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Thursday, October 18, 2007

White House Begins Move to Implement Dole-Shalala Commission Advice

This week, President Bush began moving forward on the recommendations of his post-Walter Reed scandal appointed Commission On Care For America's Returning Wounded Warriors, also known as the Dole-Shalala Commission.

From Stars and Stripes:

President Bush’s plan to reform the disability compensation system, which he sent to Congress on Tuesday, includes a four-part payment scheme targeted exclusively at a newer generation of servicemembers and veterans.

The plan is ambitious in scope and more generous than the current disability system. As proposed by the White House, it would be applied automatically only to future disabled veterans. It would be offered as an alternative to current disability benefits only for veterans separated or retired from service since Oct. 7, 2001, the day of the U.S. invasion of Afghanistan. ...

As described by Donna Shalala, Dole’s co-chair and a former cabinet member under President Clinton, the Bush plan would totally restructure how disability compensation levels are set.

The military’s role would be reduced to conducting a thorough physical and, from that, determining if an ill or injured servicemember is unfit for duty. Those found unfit would be retired with a lifetime annuity based on final rank and time in service. Annuities would set at 2.5 percent of basic pay multiplied by years served.

The VA then would award a disability rating based on any service-related injury or ailment found. In addition to the military annuity, veterans would get a three-part VA payment: (1) transition money to help adjust to civilian life; (2) a monthly payment for loss in earnings capacity, the same rationale for current disability pay; (3) a new quality-of-life payment to compensate for limits on day-to-day activities resulting from the disabilities.

In educational interest, article(s) quoted from extensively.

The changes, however, will not be extended to veterans of former eras, and that has created a bit of a sticking point. Continuing from Stars and Stripes:

Former Sen. Robert Dole, an architect of the plan as co-chairman of the President’s Commission on Care of America’s Returning Wounded Warriors, said he is getting “push back” from veterans’ service organizations. Lawmakers will feel it too, he said, but it shouldn’t deter them from giving newly-disabled vets and the current force a better disability package.

“I think we passed the baton to this generation” as being “the greatest,” Dole told the Senate Veterans’ Affairs Committee on Wednesday. “If they do a little better than we did, that’s OK. These are the grandsons and sons of Vietnam veterans and World War II veterans.” Improving their benefits, he said, “shows we’re making progress” and honoring their sacrifice.

More details from the Associated Press:

[T]here would be a single medical exam to evaluate injuries; the military and VA now do separate exams. Wounded service members and their families would receive lifetime health care coverage. Those with post-traumatic stress disorder would be eligible for lifetime treatment. Relatives could take up to 12 months off from their jobs to help with care. ...

Terry Scott, chairman of the Veterans' Disability Benefits Commission, an independent panel appointed by Congress and the president, said any overhaul of the disability evaluation and payment system could take up to five years to complete.

The prospect of a long wait frustrated some senators. "We don't have any choice, we have to do it and we have to do it quick," said Sen. Richard Burr, R-N.C. The Dole-Shalala commission has not given a cost estimate for the changes in benefits, and Dole said cost was not a factor in the recommendations.

Among the new benefits would be transition payments for service members who leave due to injuries and compensation for changes in quality of life caused by an injury.

"Maybe you won't be able to dance, maybe you won't be able to play the piano. Things you can't do that really affect your quality of life," said Dole, who was seriously injured while serving in Italy during World War II.

The Los Angeles Times adds:

[The commission] proposed potentially far-reaching changes in a system established more than 50 years ago to meet the needs of veterans of World War II and the Korean conflict.

"It's an old system, it's an antiquated system, it's an outdated system that needs to be changed," Bush said during a session with reporters in the White House Rose Garden after he met with the commission. He praised the care provided at Walter Reed but said "serious problems" had caused "bureaucratic delays and administrative failures."

He said the need for legislative action was "urgent."

Dole agreed, describing the regulations of the current system as 600 pages of "Band-Aids and amendments." The military personnel needing care now, he said, are of "a different generation than my generation, than the Vietnam generation. And the treatments are different."

When the commission issued its report, Shalala estimated that its recommendations would cost $1 billion over 10 years.

Karl Zinsmeister, assistant to the president for domestic policy, said that before costs could be assessed, officials would have to redraw what is known as the injury schedule -- the amount that service members receive for permanent wounds, such as below-the-knee leg amputation.

In a conference call with reporters, Zinsmeister said the current military disability system, which covers 3 million wounded veterans, cost the government about $30 billion a year. The new system, he said, would probably "cost a little more than the old system."

The White House also said that the Veterans Affairs department would establish "recovery coordinator" positions -- patient advocates assigned to oversee the management of individual veterans' care, help them handle paperwork and other requirements of the federal bureaucracy, and ease their transition to civilian life. Creation of such a position was a key recommendation of the commission. ...

Veterans would be reassessed every three years, and the rating system would be adjusted to reflect "modern concepts of medicine and disability," the White House said, describing the plan. ...

Severely wounded service members would be eligible for up to 40 hours of weekly in-home assistance, easing the burden on their families, the president said.

