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14-04 July 23, 2004 r The American Legion For God and country National Veterans Affairs and Rehabilitation Commission 1608 K Street, N.W. • Washington , D.C. 20006 Paul A. Morin, Chairman - Massachusetts Carol J. Rutherford, Director - Maryland NUMBERS OF COPIES 1 LIBRARY 14-04 LIBRARIAN AND MUSEUM CURATOR july 23, 2004 BUILDING I STATEMENT OF CAROL RUTHERFORD, DIRECTOR VETERANS AFFAIRS AND REHABILITATION DIVISION THE AMERICAN LEGION TO THE SUBCOMMITTEE ON HEALTH COMMITTEE ON VETERANS' AFFAIRS UNITED STATES HOUSE OF REPRESENTATIVES ON THE EVOLUTION OF VA-DOD COLLABORATION IN RESEARCH AND AMPUTEE CARE FOR VETERANS OF CURRENT AND PAST CONFLICTS JULY 22, 2004 Mr. Chainnan and Members of the Subcommittee: Thank you for this opportunity to submit The American Legion's view on the evolution of VA­ DoD collaboration in research and amputee care for veterans. The American Legion commends the Subcommittee for holding a hearing to discuss these important and timely issues. The Evolution of VA-DoD Collaboration in Research and Amputee Care for Veterans of Current and Past Conflicts Advances in the technology of warfare is saving the lives of many of service members who would not have survived the wounds of combat just 20 years ago. High-tech ceramic body armor makes combat vastly more survivable. Tremendous improvements in the way battlefield casualties are treated and evacuated have reduced fatalities significantly. These advances have not come without costs to individual soldiers, sailors, ainnen and Marines in the form of increased rates of traumatic amputation of limbs. With an increasing number 'of soldiers suffering limb loss due to combat in Afghanistan and Iraq, prosthetics researchers and clinicians "Pioneering Quality Service to veterans and Their Families" from Department of Veterans Affairs (V A) and Walter Reed Army Medical Center (WRAMC), along with experts from industry and academia, met in November 2003 to outline joint initiatives to further prosthetics research and improve care for military and veteran amputees. Numerous new initiatives were proposed at the conference to include: The C-Leg The C-Leg is a microprocessor controlled artificial leg manufactured by the Otto Bock Healthcare in Gelmany. A major topic of discussion on this item was its cost: $50,000 apiece. It was noted that no blinded, randomized clinical trials, comparing the C-Leg to less expensive hydraulic prostheses have been conducted. The American Legion notes that a trial is now ongoing at the Institute of Human Performance at the State University of New York Upstate Medical University in Syracuse NY. So far fourteen subjects have worn the C-Leg and a standard prosthesis, according to Ron Seymour, P.T., Ph.D., the principal investigator. It is noted that blinded studies are not possible with this type of medical device. A debate currently exists within VA as to whether the C-Leg is worth the cost, indicating the lack of empirical research on this device. One VA researcher noted that "precious little evidence-based data exists on appropriate treatment of amputees", generally. The American Legion recognizes that V A and DoD have the opportunity to direct national healthcare policy in this medical arena and we encourage these agencies to take the lead. Computer-Aided Design and Manufacture (CAD/CAM) CAD/CAM assists prosthetists in fitting amputees with prostheses that are comfortable, fit well and present the least risk of secondary cOlnplications such as skin sores. The American Legion is concerned that CAD/CAM equipment installed in 36 VA clinics in the mid-1990s is underutilized due to technical incompatibilities and lack of education on the PaIt of VA practitioners. The American Legion urges VA to correct this situation. Osseointegration Osseointergration is a technique in which prostheses are integrated directly to the remaining bone in an amputated limb with a titanium bolt. Titanium does not elicit a rejection response as does other materials and is the base material in dental implants. The American Legion encourages V AlDoD collaboration in development of this prOlnising aI'ea. Standardization of Measurement and Databases across VA and DoD This will help clinicians and researchers in both agencies measure functioning and outcomes of amputees when transitioning from active duty to veteran status. Conferees agreed on the need for more objective and consistent measures of gait to detennine how well lower-limb prostheses are functioning as well as new lightweight, super-strong composite materials for upper-extrelnity prostheses developed in the aerospace sector. Again, the opportunity exists for VA and DoD to take the lead in this area and we encourage them to do so. Continuing Education in Prosthetics, for Physicians, Prosthetists and Physical Therapists Another area addressed at the conference was the relative lack of evidence-based best practices at the clinic level. To some extent, prosthetic development is still more an art than a science. V A and DoD should become Centers of Excellence in amputee healthcare through an integrated 2 continuum-of-care including a team approach to treating the