Prepared Statement
of
Edward P. Wyatt, Jr.
Principal Deputy Assistant Secretary of Defense (Health Affairs)
on
The Transition of Service Members Requiring Health Care Between the Department of Defense and the Department of Veterans Affairs
Before the Committee on Veterans' Affairs
U.S. House of Representatives
October 16, 2003
Introduction
Mr. Chairman and members of this distinguished committee, thank you for the
opportunity to be here today to discuss the coordination of health care
for transitioning service members between the Department of Defense (DoD)
and the Department of Veterans Affairs (VA). Today, we have more than
253 thousand service men and women deployed in support of our nation's
defenses, including those serving in Afghanistan and Iraq. DoD is firmly
committed to providing the best health care services for our operating
forces. In the past year, more than 180 thousand men and women have left
military service, and the vast majority are eligible for VA care. Our
concern for the well being of service members extends well beyond their
time on active duty. I want to assure you that as the Principal Deputy
Assistant Secretary of Defense for Health Affairs, my highest priority
is to maintain the health of our military members with a continuum of
medical care protecting each service member from entrance into the military
to separation from the military and transition to the VA healthcare system.
I also acknowledge that we need to make improvements to our Force Health
Protection and surveillance programs. GAO has recently completed a report
on our health-assessment programs and noted various shortcomings. The
Department of Defense has accepted GAO's recommendations regarding the
implementation of an effective quality assurance program to ensure compliance
with force health protection and surveillance requirements. The Assistant
Secretary of Defense, Health Affairs is establishing a comprehensive quality
assurance program and coordinating Service specific quality assurance
force health protection and surveillance programs.
As you know, the Department of Defense and Department of Veterans Affairs
have joined forces to provide our nation's military and veterans with
improved health care services. Over the past year, many initiatives between
the two Departments have launched a new era of DoD/VA collaboration, with
unprecedented strides toward a new federal partnership that promises to
transcend business as usual, and is already seen as a model for inter-agency
cooperation across the Federal government.
We are pleased to report that we have just approved a VA-DoD Joint Strategic
plan to guide our relationship over the coming years. We believe that
this plan not only institutionalizes our current collaborative efforts
but also identifies joint objectives, strategies and best practices for
future collaboration. Through our VA-DoD Joint Executive Council, we will
ensure leadership oversight is given to all of these initiatives as we
continue to develop our strategic partnership. Coordination of health
care services for our transitioning service members is a major area of
focus in this joint strategic plan.
Force Health Protection
Protecting our forces is the primary mission of the Military Health System.
As part of our Force Health Protection program, our objectives are to
recruit and maintain a healthy and fit force, to prevent disease and injury,
and to provide medical and rehabilitative care to those who become ill
or injured. The rigorous requirements of the medical entrance physical
examination and our periodic physical examinations, HIV screening, annual
dental examinations, physical fitness training and testing, immunizations
and regular medical record reviews ensure a healthy force.
Deploying personnel receive pre-deployment health assessments that check
the individual's current health and include reviews of required immunizations
and other protective medications and measures, personnel protective and
medical equipment, serum (HIV) samples - preserved in the DoD Serum repository
- dental readiness classification, and briefings on deployment-specific
health threats and countermeasures.
We routinely deploy preventive medicine, environmental surveillance,
and forward laboratory teams to support our worldwide operations. Extensive
environmental assessments of staging areas and base sites are conducted
before and during deployments. The Army's Center for Health Promotion
and Preventive Medicine also supplies environmental sampling materials
for deployed forces, and develops pocket-sized "staying healthy"
guide books for deployed service members.
Our post-deployment health assessments gather information from deployed
service members to help medical personnel evaluate health concerns or
problems that may be related to the deployment. Face-to-face health assessments
with trained health care providers determine referrals for appropriate
medical follow-up. Blood samples are taken within 30 days and are archived.
Pre- and post-deployment health assessments and deployment health records
are maintained in the individual's permanent health record, which is available
to the VA upon the service member's separation from the military.
After service members return from deployments, health care focused on
post-deployment problems and concerns is provided by military and VA providers
using the jointly developed Post-Deployment Health Clinical Practice Guideline.
The guideline provides a structure for the evaluation and management of
service members, their families and veterans with deployment-related concerns.
It provides health care professionals access to expert clinical support
for patients with difficult symptoms and illnesses, as well as deployment-related
information.
The military health care system is actively providing world class health
care to those in uniform every day. We see 193 thousand active duty outpatients
each week. In a typical week nearly 14 hundred of our service members
are admitted to our health care facilities, and we issue them more than
2 hundred thousand prescriptions each week. Since the start of Operation
Iraqi Freedom, 13 percent of those medically evacuated were for combat
related injuries, and 87 percent were evacuated for disease or non-battle
injuries. Irrespective of the cause of a military member's illness or
injury, our focus is to provide the care needed and whenever possible,
to return that person to duty.
