[Senate Hearing 111-123]
[From the U.S. Government Publishing Office]
S. Hrg. 111-123
VETERANS ORGANIZATIONS' PRIORITIES FOR
THE 111TH CONGRESS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
JANUARY 28, 2009
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Lindsey O. Graham, South Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Roger F. Wicker, Mississippi
Jim Webb, Virginia Mike Johanns, Nebraska
Jon Tester, Montana
Mark Begich, Alaska
Roland W. Burris, Illinois
Arlen Specter, Pennsylvania \2\
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
----------
\2\ Hon. Arlen Specter was recognized on May 5, 2009, as a majority
Member.
C O N T E N T S
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January 28, 2009
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 2
Sanders, Hon. Bernard, U.S. Senator from Vermont................. 4
Tester, Hon. Jon, U.S. Senator from Montana...................... 6
Begich, Hon. Mark, U.S. Senator from Alaska...................... 7
Burris, Hon. Roland W., U.S. Senator from Illinois............... 7
Johanns, Hon. Mike, U.S. Senator from Nebraska................... 5
WITNESSES
Dean Stoline, Assistant Director, National Legislative
Commission, The American Legion................................ 8
Prepared statement........................................... 11
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka..................................... 26
Hon. Bernard Sanders..................................... 30
Adrian M. Atizado, Assistant National Legislative Director,
Disabled American Veterans..................................... 30
Prepared statement........................................... 32
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka..................................... 37
Hon. Bernard Sanders..................................... 43
Todd Bowers, Director of Government Affairs, Iraq and Afghanistan
Veterans of America............................................ 44
Prepared statement........................................... 46
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka..................................... 54
Hon. Bernard Sanders..................................... 58
Carl Blake, National Legislative Director, Paralyzed Veterans of
America........................................................ 59
Prepared statement........................................... 61
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka..................................... 65
Hon. Bernard Sanders..................................... 69
Dennis Cullinan, Director, National Legislative Service, Veterans
of Foreign Wars................................................ 70
Prepared statement........................................... 71
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka..................................... 73
Hon. Bernard Sanders..................................... 73
John Rowan, President, Vietnam Veterans of America............... 73
Prepared statement........................................... 75
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka..................................... 76
Hon. Bernard Sanders..................................... 76
APPENDIX
Stroup, Theodore G., Jr., LTG USA (Ret.), Vice President,
Association of the United States Army; prepared statement...... 87
VETERANS ORGANIZATIONS' PRIORITIES FOR THE 111TH CONGRESS
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WEDNESDAY, JANUARY 28, 2009
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:33 a.m., in
room 418, Russell Senate Office Building, Hon. Daniel K. Akaka,
Chairman of the Committee, presiding.
Present: Senators Akaka, Tester, Begich, Burris, Sanders,
Burr, and Johanns.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. Good morning. This hearing will come to
order.
Before we begin today's hearing, I extend my warmest
welcome and aloha to the three new Members of the Committee:
Senator Mark Begich of Alaska, Senator Roland Burris of
Illinois, and Senator Mike Johanns of Nebraska. I want to
welcome you to this Committee and to tell you that we have a
great year ahead of us. We have much to do and we will do it
together.
The addition of these new members has caused a temporary
shift on the dais, as you can see. Until we can work out some
space issues, I regret any inconvenience this causes to all
Members, but you will see the adjustments as we move here to
accommodate all the Members that we have now.
Another housekeeping item, given additional Membership, is
the revision of both the Committee rules and the Committee
budget. The Committee's Ranking Member, Senator Burr, and I
intend to seek additional space and funds to bolster the
ongoing oversight work which is so critical. Members will
receive these documents shortly, and afterwards I will be
polling regarding your support.
For the information of all, the Committee will promptly
hold nomination hearings on advice and consent position, so
Secretary Shinseki can have his team in place as quickly as
possible. It is my hope that the nomination for Deputy
Secretary will be made very soon, and, immediately following
that, I will schedule a hearing in consultation with Senator
Burr. Other nominations will be bundled to make maximum use of
the Committee's time.
Now to the immediate business at hand, today's hearing
offers a valuable opportunity for us to collect the priorities
of the veterans groups and craft our legislative and oversight
agenda for this session, which is why we have you all here this
early. In the coming months, all of the veterans service
organizations will have more formal legislative presentations,
but I believe we should hear key priorities now. I am also
looking for interplay between the organizations to focus on
what can and should be done in the short term, and what can
wait for later in the session.
We must, in this time of war, equip VA with the resources
to carry its missions now and into the future. I have said this
time and time again: veterans' benefits and services are a cost
of war and must be understood and funded as such.
Many of our views are in agreement, and I believe that
together we have established a good track record relating to
VA. VA health care is, in many respects, the best in the
Nation. I am proud that our collective work has contributed to
the improvements in quality and access.
Now, we must keep the momentum going. We must work to
achieve President Obama's goal of integrating more Priority 8
veterans back into the VA health care system while ensuring
that enough resources are available to maintain the quality of
care.
As someone who knows firsthand the impact on education
funded through the GI Bill can have, we must make certain that
the recent improvements to this vitally important benefit are
being effectively implemented.
Timely and accurate adjudication of disability claims
remains an issue.
I expect that benefits reform, including a hard look at the
current appellate process, the role of IT and reaching
consensus on elements of compensation, will claim much of this
Committee's attention this Congress.
There are some major legislative initiatives remaining from
the previous session that I hope will be enacted this session.
The Committee's bipartisan health and personnel improvements
bill, which I just reintroduced as S. 252, is important to this
Nation's veterans and to the thousands who work in VA hospitals
and clinics throughout this Country. Some of you worked to
include vital provisions in that bill such as enhancements to
women's health care and, for that, I am very grateful.
In the near future, I will also introduce a modified
version of S. 1315, an omnibus benefits bill, which passed the
Senate last Congress. S. 1315 included benefits for both young
and old veterans, including numerous modifications to VA's
insurance programs and benefits for Filipinos who served under
U.S. command during World War II.
I look forward to the statements of the witnesses and to
working with each of the organizations in the 111th Congress.
And I am glad, again, to be serving with my Ranking Member,
and I now call on him for his statement.
Senator Burr.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Thank you, Mr. Chairman. Aloha.
Chairman Akaka. Aloha.
Senator Burr. Let me thank you for calling this hearing and
assembling these witnesses who I look forward to hearing from.
Let me congratulate the new faces, two on your side, one on
our side.
One thing that I think you will find very quickly is that
this Committee is unlike others in the U.S. Senate. Care for
our veterans and their loved ones is not a partisan issue. If I
could borrow a sentiment from our former colleague who is now
our Commander-in-Chief, the men and women who wear the uniform,
the Nation's uniform, do not come from a collection of red and
blue States but from the United States.
And I think that is 100 percent accurate. They expect us to
leave politics aside when we act on their behalf, and I am
committed to work with the Chairman and all the Committee
Members toward that end.
Again, I welcome those new members.
This morning, we will listen to the views of some of the
leading veterans service organizations on what their top
priorities are for the 111th Congress. I often hear from VSOs
from North Carolina who provide me with a local perspective of
some of the challenges confronting our Nation's veterans. The
organizations with us this morning provide a voice to millions
of veterans nationwide. Collectively, they are a valuable
resource upon which we may draw as we develop any legislative
and oversight agenda.
I am anxious to hear your testimony, to work with you and
other important organizations like AMVETS and Gold Star Wives
on behalf of veterans and their survivors.
Looking through the testimony this morning, I found there
are some common themes from all of you:
First, funding of the VA health care system is a top
priority on everyone's list. Let me say from the onset that I
am in full agreement with the goals of providing VA a timely,
predictable, and sufficient budget. I look forward to exploring
ways we can accomplish these goals with our witnesses here
today. In my view, funding for the VA health care system should
never be a political issue.
Second, fixing the disability system and the disability
claims system is another common theme. Mr. Atizado of the DAV
calls the system ``complex and burdensome.'' Mr. Blake with PVA
states that the process is done in ``an expensive and
antiquated manner.'' Complex, burdensome, expensive,
antiquated--these are not flattering adjectives to describe a
system that is designed to help veterans with injuries
resulting from service. This is nothing new, and I hope all of
us here today can get behind innovative approaches to fixing
the system.
Finally, Mr. Chairman, another theme is ensuring adequate
mental health treatment for veterans who need help with PTSD
and TBI. Clearly, building capacity is part of the effort, and
the VA is in the midst of hiring additional mental health
professionals, but we need to make sure we focus on getting
veterans into VA for effective treatment early.
Secretary Shinseki stated he believes PTSD is treatable and
that early treatment is key. I agree, and I think every person
here understands that. It is time we develop a strategy to
implement the Veterans' Disability Commission's recommendations
of ensuring that veterans with mental health problems receive
that necessary treatment soon after that veteran is diagnosed.
Mr. Chairman, I stand ready with you and this Committee to
address these priorities on behalf of Nation's veterans and
their loved ones. Our approaches to solving some of these
problems may differ, but our goal is in fact the same.
I thank the Chair.
Chairman Akaka. Thank you very much for your statement,
Senator Burr, our Ranking Member.
Now let me call on Senator Sanders for his statement.
STATEMENT OF HON. BERNARD SANDERS,
U.S. SENATOR FROM VERMONT
Senator Sanders. Thank you very much, Mr. Chairman. I will
be brief.
I believe that over the years we have made some substantial
progress in the VA in general--VA health care in particular.
I believe that in the last 2 years, under Chairman Akaka's
leadership, we have made some very, very significant changes.
We just passed last year, as you know, the most significant
changes in GI education that we have had since World War II,
which will impact hundreds of thousands of soldiers who have
served in Iraq and Afghanistan and their families. We have
provided record-breaking VA health care budgets. We have
increased mileage reimbursement rates. We have begun the effort
to bring back the Priority 8s who were thrown out of the health
care system some years ago.
So we are making some progress, Mr. Chairman. I think we
should be proud of what we have accomplished.
And one of the reasons--one of the reasons--I believe that
we have made progress is that there is now a very positive
relationship between the VSOs--the veterans services
organizations--who are on the ground, who bring to us the
concerns that they are hearing from veterans, and us. And I
think we have worked very closely with the veterans
organizations, and it is absolutely imperative that we continue
to do so.
Just a few weeks ago, I had a meeting with about 25
veterans of my Veterans Advisory Committee in Vermont; and the
goal of that is to hear from the ground what people are
experiencing when they go into the clinics, when they go into
the hospitals, what about the claims.
So, we are making progress, but obviously we have a long
way to go. And I think there is a general consensus--you
mentioned it; Senator Burr mentioned it. There is a general
consensus on some of the problems that remain and where we have
to go.
Advanced appropriations. It is hard to run one of the
largest health care systems in the country, where you have tens
of thousands of employees, if you do not have a sense of what
you are anticipating next year. It's very difficult to do.
We need to continue, in my view, to bring Priority 8s back
on a gradual basis into the system.
We need to clearly, as you have heard, reform the claims
system. In this day and age, with all of the computer
technology that we have, it is not clear to me why it would
take so long for veterans to get their claims processed.
I think we have to move forward to an automatic enrollment
in VA for members of the Guard and Reserve.
Here is an issue that we raised in Vermont, Mr. Chairman. I
hope we can discuss it here, and I hope some of our friends
will comment on it. In my State, there is not a whole lot of
flexibility in terms of the hours in which veterans can get
into clinics and get into the hospital. You know, many people
work 9 to 5. Should there be evening hours? Should we be more
flexible in making sure that our clinics and CBOCs are
available to veterans?
I think we want to move forward in making our VA facilities
a leader in green buildings and energy efficiency.
We want to make sure we can have the best services
available in the world in the VA, but unless veterans know
about those services they are not going to be able to access
them. So we have to do a better job in performing outreach.
We do not want to forget--while we focus on PTSD and TBI
from Iraq--we do not want to forget about Gulf War Syndrome
from the war in 1991. We have still have tens of thousands of
soldiers who are suffering from that.
So, the bottom line is: we are making progress. We have a
long way to go. We will not be successful unless we work with
the veterans organizations and unless they are giving us the
best information possible about what is happening on the
ground.
We get stuck here in Washington a little bit. Your job is
to tell us what you are hearing from people who are
experiencing the VA in all of its dimensions.
Mr. Chairman, thank you very much.
Chairman Akaka. Thank you very much, Senator Sanders, for
your statement.
And now I call on Senator Johanns for his opening
statement.
Senator Johanns.
STATEMENT OF HON. MIKE JOHANNS,
U.S. SENATOR FROM NEBRASKA
Senator Johanns. Chairman Akaka and Ranking Member Burr,
thank you very much for the opportunity to say a few words. My
opening statement will be very brief because this is my first
meeting, and it is the first opportunity I have had to be in a
hearing setting with this Committee assignment.
I want to say first of all, though, that it is an honor to
be on this Committee. It is an honor to serve with this group
and think about the needs of our veterans and how we meet those
needs.
I also want to say thank you for calling this hearing
together. As I looked through the list of witnesses and the
statements, it gives me an opportunity as a new member to learn
from you as to what the needs are out there and what I need to
be paying attention to in order to be a valuable Committee
member.
It reminds me a bit of something I did when I was Governor
of Nebraska. I would bring veterans groups into the Governor's
Office on a regular basis, and we would just go around the
table, and I would listen to them as to what their veterans
needed, what they were facing out there. It just helped me in
terms of developing an agenda as Governor.
I see this hearing as that same sort of opportunity: an
opportunity for me to listen; to think about the priorities as
you identify them; and then to work with you, Mr. Chairman and
Ranking Member, to meet those needs.
Thank you very much.
Chairman Akaka. Thank you very much for your statement,
Senator Johanns.
Let me call on Senator Tester for his opening statement.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman. I too want to
thank you and the Ranking Member for calling this hearing, and
I look forward to working with both of you as we move forward
on veterans' issues in this Committee.
I also want to welcome the new Members to the Committee.
This is a good Committee. It should be very interesting. It has
been a very rewarding one for me in the last Congress, and
hopefully it will be equally rewarding in this 111th.
I also want to thank the members that are here to testify.
Your opinions are very much appreciated. We appreciate your
commitment to the veterans through your individual
organizations and appreciate your guidance and your sacrifice
in doing that. So, thank you very, very, much.
We have over 100,000 vets in the State of Montana. That is
quite high a percentage for a State of 950,000. The only State
that probably has more is my fellow Senator here to my left,
Senator Begich from Alaska. Veterans make up a high percentage
of our population. Quite honestly, when I started this job, we
went around and had hearings around the State of Montana, and I
found out things that were absolutely unbelievable, and we were
able to address many of them.
As Senator Sanders said earlier, we have much more work to
do.
We just confirmed General Shinseki to the head of the VA. I
supported that confirmation. I think he is a good man, and I
think he is somebody that we all can work with.
But, we have made a lot of promises which we have to
continue to work on to make sure that we live up to. State-of-
the-art medical facilities throughout this country are
critically important for our veterans. Making sure that we
address PTSD and TBI issues that are out there, that are real,
and that are not going to go away--we have to be proactive in
that.
This is the first time in a decade that the VA
appropriations was in place before the beginning of the fiscal
year. I think that is a step in the right direction. We need to
continue to work on that and make sure that the veterans of
this country do not have to come back every year, hat in hand,
begging for money. We need to make that budget firm and
continuous.
We need to continue innovation. The Ranking Member talked
about innovation in the VA. It is critically important,
particularly in rural America and in Indian country. We need to
upgrade the VA's IT infrastructure, so that there is better,
easier access for our veterans in this country.
And we need to deal with the backlogs in disability claims.
It is a big issue, and hopefully we can do something about that
in this Committee this year, Mr. Chairman.
It is not going to be easy. There are many challenges still
out there for our veterans. I have talked to many of you about
them. But I know one thing: If we work together--both sides of
the aisle come together and you folks are at the table--we will
do some good work.
Thank you very much for being here.
Chairman Akaka. Thank you very much, Senator Tester.
Again, I welcome our new member, Senator Begich from
Alaska, for his opening statement.
STATEMENT OF HON. MARK BEGICH,
U.S. SENATOR FROM ALASKA
Senator Begich. Thank you very much. Mr. Chairman and to
the Ranking Member, thank you for the opportunity to be on the
Committee.
I am going to actually be very brief because I am very
interested in each one of your presentations today. I have read
some of the testimony that you will be presenting. I am excited
to hear some of the ideas that you will have on how to improve
our system.
Again, I am going to be as brief as this and say thank you
very much, Mr. Chairman.
I am looking forward to your conversations, and I agree
with many of the conversations that have already occurred in
regards to the needs that we have within the system. It is one
reason why I wanted to be on this Committee. As Senator Tester
said, 11 percent of our population are veterans in my State,
and that is a significant amount of our population.
I look forward to your ideas. And I will tell you that my
father-in-law is a retired colonel. He has already sent me many
articles out of the DAV Magazine to inform me of all the
priorities you have and that I need to follow. So, already, you
have an ally within the family.
Thank you very much, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Begich.
Now let me call on the Senator from the State of Illinois,
Senator Burris, for his opening statement.
STATEMENT OF HON. ROLAND W. BURRIS,
U.S. SENATOR FROM ILLINOIS
Senator Burris. Thank you very much, Mr. Chairman and Mr.
Ranking Member. I hope we will not get our names mixed up with
the ``I-S'' and no ``I-S,'' Senator Burr.
Like my colleagues, I am very pleased to be able to be on
this Committee. I am not a veteran, but I know so many in my
community of Chicago. I am deeply concerned about how we have
so many homeless veterans in our urban areas and what is
happening with their health care. We must look at that and
determine how we can assist these individuals.
I hear horror stories about what is happening to the
hospitals there in Chicago (the closed-up one), and how
difficult it is for veterans to get services, and how far they
have to travel to get to and from those veterans hospitals.
These men and women have paid in blood and injury for our
safety and our security in this great country, and we cannot
neglect them. We cannot not assist them as they try to carry
out their lives and carry out their family lives. So you have
an ally here too.
Unfortunately, Mr. Chairman, I am going to have to duck out
because I have another committee. I have their testimony. I
will certainly read it and look forward to working with you and
this great Committee. Thank you.
Chairman Akaka. Thank you very much, Senator Burris.
And now I welcome our panel of witnesses representing
veterans organizations. I appreciate your being here today and
look forward to your testimony.
First, I welcome Dean Stoline, Assistant Director of the
National Legislative Commission for The American Legion.
I also welcome Adrian Atizado, Assistant National
Legislative Director for Disabled American Veterans.
Additionally, I welcome Todd Bowers, Director of Government
Affairs for Iraq and Afghanistan Veterans of America.
I welcome also Carl Blake, National Legislative Director
for Paralyzed Veterans of America.
I welcome Dennis Cullinan, Director of the National
Legislative Service for Veterans of Foreign Wars.
And finally, I welcome John Rowan, President of the Vietnam
Veterans of America.
Thank you all for joining us today. Your full statements
will be included and will appear in the record of the
Committee.
Mr. Stoline, will you please begin with your statement?
STATEMENT OF DEAN STOLINE, ASSISTANT DIRECTOR, NATIONAL
LEGISLATIVE COMMISSION, THE AMERICAN LEGION
Mr. Stoline. Thank you and aloha, Mr. Chairman, Senator
Burr and Members of the Committee.
Chairman Akaka. Aloha.
Mr. Stoline. On behalf of The American Legion, I thank you
for inviting us today to this hearing.
To the new Members of the Committee, I welcome you. The
American Legion stands ready to assist you and your staff with
any questions you may have, and I am here to be the spearhead
for the Legion to help you.
The American Legion's current legislative portfolio is over
200 legislative items. We stand ready at any time to present
oral and written testimony before the Committee on these
issues. I would like to highlight from our written testimony
several issues today.
The first is the new GI Bill. We would like the Committee
to ensure oversight over the implementation of this for the
August 1st deadline. We are concerned both that the VA probably
has not hired enough employees to implement it by that date,
and we also have concerns about the development of the
information technology that will support that in the out years.
One item we would like to add for your consideration on GI
Bill benefits is to add vocational and educational benefits
equal to the GI Bill benefits for those who go to college. We
think servicemembers who wish a career in other areas such as
apprenticeships to plumbing and electricity or become law
enforcement officers should have the same stipends and benefits
that accrue to those who are going to a 4-year institution.
With regard to funding of the health care portion of the
budget, The American Legion still remains desirous of mandatory
funding. However, in partnership with other VSOs, we are now
recommending the idea of advance appropriations. This would be
a policy in which the budget would be provided to the VA 1 year
in advance of the current fiscal year.
We see this as positive because the VA would be able to
plan for that budget for a year, and the Congress would be able
to oversee the expenditures, because the VA would have
knowledge of the amount of money they have for equipment and
personnel a year ahead of time.
With regard to disability compensation claims and
adjudication, that is the one great challenge I think the
Congress has this year. The backlog is ever growing and is
outrageous, in our belief, and we do not see relief in sight at
this time.
We have testified in the past on the inadequate staffing
levels of the VA, the inadequate training of the VA for its
adjudicators and the management pressure on the employees to
make decisions that are based on quantity rather than the
quality of the review of the merits of the claim.
We think that is a disservice to the veterans, and we would
like you to take a look to improving both the staffing levels
and the training for those employees and to have management be
more concerned about a quality review at the first level of the
claim rather than pass it on to the appeals level and put the
veterans in the ``hamster wheel'' of appeals and remands and 4
or 5 years before they finally get resolution of their claim.
As for the current budget, we think it needs to be
increased. We appreciate the last 2 years' increase to the
budget, but part of that budget was at the expense of over a
million and one-half Priority 8 veterans who could not enroll
in the system. And we think that is an egregious error.
We appreciate the fact that you did give funding this last
year to start re-enrollment, but the job is not done. We would
like to see the job for re-enrollment of all Priority 8s
completed in this fiscal year.
With regard to Traumatic Brain Injury, the GAO has
acknowledged that there are clinical challenges to the VA. We
support additional TBI research and funding so that they can
have the diagnostic tests to properly screen these veterans.
We are concerned about access to care for our rural
veterans. As the Nation becomes more urbanized, the military
forces are actually having more of their members come from the
rural areas of the Nation. Right now, the nationwide figures
are: one-in-five veterans who receive VA health care come from
the rural areas; and this ratio is going to grow, particularly
because the Reserve components come mainly from the rural
areas.
Consequently, The American Legion would like to see an
increase in the Community-Based Outpatient Clinics, or CBOCs,
particularly for veterans living in States like Nebraska,
Nevada, Utah, South Dakota, Wyoming and Montana, because the
veterans living in those areas face extremely long drives, a
shortage of health care providers and bad weather conditions.
VA has an Office of Seamless Transition for veterans coming
off the Iraq and Afghanistan wars. But we are concerned,
particularly with Reserve components, that those
servicemembers, as they come back from their duty, are not
getting the proper training and information from VA on their
rights and benefits. Consequently, we would like to see more
emphasis in the VA to ensure a successful transition from
military duty to civilian life.
We would like an increase in medical research and
prosthetics research because the VA has a unique understanding
of the wounds that occur to veterans, but VA should be paying
particular attention to the issues that are already at hand for
veterans in the past. That includes prostate cancer, addictive
disorders, wound healing, Post Traumatic Stress Disorder and
other medical problems. We also believe they should cooperate
more with other agencies like DOD in their research.
With regard to the different environmental exposures that
veterans have from different wars, The American Legion would
like the Congress to be forcing the DOD to release more and
more information about Agent Orange that was used outside of
Vietnam. It is almost impossible to settle some of these Agent
Orange claims and the diseases that arise from it without that
information.
With regard to the Gulf War illness veterans, we would like
the VA to continue research with the recommendation of the
Research Advisory Committee on Gulf War Veterans. We would like
VA to focus not only on the treatment but also help alleviate
the suffering of those veterans.
With regard to the Atomic Veterans, The American Legion
would like the dosage program rescinded because that program is
not working. A lot of the results come back that say the
veterans were exposed to low doses of radiation, and again it
is very hard to complete a claim and adjudicate properly for
the veteran.
With regard to information technology policy, while we
support additional funding, we want to make sure the privacy
rights of the veterans are maintained and that the information
is secure.
