[Senate Hearing 109-746]
[From the U.S. Government Publishing Office]
S. Hrg. 109-746
HEARING ON WOUNDED WARRIOR INSURANCE: A FIRST LOOK AT A NEW BENEFIT FOR
TRAUMATICALLY INJURED SERVICEMEMBERS
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 7, 2006
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
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COMMITTEE ON VETERANS' AFFAIRS
Larry E. Craig, Idaho, Chairman
Arlen Specter, Pennsylvania Daniel K. Akaka, Hawaii, Ranking
Kay Bailey Hutchison, Texas Member
Lindsey O. Graham, South Carolina John D. Rockefeller IV, West
Richard Burr, North Carolina Virginia
John Ensign, Nevada James M. Jeffords, (I) Vermont
John Thune, South Dakota Patty Murray, Washington
Johnny Isakson, Georgia Barack Obama, Illinois
Ken Salazar, Colorado
Lupe Wissel, Majority Staff Director
Bill Brew, Minority Staff Director
C O N T E N T S
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September 7, 2006
SENATORS
Page
Craig, Hon. Larry E., Chairman, U.S. Senator from Idaho.......... 1
Akaka, Hon. Daniel K., Ranking Member, U.S. Senator from Hawaii.. 3
Salazar, Hon. Ken, U.S. Senator from Colorado.................... 3
Murray, Hon. Patty, U.S. Senator from Washington................. 4
Thune, Hon. John, U.S. Senator from South Dakota................. 22
WITNESSES
Dominguez, Hon. Michael, Principal Deputy Under Secretary,
Defense for Personnel and Readiness, Department of Defense..... 6
Prepared statement........................................... 7
Mandatory Screening for Traumatic Brain Injury and Post
Traumatic Stress Disorder.................................. 10
Lastowka, Thomas, Director, Insurance Service, Veterans Benefits
Administration, Department of Veterans Affairs; accompanied by
Steve Wurtz, Deputy Assistant Director, Insurance Service...... 11
Prepared statement........................................... 13
Keith, Sergeant John, Combat Wounded Veteran, Operation Iraqi
Freedom, U.S. Army............................................. 26
Prepared statement........................................... 27
Chwat, Jeremy, Associate Executive Director, Policy and Service,
Wounded Warrior Project........................................ 28
Prepared statement........................................... 31
HEARING ON WOUNDED WARRIOR INSURANCE: A FIRST LOOK AT A NEW BENEFIT
FOR TRAUMATICALLY INJURED SERVICE-
MEMBERS
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THURSDAY, SEPTEMBER 7, 2006
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10 a.m., in room
SR-418, Russell Senate Office Building, Hon. Larry E. Craig,
Chairman of the Committee, presiding.
Present: Senators Craig, Thune, Akaka, Murray, and Salazar.
OPENING STATEMENT OF HON. LARRY E. CRAIG, CHAIRMAN, U.S.
SENATOR FROM IDAHO
Chairman Craig. Good morning, ladies and gentlemen and
welcome to the U.S. Senate's Committee on Veterans' Affairs.
Today's hearing is entitled "Wounded Warrior Insurance: A
First Look at a New Benefit for Traumatically Injured
Servicemembers.
As the hearing's title suggests, this is our first
opportunity to hear testimony about the traumatically injured
protection under servicemembers group life insurance benefit,
or TSGLI. We are working on an acronym for it, but right now I
am going to stay with TSGLI.
More importantly, it is the Committee's first chance to
examine whether this program, barely in operation for a year,
is working as we in the Committee intended it to work. I refer
to this benefit as Wounded Warrior Insurance for two reasons.
First, because it was conceived for the benefit of America's
warriors, our men and women in the military who bear the brunt
of terrorist attacks that would otherwise be targeted at you
and me and our loved ones. Second, because three young wounded
warriors from Operation Iraqi Freedom brought this need for
this insurance program to my attention.
These three Army veterans met with me in my office in April
of last year. One had lost a leg in combat. The second had lost
two legs. The third had lost his sight.
They all had spent a considerable amount of time recovering
from their traumatic wounds at Walter Reed Army Medical Center.
They told me of the financial hardships that wounded
servicemembers and their families endured during lengthy
recovery processes. They talked about spouses or parents who
quit work to be with wounded servicemembers during their
convalescence, and bills mounting up from expenses, both back
home and living away from home.
They asked that I introduce legislation to create an
insurance benefit that would help bridge the gap in financial
assistance servicemembers received from the time of their
injury to the time of their rehabilitation and their recovery.
And that is what we did.
Working with Senator Akaka, who joined me as a cosponsor of
the legislation, their idea became law in a little over a
month. Legislation typically is not enacted so swiftly without
having a lot of help along the way, and we did. Not only with
Senator Akaka, who cosponsored it, but also with senior VA and
DOD officials, who immediately answered the call by providing
assistance in drafting the bill and making their support known
early and publicly.
What has resulted from all of our collective effort is that
nearly 2,700 servicemembers with traumatic injuries have
received payments ranging from $25,000 to $100,000 under the
Wounded Warrior Insurance Program. They come from every State
in America, including 18 from my State of Idaho. These are
brave men and women who have lost their limbs, who are deaf or
blind, who are paralyzed or severely burned, or still may be
suffering from the effects of traumatic brain injury.
With injuries of this magnitude, they and their families
must be allowed to focus on rehabilitation and recovery and not
on how they will make the next rent payment, or how they will
pay the power bill. Wounded Warrior Insurance helps make that
possible.
Today the Committee will consider questions that should
routinely be asked of any Government program. Is the program
meeting the intent, the needs? Is the effort under way to
respond as we expected? How well is it being administered? How
can it be improved, if it needs to be?
We have witnesses here today with extensive knowledge of
the Wounded Warrior Insurance Program, who will help us answer
some of these questions. For my part, there are three elements
to the benefit that I consider to be essential if it is to meet
the intent of the legislative purpose.
First, eligible servicemembers must be identified quickly
so that payment can be made immediately. Delay in payment would
defeat the very purpose of the program. Second, the list of
covered injuries must be relatively straightforward so that
eligibility may be established expeditiously and not be delayed
through a lengthy, drawn out adjudication process. And third,
cooperation between VA and DOD and individual military service
branches must be present at all times so that the seamless
service may be provided to our wounded warriors.
Before I introduce our witnesses let me turn to the Ranking
Member of the Committee, my cosponsor of this legislation,
Senator Akaka. Then I will turn to other of our colleagues who
have joined us, but first and foremost, Senator Danny Akaka.
Danny.
STATEMENT OF HON. DANIEL K. AKAKA, RANKING MEMBER, U.S. SENATOR
FROM HAWAII
Senator Akaka. Thank you very much, Mr. Chairman. I want to
thank you for calling this very important hearing.
And I want you to know, Mr. Chairman, that I am very proud
to have been an original cosponsor of your legislation that
established traumatic injury protection. This important benefit
is a good example of the wonderful things that can be done when
Members work in a bipartisan manner.
This program supplements existing DOD and VA benefits. As
we discussed when we were crafting this new benefit,
servicemembers and their loved ones face many financial
hardships when a servicemember is hospitalized with injuries.
This insurance program helps ease the financial burden during
this critical time. It allows servicemembers and their families
to focus on what is really important, and that is the recovery
of the injured servicemember.
In my home State of Hawaii, 35 claims have been paid under
this program, totaling over $2 million. While I sincerely wish
that there were not so many injuries that qualified for
payment, I am nevertheless gratified that this important
benefit has been available to ease the financial burden place
on Island servicemembers and their families.
I thank the witnesses for being here today. From all
accounts, the traumatic injury protection program seems to be
running well. I hope to hear from our panelists their
suggestions on how this program might be administered even
better, and also their views on what changes might be made to
improve the existing law so that this benefit can be made. In
particular, I am concerned that the retroactive portion of this
benefit differentiates between those injured while
participating in operations Enduring Freedom and Iraqi Freedom
and those who were injured on active duty in other locations.
Again, Chairman Craig, thank you very much for calling this
hearing and I look forward to hearing the comments of the
witnesses. I have another engagement, so I will be leaving
early.
Thank you very much, Mr. Chairman.
Chairman Craig. Danny, thank you very much for being here
this morning for this oversight hearing.
Now, let me turn to Senator Ken Salazar. He is also one of
the original cosponsors of this legislation.
Ken.
STATEMENT OF HON. KEN SALAZAR,
U.S. SENATOR FROM COLORADO
Senator Salazar. Thank you very much, Chairman Craig and
Ranking Member Akaka, for holding this hearing today, and thank
you for your leadership and sponsorship of this legislation.
When I visit Walter Reed Army Hospital it is a stark, quick
reminder as to why it is that this program is so important. I
am pleased that it is up and running and that this Committee
and the Congress supported the effort.
In just a few short months, this Wounded Warrior Insurance
has given over 2,600 American heroes the resources they need to
recover from devastating traumatic injuries. Injuries that
forever alter the lives of the brave men and women who fight
for our country.
We have one of those heroes with us today, Sergeant John
Keith. Sergeant Keith, I thank you for being here to share your
story. You are a true patriot and an example to us all. Your
perspective on this program is the one that truly matters, and
I look forward to hearing your take on whether the Federal
Government is doing enough.
Most of us can only imagine what it would be like to lose a
limb, suffer extensive burns, or lose the ability to see and
hear the world around us. Yet, each and every day Americans
return from Iraq and Afghanistan and other war-torn corners of
the world with these and other life-altering injuries.
Amazingly, each and every day these same brave men and women
continue on with their lives, nourished by the love and support
of their families and loved ones and strengthened by their own
determination to lead productive and successful lives.
We would not be giving credit where it is so clearly due if
we were to attribute the recovery and prosperity of so many of
our wounded warriors to an insurance benefit alone. The Wounded
Warrior benefit merely supplements the strength and resolve of
our fighting men and women, and it can never come close to
making up for the sacrifices that they have already made for
our country.
Given the short time in which the Wounded Warrior program
was implemented and the fact that we have only seen a few
months of its actual management, I am pleased at the success it
has met with so far. However, I know that as is the case with
every Federal program, there are some knots we still need to
work through.
I am concerned, for instance, as Senator Akaka is, that
many of our Nation's greatest heroes are still unable to
collect Wounded Warrior benefits because they were injured
before the effective retroactive date. Now that we know the
program can work, I am interested to hear the perspectives of
this panel and my colleagues on whether it can and should be
expanded.
I would also like to discuss whether VA's outreach program
can be more effective, particularly to rural communities. I am
eager for the testimony of Veterans Affairs and DOD
representatives who are here with us today and hopeful that
with their help--with your help--we can make this program even
better.
Thank you for being with us today.
Thank you, Mr. Chairman.
Chairman Craig. Senator Salazar, thank you very much. Now
let me turn to Senator Patty Murray, who is also a strong
supporter of this legislation.
Thank you, Patty.
STATEMENT OF HON. PATTY MURRAY,
U.S. SENATOR FROM WASHINGTON
Senator Murray. Thank you, Mr. Chairman and Senator Akaka,
for holding this hearing. I want to join in commending both of
you for working on this really important issue and helping to
expand the servicemembers group life insurance to include
traumatic injury protection.
This was a major accomplishment for both our servicemembers
and our veterans, and I look forward to working with everyone
to ensure that this program runs smoothly. I also want to
welcome both of the panels who are here today, and I look
forward to hearing about the initial response to the program
and what impact it has had.
I think everyone in this Congress and in this room will
agree that there is nothing more important than taking care of
the men and women in uniform as they come back from combat
overseas. Nearly 20,000 servicemembers have returned from Iraq
with injuries. Thousands more have psychological injuries and,
to date, 185,000 veterans from Iraq and Afghanistan have
already sought VA health care.
So, let me be clear. Of the 589,000 separated Iraqi and
Afghani veterans, 185,000, that is over 31 percent, have sought
VA health care. That is thousands more veterans with combat-
related disabilities than either the Department of Defense or
the VA plan to take care of. The Department of Defense and the
VA have to come forward with a real, comprehensive plan on how
the Administration intends to handle providing the service that
those veterans need.
Mr. Chairman, beyond that, I am very troubled to hear that
there have been an increasing number of soldiers returning from
the battlefield with traumatic brain injuries and at risk for
mental health problems. According to the Pentagon, there have
been over 1,200 servicemembers that have returned from Iraq and
Afghanistan that have been diagnosed now with traumatic brain
injury. And there are potentially hundreds more that have not
been screened or may have problems that are undiagnosed. As we
all know, well over a third of returning servicemembers are now
seeking mental health care.
