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[H.A.S.C. No. 108–25]



FOR FISCAL YEAR 2005—H.R. 4200






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JANUARY 21, 2004




JOHN M. McHUGH, New York, Chairman
TOM COLE, Oklahoma
JIM SAXTON, New Jersey
JIM RYUN, Kansas
ROBIN HAYES, North Carolina
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VIC SNYDER, Arkansas
MARTY MEEHAN, Massachusetts
JIM COOPER, Tennessee

Lynn W. Henselman, Professional Staff Member
Elizabeth McAlpine, Staff Assistant



    Wednesday, January 21, 2004, Fiscal Year 2005 National Defense Authorization Act—Reserve Component Healthcare: Medical Holdovers in Current and Future Deployments

    Wednesday, January 21, 2004

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    McHugh, Hon. John M., a Representative from New York, Chairman, Total Force Subcommittee

    Snyder, Hon. Vic, a Representative from Arkansas, Ranking Member, Total Force Subcommittee


    Armstrong, Col. Keith, Garrison Commander, Fort Knox, Kentucky

    Cowan, Vice Adm. Michael L., Surgeon General, Department of the Navy

    Hicks, Patricia D., Director, Citizens Advocacy Center

    Inge, Lt. Gen. Joseph R., Commanding General, 1st U.S. Army

    Kidd, Col. John M., Garrison Commander, Third Infantry Division, Mechanized, Fort Stewart, Georgia

    LaChance, Sgt. Craig Allen, Medical Holdover Company, Fort Stewart, Georgia
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    Peake, Lt. Gen. James B., Surgeon General, Department of the Army

    Robinson, Steve, Executive Director, National Gulf War Resource Center, Inc.

    Stewart, Rear Adm. John M., Jr., Deputy Commander, Navy Personnel Command, Department of the Navy


[The Prepared Statements can be viewed in the hard copy.]

Daniel J. Denning, Principal Deputy Assistant Secretary of the Army (Manpower and Reserve Affairs) joint with Lt. Gen. James B. Peake

Armstrong, Col. Keith A.

Cowan, Vice Adm. Michael L., joint with Rear Adm. John M. Stewart

Hicks, Patricia D.

Kidd, Col. John M.

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McHugh, Hon. John M.

Robinson, Steve

Snyder, Hon. Vic

[There were no Documents submitted.]

[There were no Questions submitted.]


House of Representatives,
Committee on Armed Services,
Total Force Subcommittee,
Washington, DC, Wednesday, January 21, 2003.

    The subcommittee met, pursuant to call, at 9:35 a.m. in room 2118, Rayburn House Office Building, Hon. John M. McHugh (chairman of the subcommittee) presiding.

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    Mr. MCHUGH. The hearing will come to order. Good morning. First of all I apologize we are running a little late. It is all my responsibility, and the 47,000 other drivers on the George Washington Parkway who don't know how to maneuver a car.

    But let me welcome you today to this, our inaugural subcommittee get-together for the new session. And we appreciate your joining us.

    Today the subcommittee meets to hear testimony regarding the treatment of reserve component soldiers and sailors who are receiving medical care and disability processing while in a medical holdover status. And I want to, as I said, welcome our witnesses and look forward to their testimony, certainly.

    In October of last year, a series of news articles revealed that many mobilized reserve and national guard soldiers in medical holdover status felt the Army was not treating them as equals as to their active component counterparts. The articles described substandard living conditions at two Army posts in particular: Fort Stewart, Georgia, and Fort Knox, Kentucky. Many of the ill and injured soldiers interviewed at these posts reported having to wait for long periods of time, sometimes weeks and months, before receiving the medical care that they needed.

    About the same time, the subcommittee received several reports from Naval reservists who experienced problems with the management of their health care while in a medical holdover status, especially when they are undergoing evaluations of fitness for duty.

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    The subcommittee began to closely examine matters related to reserve component participation in the global war on terrorism last year, with visits to deployed reservists in January, followed by a hearing in April. The key objective of that oversight effort hearing was to determine how well the total force policy was working and whether the active, National Guard, and reserves were truly a seamless force.

    What we found then was that there were rough edges, cracks, and gaps in those seams. We began to take steps to reduce or eliminate them. Since then, the total force has expanded its wartime commitment significantly. Today the total force has just begun the largest wartime deployment and redeployment of forces—more than 250,000 personnel—since World War II.

    One result will be that the reserve components will comprise at least 40 percent of the forces deployed in Iraq. Even more relevant for today's hearing, that movement of forces will severely challenge military installations and support systems here in the United States. Therefore, we must continue to be vigilant in our efforts to assure a seamless total force.

    One key to the total force concept is guaranteeing that all of our servicemen and -women receive equal consideration and treatment when moving through the military healthcare system. In my view, the Department of Defense (DOD) stumbled badly last fall in meeting that objective. While the subcommittee is encouraged by the Army's efforts since October 2003 to examine medical holdover problems across the country, the American public and Congress need to be assured that all issues have been fully recognized and solutions are being implemented. We simply can't afford to repeat the mistakes of the past.
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    Toward that end, the subcommittee has several objectives for today's hearing:

    First, we would like to understand, especially from those witnesses with firsthand experience with the medical holdover challenges, What is or was the situation at ground level? What led to the problems? How are soldiers and sailors being treated today? And what are the lessons learned?

    Second, we want to understand from a broader perspective what systemic problems the Army and Navy identified as a result of their review of medical holdover issues and how the services are planning to incorporate the lessons learned.

    Third, we want to know specific measures the Army and Navy are implementing to assure appropriate medical disposition and living conditions for the medical holdover personnel not only in the next six months but also long term.

    And, finally, we want to understand the impact new procedures and policies will have on current resourcing, and if there are legislative, policy, and resource changes that are necessary. As the subcommittee prepares the National Defense Authorization Act for the fiscal year 2005, these are important considerations.

    Now, before I turn to the subcommittee's Ranking Member, Dr. Snyder, the gentleman from Arkansas, I would like to again thank all of the witnesses for their dedication they have shown in their various roles.
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    I especially want to acknowledge the service of those here today and others around the world who are serving in uniform, and, as the President noted last night, doing incredibly important work. And the Nation has given you and them very dangerous and difficult tasks and asked great sacrifices of them. And they are performing superbly. We are deeply indebted to them.

    So with that, and those few words, I would be happy to yield to the Ranking Member, the gentleman from Arkansas, Dr. Snyder.

    [The prepared statement of Mr. McHugh can be viewed in the hard copy.]


    Dr. SNYDER. Thank you, Mr. Chairman. And thank you for holding this hearing today. I hope that this is the first in a series of oversight hearings that we will be able to do this year on some of the challenges that are out there for our men and women in uniform.

    To me, this is one of these challenges that you all are dealing with that is solvable. Hopefully you have made strides in the direction of getting it solved. As Mr. McHugh very eloquently described at the end, our interest is seeing that it is solved, but also are there things that we need to be doing in terms of any legislative changes that need to be made or in terms of the adequacy of your resources.
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    I know there is sometimes a tendency for men and women in uniform to say, yes, we have all of the resources we need. But that may not be helpful as we are heading into a new budget year to talk about any changes that we might make.

    The final thing I would say, as we have described this hearing as being about our medical holdover personnel, and it seems to me that it is not just one problem, it is—there are two problems. You have the challenge of people who are activated; and then, as becomes clear before they ever go overseas, maybe within a few days or a few hours after arriving at their site, that they probably are not going to be able to go overseas in the condition they are in, and in fact may be heading—just need to be sent on back home to where they were and make it a very short activation.

    And then the second challenge is people who have been overseas, but have either finished their tour, or because of a medical injury or wound are having medical problems prior to being demobilized. To me those seem, I would think, to be two different challenges, probably with different solutions. And I look forward to hearing any distinctions there.

    I look forward to your testimony. Thank you all for being here.

    Mr. MCHUGH. Thank the gentleman for his leadership.

    [The prepared statement of Dr. Snyder can be viewed in the hard copy.]

    Mr. MCHUGH. Would any other member of the subcommittee first like to make opening remarks? Mr. Cooper.
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    Mr. COOPER. I will be very brief. Thank the Chairman for calling this hearing. I think the best way for Members of Congress to praise the military is to actually help them in their living and working conditions. These are some of the most professional soldiers who have ever served in a force in world history. They deserve the best. And whether it is in working conditions or in healthcare conditions, I hope that the witnesses here today will be completely open with us so that we can best find out what needs improvement.

    It is one thing to be tough and to try to tough it out, but we need to try to hear the truth so that our soldiers are well served. So please be open and honest, and we look forward to helping.

    Mr. MCHUGH. Thank the gentleman from Tennessee.

    Mr. MCHUGH. Any other opening comments by subcommittee members? We are also joined by the very respected member of the full committee, Mr. Taylor, Mr. Gene Taylor. Thank you for being here.

    We have 10 witnesses on two panels today. And we would certainly like to give each, and we intend to give each witness the opportunity to present his or her testimony to the greatest extent possible, and thereafter provide the members a chance to question and have dialogue with those witnesses.

    That being the case, I would respectfully ask that all of the witnesses do their best to try to highlight within a five minute range or so their testimony. We do have all of your written statements which will, without objection, be entered in their entirety in the record. I have had a chance to read them all. I hope my colleagues have as well.
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    And I found them very interesting. But sometimes congressional schedules make full consideration of all of those submissions in the context of the hearing a little difficult. So if you could to the best of your ability meet that request, I would appreciate it.

    Let me welcome our first panel which has been seated. And I will introduce them according to the order in which they are listed here, which I hope coincides to something I suspect, from my right to your left, but we will see how that works out. The first two witnesses I know work out that way.

    We have, first of all Mr. Steven Robinson, who is the Executive Director of the National Gulf War Resources Center, Incorporated. Next to him is seated Patricia Hicks. Ms. Patricia Hicks is Director of the Citizens Advocacy Center. Sergeant Craig LaChance, who is in Army National Guard Medical Holdover Company from Fort Stewart, Georgia. Colonel John M. Kidd, Garrison Commander, Third Infantry Division, Mechanized, at Fort Stewart, Georgia. And Colonel Keith Armstrong, Garrison Commander of Fort Knox, Kentucky.

    So welcome to each and every one of you. And with that, let me say that I would hope, as we have in the past, we would not have to use—for the members's benefit—the five minute rule. So we are going to waive that, ladies—in anticipation of ladies and present gentlemen, but we may have to revert to it if we get too off the schedule.

    Mr. MCHUGH. So with that, let me defer to Mr. Robinson. Our attention is yours, sir. And thank you again for being here.

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    Mr. ROBINSON. Thank you, Mr. Chairman.

    Mr. Chairman, there is no way I can orally detail 13 years of ''lessons learned'' failures from the first Gulf War that should have been implemented before this war in five minutes. So I request that the committee refer to my substantive comments in the testimony.

    And I would like to, before I begin, say that these problems that we are going to discuss today are not the fault of the officers to my right. I additionally request that you spend some time after this hearing talking to the soldiers in attendance from Operation Iraqi Freedom. These soldiers are currently on medical hold at Walter Reed Army Medical Center. Each one of them has a unique war story to tell, not a war story about their service in Iraq, but a war story about their battle for treatment, care, and often fair compensation.

    Many of the obstacles they have faced are directly linked to DOD health affairs policies. Four days after the start of Operation Iraqi Freedom, Assistant Secretary of Defense for Health Affairs, William Winkenwerder testified that predeployment screening was not necessary, even though it was required by law and a DOD health affairs policy issued on October 6, 1998.

    Dr. Winkenwerder's leadership failed to prescreen thousands of deploying soldiers headed to Operation Iraqi Freedom. And, unbelievably, one month later, Dr. Winkenwerder reversed his position, announcing that screening was suddenly important and that DOD would enhance the postdeployment screening process.
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    This enhancement included more questions on a postdeployment form and some limited emphasis on Post Traumatic Stress Disorder (PTSD) screening. However, the policy reversal continues to ignore things that we may be doing to ourselves. Some of those things are gang vaccinations in the effort to get soldiers processed through quickly.

    Another is the use of a drug called Larium. Another is the failure to identify and aggressively screen PTSD when soldiers are returning. All of these things combine to create a healthcare crisis, if left unattended. The policies listed below that I am going to talk about are the most serious failures that I think we need to address today.

    Predeployment screening was not conducted prior to the deployment of reserve forces to the mobilization site as required by law. Had predeployment screening been conducted at the home station, guard and reserve soldiers would have been identified to have preexisting conditions that would have prevented them from deployment, or they would have been identified as soldiers that might need to be processed out of the National Guard and reserves.

    This predeployment screening is critical because it gives a snapshot in time of the soldier's health that will be used after the deployment to determine if there are any service-connected injuries. Based on conservative estimates, as many as one-third of the citizen soldiers at one Army base were deployed to the mobilization site with service-disabling conditions.

    And because of this fact, the garrison commanders to my right were suddenly overwhelmed with returning wounded and nondeployable soldiers. Many soldiers reported that their service-disabling conditions were downgraded by local unit commanders during the predeployment process. This act, in effect, ignores established medical diagnoses in order to send the soldier to Iraq. Congress should investigate the cost to U.S. taxpayers for sending nondeployable soldiers to the mobilization site.
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    Our recommendation is that predeployment screening must take place at the home station, prior to arriving at the mobilization site. The National Guard and reserve forces must not send forward anyone who is not fit and qualified to deploy. Soldiers with preexisting disabling conditions that prevent them from deployment should be rehabilitated, reclassified, left behind, or face the medical evaluation board.

    The practice of downgrading medical profiles by unit commanders must cease immediately. Congress must address the physical readiness of the National Guard and the reserves, through TRICARE for the guard and reservists. And this will ensure that every member of the guard and reserves has adequate health care coverage.

    While on medical hold, the Department of Defense is responsible to conduct postdeployment screening and mental health assessments. The postdeployment screening is designed to record the soldier's current injuries and determine if mental health counseling is necessary. This screening completes the deployment cycle, and the documentation may later be used as evidence for claims with the Department of Veterans Affairs (DVA). Failure of local commanders to ensure this process is completed accurately will harm soldiers down the road when they file Veterans Affairs (VA) claims.

    Another part of the postdeployment screening is the mental health assessment. This committee should be fully aware that suicides are reported to be up in Iraq and some have been identified here at home. Just 10 days ago an Operation Iraqi Freedom soldier hung himself at Walter Reed Army Medical Center. Other reports of suicide have surfaced both overseas and in the States.
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    The National Gulf War Resource Center toured several military installations recently, and most soldiers we spoke with still report that they have received little to no counseling regarding traumatic events experienced during war.

    Similarly, the medical commanders report saturation in their ability to care for psychological issues. The commanders are forced to outsource appointments and therapy to the DVA or civilian providers. There are shortages in qualified providers, beds, and command emphasis to treat those who need counseling most.

    Nowhere is this apparent disregard for psychological injuries more apparent than in the case of Sergeant George Andrew Pogany, who was charged with cowardice. Nearly three months after returning from Iraq, he is just now being afforded psychological care. Our recommendation is that postdeployment screening and mental health assessments must be completed with 100 percent compliance. Aggressive mental health counseling and programs must be afforded to the returning soldiers. Congress must conduct oversight now to ensure the programs are implemented forcewide.

    Soldiers also recommend that Veteran Service Officers (VSO) be allowed to go to these bases and talk to the troops and augment the existing programs. VSOs have had combat experience. They are certified in benefits preparation. They also provide a friendly shoulder, because they know what returning soldiers are going through. If DOD cannot aggressively meet the needs of medical hold soldiers, then they should enlist the help of those who stand ready to assist.

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    Larium use is a problem that we are significantly concerned about. And although many on the committee may think it is not a medical hold issue, we would like to bring it to your attention. Suicides are up at home and in Iraq. Psychological injuries are increasingly more prevalent in this war as compared to the 1991 Gulf War.

    Recently a Marine Corps Second Lieutenant, Christopher Shay, committed suicide just days before returning home from the region. By all accounts, he was at the top of his class, deep selected for difficult missions, and a dedicated Marine. Lieutenant Shay took his own life after 12 requests for assistance in a 32-hour period. After his death, the family asked why such a talented young man would take his own life, and could Larium have played any role in their son's death.

    The response from the military stated that the soldier was not issued Larium, and Larium could not be part of the problem. The family conducted their own civilian forensic investigation and found that this was not true. The point is the military is ignoring this drug's known side effects and in some cases not telling the truth to family members, as if they are baffled by the high suicide and depression rates.

    The Pentagon has refused to consider the obvious side effects of Larium and what Larium produces in the combat scenario. Each one of these suicide events are investigated, according to Dr. Winkenwerder, but he does not see any trend in these cases that tells us there is more he might do.

    Our recommendation is that this committee should ask the Department of Defense if the side effects of Larium were considered in the DOD suicide investigations both in Iraq and here in the United States. The National Gulf War Resource Center and the concerned parents would like to know why stateside suicides are not counted in the total number reported by DOD. Soldiers want to know if Larium is a factor in exacerbating PTSD. Either way, there appears to be a significant increase.
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    Lessons learned from the first Gulf War should make us hypervigilant as our soldiers return home, and this drug needs to be investigated. In medical holdover, active duty and guard and reserve soldiers are kept in medical hold while they await either medical care or medical disposition. The purpose is to treat the soldier so they might return to duty, assign them a profile, or discharge them from service after their conditions have been diagnosed.

