Overhaul Urged in Care for Soldiers

By Steve Vogel
Washington Post Staff Writer
Thursday, July 26, 2007

A presidential commission examining the care given to wounded U.S. service members yesterday recommended "fundamental changes" aimed at simplifying the military's convoluted health-care bureaucracy and overhauling the veterans disability system for the first time in more than half a century.

The commission, led by former senator Robert J. Dole (R-Kan.) and former Health and Human Services secretary Donna E. Shalala, met with President Bush at the White House yesterday morning to brief him on their findings and to press him for quick action. "We left there feeling the ball's in their court now," Dole said.

The panel issued six broad recommendations intended to transform a troubled system for military health care and veterans' assistance that has left some injured soldiers languishing for years and resulted in inequitable and inconsistent disability benefits.

The proposals include creating "recovery coordinators" who would help each seriously injured service member navigate the complexities of care, rehabilitation and disability; giving the Department of Veterans Affairs sole responsibility for determining payments for wounded veterans; and taking aggressive steps to prevent and treat post-traumatic stress disorder and traumatic brain injury.

Yesterday afternoon, Bush announced that he had instructed Defense Secretary Robert M. Gates and Veterans Affairs Secretary Jim Nicholson "to look at every one of these recommendations, to take them seriously and to implement them."

In their final commission meeting yesterday, members unanimously approved the "landmark" measures, as Shalala described them. "We . . . knew Band-Aids were not going to cut it," she said.

The 29-page report is titled "Serve, Support, Simplify." Its six overall recommendations are broken down into 35 specific "action steps," only six of which would require congressional legislation, Shalala said. Most of the others could be directed by the White House, the Pentagon and the VA, she added.

"These are doable," Shalala said at a news conference. "I told the president that I almost brought my Nike T-shirt that says, 'Just do it.' "

Bush established the President's Commission on Care for America's Returning Wounded Warriors in March after disclosures in The Washington Post of poor living conditions at Walter Reed Army Medical Center for some wounded soldiers returning from Iraq and Afghanistan. The articles also detailed the bureaucratic maze that many soldiers experienced during their long recoveries.

Yesterday's Dole-Shalala commission recommendations cap a series of boards, reports, hearings and investigations by the Army, Pentagon and VA responding to the public outrage that followed the news reports. As part of that fallout, the Senate passed legislation yesterday that would address inconsistencies in Pentagon and VA disability ratings and would provide more money for the diagnosis of traumatic brain injury and PTSD.

White House press secretary Tony Snow initially told reporters yesterday that Bush would not act immediately on the panel's advice. "He's not going to be making recommendations; he's not going to be issuing calls for actions," Snow said.

But late yesterday afternoon, after Dole and Shalala's comments and criticism from a veterans group, Bush -- appearing on the White House South Lawn after going running with two soldiers who had lost legs in combat -- announced that he will move quickly.

The Dole-Shalala commission was created to examine the overall state of military medicine and care for veterans. Over the course of four months, the nine members -- including two wounded Iraq veterans, the wife of an injured soldier, and experts on health care and veterans affairs -- held seven public hearings and visited 23 medical facilities nationwide.

Shalala said the panel opted against a "laundry list" of suggestions and instead narrowed its report to the six recommendations with a common goal of creating a "simplified path to recovery."

The proposals include establishing an interactive benefits Web site called "My eBenefits," modeled after MySpace, which would provide customized information for service members and veterans about their health care and benefits. The panel called for increased funding to support families of the wounded.

The proposal to overhaul the disability system would end the current "confusing" structure in which the military services and VA issue parallel and often conflicting disability ratings, commissioners said. They also recommended basing the VA's payments to veterans in part on their quality of life, not just on the work-related effects of their physical and mental injuries. "This is a very important change, because in the past it was just based on your disability," Dole said.

In addition, the commission called for ensuring that Walter Reed attract and retain "first-rate professionals to deliver first-rate care," even though it is slated to close in 2011. Dole, who was injured in combat in Italy during World War II, said the Pentagon must fight the impression that Walter Reed is a "dead-end" assignment for doctors and nurses by adding incentive packages that encourage them to stay.

The panel avoided making recriminations, Dole said. "We weren't going to have a whitewash or a witch hunt," he said.

Many aspects of military health care at Walter Reed and elsewhere are "first-rate," he added. "We visited with individual veterans, their families, doctors, whoever. And sure there are problems . . . but not everybody had a problem, and I think it got a little out of proportion there," he said.

© 2007 The Washington Post Company