Page 1       TOP OF DOC
[H.A.S.C. No. 109–45]








MARCH 3, 2005

 Page 2       PREV PAGE       TOP OF DOC



JOHN M. McHUGH, New York, Chairman
JO ANN DAVIS, Virginia
JOHN KLINE, Minnesota
JIM SAXTON, New Jersey
WALTER B. JONES, North Carolina
JIM RYUN, Kansas
ROBIN HAYES, North Carolina

VIC SNYDER, Arkansas
MARTY MEEHAN, Massachusetts
SUSAN A. DAVIS, California
MARK UDALL, Colorado

Jeanette James, Professional Staff Member
 Page 3       PREV PAGE       TOP OF DOC
Debra Wada, Professional Staff Member
Jennifer Guy, Staff Assistant




    Thursday, March 3, 2005, The Care of Injured and Wounded Service Members


    Thursday, March 3, 2005




    McHugh, Hon. John M., a Representative from New York, Chairman, Military Personnel Subcommittee

 Page 4       PREV PAGE       TOP OF DOC
    Snyder, Hon. Vic, a Representative from Arkansas, Ranking Member, Military Personnel Subcommittee


    Arthur, Vice Adm. Donald C., Medical Corps, Surgeon General, U.S. Navy

    Brady, Lt. Gen. Roger A., Deputy Chief of Staff for Personnel, U.S. Air Force

    Chandler, Sgt. Christopher T., U.S. Marine Corps

    Cuomo, Petty Officer Anthony J., FMF, U.S. Naval Reserve

    Hagenbeck, Lt. Gen. Franklin L., Deputy Chief of Staff, G–1, U.S. Army

    Hoewing, Vice Adm. Gerald L., Chief of Naval Personnel, U.S. Navy

    Keeton, Chief Warrant Officer Four James Stephen, Target Acquisition Officer, Headquarters & Headquarters Battery, 1st Battalion, 206th Field Artillery

    Osman, Lt. Gen. H.P., Deputy Commandant for Manpower and Reserve Affairs, U.S. Marine Corps

 Page 5       PREV PAGE       TOP OF DOC
    Pizzifred, Sr. Airman Anthony A., U.S. Air Force

    Taylor, Lt. Gen. George P., Jr., Surgeon General, U.S. Air Force

    Webb, Maj. Gen. Joseph G., Jr., Deputy Surgeon General, U.S. Army

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

Arthur, Vice Adm. Donald C.

Brady, Lt. Gen. Roger A.

Chandler, Sgt. Christopher T.

Cuomo, Petty Officer Anthony J.

Hagenbeck, Lt. Gen. Franklin L., joint with Maj. Gen. Joseph G. Webb, Jr.

Hoewing, Vice Adm. Gerald L.

Keeton, Chief Warrant Officer 4 James Stephen

McHugh, Hon. John M.
 Page 6       PREV PAGE       TOP OF DOC

Osman, Lt. Gen. H.P.

Pizzifred, Sr. Airman Anthony

Snyder, Dr. Vic

Taylor, Lt. Gen. George P., Jr.

[There were no Documents submitted.]

[The Questions and Answers can be viewed in the hard copy.]

Mr. Andrews
Mr. Saxton
Dr. Snyder


House of Representatives,
Committee on Armed Services,
Military Personnel Subcommittee,
Washington, DC, Thursday, March 3, 2005.
 Page 7       PREV PAGE       TOP OF DOC

    The subcommittee met, pursuant to call, at 10:05 a.m., in room 2212, Rayburn House Office Building, Hon. John McHugh (chairman of the subcommittee) presiding.


    Mr. MCHUGH. The hearing will come to order, and good morning.

    Today, the subcommittee meets to hear testimony from the service medical and personnel leadership regarding the treatment of reserve component servicemembers who have been injured and wounded in Iraq and Afghanistan. And we will hear from injured and wounded members of the reserve and National Guard who have served our Nation with pride, courage and distinction.

    I wish I could say with confidence that our Nation was serving them with the same level of commitment that these brave individuals have displayed. Their courage inspires us all, and we owe them, certainly, a debt of gratitude.

    And for all of our Nation and our committee members, we certainly express that debt of gratitude and wish to thank them deeply for their service.

    And in that regard, I want to welcome them to our committee hearing this morning and certainly look forward to their testimony. Gentlemen, thank you so much for being with us.
 Page 8       PREV PAGE       TOP OF DOC

    One year ago, the subcommittee held a hearing to closely examine matters related to reserve component participation in the Global War on Terror. At issue was whether the Army was treating mobilized reserve and National Guard soldiers in a medical hold-over status as equals to their active-component counterparts.

    We were concerned then with the way the Navy was managing the health care of reservists in medical hold-over while they were undergoing fitness for duty evaluations.

    We learned at that time that there were systemic problems with the Army and Navy medical hold-over programs, yet we were encouraged by the efforts to fully recognize all of the issues and quickly implement solutions.

    Since that time, the subcommittee has been working hard, in partnership with the Department of Defense (DOD), with the services, to fix those problems. Specifically, the fiscal year 2005 National Defense Authorization Act includes a provision requiring the Department to ensure anticipated health care needs be met at mobilization installation.

    We want to hear the work that has been done to identify and to meet those needs.

    Today's hearing continues, as well, our efforts to ensure that all of our service men and women receive equal consideration and treatment when navigating through the often complex and confusing military health care system.

 Page 9       PREV PAGE       TOP OF DOC
    We recognize that the Department of Defense and the services have taken care of over 11,500 service men and women injured and wounded in Iraq and Afghanistan. They are to be commended for their steadfast dedication and commitment to caring for these brave men and women.

    However, while the Department and the services have made great progress, the subcommittee continues to hear reports of mobilized reserve component members in medical hold-over who are dissatisfied with the care and disability processing system. These reports are disturbing.

    Frankly, I am disappointed that we are back here today again to hear about the same problems that we have worked so hard to fix to this point.

    And I hope our witnesses can convince this subcommittee that eliminating the hassles that service men and women recovering from their war wounds have endured is a high priority for them.

    Today's subcommittee will examine the adequacy of medical treatment and support for the injured in reserve returning from Iraq and Afghanistan. We will want to hear as well about the state of the medical hold-over system today and how continued improvement to this program can best be achieved.

    We are particularly concerned about the thousands of families of injured and wounded reserve members, and as such, we will want to be assured that families are receiving the same level of support, regardless of whether their servicemember is recovering in a military facility or in a partner facility, such as the V.A. medical centers.
 Page 10       PREV PAGE       TOP OF DOC

    Perhaps as important as having access to medical care, the system that evaluates injured and wounded servicemembers for disability compensation must be consistent and it must be fair. And we look forward to hearing from the services about the steps that they have taken to ensure that the disability evaluation system is applied uniformly and equitably across service and components.

    And finally, we have witnessed some extraordinary achievements in both medical technology and personal endeavors by remarkable service men and women, and you will hear from two of these remarkable individuals today.

    In the past, servicemembers who sustained devastating injuries, such as amputations, were unlikely to remain in the military. Today we are seeing that circumstance change. The availability of high-tech artificial limbs and an incredible drive to continue service has led many members of our armed forces to ask to stay in the military.

    We want to hear what steps are being taken to allow servicemembers who have sustained such disabling injuries to continue their military service. And I hope our witnesses will address these issues as directly as possible in their oral statements and in response to subcommittee questions.

    At this time, I would be happy to yield to our Ranking Member and our partner, my partner in this process, Dr. Vic Snyder.

    [The prepared statement of Mr. McHugh can be viewed in the hard copy.]
 Page 11       PREV PAGE       TOP OF DOC


    Dr. SNYDER. Thank you, Mr. Chairman. As usual, I think your opening statement really captures the flavor of why we are here today and why we think this is important and why you all think this important.

    I want to welcome our first panel here.

    And Steve Keeton from Arkansas, from my district, Chief Warrant Officer Steve Keeton, I appreciate him being here today.

    I also appreciate our Surgeons General sitting in the second row there, Mr. Chairman. I mean, they could have tried to sneak in here in an hour and give their testimony.

    But I think it is important you all are here today to hear this first panel, and we appreciate you being here also.

    You know, the kind of issues that we want to talk about and want to address are the kinds of issues that do not seem important at the time of an injury or an illness. You don't worry about your luggage or your personal effects. You don't even think about, ''Well, how is my medical record going to get transferred to the veterans hospital at some point in the future?'' You don't think about, ''Well, what is my pay status going to be six months from now?''
 Page 12       PREV PAGE       TOP OF DOC

    Those are not the kinds of things that are in your mind during the acute period of an injury.

    But as time goes by, they become increasingly important, and we are concerned that people either are or have the impression that they get lost in a system that is bigger than they are.

    And so we appreciate you folks in the first panel being here to give your own personal experiences.

    And we appreciate our second panel and your effort to make the system work for our men and women in uniform.

    There is issue two, which is, in a way we have to have two systems. We have to have a system that works for somebody that is 40 years old and has been in the military for 15 years and is a wily cat and knows how to get around.

    And we have to have a system that works for a 19-year-old that is inexperienced, has never filed an insurance claim of any kind in their life, has just not had any life experience in dealing with big systems.

    And I think the testimony we will hear today brings evidence of the fact that we are not doing such a great job with those younger men and women.

 Page 13       PREV PAGE       TOP OF DOC
    Thank you, Mr. Chairman. I look forward to the testimony.

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

    Mr. MCHUGH. Thanks, Vic. As always, appreciate your leadership and your comments here today.

    A little ground rules explanation here: The good news is, as evidenced by the number of members here, we have had great participation on this subcommittee this year, and we deeply appreciate that.

    The challenge, if not the bad news, is that means that, contrary to past practices, we are going to implement the five-minute rule.

    The problem with that is that the lights up there, green and orange and red, are not working. So as one of the great three lies of the world goes, as a politician I am going to ask you to trust me.

    And this clock is working. When we get to one minute remaining, I will try to subtly signal that with two hits on the hammer. That will let the witnesses and the questioning member of the subcommittee know that.

    And with the expiration of the full five minutes, I will hit a single, more firm—at least that is the plan—signal of the gavel to try to keep some semblance.

 Page 14       PREV PAGE       TOP OF DOC
    We will certainly consider second rounds of questioning and such, given participation and time available. And I thank the members for their understanding and patience.

    And with that, it is certainly time that we welcome our first panel.

    Gentlemen, I would tell you that we have received your written testimony. That written testimony will be submitted without objection into the record in its entirety.

    Without objection, so ordered.

    But we would ask that in your own words, in a way that you are comfortable, if you could summarize your comments as we call upon you.

    And let me introduce the first panel to everyone here in the hearing room this morning.

    First, Chief Warrant Officer James Stephen Keeton of Arkansas National Guard, community-based health care organization in Little Rock, Arkansas; Hospital Corpsman 2nd Class Anthony Cuomo, United States Naval Reserve, Naval Mobilization Processing Site, Naval Station San Diego; Senior Airman Anthony Pizzifred, Lackland Air Force Base, San Antonio, Texas; and Sergeant E5 Christopher Chandler, Camp Pendleton, California.

    Gentlemen, as I tried to indicate in my opening statement, we all appreciate so much your willingness to be here today.

 Page 15       PREV PAGE       TOP OF DOC
    Look forward to your comments. And why don't we proceed down in the order in which you have been introduced?

    Which means, Chief Warrant Officer Keeton, you are up, sir.


    Officer KEETON. Sir, thank you.

    Events started happening in Iraq on 29th of June, 2004, as I was performing a crater analysis. By the time those events unfolded, I was officially out with a heart arrhythmia and some problems with some bronchial conditions in my lungs, on July the 5th.

    Over the process of the next several days, I was transferred from Al Taji, Iraq, through Baghdad, to Balad, and subsequently out of Iraq in a C–141 to Landstuhl, Germany, where I stayed an additional diagnostic evaluation and they decided to transfer me to stateside.

    At this point in time, the thing I need to say is, under no time that this process was going on was I left alone or at all displeased with the medical treatment that I was receiving. It was beyond belief, as professional as it was. I was incredibly impressed with the way that they treated me as they got me to Landstuhl.

 Page 16       PREV PAGE       TOP OF DOC
    The system, as it began to separate the administrative functions from the medical functions, sort of unraveled at Landstuhl. It was there I found out that my family had never been notified, and I called my children to tell them that things were not as bad as they originally thought. And they said, ''Dad, what are you talking about?'' And so that was a little bit testy for me to try to wade through that particular case.

    I spent approximately two weeks in Landstuhl as they went through different types of evaluations and examinations. And then they officially brought me out of Landstuhl on 21 July to Fort Hood.

    I think the thing that really bothered me the most about that trip was not, again, the medical care; it was the administrative functions and some of the things that fell through the cracks en route.

    A lot of young soldiers I found that were turning to me, asking me questions about what was going to happen to them, you know, ''What do I do about this, what do I do about that?'' So I became sort of a fatherly image on the flights that I was on simply because of the experience that I have had.

    My biggest disappointment on that flight was the arrival at Andrews Air Force Base when we deplaned and boarded buses. The V.A. was there, the VFW, the American Legion, the Red Cross, all giving us phone cards and various welcome home packages.

    But I was really dismayed when an Army chaplain boarded the bus and began to ask each soldier if they were guard or reserve or active duty. If they were guard or reserve, he passed them up and began to talk about the places that he been with the active duty soldiers, the stations he had and things like that.
 Page 17       PREV PAGE       TOP OF DOC

    When he got to me and he asked me if I was guard or reserve, I just told him, he passed me by. He said, well, you were to receive care in the destination you were going to. And he said, ''I am here for the active duty people.''

    So that is neither here nor there.

    Then when we arrived in Fort Hood it was the second, I guess, separation from administrative and medical.

    The flight to Fort Hood, through Landstuhl and everything, they took my blood pressure every 15 minutes, the nurses talked to us on the flights, they had everything that you would ever want to have notated in my medical records.

    But when we got to Fort Hood, we deplaned, and I was told to meet a specialist there at Fort Hood and he was going to carry me up to meet the cardiac people at Darnall Army hospital.

    When he carried me upstairs and I went in to talk to the people that were there, I was introduced to an internist but not to the cardiologist. And the internist scheduled some appointments and took some blood pressure and then just released me from the hospital. And I never saw the cardiologist.

    I asked him, I said, ''Look, are you familiar with the fact that I am on blood thinner and also on a low-pressure medication?'' And he said, ''Well, I think you will be all right until Monday when I will see you again.'' That was Thursday.
 Page 18       PREV PAGE       TOP OF DOC

    And what I found out when I left the hospital was my rear detachment unit did not know I was there, they had not been briefed that I was there.

    The hospital was to assign me a care manager to help me get started back into the rear area. The care manager had not come to work that day and there was no backup. I think that is what the problem was.

    But essentially I spent two days roaming around Fort Hood by myself trying to get situated into the—back into the system for the rear detachment.

    I stayed in that facility for the next two days, and I guess quite by accident one of the soldiers I was helping, the care manager that was treating her, was with her, overheard my story, and within 30 minutes I was in to see the cardiologist, and they began the treatment and evaluation there, which again, I was very satisfied.

    I stayed with the medical hold company there from 22 July to I think the 1st of October. And the doctor at Fort Hood had a plan of care and treatment that was going to hopefully be terminated in January.

    As I stayed there the medical hold company began to talk about pushing us out of the system and telling us that we had to go—those of us that were eligible had to go to the Non-commissioned Officer (NCO), receive in the state that we belong to.

    I asked to stay with Dr. Borses at Fort Hood because I felt comfortable and I felt that she had a plan to return me to duty and hopefully return me to Iraq with my soldiers. But I was told that was not possible.
 Page 19       PREV PAGE       TOP OF DOC

    So in October, I was transferred up to the Community Based Health Care Organization (CBHCO) in Arkansas and we started the process all over again.

    The first thing they did was, they found a civilian doctor that did not understand the Army system, did not read the medical records. That displeased the CBHCO, so two weeks later they found me another cardiologist and endocrinologist, an internist to work and the procedure started all over again for the fourth time.

    And currently that is where I am now in the CBHCO.

    They have recommended a surgical procedure on April 29th, which I am still in the status of what happens next.

    The things that I find troubling were, I was not, neither were a lot of the soldiers, briefed on some of the things that were going to happen to us. We had not been briefed on V.A. benefits or the V.A. system even though several of us are in the V.A. system right now attending a post-traumatic stress disorder (PTSD) clinic set up by the CBHCO in Arkansas.

    It is approximately 35 soldiers in my particular session, which I find that is very good.