    The inspections of several sites have uncovered significant problems with the Army's mobilization system, and commanders from two of these sites will detail their command views in what they have done to correct the problem. I would like to focus briefly on what we think is important.

    The military has already made great strides to take care of the insufficient housing, and the military knows that they must increase and upgrade housing at the different installations. The military recognizes that there is a shortage of doctors, and that when soldiers demobilize they are going to have to increase the number of doctors at each one of these facilities. The military recognizes that it needs to listen to its soldiers, and that usually when these problems present themselves it starts at the bottom and soldiers try to get it to be handled at the lowest level. And when it is not handled, we end up having hearings like this one today.

    Soldiers deployed with preexisting medical conditions now face Medical Evaluation Boards (MEB). In visits to military installations we encountered many soldiers who were sent to Iraq with service-disabling conditions because commanders downgraded their profiles. Many soldiers successfully completed combat operations in Iraq where these service-disabling conditions were exacerbated, and upon return to the United States and in the outprocessing phase, these soldiers reported their conditions and were told they were not service-connected because they were preexisting. Then, to add insult to injury, many were boarded out of the military for the same condition that should have prevented them from deploying in the first place.
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    Our recommendation is that local commanders must not have the ability to downgrade profiles for the purposes of deployment. The Government Accounting Office (GAO) needs to investigate this practice and determine the extent it has prevented soldiers from obtaining a true diagnosis and disability rating for the service-connected injuries they suffered while serving their country.

    The bottom line: The problems faced Army-wide related to medical hold soldiers should never have happened in the first place. It is unclear what action, if any, would have been taken had the conditions not been exposed by reporters from UPI, the National Gulf War Resource Center, and then aggressively investigated by Senator Kip Bond and Patrick Leahy.

    Educating military personnel about their rights and responsibilities, should they be placed on medical hold, will do much to alleviate the frustration and anger that are borne of uncertainty. Another key to preventing future situations like the ones at Fort Stewart is having enough medical and administrative resources to meet the needs of reserve and active duty personnel. The military needs to aggressively investigate and correct these deficiencies before they become major problems.

    The Army response at Fort Stewart is to be applauded; however, crisis management should not be the norm when it comes to proper medical care and treatment of our war-wounded veterans. We can do better. We owe it to the soldiers. We owe it to the Nation. And if we fail, we jeopardize the concept of the all-volunteer force. The military and the government must uphold the sacred covenant made between soldier and country. Thank you.

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    Mr. MCHUGH. Thank you, sir. Appreciate your insights.

    [The prepared statement of Mr. Robinson can be viewed in the hard copy.]

    Mr. MCHUGH. Next, Ms. Patricia Hicks, Director of the Citizens Advocacy Center, Elmhurst, Illinois. Thank you for being here.


    Ms. HICKS. Thank you for giving me the opportunity to speak for the injured reservists that are on medical hold. As a director with the Citizen Advocacy Center, I help people basically open the doors to government. And I received phone calls and e-mails from a number of Navy reservists that were experiencing a lot of difficulties getting access to their medical care after they returned home with orders to demobilize.

    I haven't collected data. I have no military experience. I am not affiliated with the military in any way. But what I have done is collect personal stories from reservists who feel that their trust has been betrayed, that they stepped up to the plate, they made the commitment to the military, but when they came home injured, the military didn't maintain their end of the bargain.

    I have a number of stories to try and choose from, and I selected three. And I think they do a great job of illustrating the different problems that our reservists are facing upon demobilization. And I ask that you listen and consider the Department of Defense instruction that requires that they are to be held on active duty until they are fit for remobilization, until they are fit for active duty, and consider whether or not you believe that is happening.
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    Also, the military goal of a strategic, fit, fighting force so that they can be redeployed, and basic human common sense.

    First, is Petty Officer Flores. He actually flew from California and is here in the audience today on his own expense, because he wanted to attend the hearings. I know that if you have time after we are finished talking, that he would be interested in sharing his story with you directly.

    Petty Officer Flores was mobilized to southwest Asia, and seriously injured his knee while on a Navy patrol boat. He received orders to demobilize while—I should say, came home to demobilize when his orders were completed. And before he ever saw a doctor, he was told—an orthodontics surgeon—he was told that he was fit to demobilize. He also found that he was fending for himself. He had endured three surgeries in his active duty location and was receiving physical therapy three days per week. But upon his return back to the United States, his physical therapy stopped for over one month because there was no coordination of care provided as he changed geographical locations.

    He was forced to make his own medical appointments and was calling the medical centers trying to schedule himself for the appointments and the doctor help that he needed. He was deemed fit for duty and ordered to demobilize before he ever received all of his test results.

    When Petty Officer Flores disagreed with this decision and said that he would like to take the opportunity to discuss this with patient relations, he was told by a chief at the demobilization site that he would be demobilized immediately if he proceeded with complaining, and in fact 30 minutes later was told to report the next day for demobilization.
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    He was in fact demobilized, and was only remobilized after someone from patient relations intervened on his behalf. He felt that the attitude of the demobilization staff was that they treated the injured reservists with a lack of respect and rudeness, as if they were milking the system or they were in some way scammers, just trying to stay on active duty to maintain the benefits.

    Petty Officer Flores believes that in retaliation, he has not been paid now by the Navy since November 25th, even after repeated requests as to why. The extreme stress and turmoil, he has now been diagnosed with hypertension and is on blood pressure medicine, something which he never had to take before mobilization.

    I also spoke with a chief hospital corpsman with over 25 years of military experience. He is a civilian trauma nurse. And he injured his wrist and severely injured his ankle while training with the Marines in preparation for deployment. He was found fit for demobilization, similar to Petty Officer Flores, without having his testing completed, so he had no final diagnosis.

    Only after considerable insistence on his part was he granted an 11-day medical extension to review his test results. His orthopedic doctor reiterated the need for surgery and rehabilitation for his ankle. But after a discussion between an active duty doctor and a demobilization doctor, the chief's condition was now deemed not life threatening and was instead elective. And he was demobilized with no medical care plan in place, no appointments made for him at his home location.

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    Upon his return home, and still suffering from the injuries, he realized that the Navy was not going to take care of him in a timely manner. He has a wife. He has children. He has bills to pay. He needed to have an income. So he took a job as an emergency room nurse. But the only way that he can get through his shift is with taking significant amounts of pain medication and applying ice, which is just reaggravating his injury, and which will just delay his care time.

    He still has no surgery scheduled. Six weeks ago he put in a request for his notice of eligibility, line of duty, to receive continuing medical treatment. It has yet to be approved. He still has no medical plan in place. The chief's Marine Corps unit has been notified that they will be mobilized to Iraq in the spring, but because the chief did not receive expeditious medical care, he won't be going with them.

    I also spoke with a lieutenant commander with 20 years of experience in the military. He was a critical care nurse, and was part of a team called FRSS, the Forward Resuscitative Surgical System, is one of only a handful of people that is trained to perform these duties. He was traveling with the battlefield medical team on the front lines of combat during the march to Baghdad.

    During the course of his combat work, he injured his knee and his shoulder. He was in constant pain, but he knew that there was no one that could take his place, so he stayed and completed his mission, again taking massive doses of pain medication, but still providing services. He returned home in October. And amazingly, before ever having any diagnostic testing or even seeing an orthopedic surgeon, he was deemed fit for demobilization and was going to be sent home.
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    He pleaded and protested, personally contacting doctors at Bureau of Medicine and Surgery (BUMED) to explain that he never had a test, he never saw a doctor, how can they determine that he is fit for duty. He was given a six week medical extension to get his testing done. On December 2nd he received his test results. He had a torn lateral meniscus requiring surgery, in addition to his other injuries.

    He was shocked when on the same day, he received an e-mail from the reviewing doctor at BUMED stating, ''Further medical extension is not indicated. Member is fit to separate, fit to be recalled to active duty.

    An Active Duty doctor told him, you will never be going to Iraq in the condition you are in, but they are going to demobilize you anyway. And they were right. He, too, was demobilized before he had a final test result in place, before he had a medical care plan, and basically is now in a bureaucratic hell.

    He is on his own. Because his incapacitation pay packet wasn't handled properly, he makes numerous phone calls to New Orleans and trips to the Reserve Center, all on his own expense, because this is not paid drill time, to figure out what is wrong with his paperwork. He has no income. He has a wife and he has children, and he has no money coming in because he has yet to receive incapacitation pay.

    He left—he went home in October, he came back to the United States in October. His surgery was scheduled for yesterday. Last week when he went for his preop appointment with the doctor, the orthopedic surgeon said, ''Oh, I didn't realize you really wanted the surgery. Well, I am not going to be able to provide it to you, you are going to have to go meet with another doctor.'' his surgery is now scheduled for March, at the end of March, and he has been home since October.
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    Here is a quote, as—I e-mailed some of these reservists and said I am thrilled by my opportunity to speak on their behalf. Is there anything that they would like to tell me about their experience to update me?

    This is a quote from his e-mail. If they had only kept me on active duty to get the medical problems fixed, I would not be going through this turmoil that I and my family have endured. I have always been very patriotic and committed to my country and what it stands for. I will continue to support its endeavors, but these latest experiences are tasking my internal fortitude and faith.

    These men and women that I have spoken with all knew the risks. They all knew that they might become injured, ill, or diseased while serving their country. They went anyway. And they went because they had faith in the Navy that when they came back and they needed medical care, it would be provided to them. And with the attitude of thank you, you are a hero for serving your country; not, you are making us feel like it is coming out of our pocketbook to pay for your medical care or that somehow this is their fault that they are injured, or being treated as if they are scammers trying to milk the system.

    Just a few months ago these were men and women who were charged with lifesaving medical care to combat troops, given weapons, you know, trusted to maintain the security of United States facilities overseas; but somehow when they return back to a demobilization site, they are scammers trying to milk the system; they are malingerers who want to sit and watch television at a mobilization site.

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    These people served their country, and they deserve better. And in a sense the trust has been broken. They have no expeditious medical care. As one of them said to me, ''Patty, if they would just keep me on active duty until I am fit for duty, give me the medical care as soon as possible for as long as I need it, I would go back and do it again for them. I would go back to Iraq.''

    I talked yesterday to a New York Fire Department fireman who was actually a 9/11 survivor, who was injured and survived, went to Iraq. He returned home in a body cast and was told he was fit for duty and he would begin the demobilization process. He basically said to them, okay, here is what we can do. You can demobilize me and send me back to New York, where I am going to go to the press and tell them that I am a 9/11 survivor fireman, and I came home in a body cast and the Navy told me that I was fit for duty.

    All of a sudden he was granted his medical extension. But he has also been told he needs an eight-month recovery, and he has been told by doctors the Navy won't keep you an active Duty for eight months. So he too is saying, if I am off incapacitation, I cannot be a fireman. How am I going to earn an income? He has a wife and children. They have civilian employer issues, and they really have no one to help them.

    These are people that don't know what the employers are required to provide in terms of accommodations and modifications. They don't know how to calm their employer's fear that if they reaggravate or reinjure themselves after they return to work, —what are the legal rights or the legal requirements on the part of the employer? There is no coordination of care as they change geographical locations and they change their status from active duty to reserve.
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    They also feel that they have to beg for their health care. They would like an advocate or a case manager, and they can't find one. Petty Officer Flores called his Reserve Center commanding officer. He is a reservist who is temporarily on active duty. The Reserve Center commanding officer told him, I can't help you because you are active duty. Some of the people have called the reserve inspector general for the Navy, only to be told, ''I can't help you, you are not a reservist, you are active duty.''

    But actually these people are reservists. They are temporarily on active duty, but they left a reservist and they will return a reservist. They need an advocate, and it should be found through the reserve structure.

    The Navy has admitted that they have problems and they have already implemented some procedures and are reviewing others. I participated in a phone call in San Diego with a working group. And the people that are involved in this, I believe, have a great attitude and recognize that there are problems that need to be looked at. But the overarching problem is to keep these people on active duty until they are truly fit for duty.

    Give them the medical care they need for the length of time they need it. Do not send them home without appointments scheduled, without assistance to help them reunify with their families and their employers. So many of the problems you wouldn't have if they were just kept on active duty.

    So what I am asking for is your oversight. As the Chairman mentioned, these are systemic problems, but they are solvable. They definitely are solvable. But I think the Navy needs some guidance and some oversight to truly complete this. Thank you.
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    Mr. MCHUGH. Thank you very much. I appreciate your comments.

    [The prepared statement of Ms. Hicks can be viewed in the hard copy.]

    Mr. MCHUGH. I should note as we go through this, obviously our first two witnesses have said some very interesting, very important things. And we want to come back to these and we will. But we want to continue along and provide all of the witnesses an opportunity to speak here.

    Next is Sergeant Craig Allen LaChance, who is in Medical Holdover Company from Fort Stewart, Georgia. Sergeant, thank you so much for being here. We look forward to your testimony, sir.


    Sergeant LACHANCE. Thank you, Congressman. Congressman, McHugh and committee members, I would like to thank you for the opportunity to speak with you about the reserve component healthcare. It is an honor to be here today. I would like to take this opportunity to share my experiences with you during this deployment and my subsequent assignment to the Medical Hold Battalion at Fort Stewart.

    When I left home for my activation, I would never have imagined that I would have ended up here today. I entered active duty military service in July of 1984. I was assigned to the 9th Infantry Division at Fort Lewis, Washington. I served there until 1987 when I reenlisted to become a military policeman.
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    My first duty as military policeman took me to a chemical weapons storage facility, where I served as site security non commissioned officer (NCO), sergeant of the guard, as senior custodial agent. I participated in the chemical weapons retrograde from Europe in a heavy physical security company as sergeant of the guard.

    I was transferred to Fort Polk, Louisiana at the conclusion of the mission, where I served in a law enforcement role with the 5th Division until I left Active Duty in 1991. I enlisted in the Missouri National Guard in February of 2001 as a military policeman.

    In August of 2001, I was employed by the State of Missouri in the Missouri military funeral honors program where I worked until the time of my activation. I was activated on the 1st of March of 2003 for duty in the Kosovo theater of operations.

    My unit arrived at Fort Stewart on the 4th of March 2003 to begin our train-up for our mission. On the 22nd of May of 2003, I was doing physical training (PT) at the gymnasium on Fort Stewart with my team members when I fell off of the treadmill injuring my back and my right knee. I continued with the train-up and went to the Joint Readiness Training Center at Fort Polk, Louisiana.

    My physical condition continued to deteriorate, but I wanted to complete my training. At the end of our training cycle I sought treatment at the Fort Polk hospital. I was referred to Fort Sam Houston, Texas by the physicians at Fort Polk for treatment, but at the last minute was told that I had to return to Fort Stewart because my unit had mobilized from there.

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    I returned to Fort Stewart on the 6th of July of 2003. Upon my arrival I was assigned to the Medical Hold Battalion where I found the living conditions there to be substandard and nonconducive to soldiers recovering from injuries and illnesses.

    As I began my treatment at the hospital, it became clear the reserve component soldiers were not being treated with the same care and concern that our active duty counterparts were. It took months to get appointments with orthopedics, neurology, and radiology. Finally, after the efforts of my physical therapist, I was able to get a surgery date, and surgery was performed on my right knee on the 29th of October 2003.

    In the time that had lapsed after my return to Fort Stewart, I feel that we were denied proper medical care. We lived in deplorable conditions. We were stripped of our dignity and threatened and made to feel as if we had failed the Army.

    Finally, out of desperation, soldiers, including myself, went to the media and to Congress for help. Changes were made that have in some cases helped our situation as far as living conditions and administration. However, there is still much that needs to be done.

    To me it was unacceptable that it took having to use outside avenues to resolve issues that really should not have been allowed to reach the point that they had reached.

    Even though we are not active duty, we are still soldiers with needs and families. Our injuries hurt just as baldly as our counterparts'. We have answered our call to duty, sometimes at great sacrifice. I feel that we deserve equal consideration.

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    I would like to thank you for your time and concern, and I look forward to answering any questions you have.

    Mr. MCHUGH. Thank you very much. We appreciate your comments, Sergeant.

    Mr. MCHUGH. Next is Colonel John M. Kidd, Garrison Commander, Third Infantry Division, mechanized, Fort Stewart, Georgia. Thank you so much for being here, Colonel.


    Colonel KIDD. I won't make you repeat that again fast.

    Congressman McHugh and distinguished members of the committee, it is a great opportunity to appear before you today to discuss mobilization holdovers at Fort Stewart and Hunter Army Air Field.

    Our post is the Army's premier power projection platform on the United States' east coast. It is home to the 20,000 soldiers of the Army's Third Infantry Division who spearheaded the Army's advance into Baghdad during Operation Iraqi Freedom.

