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Commission urges overhaul of veterans' care

Calls for boost in family benefits and less red tape

WASHINGTON -- A presidential commission examining the care given to wounded US service members yesterday recommended "fundamental changes" aimed at simplifying the military's convoluted healthcare bureaucracy and overhauling the veterans disability system for the first time in more than half a century.

The commission, led by former senator Bob Dole, Republican of Kansas, and former Health and Human Services Secretary Donna Shalala, met with President Bush at the White House yesterday morning to brief him on their findings and press him for quick action. "We left there feeling the ball's in their court now," Dole said.

The commission issued a package of six broad recommendations intended to transform a troubled system for military healthcare and veterans' assistance that has left some injured soldiers languishing for years and resulted in inequitable and inconsistent disability benefits.

The commission's proposals include the creation of "recovery coordinators," who would help each seriously injured service member navigate the complexities of care, rehabilitation, and disability; giving the Department of Veterans Affairs sole responsibility for determining disability payments for wounded veterans; and taking aggressive steps to prevent and treat post-traumatic stress disorder and traumatic brain injury.

Yesterday afternoon, Bush announced that he had instructed Secretary of Defense Robert M. Gates and Secretary of Veterans Affairs Jim Nicholson "to look at every one of these recommendations, to take them seriously, and to implement them."

In their final commission meeting yesterday, members unanimously approved the "landmark" measures, as Shalala described them. "We . . . knew Band-aids were not going to cut it," she said.

The 29-page commission report is titled "Serve, Support, Simplify." Its six overall recommendations are broken down into 35 "action steps," only six of which would require congressional legislation, Shalala said. Most of the others could be directed by the White House, the Pentagon, and the VA, she said.

"These are doable," Shalala said at a news conference. "I told the president that I almost brought my Nike T-shirt that says, 'Just do it.' "

The President's Commission on Care for America's Returning Wounded Warriors was established by Bush in March after disclosures in The Washington Post of poor living conditions at Walter Reed Army Medical Center for some wounded soldiers returning from Iraq and Afghanistan. The articles also detailed the bureaucratic maze many injured soldiers experienced during their recovery.

The recommendations yesterday by the Dole-Shalala commission cap a deluge of boards, reports, hearings, and investigations by the Army, Pentagon, and VA responding to the public outrage that followed the coverage. As part of that fallout, the Senate yesterday passed legislation to address inconsistencies in Pentagon and VA disability ratings and to provide more money for the diagnosis of traumatic brain injury and post-traumatic stress disorder.

White House press secretary Tony Snow initially told reporters yesterday morning that Bush would not take immediate action. But late yesterday afternoon, after Dole and Shalala's comments and criticism from a veteran's group, Bush announced he would move quickly.

The commission was created to examine the overall state of military medicine and care for veterans. Over the course of four months, the nine commission members -- including two wounded Iraq veterans, the wife of an injured soldier, and specialists in healthcare and veterans affairs -- held seven public hearings and visited 23 medical facilities around the country.

Shalala said the commission opted against a "laundry list" of suggestions, and instead narrowed its report down to six recommendations with a common goal of creating a "simplified path to recovery."

The proposals include the establishment of an interactive benefits website called "My eBenefits," modeled after MySpace, which would provide customized information for service members and veterans about their healthcare and benefits. The panel called for increased money to support families of the wounded.

The proposal to overhaul the disability system would end the current "confusing" structure in which the military branches and the VA issue parallel and often conflicting disability ratings, commissioners said. They also recommended that the VA's payments to veterans be based in part on their quality of life, not just on the work-related effects of their physical and mental injuries.

In addition, the commission called for ensuring that Walter Reed attracts and retains "first-rate professionals to deliver first-rate care," even though it is slated to close in 2011. Dole, who was injured in combat in Italy during World War II, said the Pentagon must fight the impression that Walter Reed is a "dead-end" assignment for doctors and nurses by adding incentive packages.

The commission avoided making recriminations, Dole said. "We weren't going to have a whitewash or a witch hunt," he said.

To view the commission's report, go to