and we were then able to follow those veterans as they transitioned through va and received several years of va care. and there were a couple of outcomes from that data that i think are worth noting. one was it was surprising to me, maybe not to those who work with this population all the time, that it wasn't just the limb that was affected in these patients. every organ system you looked at, by diagnostic category, had significantly elevated disability or medical disease burden in this population. so whether it's that the blast injury they suffer at the time that they're injured or the other circumstances of trauma and recovery on the battlefield are unclear, but this is a population that has quite a significant disease burden beyond those that you would think of. the second feature that stood out from that analysis was the problem of pain management and substance use disorders. i mean, in addition to the normal mental health issues that this population will be expected to have, again, i can't speak out enough the difficulty that this population has with these disorders and the difficult

guidance on the direction and operation of va's prosthetics and orthotics program and finally it is essential va reestablish itself as a leader in prosthetics research and care and maintain that position as a commitment to our wounded warriors. that concludes my testimony. thank you and i welcome any questions. >> thank you very much. miss brudeau, you may proceed. >> thank you. chairwoman berkle, ranking member micaud and members of the sub committee thank you for allowing us to testify concerning prosthetic services of the department of veterans affairs ensuring our veterans receive state-of-the-art devices in a timely member is important. in recent months the va office of the inspector general released numerous reports on sensory aids psas, inventory management, acqui significance of prosthetic limbs and prosthetic limb care. pva believes the internal audits and investigations identified many improvements and we support the recommendations. these recommendations provide not only an opportunity to improve upon the prosthetic services for veterans with amputations but for all vetera

norbert doyle, who is vha's chief procurement and logistics officer. va's prosthetics and sensory aid service is the largest and most comprehensive provider of prosthetic devices and sensory aids in the world, offering a full range of equipment and services. all enrolled veterans may receive any prosthetic item prescribed by a va clinician without regard to service connection when it is determined to promote, preserve or restore the health of the individual and is in accord with generally accepted standards of medical practice. i will briefly summarize the major initiatives under way to improve the quality and availability of amputation care. these fall under five general headings, staffing and community partnerships, accreditation of va laboratories, improved training for va staff, greater research into amputation and clinical issues, and collaborations with the department of defense. first, va's prosthetic and sensory aid service has a robust clinical staff of prosthetists as more than 75 locations and also partners with the private sector to provide cust

so dod's focus is on acute care and acute rehabilitation. va should be on long-term outcomes and long-term care for our warriors and certainly if possible, it should be done in partnership with nih and dod. but va should be taking the point on long-term care for amputees. >> do all the panelists agree with that? >> i would concur with that. i think that's absolutely essential for va, just because of the paradigm shift that did occur within dod, maintaining veterans, disabled veterans for so much longer. and providing this upfront amputee care. as they transition into va, that's certainly the lifetime care and they're focused on effective care and good outcomes. that would certainly be within their portfolio. >> i guess this would be for mr. ores or anyone else who might want to answer it. there's been some discussion about the cost in the private sector versus the va. has anyone done an analysis of what the cost is within the department of defense? >> we haven't, but i think the comments that mr. ores made were really pert ninenpertinent. the f

finally, the partnership between va and dod extends further to provide a combined collaborative approach to amputation care by developing a shared amputation rehabilitation clinical practice guideline for care following lower limb amputation. va is also supporting the department of defense by collaborating on the establishment of the extremity trauma and amputation center of excellence. the mission of this center is clinical care, including outreach, education and research, and is designed to be a lead organization for direction and oversight in each of these areas. the center is currently being implemented and will obtain initial operating capacity by the end of this fiscal year. in summary, va supports high quality amputation and prosthetics care by supporting groundbreaking research into new technologies, training a highly qualified cadre of staff and pursuing accreditation of all eligible prosthetic laboratories in va's amputation system of care. we are improving our oversight and management of prosthetics purchasing and inventory management to better utilize resources that we have b

and you talk about how the va could join in agreement with ftc to do some things here. have they done those things? >> no. and that's my frustration. i spent 16 years in the congress promoting all of higher ed. i'm a big fan of universities, private, nonprofits, the private sector, everybody. there is so much out there today in terms of regulatory authority to go after the bad conduct that all we ask is use your present authority and go after that school and you will never hear me or my association here defending one bad apple engaged in misconduct of a veteran or any other student. but let's not indict all of higher ed or even just the private sector colleges and universities for the misconduct of one school. >> ms. baechtold, and several of the rest of you hit on this, and i don't say this facetiously in any way. i am the staunchest supporter of the va, but i'll also be their harshest critic. one of the prescriptions for a better way of doing this is communication and getting data from the va. good luck with that. and i say that as i said not facetiously. they do a lot