amputee and returning him or her to wholeness. This excellence should be ddven by a definition of best care based on research in all aspects of healthcare including new devices, head-to-head trials of existing technology and best practice analysis. During the Vietnam War it took on average of four weeks for a soldier who lost a limb in combat just to amve at the Amputee Center in Valley Forge, Pennsylvania. In the current conflicts, the average time an amputee is hospitalized is just seven weeks in total including; 2 days in a Combat Surgical Hospital, 5 days at Landstul Army Medical Center in Germany and 42 days at WRAMC or other military hospital in the U.S. This improvement is due to advances in forward surgical, resuscitation and evacuation capabilities, advanced surgical techniques that convert injuries to clean surgical wounds and advances in antibiotic treatment. This, however, is only the beginning of the Government's life-long obligation to amputee veterans. Additionally, The American Legion agrees with the recommendations of the President's Task Force to Improve Health Care Delivery for Our Nation's Veterans (PTF) that stressed improved collaboration between VA and DoD as well as creating a seamless transition to veteran status. Collaboration effotts should not be limited to improving the delivery of high quality health care to the beneficiaries of the two Departments. It should include improved collaboration of research and development that improves the services and rehabilitation needed by veterans who have become amputees as a result of their honorable military service. Mr. Chairman, The American Legion is heartened by the implementation of the Army's new Disabled Soldier Support System (DS3). In previous conflicts no program to transition disabled soldiers into the V A system existed. Veterans presented themselves to V A and were required to prove their own eligibility. The deployment cycle suppOtt feature of DS3 facilitates referrals to VA. DS3 provides its severely disabled soldiers and their families with a system of advocacy, including representation by Veterans' Service Organizations (VSOs) such as The American Legion. VSOs are involved at the PhysicaVMedical Evaluation Board (PEBIMEB) level at major Military Treatment Facilities (MTFs) and follow the veteran to his or her initial contact with VA healthcare. If the soldier is medically retired, the VSO conducts a Needs Assessment and tailors specific assistance to the soldier and family. On release from DoD, the veteran is handed off to a "hometown" VSO for enrollment in VA medical care and application for VA disability compensation. Pedodic telephonic follow-up by DoD then ensues for a minimum of five years. This is a commendable initiative, designed to deliver services to the veteran with a minimum of delay and red tape and The American Legion appreciates DoD's precedential involvement of VSOs at the level of the MTF. Hopefully, this will evolve into the same symbiotic relationship that VSOs now enjoy with VA. In response to the needs of families who had spouses deployed during the Gulf War, The Amedcan Legion created The Family SuppOtt Network to assist the service member's families on the home front, especially National Guard and Reservists. This same · network of Legionnaires, Legion Auxiliary and Sons of The American Legion volunteers stands ready today 3 to provide assistance to military families of deployed service members as well as those new veterans who struggle to adjust to life outside of the military. Those new veterans, who are returning with lost limbs and unanswered questions, can turn to The American Legion Family Support Network for help in adjusting to their new life as well as assistance in navigating the often confusing landscape of benefits and entitlements provided through VA and DoD. Clearly, VA' s Medical and Prosthetic Research budget has not kept pace with inflation during the past 15 years. It is essential that Congress and the Administration support strong medical and prosthetic research programs within VA so that veterans and all citizens continue to benefit from the exceptional research capability of the Department. The American Legion supports adequate funding for VA biomedical research activities. Congress and the Administration should encourage acceleration in the development and initiation of needed research on conditions that significantly affect veterans - such as prostate cancer, addictive disorders, trauma and wound healing, post-traumatic stress disorder, rehabilitation, and others - jointly with DoD, the National Institutes of Health (NIH), other Federal agencies, and academic institutions. Since the FY 2005 VA appropriations has not yet been enacted, The American Legion strongly recommends $445 million for Medical and Prosthetics Research in order for VA to continue its outstanding work. Adequate funding will enable VA to attract and retain health care professional researchers and clinicians. Mr. Chairman, this concludes my statement. I again thank the Subcommittee for this opportunity to submit the views of The American Legion on this timely and important issue.
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