rise with me and raise your right hands.
+ [Witnesses sworn.]
+ Chairman Tom Davis. Thank you very much for being with us
+today. I think you have heard the first panel and I think we
+agreed you wanted to go after the first panel, give them an
+opportunity to air some of the problems that we have
+encountered.
+ We have a 5-minute rule. We were a little lax on it in the
+first panel. We wanted to give some of the people just an
+opportunity to tell the whole story. We will try to ask you to
+be a little more accommodating of it.
+ We have votes that could come up at any time, and it is my
+intention, if votes come up, to move straight through the
+panel, and I will stay as long as I can and then let Ms. Norton
+finish with votes, give her questions, and then close the panel
+at that point and recess, if your time permits, until after
+votes, and then we would come back and the rest of us ask
+questions. Ms. Norton would be able to go ahead with her
+questions. We have done that before. Unfortunately, we are
+allowed to do this because Ms. Norton doesn't get a vote on the
+House floor, something that Mr. Shays and myself are trying to
+rectify. I just wanted to add that.
+ Ms. Embrey, we will start with you. Thank you for being
+with us.
+
+ STATEMENTS OF ELLEN EMBREY, DEPUTY ASSISTANT SECRETARY OF
+ DEFENSE FOR EMPLOYMENT HEALTH, DEPARTMENT OF DEFENSE; DANIEL
+ DENNING, ACTING ASSISTANT SECRETARY OF THE ARMY, MANPOWER AND
+ RESERVE AFFAIRS, ACCOMPANIED BY LIEUTENANT GENERAL ROGER
+ SCHULTZ, DIRECTOR, ARMY NATIONAL GUARD; LIEUTENANT GENERAL
+ FRANKLIN L. HAGENBECK, DEPUTY CHIEF OF STAFF, G-1, U.S. ARMY;
+ LIEUTENANT GENERAL KEVIN C. KILEY, M.D., U.S. ARMY SURGEON
+ GENERAL; MAJOR GENERAL CHARLES WILSON, DEPUTY COMMANDER, U.S.
+ ARMY RESERVE COMMAND; AND PHILIP E. SAKOWITZ, JR., DEPUTY
+ DIRECTOR, U.S. ARMY INSTALLATIONS MANAGEMENT AGENCY
+
+ STATEMENT OF ELLEN EMBREY
+
+ Ms. Embrey. Thank you, Mr. Chairman and distinguished
+members of this committee. I appreciate the opportunity to talk
+today about the force health protection programs in the
+Department and how they impact the care that we provide to
+wounded service members. I want to reiterate that the
+Department is firmly committed to protecting the health of our
+active and Reserve Component members before deployment, while
+they are deployed, and, of course, upon their return.
+ I am pleased to join my colleagues today on this panel to
+address your specific concerns regarding the care for soldiers
+injured in Operations Enduring Freedom and Iraqi Freedom. Today
+I will outline the Department's current management practices,
+technological advances, and initiatives underway to address
+this very important issue, with a particular focus on the Army
+Reserve components.
+ With your permission, Mr. Chairman, I would like to submit
+my written testimony for the record and then just discuss----
+ Chairman Tom Davis. Let me note, everyone's entire written
+testimony is in the record and is a part of it, and questions
+will be based on the entire, so it will allow you 5 minutes to
+kind of accent what you want.
+ Thank you.
+ Ms. Embrey. Terrific. Thank you.
+ As you know, the global war on terrorism is the largest
+ongoing mobilization of the Reserve Component since World War
+II. In fact, since September 11, 2001, approximately 475,000
+Reserve Component members have been mobilized to support the
+global war on terrorism. Of those mobilized, 376,000, or
+roughly 79 percent, of the Army Reserve Component were
+mobilized.
+ Virtually all operations yield lessons learned, and our OIF
+and OEF experience has been no different. Early on we
+recognized that many rules and procedures that worked well for
+smaller mobilizations of shorter durations are very well
+unsuited for a large and prolonged mobilization that we are
+currently experiencing in OIF and OEF.
+ The Department and the services recognized these shortfalls
+and undertook several initiatives over the last 2 years to
+improve the medical readiness of the force overall and the
+Reserve Components in particular. These include: establishing a
+deployment health quality assurance program, establishing
+individual medical readiness standards for the total force,
+refining and expanding the post-deployment health assessment
+screening processes, establishing ability to capture
+electronically the pre- and post-deployment assessment
+information so that it could be used by medical professionals
+later on. And finally, since November 2003 we have routinely
+monitored and reported to the Secretary of Defense and the
+Under-Secretary for personnel and readiness the status of
+service members in a medical hold status.
+ The Army, with the majority of the total mobilized force,
+has taken very seriously its responsibility to provide world
+class care to the Army's sick and injured combat veterans. They
+recently have taken several initiatives to enable the Reserve
+Component soldiers in the medical hold status to receive
+treatment and recuperate at or near their homes when
+appropriate care is available locally.
+ These ongoing efforts have resulted in significant
+improvements, but we recognize that there is still much work to
+do. We are exploring new initiatives to further enhance medical
+readiness and to ensure timely and effective care of
+deployment-related illnesses and injuries. These include:
+establishing a standard annual periodic health assessment
+program applicable to the total force; working with the VA to
+identify better ways to leverage specialty care capabilities
+that they have to support our service members' needs,
+especially for Reservists; investigating options to enhance
+awareness of the health status of Reserve Component members
+over time. We do not have access to their health records as
+civilians, only when they are under our care. And, last, we are
+also working with VA to access medical records of the Reserve
+Component members, help VA get access to those records while
+they are continuing their service to us.
+ I would like to also add that we are working to streamline
+the cumbersome line of duty determination process that the
+Reserve Component members have to go through in order to access
+care for illnesses and injury, so we will be working on that.
+ Mr. Chairman and members of the committee, I thank you for
+the opportunity to be here, and I defer to the other members of
+my panel to address their particular issues.
+ [The prepared statement of Ms. Embrey follows:]
+
+ [GRAPHIC] [TIFF OMITTED] T0085.096
+
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+
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+
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+
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+
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+
+ [GRAPHIC] [TIFF OMITTED] T0085.107
+
+ [GRAPHIC] [TIFF OMITTED] T0085.108
+
+ [GRAPHIC] [TIFF OMITTED] T0085.109
+
+ Chairman Tom Davis. Thank you very much.
+ Dr. Denning.
+
+ STATEMENT OF DANIEL DENNING
+
+ Mr. Denning. Mr. Chairman, members of the committee, I am
+Dan Denning, Acting Assistant Secretary of the Army for
+Manpower and Reserve Affairs. To my left with me today are
+Lieutenant General Franklin Hagenbeck, Deputy Chief of Staff G-
+1; Lieutenant General Kevin Kiley, the Surgeon General of the
+U.S. Army; Major General Charles Wilson, Deputy Commander of
+the U.S. Army Reserve Command; and Mr. Philip Sakowitz, Deputy
+Director of the Installation Management Agency. Also with us
+today is Lieutenant General Roger Schultz, the Director of the
+Army National Guard.
+ Thank you for inviting us to discuss the medical holdover
+program. I would also like to thank panel one for their candor
+and for their obvious desire to improve the U.S. Army.
+ I would like to take a moment to introduce to the committee
+two more fine soldiers currently in the medical holdover
+program: Staff Sergeant Salvatore Cerniglia, who is an Army
+Reserve soldier from Florida who was wounded during a rocket
+propelled grenade attack in Iraq. He is assigned to the
+community based health care organization in Plant City, FL.
+This program allows him to reside at home and receive his
+medical care locally.
+ Sergeant Jamie Brown is an Indiana National Guard soldier--
+my home State--who has spent the past 15 months at Walter Reed
+Army Medical Center recovering from wounds he received from
+rocket fire during an ambush. In addition to his status as a
+medical holdover soldier receiving treatment, Sergeant Brown
+has actively assisted the medical holdover company by serving
+as an assistant platoon sergeant.