    I am not briefed nor do I know anything at this point in time about medical review boards, about Physical Evaluation Board (PEBs), medical review boards (MRBs). They say that that is coming on down the line, but I will have to attend one at some point in time. And I think maybe the apprehension is, is just what is going to happen next.
 Page 20       PREV PAGE       TOP OF DOC

    The pressure that is on the CBHCO where I am right now is from 5th Army that flushes as many people out of the system as they possibly can. So my care manager and the doctors there are all having to justify on a weekly basis why I am still on active duty and what is going to happen to me next.

    And, sir, that's the conclusion. I welcome your questions.

    [The prepared statement of Officer Keeton can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you very much. Appreciate your comments and reflection of your experiences. Next we have Petty Officer Anthony Cuomo, although listed in Naval Station San Diego I understand is from New York. Is that correct?

    Hospital Corpsman CUOMO. Yes, sir.

    Mr. MCHUGH. Well, good to see you, as a fellow New Yorker.


    Hospital Corpsman CUOMO. Chairman McHugh, Congressman Snyder and members of the committee, I thank you for the opportunity to appear before this committee and tell my story for what has been a series of troubling events as an injured reservist.

 Page 21       PREV PAGE       TOP OF DOC
    My name is Anthony Cuomo and, as stated, I am a reservist currently serving on active duty in San Diego, California. I am also an 18-year veteran with the New York City Fire Department, Bureau of Emergency Medical Services, and a World Trade Center survivor. But last, and most important, I am a father of three.

    First, I am not here today to castigate the Department of Defense or the Department of the Navy. On the contrary, I commend and applaud the active duty side of the Navy for their assistance, guidance and support in a time when we need it the most.

    Since my activation, I have been in attendance of two wars, the first commonly known as Operation Enduring and Iraqi Freedom, and the second, a war which has no name, a war of bureaucracy. This war of bureaucracy has been the hardest to endure because there is no training platform on which to prepare.

    To boil it down and condense my current situation, it comes to one word in my mind: discrimination.

    Once assigned to a naval mobilization processing site, a member of the reserves are not afforded the same rights as the men and women that don this same uniform serving on active duty.

    When I was placed on limited duty orders by the active duty Navy, and subsequently had the orders removed the same day by the medical department of the naval mobilization processing site in San Diego, limited duty status ensures the follow-on care while on active duty.
 Page 22       PREV PAGE       TOP OF DOC

    I informed this command that they were in contradiction to SECNAV instruction 1850.4E. The only answer I received was, ''Reservists are not afforded limited duty (LIMDU).''

    In my review of the instruction, I personally could not find where it states this. But if this is the case, this is wrong. Limited duty orders provide certain protection that reservists on active duty should be entitled to.

    Sadly to say that in the months that followed, my surgery failed, leaving me now in worse condition than my initial injury that happened on September 11, 2003.

    The bones of my shoulder have separated far enough that simple day-to-day movement causes pain, pain that is only curbed by the use of addictive narcotics and the use of prescription sleep aids.

    To cut to the chase, if I were on these limited duty orders that were issued to me by the Navy on December 12, 2003, I would have had the necessary surgery at the time of failure and probably would not be testifying before you here today.

    In closing, a naval mobilization processing site has one objective: to process members of the Ready Reserve on and off active duty as soon as they possibly can. And in my experience, this is the wrong destination for wounded and injured and ill members of the reserves.

 Page 23       PREV PAGE       TOP OF DOC
    These reservists are getting caught up in and reviewed as a setback as the commands strive for excellence to report their numbers up their chain of command.

    And again, I would like to thank you for having me appear before the committee and welcome any questions you may have.

    [The prepared statement of Petty Officer Cuomo can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you very much. I deeply appreciate your comments, Petty Officer. Next, Senior Airman Anthony Pizzifred, Lackland Air Force Base, San Antonio, Texas.


    Sr. Airman PIZZIFRED. Mr. Chairman and members of the subcommittee, thank you for the invitation to testify before you today.

    I am an active duty Air Force member, assigned to the 343rd Training Squadron, part of the 37th Training Wing at Lackland Air Force Base, Texas.

    I enlisted in the Air Force in 2002 and have always been interested in law enforcement and chose the security forces career field as what I was going to do.

 Page 24       PREV PAGE       TOP OF DOC
    For about eight months I worked various positions in a protection level one weapons storage area at Minot Air Force Base. In March of 2003, a tasking came down for a 13-person team to deploy in support of Operation Enduring Freedom.

    A team was sent to Indian Springs Auxiliary Field in Nevada to train for four weeks at the Air Combat Command Security Forces Regional Training Center.

    Upon completion of the course, we returned to Minot Air Force Base to conduct additional specialty training. And in November 2003 we left for Bagram Air Base, Afghanistan.

    Our duties initially consisted of patrolling the inside and outside the base perimeter and flight-line security. A few days later we ended up working missions with the Air Force Office of Special Investigations under the Counterintelligence Joint Direct Support Task Force.

    I have to admit it was not a normal Air Force operation. We dressed in civilian clothes, went off-base, found weapons or even terrorists, do what we needed to do and come back.

    Along with the normal security forces duty that we had, I felt we were really accomplishing things. And for four and a half months we performed these missions with the Air Force Office of Special Investigations.

    On March 13, 2004, it appeared to be a normal day. I got up, got my gear, proceeded to my assigned duty location. About halfway into the shift, my partner Senior Airman Joshua Beach and I were out conducting a perimeter patrol of the eastern side of the perimeter fence line.
 Page 25       PREV PAGE       TOP OF DOC

    DOD personnel previously cleared this area for land mines. About ten feet from our up-armored Humvee, we heard a loud blast from under our feet and a large smoke cloud. We were immediately blown away from one another. I fell to the ground while Senior Airman Beach tried to locate me.

    Once the smoke cloud settled and he finally got to me, we realized something bad had happened. I looked at him and noticed blood on his clothing and gear and coming from his face. Most of the blood on him was actually mine.

    He had a superficial wound to his face but nothing too bad.

    I really did not know what had occurred until he told me to look down at my feet, and I noticed that I could not see my left boot and I felt a burning sensation on my right leg.

    He did not let me look at the injured area and immediately started self-aid buddy care. Ripping off his gear, he used his shirt and a stick to make a tourniquet. He assisted me to the Humvee that was parked on the concrete road and laid me down.

    At this time, there were a lot of people showing up. Most were screaming out loud, and I asked Senior Airman Beach to tell me what was going on. He said, ''Your left foot is gone and your right leg has a lot of shrapnel wounds and you are bleeding very badly.''

    That was good enough for me. I laid down and let the medics take care of me.
 Page 26       PREV PAGE       TOP OF DOC

    One of the last things I remember was riding in a Humvee ambulance with Senior Airman Beach heading to the Combat Army Surgical Hospital on base.

    I remember them telling me it was going to be all right, and I remember looking at a nurse and asking her, ''Do you think they will let me stay in?''

    She replied, ''There is a lot of technology with prosthetics now. You have a good chance.'' I looked at her eyes, and I could tell she was serious.

    I then faded out of consciousness. The next thing I remember is saying goodbye to my team members from Minot, and the medics gave me something, and I was placed in a medical coma for about five days.

    When I woke up, I was in Landstuhl, Germany, and for the next few days I laid there just waiting to see what was going to happen.

    Once medically cleared, I got a flight back to Andrews Air Force Base and on to Walter Reed Army Medical. I spent about three weeks in the hospital, and then was discharged to Mologne House, the base hotel on base.

    I spent the next three months training on my new leg and making sure all of my medical needs were met.

    After I had a good grasp on walking, they moved me to Andrews Air Force Base, where I was put on medical hold. I was on medical hold for about two months while my paperwork went through the medical board process.
 Page 27       PREV PAGE       TOP OF DOC

    Through this whole process, my family and myself were taken good care of by the Air Force Survivors Assistance, providing my family airplane tickets and lodging while I was in the hospital.

    I met with Colonel Silva-hale, Commander of the patient squadron, to see if I could still perform my job. She sent my medical evaluation board (MEB) paperwork to the Air Force Personnel Center at Randolph Air Force Base, Texas. Two weeks later I was told to report to MEB liaison at Andrews.

    This is where I was told I was returning back to duty. I had orders about a week later to Lackland Air Force Base.

    Like I said before, the Air Force took good care of me and my family the entire time.

    Since I have been back to duty, I have ran the Army 10 Mile in Washington, D.C., graduated from the Air Education Command basic instructor course. I have had the privilege of relaying my incident at several speaking engagements, for military and civilian audiences.

    Additionally, I have played a big part in talking to new amputees at both Walter Reed and Brooke Army Medical Centers.

    I am currently in the unit's Operations Flight as a personal liability program monitor and safety representative, and my future goals are to continue a career in the military and deploy in the near future.
 Page 28       PREV PAGE       TOP OF DOC

    Like I said, overall my experience since 13 March 2004 has gone very smoothly. The only two concerns I have are with the land mine identification and amputee continuation care at Air Force and Army medical treatments.

    The area I was in was identified as cleared for land mines, as stated in briefings from local Army EOD.

    Moreover, one month prior to my incident, an up-armored Humvee was driving along the east perimeter and ran over six land mines in an area identified as cleared. Fortunately, there were no injuries sustained to the occupants of the vehicle. But I believe posting signs around the area identified for land mines cleared could have prevented my situation as well as others.

    I spoke with my previous operations officer at Bagram Air Base since he returned in August 2004, and he stated that the signs still had not been posted along certain areas of the east perimeter and also the area where I had my incident.

    My other concern is with my treatment as an active duty patient versus an Operation Iraqi Freedom/Operation Enduring Freedom (OIF)/(OEF) patient at a designated facility for amputee care.

    In my case, Air Force hospitals were not equipped or knowledgeable on amputee follow-on care, and they diverted all my treatment to Army medical centers.

 Page 29       PREV PAGE       TOP OF DOC
    However, I was referred to an Army medical center which also lacked experience in treating amputee patients or familiarity with prosthetics and discussing basic amputee medical terminology.

    I understand that these types of injuries were not common prior to the war, but I believe physicians need to get more training experience on amputee victims prior to patients arriving at any medical center.

    Again, I would like to thank you for this opportunity to present my testimony and for your continued support for our military men and women and the care and concern for our military injured. Thank you.

    [The prepared statement of Sr. Airman Pizzifred can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you very much, sir. A remarkable story.

    Our last presenter on the first panel this morning is Sergeant Christopher Chandler from Camp Pendleton California. Sergeant, good to see you. Thank you for being here, and we look forward to your testimony.


    Sergeant CHANDLER. First, I would like to say good morning, Chairman McHugh, Congressman Snyder and distinguished members of the Military Personnel Subcommittee.
 Page 30       PREV PAGE       TOP OF DOC

    My name is Sergeant Chris Chandler, United States Marine Corps.

    I was born in Denver, Colorado, on August 27th, 1980, and graduated from Gatewood High School in Aurora, Colorado, of May 1998.

    Following graduation, I began the process of becoming a Marine as I stepped onto the yellow footprints at Marine Corps Recruit Depot in San Diego on July 12th, 1998.

    On December 16th, 2001, while in support of security operations at Kandahar International Airport, I stepped on a land mine, blowing off the lower portion of my left leg and sustaining massive injuries to my left arm.

    The initial treatment that I received after sustaining my injury was from our corpsman. He proceeded to stabilize my wounds until help could arrive.

    From the accident site, I was flown to Oman, Saudi Arabia, to a field hospital where they proceeded to clean my wounds and further stabilize my condition.

    After the field hospital in Oman, I was transferred to Landstuhl, Germany and then to Walter Reed Hospital in Washington, D.C.

    The overall care that I received at Walter Reed Hospital was good. The physical therapist and occupational therapist were very professional and knowledgeable in their jobs. They would always go above and beyond their duty to help me out and my family.
 Page 31       PREV PAGE       TOP OF DOC

    They were also very, very personal. Therapists would explain everything that they were doing and the reasons for what they were doing.

    Both the physical therapist and the occupational therapist genuinely cared for myself and my family.

    The nursing staff was also very personable. The nursing staff would care to my, as well as my family's, personal needs at all hours of the day and night. Never once did they say that they could not get something for us that we needed.

    When my parents could not stay in the hospital room anymore, the nursing staff showed them that they could stay in the Fisher House that was still on the hospital grounds only a short distance away. This is just one example of how the nursing staff helped us out.

    The only major problem that I had was pain control. For about a week I was under no kind of pain control whatsoever. My complaints were dismissed as being merely phantom pains that would pass with time.

    As far as family and friends are concerned, Walter Reed supplied them with all the information, food and accommodations that they required. The key wives group was also very helpful with providing information so that my family always knew what was going on and why.

    Congressman Bill Young and his wife Beverly Young went out of their way to see to it that I was being taken care of through my whole hospital treatment, follow-ups. And to this day they still check on myself and my family.
 Page 32       PREV PAGE       TOP OF DOC

    Former Commandant of the Marine Corps General Jones and former Sergeant of the Marine Corps Sergeant Major McMichael also played a big role in helping me and my family out by ensuring that we were all being taken care of to the degree that we rated.

    As soon as I was injured, because of the nature of my wounds, I was immediately placed on a Physical Evaluation Board. The first time the board results came back to me, I was found unfit for full duty, and I rebutted this.

    A couple of months later, after I had recovered enough and re-expressed my interest to be retained on active duty in my current military occupational specialty as an infantryman, I resubmitted my package to the performance evaluation board and was found fit for full duty.

    The next step that I had to do was run a formal physical fitness test (PFT) in order to show that I was still capable of passing. I ran a PFT and received a score of 200, which was a passing score.

    The next thing I had to do was run an obstacle course to show that I could still complete it. I also ran and passed the obstacle course.

    The completion of these events put me back on a fit-for-full-duty status in the Marine Corps. Shortly after, I re-enlisted and returned to my current Military Occupational Speciality (MOS) as an infantryman.

 Page 33       PREV PAGE       TOP OF DOC
    In my particular case, being retained for active duty was met at first with reasonable questions concerning whether I was going to be able to perform in my current MOS.

    Even with these questions, there was never any hesitation for any Marine to help me out any way that I needed. Any time that I needed any help, ranging from simple questions to helping set up a timeline and place to run a physical fitness test, there was always—always—a Marine standing by to help me out.

    Nobody ever told me that it could not be done. In fact, they all said that if I wanted it bad enough, it could be accomplished.

    The Marine Corps is a brotherhood, and I could not have accomplished anything if my fellow Marines were not there by my side.

    Several months later, my name was submitted to attend jump school in Fort Benning, Georgia. In order to attend, I had to pass the physical and medical requirements of the school. No special treatment was given to me, and I was evaluated like any other servicemember trying to get into the school. I passed the physical fitness test, and shortly after I passed the medical portion.

    When I arrived to check in at jump school, I had to run another physical fitness test and was examined again to double check that I was capable of attending the school. I graduated number one in my class and was made honor grad.

    After graduating jump school, I went back to 1st Light Armor Reconnaissance Battalion and was attached with Alpha Company.
 Page 34       PREV PAGE       TOP OF DOC

    Shortly after arriving, we were deployed in support of Operation Iraqi Freedom II. We returned on October 9th, 2004, and upon returning I was made company chief scout, and shortly after I was made the battalion chief scout.

    My immediate plans are to take on this new billet of battalion chief scout and prepare new training packages for the scouts in my unit. In the long term, I would like to pick up staff sergeant and get my own line platoon. After doing another rotation, I would like to become a Marine security guard.

    I was inspired to join the Marine Corps by the ideals and images that the Marine Corps projects. I have been inspired by many Marines along the way and have formed close bonds with all of them.

    Thank you for this opportunity today to appear before you. This concludes my statement, and I am pleased to answer any questions that you may have.

    [The prepared statement of Sergeant Chandler can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you. And thank you all.

    I would say, at the risk of speaking the obvious, to those who are in this room today, we are in the presence of some real heroes, some incredibly brave and dedicated and devoted individuals. And the words ''thank you'' seem hardly adequate, but that is about the best we can do. Thank you.
 Page 35       PREV PAGE       TOP OF DOC

    We have a division here, in a sense, in that we have two from the reserve guard component and two active. I just want to start with our active gentleman, Senior Airman Pizzifred. You said you competed in the Army 10 Mile.

    Sr. Airman PIZZIFRED. Yes, sir.

    Mr. MCHUGH. They let Air Force guys run that, do they?

    Sr. Airman PIZZIFRED. Yes, sir.

    Mr. MCHUGH. Okay. Did you finish it?

    Sr. Airman PIZZIFRED. Yes, sir.

    Mr. MCHUGH. Amazing. Sergeant Chandler, just so I make sure I heard you correctly, as an amputee, you went to jump school?

    Sergeant CHANDLER. Yes, sir, I did.

