Hearing of the Senate Committee on Veteran Affairs - Update on VA and DOD Cooperation and Collaboration

Statement

Hearing of the Senate Committee on Veteran Affairs - Update on VA and DOD Cooperation and Collaboration

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SEN. PATTY MURRAY (D-WA): Thank you very much, Chairman Akaka, Senator Burr, appreciate your holding today's hearing, as we examine the VA and the DOD's efforts to ensure our service members can transition seamlessly from the VA into the -- or from the military into the VA.

And I look forward to the progress report that you're going to present today and hearing from our witnesses, particularly Deputy Secretary England and Deputy Secretary Mansfield. And I share the committee's thank you to both of you for the work you are doing on this important committee.

Mr. Chairman, it has been more than a year since news reports about the excessive red tape and substandard outpatient care for our wounded warriors came out that they were facing at Walter Reed and literally across the country.

Since that time Congress, the VA, DOD, numerous independent commissions have invested a great deal of time and work to ensure that our service members don't leave the battlefield only to have to fight their own government here at home to get the benefits that they've earned.

Congress passed levels -- record levels of funding for our veterans, including $1.8 billion in veterans' funding in the supplemental appropriations bill last year. We increased veterans' spending by $3.7 billion over the president's request in the 2008 spending bill.

We passed important legislation, including the Joshua Omvig Suicide Prevention bill, which increased the VA's capacity to reduce veteran suicides, and the Wounded Warriors Act, which improves the coordination of care for service members who transition from the military to the VA.

And numerous commissions, task forces, independent review groups around the country have been studying these problems and the -- with the transition process and making hundreds of recommendations to us.

Now, a lot has been done, but we have a long way to go, I believe, to ensure that we get this process as smooth as possible. As we found out from the Walter Reed scandal, one of the biggest problems facing our wounded warriors is the difficulty working through the bureaucratic maze to get those benefits that they have earned.

In order to deal with the problem, DOD and VA created Federal recovery care coordinators to help our service members navigate through this really difficult process.

But while DOD and VA have promised to provide a care coordinator to every seriously injured service members who wants one, so far DOD has identified more than 4,000 service members who qualify; yet, we only have 8 coordinators today.

So we have a long ways to go to provide the care that we've promised.

We also know that a lot of work remains to be done to the improve the disability evaluation system and it's my understanding the pilot project that's now being run here in Washington, DC isn't ready yet to be duplicated across the country. And this committee must continue its work on legislation to overhaul the disability system to ensure that it's fixed.

In addition, the VA and the DOD have not satisfactorily met the requirements dealing with the creation of a joint electronic health record as required by the Wounded Warriors Act.

Mr. Chairman, the DOD and VA still have a lot of work to do to improve treatment for our troops who suffer from psychological wounds of this battle.

The RAND Corporation recently released a report that found that 320,000 of our troops suffer from traumatic brain injury and 300,000 suffer from PTSD or major depression. Yet, only half of those veterans sought treatment, and of that number, only half of them received treatment that could be classified as even minimally adequate.

Now, we know that all too often the consequences of leaving PTSD and depression untreated are marital problems, drug and alcohol abuse, unemployment, and tragically, suicide. When 300,000 troops are suffering from a serious mental health problem and only one quarter of them are getting minimally adequate care, I think we ought to be worried.

We ought to be worried that we haven't made nearly enough progress to enable us to move to the next step in the process by 2009 as the administration plans.

As the central coordinating office for all of DOD's and VA's efforts to improve this seamless transition, the Senior Oversight Committee is responsible for tracking and overseeing all the efforts to improve care for our wounded warriors.

For all the reasons that I just gave, Mr. Chairman, I think it hardly seems a good time for the Oversight Committee to declare victory and pass its responsibilities to the Joint Executive Council.

The SOC is led by senior officials; it has the influence and the staff to continue to make this important progress. And I'm really concerned that if we hand those responsibilities off now, the JEC won't be able to sustain the current energy for tracking and implementing the hundreds of recommendations. And I'm concerned we're going to lose the little ground we've made if that occurs.

And lastly, Mr. Chairman, I just want to say to this committee, I am incredibly concerned about the e-mails that came out from the VA yesterday downplaying the number of suicides of our veterans. This is a serious issue for our veterans, for Americans, and particularly for us who sit on this oversight committee.

We need to have the correct information in order to have the right policies and provide the right kinds of resources, and if we can't count on the VA to tell us what they are seeing and what the facts are, we can't make the right decisions.

