Hearing Of The Subcommittee On Personnel Of The Senate Committee On Armed Services - The Implementation Of Wounded Warrior Policies And Programs

Statement

By:  Lindsey Graham Ben Nelson
Date: April 29, 2009
Location: Washington, DC

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SEN. NELSON: (Sounds gavel.) Good afternoon. The subcommittee will come to order. The subcommittee meets today to discuss the implementation of Wounded Warrior Programs, policies and plans by the Department of Defense and Department of Veterans Affairs. This hearing was originally scheduled for April 1st but, unfortunately, had to be postponed due to a series of stacked votes.

I want to thank the members of our second and third panels who were all present and accounted for, ready to testify, when the hearing was called off at the last minute. We thank you for your patience and understanding.

But actually, the delay produced a very positive result. On that same day, April 1st, Senator Graham and I were fortunate enough to meet with a group of wounded warriors and some of their family members, who very candidly shared with us the positive and negative experiences they've gone through and are still going through on their journeys through treatment, the disability evaluation process and transition to the next chapters of their lives.

During that meeting, Senator Graham and I mentioned the possibility of the group testifying at a hearing on a future date, to which they all graciously agreed. Now, little did they know the day would come so soon, but, because of the hearing's postponement, we were able to create a new first panel and have invited them all to speak about their experiences as seriously wounded service members and veterans and as spouses of wounded warriors.

We all remember February 18, 2007, the day the first in a series of articles appeared describing problems faced by our wounded warriors receiving care in an outpatient status. Many of these service members who were wounded or injured in service to our nation were living in substandard facilities, were unaccounted for and were fighting their way through a bungled, adversarial administrative process to rate their disabilities. After they left DOD care, they had to start all over with the VA. And many fell through the cracks in the transition.

And as a result of these articles and various reports on wounded warrior transition policies and programs, Congress passed the Wounded Warrior Act, which was incorporated into the fiscal year 2008 National Defense Authorization Act. The Wounded Warrior Act, among many other things, required the Department of Defense and the Department of Veterans Affairs to work jointly to develop and implement a comprehensive set of policies to improve the care, management and transition of recovering wounded, ill and injured service members. The act also required the comptroller general to assess and report on the progress made by the two departments in this endeavor. This report is near completion, so on our second panel we have personnel from the Government Accountability Office to share their findings.

On our third panel, we'll have several representatives from the Department of Defense and the Department of Veterans Affairs. They will discuss DOD and VA efforts to organize and resource Wounded Warrior Program and policy improvements as well as the accomplishments to date of the Senior Oversight Committee for the Wounded, Ill and Injured, which has been in place for nearly two years and is comprised of several high-level DOD and VA officials. In fact, in a hearing earlier this year, Secretary Gates himself pledged to chair this Oversight Committee's meetings during this period of administration transition, along with Secretary Shinseki of the VA. This is evidence of the priority placed on helping wounded warriors and their families within the highest echelons of these departments. I will introduce our DOD and VA witnesses when the third panel convenes.

Now I'm very pleased to welcome our first panel. These men and women who represent wounded active-duty service members and veterans and their families are the reason we're all here today.

We have with us Lieutenant Colonel Gregory D. Gadson, United States Army; Lieutenant Colonel Raymond T. Rivas, United States Army, retired; his wife, Ms. Colleen O. Rivas; Ms. Kimberly R. Noss, Ph.D., the spouse of a seriously wounded service member; and 1st Lieutenant Andrew K. Kinard, United States Marine Corps, retired.

The wounded warrior legislation passed by Congress required the Department of Defense and Department of Veterans Affairs to collaborate on many levels. The departments have been tasked with great challenges such as jointly developing a fully inoperable (sic) electronic health record process, improving the disability evaluation system, establishing centers of excellence for psychological health, traumatic brain injury, and eye and auditory trauma, coordinating care and much more. Collaboration on such a large scale was new ground for these two huge government agencies. The fact that these agencies have been able to work so closely on so many different levels is a sign of great commitment on their part to ensuring that our wounded, ill and injured service members and their families are given the best care management and support possible while navigating through these bureaucratic processes.

