Bush Panel Seeks Overhaul in Care of Wounded GIs

Panel promotes changes in the way the government determines disability status and benefits
by Jim Rutenberg and David S. Cloud

WASHINGTON: A presidential panel on military and veterans health care released a report Wednesday concluding that the system was insufficient for the demands of two modern wars and called for improvements, including far-reaching changes in the way the government determines the disability status and benefits of injured soldiers and veterans.

The bipartisan commission made 35 recommendations that included expanded and improved treatment of traumatic brain injuries and the type of post-traumatic stress disorders that overwhelmed public mental health facilities during the Vietnam era but remain stigmatized to this day.

President George W. Bush told reporters at the White House late Wednesday that he had directed Robert Gates, the defense secretary, and Jim Nicholson, secretary of veterans affairs, "to take them seriously, and to implement them, so that we can say with certainty that any soldier who has been hurt will get the best possible care and treatment that this government can offer."

The commission said fully carrying out its recommendations would cost $500 million a year for the time being, and $1 billion annually years from now as the current crop of fresh veterans and active military members ages and new personnel is in place…

The report was spurred by a series of embarrassing news reports about the substandard treatment returning soldiers received at Walter Reed Army Medical Center, which for years had been held up by politicians, including the president, as providing unparalleled care to American troops.

Bush named the nine-member President's Commission on Care for America's Returning Wounded Warriors in March, with Bob Dole, the former Republican Senate leader, and Donna Shalala, the former Clinton administration health and human services secretary, as its leaders.

The commission's report went beyond just the problems at Walter Reed. It proposed fixes for longstanding concerns about disparities in treatment and benefits at Department of Defense facilities, for active-duty military personnel and the Department of Veterans Affairs facilities, which treat the retired. It also recommended cutting the red tape that frustrates military families.

"This is a major overhaul and a simplification and a rationalization of the disability system in this country for our veterans," Shalala told reporters Wednesday.

The report also focused on treatment, calling for more aggressive attention to potential brain trauma caused by roadside bombs.

Even as it called for change, the report avoided harsh assessment of the administration's handling of the military and veterans health care systems. Rather, it portrayed many of the problems it was seeking to fix as resulting from advances in modern medicine that have allowed soldiers to survive injuries that would have killed them in previous wars.

"While numerous aspects of U.S. medical care are excellent, problems in coordination and continuity of care are common," the report said. "Our overall health system is oriented to acute care, not long-term rehabilitation."

And, it acknowledged, "Many of the concerns already are being addressed by Congress and in the two departments."

Indeed, the panel's recommendations came on the same day the Senate approved several related measures. The chamber approved a 3.5 percent pay raise for military personnel and the creation of programs to improve the oversight of injured service members as they move through the system, and to improve the treatment of brain injuries and stress disorders.

The most far-reaching of the commission's recommendations involve restructuring the Defense Department's disability and compensation system, which has provoked complaints from many military personnel. Currently, injured service members go through an elaborate process to assess whether their conditions are serious enough to prevent them from returning to duty.

If they are unfit, Defense Department doctors assign patients a rating that determines what level of benefits they receive.

After retiring, a service member can choose whether to receive benefits from Veterans Affairs or the Defense Department, evaluating which package is better — a choice that would be eliminated under the new recommendations.

When the commission met in April, Colonel Allan Glass of the army talked about the case of a sergeant with 18 years of active duty to illustrate the disparity in disability ratings.

Glass said the sergeant was found to have stomach cancer that had spread to his lymph nodes and underwent surgery at Walter Reed. The colonel said the army's physical evaluation board said the soldier was unfit for service but gave him a disability rating of zero percent. The army reopened the case at the behest of the soldier's senator and changed his rating to 4o percent. Yet when Glass spoke in April, he said the soldier had still not received a final disability rating from Veterans Affairs.

The commission report on Wednesday called for a change in the system that would leave the Defense Department responsible for determining if a service member is fit for duty, but transfer the responsibility for determining disability ratings and compensation to the VA Shalala
said the shift could provide savings by reducing the bureaucracy, though she said the savings had not been calculated, and were not accounted for in the plan's overall price. And carrying out that recommendation, the report acknowledged, would require Congress to pass legislation.

The commission also recommended creating a "recovery plan" for seriously injured military personnel and assigning one coordinator for each patient and their family to help them navigate the process of recovering and returning to duty or retiring from active service.

Patients are now assigned case managers, but the commission said it found that patients "typically have several case managers, each concerned with a different component of their care."

In addition, the report said, patients complained that some managers "did not understand" how to treat people with traumatic brain injuries, a condition that can affect soldiers injured in roadside bomb attacks.

When 35,000 apparently healthy returnees from Iraq and Afghanistan were screened, 10 to 20 percent "had apparently experienced a mild T.B.I. during deployment," the report noted, using the military abbreviation for traumatic brain injury.

Soldiers and their families complained in the wake of the Walter Reed revelations — first disclosed in The Washington Post — about delays in receiving benefits and treatment because of delays in sharing data between the Defense Department and the VA

Democrats noted that the administration had not embraced previous reports and their recommendations, including the recent Iraq Study Group report and those of the commission that investigated the Sept. 11 terrorist attacks.

But Bush has spent his presidency pledging support for the troops, and reports of problems in their care has exposed political and policy vulnerabilities that the Democrats have seized upon.

After a brief run Wednesday on the White House South Lawn with two veterans who were using prostheses, Bush said: "The spirit of that report is, any time we have somebody hurt, they deserve the best possible care, and their family needs strong support. We've provided that in many cases, but to the extent we haven't, we're going to adjust."

(Aides said the jog, with one veteran who lost both legs in Afghanistan and one who lost a leg in Iraq, had been scheduled earlier, independent of the report's release.)

Asked if she thought Bush would follow through on his pledge, Shalala said, "Senator Dole and I are going to keep an eye on him."

Jacqueline Palank contributed reporting.

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