    Mr. MCHUGH. I assume you jumped out of a perfectly good airplane at some point?

    Sergeant CHANDLER. Yes, sir.

 Page 36       PREV PAGE       TOP OF DOC
    Mr. MCHUGH. You obviously lived. And you graduated first in your class?

    Sergeant CHANDLER. Yes, sir, I did.

    Mr. MCHUGH. Were you the only amputee in your class?

    Sergeant CHANDLER. Yes, I was.

    Mr. MCHUGH. And you were first in your class?

    Sergeant CHANDLER. Yes, I was.

    Mr. MCHUGH. I would hate to think what you would have done in an earlier day; it would have embarrassed everybody even more.

    That is incredible. That is a testament, I suppose, to medical technology, but more to your heart and spirit, gentlemen. That is fantastic.

    What I am hearing from the four of you—and correct me if I am wrong—but by and large—and there are always glitches. For example, Sergeant Chandler, from the time of your injury until some time later, you never had pain control medication?

    Sergeant CHANDLER. No, I did not. There was an epidural placed in, but it was not placed in correctly.
 Page 37       PREV PAGE       TOP OF DOC

    Mr. MCHUGH. Okay. How long did it take to get that fixed?

    Sergeant CHANDLER. It was about a week.

    Mr. MCHUGH. Well, that is amazing in and of itself, I guess.

    Was the debate one of uncaring, or they just assumed it was placed correctly and that you were getting adequate medication, they later found out you were right, they were wrong?

    Sr. Airman PIZZIFRED. They just assumed it was placed correctly.

    Mr. MCHUGH. But by and large, medical care as medical care, pretty good. True? False?

    Sr. Airman PIZZIFRED. Yes, sir.

    Officer KEETON. Yes, sir.

    Hospital Corpsman CUOMO. Yes, sir.

    Sergeant CHANDLER. Yes, sir.

 Page 38       PREV PAGE       TOP OF DOC
    Mr. MCHUGH. Administrative problems, by and large.

    Our first two panelists said some things of great interest.

    Chief Warrant Officer Keeton, for example, did anyone ever explain to you why your family was not notified?

    Officer KEETON. I think, sir, that the explanation was that at the time of the rocket attack, I was carried to the first medical treatment facility and not my brigade's medical treatment facility. And I think that probably one or the other did not talk to each other, they assumed, I guess, from what I am being told.

    Also my records have never been coded valid injured. They were coded as an illness because of the heart arrythmia. And it is my understanding that the system may not notify your family if you are ill. That was explained to me somewhere around Fort Hood. I am not sure there is any truth to that.

    One thing that I know—and that has been an uphill battle. We tried to get my medical records coded correctly. They are still leaving out some information.

    Mr. MCHUGH. Do you feel that that was just a glitch in the system? Or would that be a further example of what senior—well, no I guess—petty officer described as discrimination?

    Officer KEETON. I do not necessarily think it was discrimination, sir, because I know that there were two other people that were—one was active duty and one was an Iowa reservist.
 Page 39       PREV PAGE       TOP OF DOC

    The Iowa reservist received blunt trauma to the chest and his family was not notified, neither was the sergeant from the 1st Cav who had a heart attack.

    So you had two battle injuries, one heart attack, and I do not think any of their families were notified.

    So that may be a glitch in the system that, if it is coded as an illness, they might not notify the family. I cannot answer that.

    Mr. MCHUGH. But you did—at least, your impression was there was a two-tiered system, one that treated active component in a certain way and another that treated guard and reserve, reserve component, in another way; is that a correct?

    Officer KEETON. Yes, sir.

    Mr. MCHUGH. Petty Officer Cuomo, obviously with the word ''discrimination'' used, you feel the same way.

    Hospital Corpsman CUOMO. Well, yes. I used that strong word because of the fact that—in saying discrimination, I mean, in the use of the term for the SECNAV instruction 1850.4E, which I have read, and it is a 310-page document, that is to care for members of the service.

    And the members of Naval Medical Center San Diego fought for me and my rights to be on limited duty orders. They called commands, and the four physicians that have seen me have called my command and stated that I needed to be on these orders so therefore I could be assured follow-on care.
 Page 40       PREV PAGE       TOP OF DOC

    I use the word ''discrimination'' because my command told me I am not afforded these rights.

    Mr. MCHUGH. Has that ever been readdressed or corrected or——

    Hospital Corpsman CUOMO. Every time I bring it up it just says reservists don't get LIMDU.

    Mr. MCHUGH. All right, thank you, gentlemen.

    I am going to yield to Dr. Snyder.

    Dr. SNYDER. Thank you, Mr. Chairman.

    Sergeant Chandler and Senior Airman Pizzifred—well, first of all, let me say to all of you: We appreciate your testimony. It is helpful. The whole point of this is to try to make things better for those that come after you.

    Sergeant Chandler and Senior Airman Pizzifred, you both are still in the military and you are both, obviously, going to pursue your military careers. Do you feel that you were given adequate information in which to make a decision about whether to stay in the military?

    Did you have a—was there a formality at some point where folks sat down with you and said, ''Okay, it is time. We figured out what your medical status is. We need to sit down and have a discussion about what your future plans are and how that fits into any desires you may have to stay in the military''? Was there a formality about that or talk about that if you would?
 Page 41       PREV PAGE       TOP OF DOC

    Sergeant CHANDLER. For me, they sat me down and talked to me about both options I did have, whether getting out, going through the V.A. or staying in—actions that I had to take.

    Dr. SNYDER. And you were satisfied with all the information you got?

    Sergeant CHANDLER. Yes, sir, I was.

    Sr. Airman PIZZIFRED. Yes, sir, the same.

    I was sat down by an MEB lady down at Walter Reed and was given a basic V.A. briefing, but I had already made up my decision to stay on active duty way before I heard that briefing. There was no point in that for me.

    Dr. SNYDER. And, Chief Warrant Officer Keeton, would you talk a little bit more about this issue of the young soldiers, of your kind of like the mother hen, then at some points it seemed like along the way for the other folks?

    You have been in the military for 38 years. Do you have any suggestions of what could have made that better?

    For example, is it because you saw people who perhaps needed some instructions on how they could have performed their job better to help the younger soldiers? Or is the problem that there may not be a job there that needs to be created in order to help the younger soldiers?
 Page 42       PREV PAGE       TOP OF DOC

    Officer KEETON. I think, sir, the only example I can give is in a 1989 JROTC rotation, the casualties were actually—or simulated casualties were flown out of country. The Air Force flew us out of country, simulated country, and inserted us back into the system.

    That appears to be the only level of training that we ever received on casualty evacuations.

    So as I thought through this, personally I think that there needs to be, upon mobilization, briefings of what would happen to you if you were a casualty, perhaps a checklist.

    Whatever they do, I think an awareness by some method of going into harm's way, going into country, that if you become a casualty, these are the procedures and these are the steps that you can expect to follow.

    Because none of them—all of the young soldiers that talked to me yielded to the fact that I was the only senior officer on deck. And they just, they say that I had extensive years of service and they asked questions from, ''Will I get kicked out of the Army?'' ''Will my medical care be taken care of?'' ''What am I going to do when I get back and I am having to go through rehab and my civilian employer does not respect that I have to go through rehab?''

    Because we have several in the CBHCO right now that are in that category that they have done everything they can do for them, but they are in rehab and they are getting ready to rehab them and put them back in the civilian community, and some of them are going to rehab three and four days a week.
 Page 43       PREV PAGE       TOP OF DOC

    So I think that the problem is, is there is a lack of training, there is a lack of knowledge at the soldiers' level of what to expect if you are a casualty.

    Dr. SNYDER. If it is, say, three or four weeks before your deployment overseas into a war zone and I am 19-years-old, I am not sure how focused I am going to be on, as Petty Officer Cuomo says, how to fight the bureaucracy about an event that may occur eight months from then.

    I may have some distant recollection of a two-hour lecture and really not have much awareness to understand what you say.

    And, Petty Officer Cuomo, I need you to give me a thumbnail description again about this limited duty status. I am not understanding that. I looked through your statement earlier today, and I need you to just tell me the distinction and why that was a penalty on you the way that was applied or not applied.

    Hospital Corpsman CUOMO. Well, limited duty status orders are reported to members of the service, in the Navy.

    If you are injured and you have a bright outlook that you can heal and move on, you will be placed on limited duty orders which are an extent of 8 months—of course, after your 30 days of convalescence of surgery.

    And if anything happens in that eight months, you are again—you are provided with follow-on care. You are given the opportunity to go back to your service. They will review the films and see if you need further surgery.
 Page 44       PREV PAGE       TOP OF DOC

    Dr. SNYDER. All right. Thank you, Mr. Chairman.

    Mr. MCHUGH. Thank you. The gentlelady from California—and I would remind the members of the subcommittee: Remember, two taps, one minute remaining; one firm tap, time is up. And, by the way, I mean Ms. Sanchez, because I just realized we have two members.

    Ms. SANCHEZ. Thank you, Mr. Chairman. I wanted to talk a little about some of the soldiers that I went to see and then ask you—and this is in particular to how you feel your families have been treated in the process.

    I went to see some soldiers at Walter Reed and spoke to one of the mothers. And she told me that her son had a wife and three kids. But we only have a policy of sending two people, two family members, in fact, to come—they were from San Diego—if the family has to come, let's say, while someone is in the hospital out here. And so the mother had to choose just one child and herself to come instead of sending the other four.

    Did any of you run into that type of situation? Or have you heard of that situation? And do you think it would be better if we had a full family policy that maybe they could come out and be with the soldier, at least initially?

    And then the second question I have is: The mother also told me that those costs of flying the wife and kid out was actually borne by the wife and that it would not be until the soldier actually got back to his home base, which could be eight or ten months at the rate this guy was going in the hospital, before he could put in for reimbursement and actually be reimbursed back for those costs.
 Page 45       PREV PAGE       TOP OF DOC

    So did any of you find in your process that there were any costs that you had to put out of pocket, that you did not realize, that you did not get reimbursed for, that might be a hardship for some of the families?

    Officer KEETON. Ma'am, my family drove to Fort Hood and met me there on their own local economy. And had it not been for the Fisher House, they would not have had a place to stay.

    Sr. Airman PIZZIFRED. Pretty much the same thing. My family was flown out from California to Germany to meet me in Landstuhl. And they had two trips back and forth between California and Walter Reed. It was two people, my mother and father.

    Everything was pretty much paid after I got to Walter Reed. But once I was at Walter Reed, they started to pay for everything.

    What I am trying to say is, she paid for the trip to Germany, but they reimbursed her once I got to Walter Reed. It was not——

    Ms. SANCHEZ. It wasn't a long lag?

    Sr. Airman PIZZIFRED. It wasn't a long time. It was until I got to my home base.

    Ms. SANCHEZ. Okay. Anybody else?
 Page 46       PREV PAGE       TOP OF DOC

    Sergeant CHANDLER. To answer your first question, ma'am, I think it is very important to have the immediate support once you are injured and put in a hospital.

    And the second question, it might be hard for some families to just pick up and go, fly out to see somebody like that, to pay out of their own pocket at first.

    Hospital Corpsman CUOMO. In my case I did not see anyone have problems that was having family come out.

    But when I was injured and after my surgery, the patient advocacy and my surgeon advised me to make a temporary move to California due to the fact that the next three to four months dressing myself was even going to be an issue. So I had my family make the temporary move outside Camp Pendleton, where I was stationed with the 3rd Marine Air Wing.

    Ms. SANCHEZ. Is there anything during this entire time that you saw that you think needs to be fixed that you should tell us about? Any of you?

    Sr. Airman PIZZIFRED. I just have an issue with continuation care.

    Like I said before, when I was at Walter Reed I was considered an OIF/OEF patient and I was seen right away. Now it is more like I am an active duty patient, not—I do not have that same status.
 Page 47       PREV PAGE       TOP OF DOC

    Ms. SANCHEZ. So you have to wait, you have to wait for appointments, you have to——

    Sr. Airman PIZZIFRED. I have to wait just like any other person on active duty.

    And sometimes that means, depending on what I have, it could be something, you know, that I need to be seen right away and it could be two weeks before I even see them.

    Hospital Corpsman CUOMO. Same here, ma'am. I would just like to see the scarlet letter ''R'' removed from my chest.

    Ms. SANCHEZ. Why do you think that—how do you feel that? I mean, what is the—is it an attitude? Is it ''No, wait in line? No, come back later''?

    Hospital Corpsman CUOMO. Not with the medical care. With medical care, the active duty Navy has always been there for me. It is just that whenever I go back to the command that I am working, ''You are a reservist, you are a reservist.'' I understand that.

    Ms. SANCHEZ. Okay. Thank you, gentlemen.

    Mr. MCHUGH. The gentlelady's time has expired right on time.

 Page 48       PREV PAGE       TOP OF DOC
    I should note, too, for the benefit of those who may not have the background material on these four individuals, Petty Officer Cuomo said he was a World Trade Center survivor—I believe that is how you described it.

    How he survived was as a member, in fact the leader, of the New York City Fire Department Emergency Services. He was there both in rescue efforts before and after the World Trade Center fell, and stayed there for a week until they finally told him to get the hell out of there and go home and see his family.

    So he did not just survive it. He was there digging in rubble and making a big difference, and he continues to serve, obviously.

    With that, happy to yield to the gentlelady from Virginia, Ms. Davis.

    Mrs. DAVIS OF VIRGINIA. Thank you, Mr. Chairman.

    And since you mentioned that, I want to just say thank you, Petty Office Cuomo. As the wife of a 30-year firefighter, I appreciate all that you did and all that you do—and to all of you for your service to our country in our finest military in the world.

    And, Sergeant Chandler, you made the comment that the Marines are an inspiration to you. I think you are definitely an inspiration to all, you and also Senior Airman Pizzifred. You are just amazing. There is just no other word for it.

    You talked about your pain medication.
 Page 49       PREV PAGE       TOP OF DOC

    And, Mr. Chairman, I would like to use just a few minutes to make a statement more than anything.

    I had a young Marine in my district that—he was not injured in Iraq, but the very problems that we have heard the guard and reservists talk about, the bureaucracy of the administration. The administration and the bureaucracy, in my opinion, cost that man his life.

    He was being treated by a doctor in the district, and with the bureaucracy, they insisted that he be treated at Walter Reed. And as you have heard these gentlemen talk about trying to get their—waiting for their appointments and the like, and then because he had all this pain and that—Sergeant Chandler made me think of it—he had all this pain but they told him the pain was not real, he did not have it.

    The young man left behind a wife and small children because our bureaucracy and our administration of our medical care did not listen, as it sounds like they did not listen to Sergeant Chandler when his pain was real.

    And I just hope, Mr. Chairman, that we can break through this bureaucracy and make sure that these men and women that put their life on the line for us, that they are treated with the utmost respect and that they are given the care.

    And, as Senior Airman Pizzifred said, he got the care when he was—from the wartime surgery and in Walter Reed, but now that he is out, he is not treated that special anymore.
 Page 50       PREV PAGE       TOP OF DOC

    And I do not think there should be a breakdown of who is treated special. These men and women, be they guard, be they reserve, be they active duty, be they harmed or injured in the war or harmed or injured in training in the United States or wherever, these are this country's brightest and finest, as I think these two gentlemen on the right have evidenced.

    And I think we let them down when we do not correct the system that, in my mind, does not reward them or give them what they need for what they have done and sacrificed for us.

    And I just hope that we can do something valuable and good in this subcommittee, as you always have, Mr. Chairman.

    And I would just say, I appreciate all of you so very much, and God bless you.

    Mr. MCHUGH. The gentlelady yields back. And I thank her for her comments. Obviously, that main point she was making is why we are all here today and why our second panel is here today as well: to try to learn where these challenges exist and work through them.

    I would next yield to the gentleman from Minnesota, Mr. Kline.

    Mr. KLINE. Thank you, Mr. Chairman. I want to thank all the witnesses for being here today. I would like to take just a couple of minutes, before I discuss some of the problems that are of concern to me, to talk about Sergeant Chandler.
 Page 51       PREV PAGE       TOP OF DOC

    Sergeant Chandler, I had the honor and the opportunity to meet you this morning, and I was very pleased to do that. I heard your story from the Commandant of the Marine Corps more than a year ago, and it was inspiring to me then and is to me now. And I have told your story, without having met you, many times.

    In 25 years of active service that I served in the Marine Corps, I had the opportunity to serve with a lot of real heroes. But none of them, in my judgment, is a match to you. It is a remarkable story, and it makes me proud again to have worn that uniform.

    Now, having said that, it seems to me that there is a divide here that the chairman discussed a minute ago. We have heard the stories from four service men, two from the reserve component and two from the active component, and the story from the active component is a better story.