the things that we talked about that we will be able to do by leveraging the capability with dod and va is that we will be able to do clinical trial type of evaluations at a number of different centers at the same time and that is one of the missions of this joint va/dod center of excellence is research coordination and studying and reporting on new technologies and developing better outcomes for care. >> and how will you ensure that at least the medical research that's going on is somehow tied back with the feedback being given back by the veterans? their experiences with the different types of prosthetics, the challenges that they have and also, pain management. is that all part of that? >> it is. i will comment and i will ask dr. webster to comment. the participants in these studies will be our veterans and active duty service members so that they will be able to report to us firsthand what their experiences are, so that's how we will tie in the feedback. we also listen carefully to our veterans as we look at their outcomes of care and their successful use of prosthetic limbs and tec

and then next we have retired major general rob worley. nen worley is the new director of va's education service and has been on board for about a month. we welcome him to his new post. and welcome to the subcommittee. we thank you for your years of dedicated service to our country in the u.s. air force as well. mr. schatz, is that correct? >> schatz. >> okay. we'll recognize you for five minutes for your testimony. >> mr. chairman, ranking members of the subcommittee, we represent every school and college and training program relative to the usage of the gi bill. the idea of adopting and applying principles of excellence as outlined in the executive order is consistent with sound educational philosophy and practices and is currently recognized, respected, and implemented throughout much of the education community. our experience tells us that while some of the proposed requirements in the executive order may be helpful to the achievement of the present schools, they also could result in the establishment of measures and systems that duplicate other approaches and services that

it spoke to an era where you couldn't go to the va and expect good service. it is a different va. is in the top quartile of health care performingers in the -- performers in the country. we're the largest direct health care system in the nation and the second largest in the world n. the '90s the va shifted to a vaulted-style approach which as you know as managers and leaders is quantitatively quantitatively-oriented health care. we've got a very, very different va that we're bringing to the table to offer health care to our veterans. we all know that for a lot of americans the slide from home to homeless is a slippery slope. even for the 1% of americans who are veterans. highly disciplined, highly motivated, they go from a leading edge performance in special operations and at the tip of the spear to a year later being homeless. what's wrong with that picture? how did we fail them? highly disciplined and highly motivated, they've got that can-do spirit somewhere in there, we've just got to reach in and get it back. and yet when they return home, a small but significant percentage o

and so there are a number of employment-related programs within va to support them getting back to work. and i want to continue, when we come back, i want to continue on the topic of homelessness, because i really want to get to the issue of when the vet comes back. i mean, how does the family, there are issues, you know, we talked a lot about the family a little bit already, but i want to see that intersect of what can a family member do to, you know, prevent a vet or a member of the military from becoming homeless. we'll be right back. (music) post-traumatic stress disorder is a clear issue for a lot of people, especially deployed troops coming home. and when they come home, they come home to communities and to families that are going to experience the effects of that, and there's pretty good evidence that people with post-traumatic stress, whether it's from a military interaction or from some other traumatic event, have more difficulty with mental illness, with depression, anxiety, with substance use, with having difficulties with family relationships, with just interactions in their

and housing. hide it is proud to partner with the va and the city -- hud is proud to partner with the va and the city of san francisco. to clarify how hard the works, hud was cleared to fund an additional 200 housing vouchers. the va identifies a homeless veteran, prefers them to the housing authority and provides them with case management services. these are all important elements of the program. hud is the federal agency that convenes the san francisco bureaus and guides the initiative. i want to make sure i acknowledge mark ruiz as the team lead for the home initiative here. also george, in the back of the broom, and toed cabrreras, whose work has been a central. we're working to find homes for chronically-homeless veterans who have a hud voucher. specifically the goal is to find housing for 50 veterans and 100 days. to accomplish this, we need owners and lamb motor -- and landlords to join our efforts. we know we have a long way to go before we can call this effort a success. it requires sustained engagement by the community. as for the housing choice voucher program, also called section 8, rent

provide guidance in the direction and operation of va's prosthetics and orthotics program and finally, it is essential that va reestablish itself as a leader in prosthetics research and care. and maintain that position as a commitment to our wounded warriors. that concludes my testimony. thank you, and i welcome any questions. >> thank you very much. you may proceed. >> thank you. chairwoman berkel, ranking member, and members of the subcommittee, thank you for allowing paralyzed veterans of america to testify today concerning prosthetic services of the department of veterans affairs. ensuring that our nation's injured veteran population is able to receive state of the art prosthetic devices in a timely manner is an extremely important issue for pva. pva has more than 19,000 members who all utilize va prosthetic services on a regular basis. in recent months the va office at the inspector general released numerous reports on va prosthetics and sensory aids, inventory management, acquisition of prosthetic limbs and prosthetic limb care. pva believes that the audits and investigations ha