So my question to this panel is going to be, if the
Department of Defense is willing to provide, to date, up to
$165 million through TSGLI, and if early detection and
screening for traumatic brain injury and PTSD will help
decrease the disabilities of returning servicemembers, why is
the Pentagon not requiring mandatory TBI and PTSD screening?
We know that allowing traumatic brain injuries and PTSD go
untreated can ultimately lead to more severe mental health
disorders and physical ailments. So, I want to know why we are
not aggressively screening servicemembers. I think that the DOD
and the VA should be more proactive and more aggressive with
the care and treatment of our servicemembers as they transition
out of service and return from combat zones.
TSGLI is part of the solution, and I am proud of what it
provides to our soldiers and our sailors, our airmen and our
Marines. But we also owe it to those servicemembers to screen
them for TBI and PTS and to aggressively pursue treatment to
help provide them with the best care as soon as possible to
make sure that we do not let these problems linger on for
years, or let them go undiagnosed until they have substantially
severe symptoms.
TSGLI eligibility has also been expanded recently from 1 to
2 years. I support that extension, but I still have concerns
about the limit of time it takes for certain trauma and mental
health problems to surface after being injured. I am afraid
that we are still, by that limitation, denying veterans the
ability to access this coverage solely because of that
eligibility period.
Mr. Chairman, TSGLI is a great first step, and I hope to
hear today how the Administration is going to aggressively
screen for and treat both TBI and PTSD, and I will pursue
within my questioning time.
Thank you very much.
Chairman Craig. Senator Murray, thank you very much.
Now, let me introduce our panelists. We have two panels of
witnesses to help us answer some of the questions that will be
asked today of this program.
On our first panel, we are joined by the Honorable Michael
Dominguez, Principal Deputy Under Secretary of Defense for
Personnel and Readiness; and Mr. Thomas Lastowka, Director of
the Veterans Benefits Administration's Insurance Service. Mr.
Lastowka is accompanied by Deputy Assistant Director for VA
Insurance Services, Steve Wurtz.
On our second panel, we are fortunate to have Sergeant John
Keith. As Senator Salazar mentioned earlier, Sergeant Keith is
a combat wounded veteran of Operation Iraqi Freedom and a
recipient of the Wounded Warrior Insurance Program.
Sergeant Keith will share with us his personal story
following his combat wounds through to his receipt of the
payment of the program.
Joining Sergeant Keith is Jeremy Chwat, the Associate
Executive Director of Policy and Service of the Wounded Warrior
Project.
As all of you have heard from my earlier comments, the
Wounded Warrior Project was instrumental in the conception of
this benefit, and Mr. Chwat's testimony is of particular value
to us today.
So we welcome all of you to the Committee. We will start
with our first panel, and with you, Mike. So, please proceed.
STATEMENT OF HON. MICHAEL DOMINGUEZ, PRINCIPAL DEPUTY UNDER
SECRETARY, DEFENSE FOR PERSONNEL AND READINESS, DEPARTMENT OF
DEFENSE
Mr. Dominguez. Mr. Chairman and Members of the Committee,
thank you for the opportunity to be here today.
And thank you for the legislation that created traumatic
injury insurance coverage for members of the uniformed
services. It is my privilege to report to you on our progress
in implementing this important program, in close cooperation
with our partners from the Department of Veterans Affairs.
I would like to open today with a few brief comments that
will supplement the more detailed written statement that I have
provided and that I request be incorporated into the record of
this hearing.
Chairman Craig. Without objection, all of your written
testimonies will be made part of the record.
Mr. Dominguez. Thank you, Sir.
Senator Craig, let me say how in my previous position as
Assistant Secretary of the Air Force, I enjoyed working with
you in your capacity as a member of the Air Force Academy's
Board of Visitors. I appreciated your leadership in that
important role and I am equally pleased to recognize your
leadership role in creating the traumatic servicemembers group
life insurance program.
I do also want to say how impressive that piece of
legislation is in terms of providing the Department of Veterans
Affairs and DOD the flexibility to set up a program, try it,
and amend it as we go, as we grow, and as we learn in it. I
think that it was a piece of enlightened legislation, Sir, and
I compliment the Committee on that work.
I mentioned already our partners in the Veterans Affairs
Department. The strong partnership with VA is an essential
component of our ability to provide quality care for those who
have served in the Armed Forces. The VA/DOD Joint Executive
Council has completed its third year in a joint effort to
enhance coordination and resource sharing. Our efforts,
together with the support and encouragement of the Congress
have improved the effectiveness and efficiency of service
delivery across a wide spectrum of programs.
The TSGLI program is a model of that cooperation, and I
thank my colleagues here today from the VA for their
contribution and their service to our Nation's veterans. There
are other significant areas of cooperation between the DOD and
the VA. One that I hope to speak to you about in the future
involves the much in the news, but also much misunderstood, DOD
and VA efforts to coordinate sharing of data from our two
electronic health record systems.
I am also pleased to acknowledge in testimony today the
extraordinary contribution to our injured and wounded from a
wide variety of private, not-for-profit organizations,
including the Wounded Warrior Project, a group you will be
hearing from in the next panel. I am pleased with our
partnership, and I am pleased with the progress we have made
implementing this program. Our work attending to our
partnership and improving stewardship of the TSGLI program is
not complete. However, we can always do better and we will work
tirelessly to do so.
So, I look forward to your questions. Thank you.
[The prepared statement of Mr. Dominguez follows:]
Prepared Statement of Hon. Michael Dominguez, Principal Deputy Under
Secretary of Defense, Personnel and Readiness, Department of Defense
INTRODUCTION
Mr. Chairman and Committee Members, thank you for the opportunity
to be here today and thank you for the legislation which created
traumatic injury insurance coverage for members of the Uniformed
Services. It is my privilege to discuss the Traumatic Servicemembers'
Group Life Insurance (TSGLI) program.
TSGLI is an extraordinary insurance program for people in uniform.
While the program applies equally to all branches of the Uniformed
Services, those of the Department of Defense represent the vast
majority of persons affected, making DOD the principal program client.
And it is in that context that we view this program--where the
Department, as an employer client, obtains a product for our people.
PRIMARY ASPECTS OF THE PROGRAM
Let me emphasize that, in the Department's view, the program is
working very well, and the Department of Defense is a satisfied
customer. In the following paragraphs, I address several aspects of the
program.
Availability
The TSGLI benefit is provided retroactively for members who
incurred severe losses as a result of traumatic injury between October
7, 2001 and November 30, 2005, if the loss was the direct result of a
traumatic injury incurred in the theater of operations during Operation
Enduring Freedom or Operation Iraqi Freedom (OEF/OIF). Beginning
December 1, 2005, every member who has Servicemembers' Group Life
Insurance (SGLI) also has TSGLI. TSGLI coverage applies to active duty
members, drilling reservists, and reservists performing funeral honors
duty or 1-day muster duty.
There are several fundamental benefits associated with the linkage
of SGLI and TSGLI coverage. First, coverage under SGLI is automatic and
includes TSGLI coverage. No member is without SGLI coverage unless he
or she specifically chooses that condition. Second, additional coverage
for traumatic injuries is included in SGLI life insurance coverage for
an additional cost of only $1.00. If the member finds the coverage
under SGLI is greater than they desire, they can make adjustments to
the SGLI coverage amount without affecting their TSGLI coverage. Third,
the DOD is an employer client for both SGLI and TSGLI, obtaining a
benefit for our people from the Department of Veterans Affairs (VA).
The VA, in turn, contracts with an insurance provider to manage the
benefits. This insurance provider underwrites the broader risks of the
program. This structure is an important aspect of the program that
makes it particularly robust. We have a great working relationship with
the VA Insurance Center staff and have always found them to be most
responsive to our needs.
Outreach for Retroactive Claims
The Services identified potential claimants for the retroactive
portion of TSGLI by reviewing casualty lists to ensure the injury
occurred during the covered period and in qualified locations. Members
listed as seriously wounded, very seriously wounded or temporarily or
permanently disabled were flagged as potential beneficiaries. A letter
was mailed to this group stating that the member had been identified as
a potential beneficiary and directing them to the appropriate points of
contact to begin the application process. In addition, those members
who had died after a period of seven or more days in a treatment
facility were identified as potential beneficiaries and letters were
mailed to their survivors.
The National Policy Director for the Wounded Warrior Project, a
group that assists men and women of our Armed Forces who have been
severely injured during the conflicts in Iraq, Afghanistan, and other
locations around the world, provided a list of significantly wounded
Servicemembers to DOD. Although not all members on this list qualified
for payment under the retroactive portion of the law, the list was a
good cross check of recipients.
Prospective Outreach
We in the DOD personnel community have worked hard to ensure that
members are made aware of the TSGLI benefit. All Services have created
a Web site for dissemination of program information and application
procedures for members. In addition, each Service provides a 1-800
number for members to call for information regarding any aspect of the
program. These resources are available for active duty, Reserve
members, members who have transitioned from a military Service, and
surviving spouses.
In November 2005, members were alerted to the new TSGLI program
through a statement on the Leave and Earnings Statement. The statement
was tailored to each Service, but stated essentially that, effective
December 1, 2005 the SGLI deduction would increase $1.00 per month for
traumatic injury protection (TSGLI). The statement then directed them
to the VA insurance Web site for additional information.
In addition to DOD press releases announcing important program
aspects, articles have appeared in various media including Military
Times Newspapers, Army Families Online, the Association of the United
States Army, The American Legion, and the National Guard Association of
the United States, which highlighted the benefits for members of the
Reserve.
The Application Process
The application process for a TSGLI benefit involves a series of
steps which allows for rapid payment of benefits to members who
qualify, with checks inserted to prevent errors. A member in a military
treatment facility will learn about the program from a patient advocate
or medical personnel who will help them obtain a TSGLI certification
form. Those members, who have suffered a loss due to a traumatic event,
submit a certification form as soon as they are able or the guardian or
attorney in fact may submit the application on their behalf. A
physician, either in a military treatment facility or civilian
hospital, documents the extent of the injuries. The certification form
is then forwarded to the respective military Service via fax or e-mail
for certification. Each Service certification officer will typically
use DCIPS--the Defense Casualty Information Processing System to
confirm the dates, type, and extent of the injury. Once certified, the
form is sent to the Office of Servicemembers' Group Life Insurance
(OSGLI) to verify SGLI coverage and make payment.
Cost
The Department of Defense bears the administrative cost of
collecting premiums and tracking coverage. DOD sent initial funding to
the VA in the amount of $28 million, broken down by the estimated cost
per Service for program startup costs. Because the program had not
begun to collect premiums from members, this amount was needed to
provide payment for prospective cases that were expected in the first
year. In addition, a $5.7 million monthly payment was sent to VA for
the Services' share of TSGLI extra hazard reimbursements, the
additional amount, over and above the amount collected through premiums
from members due to the increased injuries from conflict. This monthly
payment was temporarily suspended in April 2006 because the amount on
hand is sufficient to pay current TSGLI claims.
Delivery of Benefits
The Servicemember is the beneficiary of TSGLI. Although the member
may not name someone other than himself or herself as the TSGLI
beneficiary, if the member is legally incapacitated, the benefit is
paid to his or her guardian or attorney-in-fact. The member may choose
the method of payment from three choices: (1) Electronic Funds Transfer
(EFT), in which the TSGLI payment is electronically credited to the
bank account specified by the Servicemember, (2) An interest-bearing
checking account, in which the Servicemember receives a checkbook that
gives the member ready access to the money, or (3) A Check, in which
the Servicemember's guardian or attorney-in-fact receives a single
check on behalf of the Servicemember for the full TSGLI benefit
payable. This option is available only to the Servicemember's guardian
or attorney-in-fact, if one is needed. The Department is extremely
pleased with the responsiveness of OSGLI, which typically pays
certified claims within 48 hours of receipt.
The Appeals Process
Each Service is tasked with providing policy and implementation
guidance for the appeals process. Although each Service maintains a
unique structure for resolving appeals, the process is similar. A
member who has received a letter from OSGLI indicating that their claim
has been denied is provided contact information for the appeals
process. The letter will indicate the reasons for denial and the method
in which to appeal the decision. It is the member's responsibility to
compile the documentation for an appeal. The Service board for appeals
makes a final determination and notifies each recipient of the outcome.
