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BY JOHN MITERKO, CHAIR,
VVA GOVERNMENT AFFAIRS COMMITTEE,
WITH VVA GOVERNMENT AFFAIRS
STAFF
Retired Army Lieutenant General James B. Peake is President
Bush’s choice to head the Department of Veterans Affairs.
If confirmed by the Senate, Gen. Peake will succeed Jim Nicholson,
who resigned in July and left office October 1.
Gen. Peake,
63, has been medical director and chief operating officer
of California-based QTC Management, a provider of services
covering occupational health, injury, and disability services.
He is a 40-year veteran of the Army. A 1966 graduate of the
United States Military Academy, he began his career as an
infantry officer.
He was wounded in Vietnam while serving
as an infantry platoon leader with the 101st Airborne. After
Vietnam, the Army sent him to medical school, and he became
an Army physician. He rose steadily through the ranks, and
from 2000-2004 was Surgeon General of the Army.
Peake is “an
Army doctor and a combat veteran who will be a strong new
leader for his department,” Bush said
in announcing the nomination at the White House with Peake
at his side. “He would be the first physician and the
first general to serve as secretary.” (Gen. Omar Bradley
was Administrator of Veterans Affairs before the VA became
a cabinet department.) Gen. Peake’s nomination requires
Senate confirmation. That process will be interesting, given
the furor over less-than-adequate care at Walter Reed Army
Medical Center and many other Army hospitals that began during
his tenure heading the Army Medical Department.
Gen. Peake
was Executive Vice President and Chief Operating Officer
of Project Hope, a non-profit international health foundation
with offices and programs in more than 30 countries. He is
a fellow of the American College of Surgeons, the American
College of Cardiology, and a member of the Society of Thoracic
Surgeons.
Gen. Peake was Surgeon General when Undersecretary
of Defense David Chu, supported by Defense Secretary Donald
Rumsfeld, made the decision to downsize the Army and Navy
Medical Departments just as the Iraq War began.
Rumsfeld is gone, sacked, and
the Assistant Secretary of Defense for Health, William Winkenwerder,
is gone, sacked. So, we have to ask: Why is the architect
of this horrendous policy that has hurt so many soldiers
still there? That is a question the Senate should debate
fully before approving this nomination.
While VVA does not think that senior military
officers should publicly fight civilian authority on policy
questions, or even on resource questions, it is legitimate
to ask how hard Gen. Peake fought this downsizing of the
Army Medical Department from the inside, even though in the
end he appropriately saluted and said, “Yes, sir.”
Further, can Gen.
Peake say no to the Office of Management and Budget and to
the Domestic Policy Council in the White House, if asked
to support inadequate requests for resources to properly
care for veterans? Will he stand up for veterans against “green
eyeshade” fiscal types and do
what is right? Will he demand accountability from the staff
at the Department of Veterans Affairs?
The previous flag-level
officers appointed by the current administration have, all
too often, gone along with the bureaucracy. Does Gen. Peake
have the strength of character and independence of mind to
think anew?
MORE POLITICAL JOCKEYING
For the twelfth time in the last thirteen fiscal years, the
Department of Veterans Affairs, like most of the rest of
the government, is operating through a continuing resolution.
This means that at least for the first six weeks of the current
fiscal year, the VA has only the operating funds of the last
fiscal year. Is this any way to run the government?
In fairness
to the House leadership, at Speaker Pelosi’s
insistence, $2.9 billion was added to the continuing resolution
for veterans’ health care, to be spent by December
14. It is hoped that the appropriations bills will be enacted
by then.
Still, there was much to be pleased about in the
bill H.R. 2642 that was passed in the House of Representatives
and then got stuck in the Senate over political maneuvering.
Rep. Chet Edwards (D-Texas) hailed the record budget increases
and strong bipartisan support for the 2008 Military Construction/Veterans
Affairs Appropriations bill, which passed the House, 409
to 2.
The bill increases the VA budget by $6.7 billion above
the 2007 level, the largest single increase in the 77-year
history of the VA. It is $3.8 billion above the President’s
request for fiscal year 2008. Of particular interest to VVA
is a provision that would require the VA to obey the law
and move expeditiously to contract for completion of the
National Vietnam Veterans Longitudinal Study.
