Letter to Chuck Hagel, Secretary of Defense and Eric Shinseki, Secretary of Veterans Affairs - Status Of DOD/VA Health Centers

Letter

Congresswoman Annie Kuster (NH-02) and Congressman Dan Benishek (MI-01) this week called on Secretary of Defense Chuck Hagel and Secretary of Veterans Affairs Eric Shinseki to provide Congress with an update on the status of three health centers that provide care to military personnel and veterans affected by combat trauma. Recent reports indicate that a lack of coordination, administrative delays, and inadequate staffing levels at these facilities, known as Centers of Excellence, have prevented the centers from providing adequate care coordination for military personnel and veterans affected by eye, hearing and limb extremity trauma.

In a letter to Secretary Hagel and Secretary Shinseki, Reps. Kuster and Benishek led a bipartisan group of lawmakers in requesting that both DoD and VA report back to Congress within 60 days to provide an update on the status of these three centers.

"Although your departments have appointed key staff to these [Centers of Excellence], they have experienced serious delays because of limited funding from the VA, administrative burdens, and lack of oversight and coordination between the DoD and the VA," the letter read. "Unfortunately, these delays have hindered significant progress toward the establishment of the vision, hearing, and limb extremity centers. Ultimately all three centers of excellence have reported challenges in meeting their mandated objective: to provide the care coordination our military personnel and veterans need and deserve."

In recent years, there has been a significant increase in the prevalence of combat eye trauma among service members returning from Iraq and Afghanistan. In May of this year, the VA reported that more than 130,000 service members have some type of eye injury and 70 percent of blast injuries have associated traumatic brain injury and visual system dysfunction. In addition, the DoD reported that 298,000 service members have experienced hearing loss trauma, which may be associated with traumatic brain injury complications, and also reported significant instances of dual sensory injuries. In light of these striking statistics, the Pentagon has identified the three centers of excellence as a top priority.

Earlier this year, Kuster authored a provision requiring the DoD and VA to report on their role in the Centers of Excellence. That amendment was included in the fiscal year 2014 National Defense Authorization Act (NDAA) and earned the support of the Blind Veterans Association (BVA).

The full text of Kuster's letter is below:

Dear Secretary Hagel and Secretary Shinseki:

As you know, Congress established the Vision Center of Excellence through the fiscal year 2008 National Defense Authorization Act (NDAA) (P.L. 110-181), as well as the Hearing Center of Excellence and Limb Extremity Center of Excellence through the fiscal year 2009 NDAA (P.L. 110-147). The goal of these three centers of excellence is to enhance the care of American military personnel and veterans affected by combat eye, hearing, and limb extremity trauma through improvements in prevention, diagnosis, treatment, and rehabilitation. In addition, these centers are charged with strengthening clinical coordination between the Department of Defense (DoD) and the Department of Veterans Affairs (VA) and with developing registries with up-to-date information on the diagnosis, treatment, and follow-up evaluations for these injuries.

There has been an increasing prevalence of combat eye trauma among those serving in Operations Enduring Freedom and Iraqi Freedom. The VA reported in May 2013 that approximately 130,890 service members have some type of eye injury and 70 percent of blast injuries have associated traumatic brain injury and visual system dysfunction. In addition, the DoD reported that 298,000 service members have experienced hearing loss trauma, which may be associated with traumatic brain injury complications, and also reported significant instances of dual sensory injuries. Faced with these troubling statistics, in the 2010 Quadrennial Defense Report Secretary Gates listed these three centers of excellence as a top priority for the DoD.

Although your departments have appointed key staff to these centers, they have experienced serious delays because of limited funding from the VA, administrative burdens, and lack of oversight and coordination between the DoD and the VA. Unfortunately, these delays have hindered significant progress toward the establishment of the vision, hearing, and limb extremity centers. Ultimately all three centers of excellence have reported challenges in meeting their mandated objective: to provide the care coordination our military personnel and veterans need and deserve.

As Congress continues to finalize fiscal year 2014 appropriations, we believe that each of these specialized wounded warrior centers should continue to be provided the resources necessary to complete their missions of improving coordination of care between the DoD and VA. Prompt implementation of these three DoD and VA Centers of Excellence would allow our visually, hearing, and extremity-amputee wounded warriors to receive improved short-term and long-term individualized treatment.

To ensure that these congressionally mandated programs are promptly implemented, we therefore respectfully request that both the DoD and the VA report back within 60 days on each of the following:

- The amount of funding allocated for each center from fiscal year 2010 through fiscal year 2013 and estimated funding levels for fiscal year 2014 through fiscal year 2018;
- Each agency staffing level for government personnel and contractor personnel;
- Current joint legal governance agreements between agencies; and
- An update on numbers of service member records in the mandated joint electronic trauma registry and the agency responsible for entering the clinical data for those wounded in Operations Enduring Freedom and Iraqi Freedom.

The establishment of these centers of excellence for hearing, vision, and limb extremity is an unparalleled opportunity to dramatically improve specialized wounded care services for our nation's service members, veterans, and their families. We look forward to continuing to work with you in support of our wounded service members and veterans and again ask for the information listed above to be provided within 60 days. Thank you for your service to our country and your attention to this important matter.

Sincerely,

Ann McLane Kuster
Member of Congress

Dan Benishek
Member of Congress

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