Paul Rieckhoff, Iraq veteran and founder of Iraq and Afghanistan Veterans of America, applauds the President's move on the commission's recommendations, but reminds us today:

While the intentions of the Commission’s recommendations should be applauded, there are outstanding problems that will undoubtedly impede their accomplishment. With the Secretary of Veterans Affairs’ post filled by a temporary appointment, and a VA budget that is more than two weeks late, implementation will be a challenge.

One of the Dole-Shalala Commission’s major recommendations is already doomed. The Commission suggested that coverage be provided for family members of wounded troops under the Family Medical Leave Act. Earlier this month, this protection was denied not due to bureaucratic hurdles or funding shortfalls, but because of the President’s decision to veto SCHIP, the State Children’s Health Insurance Program reauthorization.

Today, Congress had an opportunity to override the President’s SCHIP veto-and should have voted to do so. Two largely overlooked provisions of SCHIP would address the urgent issue of protecting military families as outlined by the Dole-Shalala Commission. Sections 621 and 622, under Subtitle C, provide one year of employment discrimination protection to family members caring for grievously wounded troops, and extend permitted work leave for these caretakers from three to six months.

Right now, when a service member is critically wounded, friends and family members put their lives on hold to be at their loved ones’ bedside during the weeks and months of recuperation. Annette McLeod is one such family member. When her husband, Specialist Wendell McLeod, was injured while serving in Iraq, she rushed from her Chesterfield, South Carolina home to be with him at Walter Reed in Washington, D.C. Caring for her husband, who sustained multiple injuries to the back and head, became her full time job. After three months at Walter Reed, the human resources department at the factory where she had worked for 20 years told her she had exhausted her time off. She was forced to give up her job and all of her benefits.

Annette’s story is all too common. Thanks to improved battlefield medicine, thousands of troops are surviving catastrophic injuries, but they face long and painful recoveries at home. This puts enormous financial and emotional strain on their loved ones. According to the Dole-Shalala Commission, one in five severely wounded troops says a family member or friend has had to give up a job to provide care. Unfortunately, current law offers caregivers few employment protections. All too often, they lose their jobs, pushing their families to the brink of financial ruin.

Today, Congress had the opportunity to defend the family caregivers of wounded heroes by overriding the President’s SCHIP veto. Unfortunately, the legislation that would have given these families much-needed breathing room failed. So now, instead of focusing on recuperating, many of our injured service members will have to worry about where their family’s next paycheck will come from.

Any member of Congress who claims to support the troops should have voted to override the President’s SCHIP veto today. When this vote failed, so did a critical protection for families of our most grievously wounded troops. And now, more family members like Annette will face unfair and unnecessary financial burdens during what is already a more difficult time than most of us can imagine. Our wounded heroes and their families deserve better.

Outline of the President's plan from the White House Fact Sheet, Ensuring Our Wounded Warriors Get the Best Possible Care:

To the extent that the Administration can move forward without legislative action, we are working to implement the Commission's recommendations; however, some reforms require Congressional action:

Modernizing And Improving The Disability And Compensation Systems

Commission Recommendations

1. Change DoD Disability Entitlement for those deemed unfit for duty for combat-related reasons by providing an annuity based solely on rank and service, rather than percent disability.
2. Expand TRICARE Coverage to those unfit for duty for combat-related reasons, not just those who are at least 30 percent disabled or who have 20 years of service, as in the current system.
3. Restructure VA disability entitlement such that, for new entrants retired from service for fitness, VA benefits would include transition payments to cover living expenses equal to either three months of base pay (if no rehabilitation is needed) or family living expenses for longer-term rehab patients. The new VA disability benefits would also include "earnings-loss payments" and "quality-of-life payments."
4. Reassess all disability rating schedules to ensure they reflect modern medicine and modern concepts of the impact of disability. VA would reassess disability status every three years and adjust compensation accordingly.
5. Increase vocational rehabilitation benefits such that VA would pay a bonus equal to 10 percent of transition pay after year one, 5 percent after year two, and 10 percent after year three of training completion.


* DoD disability payments should be replaced by DoD annuity payment for all eligible service members separated or retired after the implementation date of this provision. Those separated or retired since the beginning of the Operation Enduring Freedom/Operation Iraqi Freedom will be able to choose between the existing system and the new system.
* TRICARE benefits should be extended for those seriously injured in combat or combat-related activities.
* The VA disability system should be strengthened and improved to provide for an immediate transition payment, loss of earnings, and quality of life payment.
* Individuals and their conditions will be reassessed every three years.
* The disability rating schedule should be updated to reflect modern concepts of medicine and disability.
* The disability system restructure will take effect upon conclusion of the seven-month disability compensation study, legislation implementing VA disability payment rates, and regulations updating VA's disability rating schedules.

Administrative Actions

* Beginning in November 2007, DoD and VA will pilot a replacement to the cumbersome previous system of two entirely separate disability determinations by each Department with a single, comprehensive medical exam to be administered by DoD.
* Rulemaking is underway to update the VA Schedule for Rating Disabilities to include Traumatic Brain Injury (TBI) and severe burns.