Edwards, who
chairs the Military Construction/Veterans Affairs Appropriations
Subcommittee, said to the press: “For
the 400,000 veterans, including combat wounded vets, who
are having to wait too long to have their benefits cases
reviewed, this bill means over 1,100 new VA case workers
[that] will reduce the unacceptable delays in receiving earned
benefits. This bill also increases the VA’s maintenance
and repair budget to prevent a Walter Reed scandal from occurring
in the VA system.”
This all sounds fine. But finding
1,100 fresh faces will not happen overnight, and it will
take some time to train them to do their jobs. Hence, the
400,000 figure will likely not diminish significantly for
some time.
One step that the
braintrust at the Veterans Benefits Administration (VBA)
can take is to better define what “too long” really
is.
Just as corpsmen and medics, nurses and doctors must do
triage when heavy casualties come in from the field of battle,
so, too, should the honchos at the VBA revamp the way they
work. They can triage claims. Simple claims with properly
filled-out paperwork should not take more than 60 days. More
complex, multi-part claims that require a lot of supporting
documents might need four or five months to adjudicate.
They also can
have squads of raters who specialize in, say, claims for
mental health issues such as PTSD. The VBA isn’t
doing something right, because the persistence of the problem
spans administrations.
Additionally, should the VBA bother
to think seriously about the definition of what’s “too
long,” they
might want to bring in the VSOs from the giddy-up rather
than spring new nomenclature on the veterans’ community.
Under duress, the Undersecretary for Veterans Benefits convened
a meeting with the VSOs last December, but not a single one
of our collective VSO recommendations has been implemented.
The
House bill also provides $21.4 billion for military construction,
family housing, and base realignment and closing process
(BRAC), which is fully funded with $8.2 billion.
The total
for military construction is an increase of $207 million
over the President’s request and $8.2 billion
over 2007, which should mean better barracks, housing, and
training facilities when troops return from combat. The bill
supports the relocation of 70,000 troops from bases in Korea
and Europe to the U.S. and provides funds to increase our
military forces, beginning the process of adding 65,000 Army,
27,000 Marine, and 9,000 National Guard and Reserve troops.
In
the Senate, an amendment introduced by Sen. Claire McCaskill
(D-Mo.) requires the VA to create a mechanism on its web
site for whistleblowers to report waste, fraud, or abuse
anonymously to the department’s Inspector General.
The goal is to strengthen oversight of federal agencies.
The
freshman senator attached the same measure to the Homeland
Security spending bill in July and promised to offer similar
amendments to ten other pending appropriations bills.
MEDICAL
MANAGEMENT
When the scandal broke at Walter Reed Army Medical Center
last February, the powers that be stepped all over themselves
to create commissions and task forces to investigate and
recommend solutions. The President, in fact, has taken credit
for having implemented many of the recommendations offered
by the Dole-Shalala Commission. He has sent legislation to
Capitol Hill for those recommendations that require legislative
action.
“Medical advances have enabled battlefield medics and
hospitals to provide our wounded warriors with care that
would have been unimaginable just a decade ago,” Bush
said, standing in the Rose Garden for a photo op with wounded
troops. “Yet our system for managing this care has
fallen behind. It’s an old system. It’s an antiquated
system. It’s an outdated system that needs to be changed.”
While
praising the quality of care at Walter Reed, Bush acknowledged
that there were “serious problems caused by bureaucratic
delays and administrative failures. And we’re not going
to let those problems continue.”
Because both the VA
and DoD have their own systems for evaluating and awarding
compensation to injured service members in a process that
is both difficult to navigate and confusing for the wounded
and their families, “we need to streamline
the system,” the President said. The solution?
“The Defense Department will determine whether wounded
warriors are still fit for service,” Bush said. “Those
unable to serve will receive a pension from the Defense Department,
based on their rank and length of service.
“Then they will move directly into the Veterans Affairs
system, where they will receive compensation for their disabilities.
This compensation will take into account both loss of earnings
and the overall impact on the quality of life resulting from
a service member’s injury or disability.