With regards to the Filipino veterans, The American Legion
has supported the Filipino Veterans Act for about 60 years.
However, our issue with that is how they are paid. In our
written testimony, we have given the Congress several ideas on
how to properly fund the Filipino veterans without taking funds
away from other
veterans.
With regard to the National Cemetery Administration, we
support keeping the current 75-mile service area and 170,000
veteran population, but we ask the Congress to be advised of
the increased driving times in urban areas that makes it harder
for some families to get to the cemeteries. That should be
taken into consideration as you site future cemeteries.
The American Legion regards the number of veterans being
hired in the Federal Government as too low. We think
Congressional oversight over the hiring of veterans should be
increased, particularly with VA and DOD, and at all levels of
the government. For example, in the VA's October magazine, of
the latest three veterans law judges that were appointed, none
of them were veterans, and we think that is egregious since
they are the ones who make the final determination within VA on
our claims.
Chairman Akaka. Will you wrap up your statement, please?
Mr. Stoline. Yes, sir.
The last thing I would like to say is we are concerned
about homeless veterans, and we would like the grants
increased. We would also like some provisions made for homeless
female veterans and their families.
Thank you for allowing us here today.
[The prepared statement of Mr. Stoline follows:]
Prepared Statement of Dean Stoline, Assistant Director, National
Legislative Commission, The American Legion
Mr. Chairman and Members of the Committee: On behalf of The
American Legion, I thank you for this opportunity to present today the
legislative priorities of our 2.6 million members on issues under the
jurisdiction of this Committee.
Those mandates with legislative intent create the legislative
portfolio of The American Legion for the 111th Congress. National
Commander David K. Rehbein presented The American Legion's proposals
before the Joint Session of the Committees on Veterans' Affairs held on
September 11, 2008.
Please note The American Legion's current legislative portfolio
contains more than 200 legislative resolutions and we stand ready to
present oral and written testimony before your Committee on these
issues. I will, however, take a moment to highlight those issues we see
as the most significant matters to focus upon this Congressional
session taken from the Commander's testimony.
The war on terrorism--Operations Iraqi Freedom (OIF) and Enduring
Freedom (OEF)--has generated nearly one million discharged veterans,
all of whom are guaranteed access to health care through the Department
of Veterans Affairs (VA) for the first five years after their return
home. Hundreds of thousands of OIF and OEF veterans are using their VA
healthcare benefits, thus increasing the workload of a healthcare
system that was overburdened before the war began.
It is a sacred and time honored obligation of The American Legion
to ensure these veterans have the services they need and timely access
to the care they have earned. The American Legion, working with
Congress, has made considerable progress in recent years to meet that
obligation. We especially thank the Congress for the increased funding
for the VA healthcare system, the greater attention being paid to
mental health concerns, including Post Traumatic Stress Disorder (PTSD)
and Traumatic Brain Injury (TBI) care which have become known as the
``signature wounds'' of the war we fight today, and the new GI BILL
which recognizes the significant sacrifices today's veterans make to
ensure our Nation's safety. To all those programs, Congress responded
with needed funding.
The American Legion applauds the 110th Congress for the FY 2009
funding allocations for many VA accounts that met or exceeded funding
targets proposed by The American Legion. The process of providing
adequate and compassionate services to our veterans is, as we all know,
continuous. We must stay on top of the changes in health care, in
technology, and foremost, among the veterans we serve.
We continue to work with Congress to ensure that government
agencies, particularly VA, have the resources to provide quality health
care, disability compensation, rehabilitation services and transitional
programs to all eligible veterans. We are making progress, but we are
not there yet.
For example, the outrageous backlog of VA benefits claims and
appeals remains a source of continuous frustration nationwide. And
while new attention has been given to mental health care for returning
veterans, VA providers themselves say they cannot keep up with it all.
In some communities, it is truly a crisis.
Funds have been budgeted for new VA medical facilities that have
only been in blueprints far too long. VA must move into the 21st
Century, addressing the needs of a new generation of war veterans with
unique needs now entering the system, but at the same time honor the
service of--and provide caring for--those veterans of past wars and
conflicts.
With that in mind and on behalf of The American Legion, I offer the
following recommendations to the Committee today.
veterans health care
The American Legion continues to have concerns about the effects of
current budgets on VA's ability to deliver quality care in a timely
manner. America's veterans are turning to VA for their health care
needs and, as we welcome home injured veterans from the current War on
Terrorism, it is forever our responsibility as advocates to work
together to ensure VA is capable of treating all eligible prior war
veterans as well. We especially want the Committee to take note of the
impending retirement of the Vietnam War cohort of veterans.
budget reform
The annual discretionary appropriations in Fiscal Year (FY) 2008
and FY 2009 represented a dramatic improvement over years of consistent
budgetary shortfalls, but these funding levels were achieved only
through dynamic leadership in both chambers. However, even these two
outstanding appropriations did not follow the normal appropriations
process--one was achieved through a year-long continuing resolution
with significant markups for VA medical care and the second required
the President to declare a need for emergency appropriations for VA
medical care.
With the influx of returning veterans from Iraq and Afghanistan,
the demands for various clinical providers, nurses, medical care
facilities and equipment are mounting. Assured funding is essential to
proactively meet the challenges faced at VA medical facilities. The
American Legion believes reform of the budget process for veterans'
health care would provide timely, predictable, and sufficient
appropriations for VA medical care.
For several years, The American Legion lobbied for the meaningful
reform of the Federal appropriations process as recommended by the
President's Task Force to Improve Health Care Delivery for our Nation's
Veterans (in 2003). This Task Force clearly identified the consistent
mismatch between VA health care funding and the growing demand for
health care services.
The American Legion and eight other major veterans' and military
service organizations joined forces to urge Congress to provide annual
appropriations that are timely, predictable, and sufficient. These
three components are critical for effective long- and short-range
decisionmaking by VA management. The Partnership for Veterans Health
Care Budget Reform supported legislation that would make VA health care
funding mandatory rather than discretionary. Under this concept, VA
health care funding would be formula-based, much like other mandatory
programs like Medicare, Social Security, and VA disability compensation
and pension benefits.
This concept was met with great resistance by lawmakers on Capitol
Hill; so The American Legion and its colleagues now recommend an
alternative to mandatory funding--advance appropriations. The American
Legion believes this change would assure timeliness and predictability.
Under advance appropriations, VA medical care discretionary
appropriations would be approved prior to the start of the next fiscal
year. Should The American Legion have concerns about the sufficiency of
the advance appropriations, it would have an opportunity to address any
shortfalls while testifying for the remainder of the VA appropriations
for that fiscal year.
medicare reimbursements to va
As do most American workers, veterans pay into the Medicare system,
without choice, throughout their working lives, including when they are
serving on active duty or serving in the reserve components of the
Armed Forces. However, although veterans must pay into the Medicare
system, VA is prohibited from collecting any Medicare reimbursements
for the treatment of allowable, nonservice-connected medical
conditions. Since over half of VA's enrolled patient population is
Medicare-eligible, this prohibition constitutes a multi-billion dollar
annual subsidy to the Medicare Trust Fund. The American Legion opposes
the current policy on Medicare reimbursement and asks Congress to allow
Medicare reimbursement for VA for the treatment of allowable,
nonservice-connected medical conditions by enrolled Medicare-eligible
veterans.
traumatic brain injury (tbi)
A recent General Accountability Office (GAO) report acknowledged
VA's clinical challenges in its efforts to screen OEF/OIF veterans for
mild TBI and evaluating those who screen positive on the TBI screening
tool. The challenges include the lack of objective diagnostic tests,
such as laboratory tests or neuroimaging tests like MRI and computer
tomography (CT) scans that can definitively and reliably identify mild
TBI. Other challenges include the similarity of many symptoms of mild
TBI to symptoms associated with other conditions, making a definitive
diagnosis of mild TBI more difficult to diagnose. Many OEF/OIF veterans
with mild TBI might not even realize that they have an injury and
should seek health care.
Soldiers with mild Traumatic Brain Injury were more likely to
report poor health, missed workdays, medical visits, and a high number
of somatic and post concussive symptoms than were soldiers with other
injuries. On the other hand, after adjustment for PTSD and depression,
mild Traumatic Brain Injury was no longer significantly associated with
these physical health outcomes or symptoms, except for
headache.
Clearly additional funding for TBI research and treatment is
warranted and should be appropriately funded.
access to care for rural veterans
Research conducted by VA indicated veterans residing in rural areas
are in poorer health than their urban counterparts. It was further
reported that nationwide, one in five veterans who enrolled to receive
VA health care lives in rural areas. Providing quality health care in a
rural setting has proven to be very challenging to VA, given factors
such as limited availability of skilled care providers and inadequate
access to care. Even more challenging will be VA's ability to provide
treatment and rehabilitation to rural veterans who suffer from the
signature ailments of the on-going Global War on Terrorism--traumatic
blast injuries and combat-related mental health conditions. VA's
efforts need to be especially focused on these issues.
A vital element of VA's transformation in the 1990s was the
creation of Community Based Outpatient Clinics (CBOCs) that proximate
access to VA primary care within veterans' communities. Recently, VA
scheduled the opening of 44 additional CBOCs in 21 states. The new
clinics will be fully activated in 2009, increasing VA's network of
independent and community-based clinics to 782. The American Legion
believes the clinics are warranted due to the growing population of
veterans within rural areas of the Nation. More veterans are also
migrating to less populated areas with an abundance of automobiles,
which are the primary catalysts that transport Improvised Explosive
Devices (IEDs) in Iraq.
While VA has taken the right step with the addition of more CBOCs,
The American Legion believes more are warranted. There continues to be
great difficulty serving veterans in rural areas, such as Nebraska,
Nevada, Utah, South Dakota, Wyoming, and Montana where veterans face
extremely long drives, a shortage of health care providers, and bad
weather. VISNs rely heavily upon CBOCs to close the gap.
seamless transition
VA has an Office of Seamless Transition that is available to
participate in Department of Defense (DOD), National Guard and Reserves
Transition Assistance Programs (TAP) and Disabled Transition Assistance
Programs (DTAP). However, The American Legion remains concerned that
many servicemembers returning home from OEF/OIF duty are not being
properly advised of the benefits and services available to them from VA
and other Federal and State agencies. This is especially true of
Reserve and National Guard units that are demobilized at hometown
Reserve Centers and National Guard armories, rather than at active duty
demobilization centers.
The American Legion recommends this Committee continue its
oversight of VA to ensure that all recently separated veterans, to
include Reserve components servicemembers are provided appropriate
current and future plans and policies for a successful transition of
the Nation's heroes from active duty to civilian life.
medical and prosthetics research
The American Legion believes VA's focus in research should remain
on understanding and improving treatment for conditions that are unique
to veterans. Servicemembers are surviving catastrophically disabling
blast injuries due to the superior armor they are wearing in the combat
theater and the timely access to quality triage. The unique injuries
sustained by the new generation of veterans clearly demand particular
attention. VA must be funded to provide and maintain state-of-the-art
prostheses.
The American Legion also supports adequate funding of other VA
research activities, including basic biomedical research and bench-to-
bedside projects. This Committee should continue to 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 other medical problems jointly with DOD,
the National Institutes of Health (NIH), other Federal agencies, and
academic institutions.
environmental exposures
Agent Orange
One of the top priorities of The American Legion has been to ensure
that long overdue major epidemiological studies of Vietnam veterans who
were exposed to the herbicide Agent Orange are carried out.
The Institute of Medicine (IOM) report, Characterizing Exposure of
Veterans to Agent Orange and Other Herbicides Used in Vietnam, is based
on the research conducted by a Columbia University team. Headed by
principal investigator Dr. Jeanne Mager Stellman, the team has
developed a powerful method for characterizing exposure to herbicides
in Vietnam. The American Legion is proud to have collaborated in this
research effort. In its final report on the study, the IOM urgently
recommends that epidemiological studies be undertaken now that an
accepted exposure methodology is available. The American Legion
strongly endorses this IOM report.
The IOM's most recent report on veterans' herbicide exposure in
Vietnam, Veterans and Agent Orange: Update 2006, released July 27,
2007, added two new illnesses to the category of ``limited or
suggestive evidence of association,'' AL amyloidosis and hypertension.
This is a profound finding since many Vietnam War veterans suffer from
hypertension.
The ``limited or suggestive'' evidence finding meets the threshold
of a positive association between the exposure of humans to a herbicide
agent and the occurrence of a disease in humans, as set forth in title
38, United States Code Sec. 1116, and has been used by VA to add other
conditions, including type 2 diabetes, to the list of herbicide
presumptive disabilities. Although the Secretary of Veterans Affairs,
in violation of specific reporting requirements set forth in Sec. 1116,
has yet to publish his official determination regarding this latest IOM
report in the Federal Register, The American Legion received a letter
from the Secretary on June 26, 2008, informing our organization that AL
amyloidosis is the only condition, based on the July 2007 IOM report,
that would be added to the list of disabilities presumed to be service-
connected due to herbicide exposure. The Secretary specifically stated
that he has ``determined that the evidence available at this time does
not warrant the establishment of a new presumption of service
connection based on service in Vietnam for any additional diseases
reviewed in the NAS report.''
Since, at of the time of this writing, the Secretary has not
published a notice of his determination in the Federal Register, which
will include an explanation of the scientific basis for that
determination; The American Legion is unable to comment on the
reasoning behind VA's decision not to recognize hypertension as
presumptively service-connected to herbicide exposure among Vietnam
veterans. Rest assured we will carefully review the Secretary's
determination once it is published in the Federal Register and will
take appropriate action, including, but not limited to, seeking a
legislative remedy to correct this injustice.
The American Legion is extremely concerned about the timely
disclosure and release of all information by DOD on the use and testing
of herbicides in locations other than Vietnam during the war. Over the
years, The American Legion has represented veterans who claim to have
been exposed to herbicides in places other than Vietnam. Without
official acknowledgement by the Federal Government of the use of
herbicides, proving such exposure is virtually impossible. Information
has come to light in the last few years leaving no doubt that Agent
Orange, and other herbicides contaminated with dioxin, were released in
locations other than Vietnam. This information is slowly being
disclosed by DOD and provided to VA.
Obtaining the most accurate information available concerning
possible exposure is extremely important for the adjudication of
herbicide-related disability claims of veterans claiming exposure
outside of Vietnam. For herbicide-related disability claims, veterans
who served in Vietnam during the period of January 9, 1962 to May 7,
1975 are presumed by law to have been exposed to Agent Orange. Veterans
claiming exposure to herbicides outside of Vietnam are required to
submit proof of exposure. This is why it is crucial that all
information pertaining to herbicide use, testing, and disposal in
locations other than Vietnam be released to VA in a timely manner.
Congressional oversight is needed to ensure that additional information
identifying involved personnel or units for the locations already known
by VA is released by DOD, as well as all relevant information
pertaining to other locations that have yet to be identified. Locating
this information and providing it to VA must be a national priority.
Gulf War Illness
Gulf War research is moving away from the previous stress theories
and is beginning to narrow down possible causes. However, research
regarding viable treatment options is still lacking. The American
Legion applauds Congress for having the foresight to provide funding to
the Southwestern Medical Center's Gulf War Illness research program.
The Center was awarded $15 million, renewable for five years, to
further the scientific knowledge on Gulf War Veterans Illnesses
research. This research will not only impact veterans of the 1991 Gulf
War, but may prove beneficial for those currently serving in the
Southwest Asia Theater and the Middle East.
VA must continue to fund research projects consistent with the
recommendations of the Research Advisory Committee on Gulf War
Veterans' Illness (RACGWI). It is important that VA continues to focus
its research on finding medical treatments that will alleviate
veterans' suffering as well as on figuring out the causes of that
suffering.
Public Law 103-210, which authorized the Secretary of Veterans
Affairs to provide priority health care to the veterans of the Persian
Gulf War who have been exposed to toxic substances and environmental
hazards, allowed Gulf War Veterans--and veterans of the Vietnam War--to
enroll into Priority Group 6. The last sunset date for this authority
was December 31, 2002. Since this date, information provided to
veterans and VA hospitals has been conflicting. Some hospitals continue
to honor Priority Group 6 enrollment for ill Gulf War veterans seeking
care for their ailments. Other hospitals, well aware of the sunset
date, deny Priority Group 6 enrollment for these veterans and notify
them that they qualify for Priority Group 8. To these veterans' dismay,
they are completely denied enrollment because of VA's restricted
enrollment for Priority Group 8 since January 2003. Even more
confounding is the fact that eligibility information disseminated via
internet and printed materials does not consistently reflect this
change in enrollment eligibility for Priority Group 6. VA has assured
The American Legion that this issue will be
rectified.
Although these veterans can file claims for these ailments and
possibly gain access to the health care system once a disability
percentage rate is granted, those whose claims are denied cannot
enroll. According to the May 2007 version of VA's Gulf War Veterans
Information System (GWVIS), there were 14,874 claims processed for
undiagnosed illnesses. Of those undiagnosed illness claims processed,
11,136 claims were denied. Due to their nature, these illnesses are
difficult to understand and information about individual exposures may
not be available, many ill veterans are not able to present strong
claims. They are then forced to seek care from private physicians who
may not have enough information about Gulf War Veterans' illnesses to
provide appropriate care.
VA notes that veterans may still be granted service connection, if
evidence indicates an association between their diseases and their
exposures. This places the burden of proof on Gulf War veterans to
prove their exposures and that the level of exposure is sufficient
enough to warrant service connection. IOM and VA have acknowledged that
there is insufficient information on the use of the identified solvents
and pesticides during the Gulf War.
VA states that Public Law 105-277 does not explain the meaning of
the phrase, ``known or presumed to be associated with service in the
Armed Forces in the Southwest Asia theater of operations during the
Persian Gulf War'' and that there is no legislative history explaining
the meaning of the phrase. VA has had adequate time to get Congress to
clarify the statute's intent and should have clarified the intent prior
to delivering a charge to the IOM for the report. VA's interpretation
is that Congress did not intend VA to establish presumptions for known
health effects of all substances common to military and civilian life,
but that it should focus on the unique exposure environment in the
Persian Gulf during the war. The IOM was commissioned to ascertain
long-term health effects of service in the Persian Gulf during the war,
based on exposures associated with service in theater during the war as
identified by Congress, not exposures unique to the Southwest Asia
Theater. The determination to not grant presumption for the ailments
identified should be based solely on the research findings, not on the
legitimacy of the exposures identified by Congress.
The IOM has a similar charge to address veterans who served in
Vietnam during the war. Herbicides were not unique to the operations in
the Southeast Asia theater of conflict and there had not been, until
recently, a definitive notion of the amounts of herbicides to which
servicemembers had been exposed. Peer-reviewed, occupational studies
are evaluated to make recommendations on which illnesses are associated
with exposure the herbicides--and their components known to be used in
theater. For ailments that demonstrate sufficient evidence of a causal
relationship, sufficient evidence of an association, and limited
evidence of an association, the Secretary may consider presumption.
Gulf War and Health Volume 2 identifies several illnesses in these
categories. However the Secretary determined that presumption is not
warranted
VA needs to clearly define what type of information is required to
determine possible health effects, for instance clarification of any
guidance or mandate for the research. VA also needs to ensure that its
charge to the IOM is specific enough to help it make determinations
about presumptive illnesses. VA noted that neither the report, nor the
studies considered for the report identified increased risk of disease
based on episodic exposures to insecticides or solvents and that the
report states no conclusion whether any of the diseases are associated
with ``less than chronic exposure,'' possibly indicating a lack of data
to make a determination. If this was necessary, it should have been
clearly identified.
Finally, Section 1118, title 38, U.S.C., mandates how the Secretary
should respond to the recommendations made in the IOM reports. The
Secretary is required to make a determination of whether or not a
presumption for service connection is warranted for each illness
covered in the report no later than 60 days after the date the report
is received. If the Secretary determines that presumption is not
warranted for any of the illnesses or conditions considered in the
report, a notice explaining scientific basis for the determination has
to be published in the Federal Register within 60 days after the
determination has been made. Gulf War and Health, Volume 2 was released
in 2003, four years ago. Since then, IOM has released several other
reports and VA has yet to publish its determination on those reports as
well.
The American Legion urges VA to provide clarity in the charge for
the IOM reports concerning what type of information is needed to make
determinations of presumption of service connection for illnesses that
may be associated with service in the Gulf during the war.
The American Legion urges VA to get clarification from Congress on
the intent of the phrase ``known or presumed to be associated with
service in the Armed Forces in the Southwest Asia theater of operations
during the Persian Gulf War,'' get clarification from the IOM committee
to fill in as many gaps of information as possible, and re-evaluate the
findings of the IOM report with the clarification provided.
The American Legion also urges Congress to provide oversight to
ensure VA provides timely responses to the recommendations made in the
IOM reports.
Atomic Veterans
Since the 1980s, claims by Atomic Veterans exposed to ionizing
radiation for a radiogenic disease, for conditions not among those
listed in Section 1112(c)(2), title 38, U.S.C., have required an
assessment to be made by the Defense Threat Reduction Agency (DTRA) as
to nature and amount of the veteran's radiation dosing. Under this
guideline, when dose estimates provided are reported as a range of
doses to which a veteran may have been exposed, exposure at the highest
level of the dose range is presumed. From a practical standpoint, VA
routinely denied the claims by many atomic veterans on the basis of
dose estimates indicating minimal or very low-level radiation exposure.
As a result of the court decision in National Association of
Radiation Survivors v. VA and studies by GAO and others of the U.S.'s
nuclear weapons test program, the accuracy and reliability of the
assumptions underlying DTRA's dose estimate procedures have come into
question. On May 8, 2003, the National Research Council's Committee to
Review the DTRA Dose Reconstruction Program released its report. It
confirmed the complaints of thousands of Atomic Veterans that DTRA's
dose estimates have often been based on arbitrary assumptions resulting
in underestimation of the actual radiation exposures. Based on a
sampling of DTRA cases, it was found that existing documentation of the
individual's dose reconstruction, in a large number of cases, was
unsatisfactory and evidence of any quality control was absent. The
Committee concluded their report with a number of recommendations that
would improve the dose reconstruction process of DTRA and VA's
adjudication of radiation claims.
The American Legion was encouraged by the mandate for a study of
the dose reconstruction program; nonetheless, we are concerned that the
dose reconstruction program may still not be able to provide the type
of information that is needed for Atomic Veterans to receive fair and
proper decisions from VA. Congress should not ignore the National
Research Council's findings and other reports that dose estimates
furnished VA by DTRA over the past 50 years have been flawed and have
prejudiced the adjudication of the claims of tens of thousands of
Atomic Veterans. It remains practically impossible for Atomic Veterans
or their survivors to effectively challenge a DTRA dose estimate.
It is not possible to accurately reconstruct the radiation dosages
to which these veterans were exposed. The process prolongs claims
decisions on ionizing radiation cases, ultimately delaying treatment
and compensation for veterans with fatal diseases. Therefore, The
American Legion believes the dose reconstruction program should not
continue. We urge the enactment of legislation to eliminate this
provision in the claim of veterans with a recognized radiogenic disease
who were exposed to ionizing radiation during military service.
Mustard Gas Exposure
In March 2005, VA initiated a national outreach effort to locate
veterans exposed to mustard gas and Lewisite as participants in
chemical warfare testing programs while in the military. For this
recent initiative, VA is targeting veterans who have been newly
identified by DOD for their participation in the testing, most of which
had participated in programs conducted during WWII. DOD estimated 4,500
servicemembers had been exposed.
The American Legion has been contacted by veterans who contend that
the number of participants identified was understated by tens of
thousands and that participation in these clandestine chemical programs
extended decades beyond the World War II era. Investigators have not
always maintained thorough records of the events; adverse health
effects were not always annotated in the servicemember's medical
records; and participants were warned not to speak of the program.
Without adequate documentation of their participation, participants may
not be able to prove their current ailments are related to the testing.
