Statement of

Kristin Henderson

To the

Kristin Henderson is a military spouse, author, columnist for Military.com, and frequent contributor to the Washington Post Magazine, including reporting from Iraq. Her reporting has also appeared in Military Spouse Magazine. Media appearances include BBC's "Outlook", NPR's "All Things Considered" and "Fresh Air", NBC's "Weekend Today Show", and MSNBC, among many others.

Ms. Henderson is married to a Navy chaplain who served with the United States Marines in Afghanistan and Iraq. Her latest book, While They're at War: The True Story of American Families on the Homefront, is a non-fiction account of military spouses in wartime. Her memoir, Driving by Moonlight, details her own experience during her husband's deployment to Afghanistan following Sept. 11. 

She has participated as a volunteer in the Marine Corps' Key Volunteer family support program and Compass, the Navy's spouse mentoring program. She is a member of the National Military Family Association and Military Reporters and Editors. She currently lives in Japan, where her husband is stationed.

Her website is: http://www.kristinhenderson.com.

*****

I would like to thank Chairman Akaka and the distinguished members of this committee for the opportunity to provide testimony on how the Department of Defense and the Department of Veterans Affairs are caring for the families of wounded warriors as they transition from active duty. Because these families quietly serve our country in the background, they are often overlooked. You deserve special thanks for taking note of the service of families and focusing on their needs.

Based on my interactions with wounded warrior families and those who work with them, I will address the following issues:

I. The role of the family in the wounded warrior's recovery

II. The needs of family caregivers

III. Challenges to meeting wounded family needs

An injured soldier recently told me that his wife is the reason he's still alive. For him and many other wounded warriors, that's no exaggeration. A patient's spouse, children, parents, and siblings have been shown to play a crucial role in the healing process.

After Marine SGT. Sam Nichols of Kilo Battery 3/12 was hit by an IED in Iraq, he was medevaced to Germany. His wife Erin flew to be by his side, just grateful he was still alive. But when she got there, the doctors asked her to sign a "Do Not Resuscitate" form. A neurologist told Erin that Sam's brain was so damaged that there wasn't much chance he'd recover.

That was in July 2007. Sam was in a coma for the first two months of his new life with traumatic brain injury, or TBI. By Christmas, Sam was still hooked up to a feeding tube, a catheter, and a temporary colostomy bag. But he was awake and doing physical and occupational therapy six days a week. He couldn't speak but when Erin asked him a question, he could understand and raise one finger for "yes" and two for "no." She worked with him on his alphabet board. She read "Harry Potter" and the Bible to him. When she'd ask him if she should keep reading, he'd let her know that he didn't want her to stop.

These are the successful milestones of Erin's new full-time job -- caring for Sam. "I'm there every day, loving him and being his voice until he finds his," she wrote me in an e-mail.

According to her father, "Erin doesn't sit idly by and let the nurses and therapists care for Sam. I would say she is probably the biggest reason Sam has improved as much as he has." Until recently, Sam couldn't really communicate any problems he was having. "But," says Erin's father, "Erin is so in sync with him that she knows what questions to ask him. She determined that he is having bad dreams about the IED attack in Iraq, and she determined that he was having migraine headaches and is working with the hospital staff to take care of that issue."

Erin carries around a Bible with a little card in the front flap that says being a military spouse is the toughest job in the military. The day that IED hit Sam's convoy, her job got tougher. In early December, Erin left the VA hospital in Palo Alto, California, and drove two and a half hours north to spend the day with her family. It was her 24th birthday. It was also her first day off from caring for Sam in five months.

Today, Erin continues to work with Sam fulltime. The staff at the VA recognize her as part of the treatment team. With help from the VA and the Marine Corps liaison, Erin has made a decision about which private facility to move Sam to for the next phase of his treatment. This will be her third move with Sam in less than year. She lives wherever he's being treated -- first in Bethesda, Maryland, when he was at the National Naval Medical Center, then in Palo Alto when he was at the VA's Polytrauma Rehabilitation Center there, and now near the Kentfield Rehabilitation Hospital north of San Francisco.