“Secondly, this legislation will strengthen support
for families during the recovery process. When our service
members suffer wounds, their families suffer with them. They
pray beside hospital beds. They discuss the options with
the doctors. And they help injured loved ones readjust to
everyday life.
“These commitments often require family members to
take long leaves of absence from work. Yet many family members
cannot get this time off without losing their jobs.
“Our military families deserve better,” the President
said. “So this legislation will give many parents and
spouses the opportunity to take up to six months of unpaid
leave when their loved ones are seriously wounded in combat.
“Third, this legislation will improve treatment for
Post-traumatic Stress Disorder. The commission found that
many service members still worry about the stigma associated
with this serious condition. We need to end this stigma by
encouraging those suffering to get help.
“This legislation will make it easier for our troops
to receive care for this disorder, and it will help affected
service members move forward with their lives.”
We concur with the President that “the need to enact
these reforms into law is urgent.” Now it is up to
Congress to continue the discussion and debate and do the
right thing for our wounded warriors.
The President noted
that DoD and the VA are working hard to “form a new
core of well-trained recovery coordinators. These coordinators
will work with families to establish recovery plans and monitor
the healing process, facilitate the transition to civilian
life, and ensure wounded service members do not get lost
in the system.” Accomplishing this is of critical
importance if this administration is to make any headway
toward improving conditions for the recovery of injured and
wounded troops.
RECOVERY COORDINATORS
Among the actions taken by DoD and the VA that do not need
the imprimatur of Congress is an agreement to provide “federal
recovery coordinators” to help insure medical services
and other benefits are provided to seriously wounded, injured,
and ill active-duty service members and veterans.
The agreement
puts into place one of the top recommendations of the President’s
Commission on Care for America’s Returning Wounded
Warriors, co-chaired by former Sen. Robert Dole and former
Health and Human Services Secretary Donna Shalala. The agreement
initially establishes that the first federal recovery coordinators
will be provided by VA in coordination with DoD and will
be located at top military treatment facilities throughout
the nation. They will coordinate services between the VA
and DoD and, if necessary, private-sector facilities, while
serving as the ultimate resource for families with questions
or concerns about VA, DoD, or other federal benefits.
“This agreement ensures our nation’s active-duty
service members and veterans who have been wounded receive
the very best care during their recoveries,” said Acting
Secretary of Veterans Affairs Gordon H. Mansfield. “Service
members, veterans and their families can be assured they
will have an ultimate resource they can rely on whenever
help is needed from VA or DoD.”
The first 10 coordinators
will work at military health care facilities and at any other
locations where patients are later assigned. They will be
located at Walter Reed Army Medical Center in Washington,
D.C.; the Naval Medical Center in Bethesda, Maryland; Brooke
Army Medical Center at Fort Sam Houston, Texas; and Balboa
Park Naval Medical Center in San Diego. Additional recovery
coordinators will be added in the future as needs are determined.
REMEMBERING THE MISSING
On September 2, POW/MIA Day, Defense Secretary Robert Gates
pledged that the department he heads will “neither
forget our duty to bring home all POWs and MIAs, nor relent
in our efforts to do so.” The secretary, along with
Marine Gen. Peter Pace, chairman of the Joint Chiefs of Staff,
spoke in a ceremony at the Pentagon.
While they were speaking, VVA Vice President Jack Devine,
Chair of the POW/
MIA and Veterans Initiative Committee Gary Jones, along with
Bob Maras and Bill Duker were in Vietnam, seeking information
on the fate of some 1,800 American service members who have
never come home.
Back at the Pentagon, Gates gave a special
welcome to former POWs in the audience and to the families
of Americans still listed as missing in action.
“Missing-in-action status is marked by ambiguity and
uncertainty, a severe test of spirit and resolve for anyone
seeking closure,” he said. He also cited four Americans
missing in Iraq: Staff Sgt. Matt Maupin, captured April 9,
2004; Spec. Ahmed Altai, captured Oct. 23, 2006; and Spec.
Alex Jimenez and Pvt. Byron Fouty, both captured May 12,
2007.
“They may not be well known to the public, but within
the brotherhood of arms, they will never be forgotten or
left behind,” Gates pledged.
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