mr. register is a veteran of operations desert shield and desert storm and a world class athlete winning nine gold medals in the army's armed services competition. in 1994 he suffered an injury that led to the amputation of his left leg. he went on to win a silver medal in the 2000 paralympic games where he set the long jump record with the distance of 5.41 meters. he now works with the united states olympic committee where he manages the paralympic academy program.

we have the privilege of being joined by mr. jim mayor. he served in the united states army during the vietnam war. he is a combat disabled veteran and a bilateral below the knee amputee. after serving in combat mr. mayor has devoted his life and career to assisting his fellow veterans working for 27 years with v.a. and 12 with our veteran service organizations. perhaps most notably he has also spent 21 years as an amputee peer visitor and mentor at the v.a. and walter reed army medical center. and now at the walter reed medical center where he is affectionately known as the milk shake man. gentlemen, thank you for your service to our nation and for your continued service to fellow veterans through your many worthy endeavors today. both of you are truly inspiring to all of us and it is really an honor to have you here with us today. i very much look forward hearing

from your testimony. mr. register, you may proceed. >> thank you very much, ranking member, thank you and members of the subcommittee. i know the milk shake man. it's outstanding. thank you for the opportunity to testify and the department of veterans affairs to deliver state of the art care to veterans with amputations. the naaop, the national association that promotes public policy in interest of orth dottic and prosthetic patients and providers who serve them. i served in desert shield and desert storm. my injury happened may 17th, 1994. my 18th and verse vi is tomorrow over at the pentagon where a friend of mine found photos of the actual accident. so i just have them in my bag. i'm kind of stressing out a

little bit right now seeing those photos again. it's remarkable about the prosthetic care. that's what i want to talk about a little bit today. i did go back after my injury and went to the paralympic games in 2000 and won the silver medal. kourntly now live in colorado springs. i began my initial care at the amputee clinic in denver v.a. hospitals. i started this process because of two reasons. it was close to my home and they understand the high level of activity that i am accustomed to. this was done in no wage to disparage the care i received at the denver v.a. i i came to walter reed and the v.a. hospital right here in the capital region. and had outstanding care. in my experience i've always been treated with dignity and respect at the three v.a.

hospitals that i've been fortunate to work with. limbs were provided by private practitioners under contract with the v.a. this has decreased as the v.a. has transferred to internal capacity. i developed a close relationship and would like to continue seeing my provider. my local office in town is seven minutes from my house. and he has signed a v.a. contract to provide that care and so the ongoing care received my contract was high quality and very convenient creating little disruption for my current job, my family and my lifestyle. i developed a new prosthetic that was coming out and i began

to be interested in this new technology and the v.a. hospital in denver when i went to see them for the consult said i would have to go there to get the limb fitted. i didn't realize i had a choice in the matter. believing it would increase my quality of life i agreed and began the fitting process at the denver v.a. driving 70 miles each way to receive that care. i could have just gone down seven minutes from my home to get that care done. it was also later that i realized after my fourth or fifth visit that i could be reimbursed for gas miles. that's something i didn't know. i began tweeting that out to my v.a. vets. i traveled to denver numerous times before i received my new limb. which i'm wearing today. every time i need to adjust my prosthetic, i must take time off of work.

great kair at the denver v.a., just a bit of an inconvenience. i have no complaints about the prosthetic care that i received. i consider myself to be very fortunate where i am vulnerable, uneducated about the process. i worry about those veteran who are not in position to look for themselves and accept what they're told. veterans should have a choice of options when it is desired by a patient. amputee veterans bill of rights i think is critical. i reviewed three reports recently issued by the office of the inspector general and have some general observations to offer this committee. the first is of the $1.8 billion spent by v.a. on prosthetics in fy 2010, only 54% or 3% was spent on prosthetic limbs this

is a relatively small portion of dollars spent by the v.a. on a broader category. secondly, the v.a. has a major investment in internal limb prosthetics capacity in 2009 with the development of the amputee system of care program that should be commended for its commitment and focus on important population. the report notes high satisfaction with lower limb and less satisfaction with upper extremity. we agree the v.a. should improve on this care the population requested the v.a. to publish a report on upper limb research associated with the conference held two years ago. noap takes issue with always calculation of the difference in what it asserts as a cost to the v.a. to provide prosthesis to veterans in in house capacity and the veterans health administration. the report stated that 12,000 on