A service member's ability to return to full duty is based on a careful
health evaluation by a physician. If a member is found to be unfit for
continued active duty by their attending physician, a Medical Board review
process is initiated. This document is counter-signed by another specialist
within the discipline of the attending physician - usually the attending
physician's clinical supervisor. The service member is referred to a Physical
Evaluation Board (PEB) where it is determined if the individual is fit
to perform duties. If the determination is made that the individual is
not fit to perform duties, he or she may be discharged from military service
with or without severance pay, permanently retired with disability pay,
or placed on the Temporary Disability Retirement List (TDRL) with DoD
disability retired pay, or they can apply for VA disability compensation
and can elect to receive that benefit.
Those placed on TDRL are periodically evaluated over a five-year period
to determine if they are fit to perform duties. At each step along these
medical processes, the service members are provided information about
their rights and their choices.
Seamless Transition of Health Care Services
We in DoD recognize that those men and women in uniform who are our beneficiaries
will become beneficiaries of the Department of Veterans Affairs. We have
worked to develop systems for a smooth and seamless transition from our
health care system to the VA's.
All members referred to a Physical Evaluation Board (PEB) must attend
Disability Transition Assistance Program (DTAP) training. During this
training, a counselor from the VA addresses the group and informs them
of the benefits provided by the VA, how to file a claim with the VA and
discusses how disability ratings are determined. In addition, before separation,
members with disabilities are required to file or decline to file a claim
with the VA for compensation, pension or hospitalization.
As an example, at the National Naval Medical Center, Bethesda, the Naval
treatment facility that treated all Marine Corps casualties from Operation
Iraqi Freedom early in the conflict, VA counselors conduct the DTAP VA
sessions in person and VA dispatches a counselor twice weekly to meet
with returning casualties to explain potential benefits and initiate claims
processing actions. VA counselors are full-time at Walter Reed Army Medical
Center in Washington.
Active duty members voluntarily separating from the service, who have
not been referred to the PEB are required to receive mandatory pre-separation
counseling through the Transition Assistance Management Program (TAMP).
The TAMP program is a cooperative effort between the DoD, Department of
Labor and the VA. Each separating member is required to fill out a Pre-separation
Counseling Checklist, which includes a requirement for the member to be
briefed regarding VA benefits, including health care services available.
The process for notifying the VA when a service member is being discharged
from DoD care depends on whether the member is referred to the Physical
Evaluation Board (PEB) or not. For members referred to the PEB, VA notification
occurs during Disability Transition Assistance Program counseling. For
members not referred to the PEB, the member's separating command submits
a claim package to the VA.
The Benefits Delivery at Discharge program has VA doctors actually performing
separation physicals for service members, which will serve as their compensation
and pension examination. Their objective is to make disability evaluation
decisions and award benefits within thirty days of separation. Today there
is a fully functional Veterans Benefits Administration presence at 133
military installations in 42 states, Washington D.C., Germany and Korea.
As another new pilot program, the Army has integrated VA social workers
into medical facilities to work with patients before they separate from
the military.
Since 1998, the VA has had the authority to provide veterans of combat
operations a two-year access period to medical care for deployment related
health concerns, even without a service-connected disability, following
their separation from active service.
We have already made significant progress in ensuring pertinent medical
data is transferred to the VA on service members upon their separation
from active duty. Through our Federal Health Information Exchange, an
exemplary model of collaboration between both Departments, DoD transfers
electronic health information on separating Servicemembers to the VA.
Currently, DoD sends VA laboratory results, outpatient military treatment
facility pharmacy data, radiology results, discharge summaries, demographic
information and admission, disposition and transfer information. By the
end of this year, DoD will also send allergy information and consult results.
DoD has transmitted to VA more than 54 million messages of health information
on 1.76 million discharged or retired service members over the last 22
months. To further strengthen DoD/VA electronic medical information exchange,
while leveraging departmental systems investments, we are working with
our VA counterparts to ensure the interoperability of our electronic medical
records by the end of FY 2005.
New Opportunities
DoD and VA are moving forward jointly to improve the efficiency and accuracy
of enrollment and eligibility information through the creation of integration
points that will permit VA to access the Defense Enrollment and Eligibility
Reporting System (DEERS) in real time by the end of 2005, a key objective
in the President's Management Agenda. This information technology initiative
will be a significant step to a seamless transition and will markedly
enhance the continuity of care for our nation's veterans.
Mr. Chairman, my VA colleague, Dr. Roswell, and I, share a common vision
of quality health care for our men and women serving our country, their
families, and those that have served us so well in the past. DoD's concern
for the well being of our servicemembers extends beyond just their time
on active duty. Cooperative efforts with the VA will provide the best
possible service through improved coordination of health care services
and increased efficiency to the benefit of the servicemembers, veterans
and taxpayers.