It is important DOD commits to investigating these claims as they
arise to determine if they have merit. It is also important VA commit
to locating those identified by DOD in a timely manner, as many of them
are WWII era veterans. Congressional oversight may be necessary to
ensure these veterans are granted the consideration they deserve.
blinded veterans
There are approximately 38,000 blind veterans enrolled in the VA
health care system. Additionally, demographic data suggests that in the
United States, there are over 160,000 veterans with low-vision problems
and eligible for Blind Rehabilitative services. Due to staffing
shortages, over 1,500 blind veterans will wait months to get into one
of the 10 blind rehabilitative centers.
VA currently employs approximately 164 Visual Impairment Service
Team (VIST) Coordinators to provide lifetime case management to all
legally blind veterans and all OEF/OIF patients and 38 Blind
Rehabilitative Outpatient Specialists (BROS) to provide services to
patients who are unable to travel to a blind center. The training
provided by BROS is critical to the continuum of care for blind
veterans. The DOD medical system is dependent on VA to provide blind
rehabilitative services.
The American Legion urges VA to increase funding for more Blind
Rehabilitative Outpatient Specialists.
medical construction and infrastructure support
Major Construction
The CARES process identified approximately 100 major construction
projects in the VA Medical Center System, the District of Columbia, and
Puerto Rico. Construction projects are categorized as major if the
estimated cost is over $10 million. Now that VA has disclosed the plan
to deliver health care through 2022, Congress has the responsibility to
provide adequate funds. VA has not had this type of progressive
construction agenda in decades. Major construction money can be
significant and proper utilization of funds must be well planned.
However, if timely completion is truly a national priority, The
American Legion continues to have concerns due to inadequate funding.
In addition to the cost of the proposed new facilities are many
construction issues that have been ``placed on hold'' for the past
several years due to inadequate funding, and the moratorium placed on
construction spending by the CARES process. One of the most glaring
shortfalls is the neglect of the buildings sorely in need of seismic
correction. This is an issue of safety. The delivery of health care in
unsafe buildings cannot be tolerated and funds must be allocated to not
only construct the new facilities, but also to pay for much needed
upgrades at existing facilities. Gambling with the lives of veterans,
their families and VA employees is absolutely
unacceptable.
The American Legion believes VA has effectively shepherded the
CARES process to its current state by developing the blueprint for the
future delivery of VA health care--we urge Congress adequately fund the
implementation of this comprehensive and crucial undertaking.
Minor Construction
VA's minor construction program has also suffered significant
neglect over the past several years. Maintaining the infrastructure of
VA's buildings is no small task due to the age of these buildings,
continuous renovations, relocations and expansions. A slight hesitation
in provision of funding leaves a profound impact.
The American Legion recommends Congress adequately fund the
implementation of this program.
Information Technology Funding
Since the data theft occurrence in May 2006, the VA has implemented
a complete overhaul of its Information Technology (IT) division
nationwide. Although not quite from its beginning stages, The American
Legion is hopeful VA takes the appropriate steps to strengthen its IT
security to renew the confidence and trust of veterans who depend on VA
for the benefits they have earned.
Within VA Medical Center Nursing Home Care Units, it was discovered
there was conflict with IT and each respective VAMC regarding provision
of Internet access to veteran residents. VA has acknowledged the
Internet would represent a positive tool in the veteran's
rehabilitation. The American Legion believes Internet access should be
provided to these veterans without delay, for time is of the essence in
the journey to recovery. In addition, veterans should not have to
suffer due to VA's gross negligence in the matter.
The American Legion believes there should be a complete review of
IT security government wide. VA isn't the only agency within the
government requiring an overhaul of its IT security protocol. The
American Legion urges Congress to exercise its oversight authority and
review each Federal agency to ensure that the personal information of
all Americans is secure.
The American Legion supports the centralization of VA's IT. The
quantity of work required to secure information managed by VA is
immense. The American Legion urges Congress to maintain close oversight
of VA's IT restructuring efforts and fund VA's IT to ensure the most
rapid implementation of all proposed security measures.
compensation and pension
Veterans Benefits Administration
VA has a statutory responsibility to ensure the welfare of the
Nation's veterans, their families, and survivors. Providing quality
decisions in a timely manner has been, and will continue to be one of
VA's most difficult challenges.
Claims Backlog & Staffing
In FY 2007, more than 2.8 million veterans received disability
compensation benefits. Providing quality decisions in a timely manner
has been, and will continue to be, one of the VA's most difficult
challenges. A majority of the claims processed by the Veterans Benefits
Administration's (VBA) 57 regional offices involve multiple issues that
are legally and medically complex and time consuming to adjudicate.
As of August 9, 2008, there were 618,314 claims pending in VBA,
394,201 of which are rating cases. There has been a steady increase in
VA's pending claim backlog since the end of FY 2004 when there were
321,458 rating cases pending. At the end of FY 2007, there were more
than 391,000 rating cases pending in the VBA system, up approximately
14,000 from FY 2006. Of these, more than 100,000 (25.7 percent) were
pending for more than 180 days. Including non-rating claims pending,
the total compensation and pension claims backlog was more than
627,000, with 26.5 percent of these claims pending more that 180 days.
There were also more than 164,000 appeals pending at VA regional
offices, with more than 142,000 requiring some type of further
adjudicative action. At the end of FY 2007, the average number of days
to complete a claim from date of receipt (182.5 days) was up 5.4 days
from FY 2006.
Inadequate staffing levels, inadequate continuing education, and
pressure to make quick decisions, resulting in an overall decrease in
quality of work, has been a consistent complaint among regional office
employees interviewed by The American Legion staff during regional
office quality checks. It is an extreme disservice to veterans, not to
mention unrealistic, to expect VA to continue to process an ever
increasing workload, while maintaining quality and timeliness, with the
current staff levels. The current wartime situation provides an
excellent opportunity for VA to actively seek out returning veterans
from OEF and OIF, especially those with service-connected disabilities,
as well as veterans from prior wars, for employment opportunities
within VBA. Despite the recent hiring initiatives, regional offices
will clearly need more personnel given current and projected future
workload demands. VBA must be required to provide better justification
for the resources it says are needed to carry out its mission and, in
particular, how it intends to improve the level of adjudicator
training, job competency, and quality assurance.
The American Legion recommends Congress increase VBA staffing
levels, provide appropriate training support for these employees and
increase the number of veterans of all wars hired in the VA.
Production vs. Quality
Since 1996, The American Legion, in conjunction with the National
Veterans Legal Services Program (NVLSP), has conducted quality review
site visits at more than 40 regional offices for the purpose of
assessing overall operation. This Quality Review Team visits a regional
office for a week and conducts informal interviews with both VA and
veterans service organization (VSO) staff. The Quality Review Team then
reviews a random sample of approximately 30-40 recently adjudicated
American Legion-represented claims. The Team finds errors in
approximately 20-30 percent of cases reviewed.
The most common errors include the following:
Inadequate claim development leading to premature
adjudication of claim;
Failure to consider reasonably inferred claims based on
evidence of record;
Rating based on inadequate VA examination; and/or
Under evaluation of disability (especially mental
conditions).
These errors are a direct reflection of VA's emphasis of quantity
over quality of work. This seems to validate The American Legion's
concerns that emphasis on production continues to be a driving force in
most VA regional offices, often taking priority over such things as
training and quality assurance. Clearly, this frequently results in
premature adjudications, improper denials of benefits and inconsistent
decisions.
veterans' disability benefits commission
In October 2007, after almost 2\1/2\ years of study, the Veterans'
Disability Benefits Commission (VDBC or Commission), released its
extensive report, Honoring the Call to Duty: Veterans' Disability
Benefits in the 21st Century, to the President and Congress. Due to the
history surrounding the establishment of the Commission, The American
Legion and others in the VSO community feared that it would be used as
a tool to restrict veterans' benefits. In fact, key Members of Congress
and other Federal Government officials publicly expressed their desire
to use the VDBC as a vehicle to institute radical changes in the VA
disability system that would negatively impact and restrict entitlement
to benefits for a large number of veterans. The American Legion closely
monitored the Commission's activities and provided written and oral
testimony, as well as other input.
The American Legion appreciates the Commission's hard work and
commitment and we are generally pleased with its recommendations. As
the final report contains 113 recommendations, this statement will
focus, for the most part, on recommendations that will directly impact
the disability compensation system as well as those addressed as high
priority in the Executive Summary.
The American Legion looks forward to working with Congress and VA
to implement many of these recommendations.
Filipino Veterans
The American Legion fully supports the Filipino Veterans Equity Act
and has testified in support of this legislation on a number of
occasions for several years. The American Legion's objection rests with
how Congress plans to pay for larger bill that contains the Filipino
Equity Act provision. In order to meet its PAY GO obligations, Congress
plans to repeal the Hartness v. Nicholson decision. In fact, some
Filipino veterans may very well benefit from the Hartness v. Nicholson
decision; especially should the Filipino Veterans Equity Act become
law. By repealing this decision, Congress would be denying one group of
veterans (elderly, disabled homebound)
an earned benefit to give another group of veterans (the Filipino
veterans and others) benefits. The American Legion believes it is wrong
and sets an unacceptable
precedence.
There is nothing that would prevent Congress from next year,
repealing the Filipino Equity Act to use that money to pay for some
other group of veterans. Such a ``rob Peter to pay Paul'' scheme
clearly dishonors and disrespects all veterans involved. Even worse, it
pits veterans against veterans. Thus, while The American Legion
strongly supports the Filipino Veterans Equity Act, it cannot support
this proposed PAYGO funding stream. Congress must not make a grave
mistake in the name of fairness, equality or eve fiscal responsibility.
We urge Congress to do what is right. It has other funding
options--not just the repeal of Hartness v. Nicholson but can waive the
budget rules, which Congress has already done to fund other bills; or
pass the Filipino Veterans Equity Act as part of an emergency
supplemental appropriations.
National Cemetery Administration
The mission of the National Cemetery Administration (NCA) is to
honor veterans with final resting places in national shrines and with
lasting tributes that commemorate their service to this Nation. The
American Legion recognizes NCA's excellent record in providing timely
and dignified burials to all veterans who opt to be buried in a
National Cemetery. We also recognize the hard work that is required to
restore and maintain National Cemeteries as national shrines and
applaud NCA for its commitment and success toward that endeavor.
The American Legion supports the ``75-mile service area/170,000
veteran population'' threshold that currently serves as the benchmark
for establishing a new national cemetery. However, driving (commuting)
times should be considered as inner-city traffic can significantly
increase travel times to distant cemeteries and driving time needs to
be factored in when trying to determine if the veteran population is
being served effectively.
National Cemetery Expansion
According to NCA's estimates in the President's budget request for
FY 2009, annual interments will increase to 111,000, a 10 percent rise
from FY 2007. Interments in FY 2013 are expected to be about 109,000, a
9 percent increase from FY 2007. The total number of graves maintained
is expected to increase from almost 2.8 million in FY 2007 to over 3.3
million in FY 2013. The American Legion recommends that monies for
additional employees be included in the budget.
vocational rehabilitation and employment service (vr&e)
The mission of the VR&E program is to help qualified, service-
disabled veterans achieve independence in daily living and, to the
maximum extent feasible, obtain and maintain suitable employment. The
American Legion fully supports these goals. VA leadership must focus on
marked improvements in case management, vocational counseling, and--
most importantly--job placement.
Interagency Cooperation between DOL-VETS and VA
It is our experience that the interagency collaboration and
communication between the VR&E program, and the Department of Labor
(DOL) Veterans Employment and Training Service (VETS) is lacking. The
American Legion recommends exploring possible training programs geared
specifically for VR&E Counselors through the National Veterans Training
Institute (NVTI). Contracting for standardized or specialized training
for VR&E employees could very well strengthen and improve overall
program performance.
Veterans' Preference in Job Placement
The Federal Government has scores of employment opportunities that
educated, well-trained, and motivated veterans can fill given a fair
and equitable chance to compete. Working together, all Federal agencies
should identify those vocational fields, especially those with high
turnover rates, suitable for VR&E applicants. There are three ways
veterans can be appointed to jobs in the competitive civil service: by
competitive appointment through an OPM list of eligibles (or agency
equivalent); by noncompetitive appointment under special authorities
that provide for conversion to the competitive service; or, by Merit
Promotion selection under the Veterans Employment Opportunities Act
(VEOA). The American Legion recommends the number of veterans in the
Federal Government be increased.
Provide military occupational skills and experience translation for
civilian employment counseling
The American Legion notes that due to the current demands of the
military, greater emphasis on the Reserve component of the Armed Forces
created employment hardships for many Reservists. The American Legion
supports amending Section 4101(5), title 38, U.S.C., to add Subsection
(D) to the list of ``Eligible Persons'' for Job Counseling, Training,
and Placement Service for Veterans, to include members in good standing
of Active Guard and Reserve Units of the Armed Forces of the United
States who have completed basic and advanced Duty for Training
(ACDUTRA) and have been awarded a Military Occupation Specialty.
DOD provides some of the best vocational training in the Nation for
its military personnel and establishes measures and evaluates
performance standards for every occupation with the Armed Forces. There
are many occupational career fields in the Armed Forces that can easily
translate to a civilian counterpart. Many occupations in the civilian
workforce require a license or certification. In the Armed Forces,
these unique occupations are performed to approved military standards
that may meet or exceed the civilian license or certification criteria.
Upon separation, many former military personnel, certified as
proficient in their military occupational career, are not licensed or
certified to perform the comparable job in the civilian workforce, thus
hindering chances for immediate civilian employment and delaying career
advancement. This situation creates an artificial barrier to employment
upon separation from military service.
A study by the Presidential Commission on Servicemembers' and
Veterans' Transition Assistance identified a total of 105 military
professions where civilian credentialing is required. The most easily
identifiable job is that of a Commercial Truck Driver in which there is
a drastic shortage of qualified drivers. Thousands of veterans must
venture through each state's laws instead of a single national test or
transfer of credentials from the military. We have testified alongside
members of the trucking industry to Congress for the need for
accelerated MGIB payments for these courses and other matters.
The American Legion supports efforts to eliminate employment
barriers that impede the transfer of military job skills to the
civilian labor market, and supports efforts to DOD take appropriate
steps to ensure that servicemembers be trained, tested, evaluated and
issued any licensure or certification that may be required in the
civilian workforce. The American Legion supports efforts to increase
the civilian labor market's acceptance of the occupational training
provided by the military.
Department of Labor Veterans Employment and Training Service (DOL-VETS)
The mission of VETS is to promote the economic security of
America's veterans. This stated mission is executed by assisting
veterans in finding meaningful employment. The American Legion believes
that by strengthening American veterans, we in turn strengthen America.
Annually, DOD discharges approximately 300,000 servicemembers. Recently
separated service personnel will seek immediate employment or
increasingly have chosen some form of self-employment. In order for the
VETS program to assist these veterans to achieve their goals, it needs
to:
Improve by expanding its outreach efforts with creative
initiatives designed to improve employment and training services for
veterans;
Provide employers with a labor pool of quality applicants
with marketable and transferable job skills;
Provide information on identifying military occupations
that require licenses, certificates or other credentials at the local,
state, or national levels;
Eliminate barriers to recently separated service personnel
and assist in the transition from military service to the civilian
labor market;
Strive to be a proactive agent between the business and
veterans' communities in order to provide greater employment
opportunities for veterans; and
Increase training opportunities, support and options for
veterans who seek self-employment and entrepreneurial careers.
The American Legion believes staffing levels for DVOPs and LVERs
should match the needs of the veterans' community in each state and not
be based solely on the fiscal needs of the state government. Such
services will continue to be crucial as today's active duty
servicemembers, especially those returning from combat in Iraq and
Afghanistan, transition into the civilian world. Education, vocational
and entrepreneurial training and employment opportunities will enable
these veterans to succeed in their future endeavors. Adequate funding
will allow the programs to increase staffing to provide comprehensive
case management job assistance to disabled and other eligible veterans.
The American Legion believes that military experience is essential
to understanding the unique needs of the veteran and that all LVERs, as
well as all DVOPs, should be veterans and should be additionally
educated to be able to address the needs of veterans who desire
entrepreneurial support.
The American Legion also supports legislation that will restore
language to Chapter 41, title 38, U.S.C., that require that half time
DVOP/LVER positions be assigned only after approval of the DVET and
that the Secretary of Labor would be required to monitor all career
centers that have veterans on staff assigned. Public Law 107-288 has
eliminated the requirement that DOL-VETS review all workforce centers
annually and this has minimized Federal oversight of the programs since
the ASVET has drastically cut funds allocated for this activity and
established a policy that only 10 percent of the centers operated under
title 38, U.S.C., will be reviewed, and Public Law 107-288 has removed
the job descriptions of the DVOPs and LVERs from title 38, U.S.C., and
given the States the ability to establish the duties and
responsibilities, thus weakening the VETS program across the country by
eliminating the language that required these staff positions provide
services only to veterans.
Make Transitional Assistance Program (TAP)/Disabled Transitional
Assistance Program (DTAP) a Mandatory Program
The American Legion is deeply concerned with the timely manner that
veterans, especially returning wartime veterans, transition into the
civilian sector. Annually, for the past 6 years, approximately 300,000
servicemembers, 90,000 of them belonging to the National Guard and
Reserve, enter the civilian sector each year.
In numerous cases brought to the attention of The American Legion
by veterans and other sources, many of these returning servicemembers
have lost jobs, promotions, businesses, homes, and cars and, in a few
cases, become homeless. The American Legion strongly endorses the
belief that servicemembers would greatly benefit by having access to
the resources and knowledge that the Transitional Assistance Program
(TAP) and Disabled Transitional Assistance Program (DTAP) can provide
and the TAP/DTAP program needs to update their program to recognize the
large number of Guard and Reserve business owners who now require
training, information and assistance while they attempt to salvage or
recover from a business which they abandoned to serve their country.
The American Legion strongly supports the Transition Assistance
Program and Disabled Transition Assistance Program. Additionally, The
American Legion supports that DOD require all separating, active-duty
servicemembers, including those from Reserve and National Guard units,
be given an opportunity to participate in Transition Assistance Program
and Disabled Transition Assistance Program training not more than 180
days prior to their separation or retirement from the Armed Forces.
To ensure that all veterans, both transitioning and those looking
for employment assistance well past their discharge, receive the best
care; the DOL-VETS program must be adequately funded. However, we feel
that the current funding levels are inadequate. Funding increases for
VETS since 9/11 do not reflect the large increase in servicemembers
requiring these services due to the Global War on Terrorism.
Military Occupational Specialty Transition (MOST) Program
The American Legion supports legislation that will authorize $60
million for the next ten years to fund the Service Members'
Occupational Conversion and Training Act (SMOCTA). SMOCTA is a training
program developed in the early 1990's for those leaving military
service with few or no job skills transferable to the civilian market
place. SMOCTA has been changed to the Military Occupational Specialty
Transition (MOST) program, but the language and intent of the program
still applies. If enacted, MOST would be the only Federal job training
program available strictly for veterans and the only Federal job
training program specifically designed and available for use by state
veterans' employment personnel to assist veterans with barriers to
employment.
Veterans eligible for assistance under MOST are those with a
primary or secondary military occupational specialty that DOD has
determined is not readily transferable to the civilian workforce or
those veterans with a service-connected disability rating of 30 percent
or higher. MOST is a unique job training program because there is a job
waiting for the newly trained veteran upon completion of training so
that they can continue to contribute to the economic well being of the
Nation.
The American Legion recommends reauthorization of SMOCTA (now MOST)
and adequate funding for the program.
Employment
DVOPs provide outreach services and intensive employment services
to meet the employment needs of eligible veterans, with priority to
disabled veterans and special emphasis placed on those veterans most in
need. LVERs conduct outreach to local employers to develop employment
opportunities for veterans, and facilitate employment, training and
placement services to veterans. In particular, many LVERs are the
facilitators for the Transition Assistance Program employment
workshops. There are inadequate appropriations to several states
because of policies and practices that cause these states to receive
fewer positions and/or less funding. This procedure caused a
deterioration of the available services provided to veterans in those
states, and adversely impacts the level of services provided. The
American Legion, therefore, recommends increased funding for this
program.
Homelessness (DOL-VETS)
The American Legion notes that there are approximately 154,000
homeless veterans on the street each night. This number, compounded
with 300,000 servicemembers entering the private sector each year since
2001 with at least a third of them potentially suffering from mental
illness, requires that intensive and numerous programs to prevent and
assist homeless veterans are available.
The Homeless Veterans Reintegration Program (HVRP) is a competitive
grant program. Grants are awarded to states or other public entities
and non-profits, including faith-based organizations, to operate
employment programs that reach out to homeless veterans and help them
become gainfully employed. The purpose of the HVRP is to provide
services to assist in reintegrating homeless veterans into meaningful
employment within the labor force and to stimulate the development of
effective service delivery systems that will address the complex
problems facing veterans. HVRP is the only nationwide program focused
on assisting homeless veterans to reintegrate into the workforce. The
American Legion strongly supports this highly successful grant program.
Veterans Workforce Investment Program (VWIP)
VWIP grants support efforts to ensure veterans' lifelong learning
and skills development in programs designed to serve the most-at-risk
veterans, especially those with service-connected disabilities, those
with significant barriers to employment, and recently separated
veterans. The goal is to provide an effective mix of interventions,
including training, retraining, and support services, that lead to long
term, higher wages and career potential jobs. The American Legion
recommends fully funding VWIP.
Employment Rights and Veterans' Preference
The Uniformed Services Employment and Reemployment Rights Act
(USERRA) protects the civilian job rights and benefits of veterans and
members of the Armed Forces, including National Guard and Reserve
members. USERRA also prohibits employer discrimination due to military
obligations and provides reemployment rights to returning
servicemembers. VETS administers this law, conducts investigations for
USERRA and Veterans' Preference cases, as well as conducts outreach and
education, and investigates complaints by servicemembers.
Since September 11, 2001, nearly 600,000 National Guard and Reserve
members have been activated for military duty. During this same period,
DOL-VETS provided USERRA assistance to over 410,000 employers and
servicemembers.
Veterans' Preference is authorized by the Veterans' Preference Act
of 1944. The Veterans' Employment Opportunity Act (VEOA) of 1998
extended certain rights and remedies to recently separated veterans.
VETS was given the responsibility to investigate complaints filed by
veterans who believe their Veterans' Preference rights have been
violated and to conduct an extensive compliance assistance program.
Veterans' Preference is being unlawfully ignored by numerous
agencies. Whereas figures show a decline in claims by veterans of this
conflict compared to Gulf War I, the reality is that employment
opportunities are not being broadcast. Federal agencies as well as
Federal contractors and subcontractors are required by law to notify
OPM of job opportunities but more often than not these vacancies are
never made available to the public. The VETS program investigates these
claims and corrects unlawful practices. The American Legion recommends
fully funding for Program Management that encompasses USERRA and VEOA.
Veteran- and Service Disabled Veteran-Owned Businesses
The American Legion views small businesses as the backbone of the
American economy. The impact of deployment on self-employed National
Guard and Reserve servicemembers is tragic with a reported 40 percent
of all businesses owned by veterans suffering financial losses and, in
some cases, bankruptcies. Many small businesses have discovered they
are unable to operate and suffer some form of financial loss when key
employees (who are members of the Reserve component) are activated. The
Congressional Budget Office in a report, ``The Effects of Reserve Call-
Ups on Civilian Employers,'' stated that it ``expects that as many as
30,000 small businesses and 55,000 self-employed individuals may be
more severely affected if their Reservist employee or owner is
activated.'' The American Legion is a strong supporter of the ``Hope at
Home Act of 2007,'' which is bipartisan legislation that would not only
require the Federal Government to close the pay gap between their
Reserve and National Guard servicemember's civilian and military pay
but it would also provide tax credits up to $30,000 for small
businesses with servicemembers who are activated.
Additionally, the Office of Veterans' Business Development within
the Small Business Administration (SBA) remains crippled and
ineffective due to a token funding of $750,000 per year. This amount,
which is less than the office supply budget for the SBA, is expected to
support an entire nation of veterans who are entrepreneurs. The
American Legion feels that this pittance is an insult to American
veterans who are small business owners; consequently, this undermines
the spirit and intent of Public Law 106-50 and continues to be a source
of embarrassment for this country.