But, with any undertaking of this magnitude, there are bound to be outstanding issues and problems to work out along the way. Now, I've visited with many of our wounded warriors, including soldiers from Nebraska at Walter Reed Army Medical Center. The service members I have spoken with lauded the treatment they were receiving at Walter Reed and so I commend the efforts of those who work to improve the outpatient care and treatment of our wounded warriors.

However, I also learned of many issues that indicate there is still work to be done. We've heard of the shortage of health care professionals, but we still owe it to our troops and to our country to adequately assess the medical condition of our service members prior to their deployments. I recently learned of incomplete medical assessments due to a shortage of time or manpower, which resulted, in one case, in the unnecessary exacerbation of a service member's medical condition. In another case, the incomplete medical assessment resulted in the deployment of a medically unfit service member whose condition quickly deteriorated in Afghanistan, causing him to collapse in the field. This service member consequently had to be medically evacuated from a forward deployment for a known medical condition.

When our service members return home with war wounds, it is imperative that we have the medical personnel and resources available to care for them. It's also essential that we make efforts to treat our service members as close to home as possible. The ability to receive care near their home base provides a better network of support for the service member and will likely speed recovery time.

Ensuring we have the means and resources in place for medical assessments and adequate treatment facilities is why oversight hearings such as this are so very important. And as we reflect on the work done to date in improving these policies and programs for our service members and their families, we must also identify any existing gaps or problems in the care coordination and transition process. Only after we identify problems can we work to find answers and provide the highest quality of care for our wounded, ill and injured service members and their families. But this is far more than just a procedural issue. The purpose of these massive policy and program reforms is to care for our wounded warriors.

And now it's my pleasure to welcome, just in time, Senator Graham. We're delighted to have you here with us today to discuss these critical issues, and I ask if you would like to make an opening statement.

I want to also welcome -- (laughter) --

SEN. LINDSEY GRAHAM (R-SC): He was just here. (Laughs.)

SEN. NELSON: -- Senator Webb. I understand -- is it possible that he might return?

MR. : It's possible, yes.

SEN. GRAHAM: Okay.

SEN. NELSON: Well, Senator Graham, would you like to make an opening statement?

SEN. GRAHAM: Very briefly, Mr. Chairman. I want to thank you for conducting the hearing. You've been a terrific supporter of the Wounded Warrior Program and men and women in the military in general.

We got to meet with this group. We were going to have a hearing a couple of weeks ago when we had a bunch of votes scheduled, but the chairman was kind enough to come to my office and I think we got a lot out of that meeting, meeting with our wounded warriors here and, you know, Andrew -- (inaudible) -- in my office. And we learned a lot just about -- but one thing I learned is that I don't want these hearings to be taken by anybody is that there's a lack of caring. People care a lot. There's a lot of bureaucracy out there that cares a lot. We've just got to get it focused on doing the best job it can.

Secretary Gates has put $300 million in the budget, which will help us. It's a budgetary item now for the Wounded Warrior Program. And the purpose of these hearings is to learn how to do it better and not to question anybody's motives. If the services are not being delivered well, it's not because people don't care. It's just not working right.

Now, for these warrior transition units, we hear some disturbing reports that people feel like the odd guy out. Family members felt like the command climate wasn't as responsive as it could be. That disturbs me. I'd just say this: If you're in charge of a warrior transition unit, we're going to judge you by how you take care of those who've paid a real heavy price. And I hope that problem can be fixed and is not as bad as some people have said it was.

So we're here today to learn and the best way to learn is from people who live it, and that's panel one. And the next panel are the people in charge of making sure it works. And we're going to be a team. Every American wants us to get this right. This has got nothing to do with party politics. This is the one thing that will bring this country together above all else, is taking care of the men and women who've been hurt.

So thank you, Mr. Chairman, for having the right tone and attitude about how to do this.

SEN. NELSON: Well, thank you, Senator Graham. You have been steadfast in your support for this program, whether the roles were reversed and you were chairman and I was ranking member or the current situation, and we will continue to make it bipartisan, nonpartisan, because there's nothing partisan about the need for care for our men and women and their families who serve our country in so many different ways.

And now to our first panel -- we welcome four frank assessments of the strengths and weaknesses of the system supporting wounded warriors and their families, as well as any recommendations that you may have for improvements in the future. We'll begin by hearing opening statements followed by some questions.