    Hunter Army Air Field's 12,000-foot runway, the deployment center, and Fort Stewart's proximity to the ports of Charleston, Savannah and Jacksonville, combined with its 280,000 acres of training area and the barracks of the National Guard training area, make it one of the Army's busiest mobilization centers.
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    In the last 15 months, Fort Stewart has mobilized 23,000 National Guard and Army reserve soldiers. We currently have 5,300 mobilized soldiers on Fort Stewart preparing for deployment. Mobilization is a tough mission, and it taxes the resources of the installation.

    Fort Stewart typically has a population of 15,500 servicemembers, and currently has a census of nearly 23,000. Hunter Army Air Field's population has risen from 4,800 to nearly 6,000 during the mobilization. The post also supports 32,000 family members and an additional 30,000 retirees. The sheer numbers of soldiers and volume of activities on our post requires the patience and cooperation of each and every resident in support of mobilization.

    Of the 23,000 soldiers who mobilized at Fort Stewart, we currently have 684 soldiers assigned to the Mobilization Holding Battalion, Provisional, in a medical hold status. This status includes soldiers who are not medically qualified for deployment, soldiers who have returned from theater with illness or injury, and 15 soldiers who were wounded in action. All of these soldiers are receiving regular medical care and are billeted in a combination of the Third Infantry Division's barracks, local hotels, and the post guest house. A small number of the soldiers reside in the local area with their families.

    Of the 684 medical hold soldiers, 282 did not medically qualify for deployment, and 402 returned from theater with illness or injury. Soldiers in medical hold require specialized administration and leadership which exceed that normally found in units of this size.

    To accommodate this, we have established this Provisional Mobilization Holding Battalion made up of a cadre from the Third Infantry Division and the Fort Stewart Garrison, whose mission is to provide command and control over all reserve component soldiers in holding status, either medical or administrative, at Fort Stewart, Georgia and the Hunter Army Air Field, and work toward returning them to their parent unit or civilian life.
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    The intent is to provide caring, effective leadership to the soldiers of this battalion so that they may find their way through their medical and administrative process in a timely manner.

    This organization receives 30 to 50 new medical holds per week, and releases a similar number, either returned to theater or released from active duty. In November, Wynn Army Hospital at Fort Stewart opened the Troop Medical Clinic No. 4 (TMC4) to provide specialized services to the medical holding battalion.

    Staffed with physicians, case managers, and other healthcare professionals, TMC4 orchestrates the medical care and administration of this group of soldiers, ensuring that each soldier is assisted in treatment requirements.

    Fort Stewart—and I think all of us here—is absolutely committed to taking care of our people. We always have, we always will. We are providing and will continue to provide all soldiers, regardless of component, the best health care available.

    Fort Stewart will make every effort to ensure all soldiers are treated fairly and with the respect that they have earned for their service to the Nation.

    Thank you.

    Mr. MCHUGH. Thank you very much, Colonel.

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    [The prepared statement of Colonel Kidd can be viewed in the hard copy.]

    Mr. MCHUGH. As we say, last but not least, the garrison commander from Fort Knox, Colonel Keith Armstrong, who I suspect will say that Fort Knox is the premier power and projection platform, to which I would say Fort Drum is the premier power and projection platform. But, a distinction without a difference. They are all very very important. And Colonel Armstrong, thank you so much for being here.


    Colonel ARMSTRONG. Thank you, Mr. Chairman, members of the committee. Thank you for the opportunity to speak with you today concerning the medical holdover issue.

    As the garrison commander at Fort Knox, Kentucky, I am proud to represent all of the armor and cavalrymen from our great service, along with those of the United States Marine Corps who were trained at Fort Knox and who led offensive operations in Iraq as part of the global war on terror.

    We believe Fort Knox played a major role in the success of Operations Iraqi Freedom, Enduring Freedom, and Noble Eagle. And we continue to support those operations by providing individual fillers and training teams to the theater, as well as continuing support to mobilization and demobilization missions.

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    To date, Fort Knox and the two mobilization stations we support—Fort McCoy, Wisconsin, and Camp Attaberry, Indiana—have mobilized well over 30,000 soldiers. Of that 30,000, slightly over 900 of those soldiers were placed in medical holdover status; no more than, on average, 450 at any one time. We firmly believe that all soldiers, family members, and retirees deserve equitable treatment, care that includes timely appointments, access to specialty care, billeting to standard and access to quality-of-life facilities and programs.

    I believe we achieved that standard at Fort Knox, Kentucky. Granted, we had our growing pains. But we are resolved to maintaining the high standard of service, both in medical support and well-being programs that make Fort Knox one of the Army's premier installations. Sir, thank you.

    Mr. MCHUGH. Thank you very much, Colonel.

    [The prepared statement of Colonel Armstrong can be viewed in the hard copy.]

    Mr. MCHUGH. I appreciate all of the witnesses' testimony and also your effort to be here today.

    Let me—before we get to the questioning, let me just make a couple of very quick points based on some of the previous testimony.

    Mr. Robinson mentioned Larium. Obviously that is a controversial issue. And he noted, technically correctly, that while this hearing is not focused necessarily on the issue of Larium and suicides, obviously the committee is concerned about that. And in the appropriate opportunity, we hope to—not hope, we will pursue that further.
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    I would note, however, back on May 14th of last year, I wrote the Secretary of Defense with respect to Larium, methaqualone, asked about that. We have got some responses and such. And we are going to make—2002. Lynn has just corrected me. We are so far ahead of the curve I didn't even realize it.

    And we are concerned about that. And we are going to continue to look at it. And we have recently asked the services to do some data analysis on suicides. One suicide is one too many. But we have to take this in the historical perspective. We are looking forward to those numbers. But you raise very important points, and I don't want anyone to think that we are unconcerned about that.

    The second comment I would make, with respect to Petty Officer Flores, and you make a very, very compelling presentation of his case, although his case unto itself, as I think you would agree, argues that some things have gone very, very wrong. We have made an inquiry as to the pay issue, I know. The inspector general is looking into that aspect and others of that.

    Although I don't have an answer yet today, we have tried to weigh in on behalf of the petty officer in trying to ensure that for whatever wrongs have been inflicted in the past—and we appreciate his being here today at his own expense. That shows a great deal of concern. And it is my opinion he is not here for his own case, but rather for the cause that his case represents. We need to do a better job. So thank you for making those comments.

    Let me just ask a couple of quick questions. And I would go to Ms. Hicks and Mr. Robinson first of all. Obviously, things went wrong in the past, and we can delve into discussions as to why that is—and we have been and we are going to continue—and the motivations as to why some of the very difficult things and unfortunate and unacceptable things that both of you have described have occurred.
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    But I will be very frank that my major concern, particularly as I look to, as I said, a 250,000 or so rotation coming up, is that we not repeat them. I am sure both of you are familiar with the steps that both the Navy, in Ms. Hicks' case, her major concern, and Mr. Robinson the Army, have taken new procedures as to handling these cases in a more timely manner. In the Army's case, after 25 days if you are unfit, sending you back, et cetera, et cetera, so you are not hanging in limbo, and the reallocation of resources.

    How do you think we are poised and posed to handle the next wave? Do you think we are going to do a better job, a sufficient job? Any suggestions or concerns you have I think would be very helpful, not just to the subcommittee and the full committee, but to those officials who are primarily on the second panel that are going to be responsible for this next very significant, most significant since World War II—as you noted Mr. Robinson—deployment of forces.

    We will go to the lady first as a matter of—and she defers to you.

    Mr. ROBINSON. She deferred back to me.

    Mr. ROBINSON. I am extremely pleased at the immediate and urgent response the Army took, especially at Fort Stewart, sending doctors and dollars, adding additional doctors to take care of the backlog. And I know the commanders to my right are committed to making sure that this problem is addressed as we face the next major rotation.

    These problems presented themselves in the exact same manner in 1991. They are the exact same mistakes that were made in mobilization for the first Gulf War. Many of these same types of problems can be viewed by going to reports from 1991. And if you took out the date, it would read very eerily similar to today.
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    Although I am very pleased at the immediate response, I would like to hope that the military will remain hypervigilant, because the things they do for soldiers on medical hold and when soldiers are going through the medical process are the keystones for their ability to receive care and treatment from the Department of Veterans Affairs, which is a whole other topic that we haven't touched on. But if it is not done right here in demobilization, especially for the reserve and guard soldiers, the obstacles that they will face in obtaining health care from the VA are tremendous. So I want them to be hypervigilant.

    They have taken some great positive steps. I will remain, as everyone here that follows the issue, vigilant to see that it is, in fact, enforced. It is a good step forward. I look forward to the next major rotation to make sure that it is actually implemented.

    Mr. MCHUGH. To this point, you wouldn't say—I can see on the horizon they haven't done A, B, C or D. Theoretically, we are dealing off paper right now until it happens.

    Mr. ROBINSON. I do see a problem, and that problem is the hypervigilance to look at the combat wounded, the psychologically wounded from this war. Soldiers at every installation we went to and the ones I am getting ready to go to are reporting they are not receiving adequate psychological care. We need to get the Department of Veterans Affairs combat Post Traumatic Stress experts into those med-hold facilities. We need extra doctors to talk to them. That is a concern of mine.

    As far as the process goes, predeployment, during deployment, postdeployment screening, I believe the garrison commanders are doing a really good job at it. In fact, before the Fort Stewart story broke, some weren't having much success, as the GAO reported. Since the Fort Stewart story broke, many commanders reported 110 percent compliance, which means they actually oversampled and made the people fill out these forms.
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    Mr. MCHUGH. Ms. Hicks, how do you feel about the Navy's response as it affects the days and weeks ahead?

    Ms. HICKS. It is not a quality of care issue. From what I have heard, the quality of medical care provided through the Navy is excellent. So that is not the question. Really, the question is the access, providing appropriate and timely access to the medical care.

    The people that I spoke with that were involved in the working group in San Diego have a great attitude. I truly believe they want to help the reservists and that they are encouraging the reservists and anyone else to provide them information that can help them make their job better.

    Personally, I think until the whole ''fit for duty'' is ironed out—I mean, there is a procedure in place that says you provide medical care until they are fit for duty. But some people are saying that would be fit for reserve duty or fit for active duty without consideration for the civilian employer.

    It is very complicated, and they have changed some procedures. They have changed some procedures where you can do some paperwork at the mobilization site before you go back home or have done some things where they will speed up the process, which is great. But until you fix the ''fit for duty,'' you are still going to have problems. They are fixing some subproblems, but I think the over arching need is to keep them on active duty until they are fit for duty.
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    Mr. MCHUGH. Can I ask you a question?

    You are using the words ''fit for duty.'' Do you mean fit for reserve duty or do you mean return to civilian employment? With all due respect, I don't know that it is that complicated. I just think it is not that well defined.

    Ms. HICKS. It needs to be clearly defined so everyone is using it in the same way. I have been told by people that it is fit for your mobilization duty, which is what makes sense to me. With the goal of having a fit fighting force, you wouldn't want them to be able to be fit for their Reserve duty; you would want them to be fit for what they need to do when they are activated.

    Second, they need a case manager, they need an advocate. As they are changing geographical locations and moving through different health care systems, they are on their own; and they are ill, injured or diseased, and usually not with their spouses, so they have to make difficult decisions without a lot of guidance, which is one reason they turn to me, which is very flattering to me, but is also of concern. They should be able to find the assistance within the Navy's structure.

    The ''fit for duty'' definition, providing case management and advocacy—and what a number of reservists have noted is that there appears to be conflict in goals; active duty doctors want to provide the medical care, and in many cases have been strong advocates for the reservists that they are treating. But in many cases, after the active duty doctors have conversations with demobilization doctors, suddenly, again, injuries become minimized; and it is something that you can wait to do when you get home. I know one person made the comment that if an active duty doctor writes ''should be maintained'' or ''should be held on active duty,'' that is just the reservist who manipulated the doctor into putting that into the record.
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    So I think three things: Clearly define ''fit for duty'' and keep them on active duty until they are truly fit to be remobilized, provide them with an advocate or a case manager within the existing Navy structure, and clarify that conflict in goals between active duty medicine and demobilization doctors.

    Mr. MCHUGH. Thank you very much. And I am going to ask our two garrison commanders a question and then defer to my colleagues and heed my own warning in trying to be somewhat brief.

    Gentlemen, as Mr. Robinson noted on several occasions, very graciously, I don't think anybody suggests that a garrison commander faced with the enormous challenges that you and your predecessors were facing during this period are in any way to blame. Every garrison commander I have dealt with wants to do one thing and that is, make it work, whatever it is at that particular moment, and it can be a lot of different things.

    Having said that, I would be very interested in your responses, first of all, as to when you called out for help on this process, as at some point, I am sure you did. And how you felt the response was coming back with that extra help?

    Second of all, as I asked our first two panelists, is there anything you think you may be lacking, any area of resource you may be concerned about with respect to the next wave that is cresting above our heads as we speak?

    Colonel Kidd or Colonel Armstrong, I don't know who has seniority there.
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    Colonel ARMSTRONG. In response to your first question, we forecasted early on, and I believe I can speak for most of the garrison commanders involved in the mobilization process—we forecasted early on that there was a potential problem with handling not only the mobilization loads, but in the medical pieces as it relates to the mobilization load. We did not forecast the actual impact that that would have on our ability to execute operations. So I believe that was one of our stumbling blocks.

    In the case of Fort Knox specifically—I am a power support platform, not a power projection platform, by definition——

    Mr. MCHUGH. Thank you for defining that.

    Colonel ARMSTRONG [continuing]. The power projection platform is designed to conduct unit level mobilization. The power support platform is designed to do training, basic expansion and the Continental United States (CONUS) replacement center operations, and to train individual mobilization augmentees as individual fillers to the units that are either in service in CONUS or overseas in theater.

    As a result of the magnitude of the mobilization process, Fort Knox was designated then as a power projection platform that we have been fulfilling since very shortly after 9/11. So we were performing a mission above and beyond what we were really required to perform in our wartime status. As a result of that and as a result of AR 5–9, which is area responsibilities, I then am responsible for supporting two other mobilization stations—in this case, Fort McCoy, Wisconsin, and Camp Attaberry, Indiana—specifically with medical and dental support. And when you take a medical treatment facility and Dental Activity (DENTAC) operations at Fort Knox and have to then try to spend those medical assets and dental assets not only to cover Fort Knox, but Attaberry and McCoy, we were stretched extremely thin. And for a period of time, we struggled.
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    It didn't take us very long, though, for the Medical Command—and I know that the Surgeon General will address it more specifically—but the medical command and the United States Army Forces Command (FORSCOM) 1st Army surged to give us augmentation assets to handle the garrison support piece and to handle the medical support piece.

    So, sir, I believe that the response to help initially was slow in coming, but once we identified what the real problem was, sir, I believe that we put the right people on the ground and we were able to handle the issue.

    Sir, in response to your second question, can we handle the next wave? Absolutely. There is no doubt in my mind, sir, that with the lessons that we have learned now, the provisions that had been put in place by the Department of the Army (DOA), specifically in the medical arena, the medic commander at Fort Knox is ready to handle the medical hold and the second wave as far as Fort Knox's role in that, sir.

    Mr. MCHUGH. Thank you very much.

    Colonel Kidd.

    Colonel KIDD. I took over command of the garrison at Fort Stewart in June, coming from the joint staff here. Pretty much as soon as I got there—and I might add that the hospital commander, Colonel Bartell actually arrived at the same time I did, and we actually looked at it in conjunction with Lieutenant General Inge—we recognized that we had some difficulty here, that there was a problem with the medical holds, first trying to get a good handle on how many we actually had and what their status was and where they were in the treatment, and what we were doing to either get them returned back home or back to duty.
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    As a result of that, I found that our numbers started climbing as we sort of shook the bushes a little bit and started finding more people. So I increased that from a captain leading that 300-man organization as it climbed to 500, and I established a provisional battalion. And I used the garrison support unit leadership part of that to manage that.

    We started asking for things. The hospital commander started asking for additional resources. We also have to recognize where we were at Fort Stewart at that time. The first thing that we got back from the Third Infantry Division were folks that were released from theater because of illness or injury. That was the first people that came back.

    Recognize also that our hospital had a situation where a large number of the care providers were deployed with the division or other assets in Iraq because of the combat mission there. So the post-capability to really provide care and treatment medically to a large number of people was greatly reduced during this period of time.

    We started asking for additional assets.

    I did get—I asked for resources. Looking at the billets early on, the billets that we have are well designed for short duration habitation and so that, roughly, 21-day mobilization cycle that we usually use, 21 to 25 days, they are adequate for that—not comfortable, but adequate—and they met the Army standard at the time, and the published standard that the Army had.

    But recognize that is a long, hot summer at Fort Stewart, so we started looking at trying to make some improvements; and we were working block by block through those 8,300 billets over there to try and increase the quality of life there—things like buying new mattresses, which doesn't sound like much, but it was a good thing at the time; and adding air conditioning, climate control. And improving the latrine situation was something that we under took.
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    I asked for and received permission to reallocate some funds that were sent to us for one purpose to put it on this purpose, but of course that was taking a long time to happen.