The American Legion strongly supports increased funding of the
efforts of the SBA's Office of Veterans' Business Development in its
initiatives to provide enhanced outreach and specific community based
assistance to veterans and self employed members of the Reserves and
National Guard. The American Legion also supports legislation that
would permit the Office of Veterans Business Development to enter into
contracts, grants, and cooperative agreements to further its outreach
goals and develop a nationwide community-based service delivery system
specifically for veterans and members of Reserve components of the
United States military.
The American Legion recommends funding to enable the implementation
of a nationwide community-based assistance program to veterans and self
employed members of the Reserves and National Guard.
The National Veterans Business Development Corporation
Congress enacted the Veterans Entrepreneurship (TVC) and Small
Business Development Act of 1999 (Public Law 106-50) to assist veterans
and service-connected disabled veterans who own small businesses by
creating the National Veterans Business Development Corporation.
Presently, the objectives of P.L. 106-50 (as originally envisioned) are
not being met. The American Legion supports a close review of the
organization.
The American Legion encourages Congress to require reasonable
``set-asides'' of Federal procurements and contract for businesses
owned and operated by veterans. The American Legion also supported
legislation that sought to add service-connected disabled veterans to
the list of specified small business categories receiving 3 percent
set-asides. Public Law 106-50 included veteran small businesses within
Federal contracting and subcontracting goals for small business owners
and within goals for the participation of small businesses in Federal
procurement contracts. It requires the head of each Federal agency to
establish agency goals for the participation by small businesses owned
and controlled by service-connected disabled veterans, within that
agency's procurement contracts.
Agency compliance with P.L. 106-50 has been minimal with only two
agencies self-reporting that they have met their goals (the Department
of Veterans Affairs and the Small Business Administration). In 2004,
President Bush issued Executive Order 13360 to strengthen opportunities
in Federal contracting for service-disabled veteran-owned businesses.
The American Legion recommends:
Incorporate Executive Order 13360 into SBA Regulations
and Standard Operating Procedures
The American Legion endorses these recommendations from the ``SBA
Advisory Committee on Veterans Business Affairs'' FY 2006 SBA report:
Change to Sole Source Contracting Methods
Develop a User Friendly Veteran Procurement Data base
home loan guaranty program
VA's Home Loan Guaranty program has been in effect since 1944 and
has afforded approximately 18 million veterans the opportunity to
purchase homes. The Home Loan program offers veterans a centralized,
affordable and accessible method of purchasing homes in return for
their service to this Nation. The program has been so successful over
past years that not only has the program paid for itself, but has also
shown a profit in recent years. Administrative costs constitute a
relatively small portion--less than 10 percent--of the total capital
and operating costs. The predominant costs are claims costs and other
costs associated with foreclosure and alternatives taken to avoid
foreclosure. Each claim costs the Federal Government about $20,000.
However, revenues that VA collects from different sources, including
the funding fee that borrowers pay, property sales, and proceeds from
acquired loans and vendee loans, offset this cost.
The VA funding fee is required by law and is designed to sustain
the VA Home Loan Program by eliminating the need for appropriations
from Congress. Congress is not required to appropriate funding for this
program; however, because veterans must now `buy' in to the program, it
no longer serves the intent of helping veterans afford a home.
The fee, currently 2.15 percent on no-down payment loans for a
first-time use, is intended to enable the veteran who obtains a VA home
loan to contribute toward the cost of this benefit and thereby reduce
the cost to taxpayers. The funding fee for second time users who do not
make a down payment is 3.3 percent. The idea of a higher fee for second
time use is based on the fact that these veterans have already had a
chance to use the benefit once, and also that prior users have had time
to accumulate equity or save money toward a down payment.
The following persons are exempt from paying the funding fee:
Veterans receiving VA compensation for service-connected
disabilities.
Veterans who would be entitled to receive compensation for
service-connected disabilities if they did not receive retirement pay.
Surviving spouses of veterans who died in service or from
service-connected disabilities (whether or not such surviving spouses
are veterans with their own entitlement and whether or not they are
using their own entitlement on the loan).
The funding fee makes the VA Home Loan program less beneficial
compared to a standard, private loan in some aspects. The funding fee
mandates the participant to buy in to the program; however that goes
directly against the intention of the law, to provide veterans a
resource for obtaining a home. The American Legion believes that it is
unfair for veterans to pay high funding fees of 2 to 3 percent, which
can add approximately $3,000 to $11,000 for a first time buyer. The VA
funding fee was initially enacted to defray the costs of the VA
guaranteed home loan program. The current funding fee paid to VA to
defray the cost of the home loan has had a negative effect on many
veterans who choose not to participate in this highly beneficial
program. Therefore, The American Legion strongly recommends that the VA
funding fee on home loans be reduced or eliminated for all veterans
whether active duty, Reserve, or National Guard.
homeless veterans
The American Legion supports the efforts of public and private
sector agencies and organizations with the resources necessary to aid
homeless veterans and their families. The American Legion supports
proposals that will provide medical, rehabilitative and employment
assistance to homeless veterans and their families. Homeless veteran
programs should be granted full appropriations to provide supportive
services such as, but not limited to outreach, health care,
habilitation and rehabilitation, case management, daily living,
personal financial planning, transportation, vocational counseling,
employment and training, and education.
The American Legion applauds the Department of Housing and Urban
Development (HUD)--Veterans Affairs Supported Housing (VASH) program.
This program allowed HUD and VA to make up to 10,000 supportive
incremental housing vouchers available to homeless veterans. The
American Legion urges continued support of this program.
Homeless Providers Grant and Per Diem Program Reauthorization
In 1992, VA was given authority to establish the Homeless Providers
Grant and Per Diem Program under the Homeless Veterans Comprehensive
Service Programs Act of 1992, P.L. 102-590. The Grant and Per Diem
Program is offered annually (as funding permits) by the VA to fund
community agencies providing service to homeless veterans. VA can
provide grants and per diem payments to help public and nonprofit
organizations establish and operate supportive housing and/or service
centers for homeless veterans. Funds are available for assistance in
the form of grants to provide transitional housing (up to 24 months)
with supportive services, supportive services in a service center
facility for homeless veterans not in conjunction with supportive
housing, or to purchase vans. The American Legion strongly supports
increasing the funding level for the Grant and Per Diem Program.
Domiciliary Care for Homeless Veterans Program
DCHV operates 34 sites, with 1,833 dedicated domiciliary beds,
providing time limited residential treatment with long-term physical,
psychological, and rehabilitative counseling and services including
aftercare. This program annually provides residential treatment to
nearly 5,200 homeless veterans. The American Legion supports the
program.
Veterans Industries/Compensated Work Therapy Program
VI/CWT offers vocational and rehabilitative services, ranging from
evaluation and counseling to participation in compensated work and
vocational training. Since 1994 over 32,000 veterans have been
successfully reintegrated into society as responsible members of the
community through this program. The American Legion supports the
program.
Homeless Women Veterans and Children
Homeless veterans' service providers' clients have historically
been almost exclusively male. That is changing as more women veterans
and women veterans with young children have sought help. Additionally,
the approximately 200,000 female Iraq veterans are isolated during and
after deployment making it difficult to find gender-specific peer-based
support. Access to gender-appropriate care for these veterans is
essential.
Homeless veteran service providers recognize that they will have to
accommodate the needs of the changing homeless veteran population,
including increasing numbers of women and veterans with dependents.
Access to family housing through the distribution of the thousands of
new Section 8 vouchers that will be made available through the HUD-VASH
program will offer an important new resource allowing VA staff to
assist the veteran and her family.
The American Legion supports adequate funding for all domiciliary
programs for qualified veterans. This includes funding for gender-
specific, peer-based support and access to gender-appropriate care.
summary
The American Legion appreciates the strong relationship we have
developed with the Committee. With increasing military commitments
worldwide, it is important we work together to ensure that the services
and programs offered through VA and other government agencies are
available to the new generation of American servicemembers who are
returning home as well as for the veterans of prior conflicts.
The American Legion is fully committed to working with each of you
to ensure that America's veterans receive the benefits they have
earned. Whether it is improved accessibility to health care, timely
adjudication of disability compensation claims, improved educational
benefits or employment services, each and every aspect of these
programs touches veterans from every generation. Together we can ensure
that these programs remain productive, viable options for the men and
women who have chosen to answer the Nation's call to arms.
______
Response to Post-Hearing Questions from Hon. Daniel K. Akaka to Dean
Stoline, Assistant Director, National Legislative Commission, The
American Legion
ptsd
Just this morning, the VA Inspector General issued a report on the
Temple, Texas situation. Many will recall that a psychologist at that
facility wrote a strangely worded email which set off a firestorm of
concern for those who are suffering from PTSD. In a word, the IG found
no systemic effort on the part of VA to reduce the number of PTSD
claims via inappropriate diagnosis.
Question 1. Is it your view that mental health issues, and
particularly PTSD, are receiving appropriate attention, in terms of
both compensation and care?
Response. With regard to compensation, there are still problems
with VA's processing of mental disorder claims. The American Legion
``Quality Review Team'' has visited approximately 40 of VA's 57
regional offices. During these visits we have discovered the following
adjudication problems with both the establishment of service connection
and the assignment of evaluation for mental disorders, including PTSD:
Inadequate examinations--In some cases VA doctors do not assign
global assessment of functioning (GAF) scores that are consistent with
the symptomatology noted in the examination report.
Premature negative decisions by VA adjudicators--for example, they
rate on inadequate evidence, they fail to obtain potentially positive
evidence, and in their efforts to take work credit they fail to return
inadequate VA examinations for clarification or amendment.
Inconsistent application of the General Rating Formula for Mental
Disorders (38 CFR 4.130)--for example, veterans with similar symptoms
and GAF scores often receive drastically different ratings.
PTSD Claims--Unnecessary development (really development to deny)
when there is sufficient evidence to support the existence of a
stressor in service.
With regard to PTSD care, there is a possibility that mental health
services could be lacking due to lack of mental health professionals,
such as psychiatrists. If a certain amount of psychiatrists are
warranted, there are implications that adequacy of care isn't met when
those personnel aren't in place. To date, such are the findings during
The American Legion's 2009 site visits. As site visits progress, The
American Legion can determine the extent of appropriateness of care.
collaboration on the issues
Question 2. How can your organizations collaborate to address the
concerns of those who veterans who are returning after service in Iraq
and Afghanistan?
Response. Please look at our responses to the question regarding
``Outreach.''
vba staffing
In light of the increased funding for VBA staffing, there are high
expectations that VBA will improve the quality of claims decisions, and
to do so in a timely
manner.
Question 3. What more do you believe Congress could do to assist in
decreasing the backlog, and at the same time, improving timeliness and
accuracy?
Response. Congress should continue to conduct aggressive oversight
of VA's claims processing system. Specifically, VBA must be required to
provide better justification for the resources it says are needed to
carry out its mission and, in particular, how it intends to improve the
level of adjudicator training, job competency, and quality assurance.
oif/oef illnesses
The Committee and, indeed, the full Congress, has focused a great
deal of attention on mental health and TBI matters. Yet, the most
common health condition of returning OEF/OIF veterans is not TBI or
mental illness, but instead muscle and joint pain.
Question 4. Do you have proposals on how to focus on this number
one health concern from those who have served in Iraq and Afghanistan?
Response. It is important the muscle and joint pain issue receive
the same attention as Traumatic Brain Injury and mental illness. Just
as the latter, the former must be implemented when conducting the Post-
Deployment Health Assessment (PDRHA). It must also be implemented
during the servicemember's transition from active duty to civilian
status. The American Legion believes that during the continuum of care
process, the Department of Defense (DOD) and the Department of Veterans
Affairs (VA) must educate servicemembers and veterans on mode of
treatment of the aforementioned illnesses respectively.
outreach
Question 5. How are your organizations, individually or in some
cooperative fashion, working to outreach to veterans and encourage them
to take advantage of VA care and services?
Response. American Legion Outreach Programs:
Department (State) Service Officers
American Legion Department Service Officers conduct direct outreach
to veterans and their families regarding benefits available from VA.
They also have specialized training and experience with VA regulations
and are familiar with the many VA programs and services. They provide
an invaluable service to veterans by representing them in the VA claims
process or providing other assistance as needed. This service is free
and the veteran does not have to be member to take advantage of it.
When a veteran contacts The American Legion National Headquarters,
views our Web site, or speaks to a Legion member, they are referred to
that state's Department Service Officer. A Post Service Officer's Guide
is distributed to 14,000 posts nationwide to help answer benefit
questions which also serves as a referral source for veterans wishing
to file claims.
Heroes to Hometowns
In an effort to increase transparency and cooperation between DOD
and the American people, The American Legion entered into an
understanding with the Office of the Secretary of Defense's (OSD)
Office of Military Community and Family Policy (MCFP) under the
authority of the Deputy Under Secretary of Defense for Military
Community and Family Policy, Leslye A. Arsht, to assist in outreach and
assistance efforts to transitioning severely injured servicemembers.
The American Legion agreed to provide outreach support to the military
community's severely injured as they transitioned home through a
program known as Heroes to Hometowns. This program embodies The
American Legion's long standing history of caring for those ``* * * who
have borne the battle * * *'' and their families.
Heroes to Hometowns is designed to welcome home servicemembers who
no longer serve in the military. The American public's strong support
for our troops is especially evident in their willingness to help
servicemembers who are severely injured in the war, and their ever-
supportive families, as they transition from the hospital environment
and return to civilian life. Heroes to Hometowns is a program that
focuses on reintegration back into the community, with networks
established at the national and state levels to better identify the
extraordinary needs of returning families before they return home and
with the local community to coordinate government and non-government
resources as necessary for as long as needed.
There are three charter members in each State's Heroes to Hometowns
Executive Committee, each uniquely able to contribute to overall
support with the ability to tap into their national, state, and local
support systems to provide essential links to government, corporate,
and non-profit resources at all levels and to garner the all important
hometown support.
State Heroes to Hometowns Committees are the link between the
Military Treatment Facilities and the community. The charter members
consist of the State Office of Veterans Affairs, the State Transition
Assistance Office and the State's veterans community represented by The
American Legion. Heroes to Hometowns is a collaborative effort and The
American Legion leads communities in preparation to support returning
servicemember in areas such as:
Financial assistance;
Finding suitable homes and adapting as needed;
Home and vehicle repairs;
Transportation for veterans to medical appointments;
Employment and educational assistance;
Child care support;
Arrange ``welcome home'' celebrations; and,
Sports and recreation opportunities.
When a transitioning veteran requests assistance via a web-form or
brochure available through The American Legion, the veteran's contact
information is shared with the State Executive Committee. The American
Legion State offices refer the veteran's request to the local Post,
which connects with the veteran to provide assistance. The American
Legion focuses on those needs not provided by Federal and state
agencies.
To assist in the coordination of community resources, The American
Legion
supports OSD's Military Homefront Online Support Network for military
personnel and community organizations to connect and collaborate.
Located at www.homefrontconnections.mhf.dod.mil, this online network is
dedicated to citizens and organizations that support America's service
men and women. Through the support network, veterans can easily
identify and quickly connect with national, state and community support
programs.
In 2007, the Heroes to Hometowns program expanded its vision to
include all transitioning servicemembers, to include the underserved
National Guard and Reserve components. Currently, the National Guard
and Reserve do not have mandated TAP briefings when demobilizing. This
hard-to-reach population primarily lives in rural America, disconnected
from the traditional services provided by DOD or VA. The American
Legion, with its 2.7 million members and 14,000 posts, reaches into
these rural communities conveying a consistent message of strong
support for America's military personnel; the veteran who return home;
care for the veteran's family; and a patriotic pride in America. With
the Heroes to Hometowns program, The American Legion reaches out to
provide support long after the deployment is over.
Department of Veterans Affairs Voluntary Service (VAVS) Program
The American Legion is a staunch supporter of VA's Voluntary
Service (VAVS) program. In Fiscal Year 2007, some 7,527 regularly
scheduled Legionnaires volunteered 909,137 hours at 167 VA facilities.
Legionnaires volunteer at VA medical centers (VAMCs), Community-Based
Outpatient Clinics, Vet Centers, and many other locations in support of
hospitalized veterans.
The American Legion recently entered into a pilot program with VA
in creating Heroes to Hometowns VA Volunteer Coordinators at 10 VAMCs.
These coordinators will work with the VAMC Social Work offices and
identify transitioning servicemembers' needs with community resources.
Currently, The American Legion is working with the VAVS program to
increase the level of community support at VAMCs. By providing
volunteer outreach training and resources to support a sustained
outreach program, The American Legion is working to prepare the
American Homefront for the return of our fighting men and women.
Department of Veterans Affairs OEF/OIF Welcome Home Celebration
The American Legion is an active participant in the annual OIF/OEF
``Welcome Home'' Celebration Event held at VAMCs nationwide. This event
is designed to provide outreach services and offer valuable
information, education and support to transitioning servicemembers and
their families. Legionnaires answer questions about veterans' benefits,
filing claims and military discharge review requests. Here in
Washington, DC, during the Welcome Home event held at the DC VAMC,
medical staff enrolled transitioning Marines into the VA medical system
for their five years of free medical services, while community
volunteers provided an environment of support with live music, food and
valuable information about veterans' benefits and local community
resources.
The American Legion Magazine
The American Legion uses a multimedia approach to its outreach. The
American Legion Magazine has historically provided valuable and timely
information on the issues facing America's veterans. This tradition is
carried on into the 21st Century via The American Legion Web site,
www.legion.org, a hub for information, resources and specific points of
contact for local assistance. A full library of informative brochures
outline the leading issues facing America's veterans today to the
furthest reaches of the American landscape. At any point, a
transitioning veteran may receive assistance from The American Legion
via informational brochures, printed media, web-based request forms, a
1-800 call center, state veterans' service officers and most
importantly, the local American Legion post.
The American Legion Local Post
The American Legion Post is important in providing direct outreach
as it provides a common meeting place for veterans and their families.
The local Post may be the first place a veteran stops when returning
home. It may be the first place where the community as a whole thanks a
returning veteran for their service and sacrifice.
Department of Virginia American Legion Post 270 is a leading
example of the support provided by The American Legion family. Each
year the food manufacturer ``Newman's Own'' awards financial grants to
organizations that support the military. In 2004, Post 270 was awarded
the Newman's Own ``Best Volunteer Program in the Country Supporting Our
Active Duty Military and their Families'' for the post's outreach to
Walter Reed Army Medical Center (WRAMC). All across America, American
Legion Posts have partnered with businesses to assist returning
veterans find gainful employment. Most notably, The American Legion has
partnered with Military.com and Recruit Military on veteran-targeted
job fairs.
Within the past month, The American Legion worked with WRAMC to
host a career and benefits fair for the injured servicemembers in
outpatient care. Employers, many veterans themselves, meet with injured
servicemembers and their supporting family member in a relaxed
atmosphere. Servicemembers and family members were able to have dinner
and meet with employers from all across the Nation.
The American Legion works closely with DOD, VA and the Department
of Labor (DOL) to assist transitioning veterans in accessing their
benefits and resources in order to reach their fullest potential,
regardless of location or disabilities. The American Legion believes
that more emphasis should be placed on Heroes to Hometowns and programs
that allow transparency within the government and utilizes the
established resources with communities to fulfill the unmet needs of
transitioning servicemembers. The American Legion has a proud history
of securing and protecting the earned benefits of America's veterans.
The American Legion stands ready to continue this legacy today by
caring for those veterans returning from the current conflicts.
The American Legion's departments and posts are in constant
communication with their respective National Guard and Reserve units,
nearest deployment posts, TAPs programs, and Standown hosts to ensure
veterans have received or are receiving information and guidance on
various issues that affects their concerns. In addition, The American
Legion also informs these veterans of PDRHA times and locations to
ensure these veterans and servicemembers aren't falling through the
cracks.
women veterans
Question 6. VA has said that sufficient programs and funding
already exist to care for women veterans. What would you point to as
specific problems or shortfalls with respect to women veterans and what
do you recommend that the Committee do to address these concerns?
Response. The issue of continuum of care remains a major issue
among this Nation's women veterans. In addition, for those women
veterans who suffer from Military Sexual Trauma (MST) and are
apprehensive about going to their local VA medical centers, they
(mainly by word of mouth) resort to the comfort of the Vet Center only
to find that the Vet Center doesn't have a qualified MST counselor to
accommodate the veteran. Consequently, there is a problem providing MST
counselors to those suffering from MST. Although there is the challenge
of providing adequate counseling to men suffering from MST, the
additional challenge for women veterans is their adamant desire for
anonymity. One remedy would be to have clinics with separate entrances
for men and women veterans and more female counselors.
paperwork
Question 7. What is your organization's opinion of VA's expanded
paperwork protection policy that came about as a result of the
Inspector General's audit which found that VA regional office personnel
had mishandled some claims documents--is VA's new policy on shredding
appropriate?
Response. The American Legion is pleased that VA took quick and
decisive action to address this situation. However, there are concerns
that the measures put in place are ``overkill'' and actually hinder the
regional office employee's efficiency and productivity. The American
Legion's Quality Review Team will be closely monitoring the impact of
this new policy during our regional office site visits and will be in a
better position to answer this question in more detail later this year.
Furthermore, VA should not be destroying a veteran's evidence. VA
currently has regulations that allow VA to return duplicate information
to the veteran and it should do so, rather than spend the staff time
and money to shred evidence than at some future point in time might be
relevant to the veteran's claim.
stimulus
Question 8. The Senate stimulus package includes appropriations for
VA, especially $3.7 billion included for VA infrastructure projects.
What are your views?
Response. We believe that VA should strive to award contracts to
veteran-owned and service-disabled veteran-owned small businesses and
that veterans should be employed to perform this work to the maximum
extent possible and the Congress should oversee the expenditures of
these funds to ensure these goals.
______
Response to Post-Hearing Questions from Hon. Bernard Sanders to Dean
Stoline, Assistant Director, National Legislative Commission, The
American Legion
extended and different hours for va services
As I mentioned in my opening remarks, I have heard from many
veterans who want to get to the VA for care but they can't make it
because of work. I believe we need to increase accessibility of the VA
to all types of veterans, including those with full-time jobs, by
providing evening and weekend hours so that people won't have to choose
between going to work and keeping a VA appointment. This could also
help reduce missed appointments which waste time and resources of VA
staff. My office is currently exploring what kind of authority VA needs
to begin providing extended hours on a one night a week and one weekend
day a week basis, possibly in the form of a pilot program.
Question. What do members of the panel think about this idea?
Response. The VA implemented the Advanced Clinic Access (ACA) to
prevent long delays in providing care throughout the Medical Center;
alleviating the wait list was accomplished by conducting evening and
weekend clinics. It is The American Legion's contention that the same
could be done to accommodate those who work hours not conducive to VA's
regular hours.
Chairman Akaka. Thank you very much, Mr. Stoline.
Now we will hear from Mr. Atizado.
STATEMENT OF ADRIAN M. ATIZADO, ASSISTANT NATIONAL LEGISLATIVE
DIRECTOR, DISABLED AMERICAN VETERANS
Mr. Atizado. Mr. Chairman, Ranking Burr and other Members
of the Committee, thank you for inviting the DAV to testify at
this important hearing and to listen to our priorities for the
111th Congress. We do appreciate your consideration as you
prepare your legislative agenda.
Our priorities include VA health care funding reform,
disability compensation improvements, family caregiver support
services, women veterans' health care, Traumatic Brain Injury,
and mental health care and substance use disorders. For the
sake of brevity, I will highlight only our recommendations and
refer you to my written testimony for further details.
On VA health care funding reform, the DAV thanks Chairman
Akaka and the eight co-sponsors for introducing in the 110th
Congress the Veterans' Health Care Budget Reform Act which
received bipartisan support to achieve sufficient, timely and
predictable veterans' health care funding. This bill would
allow Congress to fund VA health care 1 year in advance and
address transparency in VA's internal budget process. Advanced
appropriation retains full Congressional discretion to set
funding levels and Congress' ability to provide strong
oversight over VA programs, services and policies.
We look forward to its reintroduction and passage in the
111th Congress.
To improve VA's disability claims process, the cumbersome
and lengthy administrative claims and appeals process can be
streamlined by eliminating redundancies and creating an
integrated electronic claims process. Training, quality
assurance and accountability changes must be approached in that
order while resisting hasty broad-brush approaches. Sir, our
broad view is that VA should empower personnel with expertise
to manage and reduce the claims backlog without eroding decades
of progress.