And first, Lieutenant Colonel Gadson, if you would please start us off and then we'll work our way down the table.

LT. COL. GADSON: Yes, sir.

Chairman Nelson, Senator Graham, distinguished members --

SEN. NELSON: You might have to punch the button.

LT. COL. GADSON: It's pressed. It's red. Hello? Test, test.

SEN. NELSON: There you go.

LT. COL. GADSON: Chairman Nelson and Senator Graham, distinguished members of this committee, thank you for this opportunity to testify today to share my experiences as a wounded warrior in the Army medical system.

First and foremost, I cannot overstate how impressed I am with the treatment and care I have received since I was wounded nearly two years ago. Walter Reed Army Medical Center and other service medical centers have treated unprecedented injuries and trauma and not only successfully treated those injuries but enabled those who have been injured to rejoin society and live productive lives. For that, I am truly grateful and humbled by those in the medical community who have dedicated their lives to making us well.

Dealing with severe injury and trauma is not easy. When you consider the myriad of injuries, as well as the unfamiliarity a typical family has in dealing with an injured service member, it's easy to understand how difficult a task it is to recover. I can say from my vantage point that our medical system is up to the task.

Over the past 23 months, I have seen tremendous improvements in the quality of care for injured servicemen and their families. However, that does not mean that there isn't room for improvement or gaps don't exist in the system.

One such gap that I've personally experienced involves support from a nonmedical attendant. Current policy allows nonmedical attendants to be reimbursed for meals and lodging. The nonmedical attendants' roles are to provide assistance to injured service members in activities they cannot do for themselves, i.e., bathing and driving, et cetera. In my case, my wife was reimbursed as a nonmedical attendant while our household was at Fort Riley, Kansas. However, when we decided to relocate to the local area in proximity to Walter Reed Army Medical Center, her nonmedical attendant reimbursement was discontinued.

What I want to illustrate to you is that we don't want to put families in a hardship situation when deciding how and who will assist the service member who needs assistance. The fact that per diem and lodging are paid to nonmedical attendants shows an inconsistency in rate, essentially paying nonmedical attendants based on location. I believe there should be a set rate for nonmedical attendants as well as the per diem and lodging.

The situation that family members often find themselves in is how to deal with the loss of income while the service member recovers. I have personally seen families remain apart while the serviceman recovers because they cannot afford to remain together. This is a choice families should not be forced to make.

I would like to emphasize the Army's dedication to our wounded warriors. Our purpose here is to see continued improvement.

Thank you for holding this hearing and thank you for your continued support for warriors. I look forward to your questions.

SEN. NELSON: Dr. Noss.

MS. NOSS: First of all, I would like to thank the committee for allowing me to speak today on behalf of my husband, Sergeant 1st Class Scott Noss, U.S. Army.

Scott was severely injured in Afghanistan in 2007. He suffered a severe brain injury with damage to his frontal lobes and brain stem. He had two broken ribs, his pelvic fracture, three fractured vertebras and broken feet. So he sustained a very polytraumatic injury. However, the brain injury was the worst where he is currently minimally conscious two years later and is 100 percent dependent for daily living activities.

The past two years have been very challenging, considering that we as a country were not prepared to take care of these severely injured soldiers. Men and women of the armed forces are surviving injuries that would not have survived other wars because of the medical technology available in theater and because of our excellent training from the medic corpsmen and from the pararescuemen.

However, there is a huge gap between that technology and training available in theater and what is available stateside for continued long-term health care and services for our severely wounded warriors. I come here today representing the minority of injured, the minimally conscious realm of injury, but represent the ones who need the majority of the long-term health care for the rest of their life.

One issue that needs to be addressed is TRICARE's lack of coverage of cognitive rehabilitative therapies. Those on active duty are able to access this care but are prohibited once retired, which is why many families fight to stay in active-duty service. Unfortunately, just recently at the Department of Defense Cognitive Rehabilitation Consensus Conference, DOD commissioned a formal ECRI Institute technology assessment on the benefits of cognitive rehabilitation for combat-injured veterans. This report stated that the assessment, in quotation, "found that the available evidence was of insufficient quantity -- quality to reach meaningful evidence-based conclusion on the efficacy of cognitive rehabilitation for TBI." However, the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, a center created by this committee, recently issued a white paper supporting cognitive rehabilitation as a well- accepted and usual customary component of comprehensive rehabilitation for persons with moderate and severe TBI.