Each Service uses an existing board to act on appeals. The Army for
example uses the same board that is used for combat-related special
compensation determinations.
Uniform Application
One of the most significant goals was ensuring uniform application
of standards in the TSGLI eligibility certification process. That is,
if a member of the Air Force receives a benefit under TSGLI for an
incurred traumatic injury, a member of the Army experiencing a similar
injury should receive the same benefit. To ensure this uniformity of
application, VA, OSGLI and DOD established a joint working group to
resolve rules for application of the standards for the schedule of
payments for traumatic losses. This group has continued to hold weekly
conference calls to discuss needed improvements to the program.
Additionally, VA and OSGLI have provided training, most recently
sponsored by the Army on July 25, 2006, for all Service certification
officers. Regular communication among the Service certification
officials, Office of the Secretary of Defense, OSGLI, and VA has helped
ensure a uniform certification outcome among the Services.
Numbers of Claims
Estimates of retroactive claimants from OEF/OIF were approximately
2,100 members. This estimate was derived by examining the total number
of casualties during the period (approximately 6,300) and estimating a
high percentage of recipients among members who were victims of
explosives or burns, or listed as amputees. A total of 2,261
retroactive claims have been approved as of August 25, 2006. Estimates
for prospective claimants were approximately 1,000 members per year,
which was based on the total number of casualties reported on an annual
basis. A total of 403 claims under the prospective program have been
paid as of late August, 2006, versus our estimate of 1000.
Payment Timelines
The most significant factor in determining the amount of time that
payment takes to reach an individual member is the type of injury
sustained. Whereas injuries that result in amputation may be submitted,
certified, and paid within 7 days or less, injuries that document loss
of Activities of Daily Living (ADL) may take up to 45 days or more
because these injuries require observation over a period of time before
a physician can verify the extent of the injury. Many claims,
especially those for loss of ADLs, typically include several pages of
documentation. Service personnel who certify the claims diligently
examine each claim to ensure that potential recipients are correctly
paid.
Outstanding Issues--Activities of Daily Living Claims
At the inception of the program, VA, DOD, and OSGLI worked to
define the standards for payment of TSGLI benefits based on loss
involving the inability to carry out the activities of daily living.
Besides members who remained in a coma or suffered a traumatic brain
injury, some members, after suffering a traumatic event, remained
hospitalized without the ability to take care of daily basic functions.
Using a term understood within the medical profession, we worked to
define the limits for the loss of activities of daily living to address
members who may have suffered no visible external injuries, yet were
unable to care for themselves, losing the ability to perform two of six
typical functions: bathing, eating, toileting, transferring, dressing,
or continence.
This category of loss continues to lead all others in number of
claims and compensation amounts. It is also the most difficult in which
to find evidentiary support for the retroactive cases. Further, because
this category was not anticipated when care was given, many treatment
records do not contain the necessary documentation to support the
claims. In cases where there is little or no evidence to support the
claim for the loss of Activities of Daily Living for an extended
period, medical personnel must examine treatment records and estimate
the length of ADL loss for claim certification making these cases more
manpower intensive.
CONCLUSION
All in all, the TSGLI has proven to be a beneficial program. The
structure of the program provides strength and agility. The Department
of Defense, as the employer client, relies on VA as the Government
provider to keep the program operationally sound. The contractor
consistently brings to the program the most modern and attractive
features available to the insurance industry. This makes for a
progressive benefit that keeps getting better without increasing the
insurance premium our troops pay. Overall, the TSGLI program structure
has proven to be one of exceptional strength that keeps the program
among the best in the business.
We are very appreciative of the traumatic injury insurance provided
for our Servicemen and women in uniform by Congress. Thank you for the
opportunity to discuss this critical program that is so important to
our dedicated young men and women in uniform today.
______
Mandatory Screening for Traumatic Brain Injury and Post Traumatic
Stress Disorder
The Department proactively evaluates the health of all
servicemembers following deployments. Because of the Department's great
concern for the post deployment health of servicemembers, all of our
returning warriors receive a post deployment health assessment and
reassessment. Most major health issues are found and taken care of at
the time of the assessments.
There is currently no validated screening instrument for Traumatic
Brain Injury (TBI) to use on those returning from combat theaters.
Several questionnaires done by or at the request of unit commanders for
returning servicemembers have asked if they ever lost consciousness
and/or ``saw stars.'' About ten percent of responders said they had.
Because the Armed Forces Epidemiology Board (AFEB) recently
recommended post deployment screening, the Department of Defense (DOD)
is developing such a tool for rapid deployment. The Army has begun a
process to identify servicemembers at the time that a possible TBI
(head injury or blast exposure) occurs and to assess the
servicemembers' mental functions in order to determine their ability to
continue with their mission. This was based on an initial document
produced by the Defense and Veterans Brain Injury Center (DVBIC), which
was simplified for easier use in the field by medics. The Marine Corps
is also working on such a document; however, the Marines are working to
refine their guidance based on feedback from providers in-theater.
The goal of these processes is to identify those who have suffered
a TBI; to decide whether or not they need further evaluation at a
higher level of care; and, to provide guidance as to whether they can
continue combat or other operations that may expose them to another
potential TBI, or that may require cognitive function or reflexes that
may have temporarily degraded as a result of TBI. This process also
provides medical documentation for future evaluations.
The AFEB further recommended that DOD would benefit from a
systematic policy-driven approach to the prevention, medical
assessment, and management of TBI, and that its primary focus should be
on in-theater TBI prevention, assessment, and medical management. A
navy-sponsored conference on hospital-based treatment and
rehabilitation, including outpatient rehabilitation, convened September
18-20, 2006. A DVBIC-sponsored conference on first responders and in-
theater management of TBI will convene mid-November 2006. These
sessions will facilitate the policy driven approach as recommended by
the AFEB, and address the additional AFEB recommendations, including
implementation of a pre-deployment baseline screening tool to provide a
measure against which post deployment or post incident evaluations can
be compared.
In addition, Post Deployment Health Assessments contain four
questions that ask about symptoms which may indicate the need for
further medical evaluation for Post Traumatic Stress Disorder. Those
same questions are used on the Post Deployment Health Reassessment
which is done three to six months after individuals return from
theater.
Chairman Craig. Mike, thank you very much.
Now, let us turn to you, Tom. Please proceed.
STATEMENT OF THOMAS LASTOWKA, DIRECTOR, INSURANCE SERVICE,
VETERANS BENEFITS ADMINISTRATION, DEPARTMENT OF VETERANS
AFFAIRS; ACCOMPANIED BY STEVE WURTZ, DEPUTY ASSISTANT DIRECTOR,
INSURANCE SERVICE
Mr. Lastowka. Thank you, Mr. Chairman.
Before I begin testimony, thank you very much for the
research you must have done on this name. Not many people get
it right on the first try.
Chairman Craig. I struggle with correct pronunciations of
names, and so my staff assists me phonetically. In that form I
am a little handicapped.
Mr. Lastowka. Thank you, Mr. Chairman, for the privilege of
appearing today before this Committee. I do appreciate the
opportunity to inform the Committee of what I believe was a
very successful implementation of the Traumatic Injury
Protection Program under the servicemembers group life
insurance program, which I will henceforth refer to as TSGLI.
I will summarize my testimony and would ask that the
complete written testimony be included in the record.
Chairman Craig. Without objection.
Mr. Lastowka. TSGLI provides severely injured
servicemembers who suffer certain losses as a direct result of
traumatic injury with a monetary assistance to help them and
their families through what is often a long, arduous, and
financially difficult period of treatment and rehabilitation.
On May 11, 2005, the President signed Public Law 109-13,
which established the TSGLI program, effective December 1,
2005. VA and the Department of Defense had less than 180 days
to finalize the program design and certification process,
publish regulations and provide outreach training to
servicemembers and veterans. VA and DOD recognize the need to
ensure that implementation was given the highest priority and
was visible. Therefore, it was included as an initiative to the
VA/DOD Joint Executive Council, and we have to regularly brief
that Council on our progress.
Our goal was to have the first TSGLI payments in the hands
of eligible members prior to the December 2005 holidays. I am
happy to report that we brought this to fruition, working with
the staffs of the committees interested parties, such as
Wounded Warriors. We were able to get input and VA published
the TSGLI interim final regulation on December 22, and began
payments simultaneously.
TSGLI is automatic for all members who have regular SGLI
coverage. Based on comments during the interim final
regulation, we are looking to amend the final regulation to
include a 2-year eligibility period from date of injury to date
of loss.
The law identifies some disabilities for which payments
should be made, but also provides that the Secretary shall
proscribe other conditions by regulation. The legislation
recognized the severity of traumatic brain injury, which was a
listed disability, and defined that severity as the loss of the
ability to perform certain activities of daily living.
In the regulations, we used the same definition of severity
to define other severe injuries not usually covered by
dismemberment insurance. The loss of the ability to perform in
ADL is not a concept normally associated with traumatic injury
insurance, but rather associated with long-term care. The ADL
standards tend to be restrictive. Since TSGLI losses due to
ADLs are meant to cover members, we believe that the intent of
the law requires that ADL standards be set high so that members
sustaining the loss equivalent in severity, and I will say
emotionally, to an amputation or a similar loss would be met.
Members must show through medical evidence that they were
completely unable to perform certain activities without the
assistance of other persons or equipment. The factor in setting
the ADL standard high was that Congress contemplated that the
TSGLI premium cover all claims that would be normally
associated with a civilian population.
As of Friday, September 1, we have paid 2,697 claims for a
total of $166 million. The timeliness of claims payment is
important because the program's primary goal is to get payments
to eligible servicemembers as quickly as possible. Generally,
we are taking between 50 and 60 days from the date of injury,
not the date of loss, and this can be broken down, generally,
to an average of 30 days for the member to submit the
application. This may be because of ADLs that have to extend up
to 30 days, or that the dismemberment does not take place
immediately upon entrance into the hospital. After the
application is admitted, generally the DOD is completing the
application process within 14 to 21 days, and Prudential within
2 to 3 days.
We have conducted a review of denied claims. I am happy to
say that the insurance personnel reviewing denied claims
concluded that they would have not allowed one claim, based
upon their review, that was denied by the military. We believe
the outreach to reservists is now the greatest because they
have less contact and there may be some confusion about whether
it should cover non-combat injuries, which, in fact, the law
does allow.
Mr. Chairman, Committee Members, we believe the
implementation has been successful. We believe the goals and
the intent of the programs are being met. We will evaluate it
in the coming year to see if there are other recommendations
that we would make. Thank you, Sir.
[The prepared statement of Mr. Lastowka follows:]
Prepared Statement of Thomas Lastowka, Director, Insurance Service,
Veterans Benefits Administration, Department of Veterans Affairs
Mr. Chairman and Members of the Committee, I appreciate the
opportunity to appear before you today to discuss the new
Servicemembers' Group Life Insurance benefit, Traumatic Injury
Protection, referred to as ``TSGLI.'' I will specifically address the
implementation and management of the program, the benefits provided,
and the impact on the lives of servicemembers.
TSGLI is designed to provide severely injured servicemembers who
suffer certain losses as a direct result of a traumatic injury with
monetary assistance to help the servicemembers and their families
through what is often a long and arduous treatment and rehabilitation
period. In many instances, the family must physically relocate to be
with the injured servicemember and provide needed emotional support
during the treatment and recovery period. Relocating an entire family
is disruptive and can result in economic hardship brought on by new
and/or additional living expenses, and in some cases, the loss of a
job. TSGLI helps to lessen that economic burden by providing immediate
financial relief.
TSGLI coverage is automatic for servicemembers who are insured
under SGLI and cannot be declined separately. This criterion is normal
commercial practice--the servicemember must have the basic insurance
coverage in order to obtain a rider on that coverage. Servicemembers
pay $1.00 per month for TSGLI coverage, in addition to their SGLI
premium.
TSGLI is broadly modeled after commercial Accidental Death and
Dismemberment (AD&D) insurance coverage. AD&D coverage provides
benefits if the insured suffers a physical loss (dismemberment) or dies
due to an accident (accidental death). TSGLI is modeled after the
``dismemberment'' portion of AD&D coverage, although it deviates in
some respects from the commercial AD&D model to accommodate the unique
needs of military personnel.