+ Could those soldiers just stand for a moment? You can see
+them in the back.
+ Chairman Tom Davis. Thank you very much for being with us.
+ Mr. Denning. As you know, the Army continues to face many
+challenges, including the global war on terrorism and the
+continuing operations in Iraq and Afghanistan. In all of this,
+the Army is absolutely committed to taking care of its soldiers
+and families and providing them the best possible health care.
+This is true regardless of whether a soldier is a member of the
+active Army or Reserve Components, and regardless of the nature
+of the soldier's injury or illness, whether it occurred in
+combat or in training.
+ The Army continues to intensively manage the health care
+and disposition of Reserve Component soldiers in a medical
+holdover status. My office provides oversight over the medical
+holdover operations and, along with forces command, the
+executive agent for this program, is engaged in monitoring
+effectiveness.
+ A system analysis and review team comprised of personnel
+from my office, from FORCECOM, from the Office of the Surgeon
+General, from Human Resources Command, and from the
+Installation Management Agency, has visited and assessed the
+operations at every installation managing medical holdover
+soldiers, and we plan to continue to actively monitor our
+performance in support of soldiers.
+ In late 2003, the large number of medical holdover soldiers
+at Fort Stewart and Fort Knox exceeded the capacity of the
+military infrastructure to adequately house and provide
+expeditious medical care management to soldiers assigned to
+these installations. Upon review, we realized this problem was
+not confined to just these installations and immediately
+embarked on a series of actions to address this unacceptable
+situation. In the interest of time today I am not going to
+cover those here. My colleagues will cover it in much more
+detail later.
+ Rotation of forces for Operation Iraqi Freedom and
+Operation Enduring Freedom is expected to significantly
+increase the total medical holdover population in the coming
+months. We have taken precautionary actions to ensure this
+surge will not exceed medical command's medical support
+capacity during the third quarter of 2005.
+ One of the key initiatives we are currently executing will
+increase our medical support capacity and expand the Army's
+commitment to taking care of soldiers. This is the community
+based health care initiative. It began as a way of providing
+high quality care to Army Guard and Reserve soldiers near their
+homes while maintaining administrative control and relieving
+pressure on Army medical facilities at power projection
+platforms.
+ It has also proved itself as a means of providing a way for
+the Army to meet its obligation to provide quality health care
+for Reserve soldiers who require protracted treatment to
+achieve full recovery from their injuries and illnesses and to
+allow Reserve soldiers who are medically able to live at or
+near their homes and families, and finally to leverage sister
+services, VA and civilian health care assets.
+ I can state without reservation that the community health
+care initiative has been an unqualified success for soldiers,
+their families, and for the Army. It has evolved into an
+innovative program designed to manage the prolonged health care
+treatment needed by some Reserve Component soldiers in order
+for them to fully recover.
+ The community health care initiative ensures that the same
+high standard of care we require for all soldiers is met while
+effectively managing their health care and recovery. It helps
+alleviate stress caused by the separation of soldiers from
+their families by allowing many to reside at home during
+treatment and recovery.
+ The original five community based health care organization
+sites managing health care delivery to soldiers in some 23
+States is expanding this month with the addition of Alabama,
+Virginia, and Utah, and with three satellite operations in
+Hawaii, Puerto Rico, and Alaska. These additions, plus
+increases in capacity at our existing five sites, will provide
+for 50-State coverage.
+ We will continue to work closely with FORCECOM, the
+Installation Management Agency, Office of the Surgeon General,
+and the Army G-1 to assist in the prompt return to duty or
+release from active duty of our dedicated soldiers who serve
+our country.
+ Thank you.
+ [The prepared statement of Mr. Denning follows:]
+
+ [GRAPHIC] [TIFF OMITTED] T0085.110
+
+ [GRAPHIC] [TIFF OMITTED] T0085.111
+
+ [GRAPHIC] [TIFF OMITTED] T0085.112
+
+ [GRAPHIC] [TIFF OMITTED] T0085.113
+
+ [GRAPHIC] [TIFF OMITTED] T0085.114
+
+ [GRAPHIC] [TIFF OMITTED] T0085.115
+
+ [GRAPHIC] [TIFF OMITTED] T0085.116
+
+ Chairman Tom Davis. Thank you very much.
+ General Hagenbeck.
+
+ STATEMENT OF LIEUTENANT GENERAL FRANKLIN L. HAGENBECK
+
+ General Hagenbeck. Mr. Chairman and members of the
+committee, it is a great opportunity and I appreciate being
+invited here this afternoon to talk about this very important
+topic. It is essential for the Army in both maintaining the
+morale and the welfare of our soldiers who serve this grateful
+Nation.
+ As you know, the Army will continue to be deployed
+worldwide. We currently have 640,000 soldiers serving on active
+duty, and of those, 315,000 soldiers are deployed for overseas
+in over 120 different countries. These soldiers are from all
+the components, active duty, 155,000, our Army National Guard,
+113,000, our Army Reserve, 47,000. Even with this expansive
+rotation of troops, the soldier remains the centerpiece of the
+Army formations, and as such it is the Army's pledge to remain
+dedicated to the well-being of the soldiers and their families.
+ Since the beginning of the global war on terrorism, we have
+witnessed the largest mobilization of the Reserve Component
+since World War II. The exemplary performance of the Guard and
+Reserve soldiers alongside that of the active component is
+testimony that we are, indeed, one Army, an Army whose
+components explicitly link and complement each other. I know
+our Nation is very proud of the performance of our Guard and
+Reserve folks, and you have seen them firsthand both at home
+and on these contingency missions, and I know that you are as
+equally proud of them.
+ These soldiers deserve our continued commitment to training
+them to do their jobs and taking care of them and their
+families throughout their association with the Army. This
+includes providing the best care available to soldiers who
+become injured or ill in the line of duty while serving our
+country.
+ Though this effort has not been without challenge, we
+continue to improve our processes and strive to deliver
+compassionate and timely care to the medical holdover soldier.
+The soldiers reporting to mobilization stations and returning
+from the theater to the evacuation chain or demobilizing, the
+medical holdover population grew quickly. In the midst of
+supporting the war fight, we realized that existing MHO policy
+and infrastructure were inadequate, and we immediately embarked
+on a series of corrective actions.
+ As the G-1, I am the proponent for the active duty medical
+extension program and am responsible for its implementation,
+policy execution, and program management. The medical retention
+processing program is an Assistant Secretary of the Army
+Manpower and Reserves policy, but I am responsible for its
+implementation of guidance and the execution of the policy. And
+the medical retention processing two program is also Acting
+Secretary Denning's program. It is still being staffed for
+approval, but upon that process being concluded I will be
+responsible for its implementation, guidance, and execution of
+the policy once the program, as I mentioned, is finally
+approved.
+ Today we are processing large numbers of soldiers with
+disabilities, the likes of which we haven't experienced in over
+30 years. In 2004 we processed approximately 15,000 disability
+cases, nearly a 50 percent increase from the number of cases
+processed during the years before G-1. We are witnessing an
+even higher percent increase in the number of mobilized Army
+Guard and Reservists entering into the disability system, 134
+percent increase during fiscal year 2004.
+ Now, to meet this caseload we have added additional members
+to the three physical evaluation boards, we have increased the
+number of JAG officers assigned, we have created a mobile PEB,
+a three-member board that travels to each of the fixed PEB
+sites to augment their efforts there, and we placed liaison
+NCOs at each of the medical treatment facilities and at the
+Physical Disability Agency headquarters to assist in processing
+Reserve and National Guard cases.
+ These efforts have paid off. In June 2004 there were 900
+mobilized Reserve and National Guard cases pending PDA, and
+today that number has been reduced to 344. PDA still receives
+about 159 new mobilized Reserve and National Guard cases each
+month. While much has been accomplished, more needs to be done.