    I can't really answer on the medical side, because the—I think the sheer positivity of medical personnel and the commitment we have overseas probably retarded the effort to get us additional medical personnel; and the Surgeon General will address that a little better. Suffice to say, when the Third Infantry Division redeployed, now suddenly the census went way up on our post; and they had a little bit of a backlog coming from theater of illnesses and injuries that required attention. So again, Dr. Bartell asked for some assistance.

    It was slow in coming. I discussed with General Inge the various options that we had for moving the soldiers to other posts to try and find other housing, but housing on our post became problematic. The Third Infantry Division came back at 118 percent strength. I had permanent party barracks for 4,834, and we had 6,000 Third Infantry Division soldiers living in that space. I actually had regular Army soldiers from the Third Infantry Division living in the National Guard area at the same place that Sergeant LaChance and his peers were. So it was a very difficult situation that we found ourselves in by the late summer.

    Again, resourcing started trickling our way, but we couldn't make the changes fast enough. And I found that the chain of command I installed was not quite up to the task of leading these soldiers; and subsequently we had to make some changes there. We have a new chain of command in charge there.

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    There are still some additional resources that we need, and I know that the hospital commander has forwarded up a list of the treatment things he needs: Physicians, health care specialists and material that he needs up through the chain of command up through the Office of the Surgeon General. And so we still need some additional medical assets.

    We are really kind of mission saturated in our little hospital. It is again a post designed for about 16,000, and we are way over that. And certainly when you have the medical holds, those are not just a population; that is 600-plus outpatients that have to be seen on a regular basis, so that it puts a good bit of stress on that.

    I am concerned about pushing our dependents out because, you know, our post is mostly E–4s, young soldiers and families, and they can least afford to get pushed out on the economy. And I know that TRICARE helps with that, but it doesn't always quite get exactly where we need to go; and we are concerned, and I know my senior mission commander of the Third Infantry Division command is concerned about that.

    Additionally, I know the Army is trying to help me with some semipermanent or some additional structures to house these soldiers, so that we can get them out of hotels back onto the post, closer to the treatment facility. Currently they are housed in three hotels over literally a 50-mile radius because we do live in a small town in a rural area in Georgia. So if the Army can come through with that—and I think we are getting closer on that. And then I am going to need some additional manpower to continue to manage this. And I am working closely with General Inge's staff.

    So if all goes well and we don't get a large spike in the number of people that we have falling in this category, I think we are going to be all right here, sir.
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    Mr. MCHUGH. But you have got some resourcing requests in?

    Colonel KIDD. Yes, sir.

    Mr. MCHUGH. As you sit here today, do you have any concern—do you have concern—you may not get them. But do you have anything substantive that was suggested to you—have you been told ''no''?

    Colonel KIDD. No, sir.

    Mr. MCHUGH. What about any in-progress work with respect to the displacement of your young families you spoke about?

    Colonel KIDD. The hospital commander is working very hard to prevent that from happening. And I will say they are working additional hours and trying to hire some additional physicians. Especially, care is difficult because we are in a rural area, so we have to go all the way to Savannah for that. And we are trying to mitigate that transportation cost and that amount of hassle of having to go that distance for those families by providing transportation and other things. We are doing what we can with that.

    Right now, no one has told us ''no,'' and I think we are going to get the resources that we asked for, sir.

    Mr. MCHUGH. We may ask the second panel that. Thank you very much.
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    And I appreciate my colleague's patience. Ranking member, Dr. Snyder.

    Dr. SNYDER. Colonel Kidd and Colonel Armstrong, I think I have gotten a little bit confused here in terms of the numbers and resources and things.

    Colonel Armstrong, in your statement you stated that the vast majority of your medical hold overs are people who never deployed. In my little calculation and by your numbers, 41 percent of your people, Colonel Kidd, never deployed. So significant numbers of these people—of these folks were folks who were activated, came to your facility and perhaps very, very rapidly it was figured out by you that they were not going to go overseas, and put in a medical hold status.

    Does not the 25-day rule—what has been the impact on your numbers of the 25-day rule because it has been in effect for several months now. I would think that your numbers are substantially smaller; tell me how that has impacted on those numbers.

    Colonel ARMSTRONG. Your assessment is spot on. The 25-day rule has had a significant impact on our ability—in the number of soldiers that get referred to medical hold status since that policy has been implemented. Soldiers prior to the implementation of that policy came on active duty. Once they were activated and brought to the mobilization station, if they had a preexisting medical condition because of the screening process, they are put through at the mobilization stations, that medical condition was identified, it would prevent them from deploying, and they were put in the medical hold status. And the policy at the time was, we kept them on active duty until that medical treatment regimen had been completed or the board process had been completed to discharge them from service.
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    The vast majority of the population that I handled at Fort Knox or that I supervised through Fort Knox never deployed into theater. Those folks came with preexisting conditions. Since the inception of the new policy, the numbers have been cut significantly.

    The future story, sir, is really the good story. I don't think we are going to have a significant problem in this coming rotation, nor do I think we will have a significant problem with future rotations as a result of the policy that has now been implemented: our ability to screen medically and then discharge those people as expeditiously as possible that have preexisting conditions.

    Colonel KIDD. You are correct in your assessment. If you had asked in the midsummer, most of the people that I had had been soldiers that had come to us with a preexisting condition that prevented them from fully mobilizing. Currently, of our population, I have 162 of those soldiers that still fall into that category. The balance of those that we have either been able to make them fit or we have been able to put them through the MEB process and move them back to home station.

    Dr. SNYDER. One hundred sixty-two people who have never deployed?

    Colonel KIDD. Right, sir, that have never deployed. I have a total of 200 plus that did not deploy. The balance of those would be soldiers like Sergeant LaChance, who got injured in training.

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    Dr. SNYDER. Of the 162 how many are past 25 days?

    Colonel KIDD. All of those.

    Dr. SNYDER. Is the assessment—is there still an assessment process going on? Are you still making an assessment decision about whether they will at some point relatively soon be deployable?

    Colonel KIDD. The 162 were folks that came to us prior to the 25-day rule, so they are holdovers from last spring. The 25-day rule has had a marked impact on our post. And I would also have to say that the premobilization screening that the guard and reserve are doing before they get to our mobilization station is certainly having a great effect. The soldiers we are seeing now are in a lot better physical shape than ones we had seen previously.

    So the 25-day rule is helping us a lot. I have some that got in to us before that rule came into effect. The rule is not prior to that time.

    Dr. SNYDER. Mr. Robinson made the comment that he thought there was a warm body phenomenon going on in the deployment, that units were activating people in order, to paraphrase, to meet a certain number coming down there; and were sending people down that they knew were not going to be deployable.

    I assume the 25-day rule has taken care of that if that was going on.

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    Colonel KIDD. I think the 25-day rule—we screen them very hard when they get to Fort Stewart. So we are pretty good at screening that out, and that has helped. The unit commanders have the word now that they can't really bring anyone here that is not going to be able to make it through that screening. So right now, I think we have got a good situation on that. The unit commanders are being very good about bringing people they think are going to make it through the process.

    Dr. SNYDER. Colonel Armstrong used the comment about equitable treatment of our guard and reserve forces and did not use the term ''equal'' in that the best metaphor I know for the difference between what is equitable and what is equal is that we have had experience at the War Memorial Football Stadium in Little Rock. If you have 10 commodes in the men's room and 10 commodes in the women's room, that is equal. But the line outside the women's room will be horrifically long. If you have 20 commodes in the women's room and 10 in the men's room, that will be equitable and the lines will be about the same length.

    And my point is, Ms. Hicks, the quality of care is good, but it is the procedural access of some of our guard and reserve forces, geography—and I think your point, Colonel Armstrong, you have to figure out a way to treat these people equitably, but they are going to be treated the same because the families are not with them. They have different facilities.

    My question was—and maybe 25-day rule takes care of it—why can't more of this care be done in the home area? Is that something that you all—if people go home on leave, one of these folks on medical hold, is that what you are struggling with right now?

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    Colonel ARMSTRONG. First, let me say, being a graduate of a great institute in Texas, we must build our stadiums a little bit differently.

    Sir, we are now pursuing options of, if it is conducive to send somebody home and they can get, specifically, recovery treatment plans for a knee surgery in the local area, then we are pursuing those options. I honestly believe, sir, some of the medical specifics are more appropriately addressed by the Surgeon General.

    But, sir, across the border, we are looking at every opportunity, from a garrison perspective, in coordination with the medical treatment facility commander, at facilitating equitable medical care; and if you give me just a moment—by ''equitable medical care,'' what we did is, as a result of the med-hold population growing, we reestablished priorities within our medical treatment facility so that specifically for high-demand, low-density specialties in the hospital, the med-hold folks took priority over everyone else. Medical hold personnel took priority over active duty, took priority over my own child who has a pediatric endocrinology requirement.

    So we reprioritized that work effort within our medical treatment facility specifically to try and focus on what I consider equitable medical care, timely medical care, availability of appointments within the constraints, and availability of the doctors in the medical treatment facility and in the local area.

    I know the Surgeon General will address your question more specifically.

    Dr. SNYDER. Thank you, Mr. Chairman.
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    Mr. MCHUGH. Thank the ranking member.

    The vice chairman of the committee, the gentleman from Oklahoma, Mr. Cole.

    Mr. COLE. Thank you very much Mr. Chairman. It is tough to follow an Arkansas politician. They have a way of expressing themselves clearly.

    I was struck by the same point that Dr. Snyder was struck by in terms of what goes on in the mobilization process, that the guard and reserve units—and particularly to you, Mr. Robinson and Ms. Hicks. I have been told there are instances where—unofficially, of course—essentially guard commanders and reserve commanders are given numbers that they need to meet.

    How common do you find that in your discussions and how big a problem is that in terms of forwarding of people that shouldn't be forwarded?

    Mr. ROBINSON. I believe Colonel Kidd assessed that. I think that the problem is going to halt immediately. But it appears, by talking to the soldiers themselves who knew they had preexisting conditions and knew they should not have deployed, that the practice was in fact to deploy from home station 100 percent of the unit and let the mobilization site sort it out.

    Part of this problem may have occurred because at the time, national guard and reserve soldiers did not have routine access to health care, dental care. And so it was viewed as an opportunity to go to these places, get mobilized, get my fillings fixed, get my teeth yanked out, get my knee looked at. It was an opportunity.
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    I think Congress is going to address that issue with TRICARE for national guard and reserve soldiers.

    Mr. COLE. You are comfortable that this is a problem—without holding you to it, you feel a lot better about it than a year ago?

    Mr. ROBINSON. As the chairman stated, the wave is above us and we are going to have to wait and see what happens. I can confidently say that people I have talked to in Congress and veteran advocacy groups and others, concerned citizens, are going to watch-dog this issue and make sure it gets fixed.

    Mr. COLE. Sergeant LaChance, if I may, I was struck in your comments by the fact, frankly, that you felt the need to go outside the normal system to bring attention; and we are glad you did and your colleagues did. But can you tell us the things you did before you went outside the system that necessitated you to do that? Was it an attitude problem, a structure problem? Was there not enough regular contact in your situation by folks in a position of authority to do things?

    Sergeant LACHANCE. Sir, it was my experience when I got there that the hospital, the commanders in the medical hold, were really overwhelmed. When you try to discuss—there were issues that needed to be taken care of. The old chain of command did not foster an environment, in my opinion, to where you could go and address issues and different things like that.

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    There were a lot of hard feelings. The soldiers in the unit felt that there was a lack of integrity from the chain of command that was in place at the time. And when you have that break down, your unit is ineffective.

    We have seen things that—I have most of my experience on active duty. I spent three times the amount of time on active duty than I spent in the National Guard. And some of the things—this is my first deployment with the National Guard. Some of the things that I have seen weren't necessarily the problem of the command that was in place at Fort Stewart at the time.

    You were just talking about the 25-day rule. Well, prior to that existing, what I witnessed, personally witnessed, I seen the commander take people who had absolutely no business being deployed, none. I seen a break down in local commanders not enforcing basic Army standards, not requiring physical fitness tests—things were swept under. People simply were not fit for military service. Someone like myself and the majority of the people who were down in that medical hold who took the time to do their physical training (PT) requirements and do their height and weight requirements, we were backlogged behind people who basically hadn't. It was frustrating.

    When I came to Fort Stewart, I was under the impression that I would get a quick fix and I would be back with my unit, and it simply didn't work out. Now since the new chain of command has come in, people are more comfortable going to discuss things with the 1st Sergeant, to discuss things with the company commander. There is more a feeling of confidence.

    There are people who have come into our medical hold after November that would not have recognized our medical hold when I got there in July. They would have thought it was two completely different organizations. There has been a lot of progress.
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    Unfortunately, people like me who were there prior to the changes, were, I guess, stuck. We have been there a long time and basically, we had to start over again when the new chain of command came in. I was told that I have a medical board coming. I will be there another four, five months. But that is the reason we went outside. There wasn't a sense of confidence in the leadership or a sense of urgency from the hospital.

    It is not just from the medical hold; it is also from the hospital. There just wasn't a sense that they were concerned about addressing our issues.

    Mr. COLE. Thank you.

    Mr. Chairman, I know my time is up. I want to tell you, Colonel Kidd, I have not been on this committee for a long time, but the time I have been here—and I appreciate hearing very much somebody candid enough to tell us we had a structure in place that didn't work and frankly, I had personnel and I needed to go change them. And I appreciate you being as honest and open with that. That was helpful. And more importantly, thank you for fixing the problem.

    I have a lot of reserve and guard units in my State that are mobilized, and it helps to know that there are people that care about how they are treated and what is going to happen to them along with other soldiers.

    Thank you, Mr. Chairman.

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    Mr. MCHUGH. I thank the distinguished vice chairman.

    And let me associate myself with Mr. Cole's comments, and I am confident his words reflect all of our feelings with respect to the sense of appreciation we have for what you have done, particularly as it reflects to your fellow servicemen and women. And thank you for being here today as well.

    I am happy to yield to the gentleman from Georgia, Dr. Gingrey.

    Dr. GINGREY. Thank you, Mr. Chairman. And I will address this question really to anybody on the panel—maybe everybody on the panel. I think Mr. Robinson mentioned, of course, guard and reservists hopefully will have access to TRICARE if they don't already have adequate health insurance available to them through their employer.

    But having that coverage and having access doesn't necessarily mean that any member of a guard or reserve unit would voluntarily go and take advantage of that. They might not know that they have high blood pressure. They might not know they have the first stage of diabetes. They might not know they have a shoulder that is going to go out on them. They are young, and so they don't take advantage of the fact that they have adequate financial where with all and access.

    It would seem to me that we could maybe alleviate a lot of this problem, whether it is deliberately stacking the deck so that a reserve commander meets a quota—that expression was used—or whether they send these troops, because they don't have any idea nor does the individual reservist or guardsperson know that they have a health problem.
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    Why don't we—why isn't there some consideration to just saying every member of the guard and reserve should be physically examined, and it should be mandatorily done on a regular basis? Because, after all, you are educating them, you are training them, you are equipping them and not paying attention to their physical well-being and readiness for that activation when that occurs.

    I am a physician and Member of the Congress, and it would seem to me that that would be a very good bang for the buck.

    Mr. ROBINSON. On March 25, Dr. Winkenwerder testified that physical screenings and hands-on physicals were useless. He said that they revealed in the general population, the healthy warrior population, little beneficial information. And I think this is an example where he may be factually wrong. The cost savings that we would incur from this example of having screened people with the hands-on physical versus deploying them to Fort Stewart, tapping the power protection platform's capabilities, would have been much greater if we had just screened them first, I am positive.

    So it is, I think, in my opinion, something that we need to address with the Department of Defense health affairs policy. They seem to believe that prescreening and hands-on physicals serve no purpose.

    Dr. GINGREY. Let me interrupt you for a minute, because I do think they serve a purpose, and let me give you an example. High school athletes, certainly in Georgia, are required to have a physical before they can participate in an extracurricular activity including cheerleading. And in many of these instances, these so-called physical screenings that are done are perfunctory and not worth anything because there is not enough—it is just not adequate. It is a very brief screening. And every now and then one of these athletes that have gone through one of these physicals will drop dead on a basketball court, and then you find out they had a congenital heart problem and they had one of these physicals saying they were fit to play.
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    The problem is, it has got to be a physical that makes sense, that really tests the things that need to be tested.

    I would disagree with the doctor in that regard. If you do it right, it is worth a heck of a lot.

    Ms. HICKS. From the Navy perspective, the military medical support office recommends that they do physicals prior to mobilizing the troops. And from my understanding, what they do right now is, they do a review of their medical records, but if you have a physical on file that is at least—no more than five years old, you don't have a physical before you are actually deployed. And one of the problems, as you mentioned, is that first you probably should have a physical that isn't just perfunctory, but it is considering what you are going to do for the military while you are on active duty.

    But I have spoken with some people where the problem later is that they aggravate an injury or reinjure themselves, or the condition reoccurs while on active duty and then they are told it is preexisting and they are not entitled to treatment. And my personal opinion is, if it was documented with full disclosure on the part of the military member, and it was in the health record, and you took them and put them on active duty anyway, you just accepted the liability to provide the health care they need if the injury, illness or disease reoccurs basically if they are on your watch.