strickland, the gao just found that nih, dod, and va each lack comprehensive information on health research funded by the other agencies. gao raised concerns about the potential for unnecessary duplication and urged the agencies to find ways to coordinate their efforts. question, how is tbi research that is conducted by nih, dod, and va, the va, coordinated among the three agencies? >> well, i would reiterate that both dod and va are members of the newly established interagency coordinating council. we'll have our second meeting actually at the end of this week. but specifically, nih has partnered with the dod in building a central federal interagency brain injury research database that will allow access to researchers across the multitude of research done by both agencies. this is important, because that helps us establish better

secondly, the pentagon and va are losing the battle on mental and behavioral health with the service members and loved ones and as we just talked about is resulting on such extreme things as suicide and secretary panetta are service members and veterans and they can't get treatment to added resource to a correct diagnosis. this has been a problem for soldiers in my home state of washington. over 100 soldiers and counting have had their correct ptsd diagnosis restored after being told they were exaggerating their symptoms, lying and accused of shirking their duties. so understandably, a lot of our service members trust in confidence in the disability evaluation system has been seriously shaken in the wake of these events. i have continually raised concerns about the consistency and accuracy of behavioral health and diagnosis and have offered my recommendations on how to improve the system and as you also know the army has taken some critically important steps forward and beginning to address these concerns. the secretary has announced a sweeping, comprehensive army wide review of beha

and so on. it's not that terribly new. but with va and the saas working together in the past, those problems have been dealt with for 65 years. now we're not -- we have not been in that kind of partnership recently. we want to be, we want to be able to help va. we want to be able to say that we're looking at educational quality, we're looking at all those things, looking at appropriateness of reporting, let va look at the appropriateness of their payments. we don't feel we should be auditing a federal system's payments or federal entitlement program's payments. in essence, what we're doing, that's what we're doing with the -- we're more than happy to provide them all the information they need from our campuses to do their audits. and we would welcome the chance to continue that relationship but do it for all of our schools like we've been doing. >> i might add, sorry. if i might add, historically, there was a period of time when some of the states, including my state, state of missouri, oklahoma, in the arena of on-the-job training of

so we contract with those providers that have accreditation and certification just like the va providers do. >> for a specific product? >> that's correct. >> the other thing is, on the surveys, part of -- part of what i think doesn't reflect the sentiments of the veteran base -- and i say this from experience that we've had there in el paso. the veterans that are not getting either access to health care or upset about something, they're very good about taking these sure pries and sending them back in. it's been my experience, and i say this because i've had even some of the members of my family that have gotten those surveys because that's they're satisfied, they haven't even returned them. they just chuck them. so is there a way or a process that you factor that in, into that? in other words, if you send out 20,000 sure fayes. and you only get back one thousand, how old -- is there some way to factor in those fet veterans that don't pit it in because they're satisfied? these are multiple pages and they don't want to take time or can't take the time to answer all of those questions. i th

knowing we had this large and effective network already in place, the va reached out to us several years ago and we formed a partnership. today, service members, veterans and their families who call the lifeline can press number 1 to be connected to a va call center that provides specialized crisis services. the veterans crisis line or military crisis line, as it's known within the services, is also available in a number of european countries and in just the first five months of this year, over 85,000 lifeline calls were answered by the veterans crisis line. more than 550 calls a day. our department has also organized a series of policy academies that bring together community leaders, guard and reserve members and veterans officials from several different states to team up and share best practices. one great example was a program known as operation immersion, an initiative that brought community-based health care providers to a national guard base where they live like soldiers for a few days. they eat mres, run drills, do pt and in between, they meet with soldiers of every rank and their

we've talked with the va and we said if we build one as well in the civilian community that's completely not attached to the va, would you guys certify it? they said absolutely, go for it, so that's what we're going to do. peers work. number two, peers navigate. their principal function is to navigate at the community level. it isn't just about mental health and being a peer specialist for mental health. it's about navigating and answering every single need. which means they need to know what the community has available in all the sectors of service. when that person calls and says i need day care next thursday, the peer says, got it. i heard that. to go find you da. and i'm going to call you back and we're going to continue to follow up until you get that day care. number three, effective local community resource directory and local community collaboration. it's a terrific program that is trying to collaborate and create a blue print for how you collaborate with community services. it's a very important function. we think that military family members, military community members which is

the patient has been, i'll use the word discovered to be an amputee and they've been directed to receive their care within the va system, versus, again that outside provider. >> okay. i'll yield now to the ranking member and see if he has additional questions. >> doctor, do you have any additional questions? >> i have a few questions. >> you talked about the quality of the orthotics. and you mentioned the masters degree program. >> uh-huh. >> is it easy to find people that can do this work? i mean, is there a lot of people out there that do this? i'm kind of curious as to the experiences that you have in finding qualified people to do this job? >> frankly, there's probably not enough, between certainly the growing problem we have in this country with diabetes. we've got increasing veteran population. the baby boomers in general. so the need and demand for these services are growing, and the reality if it is we have a limited number of schools. so graduating students for, that have their -- their training in orthotics and prosthetics. it's an issue and concern, yes, but one we face in the private practice as well