In the same vein, disabled servicemembers should have a
seamless transition primarily by restructuring the substandard
military disability evaluation system.
For family caregivers and support services: Just as
severely disabled veterans face daunting and lifelong
challenges, so do their family caregivers who help maintain a
veteran's quality-of-life and independence as they live in the
community. While this role can exact a high cost on family
caregivers, they seldom receive sufficient support services or
financial assistance. In addition to psychosocial support
services, VA should conduct individual needs assessment on
family caregivers of severely disabled veterans as well as
conduct a periodic national survey for planning and policy
purposes.
Women veterans' health care: To address existing health
disparities, legislation is needed to ensure women veterans'
health programs are properly assessed and enhanced so that
access, quality, safety, and satisfaction with care is equal
for women and men. VA should improve its ability to assess and
treat women who have experienced combat or military sexual
trauma and increase the use of gender-specific evidence-based
treatments. Also, we believe VA should receive the resources to
have at least one provider with women's health expertise in
each VA medical center.
Traumatic Brain Injury or TBI is the signature injury to
Iraq and Afghanistan war veterans, which can cause devastating
and often debilitating and permanent damage. An increase in DOD
and VA specialists with TBI expertise is needed, just as more
research is needed to sustain the emerging evidence base for
TBI. And while mild to moderate TBI can be much harder to
diagnose, which often leads to lasting physical and
psychological problems, proper screening and personalized
recovery plans are essential to detect and treat TBI.
Mental health care and substance abuse disorder: Although
VA has improved its programs in recent years, the scope of care
provided and its distribution across VA does not meet the needs
of veterans. Studies looking at the trends of mental health and
substance use disorders in Iraq and Afghanistan war veterans
drive the need to ensure access to and make available robust
services. Programs that integrate the best research evidence,
clinical expertise and patient needs are critical to avoid
long-term health consequences.
The DAV thanks this Committee for its efforts last Congress
in passing the Veterans Mental Health and Other Care
Improvements Act of 2008, now Public Law 110-387.
In conclusion, Mr. Chairman, we would like to thank you as
well as Senators Durbin and Murray for introducing S. 252, the
Veterans' Health Care Authorization Act of 2009. This bill,
drawn in large part from a staff conference package based on
S. 2969, the Senate bill in the 110th, contains many provisions
that address our concerns I outlined herein.
Mr. Chairman, this concludes my testimony. I would be happy
to answer any questions you or this Committee may have.
[The prepared statement of Mr. Atizado follows:]
Prepared Statement of Adrian Atizado, Assistant National Legislative
Director, Disabled American Veterans
Mr. Chairman, Ranking Member Burr and other Members of the
Committee: Thank you for inviting the Disabled American Veterans (DAV)
to testify at this important hearing of the Committee on Veterans'
Affairs. DAV is an organization of 1.3 million service-disabled
veterans, and devotes its energies to rebuilding the lives of disabled
veterans and their families.
As you may be aware, our DAV advocacy campaign, Stand Up For
Veterans, is well underway. Its purpose is to generate greater public
understanding and build support for changes in veterans' health care
programs, benefits, and services for all the men and women injured or
disabled in service to the Nation, including those from the wars in
Iraq and Afghanistan, as well as those from prior eras and conflicts.
In this effort, our campaign focuses our organization's priorities
which we hope this Committee will consider as it prepares its
legislative agenda for the 111th Congress:
VA Health Care Funding Reform
Disability Compensation Improvements
Family Caregiver Support and Services
Women Veterans Health Care
Traumatic Brain Injury
Mental Health Care and Substance-use Disorder
va health care funding reform
While great strides have been made in Congress to increase the
level of Department of Veterans Affairs (VA) health care funding during
the past several years, there is a long history of significant delays
in receiving those funds. Notwithstanding notable improvements in the
past two years, VA has received its annual funding for veterans' health
care late in 19 of the past 22 years. Unlike Medicare or Medicaid, the
VA must rely on Congress and the President to pass a new appropriations
law each year to provide VA hospitals and clinics with the funding they
need to treat sick and disabled veterans.
Due to the late and unpredictable budget process, VA is
increasingly challenged to properly treat the physical and mental scars
of war for all veterans needing care. Further, not knowing when or at
what level VA will receive funding from year to year--or whether
Congress will approve or oppose the Administration's proposals--hinders
the ability of VA officials to efficiently plan and responsibly manage
VA health care.
Broken financing causes unnecessary delays and backlogs in the
system: hiring key staff is put off, or just not done, while injuries
like PTSD or TBI are too often not diagnosed or treated in a timely
manner. Since 2001, the number of VA patients has grown by two
million--a 50 percent increase--and our newest generation of veterans
has increasingly complex mental and physical health care needs that
will require a lifetime of care. Moreover, a 2007 report by the VA's
Office of Inspector General concluded that 27% of the injured veterans
seeking treatment at VA facilities had to wait more than 30 days for
their appointments.
For the past decade, the DAV and its allies in the Partnership for
Veterans Health Care Budget Reform--a coalition of nine veterans
service organizations with a combined membership of eight million
veterans--have sought to fundamentally change the way veterans health
care is funded. While mandatory funding has been the focus over the
past several years, the Partnership helped develop and fully endorsed
S. 3527, the Veterans Health Care Budget Reform Act, introduced in the
110th Congress. This legislation has also been endorsed by The Military
Coalition, comprised of 35 organizations representing more than 5.5
million members of the uniformed services--active, reserve, retired,
survivors, veterans--and their families. The DAV thanks the Chairman of
this Committee and his eight co-sponsors for introducing this measure
which received bipartisan support and has been endorsed by then
President-elect Obama and [the recently confirmed] VA Secretary Eric
Shinseki.
We believe this legislation proposes a reasonable alternative to
achieve the same goals as mandatory funding, by authorizing Congress to
appropriate funding for veterans' health care one year in advance and
adding transparency to VA's internal budget process. With the goal of
ensuring sufficient, timely, and predictable veterans health care
funding through advance appropriations, Congress retains full
discretion to set funding levels for each fiscal year, and the
legislation does not eliminate, reduce or diminish Congress' ability to
provide strong oversight over VA programs, services and policies.
Introduction and passage of the Veterans Health Care Budget Reform
Act in the 111th Congress would address DAV's highest priority in VA
health care.
improving va disability claims process
The Department of Veterans Affairs (VA) disability claims process
is a complex and burdensome system whose timeliness has declined in
recent years to unacceptable levels, resulting in more than 800,000
backlogged claims. The complexity of this challenge ensures that there
is no ``magic bullet'' solution capable of quickly resolving the claims
backlog. Our broad view is that it is imperative that VA empower
personnel with exceptional knowledge of current processes to manage and
reduce the claims backlog without eroding decades of progress. The DAV
believes the cumbersome and lengthy administrative claims and appeals
process can be streamlined (1) by merging and eliminating redundancies
within the benefits delivery system, and (2) integrating its electronic
framework into a single, state-of-the-art information system to create,
as much as practical, a new electronic claims process.
Another reality intertwined with the foregoing is that the quality
assurance and training programs in use by the Veterans Benefits
Administration are inadequate as tools to sample the validity of
decisions on claims. The VA must fundamentally change its quality
assurance/accountability systems and training programs in order to
successfully reform the compensation system. However, the underlying
challenge here is that it must do so without significant infrastructure
changes.
Similar to the claims process itself, the Veterans Benefits
Administration's (VBA) training programs are plagued by a lack of
accountability that perpetuates VA's inability to produce accurate and
equitable decisions on claims. Training, quality assurance, and
accountability changes must be approached in that order, while VBA
resists hasty broad-brush approaches. Subject matter experts from all
corners of the veterans' benefits arena should collaborate toward one
goal--improve training in order to improve rating quality, and hold
employees accountable in order to assure a quality product.
Military personnel injured on active duty have been hamstrung with
a Department of Defense (DOD) disability evaluation system that
discharges them from active duty with unacceptable variances in
disability ratings. These outcomes are the result of the current system
which is unmanageable and inconsistent. The problem has been a focus of
veterans service organizations for a substantial period of time and our
observations were validated by the Veterans' Disability Benefits
Commission which was chartered by the National Defense Authorization
Act of 2004. In its review, the commission found for example that the
Army is less likely than other military groups to assign a disability
rating of 30% or more, the cutoff for a person to receive lifetime
retirement payments and health care. The Pentagon has a strong
incentive to assign ratings of less than 30% so the Services can avoid
paying higher disability benefits.
The military announced on November 7, 2008 an expansion of the
Disability Evaluation System Pilot with all military services now
taking part in a follow-on of the National Capitol Region test program.
Now wounded servicemembers leaving the military may have easier,
quicker access to their veterans' benefits under this expanded pilot
program that will offer streamlined disability evaluations. That is,
provided they are of the fortunate few assigned to one of the 19
military installations. The initial phase of the expansion started on
October 1, at Fort Meade, Maryland and Fort Belvoir, Virginia. The
remaining 17 installations will begin upon completion of site
preparations and personnel orientation and training, during an eight-
month period from November 2008 to May 2009.
Although the Disability Evaluation System Pilot is a notable
improvement, its productivity pace was slow with only 700
servicemembers who participated in the pilot having their cases
finalized over a ten-month period. The issues that hinder the timely
resolution of disability claims by the VA for veterans are the same as
those for active duty servicemembers transitioning to veteran status.
family caregivers support and services
The nature, prevalence, and degree of injuries that veterans of
Operations Enduring and Iraqi Freedom (OEF/OIF) are sometimes so severe
that family members, whose lives and livelihoods have been interrupted
to care for their loved ones, need increased Federal support and
assistance.
They face daunting and life-long challenges. Often, they must drop
everything to be at the bedside and take care of the physical and
mental injuries of their sons, daughters, spouses, or parents. They
must deal with a complex system of overlapping and changing support
programs which poses a great challenge for family caregivers to
understand and navigate, too often resulting in a state of confusion
for the caregiver.
Once severely disabled veterans return home, their family
caregivers provide the needed support to maintain the veteran's quality
of life and independence while living in their community. Even though
it is widely recognized that informal caregiving can delay or avoid
institutionalization of the veteran, caring for a severely disabled
veteran exacts a high cost on family caregivers. They often shoulder
physical burdens, mental strain, and psychosocial challenges as a
result of their caregiving responsibilities. They face the disruption
and change of their family's life, withdrawal from school or loss of
employment and employer-based benefits, often sacrificing their own
health, well-being, and economic future in order to care for a loved
one.
Although close family members are often willing to bear the burden
of being primary caregivers for severely disabled veterans--thus
relieving VA of that obligation or the cost of institutionalization--
they seldom receive sufficient support services or financial assistance
from the government.
The DAV believes these informal caregivers should receive a
comprehensive array of support services, to include respite care,
financial compensation, vocational counseling, basic health care,
relationship, marriage and family counseling, and mental health care to
address the multiple burdens they face. Among other things, a
``Caregiver Toolkit'' should be provided to family caregivers, to
include a concise ``recovery roadmap'' to assist families in
understanding and maneuvering through the complex systems of care and
Federal, state, and local resources available to them. Moreover,
policymaking and planning to better serve family caregivers of severely
injured veterans should include statistically representative data from
a periodic national survey and individual assessments of family
caregivers of severely injured and disabled veterans. By supporting the
caregiver, we support the disabled veteran.
women veterans health care
Although women have historically been a very small percentage of
patients in the VA health care system, VA estimates that the number of
women using VA health care services will double in less than five years
if the current enrollment rate continues. In addition, of the more than
102,000 women who have served and separated from military deployment in
Iraq and Afghanistan, over 48,000 have already received health care
from VA. With an unprecedented and increasing number of women in the
military and serving in Iraq and Afghanistan, VA is challenged to
provide consistent, comprehensive, quality health care services to
women veterans today and in the future.
Women returning from combat theaters have unique physical and
mental health care needs. More women servicemembers are being exposed
to combat situations, have experienced sexual trauma during military
service, and need specialized post-deployment and mental health care
services. The increasing demand for services and changing demographics
of this population, coupled with the need to have more clinicians with
women's health expertise, will challenge VA resources and service
delivery systems.
According to VA's own data, women veterans receive lower quality
health care than men and do not consistently receive the recommended
health care services to meet current VA standards. Unfortunately, VA
has moved away from comprehensive women's health clinics in recent
years, favoring a health services model that is fragmented and fails to
adequately address the comprehensive needs of women veterans. It is
critical that women veterans gain access to high quality primary and
gender-specific care, as well as mental health services from qualified
clinicians.
Legislation is needed to ensure women veterans' health programs are
properly assessed and enhanced so that access, quality, safety, and
satisfaction with care are equal for women and men. To improve quality
and reduce disparities in health care services for women receiving VA
care, the Department should conduct a comprehensive long-term,
longitudinal study on the unique health challenges facing women
veterans who have served in combat theatres.
VA must also redesign its women veterans care delivery model and
establish an integrated system of health care delivery that covers a
comprehensive continuum of care and serves as a best practice in the
field. To accomplish this, VA should:
Identify and implement the best clinical models of care to
meet the comprehensive health care needs of women veterans using the VA
health care system;
Improve its ability to assess and treat women who have
experienced combat and/or military sexual trauma; and increase the use
of gender specific, evidence-based treatments; and
Receive sufficient resources to have at least one provider
with women's health care expertise on duty at every VA medical
facility.
traumatic brain injury
Traumatic Brain Injury (TBI), a common injury to OEF/OIF veterans,
can cause devastating and often permanent damage. Even mild-to-moderate
TBI, which can be much harder to diagnose, will often lead to lasting
physical and psychological problems. In addition, many OEF/OIF veterans
have suffered ``mild''--but pathologically significant--brain injuries
that have gone undiagnosed and largely untreated. Behavioral problems,
memory loss, disruptive acts, depression and substance-use disorder are
common symptoms associated with TBI.
According to a RAND study released in April 2008, 19 percent of
returning OEF/OIF servicemembers report possible TBI. The RAND study
estimated that over 300,000 servicemembers had experienced TBI, but
only 44 percent of these had been evaluated by a physician. Veterans
with TBI often have difficulty communicating their health status or
seeking proper assistance. Complicating this situation, many rural
veterans are unable or unwilling to overcome the barrier of distance to
reach the nearest VA medical facility.
In order to detect and treat TBI, proper screening and personalized
recovery plans are essential, particularly for those cases that are
mild-to-moderate in severity. There is also a need to increase DOD and
VA specialists with TBI expertise to assist in identifying and managing
the complex conditions prevalent in this population. To date, DOD lacks
a system-wide approach for identification, management, and surveillance
of individuals who sustain mild-to-moderate TBI in combat, and VA
programs addressing the needs of servicemembers with mild-to-moderate
TBI have not been fully developed or implemented.
More research is necessary to understand the long-term consequences
of TBI, as well as the development of best practices in treating these
injuries. These studies should also focus on older veterans who may
have suffered these injuries in earlier wars, detect mild-to-moderate
cases of TBI, and study their consequences. With Congressional
oversight, we are hopeful that these needs will be met by the Defense
and Veterans Brain Injury Center, one of the Defense Centers of
Excellence, whose mission is to serve active duty military, their
dependents and veterans with TBI through state-of-the-art medical care,
innovative clinical research initiatives, and educational programs. In
addition, we believe that a VA Central Office-based TBI program should
be established which would be an effective means of organizing and
improving VA's responsiveness to veterans with TBI.
mental health care
According to VA, as of August 2008, over 945,000 OEF/OIF
servicemembers have separated from military service. Of those, over
400,000 OEF/OIF veterans have sought VA health care since 2002, and
over 178,483 have received a diagnosis of a possible mental health
disorder. Within that group, 105,465 have been given a probable
diagnosis of Post Traumatic Stress Disorder (PTSD).
The above-mentioned 2008 RAND study estimated that approximately
300,000 OEF/OIF veterans had symptoms of PTSD or major depression with
the best predictor for these conditions being exposure to combat trauma
during deployment. Further, the report stated 53 percent of
servicemembers with PTSD or depression sought help from a provider, but
that 50 percent of those who sought care received minimally adequate
treatment.
Current research strongly suggests that PTSD can be treated
successfully with appropriate therapies and evidence-based treatments.
Although VA has improved its mental health programs in recent years,
the scope of care provided, and its distribution across the 1,400
existing VA sites of health care does not meet the needs of veterans
with post-deployment PTSD, depression, and co-morbid substance use
disorders. VA's National Mental Health Strategic Plan also reveals
systematic shortfalls in veterans' access, and documents gaps in scope
and quality of VA behavioral health programs nationwide.
Congress should continue to oversee implementation of the VA's
National Mental Health Strategic Plan and its Uniform Mental Health
Services initiative. Frequent reports to document progress should be
made to Congressional committees, consumer councils, veterans' service
organizations including DAV, and to VA's Committee on Care of Veterans
with Serious Mental Illness.
VA should reformulate its approach to mental health to focus on
recovery consistent with the principles of the New Freedom Commission
on Mental Health, and VA should fully implement the recommendation of
the Institute of Medicine to embrace these recovery therapies, while
furthering research in PTSD, including research in improved screening
methodologies and stigma reduction techniques.
substance-use disorder
Substance-use disorders are occurring at high rates among OEF/OIF
veterans, based on converging evidence from studies of active duty
personnel and recently discharged veterans. Studies of returning
reservists and active duty members indicate that approximately one
quarter acknowledge an alcohol problem. Rates are higher for those with
multiple deployments, a growing cohort as the war continues. This is
consistent with national studies that find rates of substance use twice
as high among those exposed to serious stress.
Substance use occurs on a continuum ranging from non-problematic
use to hazardous/harmful misuse to abuse to full dependence. For many
of these OEF/OIF veterans their alcohol misuse or abuse is new. Binge
drinking and citations for driving under the influence (DUI) are
characteristic of misuse and abuse in this age population. Many of
these veterans could benefit from short-term and early interventions,
such as motivational counseling, which have proven their efficacy.
Recent surveys of OEF/OIF veterans returning from deployment have
found increasing incidence of alcohol and other substance misuse in
this population. In an anonymous study of active duty personnel by the
DOD, 23 percent of respondents acknowledged having a significant
alcohol problem. Also, an Army study of soldiers serving in Iraq
concluded that while about 12 percent of soldiers reported alcohol
misuse, only 0.2 percent were referred for treatment. Of those
referred, only a small number received care within 90 days of
screening.
Over the past decade, VA's substance use disorder treatment and
rehabilitation services have been in decline. Only recently has VA
begun to re-evaluate, rebuild and expand these specialized programs and
to coordinate these services to address post-deployment mental health
co-morbidities. Currently VA substance abuse treatment programs are
targeted to veterans with severe substance abuse or dependence. Short-
term interventions specifically targeted to veterans with hazardous or
harmful levels of use or early abuse are generally not available.
VA should focus intensive efforts to improve and increase early
intervention and prevention of substance-use disorder in the veteran
population. Ready access to robust mental health and substance-use
treatment programs are critical to avoiding long-term health
consequences post-deployment. VA must also continue moving forward with
a Uniform Mental Health Services policy initiative that includes proper
screening and access to a full continuum of care for substance-use
disorders at all VA facilities. While some progress has been made, the
pace needs to increase.
The DAV thanks this Committee for its efforts last Congress in
passing S. 2162, the Veterans' Mental Health and Other Care
Improvements Act of 2008 (Public Law 110-387). This act, supported by
DAV, requires VA to provide a full continuum of care for substance-use
disorders, including consistent and universal periodic screening in all
its health-care facilities and programs involving OEF/OIF combat
veterans--especially those in primary care. Congress must provide
strong oversight and VA should aggressively enforce and implement these
specialized programs, and ensure that sufficient funding is made
available to achieve these goals.
DAV has been pleased by Congressional responsiveness to many of the
proposals emanating from our Stand Up For Veterans campaign that we
have shared and discussed with Members of this Committee, your staff,
and others in Congress. We thank the Chairman for introducing S. 252,
the Veterans Health Care Authorization Act of 2009. This bill, drawn in
large part from a staff conference package based on S. 2969 of the
110th Congress, contains many provisions that would address our
priorities and concerns. We urge its passage early in this Congress.
Mr. Chairman, this concludes my statement and I would be happy to
answer questions on these issues from you or other Members of the
Committee.
______
Response to Post-Hearing Questions from Hon. Daniel K. Akaka to Adrian
M. Atizado, Assistant National Legislative Director, Disabled American
Veterans
ptsd
Just this morning, the VA Inspector General issued a report on the
Temple, Texas situation. Many will recall that a psychologist at that
facility wrote a strangely worded email which set off a firestorm of
concern for those who are suffering from PTSD. In a word, the IG found
no systemic effort on the part of VA to reduce the number of PTSD
claims via inappropriate diagnosis.
Question 1. Is it your view that mental health issues, and
particularly PTSD, are receiving appropriate attention, in terms of
both compensation and care?
Response.
Compensation:
The VBA recently improved/updated the Rating Schedule criteria for
Traumatic Brain Injury (TBI), which was long overdue. We mention this
because of the interplay between TBI and mental health disability. It
therefore follows that the next logical step is to update the actual
mental health rating criteria for PTSD, which we understand VBA to be
undertaking. These moves by the Administration indeed show a proactive,
albeit slow, approach to implementing changes that are vital to
ensuring this generation's servicemembers receive compensation
commensurate with their disabilities and their resulting limitations.
With regards to obtaining service connection for PTSD, VBA still
requires a veteran to show combat exposure via official military
records, except in certain circumstances, such as diagnosis during
service. For many veterans, this remains a virtual impossibility
because of poor military record keeping, poor Department of Veterans
Affairs (VA) claims' development procedures, or both. As VBA updates
its rating criteria to incorporate 21st century understanding of
disabilities, it too must update its ability, whether through
application or through presumption, to determine who is and is not
considered a combat veteran. We raise this issue in part to bring
attention to the demoralizing reality of, following combat with the
enemy, VA denying compensation to a veteran suffering from the
debilitating effects of PTSD because his/her government refuses to
accept that he/she actually saw combat with the enemy.
Care:
Based on VA's quarterly report on VA health care utilization by
veterans from the wars in Iraq and Afghanistan, the number of VA's
possible diagnoses of PTSD has risen over the past seven years and at a
greater rate of increase between each of the quarterly reports. Such
trends allow VA to better determine the demand for health care services
in the future.
VA has undertaken a monumental transformation of its programs and
services to focus on recovery from mental health conditions and post-
deployment readjustment issues and is under tremendous pressure to
ensure implementation of the VA Mental Health Strategic Plan (MHSP) and
Uniformed Mental Health Services (UMHS) package.
Although the DAV is pleased about VA's UMHS initiative, we are
extremely concerned about the estimated timeline, resources and
staffing levels necessary to establish and freely implement the
initiative. There are many features of the UMHS package that require
transformations, such as recovery-oriented care that clinicians believe
will take years to accomplish. With a national shortage of behavioral
health personnel, we continue to hear reports from mental health
practitioners in the field that the difficulty of recruiting and
retaining behavioral health staff is a major contributing factor to the
delay in spending mental health funding.
Furthermore, VA has been a leader in research on efficacious
interventions for severe PTSD, but, as documented in a November 2007,
Institute of Medicine (IOM) report titled Gulf War and Health: Volume 6
Physiologic, Psychologic, and Psychosocial Effects of Deployment
Related Stress, these effective approaches are complex, expensive, and
time consuming. Prolonged exposure therapy, an intensive specialized
counseling treatment, was highlighted in the IOM report as being one of
the few proven effective treatments supported by evidence-based
research studies. The DAV is concerned that VA does not currently have
the capacity to deliver intensive exposure therapy.
We urge Congress to provide concentrated oversight of spending on
mental health services and require VA to provide a full accounting and
breakdown of resource allocation, distribution and outcomes of the
initiative goals. Oversight of these programs will be critical to their
success.