So I will have some more to say about that during the question- and-answer period, Mr. Chairman, but I think it should concern all of us as members of this oversight committee.

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SEN. MURRAY: Thank you, Mr. Chairman.

Secretary Mansfield, I have to say I am pretty frustrated today. I mean this committee has had to drag the VA every single day for five-and-half years since the war in Iraq started to give us accurate information, so that we can provide the services that our men and women who served us overseas get.

You know as well as I do that this committee was extremely frustrated, in fact the entire Senate, when several years ago, Secretary Nicholson, gave us inaccurate information about how far -- how long the backlogs were and how short the VA was in funding.

As a result of that we did come back, we added additional money that did indeed, because we finally got accurate information, because we yelled and screamed, and because we hauled you to it we were able to provide the additional mental health money that you just referred to, to help our men and women and particularly with mental health. But it would not have happened unless we had finally gotten the accurate information that the VA was denying.

It is frustrating to us when we have to drag that information out of you. The Walter Reed scandal from a year ago didn't come because any agency came before us. It became because a stress account showed it to us and America and then we had to react.

So I have to tell you I am very angry and upset that we find out this week that several internal VA e-mails that were made public not because you wanted them to, but because of a lawsuit that was occurring showed that the VA downplayed vastly the number of suicides and suicide attempts by veterans in the last several years.

Just a few months ago in November, the VA was confronted with an analysis that said there were 6,250 veterans who had committed suicide in 2005, an average of 17 a day. VA officials said that number was inaccurate, it was much lower.

But these e-mails that were uncovered this week, show that Dr. Katz who is the VA's top mental health official, not only backed up those alleged numbers, but he acknowledged that the numbers were much higher than that.

So what they were telling us in November and December was that the number was lower. But inside the VA, everyone knew it was higher and there are e-mails saying that and showing that to us.

So in -- and in addition to that, not only were the numbers of actual suicides, but the e-mails show that VA officials also knew and didn't tell us that they were a 1,000 veterans who received care and VA medical facilities attempting suicides each month.

Now to me that's a pretty astounding fact. It is an alarm bell that all of us need to be paying attention to. I acknowledge that we are now trying to get more mental health officials into the field. The Army in particular -- I've talked to them, worked with them, I know they are working on, I know the challenges of the health-care professions that you talk to.

But the fact is that how do we trust what you're saying when every time we turn around, we find out that what you're saying publicly is different than what you know privately. This committee, this Congress, all of us can only act on knowledge that is accurate.

It is not about a PR war, it's about making sure we've got the right information. So Secretary Mansfield, can you tell me how we can trust what you're saying to us today?

MR. MANSFIELD: Senator Murray, I share your concerns and I apologize for the fact that I have to apologize again. The last time before -- the last time I was before this committee, I think, I pointed out to you that if you have any specific information about a person or persons that are providing false information or not providing information that has been requested to please contact me and that I would do everything I can to ensure that you get the information.

SEN. MURRAY: Well --

MR. MANSFIELD: I would tell you that I agree with Senator Burr that we should have complete transparency other than individual's private medical information and perhaps some other information. There isn't a lot that the VA should be keeping secret that shouldn't be preventing for this committee to make --

SEN. MURRAY: Professor, how do you explain this?

MR. MANSFIELD: I am not -- well, I have seen one report on one set of e-mails. I haven't seen the total package and I'm not sure that I would characterize that as attempting to keep information away from this Congress or away from --

SEN. MURRAY: Secretary Mansfield, let me quote to you an e-mail from Dr. Katz. First line, top line "Shh --s-h-h exclamation mark. Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities."

"Is this something we should carefully address our self in some sort of relief before someone stumbles on it?" First sentence, Shh, how do we get accurate information if inside the VA the whole culture is, "We better not tell anybody."

MR. MANSFIELD: I know Dr. Katz and I know that he is dedicated to attempting to take care of veterans and that's been his professional career. I think it's unfortunate and I agree with you the characterization, the way that e-mail was written does not bode well and sends the wrong message.

But I think what I would read in there is how do we get this information out. How -- what's the platform, what's the method, or whatever? I have not talked to him directly about this specific e- mail, but I do understand as I said your concerns and would commit to you that I would do everything -- everything that I can to make sure that you do get the information that you request, the information that you need, the information that is required for us to continue and affect a partnership that has allowed us to move forward as you indicated with additional funds, as I indicated with more people doing the job that needs to be done.

SEN. MURRAY: Well, I have two concerns.