    Mr. ROBINSON. Sir, there is a public law, Public Law 105–85, Section 760 through 767, that was written specifically because of the lessons learned from the first Gulf War. And in that law there is a requirement that says that the Department of Defense must conduct predeployment screenings to include hands-on physicals. And with the debate that has occurred over three different congressional hearings and several GAO investigations, is a medical definition of what is ''screening.'' In fact, Dr. Winkenwerder said, ''what is a physical?'' Is it an actual inspection where you put your hands on somebody or is it screening a medical record?
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    So that is a debate I think Congress could define by changing the law and saying you must do this.

    Dr. GINGREY. Maybe Dr. Snyder and I can work on that because I think it needs to be well defined.

    Other panelists in regard to this?

    Colonel KIDD. Sir, I would say anything we can do to improve the health and fitness of soldiers that were mobilized would be a good thing. We are currently seeing, as I said earlier, though, I think that a lot of the physicals and screenings are actually taking place now back at home station before these units get here, because just looking at the numbers of people that we are turning back under the 25-day rule is much reduced from this time last year.

    Now, I know that if we could resource the guard and reserve to do physicals, they would do them more frequently, and I think that would be helpful. And anything we can do to try and improve their health or fitness, I think we ought to try to do that, because we really can't go to the fight without these folks. We don't want to lose a single member of the guard and reserve because we need every last one of them for the fight.

    Dr. GINGREY. Colonel Kidd, what I am suggesting, though, the predeployment physical, even if it is done at home, you know, there is not enough time. And of course you are coming to the realization that a soldier needs dental care or eye care or other health care. And, you know, you spend a lot of money, maybe over several years annually and monthly, training that soldier and having him or her ready, but really, they are not ready.
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    In addition to that predeployment screening which could be expected to be more thorough, but I am talking about on an annual—I mean this business of, well, you had a physical five years ago, I don't think it is adequate. I think it ought to be done on a more regular basis for the guard and reserve.

    Colonel KIDD. Yes, sir. And I think we have to establish what the right interval is. I don't get a physical every year in the regular Army, but I get looked at more frequently than a guardsman or a reservist would.

    Dr. GINGREY. Mr. Chairman, I have used all of my time, but the point is, there should be no difference in how often you are looked at and how often a member of the guard or reserve is looked at.

    Mr. MCHUGH. I thank the gentleman. And I apologize to him, because I did not refer to his particularly important credential here as a physician; and we deeply appreciate, as we do the ranking member, their particular expertise.

    And I would also say, just to under score the point, this is obviously the health screening pre- and postdeployment, an area of major concern to this subcommittee. A parochial concern of mine when the GAO found with respect to Operation Enduring Freedom, when Fort Drumm in my area—did I mention that is a premier power projection platform—that a huge percentage of those screenings were not conducted. And the anecdotal information we are getting back with respect to Operation Iraqi Freedom is that a much better job is being done. We hope that is true.
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    I see one of the key staff people from the Veterans Affairs' Committee, Chairman Smith; and Chairman Hunter of the full committee, with our full support, has asked for follow-up study on that. And it makes sense. And Ms. Hicks suggested very correctly, it only makes sense for the military because if you don't lay down a baseline as to what the particular soldier, sailor, airman or Marine is afflicted with, going in, you are assuming a whole lot of risk and expense.

    So it makes good sense a cross the border, and we hope that GAO will address that issue more effectively in the future.

    With that, I will be happy to yield to the gentleman from Virginia, Mr. Schrock.

    Mr. SCHROCK. Thank you, Mr. Chairman. I am not sure I have a lot to add to what I heard you folks testify and what the two doctors have talked about.

    I have been sitting here—you know, we talk about ''fit for active duty.'' Is that the same for reserves and guard?

    I see people shaking their heads, but I really wonder if that is the case. And maybe I am going to be a bit cynical here, but maybe the root of this comes from the attitude of the active duty forces toward the reserves. And I have good reason to say that because I was one of those when I was an active duty career Naval officer, who thought the active duty people were probably less than we were; and I am not proud to admit that and I was wrong. I have a son who is a reserve, and a chief of staff who is a reserve, so I look at that totally differently now. And I am wondering if that factors into that somehow.
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    I keep looking at the sergeant here—and he was active duty for awhile—and wondered, when you were active duty if you had experience with medical. Was it the same as you have now as a reservist?

    Sergeant LACHANCE. When I was on active duty, I really only had one significant medical problem. I had a blood vessel turn loose in my head, and I was treated at Landsthul Army Hospital. And any stories you hear about the quality of care coming out of Landsthul, Germany, I can testify are true. It is a phenomenal facility.

    That is really the only experience I had on active duty with any kind of medical other than just routine.

    Mr. SCHROCK. As an active duty person you were seen promptly and regularly, but as a reservist, you were not?

    Sergeant LACHANCE. I don't feel I was.

    Mr. SCHROCK. That is what I am saying. The difference between the way we treat our active duty people and the way we treat our reservists, I still don't think is the same. And I appreciate what Sergeant LaChance has said.

    Sergeant LACHANCE. When I was on active duty you hear the weekend warriors and the this and that, there is a different perception of National Guardsmen and reservists than there is active duty soldiers. Having been on both sides of the house, I can see that. And, yes, I feel there is a time when it seems convenient for them to call us active duty and there is a time when it is convenient for them to call us National Guard.
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    You need to distinguish: Am I an activated National Guard man or am I on active duty? That needs to be established. Am I an active duty soldier sitting in front of you right now or am a deployed National Guardsman?

    Mr. SCHROCK. When the balloon goes up, they expect you to be as proficient as the active duty guys with the same equipment that you don't have and physically the same way, and that is just not the case. I think that probably is where a lot of these problems come from.

    And I appreciate where Colonel Kidd was coming from. He said we are now just determining what the hospital needs would be at your particular post. And I think just now—this is the 21st of January, 2004; the first Gulf War was 1991. Why did we wait so long? Seems like we haven't learned the lessons of the past. But are we going to learn from this experience?

    A couple of questions: I heard Ms. Hicks say, Petty Officer Flores hasn't been paid. Why? The chief hasn't been taken care of. Why? The Lieutenant Commander with the shoulder and knee problems was never seen by a doctor. Why? The 9/11 survivor in a body cast. I'm going to ask the next panel that, so be prepared. I just don't understand that.

    I was in Iraq. I was with the first delegation that went into Iraq after Saddam fell. The thing that haunts me to this day was that the Baghdad airport in a little building which was a medical shack, there were so many sick kids, I couldn't believe it, many of them walking around with IVs in their arms; and I was bothered by that. Maybe they went over there totally fit. Maybe the conditions there and the heat and every other circumstance there caused that. But then I think, well, based on the testimony we hear here, did we send them sick in the first place? And if we did, shame on us.
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    So this is something we have to get our hands around because this isn't going away anytime soon.

    I would like to think that the war on terror is going to die tonight at midnight. It is not. It is going to go on for decades probably, and we are going to be counting on our reserves and our guard more than ever before.

    When I was there, they were seamless. Those young men and women, you could not tell the active duty from the reserve and the guard because they were all doing the same thing. And we have to make sure that they, the reserve and the guard, have the same good equipment as the active duty have, and the same medical care, or else we are going to be having these hearings more and more and more.

    Ms. HICKS. If I could interject, Mr. Schrock. You are right about the active duty medical care versus the reserves. Part of it is procedural—basically the fork in the road that you go down. If you are active duty and you have a severe injury to your shoulder or to your knee and you need some surgery, you get the surgery at the base that your family is at. You go back home and you are located near your family and children. But even more than that, you don't have to worry about your employer because your employer happens to be your health care provider. So they provide the accommodations.

    When you are on active duty, if you need eight months to rehabilitate because you had a type five rupture of your shoulder, you have eight months to rehabilitate and do light duty. Nobody looks at you like you are a scammer or you are milking the system. And you don't have the concerns of trying to go to your employer and explain the accommodations and modifications.
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    When you are a reservist, it is quite the opposite.

    So there are significant differences, that fork in the road in terms of, pretty much, your employer issue.

    Colonel ARMSTRONG. If I could, I would like to address one issue. I would like to give you a good news story. Again, as a power support platform, I am not authorized a Garrison Support Unit (GSU). So I had to overcome that, and General Inge helped me do that by activating a National Guard unit out of Ohio, 737th Quartermaster out of the Ohio National Guard.

    Sir, I would give anything, anything at all right now to be able to keep that unit on active duty assigned to my command to execute the mission that they were executing. That unit came in—specialty is to fix heavy equipment, and they came in to operate and run an organization that they had no concept on how to do it. They were the most professional group, battalion headquartered staff that I have experienced in a long time. You could not tell there they were National Guard. There was no differentiation made between the National Guard and active components. They were soldiers and they executed their mission to standard.

    Every single one of them would have rather been in the sandbox doing what they get paid to do in theater, but, sir, they didn't. They were mobilized, activated and came to Fort Knox and sent like everybody else to do their wartime mission. These guys were great, sir.

    Mr. SCHROCK. In my own case, I am sorry it took me coming here to the Hill to really understand and appreciate the role of the guard and the reserves. I should have understood that when I was active duty, but I didn't. But I certainly do now, and I am one of the biggest advocates for those folks now.
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    Thank you, Mr. Chairman.

    Mr. MCHUGH. Thank the gentleman from Virginia.

    And I would note to Colonel Armstrong, it is kind of like you have been frocked. You are a power support platform, but—you have been designated a power projection platform, but you haven't gotten the resources to be a power projection platform; is that correct? I understand you have been very creative down there, and we all compliment you for that.

    Colonel ARMSTRONG. Technically, you are correct.

    Mr. MCHUGH. And we are going to raise that with the second panel, I assure that.

    With that, I will be happy to yield to the gentlelady from Guam, Ms. Bordallo.

    Ms. BORDALLO. Thank you, Mr. Chairman.

    Let me say at the onset that I have joined many of my colleagues on this panel in a letter to Secretary Rumsfeld, urging that this issue before us today be addressed. And I am pleased that there has been response by the Army.

    I am curious, and I would like to perhaps address this to Sergeant LaChance, whether the Army is now ready for the next surge of Army medical holdovers? And we do know that right now we are deploying many, many more reservists and National Guardsmen than we did at the beginning of the war in Iraq. What kind of impact would likely result if the current number of troops in this status increased above 5,000? What kind of a situation are we going to be in?
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    Sergeant LACHANCE. From my experience—I spent a lot of time around the mobilization complex itself and the demobilization—it is basically in the same. I am impressed with the way they bring units in and they bring units out. I have seen units come home from overseas and their unit be demobilized in five to seven days, and that is an impressive number for me. I am impressed that they can bring a unit in and get them out that fast.

    The only concern I would see about numbers is a billeting issue. Are the billeting facilities—and as Colonel Kidd said, the billets that we are using for train-up or two-to-three-week Advanced Training (AT) or whatever, they are more than adequate. Long-term, no, they are not adequate.

    But the concern I would have again, it is a huge post at Fort Stewart. As far as the shortage of training areas and resources and things like that, I don't see that as a problem if the billeting space is available.

    I don't know the exact numbers that Colonel Kidd can house in the building over there, so I wouldn't comment on that. But as far as the organization of getting people in and out of there, I am very impressed .

    Ms. BORDALLO. What I have heard from many of the witnesses here, you know, they have been kept there for months, not seen in a timely—I am talking about the medical holdovers now. If this number increases, are we going to be able—is the process going to be better or worse, or are we going to have to assist you in some way in getting more personnel there, more medical professionals?
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    Sergeant LACHANCE. From what I have seen and in discussions from the doctors that have treated me, of course, they could always use more doctors and use more physical therapists. I see waiting times for MRIs. They have switched to doing MRIs 24 hours a day, seven days a week at Fort Stewart. Prior to the initial things, I waited, I believe 2 1/2 months for an MRI.

    When it was recommended that I have another MRI on my back, the waiting time was, I want to say three weeks; and what was strange about it to me was that the appointment was at midnight. At first I thought it was a typographical error. Surely they are not going to give me a doctor's appointment at midnight, but that was the case. People who are coming into medical hold now would not recognize the organization that was here.

    Ms. BORDALLO. So you think, though, that we will be able to handle the numbers?

    Sergeant LACHANCE. Yes. Administratively there are still challenges. Like I said, I will be waiting in MEB when I come back, return back to Ft. Stewart.

    I have been told it takes anywhere from four to six months to get an MEB done. And my question to you, ma'am, is: Colonel Kidd is my garrison commander. What good am I to Colonel Kidd as a soldier right now when it has been determined that I can't return to duty? What is the purpose for Colonel Kidd having to deal with me for the next four to six months?

    I am of no value to this man, none. I am of no value to the Army. Other—my unit, I am of no value to them. I am in a vacuum, so to speak. I am taking up time that other people could be putting to better use.
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    Ms. BORDALLO. Thank you very much.

    I have another question, Mr. Chairman, for Mr. Robinson.

    Could you give us an insight into the mental health of returning troops kept in the MHO, the medical holdover status, for months, and whether these conditions that they found themselves in at Fort Stewart may have contributed to postoperations depression and stress?

    I have an article here in front of me that the Army suicide rate tops recent averages. And I am just wondering, what is the mental state of these soldiers?

    Mr. ROBINSON. Well, the soldiers that we met at Fort Stewart, Fort Knox, Fort Campbell and other installations that we have been to, many on medical hold, expressed concern that the local hospitals could not provide them counselors for concerns they had related to their combat experiences.

    But also, in particular, at Fort Stewart, the conditions that previously existed and have now been addressed may have exacerbated in some cases the feeling that soldiers had, which was expressed by the sergeant, that maybe you don't care about me and my wartime experience. We are concerned about the psychological care of these returning soldiers, the war-wounded soldiers especially.

    And we are suggesting to the committee, and I have had high-level meetings with the DVA, that they augment the mobilization and demobilization sites with mobile training teams, packs of psychologists and psychologists to go into these facilities and just make sure that the soldiers are afforded the proper mental health care screening and the proper counseling that is required.
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    You know, Colonel Kidd is, as he stated, a power projection platform. He has got a hospital that is meeting significant demands. The additional problem of people that may require post-traumatic stress disorder counseling or counseling of any form is an additional burden that he may not have the resources for.

    So we need to be proactive rather than reactive and, you know, hold hearings five or six years down the road talking about what we should have done when we found out that soldiers were having high rates of PTSD and suicide.

    Ms. BORDALLO. Thank you. Thank you very much.

    Dr. GINGREY [presiding]. Thank the gentlelady from Guam.

    And now last, but certainly not least, I want to recognize the gentlelady from California, one of my colleagues who just got back from Iraq. And the gentlelady from California is recognized. Ms. Sanchez.

    Ms. SANCHEZ. Thank you, Mr. Chairman.

    Well, I have a lot of questions, but I would like to start by thanking all of you for coming before us, in particular.

    Sergeant LaChance, I have a question for you because I gather that you were active and now you are reserve. And you have seen medical—the medical system from both ends, and you have also had enough time now, I think, to be sitting there trying to figure out how you are going to get out of this void or vacuum, as you called it.
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    What are you hearing from the people who are standing in line or trying to get through or sitting in the chair next to you? What are the common problems that you are hearing with respect to National Guardsmen and reservists and their access to the system? Is it a problem with primary care? Just being seen? Is it a problem with getting specialists? Is it a problem with special tests? Is it the waiting time? Is it the lack of concern for them?

    What is—what is it that you think we need to fix?

    Sergeant LACHANCE. From my experience, ma'am, I had to see a neurologist and an orthopedic surgeon both. And, I required a lot of radiology work. MRI, I had two MRIs done on my back, and I had two MRIs done on my knee.

    Since the opening of TMC4, as Colonel Kidd had said, the waiting for primary care has gone—when I first arrived at Fort Stewart, we went to an internal medicine clinic inside of the hospital. And we would wait—we would get there at seven, eight in the morning, put our names on the list. Stay there until 4 or 4:30, sometimes without being seen at all.

    Now, since TMC4 has opened up, I have had limited dealing with TMC4, because at the point when TMC4 opened, I had already been referred to a surgeon. So I have had limited——

    Ms. SANCHEZ. Well, let me stop you there a minute. When you went in at seven in the morning, you waited until 4 or 4:30, maybe weren't seen, was that kind of like waiting in a jury room, in a certain sense?
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    What happened with the actives? Were they waiting alongside you, or do they have a different system? Do they get to make an appointment?

    Sergeant LACHANCE. There was times, ma'am, when we were told that the National Guard would be seen at the end of the day. We weren't allowed to have scheduled appointments.

    When I first went to get my MRI done on my knee at Fort Stewart, I was told that there would be no more—this is from the radiology clinic. I was told that there would be no more National Guard appointments conducted until November, which I immediately went and informed my chain of command over at the medical hold. And it was addressed.