+Acting in concert with the U.S. Army Medical Command and the
+Installation Management Agency under the direction of the
+Assistant Secretary of the Army for Manpower and Reserve
+Affairs, the following initiatives are underway: Structuring a
+comprehensive reporting system that tracks the soldier as he or
+she is medically evacuated from the area of operations until
+returned to duty or separated or retired from the U.S. Army. A
+high priority, this task force will present its initial
+recommendations to the Director of the Army staff within the
+next 2 weeks.
+ Second, as part of the information gathering and sharing
+enterprise, we are working closely with the Department of
+Veterans Affairs and the Defense Finance Accounting Services to
+better coordinate the termination of military pay and the
+initiative of Veterans Administration payments. An important
+linkage to this process is access to the Reserve Component
+soldiers' personnel documents for the calculations of retired
+and severance pay, and efforts are ongoing to bring automation
+solutions to this process.
+ Through weekly reports, inspections, and personal visits,
+the Army is keeping a close watch on the processing of the
+soldiers through the PDE system. Though we have challenges
+ahead, I am confident that we are taking the right path, the
+right direction to do this.
+ I will tell you that I am personally committed. Sergeant
+Allen, who was on panel one, was serving with me in Afghanistan
+when he was injured. I have a son who is a Reserve officer in
+the U.S. Army Reserves who was deployed once to the Gulf and is
+alerted to do again. So beyond my professional interest in this
+I have a personal interest and responsibility, as well.
+ Thank you, ma'am.
+ [The prepared statement of Lieutenant General Hagenbeck
+follows:]
+
+[GRAPHIC] [TIFF OMITTED] T0085.117
+
+[GRAPHIC] [TIFF OMITTED] T0085.118
+
+[GRAPHIC] [TIFF OMITTED] T0085.119
+
+[GRAPHIC] [TIFF OMITTED] T0085.120
+
+[GRAPHIC] [TIFF OMITTED] T0085.121
+
+[GRAPHIC] [TIFF OMITTED] T0085.122
+
+[GRAPHIC] [TIFF OMITTED] T0085.123
+
+[GRAPHIC] [TIFF OMITTED] T0085.124
+
+[GRAPHIC] [TIFF OMITTED] T0085.125
+
+[GRAPHIC] [TIFF OMITTED] T0085.126
+
+ Ms. Norton [presiding]. Thank you, General.
+ Lieutenant General Kiley, 5 minutes.
+
+ STATEMENT OF LIEUTENANT GENERAL KEVIN C. KILEY, M.D.
+
+ General Kiley. Thank you, Mr. Chairman and distinguished
+members of the committee. I appreciate the opportunity to make
+a couple of opening comments.
+ I would like to start by echoing the comments of the rest
+of the panel in thanking the soldiers that sat on panel one for
+their courage, their honesty, and for helping us in the U.S.
+Army Medical Command and the rest of the Army to make this
+process better and more effective. We are very proud of those
+soldiers. Every one of them has put a uniform on and reported
+to the deployment station, and we feel that pride when we care
+for those soldiers upon their return from combat, either as
+injuries or as illnesses.
+ In that context, I think it is important to remember that,
+as has been stated, this is a medical support to a global war
+on terrorism that is not just about medical holdover soldiers
+but about casualty receiving and the deploying and re-deploying
+and demobilizing of large numbers of Reserve and National
+Guard.
+ I am very proud of the members of the U.S. Army Medical
+Command, of the larger AMED, active and Reserve, that have
+participated in and cared for these great soldiers in their
+time of need. We have processed over 16,000 soldiers through
+the medical holdover process, 9,000 of which we have returned
+to the Army fit and healthy, another 5,000 of which have
+successfully negotiated the MEB/PEB process. And in doing that
+we have learned a great amount about the PEB process, Reserve
+and National Guard policies, and our own operations at our
+installations and MTFs.
+ I am happy to answer any more of your questions either from
+these comments or from my written statement.
+ Thank you.
+ [The prepared statement of Lieutenant General Kiley
+follows:]
+
+[GRAPHIC] [TIFF OMITTED] T0085.127
+
+[GRAPHIC] [TIFF OMITTED] T0085.128
+
+[GRAPHIC] [TIFF OMITTED] T0085.129
+
+[GRAPHIC] [TIFF OMITTED] T0085.130
+
+[GRAPHIC] [TIFF OMITTED] T0085.131
+
+ Ms. Norton. Thank you very much, General Kiley.
+ Major General Wilson.
+
+ STATEMENT OF MAJOR GENERAL CHARLES WILSON
+
+ General Wilson. Chairman Davis, members of the committee, I
+am Major General Charles E. Wilson, Deputy Commanding General
+for the U.S. Army Reserve. Thank you for inviting me to appear
+before your committee to discuss the effectiveness of Army
+medical administrative and support processes and procedures
+that govern injured Army Reserve soldiers.
+ During the past months, the U.S. Army Reserve Command and
+its leadership has listened to the concerns of all of its
+soldiers, especially injured Army Reserve soldiers and their
+families. This command has explored ways to provide the best
+health care possible, to improve administrative processes for
+the soldiers and their family, before, during, and after
+mobilization.
+ Since we know the combat and commander need a force that is
+medically fit, ready, and responsive, the Army Reserve has
+placed greater stress and scrutiny on management of medical
+readiness. We have worked hard to update our policies and
+procedures to create efficiencies, to develop compassionate and
+effective strategies for supporting our soldiers and their
+families as they prepare for war, as they wage war, as they
+endure the separation and the worry and stress that accomplish
+this as a family unit.
+ We work hard on the return home to address the challenges
+and stress of family and community reintegration. Our solutions
+are still being realized and perfected. They remain very much a
+work in progress. You, as a committee, have been concerned and
+supportive during this very trying period. With your help, we
+will succeed in meeting our mission and also providing our Army
+family with all it needs and deserves as we serve our Nation at
+war.
+ Again, thank you for this opportunity to discuss the health
+care and well-being of our soldiers and their families. I will
+be happy to answer any questions that you may have.
+ Thank you.
+ [The prepared statement of Major General Wilson follows:]
+
+ [GRAPHIC] [TIFF OMITTED] T0085.132
+
+ [GRAPHIC] [TIFF OMITTED] T0085.133
+
+ [GRAPHIC] [TIFF OMITTED] T0085.134
+
+ [GRAPHIC] [TIFF OMITTED] T0085.135
+
+ [GRAPHIC] [TIFF OMITTED] T0085.136
+
+ [GRAPHIC] [TIFF OMITTED] T0085.137
+
+ Ms. Norton. Thank you very much, General Wilson.
+ Mr. Sakowitz.
+
+ STATEMENT OF PHILIP E. SAKOWITZ, JR.
+
+ Mr. Sakowitz. Mr. Chairman and members of the committee, I
+am Phil Sakowitz, the Deputy Director of the U.S. Army
+Installation Management Agency. I thank you for the opportunity
+to discuss our contribution to the medical holdover program.
+ On a daily basis we are responsible for the equitable,
+efficient, and effective management of installations worldwide,
+but we are particularly honored by our role in support of
+injured soldiers and their families. Our headquarters and
+region staffs, in close cooperation with Forces Command and the
+1st and 5th Armies, as well as the staffs of my fellow panel
+members, oversee our medical holdover effort. Together we
+monitor the current and projected medical holdover populations
+assigned to each installation to determine if current capacity
+levels for command and control and billeting are sufficient,
+and, if not, what steps we need to consider to mitigate the
+situation.
+ The Installation Management Agency has supported over 3,000
+injured Guard and Reserve soldiers in the medical holdover
+program at any one time at 36 installations in the continental
+United States, Alaska, Hawaii, and Puerto Rico. Our specific
+roles and responsibilities fall into three areas: command and
+control of medical holdover soldiers, billeting, and transition
+processings. Let me very quickly review these three areas of
+support.