    I think it is well known that there are differences between the active component and the reserve component in a lot of areas. But where there should not be a difference is how you are treated when you are injured. And I think that is the heart of what we are trying to get at here today.

    And I appreciate your testimony very much today, and I am looking forward to my colleagues asking their questions and then getting to the next panel as we try to get to the heart of that.

    But I gather, Chief Keeton, you started to sense that difference not immediately, not when you were in-country, but as you started to come back through the system.
 Page 52       PREV PAGE       TOP OF DOC

    When did it occur to you that there might be a difference because you were from the reserve component? When was that—when did that first—that light come on and say, ''There is a difference here because I am not a member of the active component''?

    Officer KEETON. When we landed at Andrews Air Force Base. Up until that point in time you could not tell the difference. Nobody ever even mentioned, ''Are you guard or are you reserve?''

    Matter of fact the notation in my medical records occurred at Andrews Air Force Base, and they noted out to the side, ''Arkansas National Guard officer, mobilized.''

    You know, what relevance does that have? Why is it there? So it did not occur until I returned stateside.

    At Landstuhl, the administrative duties that were there merged very well with the medical care. We were given administrative things like extra clothing, a gratuitous allotment of stuff, and there was no difference. Nobody ever said anything. It was not until I got back stateside they began to make differences.

    Mr. KLINE. And so, sadly, it was when the chaplain got on the bus, that is when the light came on. You said, ''There may be a difference here in how we are treated because I am in the reserve component instead of the active component''?

    And then I paid close attention to the rest of your testimony, and it is something that we are going to have to dig to the bottom of.
 Page 53       PREV PAGE       TOP OF DOC

    Thank you, Mr. Chairman. I yield back.

    Mr. MCHUGH. I thank the gentleman, and yield back the remainder of his time.

    Next, the gentlelady from Virginia, Ms. Drake.

    Mrs. DRAKE. Thank you, Mr. Chairman. First of all, I would like to thank each and every one of you for being here. And I think it is very impressive that all four of you decided, despite what you had been through, that you were going to continue on in your careers. And we thank you for what you do for us.

    This is my first exposure to any divide between whether you are a reservist or whether you are active duty military. And I would have come into this hearing with the assumption that once you are activated that you are exactly like our active duty military.

    You look like a member—I mean, you are proudly wearing the uniform of our country and of your service. And I would think if a reservist were sitting next to Sergeant Chandler, it would look just the same, as far as the uniform goes.

    So I am very distressed to hear that there is any difference in how you are treated, either medically or in this idea of limited duty.

    And I would like to ask Petty Officer Cuomo, are you told as a reservist that there will be these differences?
 Page 54       PREV PAGE       TOP OF DOC

    Hospital Corpsman CUOMO. No, I was advised of that.

    Mrs. DRAKE. I mean, when you sign up to be a reservist, is there any break down of—or do you make the assumption that once you are activated, it would be the same as in active duty?

    Hospital Corpsman CUOMO. Well, no, ma'am. The separation between active duty and reserve, as I said, came on December 12th, when I was advised that I was not afforded those orders.

    Mrs. DRAKE. But you did not know that until you were told you would not be able to get limited duty?

    Hospital Corpsman CUOMO. Yes.

    Mrs. DRAKE. Okay, thank you.

    And, Mr. Keeton, you made the statement that your care manager did not come to work that day, and unfortunately, they did not assign you to someone else.

    Had that person been there that day, would you feel you were treated as differently, because you have repeatedly said the medical care was excellent?

    Officer KEETON. I have no way of really knowing.
 Page 55       PREV PAGE       TOP OF DOC

    Mrs. DRAKE. Was that the breakdown or it was bigger than that?

    Officer KEETON. I believe it possibly was a breakdown, because I was escorted upstairs.

    The internist that later talked to me, talked to my family, he was upset, because he said, ''When they brought Chief in to me, I really did not know what to do with him,'' even though he had my medical records.

    And I do not think he was treating me as a guardsman or an active duty guy. He never asked me that question. It never entered his mind. He was treating me medically. It was outside of the hospital that the difference began to surface.

    Even the chief of cardiology, when she found out that she had a patient that had been roaming around two days, she immediately saw me, within moments, and apologized right up front: ''You know, I do not do business like this.'' And she made extra steps to correct it. So medically speaking, I do not think they make a difference.

    But administratively, if you fall into the medical hold company, they really do, because one of the active duty people that came out when I came out, went to his rear detachment unit with the 1st Cavalry Division, and they began to take care of him on a limited duty status.

    I fell in with about 50 or 60 other soldiers into a medical hold company that was chaotic.
 Page 56       PREV PAGE       TOP OF DOC

    Mrs. DRAKE. Thank you.

    And, Senior Airman, you have raised an interesting point of the care that you received almost as if it was not quite as specialized as it should have been where you were taken as a member of the Air Force as opposed to someone—the care that Sergeant Chandler got as a member of the Marines.

    And I am wondering if that is across the board or maybe in certain cases. Our military works together very well, all the branches, if our military members should go where the best care for their injury is—regardless of branch of service—to kind of look at that component rather than, ''You are Navy, so you will go to Portsmouth Naval Hospital,'' as opposed to going where it fits the injuries you have received.

    I am sorry, we have one minute. So thank you.

    Sr. Airman PIZZIFRED. Would you like me to answer?

    Mrs. DRAKE. Yes, please.

    Sr. Airman PIZZIFRED. Well, I have been going to an Army medical center just because they have a little bit better specialized training in that. The medical stuff that I get, though, the medical care is awesome. It is just the time you have to wait and stuff like that.

 Page 57       PREV PAGE       TOP OF DOC
    Mrs. DRAKE. Okay.

    Sr. Airman PIZZIFRED. And you being an OAI/OIF/OEF patient at Walter Reed, it was right away. You being an active duty patient, you wait your turn.

    Mrs. DRAKE. Thank you. Thank you, Mr. Chairman.

    Mr. MCHUGH. I thank the gentlelady. We next have the gentlelady from California, Ms. Davis.

    Ms. DAVIS OF CALIFORNIA. Thank you. Thank you, Mr. Chairman. And thank you all for being here. For those of you who served in San Diego, I hope the community was hospitable to you.

    We are very proud of you and the professional way in which you have conducted yourself and the way that you have, I think, shown all of us great valor and courage. And I really appreciate that.

    I want to just go back to a few of the comments.

    Chief Warrant Officer, you said that the intent is to flush as many people out as we possibly can. And the way in which—it suggested to me that perhaps we are not looking out for the best interest always of the individual as they are going through that process. And I think you spoke to that in some ways.

 Page 58       PREV PAGE       TOP OF DOC
    You also suggested that perhaps if soldiers, sailors had more information going in or more ways in which they might be able to work through this once they are injured, that that would be helpful, but that they would get that information early on.

    I am just thinking about some of the informal support systems that we have, whether they are key volunteers or liaisons. Is there some role that could be played more in the community that would make a difference in this way? Or is it just the bureaucracy and the fact that it is very difficult for, sometimes, people to respond in a more human way at a time when there are so many people that are having to be cared for?

    Officer KEETON. I think, ma'am, that the first things you are seeing is the CBHCO and the medical holds, they are really a system in its infancy.

    This is the first time since possibly the Korean War, certainly World War II, that the guard has been mobilized in such large quantities. I just do not think the system was prepared to absorb the problems that were coming out of that.

    The CBHCO I belong to is trying very hard. The care managers are trying to fill in the gaps. The problem that they are faced with, I personally believe, is that the active Army wants the guard off of Title 10 as quickly as possible.

    I have been told that by more than one person that is on the administrative side of it, for whatever reason I am not sure. I cannot answer that question.

    But I have known from Fort Hood, at the medical hold company there, all the way to the CBHCO, that, yes, they want us out as fast as we can possibly get out.
 Page 59       PREV PAGE       TOP OF DOC

    As far as information is concerned about the casualties, I can only speak for myself. And it was easier for me, having 38 years of service and been around the system quite some time. As I talked to the young soldiers that came out with me, there was a lot of fear there because they just did not have the information they needed to make adequate decision.

    Ms. DAVIS OF CALIFORNIA. Sergeant Chandler, would it have made a difference for you if someone had told you what you might go through as a result of an injury early on?

    I guess, what were your expectations?

    And perhaps all of you could speak to that.

    Sergeant CHANDLER. The same thing as everybody has been saying, ma'am. I did not have any expectations. I did not know what was going to happen. If it wasn't for the help of other people that did help me in the beginning, I do not know what would have happened.

    Ms. DAVIS OF CALIFORNIA. Would it have made difference if somebody would have sat you down early on, or in small groups, and talked more about the likelihood of being injured and how the process would unfold after that, what you might need to know, what your family would need to know?

    Sergeant CHANDLER. It would make a difference to everybody else that was coming through. Myself, personally, I already knew what I wanted to do.
 Page 60       PREV PAGE       TOP OF DOC

    Ms. DAVIS OF CALIFORNIA. Anybody else want to—would you like to respond to that? Would it have made a difference?

    It sounded to me like you were pretty determined about what you wanted and——

    Sr. Airman PIZZIFRED. The day that I stepped on the land mine, five minutes after was when I asked the nurse if I was going to be able to stay on active duty still.

    Ms. DAVIS OF CALIFORNIA. Right, right.

    Sr. Airman PIZZIFRED. I mean, there was—I had no problems with anything.

    I do not think that us being told before really would have made a big difference. I mean, that is not something you think of going over there—maybe for the family members though.

    Hospital Corpsman CUOMO. Going over to fight, the last thing someone needs on their mind is that they are not going to make it back. That will just impede our fighting.

    When it comes down to being injured, you can walk out of this building and get injured.
 Page 61       PREV PAGE       TOP OF DOC

    But to go back, of course I would go back in a heartbeat if I was fit for duty.

    I was also given two command recommendations by the Navy for further medical education which I would love to jump on.

    Ms. DAVIS OF CALIFORNIA. Thank you. Thank you, Mr. Chairman.

    I think, as we go into the next panel, we are learning more about the disabled soldier support system, and how we have improved on that would be very helpful, and I suspect people will be talking to that. Thank you.

    Mr. MCHUGH. I thank the gentlelady. The gentleman from North Carolina, Mr. Jones—oh, I am sorry. Who have I got next? Walter, you are up.

    Mr. JONES. Okay.

    Mr. MCHUGH. Despite of the fact I just moved you——

    Mr. JONES. He is from North Carolina too.

    Mr. MCHUGH. That is why you are up.

    Mr. JONES. Mr. Chairman, thank you. The way we are sitting, this should not happen again that we would be side by side, but I am very fond of my friend from North Carolina.
 Page 62       PREV PAGE       TOP OF DOC

    Let me ask the two young Marine and airmen: I know it is hard for you to think that one day you might be old, particularly what you have been through. Obviously we thank you and the guard and the reserve for everything that you are doing in Iraq and those who might have been in Afghanistan.

    I want to ask you two airmen and Marine: We are debating here in Washington, soon will be debating, the President's budget, which many of us who represent districts where there is a large retired population are concerned about possible cuts that could impact on V.A. health care.

    Do you, with your follow Marines and fellow airmen, do you all have any of these concerns? Or do you think about maybe ten years from now, ''I will not be in the Marine Corps, I will not be in the Air Force?''

    Sergeant CHANDLER. From the things that I have seen, it is a bit of a concern. They do not get taken care of like they should have—or they should be getting taken of, the way that has been retired right now.

    Sr. Airman PIZZIFRED. I really have not looked at it too much. I am just trying to go day-to-day. But I don't know, I guess I am just going to wait until that happens.

    Mr. JONES. I appreciate that response, because many of us on both sides of the political aisle feel that what you are doing and have done that there should never be any question about your health care when you retire.
 Page 63       PREV PAGE       TOP OF DOC

    To that issue, I hope that we will, as Republicans and Democrats, this year, as we debate a very tight budget, that if we can find an increase for foreign aid money and have to say to the veterans' health care that you have to take less, I hope that we will do what is right and make sure that you get what you were promised.

    To those of you, National Guard and Navy Reserve and National Guard, I guess my question to you—because it concerned me greatly from some of the questions that my colleagues have asked and that you actually said—is there an atmosphere that you are not equal because you are in the reserves and the guard?

    Hospital Corpsman CUOMO. No, it was made very clear to me when I brought up to my surgeon, who was an active duty captain, I had made mention that I was an activated reservist. He turned around and quickly stated to me, ''No. You are a sailor and a patient first.''

    I cannot go on to commend how much these people have done for me at the Naval Medical Center in San Diego. I have no problem with my medical care from the active duty Navy, because they have instructed me, they have sat me down, they have given me the rules and regulations, and this is what I am afforded.

    Mr. JONES. The reason I wanted to ask that question, Mr. Chairman, is because in the 3rd District of North Carolina, we do have, and I am very proud to say this, Camp Lejeune, Cherry Point Marine Air Station and Seymour Johnson Air Force Base.

 Page 64       PREV PAGE       TOP OF DOC
    And anyone I have ever met, from being a noncommissioned officer to an officer, has really said that the guard and the reserves have really done a yeoman's job. They have been there with us. And that they have done an excellent job.

    And to the warrant officer I would like to say to you—well, let me just close by—one minute, excuse me.

    When you mentioned the chaplain on the bus, do you think that he was just doing his duty in trying to identify active duty, reserves or guard when you said that you did not respond? Or maybe I misunderstood you. Did you feel like that he was just doing his job, or was he singling out and excluding?

    Officer KEETON. Sir, I think to assist every soldier on that bus, it was his job, regardless. It should not make a difference. Those of us sitting at this table cannot look at each other and see whether we are active duty or whether we are guard or not. And it should always be that way.

    Mr. JONES. Well, I believe from those that have served with you, it is that way. And I just wanted to—because of some of the comments about high command administrative situations, I just want to make sure you know that we in the Congress see you all equally and we appreciate what each and every one is doing. Thank you, Mr. Chairman.

    Mr. MCHUGH. I thank the gentleman from North Carolina.

    When I said I moved you, I meant moved you in terms of who is to go first. I thought I had surprised you and I never want to do that, Walter. The other gentleman from North Carolina, Mr. Hayes.
 Page 65       PREV PAGE       TOP OF DOC

    Mr. HAYES. Thank you, Mr. Chairman. And, gentlemen, a couple of quick observations. Obviously, our ability to express our appreciation and that of a grateful nation is inadequate at best.

    As we talk about your injuries, particularly those who have lost limbs, the thing that I think about, sitting here—in every kind of term that it happened, but that it happened over there and not over here, again is a tribute to the job that you all are doing, and it is remarkable.

    Another consistent issue that comes up—I had a young man at Fort Bragg, 82nd Airborne, also lost a leg. And every time I have visited, whether Landstuhl or Walter Reed in Bethesda, it is always, ''Am I going to be able to get back in?''—another incredible tribute to all of you who wear the uniform, the level of dedication you have to protecting and providing freedom for us.

    So within that context, again, thank you.

    Having seen what you have seen, having been where you have been, is there anything that you can bring to us in terms of advice, suggestions, that we can do, as members and as a committee and as a Congress, to make sure that everything that you need, as an injured soldier, sailor, airman, Marine or Coast Guardsman, that we can do for you, or particularly for your families, as you face the initial issues with the injury but then long term?

    I really appreciate what Beverly and Bill Young are doing. I am very much aware, and we are working on some of that from the private side, because a lot of American citizens would love to participate. They just do not know how.
 Page 66       PREV PAGE       TOP OF DOC

    So we are trying to help establish a bridge there, because we are privileged to see and be with you and experience the things that you all do so well. But there are so many folks back home that love you as much as we do. And we are trying to help them connect with you and your families.

    So any suggestions on how we can do that?

    Sergeant CHANDLER. Just the immediate support as soon as they get to the hospital.

    Mr. HAYES. Immediate support?

    Sergeant CHANDLER. Whether it be, like, group support of people that have had similar incidents happen to them, let them know that it is going to be all right, stuff along that line.

    Mr. HAYES. And vitally important, I am sure every branch of service has a liaison person who is there from your base to, again, help coordinate those things—whatever you need there. It is a great suggestion.


    Sr. Airman PIZZIFRED. My entire process went smoothly. The Air Force took good care of everything. When I got there, the first person I saw off the plane was an active duty colonel that is an above-the-knee amputee and is now flying, so he gave me a lot of inspiration.
 Page 67       PREV PAGE       TOP OF DOC

    And, like Sergeant Chandler said, I think that was the biggest thing, was seeing people like us, in our same status, doing what they wanted to do. That helped me, kind of put a base down for me, just saying: Keep going.

