Hearing of the Armed Services Committee on Conditions at Walter Reed Army Medical Center

Hearing of the Armed Services Committee on Conditions at Walter Reed Army Medical Center

Opening Statement of Senator Carl Levin

The Committee meets this morning to address reports of substandard living conditions, poor outpatient care and bureaucratic roadblocks and delays for injured soldiers at Walter Reed Army Medical Center.

I welcome our witnesses here today, Dr. David Chu, Under Secretary of Defense for Personnel and Readiness; Dr. William Winkenwerder, Assistant Secretary of Defense for Health Affairs, General Peter Schoomaker, Chief of Staff of the Army, and Lieutenant General Kevin Kiley, Surgeon General of the Army. This Committee is determined to understand what went wrong at Walter Reed and what we need to do to make sure that it doesn't happen again, there or anywhere else.

Our nation has a moral obligation to provide quality health care to the men and women who put on our nation's uniform and are injured and wounded fighting our nation's wars. This obligation extends from the point of injury, through evacuation from the battlefield, to first class medical facilities in the United States, and ends only when the wounds are healed. Where the wounds will never heal, we have an obligation to provide quality care throughout the lifetime of the veteran.

I am sad to say that we are not meeting this obligation, although it is an obligation which all Americans accept and insist be met to the fullest.

Today's hearing is about another example of the lack of planning for a war that was premised on the assumption that combat operations would be swift, casualties would be minimal, and that we would be welcomed as liberators instead of being attacked by the people we liberated.

I am proud of the fact that our military doctors, nurses and medics have provided outstanding medical care to those who are wounded. Many service members who would have died in earlier conflicts survived in Iraq and Afghanistan because of the advances in battlefield medical care and the skill and bravery of our combat medical teams. Seriously injured troops are rapidly evacuated to world-class medical facilities like Walter Reed and Bethesda Naval Hospital, where they continue to receive state-of-the-art care as inpatients. It is when they leave inpatient status that the system has failed them.

A recent series of Washington Post articles described deplorable living conditions, failure to account for, and bungled administrative processing of injured troops in an outpatient status at the Walter Reed Army Medical Center. New reports indicate that these problems are not confined to Walter Reed, they exist elsewhere in the military and VA medical systems. Post reporters Dana Priest and Anne Hull are to be commended for bringing this tragic situation to light. The Army now acted to move soldiers out of a worn, aging facility that should never have been used to house wounded soldiers. These heroes deserve far better than that. They all volunteered for service in our military forces with great hopes and dreams for their futures. Now they are faced with the daunting task of figuring out how to live with a life-time disability - a condition they incurred in service to our nation.

It appears that the Army, especially the leadership at Walter Reed, was slow to recognize the need to increase the number of case workers and experienced non-commissioned officers to keep pace with the increased number of outpatients under their care. These NCOs and case managers are critical for assisting injured soldiers in making and keeping medical appointments, for accounting for and tracking of these soldiers during rehabilitation and recuperation, and assisting them as they process through the disability evaluation system. The Army is now hiring more case managers and bringing in additional non-commissioned officers to help these injured soldiers and their families navigate the health care system and to ensure that these soldiers have a decent quality of life while they continue to recover from their injuries. The Army is also establishing a new command structure at Walter Reed that will be focused on taking care of wounded soldiers in an outpatient status. Good leadership should have taken these steps long ago, without prompting by a series of embarrassing news articles.

Senior officers are being held accountable for failures of leadership that lead to these conditions. Unlike his predecessor who fired only those who disagreed with him, Secretary Gates has moved quickly to remove senior officials when he lost confidence in them because their actions did not measure up. Our soldiers will benefit as a result of Secretary Gates' decisive action to insist on accountably.

While the Army appears to be taking the necessary steps to repair and evacuate substandard buildings and hire additional staff to assist wounded soldiers, the more daunting task is to change an overly complex, bureaucratic, adversarial system used to evaluate and rate disabilities of injured service members. This disability rating is extremely important because it determines whether a service member who is no longer fit for duty is eligible for medical retirement or medical separation. Those with disabilities rated at 30% or higher are medically retired, entitling them and their families to healthcare through the military's generous TRICARE health care program and access to commissary and post exchange benefits. Those whose disabilities are rated less than 30% are given a medical separation with severance pay. Although these service members whose disabilities are rated at less than 30% will be able to receive health care through the VA, their families will not.

Last Friday, four colleageus and I visited Walter Reed and talked with a number of these wounded soldiers and their families . By and large, they had praise for the inpatient health care they received, and despite our personal observation of substandard living conditions for outpatients, they did not complain. What they are most concerned about is the military's disability evaluation system. Many of these soldiers have extremely complex injuries that take many operations and a long time to heal. For some, this process takes a year or more. Once they get to the point where their doctors tell them that further medical care will not improve their condition, and if it is determined that they are not fit for duty, most of these wounded soldiers just want to go home and get on with their lives. It is at this point in their treatment that they encounter the DoD disability evaluation system. This system places these soldiers in the position of having to fight for a disability rating that entitles them to medical retirement. After all they have been through, these injured soldiers should not feel that they have to fight for what we, as a nation, have a moral obligation to provide.

One soldier with whom I talked had been injured by an IED blast while on his second tour of duty in Iraq. He is continuing to receive care for his injuries in an outpatient status. He understands that he is no longer physically fit for military duty because of the seriousness of his injuries. He told me that he is "scared to death" that the physical disability evaluation system will rate his disability at less than 30% and will "put me out on the street" without the ability to take care of his family, including his children. How can we, as a nation, ask our young men and women to serve, and when they are wounded while serving, put them in a position where they are "scared to death" that we will not take proper care of them and their families? Surely we must change such a system.

The problems are not over for these disabled veterans when they leave the military. After a service member is medically discharged or separated, he or she can apply for disability compensation and health care through the Veterans Administration. The VA conducts its own assessment of the degree of disability of the veteran. Although the VA and DoD use the same standards for evaluating disabilities, their disability ratings often vary significantly; and in most cases the VA disability rating is higher than the military disability rating. Unfortunately, only the military disability rating counts when determining whether the member is medically retired with family health care benefits, or medically discharged with no benefits for his or her family. This is extremely frustrating and confusing for our wounded service members and their families who then have to fight the system to get the best rating they can.

I commend Secretary Gates for quickly recognizing that we are falling short in our obligation to our wounded service members and in a unique statement of gratitude to the reports who broke the story said that he was "very disappointed that we did not identify it ourselves." He added very accurately that our service members "battled our foreign enemies; they should not have to battle an American bureaucracy."

Secretary Gates has appointed an independent review group to identify any critical shortcomings and opportunities to improve the rehabilitative care, administrative processes, and quality of life for injured and sick members of the armed forces at Walter Reed and Bethesda, and to make recommendations for corrective actions. On Saturday, the President announced that he will also appoint a bipartisan panel to examine the medical treatment provided to wounded service members by the Department of Defense and the Department of Veterans Affairs.

The Congress also has a responsibility to act. Senator Akaka, the Chairman of the Committee on Veterans Affairs, and I, and our ranking members Senator McCain and Senator Craig, are determined that our Committees will work together to improve the care of our veterans throughout their continuum of care. We will hold a joint hearing of our two Committees in the near future to identify the remedies to the problems our wounded soldiers are facing.

The American people are deeply angry about the shortfalls in care. The war in Iraq has divided our nation, but the cause of supporting our troops unites us. We will do everything we possibly can do, not as Democrats or Republicans but as grateful Americans, to care for those who have served our nation with such honor and distinction.

http://levin.senate.gov/newsroom/release.cfm?id=270147