+ Each installation with a significant medical holdover
+population now has a dedicated command and control unit called
+a medical retention processing unit. This unit is under the
+oversight of our garrison commander, who is ultimately
+responsible for the installation medical holdover program.
+These units are commanded by a commissioned officer and provide
+soldiers with leadership and basic administrative and
+logistical support. From the time the soldier is in-processed
+to the time the soldier is out-processed we ensure we address
+the soldier's needs. This ranges from daily requirements for
+food and shelter to assisting with legal assistance, religious
+support, and transportation to and from medical appointments.
+ The units work closely with the medical team to monitor the
+well-being of the soldier and track progress through the
+medical retention process. The bottom line: the basic
+responsibility of this unit is no different than any other--
+accomplishing their mission while caring for soldiers and
+families.
+ We also take our responsibility for billeting soldiers very
+seriously and continually improving their status. Today all
+medical holdover soldiers are provided with a safe, secure,
+climate controlled room with inside latrines and accommodations
+for their medical conditions as needed. This is the standard.
+To meet these standards, we house soldiers in on-post barracks.
+When that type of accommodation is not available, we use
+temporary relocatable buildings designated for medical holdover
+soldiers, or Army on-post transient lodging, or off-post
+hotels. Billeting medical soldiers is and continues to be a
+high priority.
+ Our last area of support is in transition processing, which
+is performed at each installation transition center. These
+centers process soldiers for retirement, return to Guard or
+Reserve status, or return to civilian life. The Army standard
+is to out-process these soldiers not later than 30 days after
+receipt of orders. To get there we added 24 support personnel
+across 13 key installations. However, we have not only met
+these standards but today our Installation Management Agency
+transition centers are out-processing soldiers in 16 days. This
+is a good news story and we are continuing to work to improve
+these times.
+ I want to assure the committee that the Installation
+Management Agency remains fully committed to support the
+medical holdover program.
+ Once again, thank you for the opportunity to address you,
+and I will answer any questions at this time.
+ [The prepared statement of Mr. Sakowitz follows:]
+
+ [GRAPHIC] [TIFF OMITTED] T0085.138
+
+ [GRAPHIC] [TIFF OMITTED] T0085.139
+
+ [GRAPHIC] [TIFF OMITTED] T0085.140
+
+ [GRAPHIC] [TIFF OMITTED] T0085.141
+
+ [GRAPHIC] [TIFF OMITTED] T0085.142
+
+ [GRAPHIC] [TIFF OMITTED] T0085.143
+
+ Chairman Tom Davis [presiding]. Let me start. You heard the
+testimony in the previous panel. I read an article in the
+``Orlando Sentinel'' on Sunday that tells of 15 wounded or
+injured Guardsmen who arrived at Fort Stewart, and they have
+been blocked from seeking medical treatment at home under the
+community based health care initiative that we have just heard
+touted here. An Army colonel in Army Forces Command in Atlanta
+states that the reason is a very complex budget and statutory
+problem all wrapped up in legalese.
+ I want to refer you to these three charts over here that
+display the offices involved, the medical administration
+process involved in the Guard and Reserve and the processes,
+themselves. I mean, it looks--I think I am pretty competent,
+guys, a lawyer, and I spent 8 years in the Guard, but it looks
+pretty complicated.
+ I mean, who is getting these people through these mazes? It
+is no wonder people are falling through right and left. I know
+everybody is trying, but we end up, instead of a mission driven
+Government here, just wrapped up in rules and regulations, and
+the result is what we see. In wartime, it has just almost been
+embarrassing. I think you all would agree to that. I think we
+are all trying to fix it.
+ I guess my first question is: what do we do for these 15
+people in Florida? And how did this all happen?
+ Dr. Denning, let me start with you.
+ Mr. Denning. Sir, my university would be happily surprised,
+I suppose, if I was really a doctor, but I am not.
+ Chairman Tom Davis. That is what it says on there.
+ Mr. Denning. I know. My Mom would appreciate it.
+ Chairman Tom Davis. Well, congratulations. We held a
+hearing on diploma mills a couple weeks ago. I can get you up
+there pretty quick for $15.
+ Mr. Denning. I may need to take you up on that.
+ Sir, I will give you an alibi, I guess, or plead guilty.
+No. 1, we have a medical system in my judgment and a set of
+processes that were sized for a peacetime Army and we are
+fighting a two-front war right now, indeed, a worldwide war,
+and it is loading our systems like they haven't been loaded
+since World War II.
+ Chairman Tom Davis. Correct.
+ Mr. Denning. No. 2, some of our processes were simply not
+designed to handle large numbers of mobilized soldiers. The
+ADME process you have heard about, for example, was designed to
+take care of soldiers injured during their 2 weeks of active
+duty a year. It took us, frankly, some time to realize the
+system was under strain and breaking, and it took those stories
+in late 2003 from Fort Stewart. But the Army really swung into
+motion there.
+ Are there the stories you heard this morning? Every one of
+them I am absolutely certain is true, and your heart goes out
+to those soldiers and their families. I think we have addressed
+these. That is why you heard about medical readiness
+processing. Those charts you have over there, it is a complex
+process. Caring for soldiers, managing their care, taking care
+of their finances, shifting them between the kinds of orders
+that the statutes require us to work under is a complex
+process. I think we have it about to the point now that it will
+work very well in the future.
+ Will there be problems? I am sure there will be some----
+ Chairman Tom Davis. I was in the Guard. I understand a
+little bit how it works. You call these soldiers up. They go
+into basically Federal service by going abroad, and at that
+point why don't they just stay on that payroll until they are
+discharged and sent back to their units? Once they come back
+and they are injured, you ought to just keep them and give them
+all the Federal benefits. What is so complicated about that?
+What am I missing here?
+ Mr. Denning. Well, first of all, sir, the soldiers are
+mobilized under partial mobilization authority, involuntarily
+mobilized, 12-302.
+ Chairman Tom Davis. I understand. I mean, we can make
+this--I was a lawyer. I understand how this stuff gets written.
+But once they are over there, they are fighting side by side in
+many cases----
+ Mr. Denning. Yes, sir.
+ Chairman Tom Davis [continuing]. With regular military
+personnel. I have been over to Iraq several times. I understand
+that you can't tell the difference, and certainly the enemy
+can't tell the difference when they are shooting at them or
+putting something on the side of the road. So why not, before
+they come back, if they are ready to go back to their unit that
+is easy; otherwise, just keep them under some kind of Federal
+purview where they get the commissary and they get the PX and
+they get the medical and everything else? Why is it so
+complicated?
+ Mr. Denning. Many soldiers, sir, when they are Med-Evac'ed,
+they stay on their mobilization orders. Their pay systems
+aren't affected. Their benefits aren't affected. Nothing
+changes. When we hit that 24-month brick wall--well, it could
+be up to 24 months. Many soldiers are called up for 18 months.
+It varies by unit. But once that soldier hits the extent of his
+original set of orders, he was placed then on ADME orders, and
+that is what we have resolved now. They are going to go on to--
+--
+ Chairman Tom Davis. But some of the people in charge of the
+ADME orders were telling people 30 and 60 days. They just took
+it on themselves, even though the law allows them to do longer.
+That was the testimony.
+ Mr. Denning. That is right, sir. That is what we have
+corrected. Soldiers will be put on for longer periods.
+ Chairman Tom Davis. Well, why would they do that? I mean,
+what is the rationale?
+ Mr. Denning. Well, sir, the ADME process, as I mentioned,
+was designed as a peacetime system for the Reserve Components,
+for soldiers injured during that 2 weeks of active duty every
+year. It was never envisioned as a system to take care of
+soldiers who required long-term medical care.
+ Chairman Tom Davis. What do you think about the idea--and I
+am asking all of you--about an ombudsman or case worker or
+somebody who that soldier can call and is the soldier's
+advocate instead of an advocate for ``the system?''
