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Retired Army Lieutenant General James B. Peake is President Bush’s choice to head the Department of Veterans Affairs. If confirmed by the Senate, Gen. Peake will succeed Jim Nicholson, who resigned in July and left office October 1.

Gen. Peake, 63, has been medical director and chief operating officer of California-based QTC Management, a provider of services covering occupational health, injury, and disability services. He is a 40-year veteran of the Army. A 1966 graduate of the United States Military Academy, he began his career as an infantry officer.

He was wounded in Vietnam while serving as an infantry platoon leader with the 101st Airborne. After Vietnam, the Army sent him to medical school, and he became an Army physician. He rose steadily through the ranks, and from 2000-2004 was Surgeon General of the Army.

Peake is “an Army doctor and a combat veteran who will be a strong new leader for his department,” Bush said in announcing the nomination at the White House with Peake at his side. “He would be the first physician and the first general to serve as secretary.” (Gen. Omar Bradley was Administrator of Veterans Affairs before the VA became a cabinet department.) Gen. Peake’s nomination requires Senate confirmation. That process will be interesting, given the furor over less-than-adequate care at Walter Reed Army Medical Center and many other Army hospitals that began during his tenure heading the Army Medical Department.

Gen. Peake was Executive Vice President and Chief Operating Officer of Project Hope, a non-profit international health foundation with offices and programs in more than 30 countries. He is a fellow of the American College of Surgeons, the American College of Cardiology, and a member of the Society of Thoracic Surgeons.

Gen. Peake was Surgeon General when Undersecretary of Defense David Chu, supported by Defense Secretary Donald Rumsfeld, made the decision to downsize the Army and Navy Medical Departments just as the Iraq War began.

Rumsfeld is gone, sacked, and the Assistant Secretary of Defense for Health, William Winkenwerder, is gone, sacked. So, we have to ask: Why is the architect of this horrendous policy that has hurt so many soldiers still there? That is a question the Senate should debate fully before approving this nomination.

While VVA does not think that senior military officers should publicly fight civilian authority on policy questions, or even on resource questions, it is legitimate to ask how hard Gen. Peake fought this downsizing of the Army Medical Department from the inside, even though in the end he appropriately saluted and said, “Yes, sir.”

Further, can Gen. Peake say no to the Office of Management and Budget and to the Domestic Policy Council in the White House, if asked to support inadequate requests for resources to properly care for veterans? Will he stand up for veterans against “green eyeshade” fiscal types and do what is right? Will he demand accountability from the staff at the Department of Veterans Affairs?

The previous flag-level officers appointed by the current administration have, all too often, gone along with the bureaucracy. Does Gen. Peake have the strength of character and independence of mind to think anew?

For the twelfth time in the last thirteen fiscal years, the Department of Veterans Affairs, like most of the rest of the government, is operating through a continuing resolution. This means that at least for the first six weeks of the current fiscal year, the VA has only the operating funds of the last fiscal year. Is this any way to run the government?

In fairness to the House leadership, at Speaker Pelosi’s insistence, $2.9 billion was added to the continuing resolution for veterans’ health care, to be spent by December 14. It is hoped that the appropriations bills will be enacted by then.

Still, there was much to be pleased about in the bill H.R. 2642 that was passed in the House of Representatives and then got stuck in the Senate over political maneuvering. Rep. Chet Edwards (D-Texas) hailed the record budget increases and strong bipartisan support for the 2008 Military Construction/Veterans Affairs Appropriations bill, which passed the House, 409 to 2.

The bill increases the VA budget by $6.7 billion above the 2007 level, the largest single increase in the 77-year history of the VA. It is $3.8 billion above the President’s request for fiscal year 2008. Of particular interest to VVA is a provision that would require the VA to obey the law and move expeditiously to contract for completion of the National Vietnam Veterans Longitudinal Study.

Edwards, who chairs the Military Construction/Veterans Affairs Appropriations Subcommittee, said to the press: “For the 400,000 veterans, including combat wounded vets, who are having to wait too long to have their benefits cases reviewed, this bill means over 1,100 new VA case workers [that] will reduce the unacceptable delays in receiving earned benefits. This bill also increases the VA’s maintenance and repair budget to prevent a Walter Reed scandal from occurring in the VA system.”

This all sounds fine. But finding 1,100 fresh faces will not happen overnight, and it will take some time to train them to do their jobs. Hence, the 400,000 figure will likely not diminish significantly for some time.

One step that the braintrust at the Veterans Benefits Administration (VBA) can take is to better define what “too long” really is.

Just as corpsmen and medics, nurses and doctors must do triage when heavy casualties come in from the field of battle, so, too, should the honchos at the VBA revamp the way they work. They can triage claims. Simple claims with properly filled-out paperwork should not take more than 60 days. More complex, multi-part claims that require a lot of supporting documents might need four or five months to adjudicate.

They also can have squads of raters who specialize in, say, claims for mental health issues such as PTSD. The VBA isn’t doing something right, because the persistence of the problem spans administrations.

Additionally, should the VBA bother to think seriously about the definition of what’s “too long,” they might want to bring in the VSOs from the giddy-up rather than spring new nomenclature on the veterans’ community. Under duress, the Undersecretary for Veterans Benefits convened a meeting with the VSOs last December, but not a single one of our collective VSO recommendations has been implemented.

The House bill also provides $21.4 billion for military construction, family housing, and base realignment and closing process (BRAC), which is fully funded with $8.2 billion.

The total for military construction is an increase of $207 million over the President’s request and $8.2 billion over 2007, which should mean better barracks, housing, and training facilities when troops return from combat. The bill supports the relocation of 70,000 troops from bases in Korea and Europe to the U.S. and provides funds to increase our military forces, beginning the process of adding 65,000 Army, 27,000 Marine, and 9,000 National Guard and Reserve troops.