how is tbi research that is conducted by nih, dod and va -- the va coordinated among the three agencies? >> well, i would reiterate that both dod and va are members of the newly established inner agency coordinating council. we'll have our second meeting actually at the end of this week. but specifically, nih has partnered with the dod in building a central, federal interagency brain injury research database. that will allow excess to researchers across the multitude of research done by both agencies. this is important, pause because that helps us establish better tbi classification systems, better diagnostic criteria for mild tbi, predictive markers for dimensha, and a host of other activities that can only really be achieved through that type of collaboration. so the federal interagency traumatic brain injury research database, i think, is going to be a real facilitator. >> so you're working to improve access to databases. >> right. >> and electronic information on the funded research. mr. ditho, how are the states working with returning service members or veterans, and how do states

group or groups with a defined membership and structure to work in partnership and develop workable solutions as we implement new va and dod policy and procedures. i believe this will go a long way to bring consensus and efficiency to colleges and most important to service members we serve. to illustrate, since implementation of the post-9/11 gi bill have had the pleasure of-processing chapter 33 tuition benefits. these meetings always end with both sides walking away better informed about how each of us operate. well, most of the time. regarding the executive order, we believe most but not all of the president's principles align with existing u.s. department of education requirements. those principles if implemented by the dod and va according to to the guidelines will not reflect additional cost or burden on our institutions. we do have concerns. section 2 a requires institutions to provide prospective students with a broad range of information on an individualized standard form. prospective students routinely do not identify themselves, making it difficult for institutions to know who should be -- the va as not

state-of-the-art care, not just to the individuals, but to the dyads, to the couples and the family systems. the va was one of 16 departments whose secretaries signed off on the president's report, called strengthening military families . and those 16 secretaries pledged that they would approach this population with the highest priority over the next few years. it's a very significant move. and that means that even organizations like nasa, the department of agriculture, the department of justice, the department of education -all of those 16 cabinet level agencies have pledged to do something in the four areas of the report. and those four areas, very briefly, are increasing the psychological health of military service members and their families, that is the term that is used in the report; strengthening childcare education and military schools; strengthening opportunities for spousal employment; and making sure that all individual service members have access to services everywhere. i mean, it's a tremendous, tremendous report. and, hector, where the rubber meets the road, when you're dealing with t

she is a star, and has worked diligently for months getting the details of this conference put together. krista stephenson from the va side has been her partner and they deserve a huge round of applause. [ applause ] julie cassell is our employee education service representative, and rachel, are you here? you know, this woman has sent me more personal e-mails in the past six months than anyone else i know in the entire world, and she has the patience of a wonder woman, when i didn't respond, when i didn't care. [ laughter ] rachel is persistent, and the rest of the planning team, are you here? no. but anyways, let's give them all a huge round of applause. [ applause ] and you all have my very personal thank you. our next speaker is truly exciting. treg drewerson is the second eldest son of mr. dave dorson, an american football player that played at the university of notre dame and in the nfl for 11 seasons. dave plays college football from 1979 to 1982, and started all four years, earning all-american honors in 1981 and 1982. in 1983, dave was selected by the chicago bears in the third round of the nfl draft. during

mission, the military spouse employment partnership, wounded warrior project, hiring our heroes, and va for vets. we also build and maintain relationships directly with colleges and universities that support the gi bill and offer programs developed especially for veterans. over the past year, we have participated in more than 125 hiring events spanning 72 cities nationwide. as a result, we connected with more than 5,000 veterans and hired more than 2,000 of them. as part of our outreach to recruits, we work closely with the transition assistance program, tap, sponsored by the u.s. military. through tap we offer site assistance to active duty soldiers who will be leaving the military, including practical device on how to develop and write a resume, how to interview for a job, and how the civilian job environment works. of the many things we do to retain our employees to include veterans, mantech offers educational skills and career development training as well as mentorship opportunities. our education programs are offered through mantech university, or mtu, a first class award winning c

we've talked with the va, and we've said if we build one as well in the civilian community that's completely not attach today the va would you guys certify it, they said, absolutely, go for it. so that's what we're going to do. so peers work. number two, peers navigate. their principal function is to navigate at the community level. it isn't just about mental health and being a peer specialist for mental health. it's about navigating and answering every single need which means they need to know what the community has available in all the sectors of service. when that person calls and says i need daycare next thursday, the peer says, got it. i heard that, i listened, i'm going to go find you daycare, and i'm going to call you back, and we're going to continue to follow up until you get that daycare. number three, effective local community resource directory. the community blueprint is a terrific program that is trying to collaborate and create a blueprint for how you collaborate with community services. a very important function. we think that military family members, military community membe