    But those were the words that came out of the radiology clinic. Those would be the words that would come out of the internal medicine clinic, we will not see National Guard until after 3 o'clock or after 2 o'clock or after—which goes back to what I was saying earlier, ma'am, am I an active duty soldier or am I National Guard? You can't have a distinction.

    Ms. SANCHEZ. When you were active, did you ever hear or see that type of an attitude toward you or the other actives that you knew who were trying to access the medical care available?

    Sergeant LACHANCE. No, ma'am. When I was on active duty back in the 1980's and the early 1990's, the only time—I was stationed overseas a lot of my time. We didn't encounter National Guardsmen. At the onset of the Gulf War buildup, there were National Guardsmen that came over to relieve people who were being deployed on forward. But as far as me actually dealing with it to where I could say, did I see National Guard being treated different medically then? No, I have no experience.
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    Ms. SANCHEZ. No. But your treatment, you always felt like you could make an appointment, like you were going to be seen, like the system was working for you; is that correct?

    Sergeant LACHANCE. Absolutely. Yes.

    Ms. SANCHEZ. For Mr. Robinson, you—I think I read an article from the United Press where you talk about the stateside suicides that have happened. And your question was, well, they are not counted in the total number of suicides expressed by the Department of Defense, and your question was, why not?

    Have you had that question answered yet?

    Mr. ROBINSON. No, I have not. And, you know, often organizations like mine, nonprofit organizations or advocacy groups, really do not get a lot of access to having their questions answered.

    Ms. SANCHEZ. Why do you think the two stateside suicides haven't been included in the total for—included with the total that comes out of Iraq?

    Mr. ROBINSON. I can't speculate why. But if a soldier went and served in Iraq, made it back home, and killed him- or herself within months or days of return, I would think that would be statistically significant and something that we should look at and monitor, and be part of the overall cost of the war.
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    I don't imagine these people committed suicide because they lost hope. They are—think about the soldier that joins. They have—they are very proud. They give themselves 100 percent. It is not in their character to quit this way. So we have to really look at it and say, is there anything that we are doing that is facilitating this action? And I don't know why they are not counting them.

    Ms. SANCHEZ. Mr. Robinson, I just did return from Iraq, and I had the opportunity to talk to a lot of soldiers. And, you know, there has been this whole question of morale, what is it really like to be out there; and we got to talk to both soldiers within the green zone and also going into Baghdad, working at the airport, around different areas of Iraq in more remote types of areas.

    And, you know, I got to listen to a whole host of things that they talked to me about. Maybe because I am a woman they tend to open up a lot more, I think, than to some of my colleagues. But one of the factors that I saw in our young soldiers was not that they didn't want to do their job. They loved doing their job, they want to serve their country, they understand why they are there, they have accepted the fact that we are going to keep them there as long as we need, so they go from six months to 12 months. They almost thought they are going to be there another six months or a year.

    But one of the biggest problems that each and every one in their own way said was, you know, there are supposed to be six people in my unit doing what I do, and there are only two; therefore, two of us are doing the work of six. I am working 18-, 19-hour days. I am working seven days a week.
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    And their indication was, in one way or another this is incredible stressful, because we are talking about 19-, 20-year-old people.

    Do you think that the lack of troops, in effect—because these people are doing the work of three others or what have you, do you think that that might be one of the stresses that we are really putting these young people under?

    Mr. ROBINSON. I think it absolutely exacerbates the problem. One of the things that we saw early on, and has been widely written about, was whether or not there was a viable rotation plan.

    The 3rd Infantry Division went in and won the war, took Baghdad, and then stayed in place and fought the peace. That is not normally how we conduct military operations if we have the appropriate people to rotate in personnel who can get the warriors that, you know, just had the most significant battle that we have seen in quite some time, get them out of there, get them back to a safe place, let them refit, reorganize, reconstitute, and then, if necessary, redeploy them. But that is not what happened. So it could absolutely exacerbate it.

    The other thing that happens when the soldiers come back home is, they begin to in some cases meet obstacles, and I have to say that these soldiers will feel entitled to the best that this Nation can offer them. And when they don't get that, it creates additional problems.

    An example would be, you know, if an NFL football player sprained his pinkie, he would get an MRI that day. If a soldier breaks his leg in Iraq or comes back and falls off a truck and hurts his shoulder, he might get an MRI within a couple of months.
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    I think we owe the best that we have for these guys in whatever way we can deliver it.

    Whether the perception is real or believed that there is an inequity between the National Guard and the active duty force, it is a cancer, and it needs to be addressed. And the military needs to take steps to let them know that there is no difference, because the bullet and the bomb doesn't know a difference. And in some cases the care back home seems like it is not appropriately distributed.

    Part of the problem is exacerbated by not enough troops, absolutely.

    Ms. SANCHEZ. Thank you.

    I have just one more comment, question, and I don't know who to direct it to, maybe it is the next panel.

    One of things that I got to do is fly out to Iraq on a commercial flight instead of going with the regular Congressional Deligation (CODEL). And I always learn a lot on these flights, because the airlines tend to sit me next to, for some reason, young men in our military one way or another.

    In this particular case, I actually—I had two gentlemen in back of me that I never would have guessed were reservists for our United States, mainly maybe because I come from California, and when I think of a reservist, I think of my brother who is a Marine reservist, runs 10 miles a day, lifts weights, is in great shape.
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    And sitting behind me was a guy I thought was as old as my dad, who is 80; and I would never have guessed that he had already been eight months in Iraq, and taken two weeks, and now he was coming back. And his buddy next to him—of course, they weren't from California, they were from another State, I might add—but this guy must have been 80 pounds overweight. You know—and I work out every day, so I know what muscle is and I know what fat is; and how is it that we are putting these kind of people in a guerilla warfare situation? Just looking tells me there is something wrong here.

    How is it that we are really not screening people before we send them over into theater?

    Sergeant LACHANCE. It has been my experience with the National Guard, like I had said earlier on active duty, you are given a PT test. If you didn't pass the PT test, you were given another opportunity to pass the PT test, and then you were processed out. If you didn't meet the height and weight standards, you were processed out.

    In my experience with the Guard, you don't have that. That goes back—to the doctor over here was saying, give a physical once a year. To me, passing a PT test is kind of a prescreener to a physical. If you see a gentleman or a lady cannot pass a PT test, that is an indicator that there is something wrong. That person should not be allowed to fill a slot that somebody else might be filling. There might be a gung-ho E–4 who wants to make E–5 who can't make it because there is not a slot, because an overweight soldier, a soldier who can't pass a PT test, a soldier who has these preexisting conditions is occupying that space.
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    For me, it is frustrating. It is like I had told Colonel Kidd. He had talked about alternatives to me getting out. I don't want to be a liability to the Army. If I can't perform my duties the way I should perform my duties, then absolutely I am going to be processed out. I don't want to take a slot from that young E–4. I don't want to be a burden to the Army.

    But these units, and these on-scene commanders have caused a lot of the problems that went on. This 25-day rule is great. It is one of the best rules I have heard come out of the whole thing. But prior to the implementation of the 25-day rule, there was a big problem.

    But these unit commanders need to be held responsible for deploying people who can't pass PT tests, who can't meet these height and weight standards. Somebody needs to be held accountable for that.

    It is not Colonel Kidd's problem that a local company commander has allowed someone to carry on in the National Guard to get his pension when he is not fit for duty. And that is where, to me, the biggest problem coming from the active duty side to the National Guard side is. Because, like I said, on active duty if I would have failed the PT test, I would have been out.

    Does Colonel Kidd get a physical every year? No. Do I need a physical every year? No. Would it help in some cases? Yes. But existing Army standards if they would be enforced would take care of a lot of those problems we are talking about today.
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    Colonel ARMSTRONG. Ma'am, there is an individual responsibility and accountability that each individual soldier has to be held to standards. That standard is very clearly defined in our regulations as far as physical fitness, medical conditioning, your height, weight. So there is an individual piece.

    There is also a unit piece. In some cases, individuals and units failed and failed miserably, and I don't think anybody sitting at the table would lead you to believe otherwise.

    The flip side of that, though, is, ma'am, there were many units that came through Fort Knox, Camp Attaberry and Fort McCoy, Wisconsin, that were as prepared to go to war as any active component unit that I have been assigned to in my almost 25 years of service. There are units that are out there that are doing exactly what they are supposed to do, had their head in the game when they got their alert order, had their head in the game when they got their mobilization order, and when they came to the mobilization stations they were ready to execute their wartime mission.

    Those folks were a blessing to deal with. Those individuals or units that chose not to abide by the rules and the regulations were burdensome. That is why we are sitting here today.

    Ms. SANCHEZ. Thank you, Colonel. Thank you, Chairman.

    Mr. MCHUGH [presiding]. Thank the gentlelady.
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    Just for the record, the exchange that the gentlelady from California had with Mr. Robinson, with respect to end strength, this subcommittee, as the Members all know, has for the past two years put language into our subcommittee mark for the authorization bill that would increase end strength. And it is an important part of that equation, as we all know.

    Ms. SANCHEZ. And, Mr. Chairman, maybe one of the reasons that we are seeing some reservists who aren't really ready to go over is that people are trying to meet numbers. I mean, maybe this is a numbers game, and we are fooling ourselves with what we really have on the ground.

    Mr. MCHUGH. I suspect there are commanders who are not fulfilling their requirements because of the numbers issue for them. I don't disagree with the gentlelady.

    With that, I would be happy to yield to the gentleman from Tennessee, Mr. Cooper.

    Mr. COOPER. Thank you, Mr. Chairman. I appreciate your calling this important hearing. The witnesses have been great. I am especially appreciative to see folks who rank below general testifying. I am afraid that is terribly rare before, certainly, the full committee. So I appreciate hearing from real soldiers in the field. Thank you.

    Mr. MCHUGH. My goodness gracious, I was conducting high finance here. I apologize to the panel. And I appreciate the gentleman's brevity. We have now been nearly 2–1/2 hours on this first panel. So our compliments and words of appreciation to all of you, both for the reasons you are here today and for the fortitude that you have shown in sitting here and being patient with us.
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    But obviously we feel very strongly about this. So with our final words of thanks and with a caveat that it may become appropriate that we may wish to submit some questions to you in writing, I am not sure if that will happen, but if it does, we would deeply appreciate your continued cooperation for fulfilling those requests should they come up.

    We dismiss you—I hate that word, but we dismiss you with our deepest words of appreciation. Thank you.

    And with that, as they are departing, I would call for the second panel that I know is seated behind the first panel.

    While they are finding seats, let me try to, in the interest of time, introduce our second panel to the audience. For the record, the first witness listed is Mr. Daniel Denning, who is Principal Deputy Assistant Secretary of the Army for Manpower Reserve Affairs; Lieutenant General James Peake, who is Surgeon General, Department of the Army, no stranger to this subcommittee; Lieutenant General Joseph Inge, who is commanding general of the 1st U.S. Army; Vice Admiral Michael Cowan, who is Surgeon General, Department of the Navy; and Rear Admiral John Stewart, Jr., Deputy Commander, Navy Personnel, for the Department of the Navy.

    As I look up, they are all seated. I don't know if they are in the order in which I read them, but we will play it by ear.

    Mr. MCHUGH. Gentlemen, thank you for your patience. As I noted at the conclusion of the last panel, we spent quite a bit of time with those individuals, and your sitting there and expending what I know is very valuable time for all of you is deeply appreciated. So without a great deal of adieu, let me once more say ''thank you'' for your being here and immediately turn the attention of the subcommittee to Mr. Denning.
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    I would just say, Mr. Secretary, that as I noted to the first panel, we do have all of you gentlemen's statements, that will be, without objection, submitted in their entirety in the record. So if you could summarize your comments to the best of your ability, it would be deeply appreciated.

    Mr. Denning.


    Mr. DENNING. Thank you, Mr. Chairman.

    Good morning. I am Dan Denning, Principal Deputy Assistant Secretary for Manpower and Reserve Affairs. With me today, as you noted, is Lieutenant General Peake, the Surgeon General, and Lieutenant General Joe Inge, the Commanding General, 1st Army. Thank you for inviting us to appear before your committee to discuss the medical holdover issue. This morning it is our intention to demonstrate to the members of the committee that the Army is committed to providing outstanding health care and satisfactory housing and services to reserve component soldiers who are in medical holdover status.

    These are challenging times for our Army with the global war on terrorism, our efforts in Afghanistan and continuing operations in Iraq. We recognize that last fall, in the furor to support the warfight by rapidly training, mobilizing and deploying units, we temporarily lost sight of the situation of soldiers in medical holdover status, a critical soldier support issue.
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    Since November, the Army has been intensively managing the health care and disposition of reserve component soldiers in the medical holdover status; and I know that Generals Peake and Inge both have programmatic data and detailed anecdotal accounts demonstrating that the Army has made substantial progress and has this program under control.

    Of particular interest are soldiers who helped bring the situation to the Army's immediate attention and who have been in medical hold status since before November 1, 2003, such as those at Forts Stewart and Knox. It is obvious that the numbers of soldiers in medical holdover at those two installations, in particular during that period of time, exceeded the capacity of both medical treatment facilities and available installation infrastructure. Although the soldiers were being provided with quality medical care, the timeliness of that health care was not sufficient. Similarly, medical holdover soldiers were housed in transient billets that were not suitable for longer-term housing, nor in some cases to facilities to accommodate the medical condition of individual soldiers.

    I would like to take a moment to relate the actions the Army has taken since November of last year that now provide improved case management and support for medical hold soldiers. Acting Secretary Brownlee redirected standards for more rapid delivery of care for screening, specialty appointments and surgery. The delivery of these standards is monitored at every medical treatment facility, and Lieutenant General Peake will explain those in more detail.

    We increased medical infrastructure—more physicians, case managers, diagnostic capability—to provide more readily available, high quality treatment at our Medical Treatment Facility (MTF). We upgraded billets in which soldiers in medical holdover are housed to ensure that facilities will accommodate soldiers' medical conditions and are commensurate with active duty soldiers on the same installations. In some cases, soldiers in medical hold status have been relocated off the installation until adequate quarters can be provided on base.
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    The Army is spending an estimated 15.7 million to ensure facilities are adequate so that soldiers in medical hold status are housed in a manner that is commensurate with permanent party. We established a dedicated chain of command at each installation to monitor progress and provide necessary support for soldiers in medical hold status. Lieutenant General Inge will be able to describe this important initiative in more detail.

    And finally, Assistant Secretary Brownlee authorized a new provision in which Reserve Component (RC) soldiers mobilized after October 25, 2003, may be released from active duty if found medically unfit to deploy within the first 25 days of mobilization. These actions have resulted in a reduction in the number of predeployment medical holdovers and have postured the Army to more effectively deal with this challenge.

    At the end of October 2003, there were approximately 4,452 soldiers in medical holdover status. By January seventh that number was reduced to 2,558. And by November 1st of this year, we expect a very small percentage of this original cohort to remain on active duty, most probably for persistent medical issues or physical evaluation board processing. From now through mid-May, the period during which the highest number of units will rotate to and from Iraq, Afghanistan and the Balkans, the largest number of active and reserve soldiers will pass through Army installations since World War II.

    The Army is committed to ensuring that soldiers are medically qualified for service in a theater of operations, and providing comprehensive care and treatment to soldiers who have served and incurred illness or injury.

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    By law, each soldier is required to undergo a health assessment before deployment and upon returning from deployment to the theater of operations. The Army anticipates that health assessments for the large numbers of forces rotating in and out of theater will increase the number of medical holdover personnel. However, it is not possible to determine exactly what this number might be at this time.

    The Army is taking the following steps now to mitigate a potential increase from 500, 5,000 medical holdovers above our capacity, which is at about 5,000. We are increasing medical installation support and administrative processing resources to ensure that soldiers have access to high quality medical care, and to increase throughput of patients through treatment, medical evaluation board, and physical evaluation board processes. Those measures include everything from hiring contract health workers, buying medical diagnostic services, repairing and upgrading billets, and outsourcing administrative support for boards.

    We are developing multiple options, including support from other services, to provide appropriate health care when the patient load at medical facilities at demob sites exceeds capacity. We are using a combination of civilian contractors, civil service employees, RC medical personnel, the TRICARE network, Army, Navy and Air Force resources and the VA in meeting the immediate need for taking care of our soldiers.

    We are establishing community-based health care organizations located at our National Guard Joint Force headquarters, staffed by mobilized National Guard soldiers and reservists. These units will be under the direct command and control of FORSCOM, with Medical Command (MEDCOM) technical oversight, and will manage the health care administrative processing and soldier support for assigned medical hold soldiers. This initiative will afford soldiers with less severe health issues the opportunity to receive care closer to their homes and, in most cases, to live at home while completing their treatment. We are ensuring that adequate living facilities and a dedicated chain of command exists at every installation where medical hold soldiers will be staying to receive treatment and processing.
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    The medical funding needed to meet the medical holdover mission is estimated at 77 million. These resources will be used to hire more case managers, more orthopedic specialists, more administrative staff, et cetera. An additional 6.9 million is required to repair and upgrade billets, and it is estimated that establishing and operating the up to 13 community-based organizations will require approximately 8.5 million.

