Panel backs broad overhaul of wounded care
By William H. McMichael - Staff writer
Posted : Wednesday Jul 25, 2007 15:07:16 EDT

Seriously wounded troops returning from war should have a patient-centered recovery plan that will “smoothly and seamlessly” guide them and their families through the recovery process, members of a presidential commission said Wednesday during a hearing in Washington.

That was one of a set of six comprehensive proposals settled upon by the commission that would dramatically overhaul the care and support-structure problems made apparent by the outpatient controversy at Walter Reed Army Medical Center earlier this year.

The President’s Commission on Care for America’s Returning Wounded Warriors was one of several high-level review panels formed in the wake of those revelations.

If adopted, the commission’s recommendations would radically overhaul the current system, described by the commission as a “patchwork of programs, rules and regulations” that has become “tremendously complex” and often leads to “real or perceived inequities.”

Of 35 total recommendations — only two of which were directed specifically at Walter Reed — just six would require legislation. The other 29 can be acted upon by the Pentagon or Veterans Affairs Department.

Under one recommendation, injured service members found unfit for continued military service would receive annuity payments from the Defense Department based solely on rank and length of service, as well as a “quality-of-life disability payment” from VA. Currently, only troops who have served more than 20 years and received a 50 percent or greater disability rating from VA can receive payments from both departments.

“This is to get them on with their life ... don’t wait 20 years,” said Bob Dole, the former Kansas senator and presidential candidate who co-chaired the commission with former Health and Human Services Secretary Donna Shalala. Commission members briefed President Bush earlier Wednesday morning.

The commission also recommended making veterans eligible for transition payments after leaving the service. Those returning directly to their communities would receive short-term payments equaling three months of basic pay, as well as Tricare coverage for themselves and their families. Those taking part in VA education and training programs would receive longer-term payments. They also would be eligible for payments for earnings loss, to make up for reduced earning capacity, and quality-of-life payments to compensate for permanent physical or mental losses.

The rating system itself would be streamlined with a single, comprehensive, standardized medical exam administered by the Defense Department. Based on the results of that exam, defense officials would determine fitness for duty and VA would determine the initial disability level. The proposal resembles a Pentagon initiative announced last week.

The commission wants the Pentagon and VA to create integrated care teams of doctors, nurses, other health professionals, social workers, and vocational rehabilitation workers who would implement the recovery plan, all under the purview of a recovery coordinator — a single point of contact for patient and family.

Care for those suffering post-traumatic stress disorder would be administered solely by VA, with the commission noting VA’s long experience in the field. But the commission called upon the Defense Department to intensify its efforts at reducing the stigma associated with PTSD, noting that “the larger problem may be cultural, not clinical,” because “many service members believe it ‘unmilitary’ or a sign of weakness to betray the symptoms of psychological distress.”

That mirrored a recent conclusion of the Defense Department’s Mental Health Task Force.

The commissioners also said the Pentagon should “aggressively address its acute shortage of mental health clinicians,” and also establish a network of public-private expertise in traumatic brain injuries and partner with VA on efforts to keep current on the latest treatments for PTSD.

The commission asked Congress to make combat-injured service members eligible for Tricare respite care as well as aid and personal attendant benefits now provided for in Tricare’s Extended Care Health Option program. It also wants Congress to amend the Family Medical Leave Act to allow up to six months’ leave for a family member of a service member wounded in combat who meets other eligibility requirements in the law.

The Defense Department and VA should also continue work already under way to create a fully interoperable health records information system, and, within the next 12 months, make that system “immediately viewable” by any clinician, allied health professional or program administrator who needs it, the commission said.

The commission also said the two departments should develop an interactive “My eBenefits” web site that would serve as a single information source for service members, providing information ranging from ways to contact assigned caregivers to upcoming appointments to reminders to take medicine.

The Pentagon must also assure that Walter Reed “has the resources it needs to maintain a standard of excellence” for both inpatient and outpatient care, and must implement tailored incentive packages to encourage both retention of civilian caregivers and administrators and the recruitment of new professionals, the commission said.

Advances in battlefield medicine and follow-on treatment have resulted in the best-ever survival rate for those injured in combat, with seven out of eight seriously injured troops now surviving, the commission said. But the types of injuries those survivors must deal with are sobering.

According to figures provided by the commission, 3,082 of the 28,000 troops wounded in action are considered seriously wounded — that is, they have been awarded Traumatic Servicemembers’ Group Life Insurance, a one-time payment that varies with the severity of the injury. Of these, 2,726 have suffered a traumatic brain injury; 644 are amputees; 598 have serious burns; 391 are “polytrauma” victims; 94 suffered spinal cord injuries and 48 have been blinded.

The commission was formed by President Bush in March following February news reports about abysmal living conditions and administrative snafus endured by wounded outpatients at Walter Reed. But the panel was charged with conducting a comprehensive review of the care, benefits and services for all wounded troops.

Similar work has been or is being conducted by a plethora of commissions, including the Pentagon-appointed Independent Review Group, the Pentagon’s Task Force on Mental Health and Task Force on the Future of Military Health Care, and the Veterans’ Disability Benefits Commission. All are in the process of releasing, or have released, reports. On Capitol Hill, related measures mandating improvements have passed both houses; the Senate passed its Wounded Warrior package earlier Wednesday.

The Dole-Shalala commission began holding a series of public hearings in April. It visited 23 sites and also solicited comments from troops on continuity of care by way of a public Web site.

Ellie