    Hospital Corpsman CUOMO. The Navy's ombudsman service works very well. For example, the liaison, any problems that I had, they notified my family when I was injured in Iraq. I think they do a great job contacting families, same with support.

    Officer KEETON. I think the Family Support Division in the state of Arkansas has been super in assisting and working with the families there. The family support groups that are in the cities for the guard units have been terrific, and I have absolutely nothing but praise for them.

    I believe that along the way, family support and people that were liaisons did a super job. I have no complaints.

    Mr. HAYES. Again, thanks. And don't let the fact that you have been here today stop your ability or desire if you think of things later to plug into us. I am sure folks behind you, or wherever, would love to hear from you. And thanks for the inspiration you give us.

    One last story in my remaining 30 seconds. I was involved in one of our typical daily skirmishes around here and kind of concerned about whatever it was, inconsequential, I got a call from this sergeant who is in the hospital, Walter Reed, minus a leg. And I rushed out to call him, I was afraid something bad had happened. He said, ''Sir, just wanted to check on you. See how you were doing.'' [Laughter.]
 Page 68       PREV PAGE       TOP OF DOC

    So, again, thanks for what you all are doing.

    Mr. MCHUGH. Time is up. Great timing, gentleman. The gentleman from Kansas, Mr. Ryun.

    Mr. RYUN. Mr. Chairman, thank you very much. Let me echo what has been said by many. Thank you for your service and your sacrifice.

    And I would actually like to extend that to others that are here as well who have served our country and are still serving. We, along with many other Americans, very much appreciate what you have done.

    I would like to pause just for a moment and just comment on the Senior Airman running in the Army 10 Mile. Having a passive interest and running in my past, I find it quite an accomplishment that you have been able to do that.

    It is a great moment, a celebration. I have seen that event. I have not participated in it. And you should be commended for what you have been able to accomplish.

    Actually, one of the questions that I wanted to ask has already been asked, but if you—as I ask the second question—want to reflect on this well, you are welcome to answer it a second time.

    Urgent needs, things that you see need to be accomplished that would help make your participation and others who are following behind you better in terms of treatment, if you think of anything else as you answer this next question, feel free to comment on that first one—what we can do to continue to make things better.
 Page 69       PREV PAGE       TOP OF DOC

    But do you feel that the administrative problems that you have had to face are driving others out of the military as a result of the health care that is involved? And I would like each one of you perhaps to comment on that, either experiences you have had or particular experiences you may have heard from others.

    Sergeant Chandler, would you go first, please?

    Sergeant CHANDLER. Yes, sir. From the experiences I have seen, the administrative side never really played a role in whether a Marine stays in active duty or gets out, or reserve, whatever the case may be.

    If they want to do it, they are going to stay. If they do not, then they are going to leave.

    Mr. RYUN. Any thoughts with regard to others who might have reflected on what your experience was that would say, ''Well, maybe I don't want to stay in because of what you had to go through''?

    Sergeant CHANDLER. I do not think it really would apply to any of them, sir.

    Sr. Airman PIZZIFRED. I agree with everything. There was no—it was pretty much cut right to the chase with, ''You want to stay in? Yes or no.'' I said, ''Yes.'' Everything was kind of laid out, what I had to do from then on up.
 Page 70       PREV PAGE       TOP OF DOC

    The only thing I can say is continuation care. I think some of the other Army medical—any hospital, basically, armed services facilities, they need to get a little bit more experience and training, I believe.

    Hospital Corpsman CUOMO. My experience working at the NMPS site is that there is a fairly even amount of personnel that did go home out of aggravation, stating that, ''I do not need to do this anymore. I do not need to be told that I can't get, you know, certain things. I will go home to my civilian employer.''

    I am currently mentoring three junior enlisted at the NMPS site, and trying to instill in them what the Marines have instilled into me as a corpsman, that attention to detail and don't give up the fight.

    And I have the SECNAV instructions clearly put out on my desk and advise these junior enlisted of what they are entitled to.

    The only thing, there was a certain group of people that should not have gone home, in my medical opinion. Although I am low on the scale of medical profession, paramedic, obvious injuries need to be taken care of. And it was just a shame to see a certain group recently go home and they needed help.

    Officer KEETON. Sir, I do not believe that the frustrations, the people I know, are driving them out of the service. Their resolve is great.

 Page 71       PREV PAGE       TOP OF DOC
    Their biggest concern is, like mine was, ''Can I get back to Iraq with my team,'' and, ''What is the long-term effect?''

    So I do not hear any of that.

    Mr. RYUN. Thank you very much.

    Mr. MCHUGH. You had one minute left.

    Mr. RYUN. Yes, but I am finished. Thank you, Mr. Chairman.

    Mr. MCHUGH. The gentleman yields back. That completes a round.

    I would say to my colleagues, according to latest from the floor, we are expected to vote about 12:45. That will be the final vote for the day.

    So knowing the intoxicating effect of jet fuel, I suggest we try to move through to the second panel, but exercising the prerogative of the chair before we do that.

    Is there anything any of you would like to say? It is a variant on Mr. Hayes' question?

    We have a distinguished panel of individuals following you that have direct responsibility for the programs, from start to finish, that you have experienced. And I know several of these individuals personally, and they care. And while things may not always work as well as we all would wish, believe me, they want to make it better.
 Page 72       PREV PAGE       TOP OF DOC

    Anything you would like to say to them before we thank you and move to that second panel, beyond what you have already said? Okay.

    Well, gentlemen, again, God bless you for your service. We are speaking on behalf of a grateful nation. We wish you the best in your continued endeavors and your continued recovery efforts. And thank you so much for being here.

    With that, as the second panel makes its way, we will switch the name tags so everybody gets in the right place.

    We welcome our second panel, prodigious in numbers, as well as knowledge and other things as well.

    And let me introduce them. And I am going to read them as they appear on the page, and I hope it somewhat remotely corresponds to how they have eventually been seated. But we will find out.

    First, Lieutenant General, it says here, F.L. Hagenbeck. I think most folks, myself included, know him as Buster—General, welcome—Deputy Chief of Staff for Personnel for the Department of the Army.

    Next, Major General Joseph Webb, Jr., Deputy Surgeon General, Department of the Army—welcome, sir.

 Page 73       PREV PAGE       TOP OF DOC
    Vice Admiral Gerald Hoewing, Chief of Navy personnel, Department of the Navy—Admiral, welcome.

    Vice Admiral Donald Arthur, Surgeon General, Department of the Navy—Admiral, thank you for being here.

    Lieutenant General Roger A. Brady, Deputy Chief of Staff for Personnel, Department of the Air Force—General, welcome.

    Lieutenant General George P. Taylor Jr., Surgeon General, Department of the Air Force—General, thank you for being here.

    And Lieutenant General H.P. Osman, Deputy Commandant for Manpower and Reserve Affairs, United States Marine Corps.

    Thank you all, gentlemen, for being here. You have heard our opening comments. You have heard—I believe all of you have—the comments of the first panel and the questions.

    We have your written statements and as with the first panel, without objection, we will enter them in their entirety into the record. And we would appreciate, to the extent appropriate in your judgment, your summarizing those comments for us. And we look forward to your testimony. And with that, we will proceed in the order in which we were introduced and start with General Hagenbeck. Welcome, Buster.

 Page 74       PREV PAGE       TOP OF DOC

    General HAGENBECK. Thank you, sir.

    Mr. Chairman and members of the committee, I thank you for the opportunity to appear before you today. Today's topic of care of the injured and wounded servicemembers is an important concern for the Army, and it is essential to maintain the morale and the welfare of all our soldiers who serve a grateful Nation.

    The Army will continue to support operations worldwide, and the American soldier will remain the centerpiece of all that we do.

    Currently, as you know, we have over 640,000 soldiers serving on active duty, and of those, 315,000 are deployed or forward stationed in more than 120 countries. And these soldiers are from all of our components, from active, reserve and from the guard.

    And it is our duty to ensure that all of them are well taken care of, as are their families.

    Since 9/11, we have witnessed the largest mobilization of the reserve component since World War II. Our guard and reserve soldiers—exemplary performance alongside those of the active component. It is testimony that we are indeed one Army, and our nation should be very proud of their service.

 Page 75       PREV PAGE       TOP OF DOC
    Soldiers deserve the first-rate training and care, everything that we can give them. And this includes guaranteeing family members that soldiers who become injured or ill in the line of duty while serving our country will have first-rate treatment.

    Though this effort has not been without challenge, we continue to improve our processes, and we strive to deliver compassionate and timely care to the medical holdover soldier.

    Our medical holdover population quickly grew once soldiers began reporting to mobilization stations and returning from theater through either the evacuation chain or the demobilization process.

    In the midst of supporting the war-fight, we have realized that the existing National Health Organization (NHO) policy and infrastructure were inadequate, and we have immediately embarked on a series of corrective actions.

    In March 2004, we set up the Medical Retention Processing Program.

    The program is designed to eliminate the pressure on the Active Duty Medical Extension program and better serve our mobilized National Guard and reserve solder on contingency operations orders that are entering into the medical holdover system.

    The number of mobilized Army Guard and Reservists entering into the disability system represents a 134 percent increase during fiscal year 2004 over the previous year.
 Page 76       PREV PAGE       TOP OF DOC

    To meet this case load, we have added additional members to the three physical evaluation boards. We have increased the numbers of JAG officers assigned. We have centralized the orders publishing to ensure that mobilized soldiers do not fall off orders with subsequent pay issues. And we have augmented our holdover units with additional command and control elements.

    These efforts have begun to pay off. In June of 2004, there were 900 mobilized reserve and National Guard cases pending in the Personnel Disabilities Agency (PDA). Today that number has been reduced to 344.

    The PDA still receives about 150 new mobilized reserve and National Guard cases each month.

    While much has been accomplished, more needs to be done. Acting in concert with the Office of the Surgeon General and other Federal agencies, the following initiatives are under way.

    The Surgeon General and I are currently coordinating and streamlining our processes to retain disabled soldiers on active duty, if the soldier so desires.

    We are structuring a comprehensive reporting system that tracks the soldiers as to where they are medically evacuated from the area of operation until they return to duty or they are separated or retired from the U.S. Army.

 Page 77       PREV PAGE       TOP OF DOC
    And as part of the information gathering and sharing enterprise, we are working very closely with the Department of Veterans Affairs and the Defense Finance Accounting Services to better coordinate determination of military pay and the initiation of the veterans' administrative payments.

    An important linkage to this process is the access to the reserve component soldier's personal documents where calculations are retired and severance pay.

    And efforts are ongoing to bring automation solutions to this manual process we have today.

    So though we have challenges ahead, I am confident that we are ensuring that the proper systems are in place and that soldiers receive the care that they absolutely deserve. Thank you.

    [The joint prepared statement of General Hagenbeck and General Webb can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you, General. Next, Deputy Surgeon General with the Department of the Army, Major General Joseph Webb, Jr.


 Page 78       PREV PAGE       TOP OF DOC

    General WEBB. Mr. Chairman, Dr. Snyder, distinguished members, I bring you greetings from General Kiley. I am proud to be here representing him, and I am very happy to be here, because I know we are all here for the same reason and that reason is to do everything we can to take care of the soldier, sailor, airmen, Marines and the Coast Guard.

    I would first like to give my thanks to the members of panel one for their willingness to be here, to be examples to the other service men and women that they have been.

    It is certainly the goal of the Army Medical Department to provide world-class care from the point of injury on the battlefield all the way back to return to duty. That has always been our goal, always will be, and we want to take every step of that way treating our service men with dignity and compassion.

    The Army Medical Department has treated just over 20,000 casualties evacuated from OIF and OEF, and of these 20,000, we have already returned more than 15,000 to duty.

    Of the roughly 21,000 reservists that have entered our system, we have provided care to completion for about 16,000 of those and have already returned 10,000 of those to duty.

    I do not think there is another medical system in the world that could do that. So we are proud of what we have been able to do, but as you heard from panel one, there are still areas for us to make improvements.
 Page 79       PREV PAGE       TOP OF DOC

    We need to continue to expand our capabilities—the amputee care part—work closely with our sister services and with the V.A. so that we do provide seamless transition of care whenever and wherever our servicemembers need them.

    We also need to continue working within the Army and the services to improve administrative handling of our soldiers and always an improvement in the communications piece.

    I would like to take just a minute and highlight three of the initiatives that the Army Medical Department has initiated based on shortcomings that have been cited.

    First, we established an Amputee Care Center of Excellence at Walter Reed. I think some of you have visited that. We took those concepts and further expanded that to a second amputee center in San Antonio at Brooke Army Medical Center (BAMC).

    During the senior airman episode there at BAMC, we had just started that process there, and since his time, we have hired some world-class experts, we have continued educating our staff in advanced rehabilitations, and at the same time, we have broken ground for an advanced amputee training center on the Walter Reed campus.

    And I want to thank this committee and Members of Congress for their support in getting that resourced.

    A second example is that in association with the Assistant Secretary of the Army, Manpower and Reserve Affairs, and FORSCOM, we have developed the Community Based Health Care Initiatives that you have heard about. This allows us to transfer soldiers back to their homes so that they are at home and are receiving care there.
 Page 80       PREV PAGE       TOP OF DOC

    This is a relatively new initiative and the feedback that we have gotten thus far has been positive.

    Our pilot project encompassed 23 states, and we are now in the process of expanding that to have coverage at all 50 states.

    And I am happy to tell you that the Virginia CBHCO in Virginia Beach, that serves Virginia and the surrounding states, was activated last month and has now begun seeing patients.

    Our third example is assistance centers that we have established in many of our treatment facilities and our medical centers—a one-stop shop point of contact for assisting family members and service members that are within the hospital.

    This has really been a real benefit to our servicemembers and particularly to the family members who are not as familiar, necessarily, always, with the military aspects.

    I will also tell you that the V.A. has taken a big step, too, in putting into our facilities transition teams to assist those soldiers who will be separating from active duty and be receiving care from the V.A.

    So these are just three examples of many of the initiatives that we have taken as a result of discussions and so forth that we have had.

 Page 81       PREV PAGE       TOP OF DOC
    And I appreciate the opportunity to be here, and I appreciate the opportunity to work with this committee in doing everything that we can to provide world-class service for our servicemembers.

    Thank you.

    [The joint prepared statement of General Webb and General Hagenbeck can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you, General Webb. Next, no stranger to this subcommittee, has appeared a number of times. And yet, every time he does, we debate as to pronounce his name. And I usually get it wrong the first time and say ''Howing'' instead of ''Hoewing.'' And I apologize again, I think, as I have every other time you have appeared, Admiral.

    So consistency must be worth something, but as always, we, without exception, are very pleased you are with use today.

    And with that, I will introduce the Chief of Naval Personnel, Department of the Navy, Vice Admiral Gerald Hoewing.


    Admiral HOEWING. Thank you, Chairman McHugh, Dr. Snyder, and distinguished members of the committee. Thanks for the opportunity to be here to discuss the Navy's programs and processes for providing care for our injured and wounded sailors.
 Page 82       PREV PAGE       TOP OF DOC

    These men and women of the United States Navy appreciate your exceptional and sustained support in this entire area.

    Your commitment to ensuring that we have the programs and the resources in place to take care of our sailors and Marines, and each of their families, when any member of the service is wounded or injured, is absolutely vital to their personal morale as well as to the welfare of their families.

    We appreciate your efforts to help them carry out this Global War on Terror.

    Today, I wish to convey that we in the United States Navy remain equally committed to fulfilling the needs of our sailors confronted with such tragedies and their families supporting them on the home front.

    The Navy continues to improve our efforts and the level of care across all expanses that are in the services and provide for our wounded and our injured. And these men and women have displayed their total commitment, and they certainly deserve everything we can do for them.

    As our fighting forces continue the prosecution of the war, our sailors are proudly and impressively accomplishing many tasks set before them, alongside their comrades in arms of our other services.

 Page 83       PREV PAGE       TOP OF DOC
    It is our honor and our duty to provide them the maximum support possible and help them be able to cope with these challenges associated with recovery from their injuries.

    Again, I thank the committee for the continued support that you have provided, and I look forward to discussing the particulars with you during the question and answer session.

    Thank you.

    [The prepared statement of Admiral Hoewing can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you very much, Admiral.

    Also from the Department of the Navy, the Surgeon General of the Department of the Navy, Vice Admiral Donald Arthur. Admiral, thank you so much for being here.


    Admiral ARTHUR. Thank you, Mr. Chairman.

    I have never been prouder to wear this uniform than I am today and helping our armed services treat those who would go in harm's way, our new greatest generation.

 Page 84       PREV PAGE       TOP OF DOC
    As commander of Bethesda, as my last assignment, I launched the USS Comfort with 1,100 of our staff and watched them come back with a renewed sense of pride and orientation of what they were at Bethesda for, and that is to take care of the returning casualties.