+ Mr. Denning. I am open to that. I think we have done a lot
+though with Installation Management Agency----
+ Chairman Tom Davis. Well, we have, but I hear--not
+according to the ``Orlando Sentinel.'' There are still people
+falling through the cracks as late as last Sunday. Everything
+is fine, but I am just saying at the end of the day it doesn't
+help that soldier to know that everybody is up there trying and
+that we are getting more people. Just having someone that they
+can call as their advocate, they shouldn't have to call my
+office or Ms. Norton's office, which is what they are doing and
+that is why we are here.
+ Mr. Denning. I understand, sir. We are open----
+ Chairman Tom Davis. How does everybody feel about an
+ombudsman in a case like that? Are we open to that when there
+is somebody in a situation like that? Assign them an advocate,
+somebody that can walk them through the maze and look out for
+them. These people have taken time away from their families,
+away from their jobs. They have interrupted their careers. Some
+of them come back in body bags.
+ Mr. Denning. Yes, sir.
+ Chairman Tom Davis. Some of them come back missing limbs.
+The least we could do is, when they come back, have somebody
+there that is going to advocate for them and get them the
+maximum the system allows. We owe them that.
+ Mr. Denning. We agree completely, sir. I thought--and I
+will let the other generals speak for themselves--when we set
+up the medical readiness processing units, that is what we
+expected of those platoon sergeants and those leaders in there,
+to assist those soldiers, if they encounter difficulties, to
+help them work through the maze.
+ Chairman Tom Davis. Well, let me ask another question while
+I have the brass up here. This is just a yes or no. Can we be
+assured there will be no retaliation against the people who
+testify here today?
+ Mr. Denning. Yes, sir.
+ General Hagenbeck. Absolutely.
+ Chairman Tom Davis. OK. Is that right?
+ General Kiley. Yes, sir.
+ General Wilson. Yes, sir.
+ Mr. Sakowitz. Yes, sir.
+ Chairman Tom Davis. They were very nervous. They did not
+want to come forward. They are very respectful of everything
+everybody is doing. If you heard, there is a frustration there.
+We really asked them to, because there is nothing like having
+the victim sit up there and tell the story. We are not trying
+to embarrass, but this is an ongoing problem and I think we all
+agree they deserve better, and I think it helps you act better
+when you see something like that and you are trying to move
+something through. You have to go through lawyers to get stuff
+done, too. You just can't wave a wand and make it happen.
+ I think hopefully we are helping you get this job done, as
+well.
+ Ms. Norton.
+ Mr. Sakowitz. Mr. Denning, did you want me to talk about--
+--
+ Chairman Tom Davis. Sure. Go ahead.
+ Mr. Sakowitz. Sir, what Mr. Denning was referring to is the
+medical retention processing unit, which is fairly new in the
+Army. When the soldiers first came back a couple of years ago
+we didn't even have an Installation Management Agency. Each
+installation decided how to handle their medical holdovers. Now
+we have a standard process with these units that is to do
+pretty much what you just said from an ombudsman standpoint.
+Now, sir, it is not one-to-one. We have established----
+ Chairman Tom Davis. Of course not.
+ Mr. Sakowitz. We have established a basic military
+structure, company structure. We have a commissioned officer
+with NCOs that we have now especially assigned, which we never
+had before, to handle those particular needs. Sir, there are
+going to be areas where we might miss one or something happens.
+ Chairman Tom Davis. Sure.
+ Mr. Sakowitz. But in general I would say at those sites
+with the significant medical holdover populations, these units
+who only do that job and are assigned for them and are, in
+fact, Reservists themselves, sir, who we have called up to
+handle this, could answer, I would say, most of the questions
+that you talk about from an ombudsman standpoint and are doing
+that.
+ Chairman Tom Davis. Let me ask General Wilson, General
+Helming has expressed deep concerns about the retention rate of
+Army Reservists, and recent reports confirm unmet recruitment
+goals. Do you think that the current administrative problems
+that we are seeing for the injured has contributed to this
+decline?
+ General Wilson. I can't directly attribute that
+specifically.
+ Chairman Tom Davis. It doesn't help though, obviously.
+ General Wilson. It doesn't help, and soldiers have, sir, as
+you are well aware, very strong, informal communication network
+that works very strongly on their behalf. But I think the
+continued force of our leadership to rectify these problems and
+to deal with these issues, more importantly than soldiers, the
+families and the wives have become a strong advocate and a very
+stringent questioning body and query body. So anything we can
+do to deal with the issues that the soldier faces will always
+help us in the area of recruitment and retention.
+ Chairman Tom Davis. I think the one thing in the first
+panel that caught me, in a couple of instances where you had--
+in one case you had the adjutant general from Oregon, in
+another case you had one of the sergeants that were assigned to
+Walter Reed trying to do things. Someone upstairs--and this
+didn't come from you. I don't think it is in the regulations,
+you know, ``Why are you rocking the boat,'' you know, basically
+saying, ``It is not your problem. Why are you rocking the boat?
+Why are you doing this?'' I understand how that occurs. But at
+the end of the day those kind of advocates really help make
+things go, and we need to get that word to you as quickly as
+possible. The faster the word that something has gone wrong
+gets to you, the better able you are to correct it.
+ I think it was in that vein that we called them forward
+today. Do you understand what I am saying? Nobody likes blowing
+a whistle. These guys would go back again if they were able to
+do it. They believe in the mission. They weren't here
+denouncing the administration or the President or anybody else.
+So I think we just need to work together on this, but we are
+going to continue to overlook it, because when you look up
+there and see a chart like this, I can just tell you things
+fall through. Maybe what we need to do is establish and work
+with you to make sure those advocates are in place and working
+and trained to get the right answers for these soldiers who
+deserve that.
+ Ms. Norton.
+ Ms. Norton. Thank you very much, Mr. Chairman.
+ I was very pleased to hear your response to the chairman's
+question about ombudsmen. Let me be clear what the word means,
+and then ask you about two examples. An ombudsman has his
+allegiance to the person, not to the system. One of the
+problems with the caseworker system is those people are, of
+course, caught between their obligation to the system, that is
+to the service, and to the service person, as well.
+ Do I understand you to say that an ombudsman--and, by the
+way, we don't mean one-to-one in the sense that it would be one
+person for every member of the service, but an ombudsman who
+would have a collection, a set of members. Do I understand your
+answer to the chairman's question to be that you endorse the
+notion of an ombudsman whose allegiance would be to the
+soldier, alone, who would be an advocate for the soldier, who
+might be, therefore, advocating to people within the system and
+not feel that he had responsibility for the system or could be
+penalized for pressing the case of the soldier?
+ And, of course, everybody who presses a case has common
+sense on when he has gone as far as he can. Can I understand
+whether you mean a soldier's advocate by the word
+``ombudsman,'' which is the general meaning of the term, not
+some caseworker type person within the system? Did everybody
+have that same understanding?
+ Mr. Denning. Ms. Norton, I indicated I am open to that
+idea. I think I would first like to investigate the limitations
+of the medical readiness processing units. As I indicated we
+have NCOs there who this is their job already.
+ Chairman Tom Davis. Would the gentlelady yield for just a
+second?
+ Ms. Norton. I would be glad to yield.
+ Chairman Tom Davis. I think the idea of an ombudsman--you
+can call them whatever you want, but for a soldier,
+particularly one who has been having trouble, whether it is
+getting paid, whether it is medical, there is still a whole
+series of problems. There ought to be a number they can call
+and a person that is assigned to look after them.
+ I am not talking about a gripe session. I am not talking
+about they didn't like their orders or they got KP too much. I
+am talking about something related specifically to organized
+benefits--pay, medicine. There ought to be a number and a
+person assigned, and sometimes that person may say, you are all
+wet on this. It is just not going to work.