Unfortunately, for no other reason, the conclusion of the report stated that even though cognitive rehabilitation research shows promising results, they are not at this time covering for veteran- status-injured soldiers. If DOD will cover cognitive rehabilitation for active-duty soldiers, why will they not cover it once he is a veteran? Why is it sound therapy for an active-duty service member but not a retiree?

While I understand that this committee does not have jurisdiction over disability compensation, it is still important that you understand that compensation for men and women with mild to moderate but functional traumatic brain injuries needs to be addressed. These men and women will not have the opportunity to have a career or retirement because of their limitations from their combat injuries. What will their future entail? These individuals fall short for benefit coverages that will ensure a healthy lifestyle, but they are not employable because of their injuries.

And what about the caregivers of the severely injured soldiers? The mean age of injured soldiers is 22 years old. If this individual requires 24-hour, seven days a week care, constant supervision for safety, how can their family, which most likely are in the prime of their career, afford to quit their jobs and forgo retirement benefits to take care of their loved one?

What about the 18-year-old wife who did not have the opportunity for education and chose to take care of her severely injured husband instead of putting him in a nursing home? This wife will not have means to income and should be compensated for her care-giving capabilities and services. Nursing home is not an option for these young men and women coming back from overseas injured.

The collaborative efforts of DOD and VA have been evident. However, there is still much work to be done. For example, it would be very helpful if a Veterans Benefits Administration employee were housed in all of the wounded warrior advocacy offices, for example, the USSOCOM Care Coalition, who has been my main source of information and advocacy.

Due to the classified nature of SOCOM warriors, if a VBA employee was located in their office, the transfer of veteran status would be smoother because of the initial and continual presence from the transition of veteran status.

And finally, I'd like to say that we should not reinvent the wheel. If TBI rehabilitation and care is better in the private sector, that's where our men and women should go. This country alone has 1.5 million brain injuries a year, where the armed forces have only sustained 8,000 since 2001. The VA should have an open mind and a higher fee-based budget to provide the necessary care for these individuals, as well as TRICARE stepping up to the plate to provide such services as cognitive rehabilitation. These men and women of the armed forces have earned options and deserve the best in continued health care services for their entire life.

And I would like to say that, even though these have been the negative aspects of our journey, I do thank the DOD, USSOCOM and the Care Coalition. Scott was a proud Army Ranger and he fought gallantly for his country. I would also like to thank the VA. They kept my husband alive and has done (sic) superb.

Thank you.

SEN. NELSON: Lieutenant Kinard.

MR. KINARD: Yes, sir.

Good afternoon, Chairman Nelson, Senator Graham, members of the subcommittee.

I'm pleased to appear before you today to discuss my experiences as a warrior in transition. I hope that by sharing some of these challenges with you that I've faced, and some of the successes that I've had, that we can sort of get a collective understanding of the path forward from here. And what I'd like to focus on really are some common themes that unite a lot of the wounded warriors that are returning home.

Is the microphone close enough? Can you all hear me okay?

SEN. NELSON: I think it is.

MR. KINARD: Great.

You know, although I faced many challenges in the two and a half years of my recovery since being injured in Iraq, first of all, let me say that I would not be here today were it not for the dedication and professionalism of our medical service personnel. Every breath that I take is a testimony to their service. I mean that.

You know, I was injured, like I said, two and a half years ago. And my subsequent medical evacuation and recovery consisted of over 60 surgeries and countless hours of physical therapy, occupational therapy -- you name it. I went to just about every service except for gynecology. (Laughter.)

I was an inpatient at Walter Reed when The Washington Post broke the stories and remained there through all the changes that ensued during the fallout. And some of them have been pretty effective and some of them -- we've got, you know, some way to go forward.

If I might just make a quick comment on the GAO study that you will hear about in the next panel, I've had a chance to read that study and their assessment, their overall assessment, shows that 60 out of 76 of the criteria have been met. My comment to that is that although mathematically that sounds like a pretty good progress report, even the GAO itself admits that they did not actually study the effectiveness of each of those policies that it met. So all they did was check the box that there is a policy that was created. They didn't actually look at, is this working or not.