The DAV believes we too must do our part of oversight as veterans'
advocates. We believe the current advisory committee (the Committee on
Care of Veterans with Serious Mental Illness Liaison Council) should be
re-designated as a Secretary-level committee on mental health, armed
with independent reporting responsibility to Congress. With the
critical new focus on recovery moving away from the paternalistic
doctor patient relationship toward the patient being a partner in
determining the goals and the interventions necessary to achieve
recovery, the DAV believes it is critical to develop recovery
partnerships between VA planners, managers, clinicians, and the veteran
users themselves. The new committee should include experts from both
inside and outside VA; veteran consumers and consumer advocates, such
as veterans service organizations (including the IBVSOs); and mental
health associations concerned about VA programs and the veterans they
serve.
collaboration on the issues
Question 2. How can your organizations collaborate to address the
concerns of those who veterans who are returning after service in Iraq
and Afghanistan?
Response. As a coauthor of The Independent Budget (IB), the DAV
contributed to several articles within the document addressing the
specific needs and concerns of veterans returning from the wars in Iraq
and Afghanistan. The DAV is also one of nine veterans service
organizations that constitute the Partnership for Veterans Health Care
Budget Reform. Recognizing that a change is necessary to ensure that
all eligible veterans--including those injured in Iraq, Afghanistan and
elsewhere--have timely access to the quality medical care they need and
deserve. The Partnership supports legislation in Congress that
guarantees sufficient, timely and predictable funding for veterans
health care.
vba staffing
In light of the increased funding for VBA staffing, there are high
expectations that VBA will improve the quality of claims decisions, and
to do so in a timely manner.
Question 3. What more do you believe Congress could do to assist in
decreasing the backlog, and at the same time, improving timeliness and
accuracy?
Response. In the past couple of years, Congress has provided a
level of VBA funding that has allowed the VA to finally hire what will
hopefully prove to be a sufficient number of claims adjudicators.
However, training and experience both take time. It would be unwise to
remain idle during this interim. Congress must do its part to ensure
that VBA now has the best tools possible to assist both new and
seasoned employees in carrying out the mission of providing timely and
accurate decisions on benefits claims.
In order to meet this goal, the claims' processing system must
become more efficient, but not at the expense of current benefits or
fundamental rights provided by a grateful Nation. The DAV does not
believe such sacrifices are necessary. Congress should seek the
expertise of those that understand the benefits delivery system,
whether inside or outside the agency. Together with these chosen
experts, Congress and the agency should formulate a plan that will
maximize every opportunity for the efficient administration of the
claims process while seeking to enhance training and accountability
without disrupting that process. Simultaneously, the agency should
begin phase-in of new information systems that will allow for partial
electronic claims processing.
If Congress and the VBA can merge these goals into a comprehensive
and cohesive plan, we believe the veterans' community is ready to lend
its support as well so that all may enjoy a claims process worthy of
the sacrifices of those it serves.
oif/oef illnesses
The Committee and, indeed, the full Congress, has focused a great
deal of attention on mental health and TBI matters. Yet, the most
common health condition of returning OEF/OIF veterans is not TBI or
mental illness, but instead muscle and joint pain.
Question 4. Do you have proposals on how to focus on this number
one health concern from those who have served in Iraq and Afghanistan?
Response. To be battle-ready, soldiers deployed to Afghanistan and
Iraq carry, on average, a combat load of about 92.6 lbs (13 lbs for
electronics, 55 lbs for Uniform and Equipment, 24 lbs for the Weapon)
but can often carry 120 pounds or more including body armor, helmets,
canteens, weapons and other gear that soldiers strap in addition to the
``monster rucksack.''
For purposes of prevention against the natural rigors of military
service, the DAV believes much work has been done and is currently
underway to address the weight distribution and burden of the foot
soldier to decrease the potential work-related musculoskeletal
injuries. For example, weight reduction and function improvement in
products include: Lightweight Helmets (Marines)/Modular Integrated
Communication Helmet (Army). Both have about a 40 percent improvement
in impact protection, increased durability and ergonomics, and a half-
pound reduction. The Improved Load Bearing Equipment (Marines), or
rucksack, weighs 8.43 pounds and can hold up to 120 pounds and like the
Army's Modular Lightweight Load-carrying Equipment, both systems are an
improvement in load-carrying ability, with new suspension systems that
are adjustable for varying torso lengths and better weight distribution
at the shoulders and hips. The Modular Tactical Vest (Marines) weighs
1-2 lbs more than the decade-old Interceptor body armor, but offers
more protection with the side armor, and several other additions, and
is designed to more effectively distribute its weight throughout the
wearer's torso. The Army's Interceptor Outer Tactical Vest is more than
3 pounds lighter than its predecessor, but provides an equal level of
protection over an increased area. Other improvements have been made to
individual equipment such as the Modular Sleep System which weighed
less than its predecessor and a replacement with an Improved Sleeping
System is underway.
Body armor, rapid transport, and other life saving inventions have
exponentially improved survival and care for soldiers during the wars
in Iraq and Afghanistan. However, the treatment of their pain during
medical transit from battlefield to combat hospitals is still often
treated only with morphine which can cause side effects such as nausea,
vomiting and respiratory depression, which are not experienced with the
use of regional anesthesia. We believe that the innovative work being
conducted by Army Lt. Col. (Dr.) Chester C. Buckenmaier III, chief of
the regional anesthesia section at Washington's Walter Reed Army
Medical Center (WRAMC) warrants the Committee's attention.
Regional anesthesia affects a specific part of the body and allows
for a patient to remain mostly cognizant during an operation, whereas
general anesthesia affects the entire body. Patients that undergo
regional anesthesia are found to have a quicker recovery time after
surgery than those that undergo general anesthesia because they are not
completely sedated, and they do not suffer the negative side effects of
general anesthesia. Using a type of regional anesthesia called
continuous peripheral nerve block (CPNB) is considered by experts as an
important therapeutic tool in the anaesthetic and analgesic management
of combat casualties at WRAMC.
Lt. Col. Buckenmaier moved CPNB closer to the battlefield (21st
Combat Support Hospital in Balad, Iraq) where he performed the first
successful application of CPNB for pain management on SPC Brian Wilhelm
in theater through evacuation. Expanding this program would require
more physicians and CRNAs in the Army with the necessary training in
advanced regional anesthesia.
It is clear that the use of regional anesthesia such as CPNB is not
meant as a primary anesthetic for every situation and it is not meant
as a total replacement for the use of general anesthesia. However,
benefits to the patient in the immediate are apparent. Research shows
early and effective pain management in acute pain care is important to
prevent the development of chronic painful conditions.
In the VA, a recent study of Operation Iraqi Freedom and Operation
Enduring Freedom (OIF/OEF) servicemembers receiving treatment in VA
Polytrauma Centers found that pain is highly prevalent. The study also
noted in its clinical implications that pain should be consistently
assessed, treated, and regularly documented. The report concluded that
poly-traumatically injured patients are at potential risk for
development of chronic pain, and that aggressive and multidisciplinary
pain management (including medical and behavioral specialists) is a
necessity. The report suggested the phenomenon of pain is a new
opportunity for VA research in evaluating long term outcomes;
developing and evaluating education or policy initiatives designed to
improve the consistency of assessment and treatment of pain across the
VA continuum of care; and developing and evaluating valid pain
assessment measures for the cognitively impaired.
Regarding pain assessment and treatment for the cognitively
impaired, OIF/OEF servicemembers and veterans, who suffer from
Traumatic Brain Injury, or TBI, pose a unique problem with assessing
pain. Poly-traumatic injury includes veterans suffering from TBI and
amputation, auditory and visual impairments, spinal cord injury, mental
health conditions and burns, not to mention a whole host of fractures
and crushing and soft tissue trauma.
According to the Defense and Veterans Brain Injury Center (DVBIC),
some experts have estimated the incidence of TBI among wounded
servicemembers to be as high as 22%. Between January 2003 and March 31,
2008, DVBIC military, VA and civilian sites combined have seen a total
of 6,602 patients with TBI. According to the VA, 60% or more of
polytrauma survivors have some degree of brain injury. Brain injury is
the most frequent problem treated at Polytrauma Rehabilitation Centers.
With impaired cognition and communication skills, servicemembers and
veterans suffer from attention and concentration deficits; memory
problems; Problems with learning new skills and higher order reasoning.
Such things affect a patient's ability to report pain, its severity and
effectiveness of treatment. Moreover, an impaired patient is vulnerable
to under-treatment and over-treatment.
While there are consensus statements regarding assessing pain in
cognitively impaired and non-verbal patients, these guidelines are
based on studies in the elderly, children and persons who are intubated
or unconscious. No tools have been validated for cognitively impaired
polytrauma patients--younger adults with brain injuries--even though
prevalence of pain after TBI has been estimated at 44% or more
(Martelli et al, 2004; Sherman, et al, 2006).
Given our concerns about implementation and standardization of pain
assessment and treatment across the VA system, the DAV testified on
June 5, 2008, before the House Committee on Veterans' Affairs
Subcommittee on Health and on October 23, 2007, before the Senate
Committee on Veterans' Affairs on the Veterans Pain Care Act of 2008,
H.R. 6122 and S. 2160, respectively. We thank the Committee for its
work to include the provisions of this bill, which were included in the
Veterans' Mental Health and Other Care Improvements Act of 2008 (Public
Law 110-387, Sec. 501). We believe the goals of this provision are
laudable and in accord with providing high quality, comprehensive
health care services to sick and disabled veterans. Having been signed
into law, we believe strong oversight of VA's progress implementing
these provisions is necessary.
outreach
Question 5. How are your organizations, individually or in some
cooperative fashion, working to outreach to veterans and encourage them
to take advantage of VA care and services?
Response. The DAV has an outreach program that includes our
National Service Program for Veterans and Military Servicemembers,
Mobile Service Office (MSO) Program, Information Seminars, Homeless
Veterans, and Disaster Relief.
National Service Program for Veterans:
Our largest endeavor in fulfilling our mission to serve our
Nation's service-connected disabled veterans, their dependents and
survivors is our National Service Program. In 88 offices throughout the
United States and in Puerto Rico, the DAV employs a corps of
approximately 260 National Service Officers (NSOs) who represent
veterans and their families with claims for benefits from the VA, the
DOD and other government agencies. Veterans need not be DAV members to
take advantage of this outstanding assistance, which is provided free
of charge.
NSOs function as attorneys-in-fact, assisting veterans and their
families in filing claims for VA disability compensation and pension;
vocational rehabilitation and employment; education; home loan
guaranty; life insurance; death benefits; health care and much more.
They provide free services, such as information seminars, counseling
and community outreach. NSOs also represent veterans and active duty
military personnel before Discharge Review Boards, Boards for
Correction of Military Records, Physical Evaluation Boards and other
official panels.
National Service Program for Military Servicemembers:
Transition Service Officers (TSOs) conduct or participate in pre-
discharge transition assistance briefings, the Disability Transition
Assistance Program (DTAP), the Transition Assistance Program (TAP),
review service treatment records, and confer with Department of Defense
and Department of Labor facilitators and other participants in the
discharge process. The TSO program also allows DAV to assist
servicemembers in the development of evidence, completion of required
applications and prosecution of claims for veterans benefits
administered under Federal, state and local laws.
Mobile Service Office Program:
Part of their outreach activities involves DAV's MSO Program
designed to educate disabled veterans and their families on specific
veterans' benefits and services.
This outreach program generates considerable claims work on behalf
of veterans and their families. NSOs, often aided by Department and
Chapter Service Officers, travel to communities across the country to
counsel and assist veterans with development of evidence, completion of
required applications and prosecution of claims for veterans benefits
administered under Federal, state and local laws.
This program was revitalized in March 2001 and is the most
extensive outreach effort in the history of our organization. Thanks to
the generosity of a $1 million pledge from the Harley-Davidson
Foundation in 2007, the DAV expanded the sites visited by the MSO to
include Harley-Davidson dealerships, where benefits assistance is
offered to veterans of all generations in communities where they live.
These distinctive-looking and well equipped ``offices on wheels''
eliminate long trips some veterans in smaller towns and rural
communities must take to visit our National Service Offices. The MSO
program enhances DAV service to more veterans and their families.
Information Seminars:
DAV's Veterans Information Seminars program is designed to educate
disabled veterans and their families on specific veterans' benefits and
services.
This outreach program generates considerable claims work on behalf
of veterans and their families. The job of the NSO is to seek out
veterans, to discover if they have a claim, and to follow that claim
through to a successful conclusion.
DAV NSOs conduct these workshops and offer the best counseling and
claim filing assistance to veterans and their dependents. This
exceptional service is available free of charge and does not require
DAV membership to take advantage of this
service.
Homeless Veterans:
The DAV helps homeless veterans make the transition from life on
the streets to one of productivity and normalcy. Our motto, ``We Don't
Leave our Wounded Behind,'' is a heartfelt principle, a rule, and a
promise that we, as a grateful Nation, must keep. We must remain
steadfast in our efforts to fulfill our promise to veterans by ensuring
that no veteran who honorably served his or her country is ever left
behind.
The DAV Homeless Veterans Initiative, which is supported by DAV's
Charitable Service Trust and Columbia Trust, promotes the development
of supportive housing and necessary services to assist homeless
veterans become productive, self-sufficient members of society. Our
goal is to establish a partnership between the DAV and Federal, state,
county, and local governments to develop programs to assist homeless
veterans in becoming self-sufficient.
Without question, proper VA assistance--including health care,
substance abuse treatment, mental health services, education, and job
training, etc.--will enable homeless veterans to improve their
situations and begin the transition to once again become productive
members of the society they served and defended.
Disaster Relief:
The September 11, 2001 terrorist attacks were tragic and terrifying
to say the least. Many veterans and their families who were adversely
impacted by the tragic events visited our NSOs who provided these
individuals with DAV Disaster Relief grants on the spot, without
lengthy delays or red tape.
The Gulf Coast hurricanes, the Iowa floods, tornados and fires are
just some of the natural disasters that have adversely impacted
veterans and their families. As many residents of stricken areas were
evacuated to other communities, the DAV assisted qualified veterans at
the various evacuation sites, and participated in outreach events
coordinated by the VA.
The DAV has provided millions of dollars in disaster relief grants
in the aftermath of natural disasters and other emergencies in various
areas around the Nation. DAV disaster relief grants may be issued for
the purpose of providing food, clothing, and temporary shelter, or to
obtain relief from injury, illness, or personal loss resulting from
natural/national disasters that are not covered by insurance or other
disaster relief agencies.
women veterans
Question 6. VA has said that sufficient programs and funding
already exist to care for women veterans. What would you point to as
specific problems or shortfalls with respect to women veterans and what
do you recommend that the Committee do to address these concerns?
Response. The numbers of women now serving in our military forces
are unprecedented in U.S. history and today, women are playing
extraordinary roles in the conflicts in Afghanistan and Iraq. They
serve as combat pilots and crew, heavy equipment operators, convoy
truck drivers, and military police officers and serve in many military
occupational specialties that expose them to the risk of combat,
serious injury and death.
As the population of women veterans undergoes exponential growth
over the next decade, VA must act now to prepare to meet the
specialized needs of the women who served. Overall, the culture of VA
needs to be transformed to be more inclusive of women veterans and must
adapt to the changing demographics of its women
veteran users, taking into account their unique characteristics as
young working women with child care and elder care responsibilities. VA
needs to ensure that women veterans' health programs are enhanced so
that access, quality, safety, and satisfaction with care are equal for
women and men. We refer you to specific recommendations outlined in the
``Women Veterans Health and Health Care Programs'' article in the
Fiscal Year 2010 IB document, which is accessible online at
www.independentbudget.org.
paperwork
Question 7. What is your organization's opinion of VA's expanded
paperwork protection policy that came about as a result of the
Inspector General's audit which found that VA regional office personnel
had mishandled some claims documents--is VA's new policy on shredding
appropriate?
Response. The DAV is glad to see that VA's own internal controls
discovered the issue of document shredding. We are also pleased with
VBA's actions downstream of their discovery. Government employees
normally enjoy a presumption of law that they carried out their duties
absent evidence they did not. It was therefore a near total requirement
that such presumption be relaxed in the face of systematic record
destruction.
We are nonetheless concerned with the seemingly arbitrary dates VA
chose to employ in the foregoing relaxed standards. That noted, we
realize the difficulty in choosing any set of dates to relax
evidentiary standards of proof regarding record submission.
Moreover, the veteran community wants to see accountability. VA
employees that destroy records that may otherwise prove beneficial to
claimants perpetrate fraud upon VA beneficiaries. Title 38, United
States Code, contains clear guidelines for punishment, such as fines
and imprisonment, for claimants who defraud the government, but no
equal guidelines for VA employees who commit similar acts. Such a
legislative amendment would go far in healing wounds caused by these
dishonorable acts.
stimulus
Question 8. The Senate stimulus package includes appropriations for
VA, especially $3.7 billion included for VA infrastructure projects.
What are your views?
Response. The stimulus package recommends a total of $3.574 billion
to address VA's infrastructure needs, including support, oversight,
implementing a new ``energy efficiency initiative,'' and an additional
$195 million for development of paperless claims processing and
development of systems required to implement the Post-9/11 G.I. Bill.
The DAV has a resolution from its membership urging VA to redouble
its efforts to request adequate funding in future budgets to ensure at
minimum that VA fulfills the intent of its Capital Asset Realignment
for Enhanced Services (CARES) initiative while examining other needs
beyond those identified within the five-year period of the CARES
initiative. Moreover, the resolution also urges Congress to provide
appropriated funding sufficient to fulfill the needs for infrastructure
identified through the CARES process, plus any other infrastructure
needs VA identifies and justifies in the post-CARES period.
As part of the IB, the DAV believes the ongoing implementation of
VA's CARES indicates a large number of significant construction
priorities. While Congress has provided $4.9 billion since fiscal year
2004, the current backlog of partially funded CARES projects requires
additional funding for completion. Furthermore, VA recently estimated
major facility projects over the next five years would require over
$6.5 billion. As the IB recommended a total of $2.252 billion for VA
construction.
The DAV also recognized the importance of State Veterans Homes that
is providing more of VA's long-term care services to our Nation's aging
and disabled veterans. Based on VA's mandated priority list for pending
State Home construction grant applications for fiscal year 2009, there
exists $434 million in Priority Group 1 applications for which the
State has set aside matching funds. Applications in Priority Group 2-7
would require $531 million. We support the $258 million provision in
the stimulus package for the construction grants of State Veterans
Homes.
Finally, in our testimony before the Committee, the DAV believes
the cumbersome and lengthy administrative claims and appeals process
can be streamlined (1) by merging and eliminating redundancies within
the benefits delivery system, and (2) integrating its electronic
framework into a single, state-of-the-art information system to create,
as much as practical, a new electronic claims process. Accordingly, we
support the $195 million provision for the development of a paperless
claims processing system.
______
Questions for the Record from Senator Bernard Sanders to Adrian M.
Atizado, Assistant National Legislative Director, Disabled American
Veterans
extended and different hours for va services
As I mentioned in my opening remarks, I have heard from many
veterans who want to get to the VA for care but they can't make it
because of work. I believe we need to increase accessibility of the VA
to all types of veterans, including those with full-time jobs, by
providing evening and weekend hours so that people won't have to choose
between going to work and keeping a VA appointment. This could also
help reduce missed appointments which waste time and resources of VA
staff. My office is currently exploring what kind of authority VA needs
to begin providing extended hours on a one night a week and one weekend
day a week basis, possibly in the form of a pilot program.
Question. What do members of the panel think about this idea?
Response. As then Secretary of Veterans Affairs Jim Nicholson
stated, ``Illness doesn't follow a 9-to-5 schedule.'' He directed VA
medical centers to provide extended hours to ensure veterans are able
to receive the medical care they earned. (June 15, 2007 VA Press
Release).
Moreover, in an attempt to better manage patient access to care, VA
began a process several years ago of reengineering its clinic patient
flow through the ``Advanced Clinic Access Initiative'' developed by the
Institute for Health Improvement (IHI). The strategy emphasizes
managing demand in order to improve patient flow and thus access to
services, all within existing capacity constraints.
In the VA New Jersey Health Care System, staff applied advanced
access strategies first to primary care clinics and then specialty
clinic. In reporting the results of this implementation, working down
the backlog of appointments required adding appointments and clinic
hours for a finite period of time--again, within existing resources.
VHA contracted Booz Allen Hamilton to conduct an independent review
of its scheduling process and metrics in response to VA Office of
Inspector General (OIG) reports in 2005, 2007, and 2008, that found
reported outpatient waiting times to be unreliable. In its final
report, Booz Allen Hamilton made a number of recommendations including
VA needing to take aggressive steps to use fixed infrastructure more
efficiently. These strategies include providing services at off-peak
hours, such as early mornings, evenings, and Saturdays, when fixed
assets are, currently, largely unused. To do this effectively,
facilities should conduct surveys to understand which veterans would
use which services during alternate hours.
We believe extending operating hours of VA clinics is a reasonable
solution to increase capacity and access if there is corresponding
increase in resources to mitigate any adverse effects of increased
workload on participating health care providers and support personnel.
Chairman Akaka. Thank you very much, Mr. Atizado. And now
we will hear from Mr. Bowers.
STATEMENT OF TODD BOWERS, DIRECTOR OF GOVERNMENT AFFAIRS, IRAQ
AND AFGHANISTAN VETERANS OF AMERICA
Mr. Bowers. I would just like to point out he got that in
at 5 minutes exactly. Well done.
Mr. Chairman, Ranking Member and Members of the Committee,
thank you for inviting the Iraq and Afghanistan Veterans of
America to testify here today and for giving us the opportunity
to present our 2009 legislative agenda.
On behalf of IAVA and our more than 125,000 members and
supporters, I would also like to thank you for your unwavering
commitment to our Nation's veterans.
And I would also like to thank you all for braving the ice
this morning to make it to this hearing. Maybe next year, we
can do it in Hawaii, though that is not a formal
recommendation.
After 7 years of war, it has never been more critical to
care for our Nation's veterans. I know because I am one of
them. I still serve as a staff sergeant in the United States
Marine Corps, and I should point out that my testimony today
does not reflect the views or opinions of the Marine Corps.
At IAVA, we are committed to making sure that no
servicemember and no veteran is ever left behind. The mission
of IAVA is to improve the lives of more than 1.7 million Iraq
and Afghanistan veterans and their families.
IAVA is proud to have worked with our fellow VSOs in local
communities, with the media and in Washington to draw attention
to the issues facing our troops and veterans, and to get those
problems solved. Over the past 4 years, IAVA has grown into a
driving force behind many legislative victories for veterans.
In 2008, we saw unprecedented success. First and foremost
was the passage of the new GI Bill which will ensure affordable
college education for all veterans of Iraq and Afghanistan.
IAVA also worked to increase health care funding by $4.5
billion, to improve benefits for disabled veterans, to expand
suicide prevention and to improve treatment for Traumatic Brain
Injury. We have effectively partnered with many other veteran
and military service organizations and also the Department of
Defense, the Department of Veterans Affairs and Members of
Congress to make these successes a reality.
In 2008, IAVA launched a historic public service
advertising campaign in partnership with the Ad Council. The
groundbreaking multiyear effort seeks to ease the readjustment
for servicemembers coming home from Iraq and Afghanistan.
Extensive research was conducted to develop the Veteran Support
Campaign, including focus groups around the country, extensive
consultation with Iraq and Afghanistan veterans and the
involvement of a panel of top mental health experts.
All PSAs direct viewers to the first and only online
community exclusive to Iraq and Afghanistan veterans. This
innovative Web site will help veterans connect with one another
and link them with comprehensive services, benefits assistance
and mental health resources.
A companion PSA campaign will be launched in 2009 that will
engage and support the families and loved ones of Iraq and
Afghanistan veterans. This is the most extensive veterans'
public outreach by a non-profit in history, and we hope it will
provide not only much-needed services but innovations and
lessons learned to be shared and replicated by the VA and DOD.
While we have accomplished landmark successes in 2008,
thanks in large part to the work of this Committee, there is
still more to do. We are hopeful the new administration and the
new Congress will continue to focus on veterans' issues.
Our 2009 legislative agenda, based on extensive processes
of polling and seeking feedback from our 125,000-strong
membership, makes recommendations in four areas crucial to
today's veterans: mental health, homecoming, health care and
government accountability.