    And as those casualties came back, I have watched those who had experience in Desert Storm and in OIF take care of these casualties in an extraordinary way.

    I went to Iraq and saw many advances from my time in Desert Storm when I was with the Marine Corps.

    I saw network computers, I saw quick clot and hemostatic bandages, and I saw a better continuum of health care between the Navy and the Army and the Air Force MEDEVAC system than I had ever seen before and was amazed to see patients who were injured and in 48 hours were back at Walter Reed at Bethesda. That is an extraordinary accomplishment.

    I saw the lowest died-of-wounds rate and disease, nonbattle injury rates in country.

    The one constant, however, was the good training and rapid action of the corpsmen and medics who are saving lives on the field. And I think that is where real congratulations are owed in our medical departments.

    I was asked by the Chief of Naval Operations several months ago: Could our casualties be treated just as well in civilian hospitals? And I said, well, yes, they could. Their diseases, their injuries could be treated very well, but the civilian hospitals could not understand two things:
 Page 85       PREV PAGE       TOP OF DOC

    One is that the injury is not just to the Marine, the sailor, the airman or the soldier; it is to his or her entire family.

    And that is why it has been important to us to notify the families, to get the families united with the patients, to have them there at Bethesda, in the Fisher Houses and the Navy Lodge, to get them—and not just two members of their family, by the way. We get several members of their family on orders or we have donated tickets. We get the families there to be with their loved ones.

    We recognize also the second reason that civilian hospitals could not do, in my opinion, as good a job, is we know that these Marines and sailors are still in combat. They still are suffering the memories of what brought them to Bethesda and of seeing their loved ones, their fellow Marines and sailors, injured on the job.

    I think one of our jobs is to ensure that the moms and dads of America know that they send their sons and daughters to the military, that they will get the world's best health care if they need it.

    You heard Sergeant Chandler talk about his injuries, and you were duly impressed with his accomplishments. I would like to tell you one more thing about Sergeant Chandler.

    That is, if you are a casualty starting to grapple with your amputation, Sergeant Chandler came up from his then-duty station and walked into the room to some of the amputees and said, ''I am a fellow Marine, I am an amputee. You can do it too.''
 Page 86       PREV PAGE       TOP OF DOC

    He had such an uplifting spirit that he really motivated the other Marines. I cannot say enough about Sergeant Chandler.

    One other thing I think is wonderful about our health system is, we never ask any of our patients how sick they can afford to be. In the military we give the right care every single time, no matter whether you are a private or a general, retired or active duty, family or active duty, reserve or active duty. We have one system.

    So Bethesda and, I know, the other facilities were set up for families. We are set up with a team approach where the doctors and nurses and physical therapists and social workers are all functioning as a team.

    We have the Marine Corps liaison, and they were there just for the administrative and family needs of their Marines. Half of the people in that liaison organization were reservists.

    We also have on-site Veterans Administration counselors so that the hand-off to the V.A. was smooth.

    I would like to very much congratulate Walter Reed Army Medical Center's Amputee Center for taking such good care of our amputees when we finished the treatment at Bethesda and transferred them over to Walter Reed because that is where they could get the best care for amputees.

 Page 87       PREV PAGE       TOP OF DOC
    We pride ourselves on how well we do handoffs, not just with Walter Reed but with the Veterans Administration. We have at least weekly teleconferences with the four designated V.A. rehabilitation centers. And I have visited the Tampa V.A. center myself and can not say enough about their extraordinary care.

    The Chief Executive Officer there is a three-time wounded Vietnam veteran, a Marine who understands the mission of this facility, in my opinion.

    I would conclude by thanking the members of the committee for their undying support and offer the services of Bethesda to you, if you would ever like a tour of Bethesda and see more of the patients, it would be an honor.

    Thank you very much.

    [The prepared statement of Admiral Arthur can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you very much, Admiral. Next, we have the Deputy Chief of Staff for Personnel for the Department of the Air Force, Lieutenant General Roger A. Brady. General, thank you so much.


    General BRADY. Mr. Chairman, Dr. Snyder and committee members, thank you for the opportunity to discuss with you a very important subject. You have all led from the front to ensure consistent support to the brave young men and women who defend this country, and we appreciate it.
 Page 88       PREV PAGE       TOP OF DOC

    In war our top priorities are to accomplish the mission and to take care of our people.

    Back on the home front, the best thing you can do to support the men and women who are in harm's way is to take care of their family.

    We owe our military men and women the certainty that, regardless of what befalls them, we will look after them and their loved ones.

    When an airman is wounded in action, Air Force is doing whatever it takes to help them recover. Our Palace HART program—which stands for Helping Airmen Recover Together—follows airmen wounded in action until they return to active duty or are medically retired, with follow-up even beyond that point.

    We work to retain them on active duty if it is at all possible. If we are unable to return the airman to active duty, we work to get them civilian employment within the Air Force. In fact, I have been told that I will find them employment within the Air Force.

    Along the way, we make sure they are counseled on all the benefits they are entitled to within the Department of Defense, the Department of Veteran Affairs and the Department of Labor.

    To further our efforts, the Undersecretary of Defense for Personnel and Readiness recently stood up a Joint Support Operation Center. This center complements our own programs to ensure that no injured airman is forgotten or neglected.
 Page 89       PREV PAGE       TOP OF DOC

    One hundred and seventy-four airmen have been wounded in action; 167 of them have returned to active duty. Two were placed on the temporary disability retired list, and five are receiving ongoing care.

    I have talked to many of the injured airmen returning from war. We are proud of them and the incredible courage they demonstrate as they travel the hard road to recovery.

    Every airman I have talked to, like Airman Pizzifred, has wanted to return to active duty and to their unit as soon as possible.

    The skill and dedication of the services' medical personnel and helicopter and airlift crews have improved the odds of survival and recovery far beyond what was thought would have been possible even ten years ago.

    The Air Force is a total force: active, reserve and guard. We are all airmen.

    While our airmen may move from one duty status to another, we are determined to ensure proper care for the individuals.

    We are proud of our very professional and compassionate family liaison officers and casualty assistance representatives. These are highly trained professionals who are with the families from the point they are initially notified. And they stay with them and the member for as long as they are needed. This personal relationship is critical in properly taking care of our families.
 Page 90       PREV PAGE       TOP OF DOC

    The Casualty Assistance Officer, alongside chaplains and other friend within our community, help a family cope with difficult emotions while helping them navigate the details that attend an extremely difficult situation.

    Ladies and gentlemen, this effort is rooted in our core values of integrity, service and excellence.

    We are proud to be part of this great joint team in the Global the War on Terror.

    Thank you, Mr. Chairman, members of the committee, for the unwavering support that you have given these great Americans. Together we are determined to get this right.

    [The prepared statement of General Brady can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you so much, General Brady. Also for the Department of Air Force, the Surgeon General, Department of Air Force, Lieutenant General George P. Taylor, Jr.


    General TAYLOR. Mr. Chairman, Dr. Snyder, members of the committee, thank you for this opportunity to be with you about the care of our injured and wounded. This is the core of our mission, and appreciate your interest and support in providing for America's heroes.
 Page 91       PREV PAGE       TOP OF DOC

    I am proud to say that the men and women of the Air Force Medical Service have done an exceptional job throughout OEF and OIF to ensure active duty and reserve component personnel of all services are provided expeditious state-of-the-art care.

    We attribute our success to focusing on four health effects, which are providing care to casualties, ensuring a fit and healthy force, preventing injury and illness and enhancing human performance.

    Our light, lean, mobile expeditionary medical support is the linchpin of our ground mission.

    As part of the joint team, we now have more than 600 Air Force medics in deployed locations, including one of the two large theater hospitals, this one in Balad, Iraq.

    We also have two smaller hospitals, one in Kirkuk and one at the Baghdad International Airport.

    Just as all our own medical treatment facilities in the States, each of these facilities serves as regional hospitals for all injured and all ill.

    Our air medical evacuation system, featuring critical care air transport teams, have made possible an astonishing turnaround time as short as 36 hours from battleground to stateside medical care—unheard of a decade ago.

 Page 92       PREV PAGE       TOP OF DOC
    Caring for our injured and wounded also means ensuring that they are fit and healthy before they deploy, while they are deployed, when they return home.

    We are very proud of our deployment health surveillance program that has resulted in our lowest disease, non-battle injury and illness rates of all time.

    While we recognize that the Air Force has a lower volume of returning patients than our Army and Navy counterparts, some of that low volume can be attributed to the prevention efforts that sent them to the theater healthy.

    We are also seeking to enhance unit performance for our troops through cutting-edge research and development, helping with the revitalized physical fitness program that will improve the safety and performance of our troops in the expeditionary environment and help them survive significant injury or illness.

    The Global War on Terror has underscored the contribution of a reliant reserve component. We are working very hard to ensure our reserve component members are given timely care and returned home quickly.

    When we need to extend them for medical purposes, they may be put on medical hold and can volunteer to be placed on military personnel appropriation, or MPA orders. This allows them to return to home stations, remain on active duty and receive their Air Force salary and health benefits.

    These MPA days make up a large number of our medical hold members, which have not been sizable through OEF and OIF.
 Page 93       PREV PAGE       TOP OF DOC

    In addition medical hold numbers due to all medical conditions have decreased steadily over the last 11 months by almost 50 percent.

    Our goal is to keep our guard and reserve members on active duty until we are assured that they have received all follow-up care needed to resolve their health issues.

    The Air Force medical service is proud to be part of a joint medical team that provides outstanding care to America's heroes for all services.

    Our focus on a fit and healthy force, human performance enhancement strategies and health surveillance programs promotes maximum capability for our total force warriors.

    When one of our warriors is ill or injured, we respond through a virtually seamless system from initial field response to stabilization care at our expeditionary surgical units and theater hospitals, to in-the-air critical care in the aeromedical evacuation system and ultimately home or, if necessary, to a military or V.A. medical treatment facility.

    At every step we are focused on ensuring that our soldiers, sailors, airmen and Marines, active duty, guard and reserve, are receiving the highest level of medical care that they deserve.

    We appreciate your support as we work together in this critically important task.
 Page 94       PREV PAGE       TOP OF DOC

    Thank you, Mr. Chairman.

    [The prepared statement of General Taylor can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you very much, General.

    Our last presenter is, as the saying goes, and it applies here, certainly not least, is Deputy Commandant from Manpower Reserve Affairs, Lieutenant General H.P. Osman, United States Marine Corps.

    I should note that Marines have a reputation of being singular and tough, but there is a reason that General Osman is appearing in Marine uniform by himself where the other services have two, and that is medical care is technically provided to the Marines—not technically, is provided to the Marines.

    So we welcome you, General, and look forward to your testimony.


    General OSMAN. Thank you, sir. Chairman McHugh, Congressman Snyder and other distinguished members of the committee, I thank you for the opportunity to appear before you today to represent to you the Marine Corps' absolute determination to take care of our seriously injured Marines.
 Page 95       PREV PAGE       TOP OF DOC

    Out of respect certainly to the two Marines on the panel, Dr. Snyder, Congressman Kline, I have to tell you that in my 36-plus years of active duty the best Marines I have ever seen are the ones we have today.

    And I think Sergeant Chandler was a good representative of that, and I can tell you that he is not the only one out there like that. There are whole lots of Sergeant Chandlers out in the Marine Corps today.

    As Marines, we pride ourselves in taking care of our own. Part of our ethos is ''Once a Marine, always a Marine.'' And we believe that.

    About a year ago this time we began to flow Marine forces back into Iraq through our security and stability operations piece.

    We realize that going into the Al Anbar province, and particularly the city of Fallujah, we were going to sustain causalities. We knew that before we went in.

    We began an aggressive program at that time to make sure that we could take care of those causalities. We knew they would be coming home.

    We saw four imperatives: first, that we would do whatever was necessary for the Marine to ensure he got the medical care he deserved, she deserved, when they returned home, and that we also took additional care to make sure that the families were there and that we could care for the families.
 Page 96       PREV PAGE       TOP OF DOC

    Second, we were going to fulfill the commandant's commitment that any seriously injured Marine, if he desired to stay on active duty, we would make that happen.

    Third, that for those Marines that decided that they would want to return home, that we would help that transition to make it as seamless as possible. In particular, we are working very closely with our associates in the Veterans Administration to make sure that happens.

    And fourth, make sure that we maximize the potential in our Marine For Life program. We have over 80 hometown links spread across this country to help Marines transition when they leave the Marine Corps.

    The program was designed to help a Marine who had served four years and honorably was returning home to help him find employment, help him with educational opportunity, these kinds of things.

    And we see these hometown links being particularly important as we look at our injured Marines returning home.

    We want to make sure that that injured Marine realizes he has always got a Marine to turn to if he needs help with V.A. benefits, education, or if just wants to stop by and exchange war stories, like Marines like to do.

    Ladies and gentlemen, I look forward to the opportunity to continue to work to support our injured Marines and their families. I thank you for the opportunity today to share my thoughts with you.
 Page 97       PREV PAGE       TOP OF DOC

    Thank you.

    [The prepared statement of General Osman can be viewed in the hard copy.]

    Mr. MCHUGH. Thank you very much, General. And, gentlemen, again, thank you all.

    As you know, this is the second hearing this subcommittee has had on this issue. And I think in fairness, we can say that progress has been made, and that is a tribute to the effort and concern that you have.

    But I do think we have a ways to go. We have not heard any testimony today with respect to the adequacy of housing for medical holdovers—that was a big issue in the first hearing. We have not really heard any testimony today with respect to Americans with Disability Act compliance and those kinds of housing opportunities. But while I understand the Army and others have taken steps to address that, I think that can best be characterized as a work in progress.

    I am inclined to submit for the record a question on that, where the plans are vis-a-vis the actual funding and the progress.

    And while I think changes have substantially been made, according to the field reports we have been receiving, that still remains a question that the medical-hold individuals find themselves in substandard housing.
 Page 98       PREV PAGE       TOP OF DOC

    As barracks are being rehabilitated, they are moved to another substandard set of barracks, and after that, previous barracks is rehabed and they move to the next one, they are then move to yet a subsequent substandard housing billet.

    So if General Hagenbeck or anyone else would like to comment on the status I would be happy to hear it or we could submit it for the record, whatever you are comfortable with.

    General HAGENBECK. Sir, I can address it in a broad vein.

    Mr. MCHUGH. Please.

    General HAGENBECK. Of course, as you well know, this falls under our Assistant Secretary of the Army for Manpower and Reserve Affairs. And they have oversight of that and they have teams in the field right now doing exactly that.

    A program was laid out based on a lot of things that this committee brought to our attention at this time last year. Money was put against that for the barracks and housing, and there is a plan that is overseen and approved by the Vice Chief of Staff of the Army for improvement across the installations and posts. And we can get specifics back to you of how that money is allocated and to which post in priority.

    Mr. MCHUGH. I would appreciate that, and not just how the plan is to allocate the money, but are the resources in the recent budget request and how that will flesh out over time.
 Page 99       PREV PAGE       TOP OF DOC

    But we can do that for the record, because it was not exactly on point of this hearing.

    I have no doubt that each one of you gentlemen believe very strongly that we are operating and in fact need to operate a seamless military.

    I have been in and out of Iraq now five times. Forty-three percent of the troops on the ground there are from the reserve component, guard and reserve. We could not do it without them, and I do not need to tell you folks that.

    However, lest you think we went fishing for disaffected and troubled individuals for the first panel, we did not. They are truly, on the reserve side, the first two witnesses, symptomatic of a broader range of input we have received.

    Two of our professional staff members, on both the majority and minority side, have been out there. Ms. James and Ms. Wada have traveled to bases across all of the service branches, have talked to active and reserve folks.

    And what we repeatedly hear is what you heard commented upon in the first panel, that in perhaps subtle but very important ways, there are differences as to how the active component is treated, in these circumstances, from the reserve.

    I know that is not what you want, but I do not see how we deny that as a reality.
 Page 100       PREV PAGE       TOP OF DOC

    I would fully expect that in fact, in our oversight capacity, we would demand that you go back and try to take a look at this. And I do not mean to sound so strident about it. I know you will, because I know you care. But we are very concerned about that.

    Any comments on what you heard from the first panel about that two-track process in far too many ways? Admiral.

    Admiral HOEWING. I would just like to make a comment. You are absolutely right, Mr. Chairman, it is so important that every sailor is a sailor in the United States Navy.

    There is no difference between an active duty sailor and a reserve, and I feel like it is our responsibility to make sure that we close those gaps wherever we possibly can.