    The Army is postured to be successful at managing medical holdover soldiers. The appropriate policies are in effect. We have set standards of care and living conditions of soldiers in this status. Acting Secretary Brownlee and the Army leadership have committed that soldiers will receive the best medical treatment in the most expeditious manner, and will be billeted in facilities that are comparable to those for permanent party soldiers.

    We have put together the right team within the Army while leveraging the support of sister services, VA, and civilian health care providers. The combination of these groups will posture the Army to take care of soldiers entrusted to its care and will improve our overall readiness posture.

    Thank you for your continuing commitment and support to quality care for our soldiers and the readiness of our forces.

    Mr. MCHUGH. Thank you very much, Mr. Secretary.

    [The joint prepared statement of Mr. Denning and General Peake can be viewed in the hard copy.]
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    Mr. MCHUGH. Next, as I mentioned, no stranger to the subcommittee is Surgeon General of the United States Army, General Peake.

    Welcome, sir.


    General PEAKE. Mr. Chairman, Congressman Snyder, members of the committee, first, I want to thank you for inviting me and to thank you for the unwavering support that this committee has always given to military medicine. It is what has allowed us to provide an extraordinary quality of care with the best people, well equipped, well trained, well prepared, saving lives on the battlefield, compressing lines of evacuation, reducing the disease and nonbattle injury rates, while maintaining high standards as we take care of family members back home.

    Iraqi Freedom gets most of the attention, but as you well know, we are executing the same support in Afghanistan, Kosovo, Bosnia, Honduras, Colombia, the list goes on. But I know we are here to talk about caring for our soldiers after the deployment.

    It is absolutely our obligation and our commitment to not only give them the best possible care, but to treat them right. And frankly, I stumbled, in that we were meeting general TRICARE standards for the returning men and women, but as the members slowly claimed, I didn't really recognize early enough that those standards, fine for soldiers living at home with their wife and family, soldiers who could productively engage at work even in a limited duty capacity, were not the right standards for this group; standards with a focus on expeditious not just efficient care, and expeditious, not just effective processing for those RC soldiers who were not at home or not in permanent living quarters. And we were not as sensitive to the perception that reserve component soldiers were being treated differently with regard to medical access.
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    The good news is that I got really good people out there who were ensuring that each soldier did get quality care all along. And when we recognized the need to change our access standards to account for the unique circumstances of the medical holdover soldier, they have responded superbly.

    We reached out to the other services, to the VA, to our network, to augment us; we shifted work loads, sometimes staff; sometimes we moved patients to expedite consultation and care. We have reduced surgical wait times, insisted on specialty consultations within 72 hours. We have provided case managers to ensure things do not fall through the cracks and that there is that all-important individual attention.

    We have upped the admin staff to process the medical boards where required, and we have developed predictive models that allow us to anticipate and posture for the surges that we may expect as our Army executes really the largest troop movement since World War II. We have steadily returned soldiers home.

    From the group that was in the med holdover status before 1 November, we now have 2,370 from that cohort that was 4,452, each with a treatment plan to resolve their medical condition or to get it adjudicated. We have, by installation, visibility of those soldiers returning who come into medical hold status, and have the same processes in place to keep their treatment and process moving. At each installation, there is really close communication and teamwork between the medical system and the installation commanders that you met here earlier and the command and control structure that oversees these soldiers.

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    Sir, we are committed to ensuring these soldiers get the care to which they are entitled, and as expeditiously as we can. We are postured to respond to their redeployments. We are monitoring performance against our predictions.

    Again, I thank you and this committee for the support you have always given us; and we intend to do this mission while maintaining the same high standards we expect for all of the rest of our missions.

    I look forward to answering any questions.

    Mr. MCHUGH. Thank you very much, General.

    [The joint prepared statement of General Peake and Mr. Denning can be viewed in the hard copy.]

    Mr. MCHUGH. Next, Lieutenant General Joseph Inge, who is Commanding General, 1st U.S. Army.

    General, thank you so much for being here.


    General INGE. Mr. Chairman, distinguished members, thank you for giving me the opportunity to be here.
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    I am Lieutenant General Joe Inge, Commander of the 1st U.S. Army, headquartered at Fort Gillam, Georgia. The 1st Army's area of responsibility encompasses the 27 States east of the Mississippi River, as well as the District of Columbia, Puerto Rico and the Virgin Islands.

    The 1st Army's mission is to provide training, support to the Army, Reserve and National Guard and to mobilize those forces when they are called to active duty. Additionally, when directed, we support homeland defense for providing command and control elements within the continental United States.

    Since the attacks of 9/11, 1st Army has mobilized approximately 140,000 Reserve component soldiers to support, as General Peake said, a variety of missions, including Iran, Iraq, Bosnia, Kosovo, Guantanamo, as well as force protection forces in the United States and abroad. We typically, as we discussed earlier this morning, mobilized units at power projection platforms. An example of such a platform is Fort Stewart where, since 9/11, we have mobilized some 23,000 reservists.

    While Fort Knox is not a power projection platform, it is what we would call a power support platform. We have in fact mobilized some 6,000 soldiers there. But as Colonel Armstrong pointed out this morning, he provides extensive support to Fort McCoy, Camp Attaberry, in support of their medical initiatives.

    Since the beginning of major mobilization operations early last year, 1st Army's medical holdover population peaked at approximately 3,000 Reserve component soldiers, and has gradually fallen to its current number of approximately 2,500. While we expect the downward trend to continue, we do anticipate that there may be a short-term spike as we go through the demobilizing of some 30,000 soldiers in our area that will return from the Area of Responsibility (AOR) between now and early summer.
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    Several factors contributed to the overall decline in the number of medical holdover services, including many intensive management initiatives and a partnership of headquarters, beginning with the departments—the medical department of the United States Army, Army Forces Command, recent changes to the Army personnel policy guidance that allow the expeditious release of mobilizing soldiers with preexisting conditions.

    Throughout this process, our primary concern has been and will continue to be the welfare of the soldiers entrusted to our care. We will continue to carefully manage the medical treatment and processing to ensure that they receive both the quality of care and the statutory and regulatory benefits which they deserve.

    Thank you very much.

    Mr. MCHUGH. Thank you so much, General.

    [The prepared statement of General Inge may be viewed in hard copy.]

    Mr. MCHUGH. I mentioned that General Peake is no stranger to this subcommittee. I would note, as well, that Admiral Cowan is also no stranger to the subcommittee, Surgeon General of the Department of Navy.

    Admiral, thank you so much for being here.

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    Admiral COWAN. Thank you, sir.

    Mr. Chairman and members of the committee, I am also privileged to be here to discuss Naval medicine's efforts to ensure seamless and world-class health care for our Naval reservists who, after being called away from family, friends and work to serve their country, are now being released from active duty and returning home. It is Naval medicine's duty to ensure that these men and women, some of whom have injuries and illnesses as a result of or aggravated by their service, get timely and quality health care.

    Recently, and thanks in part to staff members from this committee, we learned that the continuity of care and medical communications for some reservists being demobilized at San Diego was simply not up to our standards. Although the numbers were relatively small, each case represents a failure on the part of our system, and each case is highly important to us and the individual involved.

    Reservists being mobilized deserve and must receive the best care, fully understanding their own medical conditions, know how to access care when they return home, and where to go if they need to get further assistance. To address these issues, representatives from Naval Personnel Command, Naval Reserve Force and the Bureau of Medicine and Surgery initiated a working group to explore our continuity of care and medical holdover policies. They found that while the processes and procedures were fundamentally sound, there were nonetheless communication breakdowns between the responsible authorities and individual patients that hampered their reserve transition.

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    Typical problems encountered were, for example, we would see processing site and senior medical center health care providers not communicating effectively with one another about treatment plans. This would result in conflicting advice from different providers, would cause confusion in the plan for care, and generate anxiety among the affected members.

    We had health care providers at the Medical Center with inadequate training in the reserve to mobilization process. There are several physicians in the room—and we all know, if you ask a doctor a question, you will get an answer—and when our physician providers who knew about that health care were asked demobilization questions, they would give an answer. Sometimes it would be wrong. Vice versa, sometimes in the processing center medical questions would be asked and answered wrong. And we had confusion that affected the outcomes for our patients.

    Finally, we were finding that the reservists didn't always fully understand their health care benefits or how to access them. There are several benefits for them. And the use of those benefits and in the maximum deployment of them can be complex and difficult to understand.

    We need do the right thing and we need to do it the right way. So, in response, Naval medicine reviewed the policies and has taken measures to improve both the policies and the communications so that we continue to provide the continuum of quality care for all of our forces, whether on active duty or transitioning back to civilian life.

    The measures we have taken include: first, establishing a single point of contact at each Navy military treatment facility to coordinate with the local processing sites to see that each case is managed in a coordinated way and ensure that all reservists receive copies of their records;
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    Second, every reservist will go home with an easily understood, written, personalized care plan and will know where to go for additional assistance if unexpected events occur after their return home;

    Finally, through our TRICARE health benefits advisors, no reservist will leave the Navy Mobilization Processing Site (NMPS) without understanding all of their TRICARE and VA benefits.

    Tomorrow, the same working group will meet again, this time in Norfolk, which is the location for medical demobilization on the East Coast. They will share the lessons learned from San Diego and will work with Norfolk to aggressively address any new issues that they may identify there.

    I will conclude my remarks by assuring this committee that we at Navy medicine are committed to working closely with the Naval Personnel Command Reserve Force and this committee to ensure that reservists receive the health care they so richly deserve. High quality health care is one of the ways that a grateful Nation thanks its service members for their service, and it is our honor and privilege to be the instruments of delivering that health care.

    This concludes my statement. I will be pleased to respond to any questions.

    Mr. MCHUGH. Thank you very much, Admiral.

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    [The joint prepared statement of Admiral Cowan and Admiral Stewart can be viewed in the hard copy.]

    Mr. MCHUGH. The next witness is Rear Admiral John Stewart, Jr., Deputy Commander, Navy Personnel Command, Department of the Navy.

    Admiral, thank you.


    Admiral STEWART. Thank you, Mr. Chairman and distinguished members of this committee; I appreciate the opportunity to appear before the committee. And thank you for the outstanding support that Congress and the subcommittee continue to provide our Naval personnel and their families during the global war on terrorism.

    I am a Naval reservist from Tennessee, currently serving as Deputy Commander of the Navy Personnel Command with additional duties as Director of Navy mobilization.

    In September of 2001, U.S. Navy began its largest mobilization since Operations Desert Shield/Desert Storm over 10 years earlier. Over 22,000 Naval reservists have been mobilized since 9/11. As of early January 2004, almost 19,000 have been demobilized. Less than 1,600 of these service members have been evaluated for medical holdover to resolve conditions that arose or were aggravated while on active duty. Currently, just over 100 sailors remain on active duty in a med-hold status.
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    A major lesson the Navy learned from Desert Shield/Desert Storm was that we needed a limited number of central points with access to systems and facilities and staffed with technical expertise to activate and deactivate our reservists more effectively. By 1996, the Navy had developed the Navy mobilization processing site concept with 15 sites established worldwide under the cognizance of the Navy regional commanders to address reserve mobilization/demobilization issues, including orders and pay, medical, dental and legal screening, equipment issues and transportation.

    This system has paid huge dividends during the global war on terrorism, resulting in relatively few medical, dental or pay issues. Each of these issues had been very problematic for thousands of our reservists in 1991, and adversely affected our recruiting and retention for years thereafter.

    In June of 2003, following conclusion of major combat operations in Iraq, Navy began demobilizing reservists. Our mission for them was completed, and the goal was to return them to their families and employers as rapidly as possible. Anticipating a spike in medical cases during demobilization, the Navy Personnel Command elected to relocate all med-hold cases that would involve extended care to either Norfolk or San Diego. Being located near our Navy medical centers at Portsmouth and Balboa would provide ready access to our extensive medical capacity, and implementation of professional case management would expedite resolution of those med-hold cases.

    Most of the Navy's 1,600 med-hold cases have been thoroughly reviewed and resolved. A significant portion of the remaining med-hold cases are now under review by the physical evaluation board for disability level determination.
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    During the demobilization processing, several reservists felt they were released from active duty too early and have submitted grievances to the Navy inspector general, Members of Congress and advocacy groups. We are aware of about 15 documented cases.

    Some of these sailors were absolutely right, and when their concerns were made known, they were recalled back to active duty, or demobilization was delayed to correct the medical condition. In a number of these cases, however, the member was demobilized because the Bureau of Personnel senior medical officer found him or her fit for duty, but with outstanding medical issues of treatment or rehabilitation to be either provided by or funded by the Navy.

    When this condition does not render the member unfit for duty, that is the correct decision. And it is not one made in a vacuum. The decision is made in consultation with the treating physician and the NMPS medical officer. When opinions differ as to the member's true condition, the Bureau of Medicine senior specialty leader for that field, such as orthopedics, is also consulted.

    Cases in which members were released prematurely—and there are a few—usually happened because of incomplete information at some point in the process; and Bureau of Medicine and Surgery (BUMED) and Bureau of Naval Personnel (BUPERS) are continuing to work very hard to improve that process and prevent future information gaps.

    Demobilization does not absolve Navy of responsibility to treat medical conditions that arise or are aggravated while on active duty. Care is continued upon the member's return home under notice of eligibility, line of duty process. The member can receive treatment at a DOD medical treatment facility, a DVA medical center, or a civilian hospital, and Navy will pay the bill. Additionally, if the member misses work as a result of treatment, incapacitation pay is also provided equal to the member's active duty pay and allowance.
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    If a member is later found unfit for duty, after demobilization, as a result of their condition, they may be recalled with their consent to receive further care or to be reviewed by a physical evaluation board for disability determination.

    I believe that the Navy is doing right by its people in returning reservists to their families, homes and civilian employers as quickly as possible while still caring for their medical needs. We are committed to continuous improvement of our procedures and systems and all complaints are taken very seriously.

    The Navy team that visited San Diego in December of 2003 to address all known issues associated with the demobilization through that NMPS site will travel to Norfolk tomorrow to continue the process of assessment and incorporating best practices. Our goal has been and will continue to be to deliver all Navy personnel, active and reserve, the best medical care and support possible.

    This concludes my statement. I welcome any questions you may have.

    [The joint prepared statement of Admiral Stewart and Admiral Cowan can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you very much to all.

    Let's, Dr. Snyder suggests he has one question. And time is fleeting, so I would be happy to yield to him.
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    Dr. SNYDER. I just wanted to ask, the comments of the first panel, when talking about the legal standards of fitness for duty, and that needs to be revisited.

    Maybe, General Peake, I will ask you. Is that—do you have enough reliability now that that standard can be applied well, or does it need to be revisited, which I think can open a whole bunch of issues?

    General PEAKE. We have accession standards, and then we have retention standards. They are pretty clear. They are basically in AR40–501.

    The issue is deployment and deployability, because that sort of depends on the theater, and there is a commander's call into that as we document in the profile what the patient's limitations are from a medical perspective; and the commander must take that into account as they determine what that soldier can do within the confines of that unit.

    If they are, by our standards, not retainable, then we need to make that determination and put them into the medical board process to make the adjudication about their fitness for duty—which is done not actually by the medics, it is done by the physical evaluation board.

    Dr. SNYDER. Thank you.

    Mr. MCHUGH. Thanks, gentlemen. Let me see if I can squeeze one in here before we have to go vote. We have got a series of, I think, four votes.
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    It seems to me we have two problems here. First is the procedural problem of adequate medical screening, predeployment; and we can pursue that. The other is the postdeployment issue, or redeployment issue, I should say. That seems to be largely—not exclusively, perhaps, but largely a matter of resourcing, which I think both the Army and the Navy are trying to resolve here. But I am sure you gentlemen heard the concerns expressed by our two garrison commanders. With respect to, first of all, Fort Stewart, are they going to have sufficient resources for this next significant wave, 250,000 whatever it is, of people that need to be processed?

    And, second of all, while General Inge suggested very correctly that Fort Knox is technically a power support platform, it is currently designated a power projection platform; and yet while expected to do that, it apparently is not getting the resources.

    Just one simple question: Are we going to resource this well enough in the next wave to accommodate the likely challenges?

    I mean, things happen you can't anticipate reasonably, but I think we can reasonably anticipate what the major challenges are going to be here. Are you gentlemen confident that the resources are going to be there?

    We will start with General Peake.

    General PEAKE. I am. And it will take management, because what we will see, as you look across the spectrum of our 34 places now where we have medical hold soldiers, different peaks and different valleys. We are watching very carefully to understand what those peaks and valleys may be in trying to project out.
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    With the 25-day rule, we are saying a lot more attention in the units before they come. And so what we are seeing is, we think, about one to two percent of those soldiers will be injured in training. The rest—those others are going home as we make those determinations, but we will have a few come out of the deploying units that will stay in medical hold, because we owe them to take care of the problems that are aggravated by service or created during their training period.

    We have been seeing about 8.7 percent of those soldiers coming back through. The soldiers that have been returning are basically running—because of one reason or another, about 8.7 percent of those that have been coming into a medical hold status.