Attached you will find the complete legislative agenda and
the IAVA legislative priorities. We have also provided hard
copies for your convenience.
At this time, I would like to highlight just a few of the
most urgent issues facing Iraq and Afghanistan veterans.
Ensuring thorough, professional and confidential screening
for invisible injuries: IAVA supports mandatory, face-to-face
and confidential mental health and TBI screenings by a licensed
medical professional for all servicemembers before and after
their combat tour. The goal of this is to remove the stigma and
seal the crack that many veterans and servicemembers tend to
fall through.
Senator Burr, I could not agree with your comments more,
that getting veterans in fast is the key to solving these
problems.
Of our membership that we were able to poll, those who
sought treatment, 70 percent said it was useful. So the key is
getting them in the door.
Advance fund veterans' health care. Advance fund veterans'
health care, emphasis. The best way to ensure timely funding of
veterans' health care is to fully fund the Department of
Veterans Affairs health care budget 1 year in advance. In
addition, IAVA endorses the annual Independent Budget produced
by leading veterans service organizations, including IAVA, as a
blueprint for VA funding levels.
I also agree with many of my members at the table today
that this is key to ensuring that servicemembers get the
appropriate care they need.
Ending the passive VA System: The VA has traditionally been
a passive, inward-looking system. Veterans must overcome
tremendous bureaucratic obstacles to get the funding and
services that the VA provides. Many veterans do not even know
the benefits they are eligible for. The VA must develop a
national strategy to promote the use of its services including
advertising VA benefits, expanding VA outreach and modernizing
the VA's online presence.
Of our poll, we found that 72 percent of our members had
visited the VA Web site, and their responses are, well, I just
will not say any here today.
We also had in our priorities veterans in the economic
stimulus package. We have seen great successes already, and I
thank the Committee for your work on this issue.
Finally, to correctly implement the new GI bill: The
historic Post-9/11 GI Bill, passed last year, included a
provision to allow servicemembers to transfer their GI Bill
education funding to a spouse or dependent. But the Congress
and the Administration can and must keep the bureaucracy moving
to keep this benefit a reality. Our office regularly receives
phone calls where servicemembers are wondering when they are
going to have this benefit and how will they understand it? And
we do not have those answers yet.
That concludes my testimony at this time. I thank the
Committee. I will be happy to answer any questions.
[The prepared statement of Mr. Bowers follows:]
Prepared Statement of Todd Bowers, Director of Government Affairs, Iraq
and Afghanistan Veterans of America
Mr. Chairman, Ranking Member, and Members of the Committee, thank
you for inviting Iraq and Afghanistan Veterans of America (IAVA) to
testify today, and for giving us the opportunity to present our 2009
Legislative Agenda. On behalf of IAVA and our more than 125,000 members
and supporters, I would also like to thank you for your unwavering
commitment to our Nation's veterans.
After seven years of war, it has never been more critical to care
for our Nation's newest warriors. I know, because I am one of them. I
still serve as Staff Sergeant in the United States Marine Corps. I have
served two tours in Iraq, and just returned from an additional
deployment last summer. At IAVA, we are committed to making sure that
no servicemember, and no veteran, is ever left behind. The mission of
IAVA is to improve the lives of the more than 1.7 million Iraq and
Afghanistan veterans and their families. IAVA addresses critical issues
facing our newest generation of heroes, including psychological and
neurological injuries, a flawed disability benefits system, and the
implementation of the historic new GI Bill. Founded in 2004 by a small
group of Iraq veterans, IAVA is dedicated to educating the public about
the wars in Iraq and Afghanistan, advocating on behalf of those who
have served, and fostering a community for troops, veterans, and their
families.
IAVA is proud to have worked in local communities, with the media,
and in Washington to draw attention to the issues facing our troops and
veterans, and to get those problems solved. Over the past four years,
IAVA has grown into a driving force behind many legislative victories
for veterans. In 2008, we saw unprecedented success. First and foremost
was the passage of the new GI Bill, which will ensure an affordable
college education for all veterans of Iraq and Afghanistan. IAVA also
worked to increase veterans' health care funding by $4.5 billion, to
improve benefits for disabled veterans, to expand suicide prevention,
and to improve treatment for Traumatic Brain Injury. We have
effectively partnered with many other Veteran and Military Service
Organizations, the Department of Defense, the Department of Veterans
Affairs and Members of Congress to make these successes a reality.
We're the new kids on the block, but we have made a substantial impact,
in a very short time. All in all, IAVA saw progress on 20 of our 28
legislative recommendations in 2008.
In 2008, IAVA also launched a historic Public Service Advertising
(PSA) campaign in partnership with the Ad Council. The groundbreaking,
multiyear effort seeks to ease the readjustment for servicemembers
returning home from Iraq and Afghanistan. Joining such iconic Ad
Council PSA campaigns as ``Only You Can Prevent Forest Fires'' and
``Friends Don't Let Friends Drive Drunk,'' the groundbreaking Veteran
Support campaign will feature TV, radio, print and online PSAs, both in
English and in Spanish. Extensive research was conducted to develop the
Veteran Support Campaign, including focus groups around the country,
extensive consultation with Iraq and Afghanistan veterans, and the
involvement of a panel of top mental health experts. All PSAs direct
viewers to the first and only online community exclusive to Iraq and
Afghanistan veterans, www.CommunityofVeterans.org. This innovative Web
site will help veterans connect with one another and link them with
comprehensive services, benefits assistance, and mental health
resources. A companion PSA campaign launching in 2009 will engage and
support the families and loved ones of Iraq and Afghanistan veterans.
This is the most extensive veterans public outreach by a non-profit in
history, and we hope it will provide not only much needed services, but
innovation and lessons learned to be shared and replicated by the VA,
and DOD.
While we have accomplished landmark successes in 2008, thanks in
large part to the work of this Committee, there is still more to do. We
are hopeful the new Administration, and the new Congress, will continue
to focus on veterans issues. Our 2009 IAVA Legislative Agenda, based on
an extensive process of polling and seeking feedback from our 125,000-
strong membership, makes recommendations in four areas crucial to
today's veterans: Mental Health, Homecoming, Healthcare and Government
Accountability.
Attached you will find out complete Legislative Agenda, and the
IAVA Legislative Priorities. At this time, I'd like to highlight just a
few of the most urgent issues facing Iraq and Afghanistan veterans.
Ensure Thorough, Professional, and Confidential Screening for
Invisible Injuries. IAVA supports mandatory, face-to-face and
confidential mental health and TBI screening by a licensed medical
professional, for all servicemembers, before and after their combat
tour.
Advance-Fund Veterans' Health Care. The best way to ensure timely
funding of veterans' health care is to fully fund the Department of
Veterans Affairs (VA) health care budget one year in advance. In
addition, IAVA endorses the annual Independent Budget, produced by
leading veterans' organizations (including IAVA), as a blueprint for
the VA funding levels.
End the Passive VA System. The VA has traditionally been a passive,
inward-looking system. Veterans must overcome tremendous bureaucratic
obstacles to get the benefits and services that the VA provides. Many
veterans do not even know what benefits they are eligible for. The VA
must develop a national strategy to promote the use of its services,
including advertising VA benefits, expanding VA outreach, and
modernizing the VA's online presence.
Prioritize Veterans in the Economic Stimulus Package. Caring for
our veterans isn't just the right thing to do--it a sound economic
investment. IAVA calls for tax credits for patriotic employers that
hire new veterans and reservists, support for veterans struggling with
student loans, and investment in shovel-ready projects like repairing
veterans' hospitals and cemeteries.
Correctly Implement the New GI Bill. The historic Post-9/11 GI
Bill, passed last year, included a provision to allow servicemembers to
transfer their GI Bill education funding to a spouse or dependent. But
Congress and the Administration can and must keep the bureaucracy
moving to make this benefit a reality.
Thank you for your time.
______
Iraq and Afghanistan Veterans of America
2009 Legislative Agenda
legislative priorities
The IAVA Legislative Priorities are the most urgent actions
Congress must take to ensure that veterans of Iraq and Afghanistan get
the care and support they have earned.
A. Ensure Thorough, Professional, and Confidential Screening for
Invisible Injuries
IAVA supports mandatory, face-to-face and confidential mental
health and TBI screening by a licensed medical professional, for all
servicemembers, before and after their combat tour. See recommendation
1.1.
B. Advance-Fund Veterans' Health Care
The best way to ensure timely funding of veterans' health care is
to fully fund the Department of Veterans Affairs (VA) health care
budget one year in advance. In addition, IAVA endorses the annual
Independent Budget, produced by leading veterans' organizations
(including IAVA), as a blueprint for the VA funding levels. See
recommendation 3.1.
C. End the Passive VA System
The VA has traditionally been a passive, inward-looking system.
Veterans must overcome tremendous bureaucratic obstacles to get the
benefits and services that the VA provides. Many veterans do not even
know what benefits they are eligible for. The VA must develop a
national strategy to promote the use of its services, including
advertising VA benefits, expanding VA outreach, and modernizing the
VA's online presence. See recommendations 1.2, 2.4, and 3.2.
D. Combat Veterans' Unemployment
IAVA supports the expansion of employment training for troops
leaving the military, tax credits for employers who hire troops and
veterans, and a new ``Green-to-Green'' program to retrain veterans for
high-paying jobs in the clean energy economy. See recommendation 2.3.
E. Cut the Claims Backlog in Half
Hundreds of thousands of disabled veterans are awaiting an answer
on their VA benefits claims. Errors in claims decisions are a primary
source of the backlog. IAVA recommends a new evaluation system that
holds claims processors accountable for the accuracy of their work. See
recommendation 3.2.
F. Improve Health Care for Female Veterans
11 percent of Iraq and Afghanistan veterans are women. They deserve
the same access to health care as any other American veteran. IAVA
supports prioritized hiring of female practitioners and outreach
specialists, increased funding for specialized in-patient women-only
PTSD clinics, and significant expansion of the resources available to
women coping with Military Sexual Trauma. See recommendations 1.2, 3.3
and 3.5.
G. Eradicate Homelessness Among Veterans
About 150,000 veterans are homeless on any given night, and
foreclosure rates in military towns are increasing at four times the
national average. IAVA calls for 20,000 new HUD-VA Supportive Housing
vouchers, an increase in the Grant and Per Diem allowances for
community organizations to help homeless veterans, and an extensive
outreach campaign to promote VA home loan and financial counseling
services. See recommendation 2.4.
i. mental health
Rates of psychological and neurological injuries among troops and
new veterans are high and rising. But many troops and veterans are not
getting the treatment they need.
In a landmark 2008 RAND study, ``Invisible Wounds of War,'' almost
20 percent of Iraq and Afghanistan veterans screened positive for Post
Traumatic Stress Disorder (PTSD) or major depression. But less than
half of those suffering from mental health injuries are receiving
sufficient treatment. Multiple tours and inadequate time at home
between deployments increase rates of combat stress.
Troops in Iraq and Afghanistan are also facing neurological damage.
When troops are near an exploding mortar or roadside bomb, the blast
can damage their brains, often without leaving a visible injury. The
vast majority of Traumatic Brain Injuries (TBIs) are mild or moderate.
But the injury is widespread: 19 percent of troops report a probable
TBI during deployment. Tens of thousands of troops are suffering from
both psychological and neurological injuries.
Untreated mental health problems can and do lead to family issues,
substance abuse, homelessness and suicide. For female servicemembers in
particular, divorce rates are very high; female soldiers faced an 8.8
percent annual divorce rate, more than 2.5 times the national average.
As of December 2008, there have been at least 196 military suicides in
Iraq and Afghanistan. These numbers do not include the many veterans
who commit suicide after their service is complete, whose fatalities
are not tracked or reported.
Troops and veterans face significant barriers to mental health
care. The Department of Defense (DOD) relies on an ineffective,
antiquated system of paperwork to conduct mental health evaluations,
and access to mental health care is difficult. According to the
Pentagon's Task Force on Mental Health, the military's ``current
complement of mental health professionals is woefully inadequate.'' The
National Defense Authorization Act for 2009 singled out mental health
professionals as a critically short wartime specialty, and authorized
new recruitment and multi-year retention bonuses for psychologists. But
as of December 2008, the bonuses had yet to be implemented.
Effective treatment is also scarce for veterans who have left the
military. The VA has given mental health diagnoses to more than 178,000
Iraq and Afghanistan veterans, or 45 percent of new veterans who visit
the VA. But VA care is not always convenient. Veterans in rural
communities are especially hard hit, and the availability and quality
of health care for female veterans ranges widely.
Exacerbating the problem of inadequate screening and treatment is
the heavy stigma associated with receiving mental health treatment.
More than half of soldiers and Marines in Iraq who test positive for a
psychological injury report concern that they will be seen as weak by
their fellow servicemembers. One in three of these troops worry about
the effect of a mental health diagnosis on their career. As a result,
many troops who need care do not seek it out.
To learn more about troops' and veterans' psychological injuries,
please see the 2009 IAVA Issue Report, ``Invisible Wounds:
Psychological and Neurological Injuries Confront a New Generation of
Veterans.'' All IAVA reports are available at www.iava.org/reports.
Mental Health Recommendations
1.1 Ensure Thorough, Professional, and Confidential Screening for
Invisible Injuries
The Defense Department must supply mandatory, face-to-face
and confidential mental health and TBI screening by a licensed medical
professional, for all servicemembers, before and between 90 and 180
days after return from combat.
To maximize the effectiveness of the TBI Veterans Health
Registry, the DOD and the VA should establish a joint protocol to share
existing and future operational situation reports (SITREPS) of all
servicemembers exposed to blasts and other causes of head and neck
injury.
1.2 Advertise VA Mental Health Services
The VA must receive specially-allocated funds to research,
test and implement an effective national and local media strategy, that
includes use of new and traditional media, to combat stigma and to
promote the use of VA services such as Vet Centers and the Suicide
Prevention hotline. The VA's campaign strategy should include a
comprehensive plan to involve Veterans Service Organizations, and
should promote behavioral and mental health services to underserved
groups, including homeless veterans, rural veterans and female
veterans.
1.3 Increase Mental Health Support for Military Families
Vet Centers should be authorized and funded to provide
services to active-duty military servicemembers and their families.
IAVA supports the expansion of VA mental health services to veterans'
families, including children, parents, siblings and significant others,
if the veteran is receiving VA treatment for mental health or
behavioral health problems.
Adequate funding must be provided to implement fully the
National Guard and Reserve Yellow Ribbon Reintegration Program, which
provides reintegration training to reserve component troops and their
families.
IAVA calls for a study to better identify the causes of
marital strain and high divorce rates among active and reserve
component servicemembers, including multiple deployments, mental health
injuries, and gaps in family support programs, particularly for the
families of female servicemembers.
IAVA supports funding for an independent review of the
scope of family violence in the military, and an analysis of the
effectiveness of the Department of Defense's response to the problem.
1.4 Combat the Shortage of Mental Health Professionals
DOD must implement a full range of special pays, including
accession and multi-year retention bonuses, as well as incentive and
bonus pays, at a sufficient level to effectively recruit and retain
critically needed behavioral and mental health professionals. Congress
should require a biannual report on the implementation and
effectiveness of the current recruitment and retention bonuses for
mental health professionals.
IAVA supports providing suicide prevention training within
combat life-saver training, the emergency medical training troops
receive from combat medics.
1.5 Address the Mental Health Needs of Female Troops and Veterans
IAVA supports increased funding for specialized in-patient
women-only PTSD clinics.
To improve the quality of health care for female veterans,
Vet Centers and VA medical facilities must be encouraged to hire female
practitioners and outreach specialists, and especially female veterans.
The veterans' suicide hotline operators should receive
additional training to respond to sexual assault-related calls.
IAVA supports increased funding for the Department of
Defense's Sexual Assault Prevention and Response Office in order for it
to expand its oversight role.
1.6 End Discrimination against Psychologically Wounded Troops
To ensure that servicemembers suffering from service-
connected psychological or neurological injuries have not been
improperly discharged, IAVA recommends imposing an immediate moratorium
on personality disorder discharges for combat veterans until an audit
of past personality discharges is completed.
When troops seek voluntary alcohol and substance-abuse
counseling and treatment, command notification should be at the
discretion of the treating mental health professional.
ii. homecoming
Even in the best of times, troops coming home from war face serious
challenges reintegrating into civilian life. But as the economy
falters, our newest veterans are being hit especially hard.
Troops are facing serious challenges returning to the civilian
workforce. Among Iraq and Afghanistan-era veterans of the active-duty
military, the unemployment rate was over 8 percent in 2007, about 2
percent higher than their civilian peers. In addition, National
Guardsmen and Reservists, ``citizen soldiers'' who leave behind their
civilian lives to serve alongside active-duty troops, are inadequately
protected against job discrimination.
In the most severe cases, economic hardship can push veterans into
homelessness. Foreclosure rates in military towns are increasing at
four times the national average, and almost 2,000 Iraq and Afghanistan
veterans have already been seen in the Department of Veterans Affairs'
homeless outreach program. Given the state of the economy, the problem
is likely to worsen in the coming years.
One major step forward for improving veterans' economic
opportunities is almost complete. IAVA led the fight to provide today's
veterans with the same kind of education benefits America provided to
veterans of World War II. In June 2008, we won. The new ``Post-9/11''
GI Bill makes college affordable to 1.7 million veterans of Iraq and
Afghanistan, but a number of technical fixes are necessary in 2009 to
maximize the GI Bill's effectiveness.
For more information about the transition challenges of new
veterans, please see the 2009 IAVA Issue Reports, ``Careers After
Combat: Employment and Education Challenges for Iraq and Afghanistan
Veterans'' and ``Coming Home: The Housing Crisis and Homelessness
Threaten New Veterans.'' All IAVA reports are available at
www.iava.org/reports.
Homecoming Recommendations
2.1 Streamline and Simplify the Post-9/11 GI Bill
IAVA calls on Congress to oversee the accurate and timely
implementation of all portions of the ``Post-9/11 GI Bill,'' including
the tuition benefit, housing allowance, book stipend, and
transferability provisions.
Eliminate the confusion of multiple education benefits by
ensuring that the Post-9/11 GI Bill covers all types of education
programs.
Veterans pursuing vocational and distance learning
programs should be entitled to the same tuition benefits as veterans
attending traditional colleges.
Rather than an unwieldy state-by-state benefit system, the
Post-9/11 GI Bill benefit should have a national tuition cap tied to
the price of the most expensive public school (currently about $13,000/
yr). Partial tuition payments should be based on a percentage of this
cap, not individual tuition costs.
The Yellow Ribbon Program, which provides matching Federal
funds for private school scholarships given to GI Bill recipients,
should be universally available to those in reserve component.
Veterans with remaining educational entitlement should be
able to use their benefit to pay back student loans.
Veterans attending school part time should receive a pro-
rated housing benefit.
Active Guard Reserve (AGR) service should be counted
toward benefits calculations.
2.2 Defend Troops Against Job Discrimination
USERRA, the Uniformed Services Employment and Reemployment
Rights Act, protects National Guardsmen and Reservists from
discrimination based on their military service. IAVA supports the
extension of USERRA protections to servicemembers working in domestic
response operations, such as hurricane or wildfire missions.
Processing of USERRA claims should be consolidated within
the jurisdiction of a single agency.
Federal and state governments should be held to the same
standard of USERRA compliance as private sector employers.
Employers who knowingly violate USERRA job protections
should face civil and criminal prosecution. Congress must direct tough
enforcement of USERRA by the Departments of Justice and Labor, and give
these agencies specific resources for this function. Violation of
USERRA should be explicitly added to the list of offenses for which
suspension or debarment from eligibility for Federal Government
contracts is authorized.
Servicemembers who face employment discrimination based on
their military service must be afforded their day in court, as intended
by the original USERRA statute. USERRA complaints should be exempt from
pre-dispute binding arbitration agreements.
To prevent employers from firing an employee while a
USERRA claim is being processed, courts hearing USERRA complaints
should be required to use their full range of legal powers, including
injunctions.
The DOD should implement a notification program for
servicemembers' employers specifically informing employees of their
USERRA obligations.
2.3 Combat Veterans' Unemployment
The employment training in the Transition Assistance
Program for separating servicemembers should be modernized and made
mandatory for all active-duty troops leaving the military.
IAVA recommends tax credits for employers who, when their
reserve component employees are called to active-duty for over 90 days,
continue to support their employees by paying the difference between
the servicemembers' civilian salary and their military wages.
IAVA supports a tax credit to promote the hiring of
homeless veterans by reimbursing the employer for a percentage of the
salary of the hired veteran.
Any economic stimulus proposals that promote ``green
collar'' jobs should include a ``Green-to-Green'' program to retrain
veterans for the new clean energy economy, and to encourage green
employers to hire veterans.
The DOD should conduct a study of the differences between
DOD and civilian vocational certifications in order to ease the
transition of certifications into the civilian world.
To help mitigate the effect of frequent and lengthy
deployments, IAVA supports new programs to provide small businesses
owners in the National Guard and Reserves with additional access to
capital, insurance, and bonding.
2.4 Eradicate Homelessness Among Veterans
IAVA calls for a one-year moratorium on mortgage
foreclosure for any servicemember returning from a combat tour. This
provision should not sunset before 2012, at the earliest. Lenders who
fail to abide by the moratorium should face stiff civil and criminal
penalties.
Congress should appropriate funding for a VA outreach and
advertising campaign in regions hard-hit by the mortgage crisis that
have high veteran and servicemember populations. The campaign should
promote VA home loan and financial counseling services. Adequate
funding should also be provided to ensure that the VA has enough loan
counselors to cope with call volume.
IAVA calls for a dramatic expansion of the HUD-VA
Supportive Housing voucher program, to include the funding of an
additional 20,000 housing vouchers. To ensure that vouchers are
reaching eligible homeless veterans, a study must be conducted to
examine voucher utilization rates, barriers to finding housing, service
delivery and coordination, and housing retention among veterans
participating in the program.
The Grant and Per Diem (GPD) program payment rate should
better match the actual cost to help a homeless veteran. The VA should
be given the discretion to increase GPD payment rates up to 150% of the
daily rate for programs that are high-cost due to their location or
range of services.
IAVA supports a pilot program to test preventative
strategies against homelessness at VA facilities. Potential strategies
should include emergency cash assistance, help with utilities, and
short-term rental subsidies.
IAVA endorses a VA ``GreenHomes'' program that would
convert underutilized VA properties into energy-efficient permanent
housing for homeless veterans.
2.5 Protect Servicemembers from Unfair Contracts
Students who are deployed overseas should be reimbursed by
their college or university for tuition paid toward interrupted
coursework.
Servicemembers should be protected from early termination
fees if a servicemember terminates a lease due to a deployment.
Protections allowing servicemembers to suspend or cancel
cell phone contracts should be extended to servicemembers whose service
contract is a part of a shared family account.
Active-duty and recently separated servicemembers and
their families should not be denied in-state tuition rates at local
public universities due to a failure to meet state residency
requirements.
2.6 Steer Veterans to Alternative Sentencing
A pilot program should be funded to test the effects of
alternative sentencing for veterans suffering from combat related
stress injuries who are arrested for non-violent crimes. The pilot
should build on the work of the Veterans Court in Buffalo, NY. The
results of this pilot should be used to create guidelines for other
states on effective alternative sentencing programs.
The VA should repeal the standing prohibition on treatment
for incarcerated veterans, and should coordinate with local
municipalities to develop counseling, recovery, and peer-support
services for veterans in the criminal justice system.
iii. health care and benefits
Far too many military families and veterans are struggling with the
bureaucratic barriers to health care and benefits. Accessing medical
care requires long waits for appointments, and is often too far away.
Even when a wounded veteran is too disabled to work, the disability
compensation process can take years.
Millions of veterans rely on the health care and benefits provided
by the Department of Veterans Affairs (VA), and about 42 percent of
eligible Iraq and Afghanistan veterans have already gone to the VA for
health care. But accessing the system is often a problem. Wait times
for appointments can be months long, and hospitals and clinics are
frequently inconveniently located. As of 2003, more than 25% of
veterans enrolled in VA health care live over an hour from any VA
hospital. The VA has already taken steps to expand access to health
care but much more must be done.