In the legislation, Congress sets forth certain losses that must be
covered by the TSGLI program as well as the range of payment amounts,
from $25,000 to $100,000. The covered losses designated by statute are:
Total and permanent loss of sight.
Loss of a hand or foot by severance at or above the wrist
or ankle.
Total and permanent loss of speech.
Total and permanent loss of hearing in both ears.
Loss of thumb and index finger of the same hand by
severance at or above the metacarpophalangeal joints.
Quadriplegia, paraplegia, or hemiplegia.
Burns greater than second degree, covering 30 percent of
the body or 30 percent of the face.
Coma or the inability to carry out the activities of daily
living resulting from traumatic brain injury.
The law also provides VA with the authority to prescribe by
regulation other losses to be covered by TSGLI. Working with the
Department of Defense (DOD), VA added a number of other losses to
ensure the program covers as many deserving severely injured
servicemembers as possible. The losses that VA added by regulation are:
Loss of both thumbs.
Loss of sight in one eye or loss of hearing in one ear.
Loss of the ability to perform of the activities of daily
living (ADL) due to a loss not covered by the legislation.
VA, in consultation with DOD, determined the payment amount for
each scheduled loss and combinations of scheduled losses, within the
range specified by statute. As a basic rule, if a servicemember suffers
two or more losses, the payment is $100,000. For losses where time is
the major factor, such as coma, brain injury, and limitations on
activities of daily living (ADL), payments are based on the length of
time the condition or limitation exists. For example, a servicemember
in a coma is paid in $25,000 increments: $25,000 after 15 days in a
coma; an additional $25,000 at 30 days; an additional $25,000 at 60
days; and the last increment of $25,000 at 90 days. A Schedule of
Losses providing the covered losses and the payment amounts is
attached.
Public Law 109-13, which established the TSGLI program, was signed
into law on May 11, 2005, with an effective date of December 1, 2005.
VA and DOD had less than 180 days to implement the program, including
developing a certification process, publishing an interim final
regulation, and conducting outreach to eligible members and veterans.
VA published the TSGLI interim final regulation on December 22, 2005, 3
weeks after the TSGLI program effective date of December 1, 2005, and
began issuing payments simultaneously with publication of the rule. We
are currently working on the final regulation. We received a comment
from the Wounded Warrior Project suggesting that the interim final rule
be amended to increase the number of days in which a scheduled loss
must occur from 365 days to 2 years. We are evaluating this suggestion
as we prepare the final rule.
For a servicemember to be eligible for a TSGLI payment, the
following criteria must be met:
1. The servicemember must be covered by SGLI.
2. The servicemember must suffer a loss that is a direct result of
a traumatic injury.
3. The servicemember must suffer the traumatic injury before
midnight on the date of the termination of the servicemember's duty
status in the uniformed services that establishes eligibility for SGLI.
4. Under the interim final rule, the servicemember must suffer the
loss within 365 days of the traumatic injury.
5. Under the interim final regulation, the servicemember must
survive for at least seven full days from the date of the traumatic
injury.
Public Law 109-13 also provided TSGLI coverage retroactively to
servicemembers who experienced a traumatic injury between October 7,
2001, and the effective date of the statute, i.e., December 1, 2005, if
their qualifying loss was a direct result of injuries incurred in
Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF).
Public Law 109-233 repealed this provision and instead provides
retroactive TSGLI coverage for servicemembers who during the period
beginning on October 7, 2001, and ending at the close of November 30,
2005, sustained a traumatic injury resulting in a scheduled loss if
that loss was a direct result of a traumatic injury incurred in the
theater of operations for OEF or OIF.
In determining the regulatory exclusions to coverage, we looked
both to the commercial model and the plain language of the statute. We
excluded injuries that result from illegal behavior by the
servicemember or self-inflicted trauma. TSGLI is not payable for
injuries caused by the following:
1. Attempted suicide.
2. Intentionally self-inflicted injury or an attempt to inflict
such injury.
3. Medical or surgical treatment of an illness or disease.
4. The servicemembers' willful use of an illegal or controlled
substance, unless administered or consumed on the advice of a medical
doctor.
In addition, TSGLI does not cover injuries sustained while
committing, or attempting to commit, a felony. Nor does it cover
illnesses or diseases, physical or mental in nature, other than a
pyogenic infection (pus forming, often secondary to a wound) or
physical illness or disease caused by a biological, chemical, or
radiological weapon, or accidental ingestion of a contaminated
substance.
TSGLI allows payments for scheduled losses resulting from multiple,
unrelated traumatic events, up to $100,000. However, we do not believe
that Congress intended for a servicemember to receive more than the
statutory maximum TSGLI benefit of $100,000 as a result of scheduled
losses due to each of several traumatic events occurring within a short
period of time. Also, VA must manage the TSGLI program on the basis of
sound actuarial principles. Congress has expressed its understanding
that the premium for TSGLI coverage will be minimal. In accordance with
that charge, we have concluded that, in the case of multiple traumatic
events occurring within a 7-day period, it is appropriate to limit
recovery to the statutory maximum allowed for a single traumatic event,
regardless of whether the losses come from multiple traumatic events
within a 7-day period. We have concluded that a period of 7 days is
appropriate to properly balance the need for actuarial soundness and
the interests of providing adequate coverage for traumatic events
separated by a greater amount of time. A member could incur a second
scheduled loss virtually simultaneously with the initial scheduled
loss. If the benefit for the initial scheduled loss were for $100,000,
we do not believe Congress intended an additional payment, beyond the
maximum provided by law.
VA has developed procedures for filing and processing an
application for benefits that facilitate a fast and thorough review by
the uniformed services. Each uniformed service has an identified office
to handle TSGLI claims. VA and DOD jointly developed a claims procedure
and certification form. The procedure is as follows:
1. The servicemember obtains a copy of the TSGLI Certification of
Traumatic Injury Protection Form. It has three parts, A, B, and C.
2. The servicemember completes Part A with basic identifying
information and banking information if payment by electronic funds
transfer is elected. Part A is submitted to the servicemember's
uniformed service office.
3. The servicemember gives Part B to a medical professional to
document the qualifying loss. The medical professional returns Part B
to the servicemember or directly to the uniformed service office
handling the servicemember's TSGLI claim.
4. The uniformed service office reviews the claim and makes the
decision on whether the servicemember is eligible for the benefit. The
decision is documented on Part C of the TSGLI Certification Form.
5. The uniformed service office sends the entire form to Office of
Servicemembers' Group Life Insurance (OSGLI) to make the benefit
payment and advise the servicemember of the award, or send the
servicemember a letter informing the servicemember of the denial.
The servicemember has the right to appeal the TSGLI decision. All
appeals, except those based on SGLI coverage, go through a DOD appeals
process. Appeals related to the servicemember's SGLI coverage are
processed by OSGLI.
One of VA's main roles in the implementation of TSGLI is the
development of procedures and issuance of guidance for handling claims
to the branches of service. A detailed TSGLI Procedural Guide was
developed for all uniformed service TSGLI points of contact. The guide
explains all aspects of TSGLI, including premiums, coverage,
exclusions, and other eligibility criteria. It also provides the
uniformed service contacts with information about the medical standards
for covered losses and how to complete the TSGLI Certification Form.
In accordance with the legislation, VA has taken the lead on
decisions relating to program policies and standards. On issues of
disagreement on policies affecting certification decisions, VA makes
the final determination with input from all parties. In contrast, VA
has left the internal procedures for claims processing to the uniformed
services to handle as they see fit. This mirrors the process for
handling SGLI death benefit claims. VA and OSGLI have provided training
to the branches of the uniformed services.
The Under Secretary for Benefits has directed all VA Regional
Office Seamless Transition Coordinators to personally contact severely
injured veterans from OEF and OIF to inform them about the TSGLI
benefit. VA and OSGLI continue to identify potentially eligible
servicemembers through outreach efforts to disabled veterans and
analysis of news stories naming injured servicemembers. Names of
potentially eligible servicemembers are provided to the uniformed
services' TSGLI office for outreach.
The ADL associated with TSGLI were identified in the program's
enacting legislation. The activities are bathing, dressing, eating,
toileting, continence, and transferring. To qualify for a benefit under
TSGLI involving ADL, a servicemember must lose the ability to perform
two of these six ADL for specified periods of time. For brain injuries,
a servicemember must prove inability to perform two of these six
activities for a minimum of 15 days up to a maximum of 90 days. For
other traumatic injuries not related to a brain injury, a servicemember
must prove inability to perform two of these six activities for a
minimum of 30 days up to a maximum of 120 days.
In the commercial insurance industry, AD&D policies do not cover
the loss of the ability to perform ADL. Therefore, to obtain a model
for use in the TSGLI program as the law required, we looked to long-
term care insurance standards. In long-term care insurance, the
policies require that the insured be unable to perform ADL for an
extended period of time in order to qualify for coverage. In
recognition of the intent of Congress that TSGLI premiums remain low,
it follows that TSGLI ADL standards must be restrictive so that
premiums can remain at reasonable rate. In addition, we believe that
ADL standards should be set at a high enough level so that only
servicemembers sustaining a loss equal in severity to an amputation or
other loss covered by the TSGLI program qualify for benefits.
Therefore, the TSGLI Program requires that a servicemember be
``unable to perform the activities of daily living'' for a period of
time ranging from 15 consecutive days to 120 consecutive days. Also, a
servicemember must show through medical evidence that they are
completely unable to perform an activity without assistance of another
person, adaptive equipment, or accommodating behavior.
There are some indications that servicemembers and physicians do
not fully understand these ADL standards. The uniformed services are
working to educate military medical professionals through onsite
training, materials, and attendance at conferences. We believe
continuing education will increase the understanding of the ADL
standards and improve the quality of claims.
It is often difficult to establish entitlement to retroactive TSGLI
benefits based on a loss of an ADL. An assessment of the
servicemember's current medical condition may not establish the date
from which they were first unable to perform an ADL. We understand it
can be difficult to contact the original treating physician or obtain
documentation of past treatment. In spite of this, ADL remains the most
frequent loss paid for both retroactive and post-December 1 claims.
In these types of cases, the uniformed services are using the same
procedure to review the medical evidence. The uniformed services will
contact the certifying medical professional and provide them with an
explanation of the ADL standards or other loss standards. In many
cases, the medical professional revises his/her initial comments. If
the medical professional still stands by the initial statement, the
uniformed service staff has a military medical physician review the
claim and determine if the medical evidence supports the medical
professional's statement. If so, the claim is certified payable, and if
not, it is certified denied.
I would now like to provide you with some current statistics on
TSGLI claims. The average amount of a TSGLI payment is $62,000. As of
Friday, August 25, 2006, the TSGLI Program has paid:
2,261 retroactive claims totaling of over $143.5 million.
403 claims since the effective date (December 1, 2005) for
a total of over $21 million.
In the past 2 months, we have seen a decrease in retroactive claims
and an increase in post-December 1, 2005, claims. This is a logical
trend that we expect to continue.
Claims for losses sustained on or after December 1, 2005, are paid
on average within 50 to 60 days of injury. This time period is broken
down as follows:
30 days for the servicemember to be stabilized and file an
application.
14-21 days for the uniformed service's review.
2.3 days, on average, for payment processing at OSGLI.
As of Friday, August 25, 2006, the TSGLI Program has denied 1,601
retroactive claims and 248 post-December 1 claims. Earlier this summer,
VA's Insurance Service staff reviewed a sample of denied claims and
agreed with the decisions rendered by the uniformed services on these
claims.
The two main reasons for denial were the medical evidence did not
support the claimed loss, or the servicemember did not claim or have
sufficient ADL limitations to qualify for the benefit. These denial
reasons point to the fact that we need to continue educating physicians
and potential claimants on the eligibility criteria for TSGLI,
especially based on ADL. In addition, the cases reviewed showed no
pattern based on the medical facility where the servicemember was
treated or based on the medical doctor certifying the claim.
We plan to conduct another review of denied claims next year after
the new Certification Form has been in circulation for a number of
months. We believe the new form, which has been enhanced to include
questions pertaining to the medical standards of the program and an ADL
questionnaire, will cut down on claims from clearly ineligible
servicemembers.
As we approach the 1-year mark since the effective date of the
program, we are planning a comprehensive evaluation of the TSGLI
Program. This evaluation will include a review of current procedures at
the uniformed services TSGLI offices as well as an analysis of program
standards and policies. Through this evaluation, we hope to be able to
identify areas of improvement.