    What we are starting to see now as cohorts come back, we are seeing a much smaller number because most of those kids come home, they are ready to get back home as quickly as they can, these young soldiers. So, you know, we are projecting at about 8.7 percent, but I am thinking that is going to be a little bit lower.

    We are projecting out the peaks, and then we have surge teams that will go and augment the Fort Stewarts or wherever as we see those peaks arise. But we are watching it on a very close basis.

    Mr. MCHUGH. Including Fort Knox?

    General PEAKE. Including Fort Knox, which has Attaberry and McCoy as a larger catchment area, if you will. And so we are working with the VA which is fairly close to Attaberry, as an example. And we are—we will go downtown. We will purchase the care where we don't have the specialties in places like McCoy, as an example.
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    Mr. MCHUGH. Thank you.

    Admirals, one word. All you have got to say is ''yes.'' .

    Admiral COWAN. Yes.

    Mr. MCHUGH. The problem has never been, as Ms. Hicks testified—in her estimation, I think, and the information we have received—the quality of medical care. And I am not excluding the Army here, but specifically, the Navy is excellent, excellent. The process has been a challenge, and that is a resource problem.

    Admiral COWAN. Yes, sir. I am confident that we have the resources to manage the next wave. I am more comfortable now that we have the processes that will prevent fewer—hopefully, nobody falling through the cracks, as the cases that Ms. Hicks talked about did the last time.

    Mr. MCHUGH. Which is—it happens, but it is frustrating. We have got one gentleman, as you know, in the audience here today that it happened to.

    Admiral COWAN. Yes, sir.

    Mr. MCHUGH. We certainly share your view. And we don't want to see that happen again if at all possible.

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    We are going to have to adjourn the subcommittee. I beg the second panel's forbearance. We are going to have to clear this room by 2 because they have a full committee briefing.

    So we won't take too much of your time. We have four votes. We hope to reconvene. I apologize, but such is the way of Congress.

    So we will stand in recess subject to the call of the Chair, I guess is the way to do that.


    Dr. GINGREY [presiding]. The hearing will come to order. We, of course, apologize. But I think everybody in this room understands the drill, if you will. So we are happy now to be back. At this point, I would like to call on the ranking member, Dr. Snyder from Arkansas, for his questions.

    Dr. SNYDER. Thank you, Mr. Chairman.

    I wanted to ask General Peake and Secretary Denning, you mentioned the—on page six of your written statement about the community-based health care organizations, I don't understand—I don't understand how those would operate. Are those a done deal? Is that going into effect? Are they already going into effect? Is this something that is being considered?

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    And then as part of that, why is there a need for that? And this is just a devil's advocate question. Why is there a need for that if we have, you know, the National Guard headquarters and facilities—I will use Arkansas, in Little Rock, and five miles from there we have the Little Rock Air Force Base with their medical facilities.

    If you are pursuing that, how does that fit into already-established systems?

    Mr. DENNING. Yes, sir. Well, first of all, the—the community-based concept is a task-organized element staffed by mobilized national guard and reserve soldiers that operate out of the Joint Force State headquarters.

    Mr. DENNING. It is really a safety valve in case our projections prove too conservative. As General Peake mentioned, right now we are experiencing less than four percent medical hold on redeploying units. Our planning factor was 8.7 percent. Going back in time, we can see numbers that were even higher. Once the wave hits, when it is still ahead of us, if we start seeing numbers well in excess of our capacity and our ability to reach out to our sister services, to other health care, the VA and other assets, we are prepared to and we are executing—we just issued the execute order yesterday to open up five of these by March 16, spread over the country, and they have a capacity of about 300 soldiers each. So it really is a fail-safe mechanism, and we are prepared, by the way, to expand it beyond that if we have to.

    Dr. SNYDER. So what does it mean—I think Arkansas is one of those five probably because the 39th Brigade was activated, and we have got 3- or 4,000, several thousand troops at Fort Hood right now. But what does it mean to be activated? Will they start processing people or——
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    Mr. DENNING. It means—what it means, sir, is that we will go ahead and alert and mobilize the guard soldiers and reservists, about 35 each, to stand up those organizations and be prepared to accept medical hold soldiers as patients. I will let General Peake explain how that process will work, but basically soldiers that are—their medical conditions dictate that they be better treated near their homes, in the case of overcapacity we would transfer them to those community-based health care organizations for treatment.

    Dr. SNYDER. Would these be people who were coming home postdeployment, or would it also include people who had problems before they were deployed that somehow the 25 day rule did not take care of?

    Mr. DENNING. I view it as primarily postdeployment, sir, but I think it would apply to both.

    Dr. SNYDER. Did you have any comment, General?

    General PEAKE. Sir, again, we are looking at this as a pop-off valve, not as the approach of choice. We are—part of the reason we are bringing them on is so that we can train them, because we don't have the case management skills and all that kind of stuff. We want to make sure they understand the process, the linkage to the medical board process and so forth. So we have got a small number that will actively participate in the training of that group, and we will reserve the right to try to pick the right person to go into that should we wind up with a bubble that we don't think we can handle appropriately.
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    We don't want to be in the situation Ms. Hicks described where we are pushing people out into a system where, you know, nobody is there to take care of them. They will still be on active duty, and then they will go through the processing. So this is a—this is a belt and suspenders approach so we don't get caught short.

    Dr. SNYDER. One of the concerns that Ms. Hicks had, she talked about the geography concerns. So your openings in five areas of the country, is the intent that they would be dealing with people in their home State primarily, that you are not going to be sending somebody from Wyoming who is at Fort Stewart and then say, okay, we don't have room for you here, we are now sending you to Arkansas or one of the other sites? It is going to be primarily to deal with home folks?

    Dr. DENNING. Yes, sir. That is the intent, although these are—these five were picked for really two reasons: One, that these were adjutant generals and National Guard assets that were leaning forward and wanted to do it; and the other factor was there is a regional spread here. The five are Arkansas, Florida, California, Massachusetts and Wisconsin. So we tried to give it a regional spread so a soldier, for example, that Fort Stewart could not handle, we were over capacity there, and was from somewhere in Massachusetts might be assigned—or anywhere in the New England area would be assigned to that community-based organization in Massachusetts.

    Dr. SNYDER. Your ability to predict, I think—I mean, what you are saying, the pop-off valve, I guess, General, was your metaphor. I remember when we were leading up to the vote over a year ago on the Iraq war, I met with—as a lot of Members did—with a whole lot of different people and some high-ranking military folks and was asking about, you know, potential estimates of casualties. And one person told me, he said, as a ballpark, you know, we ought to be prepared for easily 10,000 casualties, which seemed like a terrific number. But then just a couple of weeks ago I understand that we have now had close to 10,000 medical evacuations, not all from combat wounds, but medical evacuations. Injuries and wounded from all the services has now surpassed 10,000 medical evacuations, which means we probably have more casualties than that, there has just been a lot treated in Iraq, and plus our 500 dead. So we have had significant numbers now. And so I think it is good that you all are doing this.
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    I want to ask one final question. As you were immersed for the last several months in these numbers, when you were looking at the—now the folks that were not deployed, that were having problems before they ever got deployed, did that point you in some directions about things that the national guard and reserve forces could be working on in terms of preparing their folks? And the one that specifically comes up is dental. General, what were your thoughts from the medical perspective? Are there some things that we could have some more deployable people with, perhaps things that we need to do on this committee or that the guard needs to do?

    General PEAKE. We—I think that is an issue, because, as you know, we have not in the past been able to provide care for the reserves. We now have authority if—once they are notified that they are going to be mobilized, that we can start to apply resources against care to bring them to a deployable status. I think that we—you know, we just now have that authority and just getting that into place. And we will do that through a variety of mechanisms, whether it is at a military post or the VA.

    I mean, we have the opportunity to make a difference in that. I think it goes to the notion of holding to standards. We are all supposed to be—we have an individual responsibility to be medically ready, and the reserves say every year that I am medically ready to go. And so——

    Dr. SNYDER. I think earlier, General Peake—I am sorry Mr. Chairman, with your indulgence—you—when we were talking about the 25 day rule, it is permissive authority. Someone—you do have the authority to keep people beyond 25 days.
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    General PEAKE. Yes, sir.

    Dr. SNYDER. What you are saying is if you look ahead and say they can have four dental appointments over the next month and they will be in good shape to go.

    General PEAKE. Yes, sir. But I am talking about before they even come on mobilization status, before they ever get mobilized, that can be done back at home station, which is really what you want, so that they are—you know, they can come, and they don't waste their time getting medical care. They spend their time at the ''mobe'' site doing the training and, you know, the qualification and all those kind of things that our reservists need to be able to do.

    Dr. SNYDER. Thank you. Thank you all for being here. Apologize for the disruption in the last hour.

    Thank you, Mr. Chairman.

    Dr. GINGREY. Thank you, Dr. Snyder.

    It seems appropriate with this panel discussion on health care issues, that the two remaining members of the subcommittee are the two physician members. And, Dr. Snyder, if you have any other questions, I will come back to you.

    I wanted to—I think most of the panelists were here listening to the testimony of the first panel, and you probably heard my questions to them in regard to the physical readiness of the guard and reserve. So I want to basically address that same issue and particularly to the Surgeons General. And the first question I want to ask is the deployment physical exam for the guard and reserve once they are activated, is that identical to the physical examination that I would just assume that the active component has to pass before they are also deployed to a theater of combat?
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    General PEAKE. Sir, the requirement for a physical is every five years for a physical examination. The law—and I heard what Mr. Robinson said—is not quite that. It says medical examination. It doesn't say a physical examination or a hands-on examination.

    And I think you can get into the discussion about what is the most important part of an examination, and probably you would both agree it is the history. And then what this screening does is say, well, if you have an issue that comes out of the screening, it doesn't mean, well—what it says is that is where we need to go then to do directed intervention or further assessment, which may be a full physical examination, may be an MRI, may be any of the things that you need to make the diagnosis.

    But from an effectiveness perspective, you know, I agree with you about the school sports physicals and those kinds of things, sir, and when you are dealing with large numbers, that screening examination to include a review of medical records and to understand what the soldier is telling you, you know, face to face. And so we have that requirement; also the postdeployment. It is a requirement to be face to face with a provider, either a physician or a physician's assistant, to be able to make sure you have that eyeball-to-eyeball contact, and I have seen that being done in Kuwait actually.

    So, you know, it is—the standard is the same for active and reserve. It is the application of the standards and making sure that we adhere to those standards that is important, I think.

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    Dr. GINGREY. Admiral.

    Admiral COWAN. It is exactly the same for us. I wouldn't particularly have anything to add except that as we prepare people to deploy and redeploy, the assessments are not just the health, but the family status, psychological status, the stability of the individual, their fitness, their physical fitness. So we try to make this all a snapshot of their overall ability to go out and finish the mission. And I think all of us have a reasonable level of comfort, and the standards are the same for reserves and active duty.

    Dr. GINGREY. I want to make sure I understand. And although I am a physician, I am not a veteran, and it sounds like what you are saying is that to take your entire active component and put them through a complete hands-on physical examination every time there is an activation to some theater of operation would be a little impractical and tremendously expensive. But what I think I am understanding you to say, that every five years they do indeed go through a hands-on physical examination, and it is a very thorough examination and very similar to what the reserve component goes through when they are deployed.

    General PEAKE. Sir, the Reserve component get that same physical examination every five years, and when they are deployed, we all go through that same predeployment screening process and soldier readiness processing (SRP) and it is to check to make sure that you have had the health protection things like your immunizations, that you have your two pair of glasses and your gas mask inserts and those kinds of things, and that there are no problems that have arisen since your last physical, which was sometimes as far away as five years or within that five-year period.

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    Dr. GINGREY. And you are saying then that the reserve component, that they get that same physical examination every five years, it is just back home. It is before they have been activated, and it is done routinely and not just when they are activated.

    General PEAKE. That is correct, sir. And now the issue is adherence to it, and we are just putting in place the process so that we can start to have the roll-up of that kind of data, and it is being entered in a Web-based system so that we can start to have visibility of it. And I will tell you the National Guard General Schultz has taken that on very significantly to make sure, because then it starts to give you the data to do the command management things, to make sure that the right things are being done.

    Admiral COWAN. It is frequently harder to be as successful in the reserves. You already hit on that with the dental issues. We do have more dental issues with reservists during a deployment for the obvious reasons. But the standards are the same, and we try to—we try to manage these communities so that they are indistinguishable from one another medically.

    Dr. GINGREY. Let me ask one more question, and bear with me. When we embarked on Operation Iraqi Freedom, it couldn't have come as a surprise to the leadership of the Pentagon that there would be a significant number of troops moving through Fort Stewart or the other power projection platform. And it only stands to reason that out of tens of thousands of troops that would be moving through these bases, considering the number of activated reservists, that there would be a large number of medical holdover personnel. My question is, why did the services appear to be caught by surprise with what to do with these holdovers at Fort Stewart and the other facilities? Should we not have been better prepared for the level of holdovers?
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    Mr. DENNING. I will take that one on, sir. I think I have already admitted we were—we had our eye off the bubble here to a degree. I have to say, though, the Army met TRICARE standards. And I think the facilities, they were quite adequate for—as transient billets.

    Where I, at least, missed the ball was putting the two together, if you will; that once a soldier is in medical hold, a Reserve Component (RC) soldier is in medical hold, he is away from his family, and the transit billets, you know, what might be adequate for three or four weeks are not adequate for three or four months; and that the TRICARE standards, which AC soldiers and families who are right there on base are able to tolerate, when a soldier is away his family, away from his domicile, away from his job, his normal doctor, waiting that long and keeping him on status awaiting treatment was not the right thing to do. And that is why the Army then moved aggressively to fix that.

    Did we know the problem was coming? General Inge will tell you we certainly did. He was tracking, and Fifth Army as well were tracking these numbers right along. I think if there was a failure, it occurred at my level in not recognizing how these—how this perfect storm, if you will, how these different elements just came together at one time, and we—and efforts of Sergeant LaChance and Mr. Robinson and others came to our attention.

    General INGE. Congressman, I think I should step in here. I have got a tour at Fort Stewart as the assistant division commander, and I have got five years before that in the Third Infantry Division (3ID), so that organization is dear to my heart. I think if—and it is my responsibility to load the mobilization stations. I decide where they go. I have the final call on who goes where and in what numbers, and we manage that day-to-day very carefully. We do our very best to mobilize people as close to their home as they can, depending on what the mission is and depending on whether you have to bring packages together. Sergeant LaChance, for example, had the Kosovo package not come together at Fort Stewart, would have mobed at Fort Leonard Wood instead of coming to Fort Stewart.
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    I think one of the things that I missed as I worked this issue was—and I had been in and out of Fort Stewart six or eight times while the 3ID was going, at least that many. I missed the coming together of the reserve component holdovers and the emotion and load of the 3ID coming home. I missed that the 3ID was coming home at 118 percent strength. At the same time, we moved medical hold people from the 3ID barracks into the training facilities. It created a perception of we, they, haves and have not. And I think we have—I am comfortable we have corrected that.

    But the other point that needs to be made is what have you done for Fort Campbell, because the 101st is coming home, and Fort Drum, because the 10th—and I will tell you we have set down and worked the loads there. We thought that we won't exceed capacity of either hospital or billeting place, and I am comfortable that we won't see this problem again. I would never say never, but I am comfortable it has been worked very hard.

    Dr. GINGREY. Well, I appreciate the frankness, General Inge, of your remarks in response to that question, and Mr. Denning as well, because I think Sergeant LaChance has brought a lot of very definite concerns to us that have obviously resulted in some positive effects, and I just appreciate you being forthright with the subcommittee and helping us going forward to solve this problem.

    Dr. Snyder, do you have any other questions? Any further questions? Any of the panel members like to make any closing comments at this point?

    Well, I want to, on behalf of the subcommittee Chairman Representative John McHugh, the Ranking Member Dr. Snyder, and the other subcommittee members, I want to thank all of you for being here with us today and testifying before the Total Force Subcommittee of the House Armed Services Committee. Again, I apologize for the fractionation of the hearing because of having to break for the votes, but both the panelists of the first panel, Sergeant LaChance, the others who are still here, and the panelists on this second panel, Mr. Denning, the Surgeons General, General Peake and Admiral Cowan, General Inge, and Admiral Stewart, we are very, very appreciative of your patience, and I feel that we have learned a lot.
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    I certainly, as a member of the committee on total forces and as a physician Member of the Congress and a member of the full committee, have great concerns about a lot of things pertaining to the guard and reserve and the length of deployment, the notification time, how they are used; but in particular, of course, in regard to this hearing, the health care issues, and to make sure that—I think Dr. Snyder said it best—as far as equal versus equitable. And I think that cuts right to the chase of this whole hearing, and I think we have learned a lot as a subcommittee, and I hope all of the people that are here that have been with us for the last three or four hours during this hearing have learned a lot as well, and going forward that things are definitely going to improve, as Mr. Denning pointed out, in regard to anticipation.

    And I just want to thank all of you for being here. And at this point I declare this hearing closed. Thank you.

    [Whereupon, at 1:35 p.m., the subcommittee was adjourned.]