Category Archives: report

GAO Testimony – DOD and VA

Transition Field Unit staffingGAO Testimony – DOD and VA

This is a troubling situation.  We have our kids off at war and they become severely injured, physically and mentally.   Our country has pulled out all stops to provide the best possible care for them and still we have problems.  Due to the protective gear and terrific and speedy medical care, thankfully more and more are surviving.  This shift in the severity and long term recovery needs requires major adjustments in our programs for treatment and rehabitation, for our benefits and compensation programs.  The cause and effect has driven the case loads and delays out of sight at the expense of our wounded heroes.

The good news is that that there is a scramble going on to correct these problems as soon as possible. There are people in high places capable of fixing the problem that have a heart for our heroes and are working very hard to fix the problems.  There are people in our VA and in militray trauma centers that are just as frustrated as we are.  There is a continuum of care mentality for our soldiers starting at the battlefield and continuing through our VA system. There are programs under development to reduce the time required to make determinations before our heroes get the treatment and benefits they need.

The bad news is there are still more than 150,000 cases more than 6 months old among the pending 600,000 cases in the VBA system, and we have no idea how old these cases really are.  The GAO found that new programs designed to correct the problems are not yet fully off the ground and there are severe staffing problems in key places, both on the active duty side and the veteran side of the picture. It appears to me that some of it is due to needing to move physicians from one program to staff another, leaving both under staffed. 

(Download Here)

What the GAO found

Warrior Transition Unit

Challenges have emerged for staffing the Warrior Transition Unit in which servicemembers are assigned to three key staff – a physician care manager, a nurse care manager, and a squad leader. For example, as of mid-September 2007, over half the U.S. Warrior Transition Units had significant shortfalls in one or more of these critical positions. In addition the number of recovery coordinators and how many servicemembers each would serve have yet to be determined.

Transition Field Unit staffing

This table shows that in actuality we have only 35% perminent staffing for these teams.  More than 450 of the existing staff (19%) have been borrowed from elsewhere, likely reducing the staff, already short, in othere facilities.   The table below shows where those with less than 50% staffing are located. 

 Staffing problem locations

PTSD and TBI 

Three independent review groups examining the deficiencies found at Walter Reed identified a range of complex problems associated with DOD and VA’s screening, diagnosis, and treatment of TBI (Traumatic Brain Injury) and PTSD, signature injuries of recent conflicts. Both conditions are sometimes referred to as “invisible injuries” because outwardly the individual’s appearance is just as it was before the injury or onset of symptoms. In terms of mild TBI, there may be no observable head injury and symptoms may overlap with those associated with PTSD. With respect to PTSD, there is no objective diagnostic test and its symptoms can sometimes be associated with other psychological conditions (e.g., depression).

TBI and PTSD chart
 
This table outlines what is being implimented (or planned) for handling TBI and PTSD better.   However, according to Army officials and the Independent Review Group report, obtaining qualified health professionals, such as clinical psychologists, is a challenge, which is due to competition with private sector salaries and difficulty recruiting for certain geographical locations. 

Data Sharing

In addition, the Dole-Shalala Commission noted that while VA is considered a leader in PTSD research and treatment, knowledge generated through research and clinical experience is not systematically disseminated to all DOD and VA providers of care.

Data Sharing

This table shows the efforts being taken to improve the data sharing between organizations. 

Disability Evaluations

As GAO and others have previously reported, providing timely and consistent disability decisions is a challenge for both DOD and VA. To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks.   To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks. The Army has also developed and conducted the first certification training for evaluation board liaisons who help servicemembers navigate the system. To address more systemic concerns, the Senior Oversight Committee is planning to pilot a joint disability evaluation system. Pilot options may incorporate variations of three key elements:

(1) a single, comprehensive medical examination;

(2) a single disability rating done by VA; and

(3) a DOD-level evaluation board for adjudicating servicemembers’ fitness for duty.

DOD and VA officials hoped to begin the pilot in August 2007, but postponed implementation in order to further review options and address open questions, including those related to proposed legislation.

Fixing these long-standing and complex problems as expeditiously as possible is critical to ensuring high-quality care for returning servicemembers, and success will ultimately depend on sustained attention, systematic oversight by DOD and VA, and sufficient resources.