We are also considering whether to provide by regulation a time
limitation on filing a claim for TSGLI. Currently, the program has no
time limit for filing claims. This is problematic as it represents a
liability against the program that we are unable to anticipate and
budget for actuarially. In addition, with no claim filing time limit,
servicemembers are able to apply years from now for the benefit and
will face the difficulty of obtaining medical evidence proving the loss
dates back to a traumatic injury that occurred in service.
Mr. Chairman and Committee Members, it has been an honor and
privilege to be involved in the implementation of the TSGLI benefit. I
would like to recognize and thank the Committee for your significant
efforts in creating this benefit for our Nation's servicemembers. I am
happy to report that the implementation of TSGLI has been extremely
successful. I believe the goals and intent of the program are being
met. We will continue to evaluate the program to assure that it
operates to the highest standards so that our servicemembers are well
served.
TSGLI Schedule of Losses
------------------------------------------------------------------------
Then the amount that will be
If the loss is paid is:
------------------------------------------------------------------------
1. Total and permanent loss of sight in $100,000
both eyes.
2. Total and permanent loss of hearing $100,000
in both ears.
3. Loss of both hands at or above wrist $100,000
4. Loss of both feet at or above ankle. $100,000
5. Quadriplegia........................ $100,000
6. Hemiplegia.......................... $100,000
7. Paraplegia.......................... $100,000
8. 3rd degree or worse burns, covering $100,000
30 percent of the body or 30 percent
of the face.
9. Loss of one hand at or above wrist $100,000.
and one foot at or above ankle.
10. Loss of one hand at or above wrist $100,000
and total and permanent loss of sight
in one eye.
11. Loss of one foot at or above ankle $100,000
and total and permanent loss of sight
in one eye.
12. Total and permanent loss of speech $75,000
and total and permanent loss of
hearing in one ear.
13. Loss of one hand at or above wrist $100,000
and total and permanent loss of speech.
14. Loss of one hand at or above wrist $75,000
and total and permanent loss of
hearing in one ear.
15. Loss of one hand at or above wrist $100,000
and loss of thumb and index finger of
other hand.
16. Loss of one foot at or above ankle $100,000
and total and permanent loss of speech.
17. Loss of one foot at or above ankle $75,000
and total and permanent loss of
hearing in one ear.
18. Loss of one foot at or above ankle $100,000
and loss of thumb and index finger of
same hand.
19. Total and permanent loss of sight $100,000
in one eye and total and permanent
loss of speech.
20. Total and permanent loss of sight $75,000
in one eye and total and permanent
loss of hearing in one ear.
21. Total and permanent loss of sight $100,000
in one eye and loss of thumb and index
finger of same hand.
22. Total and permanent loss of thumb $100,000
of both hands, regardless of the loss
of any other digits.
23. Total and permanent loss of speech $100,000
and loss of thumb and index finger of
same hand.
24. Total and permanent loss of hearing $75,000
in one ear and loss of thumb and index
finger of same hand.
25. Loss of one hand at or above wrist $50,000 for loss of hand plus
and coma. the amount paid for coma as
noted in Item 37 of this
schedule up to a combined
maximum of $100,000.
26. Loss of one foot at or above ankle $50,000 for loss of foot plus
and coma. the amount paid for coma as
noted in Item 37 of this
schedule up to a combined
maximum of $100,000.
27. Total and permanent loss of speech $50,000 for total and permanent
and coma. loss of speech plus the amount
paid for coma as noted in Item
37 of this schedule up to a
combined maximum of $100,000.
28. Total and permanent loss of sight $50,000 for total and permanent
in one eye and coma. loss of sight in one eye plus
the amount paid for coma as
noted in Item 37 of this
schedule up to a combined
maximum of $100,000.
29. Total and permanent loss of hearing $25,000 for total and permanent
in one ear and coma. loss of hearing in one ear
plus the amount paid for coma
as noted in Item 37 of this
schedule up to a combined
maximum of $100,000.
30. Loss of thumb and index finger of $50,000 for loss of thumb and
same hand and coma. index finger of the same hand
plus the amount paid for coma
as noted in Item 37 of this
schedule up to a combined
maximum of $100,000.
31. Total and permanent loss of sight $50,000 for loss of sight in
in one eye and inability to carry out one eye plus the amount paid
activities of daily living due to for the inability to carry out
traumatic brain injury. activities of daily living due
to traumatic brain injury as
noted in Item 37 of this
schedule up to a combined
maximum of $100,000.
32. Loss of one hand at or above wrist $50,000 for loss of hand plus
and inability to carry out activities the amount paid for the
of daily living due to traumatic brain inability to carry out
injury. activities of daily living due
to traumatic brain injury as
noted in Item 37 of this
schedule up to a combined
maximum of $100,000.
33. Loss of one foot at or above ankle $50,000 for loss of foot plus
and inability to carry out activities the amount paid for the
of daily living due to traumatic brain inability to carry out
injury. activities of daily living due
to traumatic brain injury as
noted in Item 37 of this
schedule up to a combined
maximum of $100,000.
34. Loss of thumb and index finger of $50,000 for loss of thumb and
same hand and inability to carry out index finger plus the amount
activities of daily living due to paid for the inability to
traumatic brain injury. carry out activities of daily
living due to traumatic brain
injury as noted in Item 37 of
this schedule up to a combined
maximum of $100,000.
35. Total and permanent loss of hearing $25,000 for total and permanent
in one ear and inability to carry out loss of hearing in one ear
activities of daily living due to plus the amount paid for the
traumatic brain injury. inability to carry out
activities of daily living due
to traumatic brain injury as
noted in Item 37 of this
schedule up to a combined
maximum of $100,000.
36. Total and permanent loss of speech $50,000 for total and permanent
and inability to carry out activities loss of speech plus the amount
of daily living due to traumatic brain paid for the inability to
injury. carry out activities of daily
living due to traumatic brain
injury as noted in Item 37of
this schedule up to a combined
maximum of $100,000.
37. Coma from traumatic injury and/or At 15th consecutive day in a
the inability to carry out activities coma, and/or the inability to
of daily living due to traumatic brain carry out activities of daily
injury. living--$25,000.
Note 1: Benefits will not be paid under At 30th consecutive day in a
this schedule for concurrent coma, and/or the inability to
conditions of coma and traumatic brain carry out activities of daily
injury. living--Additional $25,000.
Note 2: Duration of coma includes the At 60th consecutive day in a
day of onset of the coma and the day coma, and/or the inability to
when the member recovers from coma. carry out activities of daily
Note 3: Duration of the inability to living--Additional $25,000.
carry out activities of daily living At 90th consecutive day in a
due to traumatic brain injury includes coma, and/or the inability to
the day of the onset of the inability carry out activities of daily
to carry out activities of daily living--Additional $25,000.
living and the day the member once
again can carry out activities of
daily living.
Benefits can be paid for both
conditions only if experienced
consecutively, not concurrently.
38. Total and permanent loss of speech. $50,000
39. Loss of one hand at or above wrist. $50,000
40. Loss of one foot at or above ankle. $50,000
41. Total and permanent loss of sight $50,000
in one eye.
42. Loss of thumb and index finger of $50,000
same hand.
43. Total and permanent loss of hearing $25,000
in one ear.
44. The inability to carry out At 30th consecutive day of the
activities of daily living due to loss inability to carry out
directly resulting from a traumatic activities of daily living--
injury other than an injury to the $25,000.
brain. At 60th consecutive day of the
Note: Duration of the inability to inability to carry out of
carry out activities of daily living activities of daily living--
includes the day of onset of the Additional $25,000.
inability to carry out activities of At 90th consecutive day of the
daily living and the day when the inability to carry out
member can once again carry out activities of daily living--
activities of daily living. Additional $25,000.
At 120th consecutive day of the
inability to carry out
activities of daily living--
Additional $25,000.
------------------------------------------------------------------------
Chairman Craig. Thank you very much, Tom.
Let me first recognize Senator Thune who has joined us. He
is another original cosponsor of the legislation.
John, why don't we allow you any opening comments you want
to make with the questions you would ask at the time that we
get there. Is that OK?
Senator Thune. That is fine.
Chairman Craig. Let me now proceed with questions, and then
we will go through in that order, because I know that Senator
Akaka needs to go to another hearing, so we will get to you
quickly, Danny.
Let me ask generic questions of all of you who are before
us, because clearly we are in that stage of looking at it,
wanting to know if it is working the way it was intended to. I
have laid out the three principles that I thought were
critically important in the concept of the legislation and the
legislative intent before.
Right now, payments are being received within 50 to 60 days
of when the traumatic injury occurs. Do you expect processing
time to improve as the military services and the VA gain more
experience with this benefit? This question is to both of you,
Mike and Tom, and also to you, Steve, if you wish to
participate.
Mr. Dominguez. Sir, I would say yes. As we get more
experience, as we streamline the process, processing time
should improve. There is a big piece in the front end that is
under the control of medical personnel. As Tom was saying, you
may not suffer a loss because the medicine is so good and these
guys work so hard to restore people to health that from the
time of injury to the time that they actually incur a covered
loss could be a long time.
Also, in the initial stages, this is not a first priority
for many families. So, that time up to when they get the
certification--they fill out the form--there are a lot of
things going on in there. We have advocates, patient advocates
and case managers, working with the family. When they are ready
to move on that, they will be moving. The two to 3 weeks after
that we need to scrunch down in the DOD.
I am very pleased with how fast the Veterans'
Administration processes it once we get it to them.
Chairman Craig. Tom, any comment on that?
Mr. Lastowka. Similarly, Sir, I think we generally defer to
the medical community and we have VA and DOD personnel at
places like Bethesda and Walter Reed. We defer to their
judgment on when the families should be approached.
I think that is one place we can look at as we review our
first year. We will be looking at that. The adjudicative
process--the Army is currently taking, for instance, 12 days. I
think that is a reasonable time given the adjudicative process
we ask them to do. Certainly, the processing by Prudential in
the 3 to 4 days is reasonable.
So, I think there are opportunities. I could not identify
what they are right now. I do believe, since we have generally
measured from date of injury to date of payment, that 50 to 60
days processing time is probably longer than the date of loss
to the date of payment, although I do not have specific
statistics on that.
Chairman Craig. Certainly, for those of us looking in
instead of those who are there, hands-on--medical professionals
and families and certification, 50 to 60 days processing time
appears and sounds to be, to me, a long time.
Now, has a target processing time been established, and is
there a private sector model to use as a benchmark? How are you
examining that as it relates to narrowing that window, if
possible?
Mr. Lastowka. At the moment, I am not aware of a private
sector benchmark for, I will say, date of injury to date of
adjudication of, basically, long-term care insurance. The
Insurance Service, generally, we look to customer service and
we measure customer complaints. I am not aware of servicemember
complaints on the time window. So, that would tend to make me
feel good about that.
Again, I recognize with you that there is some control
between that 30 and 60 days that we may be able to identify,
and we will look to do that as we start reviewing the program
as the first anniversary date comes up.
Chairman Craig. OK.
Mr. Dominguez. Senator, if I might. The average includes
things that are quite extraordinary, like the 1 year it took
because the medical personnel were trying to save the leg of
this injured servicemember. So that goes into these averages.
The loss of activities of daily living require the
physicians to observe for a period of time before they state
that this has been a covered or eligible loss. So that goes in.
So, when we look at these benchmarks, we really need to look at
them in that front end piece by the nature of the injury.
Clearly, as I said, I want to get better at the middle time
where we are doing the adjudication certification process and
streamline that, and we will be aggressive in doing that.
Chairman Craig. Thank you very much. Let me turn to Senator
Akaka.
Danny.
Senator Akaka. Thank you very much, Mr. Chairman.
Mr. Lastowka, what would the impact on your office be if
the law was amended to retroactively make all traumatically
injured servicemembers eligible for traumatic injury
protection?
Mr. Lastowka. Sir, I am sorry, I do not understand----
Senator Akaka. What would be the impact on your office if
the law was amended to retroactively make all traumatically
injured servicemembers eligible for traumatic injury
protection?
Mr. Lastowka. I think the impact would be more on the
program than the office, and that would be financial, because
obviously nobody has been paying premiums, if you go
retroactive to the first Persian Gulf War or something like
that.