Aggressively Preventing And Treating Post-Traumatic Stress Disorder And Traumatic Brain Injury

Commission Recommendations

1. Expand VA health coverage to ensure that all veterans of Operation Enduring Freedom and Operation Iraqi Freedom with post-traumatic stress disorder (PTSD) receive care related to this condition.
2. Address DoD shortage of mental health clinicians.
3. Conduct awareness training and provide clinical guidelines for PTSD and traumatic brain injury (TBI).


* All Operation Enduring Freedom and Operation Iraqi Freedom veterans should be allowed to receive PTSD care from the VA without first showing service connection.

Administrative Actions

* Secretaries of the military departments have begun using existing authorities such as incentive pay and bonuses to recruit and retain sufficient experts in mental health fields.
* DoD and HHS are working on an MOU to provide additional mental health professionals to meet short term needs.
* By November 30, 2007, DoD and VA will establish a National Center of Excellence to conduct training and research, deliver care, and disseminate clinical best practices with regard to TBI, PTSD, and other mental health conditions.
* DoD has expanded mental health and TBI training programs for deploying service members.
* VA is working to screen all patients for PTSD as part of their initial treatment.

Significantly Strengthening Support For Families

Commission Recommendations

1. Expand TRICARE respite care and aide and personal attendant benefits to service members seriously injured in combat.
2. Provide training and counseling to family members to support them as caregivers. DoD and VA should standardize and assure universal access to family services early in the treatment process. This package should include education about the service member's injuries and expected progress, caregiver training and counseling, and psychological services.
3. Amend the Family Medical Leave Act (FMLA) to allow up to six months of unpaid leave for family members of combat-injured service members, and allow combinations of unpaid and paid leave, when available.


* TRICARE respite care and aide and personal attendant benefits should be provided to service members seriously wounded in combat under Extended Care Health Option (ECHO).
* Many family members of service members with combat-related serious injuries should be eligible to receive 26 weeks of unpaid leave within the first 24 months following the injury or diagnosis of the injury.

Administrative Actions

* DoD and VA have implemented family caregiver training.
* DoD and VA are developing a package of employment options and health care options for caregivers of seriously injured service members.

The Administration Is Acting Now To Implement Recommendations That Do Not Require Legislative Action

Immediately Creating Comprehensive Recovery Plans To Provide The Right Care And Support At The Right Time In The Right Place

Commission Recommendations

1. Those seriously injured in combat will receive an individual Recovery Plan that leads them back to duty or public life seamlessly guiding and supporting them through medical, rehabilitation, and disability programs.
2. A Recovery Coordinator will be assigned to service members seriously injured in combat to serve as their ultimate resource in the recovery process. The Public Health Service (PHS) Commissioned Corps will help develop this cadre of well-trained and highly skilled advocates.

Administrative Actions

* On September 19, 2007, DoD, VA, and the Department of Health and Human Services (HHS) signed a joint Memorandum of Understanding (MOU) for the creation of a joint Recovery Coordinator Program for service members seriously injured in combat or combat-related activity.
* By December 1, 2007, DoD and VA will develop the Recovery "Life" Plan to be used by the Federal Recovery Coordinators for seriously injured service members with combat-related injuries.
* VA will take the lead on creating the organizational structure for the Federal Recovery Coordinators. The PHS Commissioned Corps will serve as consultants for program development and care management.

Rapidly Transferring Patient Information Between The Departments Of Defense And Veterans Affairs

Commission Recommendations

1. DoD and VA must continue the work under way towards a fully interoperable IT system that will meet long-term administrative and clinical needs.
2. DoD and VA must, within the next 12 months, have all patient information viewable by any clinician, health professional, or administrator who needs it within either department.
3. DoD and VA must develop a plan for a user-friendly health and benefits portal for service members, veterans, and family members.

Administration Actions

* No later than October 31, 2008, DoD and VA will make available and viewable all essential health and administrative data.
* By March 31, 2008, DoD and VA will have the ability to share all essential health images.
* DoD and VA are creating a single Web portal to provide for the care and support needs of veterans and their families.

Strongly Supporting Walter Reed By Recruiting And Retaining First-Rate Professionals Through Closure In 2011

Commission Recommendations

1. DoD must ensure that Walter Reed (WRAMC) has the resources it needs in outpatient and inpatient care.
2. DoD must implement tailored incentive packages to encourage civilian personnel to continue working at Walter Reed, and enable recruitment of new professionals as needed.

Administrative Actions

* The Secretary of the Army will ensure that WRAMC has a sufficient budget to fund recruitment and retention bonuses.
* The Secretary of the Army is pursuing additional recruitment authorities to hire and assign health care practitioners and support personnel.
* DoD sent a request to the Office of Personnel Management to authorize DoD's use of retention bonuses to retain high-quality personnel.
* DoD is creating a "guaranteed placement program" to ensure that critical employees at Walter Reed will have placement at the new National Military Medical Center if they stay in place until WRAMC closure.

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