And what I'd like to talk to you about today is, you know, how can we sort of look at some of these policies that have been out there and say are they working or are they not? How can we reduce redundancies within the system? How can we sort of streamline things so that the net effect is a decrease in the amount of confusion amongst the wounded veterans and their families?

You know, the biggest item that I could sort of sum up is case management, case and care coordination. You know, the need for competent case management at all phases of transition cannot be overstated -- what is especially critical during the rehabilitation and reintegration phases of a person's transition. You know, if you can get the proper care identified, I think you're going to have a very successful chance of a good recovery. You know, when my doctors knew what was going on and when we identified, you know, which specialty service did I need to go see, there's no question, I thought the care that I received at Walter Reed and Bethesda were excellent.

However, the problem arises in an outpatient status. Keeping track of the number of case managers alone can be overwhelming. I can count on, you know, eight different case managers that I had to keep track of at any one time. The burden and responsibility fell on me to make sure that I knew which of my case managers to go to for which problem, and, in effect, you know, I was left with a handful of business cards. You know, they all said call me if you need any problems (sic) and I said I don't really know, you know, what to ask or not to ask.

So one of the things that has been a great success, I think, has been the creation of an overall care coordination program within the DOD and the VA. The DOD has a coordination program called the recovery care coordination program, RCCs. The VA has, on the other hand, FRCs, federal recovery coordinators. And what they simply do is bring together all of the resources that we have available within the DOD and the VA and at a 30,000-level view say, how can we coordinate some of these things? And it's a one-stop shop.

But what my concern is is that while the RCCs and the FRCs are really doing the same thing and the only difference is what category of wounded person they're treating -- FRCs typically manage the care of the more seriously injured and the more critically injured service members, while RCCs are the less severely injured. But the two systems are administered by two different departments. One's by the VA, one's by the DOD, and yet they're supposed to be doing the same thing and bringing the same resources to bear. So my question is, you know, at what level are we going to be coordinating these two programs to make sure that we're getting the most effective treatment delivered to the service member, and we're reducing redundant programs so that we can also make sure we're spending dollars on beans and bullets where we need to and -- as well as maximizing our dollars spent on our wounded warriors.

I'd also like to comment briefly on the disability evaluation system pilot program that was created directly as a response to some of the criticisms raised in the Walter Reed coverage by The Washington Post. In an effort to simplify and streamline the process, before the DES pilot was created, a recovering service member would have to be rated, their whole body rated by the DOD, found unfit to continue service, then transferred into the VA, rated again, and then receive disability compensation. And the VA would take quite awhile, and there would be a many-month gap between receiving that critical compensation. And what we did was we streamlined that process by eliminating one of those two medical examinations. But at the same time, I think we still need to make sure and follow up that the Department of Defense and the VA are doing the handoff correctly and effectively. You know, for myself, and I don't want to get into specifics of my case, that's -- I'm not here for my specifics today. But as an example, it took me roughly nine months for the DOD and the VA to figure out that my legs were not growing back. So you know, there's some efficiencies that I think we can still continue to enjoy and benefit from if we take hard looks and ask the second and third panel of witnesses how we can really make it work for us up here on the first level.

So thank you, gentleman and ma'am, for your time, and I appreciate -- answer your questions.

SEN. NELSON: Well, thank you very much, Lieutenant Kinard.

We've had join us, since we began, Senator Hagan from North Carolina, Senator Begich from Alaska, Senator Chambliss from Georgia and Senator Thune from South Dakota, a neighbor, and Senator Wicker from Mississippi. Why don't we ask if there are any comments that you'd like to make before we turn to questions.

Any opening statements? Comments?

Okay. I guess we're reading to turn to some questions. Should we try to do it -- about six minutes, questions? Okay. Some of these questions will, in one way or another, be comparable to some of the testimony you've already made, but perhaps it'll be a little bit different. For example, this one: Where you had care case managers and they were working with you, do you think they were effective in getting you better care?

Will start with you first, Lieutenant. I know that --

SEN. GRAHAM: It's "Kynard."

SEN. NELSON: "Kynard," I'm sorry.

