| Wednesday, March 28, 2012. Chaos and violence continue, Congress hears excuses from VA and DoD, Baghdad continues on lockdown, Nouri goes after another political rival, and more. US House Rep Jerry McNerney: I think the goal is to make it seemless for the service member to go from -- obviously, that's the goal. Are there technical issues like communication between computers or any of that a problem at all? Or can we just put that one to bed now or do we need to talk about that for a little while? John Medve: [. . . Microhphone not on at the start of remarks] the question, we're working on that. You're familiar that we're trying to develop or have on the boards developing an integrated lifetime health record which once that comes into fruition will be, I think, a great asset for us. In terms of the Integrated Disability Evaluation System and moving people through that process, we have one system called the Veterans Tracking Information that we use to manage where people are in the process so that we have the metrics and understand where they're at. We monitor those things every two weeks at the VA. The VA chief of staff holds a bi-weekly performance, uh, meeting with every single executive that manages a part of that process down to the local level. As part of those discussions, if there are issues that we're having in terms of transmissions of data or any of that, he immediately calls our office of information technology to bore in on the problem and to fix it. Ranking Member Jerry McNerney: Well that sounds good. Is there a -- except for -- I want to get an idea of when these medical records are going to be standardized so that we can get this transition, that part of it, out of the way. So do you have an idea about when that can be expected to be finished? John Medve: Sir, I know the two Secretaries, as Mr. Neabors alluded to, meet every quarter. At the last meeting, at the end of February 27th, one of the marks on the wall is that we're putting the integrated health record at the James A. Lovell Federal Level Health Care Center, that's the pilot site for it. They have required that there be two additional sites be in place by 2014 in order to build this and so it's going to be a growing development over the next several years. Ranking Member Jerry McNerney: That's -- that's not good enough. That's not even good enough. McNerny was question the VA's John Medve (Office of VA-DoD Collaboration) this morning. The House veterans Subcommittee on Disability Assistance and Memorial Affairs was addressing a number of issues. Subcommittee Chair Jon Runyan noted at the start of the hearing, "This is my hope that this oversight hearing will shed some light on some of the problems that we have encountered in the implementation of IDES so we may work together to find the best solution possible." There have been too many problems for service members and veterans in the system.This includes the transition of a service member to a veteran. Congress has been asking for this to be fixed, Congress has generously funded all techonology requests on this issue and Congress has repeatedly asked both DoD and VA if additional funding was needed. One of the most basic problems was that DoD used one computer system and VA another and the two couldn't communicate. This was eye rolling -- some might say typical -- six years ago when we first started hearing about it in hearings we attended (and it may have been addressed prior to 2006). It's no longer excusable. Too much money has been spent, too many years have passed. This issue should have been completely dealt with some time ago. Two years from now, VA testified, there will be a pilot site to test these things that were identified over six years ago? Eight years after identification and after all the funds Congress has provided to fix this issue, a pilot program will take place. ("At least eight years" -- again, we've only been attending the veterans committee hearings since 2006.) In the section we were quoting at the start, Ranking Member Jerry McNerney was informing the first panel that it wasn't good enough. That describes the first panel: Not good enough. They would go on and attempt to mislead as McNerney's questioning continued. Jim Neighbors: Sir, if I could chime in -- thank you for your question. DoD and VA are actually sharing more information right now than any two organizations in the nation. Now if I could just give you some statistics, please, on what that sharing is. Service members' data, again, that has been shared with VA is over a million times already and what that turns into as far as laboratory results is we've shared 23 million of them to date and this is in IT form, this is machine readable, things we've pushed for. So they're not paper. Radiology 3.6 million reports, pharmacy 24 million records and patients have engaged on their medication and allergy recommendation from what was about 27,000 to now 1.2 million which is significantly improving patient safety. Those are just some areas, it's not an entire IDE chart. So between our organizations, we are actually are doing some of the sharing already. And, if I could, there are actually four locations pilot wise, which we're including private providers such as Kaiser Permanente or