    I would like to quickly mention a couple things that have happened in the Navy since the testimony about a year or so ago. Because of some of those demobilization problems that we were facing at the time, we have completely revamped our Navy mobilization processing system to where we now do it through two sites instead of doing it through multiple. It allows better training and education of our folks that actually do those things.

    We have created a comprehensive demobilization checklist. We have put additional training for our medical support folks in the administrative process. We have assigned primary care managers now to all of our folks to be able to help them in this assistance.

 Page 101       PREV PAGE       TOP OF DOC
    What I learned today is that there is a difference between our limited duty processing capability and the medical hold processing.

    I need to go back and find out what those differences are, because the intention of the medical hold process is to provide those same cares and those same protections to the individuals. And we have to understand what those differences are. And I take that on personally to go back and take that one on.

    Mr. MCHUGH. I appreciate that. Let me ask you a follow-up. You heard the first panelist and the petty officer comment that his—and I think that he has been accurately informed—that there is no limited duty for the reserve component, LIMDU, in the Navy. Can you tell this panel why that is the case and the reason behind it?

    Admiral HOEWING. The medical hold is the terminology we use for limited duty for our reservists. They go on medical hold because, at the demobilization process, the outcome is different in that we are returning those folks back to their families, back to their homes as they leave the service.

    And I think there is an internal process that could be causing some of the frustration, in that those folks that are on medical hold have to come back and request to remain on medical hold status. And that is where I want to back and see if we can't align, through our business process, between the surgeon general and myself, making it exactly the same as the limited duty process.

    Mr. MCHUGH. Yes, because obviously that is important. And I do not think anybody should disagree—perhaps they would—but they should not disagree that if your ultimate outcome, as a difference between active and reserve exists, then you have to treat them differently.
 Page 102       PREV PAGE       TOP OF DOC

    But the suggestion is that that difference in classification is having a real difference in how the individual is treated while they are in that status, while they are on the medical hold, or LIMDU, in terms of actives.

    So we certainly encourage you to look at that. And maybe we could submit a question for the record so that you could follow back on that.

    I had a whole lot of other questions, but we have some very loyal panelists here, and I want to yield to the ranking member, the gentleman from Arkansas, Dr. Snyder.

    Dr. SNYDER. Thank you, Mr. Chairman.

    I mean, you are right to point out that we have a lot of questions and confusions in our mind, but it is a very complex topic—multiple topics, and I am not sure how we are going to sort all this out as the time moves by.

    I recall, General Osman, years ago in my Vietnam days—by the way, we are going to need to get an astronomer, Mr. Chairman, we have so many stars at this table today, to sort it all out.

    But I remember being—well, I think I was 21 on some kind of little honor guard for, I believe it was Admiral McCain. I think he was in charge of the forces of the Pacific at the time, John McCain's father. And so there was about as many three-star generals with him as there are here today.
 Page 103       PREV PAGE       TOP OF DOC

    And, of course, as a 21-year-old E3, I think at the time, we thought that a lieutenant general was a god. General Osman still is. [Laughter.]

    But you are not. You are people trying to sort out what our petty officer talked about, the bureaucracy, and these are difficult challenges.

    General Hagenbeck made the point that this committee has brought to your attention some things last year.

    Well, I hope that is not our job to do that. I mean, the papers were filed with stories. I would hope that there is a system out there to monitor. I mean, I hope that you are sending staff out like these folks went out and look for problems as a way of staying on top of it.

    I had some specific question—I guess, one further comment: this issue between how we treat the active component and the reserve component.

    I remember when I was in medical school, I had a very elegant, old ophthalmologist as one of the instructors who used the rule of Baby Bear's porridge: that it has to be just right.

    The reality is, the active component is not the same as the reserve component, and it ought to be from the chaplain's perspective, I think. But it may not be from General Brady's perspective when he is talking about employment opportunities ahead.
 Page 104       PREV PAGE       TOP OF DOC

    Because you have one guy that very much wants to stay in the military and you have another person who has a hardware store he owns back home and he needs to get back, he has to be rehabilitated enough he can run his hardware store.

    If I am greeting people at a base when there are new folks just coming in, the Marines, General Osman, at Camp Pendleton, I have reservists mixed with active duty folks, well, I know I probably got my active guy who has probably got his family just a few miles away.

    My reserve component guy, his family—we have a Marine Corps Reserve unit in Little Rock—may be in Arkansas, and I need to treat him differently because he has no family support.

    So I do not know how we do this to get this just right, because there are different expectations for the reserve component and the active component. But we continue to hear stories that we do not have it just right yet.

    And then we have this whole issue of the GAO study that came out in February 2005 that talked about how the Army—what is the title of that study? It is the military pay, ''Gaps In Pay And Benefits Create Financial Hardships For Injured Army National Guard And Reserve Soldiers.''

    And I think the Army acknowledged in there, the Pentagon acknowledged it, there is work to be done on how we deal with those things.

 Page 105       PREV PAGE       TOP OF DOC
    I wanted to ask a couple of specific questions—and I think to our surgeons general.

    Why is it that when the National Guard and the Army Reserve were mobilized in large numbers over the last couple of years that the figure that we were told is at about one in five—about 20 percent—were not medically fit for deployment?

    But when the Navy Reserve and the Marine Corps Reserve mobilized people for deployment, that the number was less than two percent or three percent?

    Why is there such a dramatic difference in the medically fit for duty between the Marine Corps Reserve and the Navy Reserve and the——

    Mr. MCHUGH. A truly excellent question.

    Dr. SNYDER. Well, thank you. General Osman, you want to start?

    General OSMAN. Based on the discussion that we had briefly yesterday, I did some research to see what percentage of our mobilized reserves were not brought on active duty because of medical problems. And it turned out to be literally less than one percent. So a very, very small percentage.

    And as I began to try to figure out why that was so, because as you pointed out, they certainly do not have access to regular military medical care within the reserve unit.
 Page 106       PREV PAGE       TOP OF DOC

    Several things: One, the training that we do, mobilization exercises, identify individuals that possibly could be having medical problems so they can be addressed before we actually conduct a real mobilization.

    Second thing may be, in our reserve units we have active duty Marines. It is called the INI staff. And those active duty Marines are there to help ensure that the reservists are in fact as ready as possible should they have to be mobilized.

    And I think that close attention to the reservists from the active duty side is a big part of it.

    Often times we hear the expression ''total force.'' I really believe that it is a true term to describe Marines.

    And it is amazing to me, as I have worked with a lot of Reserve Marines in the last several years, I never know whether they are active or reserve unless they raise the issue with me just in a casual conversation.

    So I think it is a combination of these things that have allowed us to maybe succeed in that particular areas.

    Dr. SNYDER. Admiral Arthur, do you have a comment on that?

    Admiral ARTHUR. I know our rate I believe was 1.3 percent, and I think we did some things 2 or 3 years ago which really affected the commander officer's visibility of his or her Marines and sailors, and that is, we made officers responsible on their fitness reports to their higher authorities for the medical status, the readiness, of their sailors and Marines.
 Page 107       PREV PAGE       TOP OF DOC

    We also really had strict compliance with those readiness requirements.

    We also might not have used as many Individual Ready Reserve (IRR) people and might have had more—so I am not sure of why we were so low. But I know that we pay a lot of attention to that medical aspects very much.

    General WEBB. Yes, sir, our figures show that, upon mobilization, somewhere between two percent and four percent of the reservists that were mobilized had conditions that would not allow them to be deployable as is.

    Dr. SNYDER. That is not the number that we had been told. We had been told 20 percent—one in five. Now, why do we have that discrepancy in number?

    General WEBB. Upon mobilization, we see that two percent to four percent. Upon deployment, during that cycle of deployment, we see six percent to eight percent. And upon redeployment, there is another percentage.

    So the cumulative percent today is roughly 10 percent to 12 percent of it.

    Dr. SNYDER. Well, maybe we can sort out that number. I mean, I thought I was told very definitively by, I don't know, I think the Arkansas National Guard, that this one in five number, but your number does not get to one in five.

    Well, in the interest of time, Mr. Chairman, I think I will—thank you.
 Page 108       PREV PAGE       TOP OF DOC

    Mr. MCHUGH. Yes, I would associate myself with the ranking members's comments. The figures that we had been informed of were substantially higher than that. So clearly we need to look into that more deeply.

    I think the answer is quite simple. As was said, you have to make those in command responsible for who they rate ready for deployment and who they don't. And I don't think that has happened uniformly. But in any event, enough pontificating on my part.

    The gentlelady from California, Ms. Sanchez.

    Ms. SANCHEZ. Thank you, Mr. Chairman. And thank you, gentlemen, for being before us. You are right, it is a bunch of stars, Vic.

    I have a question. I am sure you are aware of the current legislative proposals to dramatically enhance the death gratuity payable to deceased servicemen's next of kin from the current $12,000 to $100,000. There has been a lot in the paper about it, et cetera, and we have had a bill here in the House.

    The same proposal would also increase the amount of Servicemembers Group Life Insurance (SGLI) insurance. These proposals are motivated by a sound desire to assist families to recover from long-term costs associated with the death of a service man.

    Yet when a service man is severely wounded, and forced into disability retirement, he and his family often face equally daunting long-term costs as they struggle to adjust to the life of pain, disability and earning limitations.
 Page 109       PREV PAGE       TOP OF DOC

    In light of those realities I am look at introducing some legislation to provide for a lump sum gratuity for our disabled troops at the time of discharge.

    There is existing authority in Title 10 for disability severance pay and I would like to see that greatly enhanced. The rationale is exactly the same as the death gratuity; in some ways even more compelling.

    The money would help ameliorate the transition to a life of painful struggle for the soldier and his family. It would pay off debt, provide a foundation of savings, offset the loss of income during the long period of therapy, purchase time off from work for a spouse or parent, and give the disabled troop a head start on a hard road.

    Unlike the survivors of a deceased soldier, the family of the disabled gets zero life insurance and they have to adjust for caring for the wounded. I would like to know whether you gentlemen would support this type of a concept in principle.

    Maybe we will start here and go down the line.

    General HAGENBECK. Absolutely. I am very supportive of that philosophically. I will leave it up to the money changers to figure out how to do it.

    We owe these young soldiers, sailors, airmen and Marines that have served our country. We cannot leave them in the lurch. We have to take care of them. And if that is the best way to do it then I certainly support it.
 Page 110       PREV PAGE       TOP OF DOC

    General WEBB. Yes, ma'am, I am always supportive of initiatives that will assist our service men.

    Admiral HOEWING. The same way, ma'am. It is very important that we be able to provide that transition opportunity for families and support any opportunity and look forward to see.

    Admiral ARTHUR. Yes, ma'am, thank you for that proposal.

    I have two comments. One is the word gratuity. I am not sure if that is the right word, because our folks are real American heroes and there might be another word that honors them.

    The second comment I would make is if it is a lump sum, I would like somebody to tailor that. Because there are some injuries that are relatively minor, and others where we are dealing with paraplegics, quadriplegics, where there are lifetime impacts that I think we have to have the flexibility to be able to accommodate the most serious of our injured.

    Ms. SANCHEZ. And I think, when we are looking at this, as we are looking through the definitions of disabled, et cetera, we are actually looking at those who are much more disabled, if you will, and really have the lifetime pain and the family really is affected by that.

    Admiral ARTHUR. I would also extend some government programs for hiring people who are disabled in one way or another but fully able to work.
 Page 111       PREV PAGE       TOP OF DOC

    General BRADY. Yes, ma'am, absolutely we support your efforts and appreciate your efforts to support our wounded. We are pleased to be working with you and your staff, sorting out what the appropriate details are.

    General OSMAN. Congresswoman Sanchez, as I mentioned in my remarks the importance of the transition piece, and it sounds like you have offered up another way to assist in that transition process. If we identify individuals who truly are going to have long-term suffering there is absolutely no possibility for further service. I think your idea has some special merit.

    Ms. SANCHEZ. I did notice that you did comment on that in your remarks. We will be working, hopefully with our chairman and with our ranking member to see if we cannot put something out there. I thank you.

    I have some other questions, but I will submit them for the record, Mr. Chairman.

    Mr. MCHUGH. The gentlelady yields back 33 seconds, thank you.

    Ms. SANCHEZ. Do I get that some other time?

    Mr. MCHUGH. We will talk about it. We will talk about it. The gentleman from Minnesota, Mr. Kline.

 Page 112       PREV PAGE       TOP OF DOC
    Mr. KLINE. Thank you, Mr. Chairman. Thank you, gentlemen, for being here.

    General Osman pointed out that with, I think that with Dr. Snyder and I here we are at way more than critical mass for Marines in the House. We represent about 40 percent, I think, now you and I. And that is a good thing.

    I want to follow up on what I was talking to the first panel about and what has been mentioned here.

    I think that Dr. Snyder made the point that, while we talk about the total force—and I believe that when a soldier, sailor, airman or Marine is wounded, whether they are active or reserve component, that the corpsman or medics is treating them the same, that the hospital is treating them the same. They are getting terrific medical care and we heard that from the first panel.

    And just by the way with the Air Force here, I had the opportunity when I was over in Iraq a few weeks ago to look at that air evacuation stream that takes these wounded from Baghdad to Landstuhl and back here. And it is remarkable that with some—a number like 19,000 that have been moved to that system, only one has died in that air transport. And that really, really is amazing.

    So again, my point is, is that active or reserve, in terms of treating the wounded on the battlefield, in the hospital, in transport, I think it is about the same.

 Page 113       PREV PAGE       TOP OF DOC
    But there is a difference that was pointed out here. When a soldier or Marine—and Sergeant Chandler was a terrific example, and the senior airman. They are part of an active duty family. They usually have an Army or Navy or Air Force hospital that is close by. They stay there. They are surrounded by other members of the service.

    They are in a family that takes them forward. Their employer continues to be the Marine Corps or the Army or the Navy or the Air Force.

    But if you are a member of the reserve component, you start—I believe and I am afraid that you start to be pulled away from that family.

    You go back to an employer that is not the Marine Corps or the Army or the Navy or the Air Force, you are often far removed from that military hospital and you are getting your follow-on care in a V.A. hospital, or you may not even be close to one of those.

    And so I am very concerned that we look at how we are dealing with that transition from Walter Reed or Bethesda to back to work for the members of the reserve component.

    And it sounds like the Army has, with it is medical holdover program, the MHOs, and you go into some regional areas, that you are starting to look at that.

    The Air Force, it sounded like that you are as well.

    But I wonder if you just could very briefly address my concerns there and tell me if I am missing the boat here and what is happening with the members of the guard and reserve as they make that transition.
 Page 114       PREV PAGE       TOP OF DOC

    And I know we do not have much time, so start with the Army.

    General WEBB. One of our concerns with that population was that we not isolate them, that we not have the perception from their viewpoint, or anybody else's, that they were a different category or a different class.

    Also, our concern that part of the healing process is allowing them to be close to that support network, particularly the families, and that is one of the reasons that we went to community-based health care organizations, to get them back with that support—a young program encouraging and that I believe you would find a majority of the people that are in that program are very satisfied with it thus far.

    General HAGENBECK. Just a follow-up on that from the procedural standpoint.

    Both General Helmly and General Schultz are both committed to ensuring that their chain of command remains engaged with their young soldiers as well.

    And additionally, we are looking at some processes that we think can also help in the transition back. And we are looking at how we can expand that. If I get an opportunity later today to talk about the disabled soldiers support system, that is somewhat the genesis of what we are looking at for the future.

    Admiral HOEWING. Very quickly, sir, I am going to yield to the surgeon general on the medical aspects. But you are going to hear from the Marines about the Marine For Life program and how they have expanded that.
 Page 115       PREV PAGE       TOP OF DOC

    We are using many of those same techniques to make sure that not only our wounded, as they go back to their community, but also those that are leaving the demobilization process are being linked to the communities also.

    Admiral ARTHUR. Quickly, I chagrin to hear that perhaps we have a difference in the definitions of MEDHOLD versus limited duty. We are going to look at those.

    But as far as the Navy is concerned, we don't care whether it is active or reserve, Army, Navy or Marine Corps, Coast Guard, Air Force, it does not matter.

    Mr. MCHUGH. Your time has actually expired. But I hear rumors that General Brady talks so quickly that time actually reverses. So I would be happy to hear him.

    General BRADY. Our kind tend to be members of wings and units. So when they go back to a wing, that is where they demobilize from.

    They are also with units, so they have assigned medical personnel. So that helps them make that transition.

    Our Helping Airmen Recover Together, HART program, is a follow-on program that stays with them for five years, even if they separate from us. So we have lots of ways to do that.

    The joint supporting operating center that the Office of the Secretary of Defense (OSD), set up is also a benefit of them over and above what the individual services do. That is going to help us as a Department of Defense track our people longer-term.
 Page 116       PREV PAGE       TOP OF DOC

    Mr. MCHUGH. And I am going to assume that either or both of you gentlemen want to respond. I would suggest that, gentlemen, we move to a written question. We do have two panel members who have yet to question. If we have not been called to a vote, we can go back for oral response.

