Poorly networked systems leave vets on their own when seeking care

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Wounded soldiers tell lawmakers that the lack of a seamless transition from Defense and Veterans Affairs reduces the quality of health care.

Despite efforts to create a seamless transition between the Defense and Veterans Affairs departments' health care systems, injured troops continue to encounter logistical hurdles and are not getting the support they need, witnesses testified before a House panel on Thursday.

Army Staff Sgt. Sean Johnson, blinded by blast injuries in Iraq, told members of the House Veterans' Affairs Subcommittee on Oversight and Investigations that he had to provide VA with a paper copy of his military medical records to receive treatment. Johnson's wife, Melissa, said during an interview that her husband's paper records can be measured in volumes, not pages.

Johnson, who also suffers from post-traumatic stress disorder and traumatic brain injury as a result of the mortar attack in March 2006, is still awaiting a medical discharge from the Army Reserve 452nd Ordnance Company in Aberdeen, S.D. He told lawmakers that when he returned home to Aberdeen from the Fort Riley Army hospital in Kansas, Army and VA officials did not contact one another, so he had to initiate the process for continuing care with VA.

Despite his wounds, Johnson said neither the Army nor VA checked if his blast injuries had caused traumatic brain injury, even though he and his wife had concluded that his deteriorating vision, poor concentration and dizziness indicated he suffered from the disability. The Army and VA instead diagnosed him with digestive tract problems, he said.

In February 2007, VA determined Johnson had a "mild" case of traumatic brain injury due to multiple blast exposures, but by May 2009 he had lost all vision.

Families of veterans end up as primary caregivers, but Johnson's wife said VA has not provided her with much assistance. She told lawmakers VA did not provide her with any information on PTSD or traumatic brain injury and added, "Everything we know, we looked up ourselves on Google."

Melissa Johnson told Nextgov that VA needs to do a better job of educating families on the medical conditions of wounded soldiers. Sean Johnson told lawmakers that if a wounded soldier is diagnosed with PTSD or traumatic brain injury, VA should immediately provide the soldier's family with literature on the subjects.

Dr. Madhulika Agarwal, chief of patient care services, told the hearing that VA works with family members and veterans prior to the wounded soldier being discharged so they can train and educate them on specific health care needs and issues.

VA case managers actively help veterans re-integrate into home communities, she said. The department provides skilled home care, home aide services and a variety of respite care options to support veterans and their families who require additional assistance at home, Agarwal added.

Johnson said VA admitted him in 2009 to a facility in St. Cloud, Minn., for inpatient treatment for PTSD, but ongoing care is difficult because the city is a three-hour drive.

Melissa Johnson said VA briefly provided PTSD counseling via a telehealth hookup at its Aberdeen clinic from June 2008 to September 2008, but the program abruptly ended due to a lack of funding, she believes. She said the telehealth PTSD counseling was valuable because it included peers, and VA should renew the program because veterans respond well when listening to other veterans' experiences.

Retired Army Capt. Jonathan Pruden, an outreach coordinator for the Wounded Warrior Project in the southern states, told the hearing that VA should take a holistic approach to treatment of wounded Iraq and Afghanistan veterans who suffer from PTSD, traumatic brain injury and substance abuse problems, rather that treating each of the disabilities in isolation.

VA should develop a central clearinghouse of information on the facilities and programs to treat the related problems, said Pruden, who had his right leg amputated as a result of wounds he received in Iraq in 2003. A database would help clinicians easily locate available in-patient treatment facilities, he added.

Defense established the Post-Deployment Health Reassessment Program in March 2005 to identify mental or physical injuries resulting from combat, including PTSD and traumatic brain injury.

Every Afghanistan and Iraq combat veteran is supposed to fill out an electronic post-deployment health assessment form, but a recent audit of a central Defense database showed the forms were missing for about 23 percent of 319,000 veterans, Joseph Wilson, deputy director of health care for the Veterans Affairs and Rehabilitation Commission at the American Legion, told the subcommittee.

He said the American Legion believes the administration of the post-deployment health reassessment program is essential to successfully transitioning service members from Defense to VA, because the results would disclose signs of debilitating illnesses such as PTSD and traumatic brain injury.

Noel Koch, undersecretary of Defense for wounded warrior care and transition policy, said the testimony from veterans at the hearing left him "shaken." He acknowledged that Defense and VA have communications problems that have impeded care as service members transitioned between the two departments. But development of a Virtual Lifetime Record, a medical file that will follow troops from the time they join the military through their transition to VA, will resolve many of the problems identified by the veterans at the hearing, he said.

Koch said Defense needs to better track blast injuries that can cause traumatic brain injury and also develop a policy to send troops home from combat after three blast incidents, which the Marines currently do.

Rep. Timothy Walz, D-Minn., said he found the problems described by veterans seeking to navigate the bureaucracy in Defense and VA appalling, and added he wants to see action by the two departments even if that requires a "systemic cultural change."

If money is a problem to care for Afghanistan and Iraq veterans, Rep. Harry Mitchell, D-Ariz., suggested the possibility of a supplemental appropriation. Care should be funded "the same way we paid for the wars," he said.

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