something. Where we would bring them into the fold here too. So between government entitites, we have that actually going on right now. So you're right. We're not where we need to be. We're not completely there. Absolutely. But there is stuff going on that is servicing our veterans. And the second thing I'd like to say, sir, if I could please, that's entity to entity. As far as giving of VA -- excuse me, a veteran or service member their records, we can do that right now. We're working very closely with VA to enroll our service members as they come in the door into a platform, an IT platform, called the E-Benefits Platform. That will then allow -- or that allows -- and we've got 1.4 million of them already signed up now. But then at any point in time after that, from anywhere in the world, 24-7, they can actually download their medical records and hand them off to a private provider or anybody that they are involved with through that continuum right now. And that's called the Blue Button Capability. Maybe you've heard that or not. And if I can jump in, DoD and VA were sharing information -- as he's decribing -- some time ago. This isn't expected progress, this is more of the same. And to be even more clear on this, DoD and VA were always supposed to be 'sharing.' That's transporting the medical records from DoD to VA as the service members switches to the status of veteran. Neighbors repeatedly misleads. We could fill three more snapshots with examples. Instead, we'll just note two here. Ranking Member Jerry McNerney: I haven't heard that. One of the things that Mr. Medve was saying is that you can track an individual through the process. But is there an advocate for that individual? Or does that get passed on and the individual finds himself or herself calling in and getting the run around? I mean, what we need is an advocate. Whether it's DoD or VA or the joint-effort, Mr. McDonnell, sort of going into that, an ombudsman, an advocate or some coordinator that that person can go to when they are in trouble from start to finish. John Medve: Sir, yes, thank you for the question again, Congressman, in IDES, when someone is enrolled in it, there's the PEBLO, Physical Evaluation Board Liason Officer, that when that invidual is referred is who greets them at the entrance to that process. That is the single point of contact that will shepherd them through IDES -- as they are in each different stage, they are briefed by that person where they stand, where their medical evaluation schedules are done when they're supposed to appear before any boards and all that. Once we get to a point where they are going to be determined to be separated, we the VA sitting with the DoD PEBLO have what we call Military Service Coordinators that then sit down with the individual as a team and explain to that individual what their VA benefits. So that's what happens inside the IDES. Now also -- Ranking Member Jerry McNerney: Does the service member of former service member get to check off on that and say that they're okay with that transition at that point? John Medve: I'll defer to Mr. Neighbor since that gets into the military administrative process. Jim Neighbors: Absolutely, sir. At any point in time when an evaluation takes place, that service member has reclima capabilities at a number of venues. Each one of the services has a number of boards that does the exactly what we're talking about here which is the evaluation of their disability and the rating. They can then take that to a department wide -- Excuse me, let me say that again the service wide board that is more of a formal activity where they make sure that the rulings have been applied equally across from the local board itself. If the service member doesn't believe that is equitable, they actually can go to another level and they can actually go to what's called the Board of Correction for Military Records level also. So there are a number of points where the person can say, "You know what? This wasn't fair. I need another look." And they can be reversed or they can be upheld as any board can do. But, yes, sir, there is. And now Neighbors misleads again. The question was about an advocate originally -- does the service member have an advocate with him or her throughout the process and then they were asked what about if the service member didn't feel ready for the switch: "Does the service member of former service member get to check off on that and say that they're okay with that transition at that point?" Neighbors did not answer that question. He deliberately misled about an appeal process that was in place prior to the need for a seemless transition becoming a talking point of DoD. You are a service member. You have a PEBLO assisting you throughout your various processes. Now you're being informed you're about to discharge and transition from service member to veteran and you're not ready -- this was McNerney's question, remember? -- are you able to speak to someone or slow the process or get additional assistance with the change? That's never answered. (So the answer is probably no.) Instead, Neighbors attempts to distract by going into great detail about the appeals process that's been in place for decades and has nothing to do with seemless transition