average for prosthesis while the average cost with prosthetic limb was approximately $2900. this is highly suspect calculation of the true cost of prosthetic care. we want to know what the costs are associated that went into that report. as the vmt a. enhances its sbirnl prosthetic capacity it's important to recognize the he jat mat role who have provided care for decades along with private prosthetics in their hometown communities preserve quality by allowing choice and provider. i think in the last two points is i think it's important that the v.a. maintains access to local private prosthetics under contract with the v.a. to

service veterans. this is why we agree with recommendation in the health care inspectors report that v.a. addresses concerns with the v.a. approval process for fee based and v.a. contract for prosthetic services to meet the needs of vet ans with amputations. we ask the committee to seriously consider in legislations that seeks to address this issue an injured and amputee vaeterans bill of rights. i thank you for this opportunity to testify before you. i welcome your questions. >> thank you very much, mr. register. mr. mayor, you may proceed. >> thanks for the chance to talk to the subcommittee today. thank you for those kind words in your introduction. i really appreciate that, ma'am. i've received db like john, i've received a lot of prosthetic care. i received it from the v.a.,

from brook army medical center from walter reed and the private sector. and your reference to my peer mentoring and peer visiting amputees at woulder reed over the years, i've gotten to know the current warriors and their families their concerns. in short i think i understand the catastrophic injuries they have overcome through military administration. i understand it from being at their bedside and i understand it from being in that hospital bed myself. as of may 1st, there's 1,459 amputees -- i'm sorry, warriors with amputations. the care for those warriors is at the very core of the v.a.'s mission. it's clear that v.a.'s prosthetics today is at a crossroads.

v.a. to me has the chance to regain its leadership role that you referred to. and the excellence in this field of prosthetic provision and amputee care. but the current direction and recent decisions involving prosthetic care suggest that the veterans health administration vha is about to further compromise its ability to serve these veterans. in 2004 eight years ago the secretary testified before this committee that v.a. in his opinion had lost its edge in prosthetics. and it wasn't doing enough to ensure the v.a. developed world class prosthetic care and rehabilitation programs. his primary solution at that time was to build a quote, center of excellence in amputee research and rehabilitation. the secretary's words of eight years ago still ring true today. but the number of warriors with amputations has since increased

by over 900%. in 2006 congress revisited this issue and proposed legislation to create in v.a. five such centers. the leadership from the vha opposed the bill and the legislation died. in my humble opinion as a result of some of that history is v.a. was eclipsed by d.o.d. since 2006 d.o.d. has not established just one, but three amputee centers of excellent which are holistic in care. the warriors there receive world class care and when they're no longer on active duty they're going to have to turn to the v.a. in my opinion the v.a. has to ensure that the expertise is necessary to continue the level of clinical care that the warriors have become accustomed to in the military and the v.a.'s administrative processes guarantee timely care. i want to reference your remarks

madam chairwoman about transfer of warranted prosthetic purchases within prosthetic services in the v.a. to acquisition. to supply. i totally agree. i think the potential wait times because the lack of knowledge on the supply side about prosthetics if this were a bulk purchase item, i probably wouldn't be worried about it. i know john and i know that when prosthetics are delayed it's not a wait time. it's an inability to function in my life or to thrive in life. i want to couple that with i understand that v.a. is moving toward decentralizing the funding for prosthetic purchases. this is an issue that was solved 20 years ago by centralizing or fencing off those funds soloical v.a. medical facility directors would not use that money for other purposes. 20 years ago, veterans were delayed to the next fiscal quarter or the next fiscal year

because the moneys were used for other purposes. i'd like to summarize by saying what i think needs to happen with v.a. right now. i think it's time for them to suspend the decision -- their decision on vha transfer of the prosthetic purchases to supply. also to kind of drop any discussions about decentralizing the funding. at the same time, it's time for a full scale program evaluation led by a little more impartial body such as v.a.'s office of policy and planning and put stake holder cohorts on that effort. i lst those in my written statement. thanks for the chance to be here. >> thanks very much. i will yield myself five minutes for questions. i'll start with you mr.