I would have to defer to DOD because that would be their
appropriative funds. Certainly, it would not impact the TSGLI
or SGLI funding because the retroactive is paid for out of
appropriated funds.
One impact I could see as a difficulty would be to
adjudicate such claims several years after things had taken
place. The difficulty to get documentation depends on how far
back that retroactive period would go. If it went back 10
years, 20 years, just the ability to determine the condition of
servicemembers within a year or two of their traumatic injury
would be very difficult.
Senator Akaka. What kind of difficulty would there be in
reaching back records to make that determination of
eligibility?
Mr. Lastowka. A lot of the disabilities, including those
that depend on examination of the activities of daily living, I
do not think that you would find that documentation existing in
medical records. I do not think there would be many treating
physicians that are no longer living. So, to be able to compile
what activities of daily living a person was or was not able to
perform 10 years ago, I do not think you would necessarily find
that in the contemporaneous medical records.
Although I certainly have not looked at that. Certainly, in
the commercial model, with our recommendation to go to the 2
years, we would be at close to the commercial limit of what
they normally would do under an insurance program.
Senator Akaka. Mr. Dominguez, is there an inequity among
our wounded servicemembers regarding the application of
retroactive payments only to those injured during OIF and OEF?
Mr. Dominguez. Senator, I would say no. From the following
point of view that the program that is set up is an insurance
program, where you pay a dollar to buy this insurance. And
then, if you are subsequently injured then you get this
coverage.
The Congress extended or made that retroactive without
anyone having paid those premiums without having purchased the
insurance because of the compelling and unique circumstance of
being at war. I think that was a noble and a just thing to do
for the people who were exposed to that very unique risk. And
it was their sacrifice in their wartime injuries that, as
Senator Craig mentioned earlier, brought this issue to the
fore.
So, I am very comfortable with the distinction made by the
Congress in the way it structured the retroactive payments.
Senator Akaka. Thank you very much, Mr. Chairman. My time
is almost up.
Chairman Craig. Thank you, Danny.
Senator Murray.
Senator Murray. Yes. In my opening statement I talked about
how early detection and screening for traumatic brain injury
and PTSD will decrease the disabilities of returning
servicemembers. So, I want to go back and ask why we are not
having mandatory screening for both brain injury and PTSD.
Mr. Dominguez. Senator, I am, unfortunately, unprepared to
answer that question today. I would like to take that for the
record.
I have very high confidence in the quality of medical care
being delivered to our men and women in uniform. I think that
the attention that is focused on that and the energy behind it
is really quite extraordinary. I do not think that I could sit
here and say that our people need something that is not being
delivered. My bias would be that if it is necessary, those
people in the hospitals are doing it and taking care of people.
On the mandatory screening for everyone, that's a different
issue. So, I would like to consult with the physicians and get
you an answer.
Senator Murray. If you could check on that, and I would
also like to know how a mandatory TBI screening upon separation
would affect this benefit. If you could do some research and
get back to me on that, I would appreciate it.
Mr. Dominguez. Yes, Ma'am. I would be happy to do that.
Senator Murray. All right.
This legislation was meant to provide this benefit to those
with traumatic injuries. Is there anybody out there with
traumatic injuries that we are missing?
Mr. Lastowka. I think VA has conducted extensive outreach,
especially at the direction of the Under Secretary for Benefits
under our Seamless Transition Program. He asked that we
personally contact any individual that had been identified as
severely disabled, but I would never say that anything was 100
percent perfect.
Senator Murray. Right.
Mr. Lastowka. We do have some concerns, especially where
National Guardsmen and reservists are concerned.
Senator Murray. Yes. That was my specific question. I
wanted to find out what you were doing for Guard and Reserve
members. Are you contacting their families so that they know
about this benefit? How are we getting the word out to them?
Mr. Lastowka. We had a training session, Ma'am, in which we
participated with the veterans benefits coordinator for every
State and National Guard. We instructed them in that program.
We are using publications that cater to the military to place
articles concerning very specifically the fact that it is 24/7,
not limited to combat. That is the direction that we are going.
If there is a population that we are more likely to miss,
it will be those people not on active duty.
Senator Murray. Right. I would just really urge you to
focus on the Guard and the Reserve, because if anybody is going
to be missed, they will be the ones. And continue to work those
channels and any others you can to make sure that they and
their families know about this.
Mr. Dominguez. And that, right now, is our focus, Ma'am.
Senator Murray. Thank you very much.
Thank you, Mr. Chairman.
Chairman Craig. Patty, thank you very much.
Now, let me turn to Senator Thune. Again, John, thank you
for joining us.
OPENING STATEMENT OF HON. JOHN THUNE,
U.S. SENATOR FROM SOUTH DAKOTA
Senator Thune. Thank you, Mr. Chairman, and thank you for
holding this important hearing to review the effects of the
legislation that was enacted to benefit the soldiers who have
suffered severe wounds in the line of duty on the War on
Terror. I want to welcome our panelists here today and thank
you for your oversight of this important program.
I particularly want to recognize Sergeant Keith, who
represents the very best--the American ideals of patriotism,
service, and sacrifice. He is certainly an inspiration to all
of us. Thank you for your service.
I also want to extend a profound debt of gratitude to all
of the veterans who have put themselves in harm's way for our
country, most particularly to those who have been severely
wounded as they faced the enemy.
I was very happy, Mr. Chairman, to cosponsor this measure,
and am, obviously, as you are, very interested in learning how
our efforts have played out. To date, there are 11 South Dakota
servicemembers who have taken advantage of this benefit, and
over 2,500 nationwide. Obviously, this is not a partisan issue.
No one can disagree that we have to do everything within our
power as a government to ensure that these brave soldiers who
have sacrificed so much receive every bit of help that they
require.
So, again, I want to thank you for holding this hearing and
I appreciate the testimony of our witnesses today.
Mr. Chairman, I would simply like to follow up with a
question that has sort of been asked in different ways today
but I think it is really important, in terms of a benefit like
this and just making people aware that it exists and I think
the key to measuring whether or not we have been successful in
achieving what Congress has set out to do is being able to
ascertain whether or not potential beneficiaries know that
benefit exists and are able to take full advantage of it.
From what I understand, the outreach efforts that are being
made to potential beneficiaries are primarily based on news
stories that name soldiers who have been severely injured in
OIF or OEF. And I guess the question, again, is--it kind of
ties into Senator Murray's line of questioning, too. Is it
possible that there are potential beneficiaries that are
overlooked by the approach that is being used, and are there
ways that we can cast a wider net other than simply researching
news stories, in terms of finding out about people who might be
able to benefit from this program?
Mr. Lastowka. Senator, it is true that we do research every
news story that talks about a disabled soldier who may not have
gotten the benefit, but there are other efforts that we do use.
In the insurance program, we personally contact every
military member who is being discharged with a service rating
of 50 percent or greater. Our primary reason for beginning that
personal contact was to inform them of the SGLI extension for
free insurance for disabled members.
Obviously, the veterans that we are talking to, the
veterans who have been discharged, are a target group for
TSGLI. So we will also speak to them about TSGLI. I mentioned
that the Under Secretary had required that every regional
office speak to every identified seriously disabled, under the
Seamless Transition Program, to be contacted.
Of course, most of our beneficiaries are in the military.
They are on active duty, often showing up at Walter Reed and
Bethesda, where we are staffed with people that are very
knowledgeable about the program. As I mentioned to Senator
Murray, our concern right now is primarily to those people who
are not on active duty that may be injured not as a result of
active duty, but are paying that premium which would cover
their non-active duty case and that is where we are focusing, I
will say, publicity and education efforts.
Mr. Dominguez. Senator, if I might add. I agree that the
tough problem will be the Guardsmen and the reservists who are
injured in their civilian status. We can work that through the
chain of command. We are working that through the chain of
command. If someone stops showing up at your selected Reserve
unit for drills, you go find out why. If it is because they
have been injured, then you know that they are eligible for
TSGLI.
The chain of command is important. We use that in the
hospitals. In preparation of this hearing, I checked and
confirmed that there is a human being in every military
treatment facility assigned to every patient with a mission of
making sure that patient knows if they are eligible for TSGLI
and to help them fill out the form.
So, as we move prospectively, the chance of us missing
someone diminishes. So, to check on the awareness of this, we
are incorporating questions about this benefit into our status
of forces surveys that we do every year to ask questions and
get a sense of what the force is thinking or feeling. So, this
benefit will be in that survey this year.
Senator Thune. And my understanding, too, is that, in the
prepared DOD statement, Under Secretary, that there have been
like 2,000 denials of the benefit. I know denials are
inherently necessary as part of the program, but are there
clarifications that we should be making to the law to ensure
that the possibility of a mistake in denial is lowered?
Mr. Dominguez. Sir, let me leap into that first, and then
defer to my VA colleagues. I wanted to say, as I mentioned
earlier to Senator Craig, this is a superbly crafted piece of
legislation. It allows the Veterans' Administration and the DOD
pretty much wide latitude to fix any problems that we see. So,
I do not see a need for any legislation.
Tom can speak more eloquently to the nature of the denials,
but on the positive side, I just told you about the patient
advocates assigned to every patient in these military treatment
facilities. Were I one of those people, I would make sure that
we filled in an application and sent it in regardless of
whether I thought it met the criteria. I would let the system
decide. I cannot say that is what is happening, but I know that
is what I would be doing.
Mr. Lastowka. Yes, Senator. On the retroactive period,
there was a lot of publicity about TSGLI and potential
eligibility even before we established the criteria. I think
that, like a lot of insurance policies, people do not
necessarily know what they contain until they need them.
I think the large number of denials, honestly, were because
of the successful outreach effort where people submitted claims
because they were hospitalized and injured while in the
military and people were not sure what the criteria were.
Just like Mr. Dominguez says, I would rather have 1,000
people apply for the benefit and be denied than to have two or
three not apply, and therefore not get the benefit. I think as
general education goes, that may impact the denial rate. On the
appeals, we know that there have been, I think, 1,400
approximate appeals of decisions made by DOD, and 17 of them
were reversed.
And, as I said, when VA personnel reviewed denied claims we
would not have reversed even one of the claims that we
reviewed. So, I think the denials are legitimate. I think, as
you look across the branches of service, the consistency of the
denial rate across branches of services all argue to the fact
that we are administering the law as you intended. If anything,
it is because people do want to explore whether or not they
might be eligible for a benefit, but those people that you
intended to get the benefit, I believe, are getting that
benefit.
Senator Thune. Thank you, Mr. Chairman.
Chairman Craig. Thank you, John.
Let me continue that line of questioning. While I
appreciate you recognizing that, when we crafted this
legislation, we gave you flexibility because it was important
that it get defined properly to fit. I think Congress knew
where we wanted to go, but we did not know quite how to get
there. That is where we relied on the experts, the medical
professionals, to shape it in. That is why you were given that
flexibility.
With that understanding, from your testimony I gather that
there is a considerable complexity in resolving some claims for
payment. In particular, claims based on limitations of ADL, or
activities of daily living. How is that problem being addressed
would be my first question. Is there more training of medical
professionals responsible for documenting losses of ADLs? Is
that an answer? Is there a quality review process to determine
whether ADL criteria are consistently and accurately applied?
If you will explore that area with the Committee and for
the record I think it would be greatly appreciated.
Mr. Lastowka. Senator, Mr. Chairman, obviously, to a
layperson, it is easier to understand the concept of an
amputation than it is to understand the concept of an activity
of daily living.
Chairman Craig. Yes.
Mr. Lastowka. And so, as you look at that, it is more
complexly defined, although it is defined. So, we have focused
a lot of time and effort in developing training and guidelines.
The guidelines, I believe, are quite objective.
We, with DOD, are developing what we believe to be clear
standards to determine ADL and the loss there, and to
communicate them. We have been holding, through August, weekly
conferences with DOD, people in charge of the program, and, I
will say, their claims examiners, to define what we mean.
We have recently expanded the TSGLI certification forms to
include separate questionnaires for medical professionals to
use that would provide very detailed information pertinent to
the ADL losses. One of our concerns is that we believe the
Congressional intent was that this program be for severely
disabled personnel, the equivalent of Sergeant Keith, the
multiple amputation, the paraplegia. We do not want to diminish
that with a standard--I do not want to diminish anyone's claim,
but we have had things such as twisted ankle. We had torn
rotator cuff, broken jaw--people claiming that they could not
perform activities of daily living. We do not believe that was
the intent.