or efforts in the last six years (or even the last decade) to improve and simplify the process for today's service members and veterans. But before we get to that, we're going to note the strong objection US House Rep Timothy Walz registerd. US House Rep Tim Walz: But I'm going to highlight this issue of the discharges from DoD on personality disorder. I'm truly troubled about this. If this is truly about honoring the commitment to care, this is the third hearing I've sat here where we've talked about something like this. In 2007 we were going to get this fixed, we were going to get it fixed in 2010, September 15th. And there's a report today, my friends over at the Vietnam Veterans of American, through a Freedom of Information Act, we're at it again. So we've got soldiers, they go to war, they come back and they're being diagnosed with adjustment disorder or personality disorder. It gets stamped on their discharge papers "Discharged for Personality Disorder," they're denied VA benefits and that's on their permanent record to follow them for employment. So, Mr. Neighbors, I know this is not your area of expertise, if I could say, I'm not putting you on the spot for the entire Department of Defense, but I would like you to . . . What do you think when you hear this again? Because all the issues you're talking about -- and I don't want to distract us from this very broader issue, but I do feel like I need to speak up for these 31,000. I do need to try and figure out how we right this wrong. Because the idea that you would be diagnosed with an adjustment disorder after being in Afghanistan? I don't know. If I could just turn it over, I know it's very general but -- Jim Neighbors: I really appreciate the question and it is an important issue. I'm going to go out on a limb here and try to narrow it a little bit. I think what you're referring to is the reports of what's happening at Madigan and out on the West Coast? Am I correct on that or is it? US House Rep Tim Walz: Well there was a new, I had the thing. We just had a new Freedom of Information request and the study was put together on this from Vietnam Veterans of America, I'll make sure we get a copy to you to make sure you see that. And I'm stopping Walz there. No, it's not the same thing. Walz didn't say it was. But there's no excuse for a VA or DoD official going before the Congress this morning not to know what VVA released. Madigan is about PTSD diagnoses being changed for active duty service members (it may be happening to other groups as well but that's what is known about Madigan at present). What Walz was asking about was service members returning to the US and being discharged. And their discharge is a PD (personality disorder) and it is done that way not to deny PTSD benefits but to deny all benefits. A PD discharge leaves a service member with the news that he or she will be paying out of their own pocket for all health care they may need. Just from what Walz described, Neighbors should have known this wasn't the same issue. And if Neighbors honestly doesn't know the difference between a PTSD diagnosis and a PD diagnosis, that's really scary. More likely, this was yet another attempt to distract and mislead. Some idiot -- and I use that word intentionally and after careful consideration -- from DoD was called up by Jim Neighbors and began talking. Subcommittee Chair Jon Runyun instructed to speak into the microphone at which point he decided he was a race with his tongue and the losers were the listeners. Whatever his name was, he began talking about PTSD as well and continued doing so. As Walz was trying to get across, a PD discharge is based upon the belief that these service members came into the service with a mental issue or problem and it wasn't discovered until late in the service. That's how you do a personality discharge. We've covered War Criminal Steven D. Green repeatedly here. He got a personality disorder discharge and deserved it. It was a mistake to let him into the military (and he was one of those recruits who had a choice between doing time or joining the military -- had he not joined, the judge would have sentenced him to time behind bars). Steven Green was a good case. What Vietnam Veterans of America is highlighting is using citizens to fight your wars and then, after you've used them (and often as they're ready to leave the military), 'discovering' a personality disorder that makes them unfit to serve and allows you to give them a PD discharge which means that they have no medical benefits which, for the government, means they don't have to pay out money for treatment. VVA's argument is that once again PD discharges are being used to deny those who have the benefits they have earned. Here's VVA's press release in full: (Washington, D.C.)