register. when you received your injury you received care both from the d.o.d. as well as from the v.a. . >> i did. you mention that had in your opening statement. >> i did. >> can you compare and con that's? >> yes, i will. i want to clarify at the department of defense at walter reed this is before the bells and whistles they have now with the amputee care. it is extraordinary what the service members have. i would liken them they were pretty much the same. they were on an equal basis. i had a prosthetic limb that was made there and over in the v.a. that was right here in the d.c. area. i had no issues between one or the other. when it came time for understanding a higher level of

activity i found both lacking in that knowledge base. so i began seek it out as trying to become a world class athlete again and looking on j not just what was going on in the united states but around the world. what other people were running on, that's when i started looking at who needs to begin to align this thing to run at my optimum time. that that i found outside the system. that expert tease is so critical that i went all the way to california from virginia to find one pros thetist who knew how to get me aligned right. if i did not get that person i would not be a silver medallist today. i think for my ongoing care right now again it's not -- it was more of the inconvenience than it is for what i see. having been done to brook army medical center in san diego, california and here at walter

reed that the care is exquisite and these individuals coming through are not. they're looking to get back into the fight. they're looking to go back into their units. that's the same level of high activity that i found lacking before that they're now receiving to go back and do these things. amputees are now back in the fight. they're going on to higher employment. they're going on to being with their families. that's what i sea as the difference. >> thank you. mr. mayor, in your opening remarks you talked about the fact that the v.a. has lost its leadership position in prosthetics. i'd like to know if you can maybe identify or help me understand when and how v.a. lost its premier status and military took that over. >> i'll try. i had the pleasure of being the first staff committee manager for the very first v.a. prosthetics advisory committee

many the early 90s when is sktary ran the v.a. i didn't have have a vote. i just took the notes and organized the agenda. the burning issues of the day are already being reconsidered by vha. my quarrel is not with the psas employees and their ability. they're professionals. they do a good job. my quarrel is at the more senior ranks of vha management it really doesn't matter who's there culturally. i understand the motivation, culturally they look for because of budget reasons, they look for flexibility at the local management level. at the medical facility. prosthetics moneys and procedures are a very interesting, large target. that's how i would summarize it. >> thank you, mr. register in your testimony you talk about differing needs depending on

whether it's an upper body or lower extremely. can you talk about that with us in the needs as you see them are different? >> i think with upper extremities the use of getting the hand function back is one that's pretty critical. as you look at how that's come and developed over time, it's really amazing of the intricatesies that the upper bodies have with getting that limb function back. with lower extremities it's a matter of just gait and walking and functionality of limb. it's kind of comical what's inside the world of amputees below the amputees when i'm at brook army medical center is below the amputees.

i think it's a matter of functionality and walking again and getting back upright. with arms we rite with our arms. they're more mechanical as far as what we're doing. they're more tangible with that. i think that's a difference. >> thank you very much. we'll yield to the ranking member for his questions. >> thank you very much, madam chair. i want to thank both of you for your service to this great nation and for coming here today as well. mr. play your, you recommended for the strategic plan for vha can participate in at the operational controls should be centralized in the secretary's office. could you explain a little more why that should be. >> it's just an opinion based on

historical experience. like i said, vha and psas have a long history of dedicated professionalism. but when it comes down to these issues, you know, i'm just hear to tell you -- john is right. this generation of warriors are athletes. my day, we wanted to learn how to walk. walking don't get it for these guys and gals. they run, they climb mountains, they go into paralympics. i get out of breath just watching them. i'm here to tell you if i think the complaints were big 20 years ago, wait a couple months let these policies go into effect. you know who's going to get the completes. it's going to be members of congress and veteran service organizations. that's why i go, okay, no knock to vha senior management let them participate. but the secretary has shown a pretty activist style when it comes to large issues, cool.

>> you mentioned the department of defense has superiority over the v.a. as it relates to this issue. why do you think that is in the fact it doesn't have to go up to the secretary, the department of defense. it appear it's down at the lower level. why is that? >> i think it's a question of leadership recognizing the clientele and their needs and the fact that john said a number of them want to get back in the fight. they've got to be certified to return to duty. congress provided funding. congress still provides funding. it's known as g watt funding. my only concern about that is given the budget situation, i don't know how much longer the funding is going to let the centers operate at the level they do. i think the real key is what i called holistic. i don't want to go into the details of trying to name it.