Erin Nichols' career has been set aside. Her future is on hold. Many marriages don't survive this kind of challenge, but Erin writes, "He knows he is loved and has every reason to fight." Late last month, a chest treatment made it possible for Sam to finally whisper to her, "I love you."

The fact that the Nichols' marriage has made it this far is a tribute to Erin, and to the support she's received from the VA. In fact, when Sam's transfer to the private facility was delayed two weeks, Erin was actually happy that they would have a little more time with the VA nurses and therapists she now considers part of her family.

However, we still have a long way to go before every dependent feels as well cared for as Erin does.

Even before Paula's husband left for Iraq for the third time, she knew something was very wrong with him. She was right. Her soldier was suffering so severely from post-traumatic stress disorder that when he was finally diagnosed eight months into his fifteen-month deployment, he was sent straight back to Fort Bliss, Texas. (Because of his worries about stigma, as well as the inability to trust that is a symptom of PTSD, he asked that his name be withheld.)

"He was completely changed," Paula says of him when he returned in the summer of 2007. He was depressed, suicidal, and self-medicating with alcohol. She remembers, "He was always very loving. He wasn't aggressive at all before he went into the military." But he was now so aggressive and verbally abusive toward Paula and their four children, ages 2 to 12, that he was temporarily removed from the family. The stress of his homecoming forced Paula, who is 30, to drop out of school, where she'd been studying human resource management.

He was assigned a case manager, who scheduled his therapy and anger management classes. Paula got some counseling. Although her husband had planned to make the Army a career, he could no longer function effectively as a soldier. And so the process began to transition him out of the Army.

According to Paula, the case manager was good but new, and didn't know enough to help them navigate the system -- evidence that the system is only as good as the people who administer it, or only as good as their training. "There was no information about what we do next," says Paula. They didn't even know whom to contact at the VA.

So Paula did her own research. Surfing the Internet, she chanced upon the Army Wounded Warrior program (AW2) and connected with an AW2 representative on Fort Hood, Texas. Paula also stumbled across Operation Homefront, a private charity that provides assistance to military families in crisis.

Meanwhile, the disability rating process took much longer than they were told to expect. In my conversations with disabled veterans, this comes up as an almost universal problem, as does accessing care in a timely manner. Another veteran suffering from PTSD tried to commit himself, but was told by the VA that he would have to wait two months. A private charity, USWelcomeHome.org, has stepped in to find a mental health practitioner near where that veteran lives to provide pro bono interim care so that he is at least receiving some counseling support while he waits.

In the case of Paula's husband, the delay and lack of information during the transition has led to a gap in treatment. Left to deal with his anxiety and other symptoms on his own, his solution has been to isolate himself. Paula is no longer receiving counseling either. Even the children have fallen through the cracks. They have essentially lost the father they used to know, what experts call a "metaphorical death." Yet they've had no therapy or expert guidance other than what Paula has been able to tell them herself. Paula, who's responsible for caring for her children and her disabled husband, has never been offered respite care.

Two weeks ago, the family left Fort Bliss and the Army for San Antonio. They moved there not because they're from Texas (they're from a distant state), but rather because they heard that in San Antonio they could find the long term services they are going to need from the VA and various private organizations. Operation Homefront is providing them with a free apartment in its new transitional housing complex near Brooke Army Medical Center. AW2 continues to advise them.

On top of having their lives turned upside down by their soldier's psychological injury, this family has taken a huge financial hit. He is not well and has no job, but his 30% disability rating means his income is now a fraction of what it was on active duty. As Paula settles the children into their new schools, she's attempting to get back into the work force after many years as a homemaker. The only employment readiness help that she has received came from the AW2 representative, who alerted her to an upcoming job fair.