– Since 2008, the Department of Defense (DoD) has illegally discharged hundreds of veterans on the alleged basis of personality disorder (PD), denying them veterans' benefits, according to a Vietnam Veterans of America (VVA) analysis of newly disclosed records released today. The analysis further concludes that since Fiscal Year (FY) 2002, the Navy has discharged the most service members on this basis in absolute terms (7735), and in FY 2006 the Air Force set a military record for the Afghanistan and Iraq era when PD discharges accounted for 3.7 percent of all airmen being discharged (1114 of 29,498 service members). The VVA report, Casting Troops Aside: The United States Military's Illegal Personality Disorder Discharge Problem, is based on records obtained by VVA in federal Freedom of Information Act litigation. The report found that, since 2008, internal DoD reviews discovered hundreds of illegal PD discharges, and since FY 2001, the military has discharged over 31,000 service members on the alleged basis of PD. PD can be used as the illegal basis for incorrectly discharging veterans suffering from Post-traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI). The DoD considers PD a preexisting condition, and a PD diagnosis renders veterans ineligible for several benefits. "On a veteran's discharge paperwork it states clearly, 'discharged for personality disorder,' and not only does it keep veterans from benefits they may have earned, but it is one of the first things that prospective employers see. Anyone who sees the veteran's DD-214 can determine the reason for discharge. " said Paul Barry, President of VVA Chapter 120, Hartford, Connecticut. "Shame on the Department of Defense," said Dr. Thomas J. Berger, VVA Executive Director for the Veterans Health Council. "It acknowledged the widespread illegality of these discharges and changed its rules going forward but has left 31,000 wounded warriors alone to fend for themselves, denied even basic medical care for their injuries." In 2008, Congress directed the Government Accountability Office (GAO) to investigate illegal personality discharges. The Congressional pressure prompted new DoD regulations, but VVA has found that illegal personality disorders continued through FY 2010, and that since 2007, the total number of PD discharges has increased at least 20 percent, according to documents released under one of two pending VVA Freedom of Information Act (FOIA) lawsuits. In a document obtained by the FOIA lawsuit, a Navy report on 2008-2009 PD discharges noted that only "8.9 percent [of PD discharges] were processed properly. …This does not paint a pretty picture." Additionally, VVA analysis of DoD documents uncovered a two-fold rise in Adjustment Disorder (AD) discharges in the United States Air Force from FY 2008 to FY 2010 that may signal that AD discharges have now become a surrogate for PD discharges. "Everyone agrees that illegal personality disorder discharges occurred," said Robert Cuthbert, Jr., a student intern with the Veterans Legal Services Clinic at Yale Law School representing VVA in the FOIA litigation. "Some of these veterans may suffer from undiagnosed PSTD or TBI. The Department of Defense must act justly, responsibly, and promptly to help them heal." Vietnam Veterans of America (VVA) is the nation's only congressionally chartered veterans service organization dedicated to the needs of Vietnam-era veterans and their families. VVA's founding principle is "Never again will one generation of veterans abandon another." The report was prepared for VVA by Melissa Ader, Robert Cuthbert Jr., Kendall Hoechst, Eliza H. Simon, Zachary Strassburger, and Prof. Michael Wishnie of the Veterans Legal Services Clinic at Yale Law School. Let's go to the Madigan issue now. The Madigan Army Medical Center on Joint Base Lewis-McChor is in the state of Washington. One of their two US Senators is Patty Murray who is also the Chair of the Senate Veterans Affairs Committee. Madigan raised flags when it was learned (a) the costs of PTSD treatment had been discussed/lamented at an administration level and that (b) after this discussion/lament, service members diagnosed with PTSD had their diagnoses changed. This morning at the Defnese Appropriations Subcommittee hearing, Senator Murray questioned the Army Surgeon General Lt General Patricia Horoho. I was at the House hearing, Wally attended this hearing and took notes on it. Senator Patty Murray: General Horoho, you and I have had a number of discussions about the invisible wounds of war and the challenges soldiers are facing seeking behavioral health care and, as you well know, Madigan Army Medical Center in my home state of Washington is dealing now with how to handle these wounds and provide our soldiers quality consistent care -- especially for our soldiers who are going through the Integrated Disability Evaluation System. Now I think that some of the issues that have been raised at Madigan are unique to that facility but I do continue to have a number of concerns not only about the situation at Madigan today but the implication for our soldiers really across the Army who may have also struggled to get a proper diagnosis, adequate care and an honest evaluation during the Integrated Disability Evaluation System process. I wanted to ask you today, prior to 2007, Madigan did not use the forensic psychiatry to evalate soldiers in the medical evaluation process. And wanted to ask you today, why was that system changed in 2007. Army Surgeon Gen Lt Gen Patricia Horoho: Thank you, Senator, for the question. The first thing I'd like to do is just pick up on the word, when you said "invisible wounds." I know it has been said during this war that the signature wound is