it's the merger right together of physical therapy, outpatient therapy, adaptive sports, challenges, to me one of the best kept secrets in the military is the outpatient nurse amputee manager. for years at walter reed i watched this individual quietly fix problems, keep the track on recovery, but the advocate, and never in a way that calls attention to his role, but really calls attention to the warrior. i think that's what makes it work. i think co-locating research with the clinical part instead of being stand alone is another big accomplishment. >> great. thank you. mr. register, how long does did it take you to get the new technology that permits micro processing role of the knee through the v.a.? >> i've done it twice now. the first time with -- it was here in the virginia area when i

first got what we call the c leg. that is kind of the first micro processing technology that worked pretty well. that process took about a month to maybe month and a half maybe six weeks. the current process of going back and forth it took about three months to get that prosthesis. in fact, the situation was i was going up -- i try to show by example. i attended the national wheelchair games. i had a wheelchair made for playing wheelchair basketball. my chair had come in. i went back up to the v.a. to get it up in the denver area traveling 70 miles and go there to get it. on the way i just -- i kind of sent a note and i was in the lobby area. i saw an email saying you know what? your leg is here. it's in. i said, great.

it's all just putting it on. i can walk out of here with it. he said, no, we want to come back again and we want to fabricate it and make sure it's good to go. i could have left that day with three pieces of equipment, my wheelchair, my sports chair and my artificial leg. but because the v.a. wanted to ensure that the fabrication of my socket was done to marry that with the new x 2 that i have was kind of funny and ludicrous to me that i could not go and put it on with my alan wrench and walk out the door with it. >> thank you. >> now the gentleman from tennessee. >> thank you. both of all thank you for your service to our country. i want to congratulate the staff for the most akro anymores i've

ever seen. i counted at least a dozen. i thought the plo was -- but whatever. it's a different organization here. is there a dropoff? i've been to walter reed on multiple occasions. it is unbelievable. and now bethesda to see the amputees up and about and the care they're getting. is there a drop off when these warriors are handed off. the ones that don't return to duty. many of them are. there is a different expectation. and mr. mayor and i and our generation there is a complete different view of the young people now. is there a dropoff? do you see that and in your case because you're incredibly motivated not in your case? >> thank you for the question. and i think with what mr. mayor was saying is spot on. there is i see a little bit of a

drop that happens from d.o.d. to the v.a. i think it's a larger issue than just the amputees. i think there's a systemic care that has to happen. a continue yum of care that goes forward. what i am seeing now with the drop it has to do my personal opinion is that there's a center of excellence when these young men and women are coming back to the hospitals they're coming back as units. when we see a killed in action i'm looking at the paper. i know there's going to be six or seven other young men and women hit the hospitals that survived that. those are the ones that i'm focused in on. when i see them come back, they are extremely motivated to get back because they don't want as the soldiers creed is they don't want to leave a fallen come raid. they don't want to leave their buddies on the battle field. they feel they've lost that ability to fight. once they get mechanisms and tools to rehab tate, they're ready to be active again. i think on the v.a. side the

population has always been different that has not been the activity level hasn't been as high for getting back into like a war fighting situation. so i think that's the drop. what i do see on the v.a. side is with the new sports center, the sports programs, they're really pushing out into the communities now increasing the activity level of the veteran patient. so those that are coming to the v.a. hospitals are being linked with community based programs across the united states and that's at its infancy, to the model is being changed. that's going to change the dynamic for the v.a. >> part of it too may be generational. as you are older the expect may ambulate. if i can ambulate well that's a success. a 23-year-old that's not a reasonable outcome. your reasonable outcome is to return to mountain climbing, snow skiing whatever i did before, backpacking whatever it may be. i totally agree with you on the

upper and lower extremeitextrem. that's a young one. we graduated a young medical student who's now a physician who lost his right arm in a blackhawk and went back and went to medical school. it's tougher for him he's going to emergency medicine, but because of the dexterity you need with you can walk and it's difficult for him to do some things. that's probably the satisfaction difference that you see if you get back to jumping and running like you are, you feel pretty good about that whether you have a prosthesis or not. the other thing you brought up a great point, it's very individual who you relate to. i know as a physician myself, when you have a relationship with that patient, you have a great confidence in the fellow you work with. they know you, they know your leg. they know exactly about you. i want to just say for myself, but i think i can speak for most of the committee, i don't care what it costs for you to get the care you need for a wounded warrior to get the