If Paula had not been lucky enough to find AW2 and Operation Homefront on her own, it's an open question as to what would have become of her and her family. Without the help of those two organizations, Paula's husband would have transitioned from the DoD system to nowhere. This family, which has already sacrificed so much for our nation, should not have to rely on luck to avoid being abandoned with most of their needs unmet.

Expert advocates for military families at the National Military Family Association (NMFA), the Military Officers Association of America (MOAA), and others, confirm that Paula's experience is not unique. They concur that despite recent legislation and good intentions, the military family piece of the transition process is not yet in place.

What do the families of wounded warriors need? Both Paula and Erin's stories reveal the specific types of support that are absolutely necessary for family caregivers. I want to emphasize that since many soldiers are single, caregivers include not just spouses, but also parents and siblings.

1) One-stop shop for information. Families need a transparent transition process during which information is easy to access and options are clearly laid out. During transition, veterans and/or their caregivers are sorting through complex issues and making major life decisions about care and benefits that will affect them for the rest of their lives. They need knowledgeable assistance to make the best decisions possible. At the very least, transitioning families need a one-stop shop for information referral modeled after MilitaryOneSource.com.

2) Caregiver training. VA currently has eight caregiver assistance pilot programs providing health care education, training, and resources. This needs to be rolled out nationwide and enhanced. What's needed is a standardized, certified training program that's accessible to caregivers across the country, wherever they may be located, including rural areas. Such training is needed whether the injury is physical or psychological, but it's especially crucial for TBI caregivers, who have a long road ahead of them. In addition, caregivers need stress management training and access to 24-hour supervision.

3) Compensation and job placement assistance. More must be done to compensate family members who sacrifice their careers and/or relocate to care for America's wounded warriors. This includes lost pay and costs associated with transportation and relocation. Family members who are still able to seek outside employment, but are starting over because their caregiver role has required them to relocate or re-enter the work force after a period of unemployment, should receive career counseling, employment readiness assistance, and help with job placement.

4) Childcare and child counseling. Children must be added to the list of priorities. An injury is traumatic for everyone -- when a soldier is wounded, the whole family is wounded. Children of the wounded are especially vulnerable. They need professional counseling and extra caregiver attention, even as their primary caregiver's time and energy is being monopolized by the often overwhelming needs of the injured veteran. Sometimes it's not possible to simultaneously care for an injured veteran and parent a small child -- for instance, while taking the veteran to appointments where the presence of children isn't appropriate. Those caregivers need free, safe, reliable childcare.

5) Respite care. The VA's four Project HERO (Healthcare Effectiveness through Resource Optimization) demonstration sites are providing drop-off respite care. These must be expanded. Access to in-home respite care with 24-hour availability is urgently needed and should be added.

6) Counseling and peer support. Counseling for dependants is very accessible while they're still in the DoD system. The barriers arise during the transition to the VA system, including the physical move that usually accompanies the transition, during which existing providers are left behind. They're also leaving behind their formal and informal networks of support. Suddenly, they're isolated in a new location, and isolation increases the risk of depression and other problems that undermine the family member's ability to be an effective caregiver. To its credit, the VA has called for recognition of the impact a struggling caregiver can have on the recovering veteran. To that end, the Vet Centers' mandate must become more inclusive of military families. Peer support groups for family members must be expanded and actively promoted.

Experts at NMFA and MOAA, both previously mentioned, and other members of the Military Coalition, as well as Disabled American Veterans, and Paralyzed Veterans of America, have developed detailed proposals for meeting these needs. My purpose here is to affirm that, indeed, family needs are not yet being adequately met and that such prescriptions are still critically necessary for continued improvement.

The stories told by family members like Paula and Erin not only highlight their needs. They also hint at the challenges that are preventing those needs from being met as consistently as they should be.