an invisble wound, I would submit that it is not invisible to the family nor is it invisible to the soldier that's undergoing that -- those, uhm, challenges, behavioral health challenges. The reason -- and I'm-I'm guessing on this, ma'am, because I wasn't there prior to -- but, uh, prior to 2007, we were a nation that entered into war in about 2001 when we were attacked in 2002 timeframe. And we had a very old system. That was the Methold -- a methold system, which was two separate systems, how we managed those service members, active and reserve component, and that was a system which has been in place for many, many years. And what we've found with the large number of deployments and service members that were exposed to physical wounds as well as behavioral health wounds is that we found that the Army system was overwhelmed. And that really is what was found in the 2007 timeframe -- is that we didn't have the administrative capability as well as the logistical support that needed to be there and that's why we stood up our Warrior Transition Units. So we had a large volume going through the disability process that was an old, antiquated process and we had an overwhelming demand on our army that we needed to restructure to be able to support and sustain. Senator Patty Murray: But prior to 2007, there wasn't a forensic psychiatry that added an additional level of scrutiny. Army Surgeon Gen Lt Gen Patricia Horoho: It's -- Senator Patty Murray: Correct? Is that correct? Army Surgeon Gen Lt Gen Patricia Horoho: It's -- I honestly will need to take that for the record because I don't know in 2006 if they had forensics or not. So I can't answer that question for you. I would like to give you a correct answer, so if I could take that one for the record. Senator Patty Murray: I would appreciate that. And, as I mentioned, I am really concerned that soldiers, Army wide, have been improperly diagnosed and treated by the Army. What have you found under your investigation of soldiers getting incorrect MEPB evaluations at other facilities? Army Surgeon Gen Lt Gen Patricia Horoho: Ma'am, if I could just, uh, When soldiers are getting diagnoses of PTS or PTSD, we use the same diagnostic tool within the Army, Navy and the Air Force which is the same tool that is used in the civilian sector. So it is one standard diagnostic tool that is very well delineated on the types of symptoms that you need to have in order to get a diagnosis of PTS or PTSD. So we are using that standard across the board and we have been using that standard across the board so -- Senator Patty Murray: But we do know now at Madigan there were soldiers were incorrectly diagnosed. And we're going back through. There were investigations going on to re-evaluate and my question is: There's been a lot of focus at Madigan, I'm concerned about that system-wide. And you're doing an investigation system-wide to see if other soldiers have been incorrectly diagnosed, correct? Army Surgeon Gen Lt Gen Patricia Horoho: Yes, ma'am. So if I can just lay things out and reiterate some of our past conversations. We have one investigation that is ongoing. Actually, it completed and it's with the lawers that's being reviewed. The Deputy Surgeon General, General Stone, initiated that investigation and that was to look into -- Senator Patty Murray: System-wide? Army Surgeon Gen Lt Gen Patricia Horoho: No, ma'am, that is the one at Madigan that's looking at the forensics. Then there's another investigation that was launched by the Western Region Medical Command into the command climate at Madigan Army Medical Center. And then what I initiated was an IG assessment that looked at every single one of our medical treatment facilites and the provision of care to see whether or not we had this practice of using forensic psychiatric and psychological medical evaluation process. Senator Patty Murray: Okay, well my question was whether you had found other facilities with incorrect diagnosis and I want you to know that I have asked my Veterans Affairs staff to begin reviewing cases from throughout the country of service members involved in this process. And we are just beginning our review right now but we have already encountered cases in which a service member was treated for PTSD during their military service, entered the disability evaluation process and the military determined that the service member's PTSD was not an unfitting condition. So my concern is the significant discrepancy now between the Army's determination and the VA's finding that the soldier had a much more severe case of PTSD. Now our review on my Committee's ongoing but besides bringing individual cases to your attention, I wanted to ask you what specific measures do you look at to evaluate whether soldiers are receiving the proper diagnoses and care and honest evaluation? Army Surgeon Gen Lt Gen Patricia Horoho: It's, uh, we are within the Army, our role as the physician is to evaluate the patient not-not to determine a disability. So they evaluate and identify a diagnoses and a treatment plan and then once that is done during the treatment and if they are determined where they need to go into the disability system, then once they're in the disability system, now because of IDES that occurred in 