Defense, VA lay out plans to improve health care for wounded soldiers

Top officials from the departments of Veterans Affairs and Defense said on Tuesday that they plan to improve the health care for troops wounded in Iraq and Afghanistan by providing them with "a life map for recovery" that integrates all their heath records into one package and lays out a listing of follow-up services.

In a joint statement submitted to a hearing of the Senate Veterans Affairs Committee, Dr. Lynda Davis, deputy assistant secretary of the Navy for Military Personnel Policy, and Kristin Day, chief consultant for care management and social work at VA, said Defense and VA partnered in October to establish the Joint VA/Defense Federal Recovery Coordinator Program.

Program coordination officials will develop several Web-based applications, including a Federal Individual Recovery Plan and a National Resource Directory, they said. They will team with military health care personnel to use the recovery plan to create in one set of documents a so-called life map for recovery for wounded, ill or injured service members, as well as veterans and their families.

The recovery plan will provide a complete menu of care (integrated documents that include all health services and health organizations, including longitudinal records, and clinical and nonclinical services) to service members headed back to duty or retirement, Davis and Day said. The plan will include information on support services and resources for health care providers and the wounded service members and veterans, they added.

VA and Defense developed the application based on recommendations from the President's Commission on Care for America's Returning Wounded Warriors, which President Bush formed in response to critical reports of military health institutions such as Walter Reed Medical Center in Washington, providing poor health care services to wounded soldiers returning from Iraq and Afghanistan. Last August, the commission, headed by former Sen. Bob Dole, R-Kan., and Donna Shalala, secretary of the Health and Human Services Department in the Clinton administration, recommended that Defense and VA develop within a year a Web-based portal to provide patients with health care and benefits information from the two departments.

Deputy Secretary of Defense Gordon England and Veterans Affairs Deputy Secretary Gordon Mansfield told the Senate Veterans Affairs Committee in February that they planned to set up an eBenefits Web portal that will meet the commission's mandate, but they did not provide a timeline.

The commission also said the Web portal should provide patient records to recovery coordinators, who work directly with wounded soldiers in military clinics and hospitals, to clinicians and other health care professionals in both departments.

Davis and Day also described the National Resource Directory, developed in collaboration with the Labor Department, that wounded service members, veterans and families will use will use to find health services offered by federal, state and local agencies and veterans services organizations. Health care providers and the general public will be able to use the directory as well, Davis and Day said.

But for the time being, care for wounded soldiers still remains in disarray, says retired Air Force Col. Peter Bunce, whose son Justin, a Marine corporal, was severely wounded by an improvised explosive device in Iraq in March 2004. Peter Bunce, who testified before the committee, says families still must battle a disorganized, paper-based system on their own to obtain needed care.

Peter Bunce said his son lost an eye as a result of an IED blast and also sustained traumatic injury from a piece of shrapnel that penetrated the frontal lobe of his brain. Peter Bunce said he considers the brain injuries the "signature wound" of combat operations in Iraq and said the effects of those injuries are felt not only by the wounded soldiers but also by their families, who as caregivers are often left to manage much of the wounded soldiers' daily lives.

The burden that they bear in dealing with traumatic brain injuries is compounded by what Peter Bunce described as "the multitude of bureaucratic hoops that families are expected to jump through for services [which] can be the breaking point for that veteran's support system."

Case management at the VA Medical Center in Washington, where Justin Bunce receives treatment, only schedules appointments, Bunce told the panel. "Case management has been the sole responsibility of my family," he said. "We have had to navigate ourselves through the stovepiped departmental nature of care at the VA.

"We have been the ones, not VA personnel, to make trips to other VA hospitals in Tampa, [Fla.], and Milwaukee to bring back best practices for … therapeutic care to our local VA hospital that is ironically located in the heart of our nation's capital just a few miles from the Veterans Administration [sic] headquarters," he added.

Poor case management at the VA Medical Center is the cause of Peter Bunce's inability to obtain a review of the medications prescribed to Justin Bunce by various medical departments and evaluate the dosages and how the medications may be interacting, Peter Bunce told the committee. He said the only way he can keep track of clinicians providing care to Justin was with "a fistful of business cards, [which] does not suffice when families are overwhelmed with day-to-day recovery, therapeutic, medical and emotional issues."

Peter Bunce gave the committee his own recommendations for care at VA, which reflect those made by the wounded warriors commission and which appear to be the goal of the new eBenefits Web portal:

• A wiring diagram detailing the responsibilities of the different VA team members in the various medical departments that delineates their respective roles in rehabilitation, therapy and medical care.
• One document for each family listing the names and phone numbers of the entire member on a patient's health care team and department extensions.
• A flow chart allowing a family to track the process for making appointments, referrals, contacts for financial services, and insurance and legal assistance, and explaining how to access free outside medical and therapeutic services.