"In our national survey of injured service members," said Shalala, who co-chaired the President's Commission on Care for America's Returning Wounded Warriors with Dole, "less than half understood the DoD's disability evaluation process. And only 42 percent of retired or separated service members who had filed a VA claim understood the VA process."
That lack of understanding provides a significant obstacle to returning wounded soldiers to active duty or getting them the benefits they need to return to work in civilian life, the senators and witnesses said.
"Today's soldier chooses a military career, and their expectation is the same as it would be for any professional working in any organization across America," said Sen. Richard Burr, R-N.C., Veterans' Affairs Committee ranking member. "If one is hurt on the job, one expects quick, effective and relatively hassle-free physical, vocational restoration and support services from the employer."
The commission's first recommendation would simplify the disability process by assigning the Defense Department sole responsibility for performing the physical exam that determines a soldier's fitness to serve. If that exam reveals that a soldier is not fit to serve, the VA should use the results to assign a disability rating, Shalala said.
"DoD should determine fitness standards and provide for the health and readiness of the military workforce," she told the senators. "VA's mission is to care for our nation's veterans by providing appropriate benefits and services."
Retired Lt. Gen. James Scott, chairman of the Veterans' Disability Benefits Commission, told the panel that the current system, which requires independent examinations by Defense and VA, frequently results in inconsistent disability ratings.
Patrick Dunne, the assistant secretary for policy and planning at VA, said the department is running exercises to test a one-examination system and to make sure it would produce fair, consistent disability ratings and provide quick service.
"We envision it cutting in half the time it takes for a service member to go through [the Disability Evaluation system], from the time the member is referred for a Medical Evaluation Board to the time the member is discharged from active military service and receives his or her first payment from VA," he said.
The commission's second recommendation calls for Congress to provide those service members disabled because of injuries sustained in combat and their families with lifetime health care coverage and pharmacy benefits through the Defense Department's TRICARE program.
Shalala said this health care guarantee would improve veterans' prospects of employment, because it would allow them to consider taking jobs that did not provide full health benefits.
"Many of these young people can take a job, but finding a job that has benefits that will cover their families is a real challenge," she said. "It will change their lives if this benefit is available. They will have a lot more choices."
In addition to calling for comprehensive health care, the commission also recommended that Congress establish a "presumptive eligibility" standard that would make veterans of the Iraq and Afghanistan conflicts eligible for lifetime treatment for post-traumatic stress disorder through the VA.
"We want to make it clear that there ought not to be a time constraint, because PTSD can show up two or three years later," Shalala said. "I think that making it very clear that they have access to services -- lifetime services -- is extremely important."
Shalala asked Congress to restructure the payment of veterans benefits into three categories: transition payments that would provide three months of base pay for veterans finished with rehabilitation, or living expenses for the duration of education or work training programs; earnings loss payments that would compensate soldiers for diminished earning capacity related to their service; and quality of life payments.
"People have a social life. Maybe you won't be able to dance, maybe you won't be able to play the piano; there are things you won't be able to do, and we think it's time it's recognized and paid for," Dole said.
Shalala also said Congress should amend the Family and Medical Leave Act to extend unpaid leave for a family member of a wounded service member from 12 weeks to six months. She also recommended that service members with combat-related injuries be made eligible for an aide and personal attendant benefit to ease the care-giving burden on their family members.
All of these changes to veterans' experiences should be accompanied by modifications of Defense and VA systems, Dole said. One innovation he reported was already under way is the creation of a unit of 50 to 100 recovery coordinators who are currently being trained by the Public Health Service and who will be assigned to wounded service members when they return to the United States.
Dole said a number of the veterans he worked with "each had case manager after case manager. One told us he had over 10 and could never remember what they were managing, never mind their names."
In addition to eliminating turnover, the recovery coordinators will be able to bridge divides between the VA and the Defense Department.
"We thought it best to place these individuals outside of either the DoD or VA," Dole said. "Part of this reasoning was because we were concerned that VA or DoD employees would not be allowed to effectively reach out to the other department, marshaling needed services, with any degree of authority."
The coordinators will be responsible for creating and guiding wounded service members through complete recovery plans, including helping them negotiate a new and simplified network of benefits, and exploring both VA and private sector options.
Dunne said the hiring of 100 patient advocates would also help veterans negotiate the disability system.
"These men and women, often veterans themselves, recognize the difficulty in understanding the many different programs and processes which come into play," he said.
Dole also said that service members soon will have access to a customized Web portal that would provide them with information specific to their situation, further minimizing confusion about benefits. That system is in the testing phase.
Dole and Shalala's final recommendation sought full support for the Walter Reed Army Medical Center until it closes, to prevent any veterans from being victimized by deteriorating conditions.
But they concluded that it is time for a paradigm shift in delivering benefits to service members and veterans.
"Someone's got to stand up and say it's a different kind of warfare, it's a different kind of generation," Dole said. "Maybe we ought to move ahead."