In the Senate, an amendment introduced by Sen. Claire McCaskill (D-Mo.) requires the VA to create a mechanism on its web site for whistleblowers to report waste, fraud, or abuse anonymously to the department’s Inspector General. The goal is to strengthen oversight of federal agencies.

The freshman senator attached the same measure to the Homeland Security spending bill in July and promised to offer similar amendments to ten other pending appropriations bills.

When the scandal broke at Walter Reed Army Medical Center last February, the powers that be stepped all over themselves to create commissions and task forces to investigate and recommend solutions. The President, in fact, has taken credit for having implemented many of the recommendations offered by the Dole-Shalala Commission. He has sent legislation to Capitol Hill for those recommendations that require legislative action.

“Medical advances have enabled battlefield medics and hospitals to provide our wounded warriors with care that would have been unimaginable just a decade ago,” Bush said, standing in the Rose Garden for a photo op with wounded troops. “Yet our system for managing this care has fallen behind. It’s an old system. It’s an antiquated system. It’s an outdated system that needs to be changed.”

While praising the quality of care at Walter Reed, Bush acknowledged that there were “serious problems caused by bureaucratic delays and administrative failures. And we’re not going to let those problems continue.”

Because both the VA and DoD have their own systems for evaluating and awarding compensation to injured service members in a process that is both difficult to navigate and confusing for the wounded and their families, “we need to streamline the system,” the President said. The solution?

“The Defense Department will determine whether wounded warriors are still fit for service,” Bush said. “Those unable to serve will receive a pension from the Defense Department, based on their rank and length of service.

“Then they will move directly into the Veterans Affairs system, where they will receive compensation for their disabilities. This compensation will take into account both loss of earnings and the overall impact on the quality of life resulting from a service member’s injury or disability.

“Secondly, this legislation will strengthen support for families during the recovery process. When our service members suffer wounds, their families suffer with them. They pray beside hospital beds. They discuss the options with the doctors. And they help injured loved ones readjust to everyday life.

“These commitments often require family members to take long leaves of absence from work. Yet many family members cannot get this time off without losing their jobs.

“Our military families deserve better,” the President said. “So this legislation will give many parents and spouses the opportunity to take up to six months of unpaid leave when their loved ones are seriously wounded in combat.

“Third, this legislation will improve treatment for Post-traumatic Stress Disorder. The commission found that many service members still worry about the stigma associated with this serious condition. We need to end this stigma by encouraging those suffering to get help.

“This legislation will make it easier for our troops to receive care for this disorder, and it will help affected service members move forward with their lives.”
We concur with the President that “the need to enact these reforms into law is urgent.” Now it is up to Congress to continue the discussion and debate and do the right thing for our wounded warriors.

The President noted that DoD and the VA are working hard to “form a new core of well-trained recovery coordinators. These coordinators will work with families to establish recovery plans and monitor the healing process, facilitate the transition to civilian life, and ensure wounded service members do not get lost in the system.” Accomplishing this is of critical importance if this administration is to make any headway toward improving conditions for the recovery of injured and wounded troops.

Among the actions taken by DoD and the VA that do not need the imprimatur of Congress is an agreement to provide “federal recovery coordinators” to help insure medical services and other benefits are provided to seriously wounded, injured, and ill active-duty service members and veterans.

The agreement puts into place one of the top recommendations of the President’s Commission on Care for America’s Returning Wounded Warriors, co-chaired by former Sen. Robert Dole and former Health and Human Services Secretary Donna Shalala. The agreement initially establishes that the first federal recovery coordinators will be provided by VA in coordination with DoD and will be located at top military treatment facilities throughout the nation. They will coordinate services between the VA and DoD and, if necessary, private-sector facilities, while serving as the ultimate resource for families with questions or concerns about VA, DoD, or other federal benefits.

“This agreement ensures our nation’s active-duty service members and veterans who have been wounded receive the very best care during their recoveries,” said Acting Secretary of Veterans Affairs Gordon H. Mansfield. “Service members, veterans and their families can be assured they will have an ultimate resource they can rely on whenever help is needed from VA or DoD.”

The first 10 coordinators will work at military health care facilities and at any other locations where patients are later assigned. They will be located at Walter Reed Army Medical Center in Washington, D.C.; the Naval Medical Center in Bethesda, Maryland; Brooke Army Medical Center at Fort Sam Houston, Texas; and Balboa Park Naval Medical Center in San Diego. Additional recovery coordinators will be added in the future as needs are determined.

On September 2, POW/MIA Day, Defense Secretary Robert Gates pledged that the department he heads will “neither forget our duty to bring home all POWs and MIAs, nor relent in our efforts to do so.” The secretary, along with Marine Gen. Peter Pace, chairman of the Joint Chiefs of Staff, spoke in a ceremony at the Pentagon.
While they were speaking, VVA Vice President Jack Devine, Chair of the POW/
MIA and Veterans Initiative Committee Gary Jones, along with Bob Maras and Bill Duker were in Vietnam, seeking information on the fate of some 1,800 American service members who have never come home.

Back at the Pentagon, Gates gave a special welcome to former POWs in the audience and to the families of Americans still listed as missing in action.

“Missing-in-action status is marked by ambiguity and uncertainty, a severe test of spirit and resolve for anyone seeking closure,” he said. He also cited four Americans missing in Iraq: Staff Sgt. Matt Maupin, captured April 9, 2004; Spec. Ahmed Altai, captured Oct. 23, 2006; and Spec. Alex Jimenez and Pvt. Byron Fouty, both captured May 12, 2007.

“They may not be well known to the public, but within the brotherhood of arms, they will never be forgotten or left behind,” Gates pledged.



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