2010, they now have that evaluation done by the VA, the compensation examp, that's the C and P that's done by the VA. And then they are brought back into the disability systems. But the physical evaluation board, the PEB, is actually where the determination for disability is made. That is not a medical, that is an administrative action that falls under our G1. So I just want to make sure that we don't mix what we do within the medical community in treating and evaluating and what gets done in the disability process that's an administrative process that is reviewing the evaluation from the VA and then the evaluation from the medical to determine disability. Senator Patty Murray: My concern is that every single soldier who has mental health disability, PTSD, gets the care that they need and that they get the support that they need and they're adequately cared for whether they leave the service or are sent back overseas or whatever. So we're going to continue to look at the system-wide and, as you know, the problems at Madigan were allowed to go on for years and I'm really concerned that lack of oversight over the disability evaluation system is much more broad. And we're going to be following to see what steps you take to ensure that this process is maintained not just at Madigan where there's a severe focus right now but nation-wide. And, again, thank you to Wally for that. It's interesting that Horoho referred repeatedly to a concluded study but didn't note the findings. That's probably best since it's not yet been released; however, it's interesting because, Greg Barnes (Fayetteville Observer) reports that yesterday John McHugh was at Fort Bragg and discussing the not yet released study at a press conference. The Council on Foreign Relations Meghan L. O'Sullivan observes this afternoon, "The meeting offers the Baghdad government its first real opportunity to demonstrate how it intends to orient itself as a regional actor. Iraq has understandably been consumed by internal challenges over the past nine years. This inward focus has led to a foreign policy focused on alleviating Iraq's debt burden, getting out from under United Nations Chapter VII sanctions, gathering support for the fight against terrorism and extremism, and urging greater acceptance of the new Iraq." Alsumaria TV reports Foreign Minister Hoshyar Zebari declared today that Arab states have sent 12 Foreign Ministers to Baghdad thus far for the Arab League Summit. KUNA adds that Zebari "announced its [Iraq's] full support of the effort exerted by the joint envoy of the United Nations and Arab League Kofi Annan to end crisis and violence in Syria, while stressing its opposition to foreign intervention in the Arab country." The Foreign Ministers are meeting today. Nouri is supposed to deliver a speech today. AFP notes, "Iraqi President Jalal Talabani has accepted the credentials of the first Saudi ambassador to Baghdad since Saddam Hussein's 1990 invasion of Kuwait, the president's office said on Wednesday." Al Jazeera splashes some reality by explaining: For the first time since that conflict, Iraq also officially received an ambassador from Saudi Arabia, Fahd bin Abdul Mohsen al-Zaid, though he will function only as a "non-resident" ambassador and is already the Saudi envoy to Jordan.
The summit was not particularly well attended. At least five countries sent foreign ministers, including Bahrain, but both Qatar and Egypt did not send their top diplomats, and others were absent. Who's meeting and greeting? AFP's Prashant Rao Tweets: prashantrao PM has so far met leaders of 6 members for : , , , , , Al Rafidayn notes that Nouri's reps began pressing other leaders yesterday on dropping Iraq's debt. Kurdish MP Mahmoud Othman Tweeted today: "We hope that the Arab summit will cancel the debts on Iraq&help it in investments, economic prosperity,as well as fighting terrorism." Jane Arraf is a correspondent for Al Jazeera and the Christian Science Monitor. She Tweeted on the summit today: Also noting obstacles to reporting is AFP's WG Dunlop: And NPR's Sean Carberry Tweets: Those are Tweets on the problems the press has encountered. We'll try to include some reports on those problems from the Iraqi press in tomorrow's snapshot. We'll close by noting the disturbing news of the day and news that wasn't picked up and front paged but should have been. Nouri al-Maliki is now going after Iraq's Communist Party. Al Mada reports that Nouri's security forces stormed the political party's headquarters and arrested 12 people who were arrested and questioned about protests. Ali Hussein (Al Mada) notes the Communist Party has a long history of fighting for Iraq, not against it. Hussein reports that Nouri's tanks have been sent to surround the homes of Communist Party members in Baghdad. Those who paid attention in December will remember that Nouri ordered tanks to circle the homes of Iraqiya members right before he demanded that Deputy Prime Minister Saleh al-Mutlaq be stripped of his posts and ordered the arrest of Vice President Tareq al-Hashemi on charges of terrorism. Both al-Mutlaq and al-Hashemi are members of Iraqiya as well as Sunnis. Ali Hussein notes that Nouri also ordered tanks to circle the homes of Communist Party members last year. | 