MR. KINARD: Thank you, Senator Graham. (Laughs.)

SEN. NELSON: I like to get names right.

MR. KINARD: The question, sir, is, were my case managers effective in delivering? Yes and no. I feel that the sheer volume alone of case managers, the number of case managers there are available creates a diffusion of responsibility within the overall system. Having the RCC program and the FRC program, which are relatively new, but what they do is they bring all those together to a -- one person that I can call and say, let's figure this out together. I think that is certainly a great improvement that the Department of Defense and the VA have made. And so I can't say in every single case that the case managers drop the ball, but it certainly will make it easier, having these programs in place with effective oversight and coordination between the two departments, to allow us to achieve the maximum medical benefit.

SEN. NELSON: What we did see, though, is in bringing a case manager in, at least it appears that we got over the hurdle that we had where people were unaccounted for, wounded warriors were unaccounted for. At least it was -- that part of it was effective in having you accounted for. Did we make any progress there?

MR. KINARD: I think the individual services have made tremendous efforts in accountability. And, you know, at the end of the day, just looking at this issue through the lens of your average patient, 18- to 24-year-old male, he's going to try that guy in uniform. He's going to go to the sergeant. He's going to, you know, the NCO. I think we've done a tremendous job, and the services ought to be commended for how they've really stepped up to the plate with case management and with accountability.

SEN. NELSON: Thank you.

Dr. Noss.

MS. NOSS: I was very fortunate to have the SOCOM care coalition manage Scott's, I mean, continue to manage Scott's care and his active-duty status and now that he will be a part of the Care Coalition for life. And if we are trying to have a system to be (bottled ?) by, I really do think it's the Care Coalition. They've done a fabulous job ever since General Brown started the organization. So I have not had any bad experiences when it comes to case management because of the Care Coalition.

SEN. NELSON: Okay. Mrs. Rivas.

MS. RIVAS: We haven't had any bad experiences, either. The case manager, in fact, saved us when he first arrived at BAMC. He just sat there in a room and at that point, he didn't have a case manager. And when they assigned him a case manager, that's when things started moving along. And with the traumatic brain injury, he couldn't remember anything. So she coordinated everything and made sure that he got to where he needed to be and that all of his care was taken care of. So we had a wonderful experience. And then later on, SOCOM came in, the Care Coalition. At first, they didn't realize he was there. He was kind of in limbo. And when they found him, that's when the ball started rolling, too. And they have stayed with us afterwards and made sure that we are up on any new care issues that arise. They've both been wonderful.

So anything you want to mention?

I need to add this, too: The case manager, she was the one that was able to get him outpatient -- farmed out to Riosa. It's an institute that helps with mild to severe brain injuries. And if it wasn't for that, he wouldn't be where he is today. That outpatient care has been wonderful.

SEN. NELSON: Such a simple concept but an essential part of the tracking and keeping care appropriate and constant so that something doesn't just lose its momentum --

MS. RIVAS: Well, it's made all the difference in the world to us, to where he is today and to where he was. He couldn't do simple things, and -- just getting dressed, just feeding himself. And he stuttered terribly, he couldn't carry on a conversation. And they worked with him on every aspect and he is so much better today. And then I have to say, even the VA -- we have a wonderful VA vocational counselor that we've been put in touch with, and she got him involved in the Easter Seals program. So it's just having that contact.

SEN. NELSON: Thank you.

Lieutenant Colonel Gadson.

LT. COL. GADSON: Yes, sir. I would echo what Lieutenant Kinard -- Andrew Kinard said. The multiple case managers can be a bit confusing and I personally have raised a question as to why, in fact in Andrew's and my case because we're amputees, we have a specific amputee case manager, and then we have another case manager, and he may even have some additional ones. And so I guess the frustration is, where is the accountability? Even to this point, I would say that I don't understand what the clear delineation between responsibility is. And so there's a potential gap. Not that I've had any personal issues with it. You know, you've got to be on your game and understand what's going on and make sure that doesn't happen, and so I feel like I've been able to for the most part advocate for myself. So I think there's room to streamline that, and I think they recognize that, but we haven't gotten there yet.

SEN. NELSON: Senator Graham.

SEN. GRAHAM: Thank you, Mr. Chairman.