MR. MANSFIELD: Okay.

SEN. MURRAY: One is that we have to know what the facts are. We have to know that the VA is sharing with us what the facts are. We have to be confident that what you're telling us allows us to do our jobs. And secondly, and importantly, we need to be dealing with this issue.

I -- the RAND report that I talked about a few minutes ago, said that 20 percent of our military service members who have returned from Iraq and Afghanistan more than 300,000 have reported symptoms of PTSD or major depression.

Of those 300,000, the -- only half have sought treatment and of the half that sought treatment only half of those are receiving, quote, "minimally adequate care."

So, Mr. Secretary, if we don't have accurate information or we can't trust the information from you, we can't deal with this.

But secondly and just as critically, we are not dealing with a critically important issue and that is the mental health care, the invisible wounds of war of the men and women who are coming home. The suicide rate is a red alarm bell to all of us that there is a problem out there.

If that red alarm bell is being hidden inside the VA so that we are underestimating it so we don't know about it, we and this country can't take care of a critically ill problem.

Mr. Secretary, I worked on a psychiatric ward during the Vietnam War. I know what happens to our soldiers and I know that if we as a country deny that something has happened to them they are walking time bombs for decades.

We have a responsibility when we send our men and women to war when they come home to make sure we treat them. And we treat them well and we give them the respect and the dignity and the help and support that they need.

If we're not getting accurate numbers from you, if those numbers are being downplayed, if the attitude inside the VA is "shh" then we are doing a disservice to the men and women we've asked to serve us.

So I am really upset about this and I hope that every conversation inside the VA is upset about this. And I hope what Senator Burr said about us having transparency has gotten through to the VA, finally.

We are not your enemy, we are your support team. And unless we get the accurate information we can't be there to do our jobs. That's why I'm upset.

MR. MANSFIELD: Senator, let me again say that I apologize for the implications here, I apologize if there has been an effort.

I do not believe there has been an effort to not provide the accurate information. I know that the VA has been concerned for a number of years about this mental health problem and started ramping up on this issue -- (cross talk) -- years ago --

SEN. MURRAY: Then why -- do you disagree with the RAND report?

MR. MANSFIELD: Again, I have to make the point that we have acquired the resources that this Congress gave us to deal in this issue to the extent that --

SEN. MURRAY: Not requested by the administration because they didn't have accurate numbers. We had to dig and get our own information to do that.

MR. MANSFIELD: I did indicate the amount of money provided by the Congress.

SEN. MURRAY: Thank you.

MR. MANSFIELD: And again that is a partnership and I do thank you for the efforts that you and this committee and other folks on the Hill have put forward to ensure that we are able to get the job done. And as mentioned here we are applying, you know, significant resources in an effort to get that done.

And as indicated here, I mean, this article, which I'll share with you, talks about the fact that as the VA -- (inaudible) -- behavioral health providers the private sector is feeling the pinch. I mean, we all are out there doing what we can. We've hired 3,100 more --

SEN. MURRAY: But I hope you take the message back to the VA that we want accurate information. But I also I want to --

MR. MANSFIELD: Madam Secretary there -- I do know and as I indicated in our previous discussions unfortunately, I have to admit that you do want information. I've made that commitment and I will continue that commitment to be sure that you can get what you want.

SEN. MURRAY: Okay, and let me also ask you, the RAND estimates the PSD -- PTSD and depression will cost as much as $6.2 billion in the two years following deployment, but believe that investing in high-quality treatment could save us close to 2 billion. Mr. Secretary, either one of you, do you agree/disagree with that?

MR. MANSFIELD: There is no doubt that the sooner we identify these issues that the sooner we get qualified practitioners dealing with them, the better off these individuals are going to be. I have to tell you that one of the things that bothers me the most is the applications we have right now, for example, for Vietnam veterans who were coming in 35 or 40 years after the war, and applying for PTSD benefits because --

SEN. MURRAY: That's what we don't want to see 35 years from now.

MR. MANSFIELD: Exactly, and then that's the feeling in the VA that we need to make sure that we do it different, that we do it better, that we catch these folks early, that we get them into treatment, that we make sure we take care of them.

And that I can tell you, is the secretary's attitude, my attitude, Dr. Katzman's attitude, and the VA Medical Corp out there, you know, 196,000 plus people want to make sure we take care of these individuals, that is our job, that's our requirement, that's our commitment.

SEN. MURRAY: My time is -- Mr. Chairman, thank you.

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