    Mrs. Drake is next. The gentlelady from Virginia, Ms. Drake.

    Mrs. DRAKE. Thank you, Mr. Chairman. I have a couple of questions.

    First of all, it was very clear you do everything you do to retain the servicemember as an active duty member. But from panel one, they seem to be of the thought you do everything you can do to separate a reservist. Could you comment on that? Is that truly the way?

    I mean, neither one of them were separated, who were here today, but that seemed to be the thought process.

    Can you also look at that, too, and see if that is a true statement? Or maybe it was just their perception.

    Admiral ARTHUR. Ma'am, I think there may be two different philosophies of the active duty. Our goal in active duty is to get them back to duty, and we try to do that as soon as possible.

 Page 117       PREV PAGE       TOP OF DOC
    We had two people come back who were injured, medical people who were injured who had lost extremities and both were retained on active duty and worked at Bethesda.

    Our aim with the reservists, however, most of the time, is to get them back to their homes, to their jobs, to their communities, because that is really where they would rather be.

    Mrs. DRAKE. Maybe that is the problem, then, is they are perceiving you are trying to get them out where you are thinking you are doing a good thing to get them back to their families.

    Admiral ARTHUR. We would like to have them back with their families. But if we want to get them back with as much of their treatment necessary.

    Now, if they have broken and arm and they are in a cast, with a simple fracture, they can go back home and heal and have follow up.

    But if there are some complicated things such as an extremity loss, where I think the world's experts are at Walter Reed and other places where the military deals with this, perhaps it is better for the member to either have that rehabilitations in the military hospitals or at a Veterans Administration hospital close to their home of record so that they can at least be home with their mothers, fathers and wives and family.

    Mrs. DRAKE. So maybe we can look at explaining that to them better, as you begin to look at the other difference.
 Page 118       PREV PAGE       TOP OF DOC

    Another question I have is: What are we doing to streamline this medical check-up process so they can be seen in their community-based health care?

    You said you have one in Virginia Beach. But information we have is that it is very low numbers in comparison, people who are able to use those centers. Is that——

    General WEBB. Well, today currently we have about 1,500 solders that have transferred to the CBHCO. There are a few conditions that we feel are best treated in our Medical Training Facilities (MTFs).

    Anytime we look at transferring a patient to the CBHCO, need to make sure they can be handled there, both administratively, but also that the health care that they are going to require is available locally. So that is one important factor.

    Another issue is that soldiers that want to go home, we should be able to look at a way of getting them home. And there are some locations where administratively we are not capable today of transferring additional patients.

    Originally we were set up for about a 300-person cap per location, and we are in the process now of increasing the staff so that we can raise that up to 500 or whatever may become necessary.

    Mrs. DRAKE. The last question I have deals with this continuation of care, whether in the community or in the military facility, because we heard—certainly they get excellent care at Walter Reed.
 Page 119       PREV PAGE       TOP OF DOC

    But then when they go back into active duty, is there any priority there on how servicemembers are seen based on their needs? Because we seem to hear in panel one that they did not feel that was adequate enough to get back in.

    And it may be the adjustment from the great care at Walter Reed to the regular care, just like when a person leaves intensive care and goes to a regular room, there is a little difference until they adjust to that.

    General TAYLOR. Just to comment from my perspective I think you probably picked it outright. Certainly for all airmen that are seen by our medical treatment facilities, we strive to give them a proper balance in access, urgent care, for routine care, and for follow-up and for consultant care.

    I also understand that a lot of those people—for example, Airman Pizzifred returned to San Antonio at Lackland Air Base. That same facility has people, specialists, deployed to Balad right now.

    So we strive very strongly to try and keep access after these folks.

    But I would agree, probably your preliminary assessment is right, that as you step down in care and return to regular flying of the Air Force, there is a difference from being an amputee at Walter Reed and being back in the line of the Air Force again.

    But certainly we all strive to provide the access to that everyone deserves.
 Page 120       PREV PAGE       TOP OF DOC

    Mrs. DRAKE. And I would just like you to look at that. Are we not seeing people as quickly as we should for their particular need?

    General TAYLOR. Correct, yes, ma'am.

    Mr. MCHUGH. The time of the gentlelady has expired. I would associate myself with her comments. I think we got the Paul Newman failure to communicate syndrome here in some instances.

    The first hearing we had, we heard many, many complaints that medical holds was ongoing too long, that folks were being positioned in places that did not need to be and wanted to get back home.

    The Army establishes their community-based program, and we are hearing now that some folks feel they are being flushed out before they are ready to go home.

    I suspect there is a difference in quality of care and levels and such.

    Ms. Drake I think has struck on an appropriate point about needing to make sure we are not moving people downstream who in fact medically should not be.

    But beyond that, I think it comes back to a question of information to those in the system and urge you to certainly focus on that even more diligently than we hope you have.
 Page 121       PREV PAGE       TOP OF DOC

    The gentlelady from California, Ms. Davis.

    Ms. DAVIS OF CALIFORNIA. Thank you. Thank you, Mr. Chairman. Thank you to all of you for being here. And just to follow up on that, I think the flushing comment was based on the perception, I believe, from a prior hearing that in fact people who were within the bureaucracy were getting more credit for demobilizing the guard or reserve than for making sure that there was a seamless transition for them.

    And it sounds as if you are certainly taking a look at that and we are working with it.

    But if that is the perception out there, even though it may not be the reality, then we obviously have a problem, and I appreciate the fact that you are addressing it.

    I wonder, Lieutenant General, if you could speak for a second to the disabled soldier support system. And what I want to ask you within that, because we have limited time, is not so much to give us perhaps what is a really good story about how that has developed. But it is my understanding that this was not in place, obviously, until about a year ago. And it was put in place because the system was unwieldy, people were not being served properly.

    If we are to look to a few years from now and we say, ''Well, we had this disabled soldier support system in place,'' what do you think, looking down the line, we would say? ''Wow, we missed this''? You know, these were the areas that we did not address, and how can we be a little more aggressive right now about trying to address those up front?
 Page 122       PREV PAGE       TOP OF DOC

    General HAGENBECK. Well, thank you, ma'am, that is a great question. And I hope we do not have to wait several years to find out the holes in it.

    What we are doing right now is that—we call it an after-action review that we are doing every quarter, every three months. And we are bringing in families and those disabled soldiers to go completely through the process.

    And, as you know, the acronym DS3 is a network, an advocacy group, if you will, that a soldier is assigned by face to a particular case manager who works all of those seams on problems that may arise, whether they are financial problems, transition back to hometown, USA, problems with the Veterans Administration, if that were to happen.

    And so, we are actually cataloguing and tracking all of that right now to ensure that we can make this seamless for them as they transition back into their communities.

    Ms. DAVIS OF CALIFORNIA. Do you feel that the training for those individuals is what it should be? Do we have enough people that are engaged on doing that? Are we building largely on a volunteer corps in some cases?

    General HAGENBECK. No, ma'am. First of all, I cannot answer the question if the training is adequate. We have put a program in place. This spring, we have begun the hiring of 46 contractors to help us with it.

    Right now, the applications, I think with one exception, are previously uniformed personnel—primarily Army but some Marines as well, headed by a uniformed colonel—and we put over $10 million against this for this fiscal year.
 Page 123       PREV PAGE       TOP OF DOC

    And so this is becoming institutionalized. We do have a training program for all. It is not a matter of—it is not a job placement program, for certain. We are only hiring people whose hearts are in the right place to do this.

    So we think we are going down the right path, but we will continue to adjust as we need to.

    Ms. DAVIS OF CALIFORNIA. Thank you. Thank you, Mr. Chairman. And I know that today we have really focused more on physical disabilities. And I hope that this committee is going to also be dealing with the mental health problems of our servicemembers returning from Iraq and Afghanistan. I look forward to those hearings as well. Thank you.

    Mr. MCHUGH. I thank the gentlelady and, as always, I deeply appreciate her participation.

    As promised, because the bells have not rung for a vote, we could return to my colleague from Minnesota's earlier question that everyone but General Taylor and General Osman got to respond to. Do you want to refresh their memories?

    Mr. KLINE. Yes, thank you. I am familiar with the Marine For Life program, so General Osman does not have to explain that if that is where he was going.

    And if General Taylor had any comments about how we are taking care of those members of the reserve component who are back.
 Page 124       PREV PAGE       TOP OF DOC

    General TAYLOR. I think the reason I was blinking is because General Brady and I teamed together pretty strongly on all of this. The Air Force is established differently because we have medical units within the wings, and those medical units are responsible for the health of those troops.

    So, certainly, if you have a wing that has an injured guardsman or reservist return, they are going to be working their local providers for trying to work those people into the system.

    So we usually do not have that much of a problem locally, because there is a local advocate for every injured or ill person that returns to home station.

    One of the things that we have to work very carefully on and we continue to work with our Veterans Administration colleagues for those folks that are separated from the Air Force due to illness or injury and ensure we get as timely a handover as we spoke in the opening about medical record information to ensure that we have a seamless handover.

    And certainly as we continue to field the very these very advanced prosthetics you see these soldiers, Marines and airmen wearing, we have to make sure that this is now a lifetime investment we have in these people.

    We need to make sure that we continue to invest in the technology and the follow-up for this care, whether they remain in the Air Force or they will turn into veterans one day and be eligible for care in the V.A. situation.
 Page 125       PREV PAGE       TOP OF DOC

    So I know that the Army is working very hard in our outreach program to make sure they are tracking each amputee and making sure that handoff is great and we continue to advance the science across the system, the military system and the veteran system. .

    Mr. KLINE. Okay, thank you, Mr. Chairman.

    Mr. MCHUGH. I would be happy to yield to the distinguished Ranking Member.

    Dr. SNYDER. Thank you, Mr. Chairman. I have two questions I wanted to ask, first to General Osman and General Hagenbeck. We had the two very eloquent statements by our two young men who received bad injuries but are continuing their military career, one from the Air Force and one from the Marine Corps.

    Is there a difference in the way the Army—difference between the Army and the Marine Corps in the way you administratively look at these young folks who have these kinds of injuries in terms of their continuing their career in the military or getting out in terms of how they are evaluated, disability rating, how they will be treated at the completion of their military career in terms of the information they are given?

    Are you aware of any differences between you all?

    General OSMAN. It is difficult to speak for how the Army operates, but I would think it would be very similar.
 Page 126       PREV PAGE       TOP OF DOC

    And, obviously, we partner very closely with the Navy. The Physical Evaluation Board is a board that consists of line officers as well as doctors to make the determination as to whether or not the individual is fit for duty.

    There is an informal board that is held initially to give the individual an opportunity to try to, in a very quick manner, determine whether or not he is fit for duty.

    Dr. SNYDER. You have that subsequent question, though: At some point, Sergeant Chandler will retire, and then it becomes an issue of, is he being given the same information in terms of how he will be treated by the military on retirement in terms of disability.

    Do you have a sense of that?

    General OSMAN. Again, an individual who is leaving the Marine Corps goes through a fairly exhaustive transition program to ensure he fully understands the benefits to which he will be entitled either from the service or from the V.A.

    So I am absolutely convinced that when Sergeant Chandler—probably Sergeant Major Chandler someday when he retires—will thoroughly understand what is going to be available to him and ensure that he is cared for the rest of his life.

    General HAGENBECK. I would suspect, from a legal aspect, that we are under the same provisions, but we will close the gap with the Marine Corps to make sure, in fact, that that approach is the same.
 Page 127       PREV PAGE       TOP OF DOC

    I will tell you that since 9/11, our approach also has been to—it is really a cultural change inside the Army.

    In previous years, back through at least the year tenure in the Marine Corps, from an Army perspective because of the different kinds of forces that we had, it was often getting wounded was looking at a ticket out of theater and coming back to the world—and you have experienced that.

    These young soldiers in the volunteer Army don't want to hear that. You know, when they are wounded in Iraq or Afghanistan, they are on a litter getting put on a MEDEVAC helicopter. They don't want to hear a medic telling them, ''That is your ticket out of here. You are going back home, and you are going to be out of the Army.'' They want to stay on the team.

    And so from a philosophical standpoint, we have taken that on so that upon arrival at Walter Reed, or wherever they go from Landstuhl, that we now have people on site that ensure that they are told that if they want to remain a member of the Army team that we will go to extraordinary lengths to make sure that happens.

    Dr. SNYDER. May I do that as a question for the record, perhaps, jointly to you, General Osman, and you, General Hagenbeck, to put your heads together and see in terms of how the expectations of these young folks at the completion of their military career, are you all giving them the same information, and the expectation is will they be treated the same?

 Page 128       PREV PAGE       TOP OF DOC
    I am told that the incentive may be a more positive one for a young Marine to complete his military career with an injury than in the Army. I do not know if that is accurate or not.

    My second question is—and you were touching on it, I think, General Brady—with regard to the V.A. and the transfer of military records.

    I am told that it is not very good, that we have been talking and struggling with this for 20 years, that we still have issues of how, when a person is not getting out of the military and wants to go be picked up by the V.A., that we still struggle with this issue of transfer of medical records.

    It is also my understanding that there really are some problems with regard to mental health services, that when a person is in—for a variety of reasons. It may be partly due to what the person in the military is saying that there is somewhat of an incentive for people not to come forward and say they are having mental health problems while they are still on active duty.

    But when they show up at the V.A., that may be their number one complaint, you know, ''I have been having nightmares and sleepwalking and lots of things for the last eight months ever since I got back,'' and yet they have not—that is not in their records anyway.

    I do not know what the answer is on that, but those are the two issues.

    When I fished around today with the staff at the Veterans Affairs Committee, we still have not found the medical records being transferred properly, and the active component is not giving accurate information about what the mental health status is of these folks.
 Page 129       PREV PAGE       TOP OF DOC

    General BRADY. Sir, I will clear all the details with Dr. Taylor, but clearly there is work to be done in process in terms of the—start to take over the yearly physicals, et cetera, for the V.A.

    So there's some real bureaucracy there and perhaps redundancy in terms of we ought to be able to work—when it's pretty clear that the individual is not going to stay on active duty and is going to go into the system, that we ought to start working—be able to work that sooner and have it be more receptive to work him into the V.A. system.

    General TAYLOR. Just a few comments.

    We have been working very hard for the last four years on closing the gap between the DOD and V.A. This is one of the president's 14 management initiatives, is to close that gap.

    We are working very hard on electronic medical records.

    As you know, the V.A. has an electronic system. The military is building an electronic system today that will be able to eventually read each other's medical records.

    So there is going to be an electronic medical records solution to this flow of information coming very soon, within a couple of years.

    One of the wonderful things that the V.A. did very early on was place V.A. counselors in the major medical centers where folks that are ill and injured are coming back.
 Page 130       PREV PAGE       TOP OF DOC

    So that has been able to kick start the process very early so that the members, the active duty and guard and reserve members, knew what they had to go through for a V.A. processing, and V.A. was aware of the issues on the other end.

    There is an incredible amount of work being done in the department right now, strategical levels, strategic and tactical levels, to try and close these gaps.

    And I am sure we will get a chance to talk more about this in the future.

    Mr. MCHUGH. I thank the gentleman.

    I would say just in closing—because as we have all heard, we have been called for a vote—I think all of us, the members of the second panel and everyone on this subcommittee, are very privileged, because we are privileged jointly to serve the same people represented by the first panel—heroes, folks who are both active and reserve want nothing more than to get back to their units, get back to service.

    And I know you share our concern that we do the best job we possibly can. The fact of the matter is, we not only can do better, we have to do better.

    We have brought up some issues today that we will follow up with written questions, whether it is on the issue of ADA compliance and housing, or the issue of consistency across the board, both within the services and amongst the services, on disability ratings, medical boards, application and such that are key to ensuring that this system works from beginning to end.
 Page 131       PREV PAGE       TOP OF DOC

    And I am not about to lecture any of you gentlemen as to those component parts. But it is our job to try to encourage and ensure that progress is being made and we are going to do that.

    And to the extent that we need to get back here again in the future, we will. I suspect that will be the case at some point. But thank you for your efforts thus far.

    As I said in my opening comments, no one here questions your dedication to the objective or your great desire to try to do the best by those whom you serve, incredible men and women in uniform in service to this nation.

    So with that and our appreciation and anticipation of your very studious and learned and very satisfying response to our written questions when submitted, we will adjourn this subcommittee and wait for the next subject to the call of the chair.

    Subcommittee is adjourned.

    [Whereupon, at 12:52 p.m., the subcommittee was adjourned.]