+ But right now they go up through the chain of command, and
+that has just not seemed to work, simply because people in the
+chain have other activities as they see their mission, not that
+they are against the soldier, but they are trained to do other
+things, somebody who's trained to know all the ins and outs of
+the benefit structure, of the pay structure, of the problems
+that can occur, the orders not being cut in time, those kinds
+of things. That is all we are asking.
+ Obviously, we are not asking you to sign off on a blanket.
+The concept of that seems to me--I am talking about an injured
+soldier coming back from the war. There is a person that they
+can call on the ground if they have a problem.
+ One of the biggest problems we had here was they couldn't
+get orders cut. They didn't know where they were going to live.
+They didn't know what their families were going to do. They
+couldn't get leave. Do you understand what I am saying? That is
+what we are talking about.
+ General Hagenbeck. Sir, if I could, we have established
+that inside what we call our ``disabled soldier support
+system.'' It only involves right now about 260 soldiers, and
+those are most seriously wounded soldiers, those that have lost
+limbs, eyesight, have been paralyzed. We have set up an
+office--we have funded it last fiscal year with $4 million. I
+believe it is $7 million for this fiscal year--to be exactly
+what you described.
+ So I think we have taken the first step, and I think
+conceptually we are supportive of that, understanding that we
+never want to take away that responsibility that chain of
+command has, that first sergeant company commander that needs
+to work in concert. But we do agree that there has to be
+someone that soldier can go to to cut across the bureaucratic
+lines at some of these stovepipe organizations when he can't
+get resolution.
+ Chairman Tom Davis. And you agree that today, the couple of
+situations we heard, that would have helped a lot?
+ General Hagenbeck. Absolutely would have helped. Yes, sir.
+ Chairman Tom Davis. Yes.
+ Ms. Norton. And, of course, the command structure needs all
+the help it can get. I am sure they would be the last people to
+say that they wanted to handle these everyday, run-of-the-mill
+complaints rather than have it go to somebody whose job it was
+to followup.
+ I want to just test to see how this would work, because
+let's say that we have countless examples of relatives--wives,
+parents, members of the military who are not able to maneuver
+for themselves, call their Congressman. You really do not want
+Chairman Davis and I to be the advocate. I am sure that is the
+last advocate you need. But that is what happens.
+ Chairman Tom Davis. I am not sure they want to answer to
+you.
+ Ms. Norton. Exactly. So all we are saying about ombudsman
+is it is in your best interest, as well. But we are very
+worried about what happens to the relatives, because we are
+getting the same kind of terrible, horrific complaints from
+them, being on the phone for hours, being passed from one part
+of the Army to the next part of the Army.
+ I wonder if there is a, let's say even for these 200 or so,
+or for any others, if there is a central location or phone
+number where someone who is a relative of the Reserve or
+National Guard can call and get answers to the question about
+the treatment and the Army or about some of the issues that
+have been raised here so that this would not be passed on to
+the already anxious relatives of these members of the service
+to whom they turn when they are not able to get any answer
+themselves.
+ General Hagenbeck. If I could answer that initial question,
+we have established an 800 number for what we call ``DS3,''
+disabled soldier support system. So I think conceptually we
+know how to do that, I mean not just conceptually but in
+concrete terms. But, again we would need to----
+ Ms. Norton. That 800 number directs them to where?
+ General Hagenbeck. They have a case manager, exactly that,
+an ombudsman who then takes----
+ Ms. Norton. Don't call the case manager the ombudsman. We
+have had all kinds of problems with case managers.
+ General Hagenbeck. I am perhaps defining it differently
+than you, but the point is that is their go-to person by name
+and who they are. They keep a complete file on them and they
+are responsible for that soldier, and they are responsible for
+being their advocate, whether it is entry into the VA system,
+they are having problems medically, financially, or whatever it
+happens to be.
+ Ms. Norton. General Wilson, you had a response?
+ General Wilson. Yes. Given much like the Guard, most of our
+soldiers, the overwhelming majority comes from the community,
+itself. Between the Guard and the Reserve there are over 3,000
+local locations that soldiers are mobilized from. In our case,
+we have the Army one source, which is a 24-hour, 7-days-a-week,
+365-day telephonic or web-based source for dealing with the
+full range of issues, from medical and dental benefits,
+training and support to help readjustment and reintegration
+into civilian life and their jobs, reunion and marital
+reintegration with spouse, children, and personal social
+adjustment. The beauty of this program, it is one source. We
+publicize it in all of our family support and our rear
+detachment operation sites. With this program they have a
+benefit of receiving up to seven in-person consultations
+relevant to issues.
+ So the Army Reserve and I believe the Army National Guard,
+but I can't answer for sure with that, have the Army one source
+where they can go out and find this type of information or be
+referred to a specific source for support.
+ Ms. Norton. Thank you very much.
+ Ms. Embrey. Excuse me?
+ Ms. Norton. Yes, Secretary Embrey.
+ Ms. Embrey. I would like to also add that just 2 weeks ago
+we had a ribbon-cutting ceremony announcing a DOD-wide program
+for the severely injured joint support operations center, and
+the objective of that center is to provide 24/7 access to
+anyone who is unaware of the service specific program so they
+can get information about how to access and resolve their
+problems in navigating. It specifically is designed for the
+injured service member and their families.
+ We recognize this is an important emerging issue that
+sometimes information about what is available is not known to
+individuals at the ground level. This is a way in which to have
+DOD-wide access to get that information and to refer to the
+programs that are viable and active in each of the services.
+ Ms. Norton. You have to believe these soldiers have e-mail
+and voice mail. They know how to phone home when in trouble.
+ I have a very specific question, a concern I have about
+Walter Reed here in the District, where I am told that as of
+January of this year, just this past month, that soldiers being
+held there on medical hold are being compelled to pay for their
+own meals. I need to know if this is true. Enlisted soldiers
+apparently--again, according to the information I have been
+able to get hold of--get $267 in allowances per month to pay
+for meals.
+ At Walter Reed, after a soldier has returned from the
+battlefield, the cost would be $450 a month. I would like to
+know is it true that these soldiers on medical hold have to pay
+for their own meals that other soldiers receive free of charge?
+That is a pretty specific question and I need to know yes or no
+if that is the way it works.
+ General Kiley. Those medical hold soldiers that are in an
+outpatient status during basic allowance subsistence allowance
+are required, when they use the dining facility at Walter Reed,
+like all the other soldiers assigned to Walter Reed, both
+active duty and Reserve, are required to pay for their meals as
+they go through the food line. They have an option to go on
+separate rations, as I understand it, and give up that $280 a
+month of subsistence allowance, at which time their meals in
+the dining facility are free.
+ That is no different than any other hospital----
+ Ms. Norton. Wait a minute. Let me understand this. I
+thought that the $267 was for enlisted soldiers to pay for
+their meals, but that at Walter Reed that is not what you got.
+You had to pay for all three meals. Is that not the case?
+ General Kiley. If you are an outpatient. If you are an
+inpatient, you are not paying for your meals.
+ Ms. Norton. Of course.
+ General Kiley. But because if you are----
+ Ms. Norton. But you are in a hold company. You are trapped
+there.
+ General Kiley. If you are assigned to Walter Reed or if you
+are assigned to the medical holdover unit at Walter Reed in an
+outpatient status, then you are authorized to pay and
+privileges for a soldier that is not living in the barracks and
+having a mess hall to go to, a dining facility to go to. So
+under those circumstances, the Army gives those soldiers money
+to buy their meals at the dining facility, or to buy meals----
+ Ms. Norton. So they receive----
+ General Kiley [continuing]. Or Burger King or McDonald's.
+ Ms. Norton. So this soldier in medical hold receives how
+much money to buy his----
+ General Kiley. As far as I understand it, just like every
+other soldier on active duty who is not sick in hospital and
+not on a meal card, which is the Army's way to give them free
+meals--you either get a meal card and you don't get any monthly
+allotment and then you either eat at the mess hall with this
+meal card free, or you have to go find----
+ Ms. Norton. So they can get this meal card?