Now, I do not say that is the vast majority, but I think
the vast majority----
Chairman Craig. No, I believe, for the Committee--at least
for this Member of the Committee--that is a reasonable
interpretation. It was not to be a broad net. It was to be a
specific net for those who were by, what we think, a reasonably
clear definition as traumatically injured.
Mr. Lastowka. I think we and DOD arrived at that, certainly
our commercial partners, OSGLI, through Prudential, would
concur in that. It is something, Sir, that we will look at. We
are planning to do a complete program review shortly after the
anniversary date in order to address all of your issues.
Mr. Dominguez. Sir, if I might, I would like to compliment
the VA, my VA colleagues here, on the really aggressive and
effective workshops and training and weekly discussions. We
connect the people who are doing this work together and work
through those things, including bringing these people together
and running through examples of the problems.
And that has been the initiative of the Veterans Affairs
Department and, really, my hat is off to them for the work they
have done to make this standard across services so that we
can--we have high confidence that a determination in the Air
Force would be the same determination reached in the Marine
Corps.
Mr. Lastowka. Sir, if I could add one more thing.
As I talked about the layman understanding versus, I will
say, the claims examiner, if it was truly confusing to the
claims examiner, I do not think DOD could be processing these
in the average of 12 days.
Mr. Wurtz. Mr. Chairman, the only thing that I would add is
that we have created a very detailed procedures guide. We have
brought one down with us today, I believe to the staff, that
will address some of these issues.
Chairman Craig. All right. Gentlemen, my last question,
then would be, as the operational and policy issues arise, is
there an ongoing collaborative effort between DOD and VA in
this? It appears there has been to date. Does that continue on
a regular basis?
Mr. Lastowka. That continues, Sir. The weekly calls are now
biweekly calls. Obviously, they can call us up at any time that
they wish to, but I think that we continue to cooperate. As
recently as a month ago, we were reporting to the Joint
Executive Council concerning the progress.
Chairman Craig. OK. Well, gentlemen, thank you very much
for your time and your testimony this morning. The Committee
will stay alert to this program. We wanted to achieve the goals
that Congress intended it to, and it appears we are clearly on
our way to doing that.
Thank you.
Now, let me invite our second panel forward. Sergeant John
Keith, United States Army, combat wounded veteran of Operation
Iraqi Freedom; and Jeremy Chwat, Associate Executive Director,
Policy and Service, Wounded Warrior Project.
Gentlemen, again, thank you so much for being with the
Committee this morning.
Sergeant Keith, we will turn to you first. Please proceed.
STATEMENT OF SERGEANT JOHN KEITH, COMBAT WOUNDED VETERAN,
OPERATION IRAQI FREEDOM, U.S. ARMY
Mr. Keith. Thank you, Mr. Chairman.
Thank you for allowing me to address the Committee. On
November 9, 2004, while responding to an insurgent attack on a
battalion convoy, the vehicle I was riding in was struck by a
rocket propelled grenade, an RPG. The RPG struck the driver's
side rear door where I was sitting. The blast shattered my
femur bone, it took a big chunk out of my thigh, my ears were
ringing, and it felt like I was on fire.
The medic came and took me to the international zone and
that is the last thing I remember. I woke up 14 days later at
Walter Reed Army Medical Center. After leaving Iraq, I went to
Langstul, Germany. That was where my wife, Pam, my parents,
Brenda and John, Sr., met me. They told me I have to stay in
Germany for 2 weeks due to a double lung injury.
Within a few hours after arriving, the doctors told them
that my lungs were improving, so I could be flown back to the
States. My wife flew back to the States with me on the medevac
plane and took care of me. I was then taken to Walter Reed Army
Medical Center. While at Walter Reed, I underwent surgery on my
leg every other day. I was able to keep my leg until December
22, 2004. The doctors and I decided to take my leg off because
I wanted to have an active life.
After spending 60 days as an inpatient, I moved to the
Mologne House where I spent the next 5 months living in a hotel
room with my wife and two kids. All during this time, I was
still assigned to Fort Hood, Texas, maintaining a house there
with full utilities and also trying to support a family of four
here in Washington, DC, eating out three times a day, renting a
car, gas, and purchasing clothing for two growing kids. It was
very difficult on a sergeant's pay. We went through our savings
and more during this time.
I learned about the insurance through the Wounded Warrior
Project team I met at Walter Reed Army Medical Center. Every
time I saw them they gave me an update on the progress of the
bill. At first, I did not know whether I would qualify because
I was injured before the bill was passed. But, as time went on,
I understood it was retroactive to the start of the war.
I remember thinking that the Government is really trying to
take care of my family, even though I was just an enlisted
Sergeant in a big Army. I received the maximum TSGLI payment
due to the loss of my left leg above the knee, for being in a
coma for 14 days, hearing loss in my left year, traumatic brain
injury, and a third degree burn on my abdomen. I was able to
replace my savings account, pay off most of my debts, and buy
my wife a new van.
So, whatever the Army will decide to do with me, either to
stay on active duty or move me to the VA system, let me stay in
or let me go, it will be OK. I hope that the Army will let me
stay so I can finish what I started.
Thank you, Sir.
[The prepared statement of Mr. Keith follows:]
Prepared Statement of Sergeant John Keith, Combat Wounded Veteran,
Operation Iraqi Freedom, U.S. Army
On November 9, 2004, while responding to an insurgent attack on a
Battalion convoy, the vehicle I was riding in was struck by a Rocket-
Propelled Grenade (RPG). The RPG struck the driver's side rear door
where I was sitting. The blast shattered my femur bone, taking a big
chunk out of my thigh. My ears were ringing and I felt like I was on
fire. The medics came and took me to the International Zone and that
was the last thing I remembered. I woke up 14 days later. After leaving
Iraq they sent me to Langstul Germany, that is where my wife Pam, and
my parents John, Sr., and Brenda met me. They were told that I would
stay in Germany for 2 weeks due to my double lung injury. Within 4
hours of arriving, the doctors told them my lungs were improving so I
could be flown back to the States. My wife flew back to the states with
me and took care of me. I was taken to Walter Reed Army Medical Center
(WRAMC). While at WRAMC, I underwent surgery every other day on my leg.
I was able to keep my leg until December 22, 2004. The doctors and I
decided to take the leg off because I wanted an active life. After
spending 60 days as an inpatient, I moved to the Mologne House, where
we spent the next 5 months living in a one-room hotel.
All during this time I was still assigned to Fort Hood, Texas, and
maintaining a house there with full utilities. Also, supporting a
family of four here in Washington, DC, with food, eating out three
times a day, renting a car, gas and purchasing clothing for two growing
children was very hard to do on a sergeant's pay. We went through our
savings and more during this time.
The way I learned about the insurance was through Wounded Warrior
Project team I met at WRAMC. Every time I saw them they gave me an
update on the progress of the bill. At first, we did not know if it
would apply to me because I was injured before the bills were passed.
But as time went on, I understood it to be retroactive to the start of
the war. I remember thinking that my government really is trying to
take care of my family even though I was just an enlisted sergeant in a
big Army.
After receiving my TSGLI, payment of the maximum payment, due to
the loss of my left leg above the knee, being in a coma for 14 days,
hearing loss in the left ear, traumatic brain injury, and third degree
burns to my abdomen. I was able to replace my savings, pay off most
debts, and buy my wife a new van. So, whatever the Army will decide to
do with me, either by staying active duty or move to the VA system, let
me stay in or let me go I will be OK. We will be OK. I hope the Army
will let me stay in to finish what I started.
Chairman Craig. Sergeant, thank you very much for that very
important testimony. We appreciate that for the record.
Before I question you in any way, let me turn to you,
Jeremy, for any comments you would wish to make before
questioning. Thank you.
STATEMENT OF JEREMY CHWAT, ASSOCIATE EXECUTIVE
DIRECTOR, POLICY AND SERVICE, WOUNDED WARRIOR PROJECT
Mr. Chwat. Thank you, Chairman Craig.
I thank you for convening this hearing and allowing me to
testify about the Wounded Warrior Project's perception on the
implementation of the new traumatic servicemember group life
insurance program.
The Wounded Warrior Project is a nonprofit organization
that assists the men and women of the United States Armed
Forces who have been severely injured during the War on
Terrorism in Iraq, Afghanistan, and other hot spots around the
world.
One of our finest achievements has been the role we have
played in the creation of the new traumatic injury insurance,
on which this hearing is being held. The Wounded Warrior
Program is still amazed by the speed with which this
legislation was introduced and passed. We remain eternally
grateful to you, Chairman Craig, for your unyielding commitment
to seeing this legislation through to enactment.
Additionally, we once again thank Senator Akaka, Senator
Salazar, and Senator Thune for cosponsoring this measure, and
for their leadership in having the program enacted.
While none of this would have happened were it not for the
determination of this Committee and the Chairman, once the bill
was enacted, the lion's share of the work done on developing
and implementing this program was by the Department of Veterans
Affairs' Office of Servicemember Group Life Insurance, as well
as by the Department of Defense, and the contact and claims
certifying officials from the individual service branches.
Wounded Warrior cannot speak highly enough of all the time
and effort that has gone into creating this program, and I
would like to publicly thank all of the involved agencies on
behalf of the severely injured servicemembers and their
families who, in their time of greatest need, have had many of
their financial fears allayed as a result of these insurance
payments.
Overall, we are very pleased with the TSGLI program
implementation. While there have certainly been bumps in the
road during the implementation process, in just about every
instance, VA and DOD have worked to remedy the problems, and
the program continues to function with ever-increasing
efficacy.
For example, early on in the implementation process, there
were concerns raised about the difficulty in filling out the
application form and substantiating the servicemembers
inability to perform various activities of daily living. In
response, VA has worked to create a new and more comprehensive
form that should eliminate many of these problems.
Additionally, while manpower was stretched thin during the
initial implementation process due to the onslaught of
retroactive claims, these manpower issues have been worked out
over time and no longer seem to be as much of an issue.
Still, while we are happy with how the program has worked
out, we are concerned with one inequity in the implementation
of the retroactive payments. As you know, the intent of the
traumatic injury rider is to help severely injured
servicemembers and their families during the long and arduous
treatment and rehabilitation periods that follows the
occurrence of severe injuries.
In most instances, this new insurance program has become
the intended financial bridge from the time of injury until the
warrior is eligible for VA benefits. It has allowed most
families the flexibility to put their lives on hold at a
moment's notice and be with their loved one during an
oftentimes lengthy period of convalescence and recovery. It has
ensured that most injured servicemembers can concentrate more
fully on their recovery and the transition back into civilian
life, rather than on the financial impact of their catastrophic
injuries.
Unfortunately, there are still a handful of Wounded Warrior
servicemembers who were recently wounded while on active duty
who do not qualify for the insurance payment. In addition to
covering all active duty servicemembers with qualifying
injuries incurred after December 1, 2005, thanks to Congress's
generosity, the program makes retroactive payments to those
servicemembers who incurred qualifying injuries since the
beginning of Operation Enduring and Iraqi Freedom.
As you know, Wounded Warrior never asked for any
retroactive payments while lobbying for the traumatic injury
insurance, and we remain extremely grateful that Congress had
the foresight to extend payments to those warriors who were
injured prior to the legislation's effective date.
Unfortunately, as currently written, not all retroactive
injuries are covered and this has resulted in confusion and
perceived inequity on the part of some severely wounded
servicemembers. As currently written, the regulation dictates
that in order for a retroactive injury to be covered it must
have been incurred in Operations Enduring Freedom or Iraqi
Freedom. It then defines ``in Operations Enduring Freedom or
Iraqi Freedom'' to mean that the servicemember must have been
injured while deployed ``outside the United States on orders in
support of Operations Enduring Freedom or Iraqi Freedom or
served in a geographic location that qualified the
servicemember for the combat zone Tax Exclusion under 26 U.S.C.
211.''
By defining ``in Operations Enduring Freedom or Iraqi
Freedom'' as such, the regulation has disqualified a number of
traumatically injured servicemembers from payment based solely
on their location at the time their injury was incurred.
Wounded Warrior project believes that there should be no
difference between injuries incurred prior to December 1, 2005
or after December 1, 2005, and that the same criteria that
apply to prospective injuries should apply to retroactive
injuries. It is inequitable to deny retroactive payments to
those who have suffered the same grievous injuries based solely
on the location where the traumatic event took place.
