Statement of
Stephen Hunt, MD
Director, Deployment Health Clinic
VA Puget Sound Health Care System

August 3, 2005

Good Morning, Senator Murray, my name is Dr. Stephen Hunt. I am a physician and director of the Deployment Health Clinic at the VA Puget Sound Health Care System.  VA Puget Sound is the largest of the VA medical centers in Washington State and serves as the main referral center for tertiary care. This integrated delivery system is the result of thorough financial planning, clinical program integration, expanded access and coordination of care among the five VA facilities located in the States of Alaska, Idaho and Washington.   
VA Puget Sound Health Care System had approximately 612,377 patient visits in fiscal year 2004, providing care to 59,329 veterans, throughout the state and across the VISN.  So far this year, we have provided care to 5.7% more veterans than last year at this time including 1,567 OIF/OEF veterans.
 In my clinic I have evaluated and continue to follow medically over 200 combat veterans who have returned from service in Iraq and Afghanistan. I see new returning veterans daily in my clinic.

I would like to thank the Senate Veterans' Affairs Committee for providing this opportunity to share with you this information on work that is being done to meet the needs of combat veterans returning from Iraq and Afghanistan, and would like to thank you all for attending. I would particularly like to thank any veterans present for their service and their continued input into this most important issue?providing care for those who have served.

Through the experiences and struggles of returning combat veterans over the years, we have learned about the impacts of war on military service personnel. We have learned that war often involves combat that may cause physical wounds and injuries. We have learned that war may frequently involve psychological traumas that may cause emotional disturbances. We have learned that war may involve toxic environmental exposures that may cause acute and chronic health effects. We have learned that the complex and challenging environment of war may result in medically unexplained symptoms.

We now know that being involved in combat may affect a person's body, mind and spirit. We understand that these effects impact not only the veteran, but also the veteran's spouse, the veteran's children, the veteran's extended family and the veteran's community.

We have learned a great deal about how to treat the wounds of war. We are better able to treat wounds on the battlefield, better able to evacuate the wounded, better able to treat and rehabilitate individuals with spinal cord injuries, head injuries, and amputations; we are better able to treat post traumatic stress disorder (PTSD), depression, panic attacks and anxiety disorders. We have better rehabilitation programs and social services.

We know what we need to know about the impacts of war on military personnel. Now we must do what needs to be done to meet the needs of the individuals returning from Iraq and Afghanistan.  There are three necessary components to meeting the needs of returning combat veterans: the care must be integrated, the care must be comprehensive and high quality, and the care must be ongoing.

Integrated Care

The Department of Veterans Affairs (VA) and the Department of Defense (DoD) have developed an increasingly effective partnership to meet the needs of our newest veterans by assisting them with a smooth transition from active duty to civilian life.

It is our joint goal to ensure that every serviceman and woman returning from combat receives prompt consideration and world-class service.  Together, the VA and DoD are finding ways to move records more efficiently between the two agencies; ways to share critical medical information electronically; ways to protect the health of troops stationed in areas where environmental hazards pose a threat; ways to process benefits claims quickly and efficiently; and, in all ways possible, to hold open the doors to an uncomplicated passage from soldier to citizen.
Benefits and Services

Veterans, including Reserve and National Guard members, who served in a theater of combat operations are eligible for hospital care, medical services, and nursing home care for injuries or illnesses that may be related to combat service for a period up to two years beginning on the date of discharge or release from service.

This two-year eligibility for medical care is available even if there is insufficient medical evidence to conclude that the veteran's illness is the result of combat service.  At the end of the two-year period, these veterans can continue to receive free health care for injuries and illnesses officially connected to military service.

In addition to health care, VA offers a spectrum of programs for veterans, including disability compensation, vocational rehabilitation, prosthetic services, life insurance, pension, education benefits, specially adapted housing and automobile grants, and survivor and burial benefits.  VA programs for veterans with a service-connected injury or illness apply equally to those who served in the regular active duty forces and to National Guard members or reservists returning from federal activation.

VA Puget Sound Health Care System and VISN 20 were leaders in establishing a seamless transition program based at Madigan Army Medical Center (MAMC), where two VA social workers are working full time/side-by-side with MAMC personnel as discharge planners, to ensure a smooth transition to VA services at locations nearest to the veteran's residence after discharge.  Through this coordination, the veterans are known at the local VA facilities that process their benefits claims, and continuity of their medical care, including medications and therapy, is ensured.

VA Puget Sound Health Care System Deployment Health Clinic

Unique to VA Puget Sound and VISN 20 is the Deployment Health Clinic. The Deployment Health Clinic is dedicated to the care of veterans who are experiencing health concerns related to a specific deployment.

When veterans come to the Deployment Health Clinic, they receive a comprehensive evaluation including post-combat assessment, physical examination, mental health evaluation, benefits counseling, and assistance with compensation and pension claims issues. They will then continue to receive their primary medical care as well as their mental health follow-up from the Deployment Health Clinic staff. Individual treatment, group treatment, marital counseling and sub-specialty referral are all available. Female providers and liaison with the Women's Clinic are available to meet the unique needs of returning female combat veterans.

The purpose of the DH Clinic is to:
1. Address and support veterans in all aspects of life which have been affected by their combat experience
2. Provide support in an accessible and integrated way
3. Provide support in an ongoing way for as long as it is needed
4. Provide the support necessary for the veteran and his/her family to readjust, recover, and be optimally functioning in all realms as soon as possible after return from combat and for the long term.   

To date, 250 newly returning soldiers have been seen in the Deployment Health Clinic and have received both a physical and mental health assessment as part of their post-deployment health evaluation. Approximately 400 individuals have contacted the clinic to date and have received referrals or assistance in other ways.

Integrated Care, Quality Care, Ongoing Care

The integration of services between the DoD, the VBA, the VHA, Readjustment Counseling Centers (Vet Centers), Veterans' Service organizations and community resources is occurring in ways far beyond what has been seen following prior combat deployments. The quality of care within the VA and satisfaction ratings of veterans relative to their VA care are high. We have programs, personnel and systems in place to provide the care which is needed and deserved by combat veterans returning from Iraq and Afghanistan. We will continue our efforts to provide that care; when our efforts are less than optimal, we depend upon the feedback of veterans and their families to help us to improve our work.

I conclude by thanking those veterans and their families who are present today for their service, and by thanking Senator Murray and the Senate staff and those of you in attendance today for your interest and support in the needs of our returning combat veterans. It is our national responsibility to collectively embrace and to ultimately succeed in this mission.