+ General Kiley. Yes, ma'am, that is my understanding. That
+is my understanding.
+ Ms. Norton. And then they could have three meals a day----
+ General Kiley. Free.
+ Ms. Norton. Free?
+ General Kiley. Yes, ma'am. But when they get the meal card
+they give up the monthly what is called subsistence allowance,
+the----
+ Ms. Norton. Wait a minute. The monthly subsistence
+allowance, that is not just for food?
+ General Kiley. Yes, ma'am. For food.
+ Ms. Norton. So they give up the whole thing then?
+ General Kiley. Well, they are getting three meals a day, 30
+days out of the month.
+ Ms. Norton. And they are living free of charge on the base,
+is that it?
+ General Kiley. Yes, ma'am. They are in the barracks or in
+the hotels.
+ Ms. Norton. I see. OK.
+ Could I ask you about the--we are interested particularly
+in equal treatment between the Guard, Reserve, and the enlisted
+members. As I understand it, for some of the active duty
+medical extension soldiers prior to this war, for example, in
+Bosnia, the way it works apparently is that some of the injured
+Army Reserve Component soldiers in prior wars like Bosnia used
+the active duty medical expense process, whereas for these
+soldiers you have to apply through the medical retention
+process. Why were they not allowed to use the active duty
+medical expense process, especially since some of the soldiers
+in Bosnia were allowed to do so?
+ General Kiley. If I understand----
+ Ms. Norton. Why isn't there a single system, in other
+words, no matter what theater of war you are in, you use the
+same process?
+ General Kiley. I think the key--and I could be corrected if
+I am wrong, but I think the key in this process, which is where
+the ADME process evolved from, started with soldiers that were
+injured during training. A medical assessment was made of the
+nature and extent of their injury, depending on the
+circumstances under which they were activated, and then a
+decision was made as to how long they would remain on ADME.
+ Even during Bosnia, the numbers of soldiers that flowed
+back to continental United States, Reserve and National Guard
+soldiers, was small enough that the administration of the ADME
+process, to include consultation with physicians repetitively,
+was robust enough to handle those relatively small numbers. I
+think what we experienced--and as you know I was at Walter Reed
+from 2002 to 2004 as a commander--the numbers just exploded on
+us.
+ And so, in attempting to follow the regulations and
+attempting to be good keepers of the faith, as it relates to
+the law and the regulations, we had to work through this very
+burdensome system, and hence we discovered, frankly, pretty
+early on that soldiers were dropping off. We were hearing this,
+frankly, at morning report at the hospital, and that hold knew
+about it. It was a function of coming to the realization that
+we needed to change the way we were doing business.
+ It took us a little while to do it, and I believe by the
+first of March we will have just about everybody off ADME. But
+that is just an older system that served us well when the
+numbers were real small under the circumstances we were
+operating under.
+ Ms. Norton. Mr. Denning.
+ Mr. Denning. Yes, ma'am. Since the fall of 2003 and the
+Fort Stewart incidents, we all at this table, particularly the
+Surgeon General, have worked--I think ``tirelessly'' may be too
+strong a word, but really hard to ensure that the AC soldiers
+and the RC soldiers were treated absolutely the same, that
+there was no discrimination. In fact, I can sit here before you
+today and tell you that the RC soldiers are treated at least as
+well if not better than their AC counterparts in terms of
+access to the medical care system.
+ The Surgeon General has established very specific
+guidelines in terms of waiting time for appointments, priority
+order, to ensure that RC soldiers get the best quality health
+care available.
+ Ms. Norton. Ms. Embrey, I just have to ask, the total
+failure of the planning process, so that after troops were in
+there you all began to somehow understand that you would have
+people back here that would be held in companies like the
+company at Walter Reed. What was the flaw in the planning
+process? Did you expect simply to get into, let us say, Iraq
+and get out with almost nobody injured and that would be it?
+ You had a long time to plan for this. The discussion on
+whether or not we would go to war had to have gone on for at
+least a year. You had to go back and forth to the United
+Nations. It was very controversial. There was lots of things. I
+mean, why wasn't the planning done there? What was the flaw in
+the planning?
+ Was it that you anticipated not having or having almost no
+injuries and therefore didn't plan on having this number of
+Guard and Reserves there? And if so, if that was your thinking,
+on what basis did you believe that you did not have to plan for
+so many injured members of the Guard and Reserve?
+ Ms. Embrey. I think I will answer this in a couple of
+different ways. The first is there are a number of factors that
+have contributed to the situation we are in. The first is that
+we organize as units and there are various specializations in a
+unit, and one of the specializations in those units is to
+understand how to navigate the process in your command and
+control structure.
+ When we mobilize, especially Guard and Reserve, they go and
+there is a pre-deployment process screening where we try to
+identify those who are not physically or medically ready to
+deploy. There is a certain percentage of those folks that stay
+back, but the rest of the unit goes, along with the expertise
+to help them navigate the process.
+ Then, while they are there, those who get injured are, if
+they are severely injured, are medically transported back to
+the States through various points of care, returned to a place
+where their special requirement can best be provided, and again
+their expert that helps them navigate the system from their
+unit is not with them.
+ When they return, through a post-deployment process
+individuals identify their concerns, their physical problems.
+They are referred and then taken care of, and some of them end
+up in medical hold. Again, the rest of their unit and the
+expertise to help them navigate the system has gone home.
+ That is part of the problem, and I believe that----
+ Ms. Norton. Yes, we understand the problem. My question
+was: what was the flaw in the--was this all unforeseeable?
+ Ms. Embrey. I don't think it was unforeseeable. I cannot
+speak for the Department on failure to plan. I think there was
+a very good understanding that we were trying to screen
+individuals who would not deploy with medical problems. I think
+we thought that our peacetime structure would be able to handle
+the anticipated casualties. We realized going in that this is a
+marathon, not a sprint, and we are now having to make
+adjustments based on what we are learning.
+ Ms. Norton. That is precisely my question. The President
+warned everybody from the beginning of September 11 don't
+expect this to be over soon. I only dated back to when we began
+to discuss going in Iraq.
+ Ms. Embrey. Would Congress have agreed to a surge in the
+force structure in order to accommodate these requirements?
+ Ms. Norton. Do you for a moment believe that if you had
+come to this committee or to the Armed Services Committee and
+said, we expect real problems to develop because of the number
+of injured soldiers who may be coming home for a system that is
+not equipped to handle them on base, and so they will be held
+in medical hold, do you for a moment believe that Congress
+would have said, go away?
+ I mean, you are returning your question to me? We expect
+you to do the planning, come to us, and say, this is a warning,
+everybody. We are not equipped to handle this. It is a question
+of resources. You need to alert us. Are you saying you alerted
+us and we did not respond?
+ Ms. Embrey. No.
+ Ms. Norton. Well then don't come and tell me, would we have
+responded. The question is why did you not alert not only this
+committee but a number of other committees who first and
+foremost think of the men and women on the ground and then
+think about everybody else? So I can only take yours to be a
+rhetorical question.
+ Now, let me finally say--and the reason we ask it, very
+frankly, is that the committee, you know, is really looking for
+remedies. The message we are sending is that we very much
+respect the way the military fights wars. We have not respected
+the way the military has cared for these injured soldiers
+coming home. We don't think that the people on the ground or
+what happens on the ground is broken. I think you will agree
+that this was broken, is being fixed. We have noted the way it
+is being fixed, are appreciative, but because we are involved
+in a longtime conflict the message is plan, plan, plan, just
+like you plan to go to war in some respects and not other
+respects.
+ It is absolutely inexcusable not to do the proper planning
+that will help us take care of people who have been injured in
+war. It has been heartbreaking to hear the testimony of these
+soldiers here today, and we just want to make sure the planning
+is done to make sure it doesn't happen again.