To overcome those challenges, the nuts and bolts of what must continue to change have been well-documented elsewhere by groups such as those listed above, and deserve mention here:

--Improved timeliness of the disability claims process

--A permanent institutional structure for joint DoD/VA oversight

--A process for rolling out best practices throughout the VA system

When it comes to addressing the needs of military families, DoD has had a huge head start over the VA, ever since military wives first began demanding better support in the immediate aftermath of Vietnam. Not only is the VA now playing a game of catch up in caring for families, but it's doing so on an impossibly enormous playing field -- the number of veterans, dependants, and survivors adds up to 70 million people.

Our entire nation, not just the VA, has an obligation to care for veterans and veteran families. Leaving it all to the VA simply deepens the growing gulf that exists between those who enjoy the benefits of citizenship and those who protect them. The VA certainly should continue to do all that it is doing, and more, and the Congress should close the funding gap to make that possible. But it's neither realistic nor desirable to expect the VA to shoulder, all by itself, what should be the responsibility of every American.

Quite frankly, caring for veterans and their families is in every American's self-interest. I mentioned earlier that when a soldier is wounded, the whole family is wounded. But the ripple effect doesn't stop there -- the community is wounded, too. Unaddressed physical and psychological wounds result in troubled children and disrupted classrooms, domestic violence and increased police calls, snowballing health problems and more frequent emergency room visits. All this costs the community.

Many civilian organizations and communities have begun to recognize this and are making an effort to educate themselves and reach out to veterans and families. On the mental health front, civilian groups as varied as GiveAnHour.org, USWelcomeHome.org, and the Deep Streams Zen Institute have begun organizing community support. Some of the services these groups provide aren't even possible for the VA to offer within its medical model, yet are wanted and needed by a significant number of veterans and families. That said, strengthening VA partnerships with civilian organizations must be done in a way that does not undermine the expert, comprehensive, trackable in-house care that veterans service organizations have fought so hard to ensure.

"The community is ready," to partner with the VA, according to Michael Wagner, co-founder of USWelcomeHome.org. "They just need to be tied into the system in some way. They need training in how to work with veterans." Communities even need education about the VA itself. They may contact the benefit or medical elements and think they've talked to the Vet Center, not realizing that these are three discrete organizations within the VA.

Communities that try to partner with VA should not get the response that a group in the Dallas-Fort Worth area received. When Mental Health America of Greater Dallas and the Mental Health Association of Tarrant County were awarded half-million-dollar grants to work with veterans, they organized a community education conference and invited the VA to come talk to them. The VA didn't show up.

The VA's own National Center for PTSD (NCPTSD) provides an excellent model for community education and partnering. I have participated in two one-day educational conferences that were organized by Vermont communities with help from NCPTSD. They were attended by civilian teachers, clergy, police officers, medical and mental health practitioners -- anyone in the community who was likely to cross paths with veterans and their families.

Remember, it was civilian community organizations that saved Paula and her military family when they fell through the enormous gaps that remain in the DoD-VA safety net. You, the members of this committee, could use your bully pulpit to encourage more communities to help close those gaps, even as you continue your laudable efforts to push for a seamless process for wounded warriors and their families as they transition from DoD to VA.

Thank you for giving me this opportunity to give voice to the wounded families who are living through that transition.

# # #

Tony Neria and his daughter Erin Nichols, whose Marine husband Sam suffers from TBI, have provided the following additional information to clarify Erin's experience with the VA. (Erin is communicating through her father Tony due to limited time and communication options following Sam's move last week to Kentfield Rehabilitation Hospital.)

As specified in the statement, Erin has received excellent support from the staff at the VA's Palo Alto Polytrauma Rehabilitation Center. However, when it comes to other forms of support for families from the wider VA system, there is still room for improvement.

QUESTION #1: What support have you received from the VA that is specifically aimed at supporting you and making you a more effective caregiver for Sam?