Should the rule remain as written, brave men and women who
were traumatically injured after October 7, 2001, but before
December 1, 2005, will be denied the same retroactive payment
given to their wounded comrades, based solely on the location
they were ordered to, or were at, when their injuries occurred.
Brave men and women like Seaman Robert Roeder, who was injured
on January 29, 2005, when an arresting wire on the aircraft
carrier, the USS Kitty Hawk, severed his left leg below the
knee.
Seaman Roeder was stationed out of Yokuska, Japan, and his
ship was on its way to the Gulf of Arabia when his injury
occurred during flight training operations. Although the ship
was on its way to the Gulf and the training exercises being
conducted were in preparation for action in either Operation
Enduring or Iraqi Freedom, Robert's injury does not qualify for
payment under the interim final rule as written.
Robert was hospitalized at Brooke Army Medical Center in
San Antonio, Texas, for over a year and his recovery and
rehabilitation has been just as strenuous and arduous as it
would have been had his ship made it to the Gulf of Arabia
prior to his injury. Seaman Roeder is not the only wounded
servicemember being impacted by this inequity. We strongly
believe that corrective legislation should be passed so that
Seaman Roeder and other warriors like him will not be deprived
of this vitally important insurance.
Again, Wounded Warrior is very pleased with the overall
implementation of the TSGLI program, and we are very grateful
for the hard work that has gone into making this program a
reality. I cannot overstate how many people and families have
benefited from this insurance at a time in their lives when
they needed all of the assistance they could possibly get.
The Wounded Warrior Project is honored to have played a
role in its creation, and I thank you again for giving us this
opportunity to testify.
[The prepared statement of Mr. Chwat follows:]
Prepared Statement of Jeremy Chwat, Associate Executive Director,
Policy and Service, Wounded Warrior Project
Chairman Craig, Ranking Member Akaka, and Members of the Committee,
I thank you for convening this hearing and for allowing me the
opportunity to testify about the Wounded Warrior Project's perception
on the implementation of the new Traumatic Servicemember Group Life
Insurance (TSGLI) program.
The Wounded Warrior Project (WWP) is a non-profit organization that
assists the men and women of the United States Armed Forces who have
been severely injured during the war on terrorism in Iraq, Afghanistan
and other hot spots around the world. Beginning at the bedside of the
severely wounded, WWP provides programs and services designated to ease
the burdens of these heroes and their families, aid in the recovery
process and smooth the transition back to civilian life. We strive to
fill the vital need for a coordinated, united effort to enable wounded
veterans to aid and assist each other and to readjust to civilian life.
One of our finest achievements has been the role we played in the
creation of the new Traumatic Injury Insurance on which this hearing is
being held. WWP is still amazed by the speed with which this
legislation was introduced and passed and we remain eternally grateful
to Chairman Craig for his unyielding commitment to seeing the
legislation through to enactment. Additionally, we once again thank you
Senator Akaka for cosponsoring the measure and for your leadership in
having the program enacted.
While none of this would have happened were it not for the
determination of Chairman Craig and Ranking Member Akaka, once the bill
was enacted the lion's share of the work done on developing and
implementing this program was by the Department of Veterans Affairs'
Office of Servicemember Group Life Insurance as well as by the
Department of Defense and the contact and claims certifying officials
from the individual Service branches. WWP cannot speak highly enough of
all the time and effort that has gone into creating this program and I
would like to publicly thank all of the involved agencies on behalf of
the severely injured servicemembers and their families who, in their
time of greatest need, have had many of their financial fears allayed
as a result of these insurance payments.
Overall, the Wounded Warrior Project is very pleased with the TSGLI
program implementation. While there have certainly been ``bumps in the
road'' during the implementation process, in just about every instance
VA or DOD have worked to remedy the problems and the program continues
to function with ever increasing efficacy. For example, early on in the
implementation process there were concerns raised about the difficulty
in filling out the application form and substantiating the
servicemember's inability to perform various Activities of Daily Living
(ADLs). In response, VA has worked to create a new and more
comprehensive form that should eliminate many of these problems.
Additionally, while manpower was stretched thin during the initial
implementation process due to the onslaught of retroactive claims,
these manpower issues have been worked out over time and no longer seem
to be as much of a problem.
Still, while we are very happy with how the program has turned out,
we are concerned with one major inequity in the implementation of the
retroactive payments. As you know, the intent of the traumatic injury
rider is to help severely injured servicemembers and their families
during the long and arduous treatment and rehabilitation period that
follows the incurrence of a severe injury. In most instances this new
insurance program has become the intended financial bridge from the
time of injury until the warrior is eligible for VA benefits. It has
allowed most families the necessary flexibility to put their lives on
hold at a moment's notice and be with their loved one during an
oftentimes lengthy period of convalescence and recovery. It has ensured
that most injured servicemembers can concentrate more fully on recovery
and the transition back into civilian life rather than on the financial
impact of their catastrophic injuries. Unfortunately, there are still a
handful of wounded warriors who do not qualify for this insurance
payment.
In addition to covering all active duty servicemembers with
qualifying injuries incurred after December 1, 2005, thanks to
Congress' generosity the program makes retroactive payments to those
servicemembers who incurred qualifying injuries since the beginning of
Operations Enduring and Iraqi Freedom. As you know, WWP never asked for
any retroactive payments while lobbying for Traumatic Injury Insurance
and we remain extremely grateful that Congress had the foresight to
extend payments to those warriors who were injured prior to the
legislation's effective date. Unfortunately, as currently written, not
all retroactive injuries are covered and this has resulted in confusion
and perceived inequity on the part of some severely wounded
servicemembers.
As currently written the regulation dictates that in order for a
retroactive injury to be covered it must have been incurred, ``in
Operations Enduring Freedom or Iraqi Freedom''. It then defines ``in
Operations Enduring Freedom or Iraqi Freedom'' to mean that the
servicemember must have been injured while deployed, ``outside the
United States on orders in support of Operations Enduring or Iraqi
Freedoms or served in a geographic location that qualified the
servicemember for the combat zone Tax Exclusion under 26 U.S.C. 211.''
By defining ``in Operations Enduring Freedom or Iraqi Freedom'' as
such, the regulation has disqualified a number of traumatically injured
servicemembers from payment based solely on their location at the time
their injury was incurred. WWP believes that there should be no
difference between injuries incurred prior to December 1, 2005 or after
December 1, 2005, and that the same criteria that apply to prospective
injuries should apply to retroactive injuries. It is inequitable to
deny retroactive payments to those who have suffered the same grievous
injuries based solely on the location where the traumatic event took
place.
Should the rule remain as written brave men and women who were
traumatically injured after October 7, 2001, but before December 1,
2005, will be denied the same retroactive payment given to their
wounded comrades, based solely on the location they were ordered to, or
were at, when their injuries occurred. Brave men and women like Seaman
Robert Roeder who was injured on January 29, 2005, when an arresting
wire on the aircraft carrier, the USS Kitty Hawk, severed his left leg
below the knee. Seaman Roeder was stationed out of Yokuska, Japan and
his ship was on its way to the Gulf of Arabia when his injury occurred
during flight training operations. Although the ship was on its way to
the Gulf and the training exercises being conducted were in preparation
for action in either Operation Enduring or Iraqi Freedom, Robert's
injury does not qualify for payment under the Interim Final Rule as
written. Robert was hospitalized at Brooke Army Medical Center in San
Antonio, Texas for over a year and his recovery and rehabilitation has
been just as strenuous and arduous as it would have been had his ship
made it to the Gulf of Arabia prior to his injury.
Seaman Roeder is not the only wounded servicemember being impacted
by this inequity in the regulation. We strongly believe that the
regulation should either be rewritten or corrective legislation should
be passed so that Seaman Roeder and other wounded warriors like him
will not be deprived of this vitally important benefit, one with a
stated mission of assisting in their rehabilitation and transition into
civilian life.
Again, WWP is very pleased with the overall implementation of the
TSGLI program and is very grateful for all of the hard work that has
gone into making this program a reality. I cannot overstate how many
people and families have benefited from this insurance at a time in
their lives when they needed all the assistance they could get. The
Wounded Warrior Project is honored to have played a role in its
creation and I thank you again for giving us this opportunity to
testify.
Chairman Craig. Jeremy, thank you very much.
Sergeant Keith, first of all, on behalf of the Committee,
let me thank you for your service and your commitment. As many
of my colleagues have already said, you are, without question,
one of our heroes, and we do not state that lightly.
You are also a perfect example of why we moved the
legislation that we did, that is now law. Because we
recognized, as was so clearly stated by those who the Wounded
Warrior Project brought to me, that this was not just about you
or the particular service person. It was about the family, the
wife, the mother, the father, the children, and oftentimes we
forget that when we see a wounded servicemember. Our eyes and
attention are focused on them. But behind them, in almost all
instances, is a family that is suffering in some form and to
some degree. Certainly not to the physical extent, but maybe to
the mental extent, and all the emotions that go with that, as
you well know.
In all of that, one of the greater frustrations is
continuing on. And if you have a financial burden, it adds to
that dramatically. So, I think your testimony today, the way
you laid it out for us, is extremely important for the record
and it reflects clearly what we intended to do with this law.
Mr. Keith. Thank you, Sir.
I have said it many times that not just the soldier gets
wounded, the whole family gets wounded. It was a very stressful
time for my whole family. My daughter, who is 5 years old, did
not really know what was going on. She just knows that Dad lost
his leg. My son, fortunately, is only going to know me with
having only one leg, but I can still get him if he gets in
trouble.
[Laughter.]
Chairman Craig. For a time.
Mr. Keith. I will catch him. I will get him, eventually.
The whole program, I had nothing but good experience. The
Army Wounded Warrior Program initiated the paperwork, I think
it was like 2 days before it was supposed to be enacted, to
make sure that we would get all of the paperwork filled out by
the doctors and all that.
They met with us on a Wednesday when we went through
amputation clinic, and we filled out all the paperwork then so
they could submit it that day. I received mine about 30 days
later, but everything went smoothly.
Chairman Craig. Good. Well, thank you very much.
Jeremy, first of all, we appreciate your overall reaction
to what you brought to us and hoped to be a success. By most
definitions, I think it clearly is a success. But you also
bring up the issue of definition, and those who fell outside of
that definition.
In bringing the case in point, and the individual that you
brought in that case, has Wounded Warrior Project, in any way,
determined the number of those who are qualified that might be
out there, but fall outside of the definition?
Mr. Chwat. I have personally heard of a handful of cases.
It really depends on how widely you extend the definition.
Chairman Craig. Yes, of course.
Mr. Chwat. Do you extend the definition to include all
active duty servicemembers who may have been stateside in
training who were injured in some way, be it on the way to or
from base, or those types of things, or do we expand it to
include those who were clearly on route to combat or in a
specific training exercise?
So, it really would depend on how we redefine the
retroactive applicability. I should note that, though, when it
came to the increase in the servicemember group life insurance
benefit for survivor families who died before that insurance
premium was raised, the benefit was raised, that Congress did
go back and retroactively apply it to all of those
servicemember families who lost a loved one during that time
period.
So, there is some Congressional precedent to do that.
Chairman Craig. Yes, there is.
Well, we will take a look at that. I think that you make a
very important point. When we write legislation, you never
quite know where the lines fit or do not fit, are fair or
demonstrate an inequity.
As we all know, lines have to be drawn, and it is important
that they are effectively drawn, just like the last panel. How
do you define traumatic? It was not intended to be broad. It
was intended to serve those who truly fit a definition. And, at
the same time, it was not intended to exclude those who fit the
definition, but fell outside the fine line of time or
relationship to a given point in time in operations.
So, I appreciate you bringing that before the Committee. We
will take a look at that and work with DOD and VA to see where
that might fit, and what might be more appropriate in
relationship to that.
The example that you have cited--I do not think that we can
quibble over that, but by apparent definition, that gentleman
falls outside the line.
Mr. Chwat. Yes.
Chairman Craig. Well, thank you both very much again for
participating and being with us through this, especially the
Wounded Warrior Project. You have served your purpose mightily,
and I think the Sergeant would agree with that.
Mr. Chwat. Thank you.
Chairman Craig. Thank you both very much. We appreciate it.
Mr. Keith. Thank you, Sir.
Chairman Craig. The Committee will stand adjourned.
[Whereupon, at 11:15 a.m., the hearing was adjourned.]