+ I have only two more questions. We heard testimony from one
+of the prior witnesses, Sergeant Forney, again over a situation
+at Walter Reed where he had to use his own funds to buy
+supplies and equipment. I need to know whether that has been
+entirely cured, why it was that anybody would have been
+responsible for having to do that, why a soldier had to put out
+his own funds. I am not even sure whether he was repaid.
+ General Kiley. I have no idea either, Congresswoman.
+ Ms. Norton. Well, would you followup on his testimony----
+ General Kiley. I certainly will.
+ Ms. Norton [continuing]. And report back to this committee
+what you were able to find?
+ Final question: I asked the prior panel and was told by
+that panel that you would be the appropriate panel to ask for
+answers to some of the most disturbing testimony about post
+traumatic stress disorder. We are told that it may arise some
+time after, some months, for example, after the soldier is
+back, may linger for some time.
+ We wonder whether or not, under your current system and
+regulations, whether or not somebody who suffers from post
+traumatic stress disorder can ever be considered to have a
+disability as described under Army regulations, or, if not, how
+such a person who now must come back to civilian life is
+expected to navigate through the rest of his problem.
+ General Kiley. I would be happy to try to answer that
+question. I think it is a very good one, frankly, and the Army
+Medical Department and the Army and, frankly, the Department of
+Defense has taken a great interest in this process. As you
+know, there was an article published recently in the New
+England Journal by one of our medical health care screening
+teams that documented a not insignificant number of soldiers
+who, on a survey, answered that they were having problems, be
+it nightmares, anger, alcohol, or family disturbance issues. We
+recognize that, recognized it in terms of the pre- and post-
+deployment screening that we do for every single soldier who
+comes back, both active and Reserve, National Guard. They get a
+face-to-face screen during the demobilization process.
+ We have also recognized that process, alone, may not be
+enough--specifically, that soldiers won't admit that they have
+issues, or they think that once they are back at home, they
+demobilize, they are looking forward to getting back with their
+family, that some of the issues they may or may not have been
+worried about are now going to be resolved.
+ There is no question that every soldier that mobilizes and
+deploys goes through a traumatic experience just in the
+mobilization and deployment, and then with combat operations it
+can be a significant shock to the system, so to speak. Like
+everything else in human nature, there is a bell-shaped curve
+of resiliency associated with that.
+ But we have gotten more sensitive and more aggressive in
+seeking out soldiers and asking them how they are doing. We
+have actually done some followup on soldiers who went through
+the original screening and found that over time they actually
+start to admit and recognize that some of the problems they
+have been struggling with haven't gone away. So we are in the
+process of identifying that systemically and clearly offering
+opportunities for soldiers to come back and see us.
+ Just recently, as you probably know, the Secretary directed
+the services to begin a formalized process at the 90- to 180-
+day mark to bring soldiers back and screen them, and we are in
+the process of working our way through the policies and the
+resources required to execute that.
+ The second part of that is once we have identified soldiers
+that may need counseling or help, it is collating the resources
+to provide that. The mental health communities in general are
+already very busy--psychiatrists, psychologists, social
+workers, and other counselors--and we want to make sure we have
+some place to refer our soldiers, Sailors, Airmen, Marines when
+they do recognize that they have some problems.
+ Our experience is that most of those soldiers, almost all
+of them will resolve these issues, particularly with some
+assistance, but PTSD is recognized and I am understood to
+believe that in its most severe forms it is recognized as a
+disability with sort of the PEB system and soldiers do get
+recognition of that, depending on the nature and the extent of
+their symptoms.
+ It is often a temporary position that does heal itself over
+time, and so in some cases those soldiers will go into a TDRL
+status and come back in 18 months, and we will sit down with
+them again and see how they are doing.
+ We are very sensitive to this. Some of this is an outgrowth
+of the first Gulf war and our work in dealing with and the
+development of the diagnosis of post traumatic stress syndrome.
+ I hope that answers your question.
+ Ms. Norton. I appreciate your answer, because I could not
+agree more when somebody comes back from war the notion of
+stress, waiting to see whether or not or at least following the
+soldier to see if that stress will develop into some long-term
+problem, that is a close call. As long as you are following the
+soldier, I think we would be satisfied.
+ Let me tell you what leads me to ask about disability. When
+you see the number of soldiers--I mean, appalling number--from
+the Viet Nam war that are on the streets homeless, you
+recognize that you never want to see that happen again. I
+realize that was a draft. There may have been many there who
+are very unlikely volunteer soldiers.
+ But it has seared itself into the consciousness of Members
+of Congress, because those are people who will call our
+offices, whose families will call our offices, the notion that,
+as difficult as it is to decide whether or not we are dealing
+with something that can truly be called a disability and, hey,
+that is your job as well, as long as that is something that is
+not off the table or impossible to get in appropriate places,
+that would certainly satisfy me.
+ I am particularly concerned in the volunteer Army about
+that because one's heart goes out as one hears interviews on
+television members of the service who are asked, well, would
+you go back, or who volunteer that they want to go back. These
+are people who have lost limbs or worse. These are folks who
+have imbibed the notion that they have done a service for their
+country, who say, I have somehow or feel often I have abandoned
+my fellow soldiers, and what I need to do in order to feel
+right about myself is to go right back there and serve as long
+as they serve. That is the psychology one hears over and again.
+ I have to tell you I believe the press goes around trying
+to find somebody who will say the opposite, and they just can't
+find people. They all seem to say, I want to go back, or, I
+would go back if I could. That leads me to believe that what
+you just said, General Kiley, is the case. Hey, that is not the
+right thing to say if you are a soldier, that you are feeling
+any pain, that you don't want to go back. Therefore, the
+possibility that these volunteer soldiers who have absorbed the
+notion that they are first and foremost a soldier need to be
+followed very, very carefully, because their reluctance to
+admit is perfectly understandable.
+ Finally, in closing this hearing, I want to thank all of
+our witnesses, and I especially thank you. This has been an
+accountability hearing. You can imagine that we feel a very
+special obligation when we continue to hear in our own offices
+about these problems. We know that you have responded to some
+of the problems that have been brought to your attention
+through the GAO and through hearings of this committee, and I
+want you to know that, despite our questioning, we appreciate
+the fact that the Army has been responsive to the committee,
+and we will press you further until we think the system has
+been entirely fixed. That is our obligation. We think you
+believe it is yours.
+ Before we adjourn, the chairman has asked me to say that he
+has a request of the Army. As you have done for this committee
+on the issues of the Guard and Reserve pay, he requests
+quarterly briefings to be provided to the committee on the
+state of the medical administrative treatment of Guard and
+Reserve forces. It appears that you have some distance to go to
+improve the oversight, infrastructure, patient service, and
+efficiency of your policies.
+ Also, to better address the questions of Reserve Component
+members, their families, and congressional case workers, he
+also asks that the Army takes steps to provide a one-call
+ombudsman office, and, if I may add, described the way we
+described it, differently from the case worker who is torn
+between the system and the soldier--a one call ombudsman office
+where staff trained in all Reserve Component administrative
+issues can answer questions in a timely and comprehensive
+manner.
+ We would also like to add that the record will be kept open
+for 2 weeks to allow witnesses to include additional
+information into the record. That includes witnesses from the
+service, witnesses who may be family members, or members of the
+service.
+ Again, we thank you for coming.
+ The hearing is now adjourned.
+ [Note.--The GAO report entitled, ``Military Pay, Gaps in
+Pay and Benefits Create Financial Hardships for Injured Army
+National Guard and Reserve Soldiers,'' is on file with the
+committee.]
+ [Whereupon, at 1:40 p.m., the committee was adjourned.]
+ [The prepared statements of Hon. Candice S. Miller and Hon.
+Brian Higgins, and additional information submitted for the
+hearing record follow:]
+
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