ERIN (via her father Tony): The staff at the VA hospital has been very receptive to letting Erin be a part of all aspects of his recovery. During therapy or any procedures by the nurses or doctors, Erin is allowed to be right there with them encouraging Sam and providing feedback to the staff. Erin has at times, even given the doctors information about Sam that led to additional medication. For example, she determined that Sam was having migraine headaches by her constant observing of Sam's movements and facial expressions...and eventually by asking him yes/no questions was able to determine what was causing him pain. 

Erin mentioned the recreational therapists have been a big help to her. They basically organize functions and outings for the patients and family. Erin spends so much time in the hospital with Sam, it is a great relief for her to take some time for herself and get away.

The whole staff at the VA hospital, doctors, nurses and therapists have been very good to Erin. They are courteous and kind and caring people. The overall environment created by the staff at the Polytrauma Center at the Palo Alto VA hospital is one of a family atmosphere. I just hope this is the same at all VA hospitals.

The staff at the VA hospital also takes the time to explain to Erin the procedures they are performing. When appropriate, they allow Erin to be right in there with them helping with the various therapies and other procedures. Erin really believes this has had a very positive effect on Sam's recovery.

QUESTION #2: Has anyone made you aware of or referred you to a support group for the wives of wounded warriors? If so, who referred you and what organization if any is sponsoring or organizing the support group?

ERIN (via Tony): Erin hasn't asked about any support groups and has not been told about any.

QUESTION #3: Has it been easy or hard for you to get information from the VA about benefits for yourself (not Sam)?

ERIN (via Tony): Same response as question #2.

QUESTION #4: Have you had contact with any caregiver support providers who are external to the VA? If so, were they partnering with the VA or completely separate from the VA, and how important have they been to your ability to be effective in caring for Sam?

ERIN (via Tony): Same response as question #2.

QUESTION #5: What was the transition like from the DoD medical system to the VA system? What about it was smooth or bumpy or baffling? Which system did you feel supported you better as a caregiver?

ERIN (via Tony): The transition for my daughter from the DoD facility (Bethesda NNMC) to the VA hospital in Palo Alto was very hard for her. She felt so safe and secure in Bethesda because she was "on base" at the Navy Lodge and there were Marines assigned to the hospital to support her. When she and Sam arrived in Palo Alto, the Fisher House was full, so she had to stay in a hotel about 15 minutes down the road. It was quite a shock for her. Also, when she first arrived in California, Sam was flown into Travis AFB and Erin had to stay in the TLQ. She was starving when she arrived and was very scared and tired. There was a VA support person from Sacramento that came later in the evening and asked if she needed anything... the VA representative went out and got Erin some fast food. I'm hoping this was not an accident and all families have a VA rep waiting for them when they get off the airplane to help with their transition to the VA hospital. 

One other very important part of Erin's support network is the Marine Corps liaison at the hospital. If it were not for the Marine assigned to the VA hospital, I think Erin would really feel abandoned by the Marines.

TONY: It is true that Erin, as the wife of a severely wounded warrior, is carrying most of the burden of Sam's injuries and there needs to be much more mental health support for her. But Sam's and Erin's families are also suffering too.  Speaking for myself, I have really just been noticing how much this experience has sent me into a depression. My work has suffered greatly. There are days when I sit in front of my computer at work and can't function, or function at a rate much lower than before Sam's injuries. There should also be counseling or some type of mental health care support for the families of the wounded. 

On the financial front -- our families spend a lot of money visiting Sam and Erin. The drive from Sacramento to Palo Alto is 2-1/2 hours. Now it will be a little under 2 hours to Kentfield. Sometimes we stay overnight in a hotel. There has been some wonderful support from local and national charities, but the bottom line is the financial burden on Erin and Sam's support group has been great.  Sam's father and mother usually drive down once a week to see them as do his brothers and myself and wife. I don't know if this is out of your realm of interest at this time, but I just wanted to point out that there is a need for support for the families of wounded warriors, both financial and mental.

# # #