I thank the panel for sharing your experiences with us.

Make sure I get this right. You get wounded, you get back home, your active-duty pay continues until you're medically discharged. Is that right?

MR. : Correct.

SEN. GRAHAM: Now, in terms of support for the spouse that's life is changed as much as yours has, there is no -- there is a compensation stream? Is that right, Colonel Gadson?

LT. COL. GADSON: Well, sir, first I'd like to say that there is -- they have the TSGLI, which is the traumatic insurance that you get, that a family or --

SEN. GRAHAM: Right. How much is that?

LT. COL. GADSON: Well, it really depends on your injury. There's no set amount --

SEN. GRAHAM: Okay, gotcha. But you get a payment?

LT. COL. GADSON: You get it in payment. That in some cases can be used to offset that. But I can tell you certain circumstances where people have had to move and they haven't been able to sell their house, and it starts to eat into those -- you know, eating into money that wasn't necessarily designed for that.

SEN. GRAHAM: But my question is, a family member is going to maybe have to quit their job -- Dr. Noss --

LT. COL. GADSON: Yes, sir.

SEN. GRAHAM: -- or certainly, you know, their life is affected dramatically. What income stream is available to them?

Dr. Noss?

MS. NOSS: Yes. Right now, through the VA benefits, they have a small portion, it's called aid and attendance, which is to utilize to pay for care-giving hours or to be utilized by the family member who is doing the care giving.

SEN. GRAHAM: How much money did that mean for you?

MS. NOSS: Five hundred and eighty dollars a month.

SEN. GRAHAM: Okay. Andrew, you're not married, I know. Your dad's a doctor and your mom -- are fairly well off, but there are a lot of guys your age that don't have that. What do single guys get?

MR. KINARD: Single guys with their family members coming to take care of them?

SEN. GRAHAM: Right.

MR. KINARD: I am not familiar with the compensation, sir.

LT. COL. GADSON: Senator Graham, I believe right in the D.C. area, the per diem for a caregiver or a non-medical attendant would have been about $30 a day.

SEN. GRAHAM: Okay. And your concern is it shouldn't be based on where you're located, it should be a flat rate with a bump-up based on location, right?

LT. COL. GADSON: Plus per diem, yes, sir.

SEN. GRAHAM: Ms. Rivas, did you get any income support?

MS. RIVAS: I'm not aware of any of this. We lived off his retirement pay and savings and so this is new information to me.

SEN. GRAHAM: All right. Well, that's why we have these hearings.

Now, the point that I'm trying to make is that the country needs to come to grips with the fact that the moment the person is catastrophically, "devastatedly" injured, the family changes. And I think most Americans would like an income stream available to family members who provide that support that otherwise would be given by the government. But the one thing, highly unlikely that -- the caretaker's not going to live with you 24 hours a day, maybe, like a family member. So that's something, Mr. Chairman, I think we can look at, is finding a revenue stream.

Now, Dr. Noss, how old are you?

MS. NOSS: I'm 28 years old.

SEN. GRAHAM: Okay. What's your educational background?

MS. NOSS: I have a doctorate in chemical engineering. I actually just graduated this past semester.

SEN. GRAHAM: Most of the people in your husband's -- how old is your husband?

MS. NOSS: He's 31 -- '77.

SEN. GRAHAM: Okay. But as Andrew said, most of these wounded people are young people, right?

MS. NOSS: Yes, sir.

SEN. GRAHAM: What have you found in terms of their spouses' capability or family members' capability to survive these injuries financially?

MS. NOSS: Actually, the two years I have been inpatient with my husband, because Scott is still inpatient at the VA in Tampa, a lot of -- majority of the families are very young. Most of the wives who come with their injured husbands don't have a job. They were stay-at- home mothers, they were 17-, 18-, 19-year-old, high school-educated young women.

SEN. GRAHAM: Andrew, what would you have done if you hadn't had the family you had?

MR. KINARD: Sir, I would have been by myself. You know, my dad, he left his practice for two months, came up to Washington, D.C. and moved up there. My mom lived up with me for over seven months, and it wasn't until I was discharged from the hospital and able to sort of take care of myself.

(END OF TODAY'S COVERAGE. COVERAGE WILL RESUME TOMORROW.)