You are invited to download and read the entire report here:  GAO Report (pdf – 32 pages)

Oldtimer

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Women Warriors

U.S. Department of

Veterans Affairs

Seal

 Women Veterans:  Past Present and Future

Revised and Updated

 May 2005

Robert E. Klein, Ph.D.,
Office of the Actuary
Deputy Assistant Secretary for Policy,
Assistant Secretary for Policy, Planning, and Preparedness

I thought we should give some thought on this Veterans Day weekend to our women warriors.   (Download Full 27 Page Document Here)

 The above document has been prepared by the VA and may be of interest to our women warriors and veterans.  All the bold print above and below are copied directly from the VA document.

     “Women are a vital part of the armed forces and the community of veterans. The study of women veterans begins with the history of women in the military and the changing role of women in the military.”

Brief Outline:

Women in the Military: A Historical perspective in Brief

The Population of Women Veterans

Age

Geographic Distribution

Race and Hispanic Origin

Marital Status

Socio-Economic Characteristics

Educational Attainment

Employment

Family Income

Use of VA Benefits

Compensation

Pension 

Educational Benefits, Vocational Rehabilitation, and Employment

VA Home Loan Guarnaty

VA Life Insturance

VA Burial Benefits

Health Care

 

A Final Thought :         “The important role of women in our nation’s defense and as part of the veteran population over the years cannot be over-stated nor covered adequately in these few short pages.  Their history is a glorious one and sadly one not always acknowledged or appreciated.  With time, however, has come deserved recognition, both for women in the military and for women as veterans.  And with their projected larger numbers, with full integration in all branches, including combat units, and with greater racial and ethnic diversity in the armed forces, women will change the face not only of our military, but of our veteran population as well.  Women will make up a larger share of the veteran population, add to its diversity, and require veteran services geared to their specific needs.  The debt owed to all our veterans and to women in particular demands nothing less than full attention and action.”

 The above document may be downloaded here

They are All Heroes

They Are Veterans

Oldtimer
 

Report – Homeless Young Adults Ages 18-24: Examining Service Delivery Adaptations

Report – Homeless Young Adults Ages 18-24: Examining Service Delivery Adaptations

This report, published by the National Health Care for the Homeless Council, discusses key issues faced by homeless young adults and articulates effective short- and long-term strategies for addressing them. The report is organized around four main topics: health care, housing, education/employment, and social support. For each topic, the report offers brief descriptions of service barriers and short and long-term strategies for overcoming them.

pdf IconThis is a 50 page pdf you can read or download here
 

54 Ways to Help the Homeless

54 ways to help the homelessThis booklet was written by a Jewish Rabbi, Charles A. Kroloff and published by Hugh Lauter Levin Associates, Inc. and Behrman House, Inc.   It is Distributed by Macmillan Publishing Company,  Copyright 1993 Hugh Lauter Levin Associates, Inc. and Behrman House, Inc.

The “about this book” note says this about the book: 

NOTE:  Fifty-four represents a multiple of the number 18, which in the Jewish tradition represents “life.”

You may reproduce this book entirely, or any section of it, for non-profit use without seeking permission from the author or publisher provided proper credit is given.

The permission is granted in order to permit the widest possible distribution of its contents in schools, religious institutions, and by individuals who want to inform others about ways to help homeless people.  

Additional copies of the book can be ordered from the publisher.   All profits from the sale of this book will be donated to organizations that are serving the homeless people of our nation. — The Publishers   Behrman House Inc. Hugh Lauter Levin Associates, Inc.  235 Watchung Ave. 2507 Post Rd.
 West Orange, NJ 07052 Southport, CT 06490

 This book is easy to read and a great resource for any church or secular organization to distribute.  It will change the way you look at the homeless forever.  You can read it here:

54 Ways to Help the Homeless 

Although the Rabbi and the publisher have given you permission to freely copy it, the right thing to do and a good way to help the homeless, is to buy a copy or many copies and then give them away.    You may also want to download (requires some reformatting) and copy a section at a time and distribute it one section each week to your organization or class or small group.  The book will last about a year that way.