A fundamental problem with VA health care is unreliable funding
from Congress. Unlike the allocations for Medicaid and Medicare,
funding for the Veterans Health Administration is not mandatory. As a
result, veterans' groups must fight each year to ensure that Congress
provides adequate funding. In the past two years, however, Congress
finally made veterans a priority, providing the VA with record budget
increases. But when the VA budget is passed late, as it has been 17 of
the past 20 years, hospitals are forced to ration care and scrape by
with temporary funding bills. Appropriating funding for the VA one year
in advance would allow veterans' hospitals to better plan their
budgets, cut wait times, and ensure veterans have access to the care
they need--and it would cost no additional money.
The VA also provides benefits to promote veterans' education, to
help veterans buy a home, to compensate for combat-related
disabilities, to provide for veterans' funerals, and to support troops
and veterans' survivors. Almost 4 million veterans receive VA benefits,
but for many, accessing the benefits they have earned is a difficult
process. The DOD and the VA each have their own complicated and
confusing disability benefits systems. As troops transition from the
DOD to the VA, medical records and military service records regularly
get lost in the shuffle, leading to long waits for benefits processing.
Even within the VA system, veterans face inexcusable delays. With over
800,000 claims filed annually, the current average wait time of 6
months is unacceptable. According to the VA's own numbers, about 12% of
ratings decisions are inaccurate. These wrongly-decided claims can take
two years to complete the appeal process, and are the primary source of
the claims backlog.
Since the scandal at Walter Reed Army Medical Center in 2007 drew
attention to the bureaucratic red tape that wounded troops face, the VA
has added more claims processors. However, the current VA system
rewards the quantity of claims processed, not the quality of
processors' decisions. The VA must refocus its efforts to effectively
train the new workforce and to link performance reviews to both
quantity and quality of claims processed. With these systems in place,
stories of VA backdating claims or shredding paperwork could finally
become a distant memory.
For more on troops and veterans' health care and compensation
issues, consult the 2008 IAVA Issue Report: ``Battling Red Tape:
Veterans Struggle for Care and Benefits.'' All IAVA reports are
available at www.iava.org/reports.
Health Care and Benefits Recommendations
3.1 Reform Veterans' Health Care Funding
To ensure timely and predictable funding, the VA budget
should be appropriated at least one year in advance.
IAVA endorses the annual Independent Budget, produced by
leading veterans' organizations (including IAVA) as the blueprint for
VA funding levels.
The Government Accountability Office should audit the VA's
internal budget model. The VA must be prepared to accurately project
the number of veterans who will use VA health care, taking into account
increases in demand due to an influx of Iraq and Afghanistan veterans
and the downturn in the economy.
3.2 Cut the Claims Backlog in Half
IAVA supports the Veterans' Disability Benefits
Commission's call to mandate a 50% decrease in the claims backlog in 2
years. To make this possible, IAVA recommends a new evaluation system
that rewards claims processors based on the accuracy of their work, not
just the quantity of claims processed.
To make claims more consistent between regional offices,
the VBA must reassess training requirements. Claims processors at the
VA regional offices should receive annual standardized training
specific to the errors found in each office's processing during the
previous fiscal year. The VBA should hold claims processors and their
managers accountable for meeting the annual training requirement, and
should provide opportunities for knowledge-sharing, in the model of
CompanyCommand.army.mil and PlatoonLeader.army.mil.
IAVA believes it is the VA's responsibility to clearly
inform veterans about the requirements to substantiate a claim. The VA
should publicize the criteria for claims establishment, and the VA's
``Duty to Notify'' should include providing the claimant with a
thorough explanation of the elements needed to substantiate a claim.
Veterans should be able to waive the waiting period for
evidence submission if the claim is fully developed.
Appeals forms should be sent out with Notice of Decision
letters, to expedite the process if the veteran chooses to appeal.
3.3 Improve Access to Care
Military families face significant barriers to receiving
mental health care under TRICARE, including inaccurate lists of local
providers, low provider reimbursement rates, and high levels of
paperwork. IAVA recommends a study to determine the extent of these
barriers and how they can be minimized.
IAVA recommends that the VA mandate uniform services at
women's clinics. Currently, women's clinics vary in the services they
deliver, from gender-specific care to general primary care. Women
veterans should have access to female primary care providers when
requested, and if necessary, the VA should contract with local health
care providers to offer this service.
The Secretary of the VA should design and implement
national guidelines to instruct VA facilities when it is appropriate to
contract with local community health care providers in areas where
rural veterans do not have reasonable access to care.
VA funding should be provided to promote, oversee, and
evaluate a pilot program that creates a network of drivers for veterans
struggling to find transportation to the nearest VA hospital.
3.4 Smooth the Transition from the Military to the VA
Enrollment in VA health care should be required for all
troops leaving active-duty service, whether from the active or reserve
component, with the opportunity to opt out, rather than opt in.
Participation in the Benefits Delivery at Discharge program must be
mandatory.
The disability process should be streamlined, so that the
DOD determines fitness for duty, and the VA determines disability
compensation. The DOD should perform a thorough medical examination for
all troops prior to their separation, and DOD records, including the
DD-214, should be electronic and interoperable with a state-of-the-art
VA system. The DD-214 should be updated to include email addresses.
Benefit Resource Counselors should be available for all
National Guard and Reserve units. An incentivized training program
should be established in coordination with the DOD and VA that would
train at least one member of every National Guard and Reserve unit on
available Federal and state benefits for servicemembers and their
families.
3.5 Ensure Benefits are Fair
The VA disability benefits schedule should be revised to
provide adequate compensation for both loss of earning capacity and
quality of life, and to accommodate new kinds of disability, including
Post Traumatic Stress Disorder. While the Rating Schedule is revised,
all compensation rates should be increased as recommended by the
Veterans' Disability Benefits Commission.
As recommended by the VA's Advisory Committee on Women
Veterans, the Veterans Benefits Administration should put in place a
procedure to identify, track and report to Congress the outcomes of
disability claims that involve Military Sexual Trauma (MST), in order
to better understand the number of MST-related claims submitted
annually, length of processing times, denial rates, and the types of
disabilities that are associated with MST.
IAVA supports concurrent receipt of veterans' disability
and military separation or retirement benefits.
IAVA urges the complete repeal of the Widow and Widower's
Tax.
All National Guardsmen and Reservists who are veterans of
the wars in Iraq and Afghanistan should qualify for early retirement
based on the length of their active-duty service.
3.6 Expand Health Tracking for Iraq and Afghanistan Veterans
Congress should fund a pre- and post-deployment
longitudinal study that bridges the gap from Department of Defense and
the Department of Veterans Affairs to track veterans' mental health
problems, diseases and mortality.
Troops returning from a tour in Iraq or Afghanistan should
be required to enroll in the Gulf War Registry Program, with the
opportunity to opt out, rather than opt in.
3.7 Care for the Caregivers
IAVA recommends the creation and expansion of pilot
programs to certify and train family caregivers of veterans as personal
care attendants, so that they can receive compensation from the
Department of Veterans Affairs.
The VA should build on its current partnership with local
universities to provide respite care to family caregivers. Graduate
students should be trained to provide respite care for families caring
for wounded warriors.
iv. government accountability
American troops and military families have responded to the demands
of a prolonged two-front war with tremendous courage and dedication.
But the government has not consistently shown the same commitment to
supporting those called to serve.
The wars in Iraq and Afghanistan have been a heavy burden for our
Armed Forces, who represent less than one half of one percent of the
American people. The military now regularly requires troops to serve
multiple, extended combat tours. As General Peter Schoomaker, the
former Chief of Staff of the United States Army, warns: ``While our
Soldiers are responding with extraordinary commitment, particularly in
the face of adversity and personal hardships, we cannot allow this
condition to persist.''
At the same time, funding for the Iraq and Afghanistan wars has
become a political football, used by politicians on both sides of the
aisle to disguise the wars' cost and fund unrelated pet projects.
Finally, although our troops and military families prove their
dedication to our country every day, they are all too often stripped of
their rights as citizens. Military voters regularly receive their
absentee ballots too late to allow them to vote. In addition, over
40,000 non-citizens serve in the U.S. military today, but they receive
little protection for themselves or their families against unfair
application of immigration laws. The last thing troops in the American
military should be worrying about while deployed is the possibility
that their spouses at home may be deported.
Government Accountability Recommendations
4.1 Issue a National Call to Service
IAVA supports Congressional efforts to expand nonmilitary
service opportunities. The President must call on all Americans to show
their support for our Nation's troops and veterans by joining them in
serving the Nation in the military or on the homefront.
4.2 Prevent Military Voter Disenfranchisement
All too often, military personnel receive their ballots
too late to be counted. States should provide uniform, simple access
procedures for military and military dependent absentee voting that is
valid in all 50 states. These procedures should include a re-
examination of the dates limiting how early one can apply for an
absentee ballot, to ensure troops can feasibly apply for and receive a
ballot in time to cast their ballots. Election mail must be protected
and prioritized, so that troops overseas receive their ballots on time.
4.3 Provide a Road to Citizenship for Military Families
IAVA believes that the deportation of spouses of troops
deployed to a combat zone should be deferred until at least two years
after the deployed servicemember returns from combat. In addition,
surviving widows and widowers of those killed in action should be
eligible for expedited citizenship and/or ``bereavement visas'' to
allow them to visit family in their country of origin in the years
after their spouse's death.
4.4 End Abuse of the Emergency Supplemental Process
IAVA recommends that the DOD be obligated to report
detailed equipment reset expenditures within the procurement accounts
in a way that confirms that funds appropriated for reset are expended
for the correct purposes.
Emergency supplemental funding undercuts Congressional
oversight of spending. While supplemental funding is crucial for real
emergencies, IAVA opposes the use of emergency supplemental to fund
predictable military needs.
______
Response to Post-Hearing Questions from Hon. Daniel K. Akaka to Todd
Bowers, Director of Government Affairs, Iraq and Afghanistan Veterans
of America
ptsd
Just this morning, the VA Inspector General issued a report on the
Temple, Texas situation. Many will recall that a psychologist at that
facility wrote a strangely worded email which set off a firestorm of
concern for those who are suffering from PTSD. In a word, the IG found
no systemic effort on the part of VA to reduce the number of PTSD
claims via inappropriate diagnosis.
Question 1. For each of you, is it your view that mental health
issues, and particularly PTSD, are receiving appropriate attention, in
terms of both compensation and care?
Response. It is IAVA's belief that there needs to be full review of
all previous congressionally mandated and chartered commission and
their recommendations that pertain to PTSD compensation. Commissions'
such as the Presidents Commission on Returning Wounded Warriors and the
Veterans Disability Benefits Commission have made multiple
recommendations that IAVA fully supports but have yet to be
implemented. Congress must review these recommendations and prioritize
the implementation based on veteran needs and gaps based on the VA
FY2008 Performance and Accountability Report.
The VA disability benefits schedule should be revised to provide
adequate compensation for both loss of earning capacity and quality of
life, and to accommodate new kinds of disability, including Post
Traumatic Stress Disorder. While the Rating Schedule is revised, all
compensation rates should be increased as recommended by the Veterans'
Disability Benefits Commission.
collaboration on the issues
Question 2. How can your organizations collaborate to address the
concerns of those who veterans who are returning after service in Iraq
and Afghanistan?
Response. To draft IAVA 2009 Legislative Agenda, IAVA conducted
direct polling of our membership to establish a solid foundation of the
priorities that OIF and OEF veterans seek to have addressed this year.
These priorities have been identified as:
Ensure thorough, Professional, and Confidential screening
for invisible injuries. IAVA supports mandatory, face-to-face and
confidential mental health and TBI screening by a licensed medical
professional, for all servicemembers, before and after their combat
tour.
Advance-Fund veterans' Health Care. The best way to ensure
timely funding of veterans' health care is to fully fund the Department
of Veterans Affairs (VA) health care budget one year in advance. In
addition, IAVA endorses the annual Independent Budget, produced by
leading veterans' organizations (including IAVA), as a blueprint for
the VA funding levels.
End the Passive VA system. The VA has traditionally been a
passive, inward-looking system. Veterans must overcome tremendous
bureaucratic obstacles to get the benefits and services that the VA
provides. Many veterans do not even know what benefits they are
eligible for. The VA must develop a national strategy to promote the
use of its services, including advertising VA benefits, expanding VA
outreach, and modernizing the VA's online presence.
Combat veterans' Unemployment. IAVA supports the expansion
of employment training for troops leaving the military, tax credits for
employers who hire troops and veterans, and a new ``Green-to-Green''
program to retrain veterans for high-paying jobs in the clean energy
economy.
Cut the Claims Backlog in Half. Hundreds of thousands of
disabled veterans are awaiting an answer on their VA benefits claims.
Errors in claims decisions are a primary source of the back-log. IAVA
recommends a new evaluation system that holds claims processors
accountable for the accuracy of their work.
Improve Health Care for Female veterans. 11 percent of
Iraq and Afghanistan veterans are women. They deserve the same access
to health care as any other American veteran. IAVA supports prioritized
hiring of female practitioners and outreach specialists, increased
funding for specialized in-patient women-only PTSD clinics, and
significant expansion of the resources available to women coping with
Military Sexual Trauma.
Eradicate Homelessness among veterans. About 150,000
veterans are homeless on any given night, and foreclosure rates in
military towns are increasing at four times the national average. IAVA
calls for 20,000 new HUD-VA Supportive Housing vouchers, an increase in
the Grant and Per Diem allowances for community organizations to help
homeless veterans, and an extensive outreach campaign to promote VA
home loan and financial counseling services.
All of these priorities have been shared with every Veteran Service
Organization as registered with the Department of Veterans Affairs. It
is IAVA's goal to serve as a conduit between our newest generations of
veterans.
For the past three years, IAVA has been in full support of the
Independent Budget as established by the leading veteran Service
Organizations. In addition, IAVA supports many of the recommendations
and resolutions established by The Military Coalition. IAVA has been a
member of The Military Coalition as of June, 2008. IAVA will continue
to pursue effective VSO partnerships to ensure veterans are
appropriately represented from all generations.
vba staffing
In light of the increased funding for VBA staffing, there are high
expectations that VBA will improve the quality of claims decisions, and
to do so in a timely manner.
Question 3. What more do you believe Congress could do to assist in
decreasing the backlog, and at the same time, improving timeliness and
accuracy?
Response. IAVA supports the Veterans' Disability Benefits
Commission's call to mandate a 50% decrease in the claims backlog in 2
years. To make this possible, IAVA recommends a new evaluation system
that rewards claims processors based on the accuracy of their work, not
just the quantity of claims processed.
To make claims more consistent between regional offices, the VBA
must
reassess training requirements. Claims processors at the VA regional
offices should receive annual standardized training specific to the
errors found in each office's
processing during the previous fiscal year. The VBA should hold claims
processors and their managers accountable for meeting the annual
training requirement, and should provide opportunities for knowledge-
sharing, in the model of CompanyCommand.army.mil and
PlatoonLeader.army.mil.
IAVA believes it is the VA's responsibility to clearly inform
veterans about the requirements to substantiate a claim. The VA should
publicize the criteria for claims establishment, and the VA's ``Duty to
Notify'' should include providing the claimant with a thorough
explanation of the elements needed to substantiate a claim.
oif/oef illnesses
The Committee and, indeed, the full Congress, has focused a great
deal of attention on mental health and TBI matters. Yet, the most
common health condition of returning OEF/OIF veterans is not TBI or
mental illness, but instead muscle and joint pain.
Question 4. Do any of you have proposals on how to focus on this
number one health concern from those who have served in Iraq and
Afghanistan?
Response. A recent report from the Washington Post highlighted that
current combat loads carried by servicemembers in Iraq and Afghanistan
are resulting in large amounts of orthopedic injuries. During their
combat tours in Iraq and Afghanistan, it is common for servicemembers
to carry loads as heavy as half their body weight. Depending on the
length of their deployment, this constant strain can last up to 15
months and recovery time is shortened due to inadequate dwell time
between multiple deployments. The numbers of non-deployable Army
personnel is increasing at a staggering rate and other branches are
also feeling the strain. Never before have servicemembers been
subjected to such heavy loads for such extended periods of time and at
a constant rate.
IAVA recommends that a joint review be conducted by DOD and VA into
the long term effects of carry large combat loads has on acute
orthopedic injuries and musculoskeletal system of OIE and OEF veterans.
outreach
Question 5. How are your organizations, individually or in some
cooperative fashion, working to outreach to veterans and encourage them
to take advantage of VA care and services?
Response. IAVA has recently launched a multi-tiered veteran's
outreach campaign in partnership with the Ad Council. The goal of this
national media effort is to drive veterans to the Nation's first online
social networking Web site exclusive for OIF and OEF veterans. This Web
site communityofveterans.org has established a secure online community
for veterans to voice their concerns about issues ranging from PTSD
disability compensation to difficulty accessing VA care. Below are
highlights from the campaign.
Campaign Overview:
IAVA has partnered with the Ad Council to launch a
groundbreaking Public Service Advertising (PSA) campaign on Veterans
Day 2008. This multiyear, national effort addresses readjustment issues
and seeks to ease the transition for veterans returning home from Iraq
and Afghanistan.
The campaign will feature two distinct series of PSAs
(including TV, radio, print, outdoor, Web and rich media); one focused
on Iraq and Afghanistan veterans and a second on the families and loved
ones of veterans who are also impacted by transitional issues.
The new campaign was developed in partnership with the Ad
Council, a non-profit organization that has created some of the
country's most iconic PSA campaigns including ``Friends Don't Let
Friends Drive Drunk'' and Smokey Bear.
Strategy:
The Ad Council, IAVA and ad agency BBDO conducted
extensive research to develop this campaign. We held several rounds of
focus groups in three cities across the country with veterans, their
families, and members of the general public. We also regularly
consulted with a panel of distinguished mental health experts about the
direction of the campaign. We will continue to hold briefings with a
range of experts to solicit feedback and input going forward.
Online Component:
The works aimed at veterans directs them to the first and
only online community exclusive to Iraq and Afghanistan veterans
through a new social networking Web site, communityofveterans.org
The innovative Web site will offer a platform for veterans
to connect with one another and act as a portal for comprehensive
mental health resources, with the goal of increasing the number of
veterans who seek treatment for issues including PTSD and depression.
The campaign takes advantage of web 2.0 by reaching the
modern veterans online--where they are already. It will act as a
MySpace or Facebook plus exclusively for veterans, transforming the way
that veterans interact with one another and talk about transitional
issues.
About the Ad:
Created pro bono by ad agency BBDO in New York, the
compelling TV PSA, Alone, follows a young servicemember when he returns
from Iraq. He is filmed in a completely empty airport terminal, alone
on a subway and walking through desolate New York City streets.
Eventually, he is approached by another Iraq veteran who extends his
hand and welcomes him home. When the two men shake hands, the deserted
city comes alive, illustrating the power of connecting with another
veteran.
The magnitude of this shoot was incredible and required
extraordinary help from the city of New York. With the City's aid, we
shut down an entire terminal at JFK International Airport, a subway car
on the 7 line, and multiple New York City blocks, including in front of
the Flat Iron Building and in the financial district.
Issue Background:
IAVA and Ad Council developed this campaign to address the
urgent challenges facing America's newest generation of veterans. There
are 1.7 million men and women who have served, or are currently
serving, in Iraq and Afghanistan.
1 in 5 Iraq and Afghanistan veterans will suffer from a
mental health problem, ranging from depression to Post Traumatic Stress
Disorder (PTSD), and over time, as many as 30-40% of new veterans could
face serious psychological injuries.
Untreated mental health conditions can cause or aggravate
other debilitating problems in the Veterans' community including high
rates of unemployment, homelessness, substance abuse, divorce, child
abuse, and suicide. Many avoid seeking help because of the stigmas
around seeking treatment or being diagnosed with a mental illness.
Campaign Long-term Objective:
The challenges facing returning veterans are broad and
multi-faceted and will not be solved overnight. There is no quick fix
or cookie cutter solution. This campaign's long-term objective is to
gradually decrease the depression and PTSD-related outcomes among
returning veterans and encourage them to take that safe, first step in
getting help. Through this campaign we can begin to change the way that
both private citizens and the government talk about and address these
issues.
Family Campaign:
A complementary PSA effort that will launch in the coming
months will seek to engage the families and loved ones of these
veterans. That body of work will empower veterans' loved ones to start
a conversion and encourage the veteran to seek help if necessary. A Web
site dedicated to providing resources and information for families,
supportyourvet.org, will also launch in the coming months.
women veterans
VA has said that sufficient programs and funding already exist to
care for women veterans.
Question 6. What would you point to as specific problems or
shortfalls with respect to women veterans and what do you recommend
that the Committee do to address these concerns?
Response. 11 percent of Iraq and Afghanistan veterans are women.
They deserve the same access to health care as any other American
veteran.
IAVA supports increased funding for specialized inpatient women-
only PTSD clinics.
To improve the quality of health care for female veterans, Vet
Centers and VA medical facilities must be encouraged to hire female
practitioners and outreach specialists, and especially female veterans.
The veterans' suicide hotline operators should receive additional
training to respond to sexual assault-related calls.
IAVA supports increased funding for the Department of Defense's
Sexual Assault Prevention and Response Office in order for it to expand
its oversight role.
IAVA recommends that the VA mandate uniform services at women's
clinics.
Currently, women's clinics vary in the services they deliver, from
gender-specific care to general primary care. Women veterans should
have access to female primary care providers when requested, and if
necessary, the VA should contract with local health care providers to
offer this service.
As recommended by the VA's Advisory Committee on Women Veterans,
the Veterans Benefits Administration should put in place a procedure to
identify, track and report to Congress the outcomes of disability
claims that involve Military Sexual Trauma (MST), in order to better
understand the number of MST-related claims submitted annually, length
of processing times, denial rates, and the types of disabilities that
are associated with MST.
paperwork
Question 7. What is your organization's opinion of VA's expanded
paperwork protection policy that came about as a result of the
Inspector General's audit which found that VA regional office personnel
had mishandled some claims documents--is VA's new policy on shredding
appropriate?
Response. IAVA agrees with the chairman's statement that the
current freeze of document shredding as established by former Secretary
Peake is not a long term solution. We look forward to finding out the
status of the current policy changes that will take effect when the
Committee receives testimony next month regarding this issue. It is
paramount, that veterans are not shortchanged by destruction of their
supporting documents when filing Disability Claims. The VA must also
prioritize the importance of destruction of documentation containing
personal information to ensure the privacy of veterans is protected.
stimulus
Question 8. The Senate stimulus package includes appropriations for
VA, especially $3.7 billion included for VA infrastructure projects.
What are your views?
Response. IAVA is grateful for what Congress has provided in the
stimulus package. IAVA fully supported the Senate version.
______
Response to Post-Hearing Questions from Hon. Bernard Sanders to Todd
Bowers, Director of Government Affairs, Iraq and Afghanistan Veterans
of America
extended and different hours for va services
As I mentioned in my opening remarks, I have heard from many
veterans who want to get to the VA for care but they can't make it
because of work. I believe we need to increase accessibility of the VA
to all types of veterans, including those with full-time jobs, by
providing evening and weekend hours so that people won't have to choose
between going to work and keeping a VA appointment. This could also
help reduce missed appointments which waste time and resources of VA
staff. My office is currently exploring what kind of authority VA needs
to begin providing extended hours on a one night a week and one weekend
day a week basis, possibly in the form of a pilot program.
Question 1. Mr. Bowers, the IAVA has also discussed the important
of changing the VA from a passive to an active institution when it
comes to helping veterans. Is this a proposal that the IAVA would
support?
Response. Yes. IAVA fully supports any initiative that effectively
increases outreach of services and benefits to OIF and OEF
servicemembers and veterans. This legislation matches our 2009
Legislative Agenda recommendation #1.2.
1.2 Advertise VA Mental Health Services
The VA must receive specially-allocated funds to research,
test and implement an effective national and local media strategy, that
includes use of new and traditional media, to combat stigma and to
promote the use of VA services such as Vet Centers and the Suicide
Prevention hotline. The VA's campaign strategy should include a
comprehensive plan to involve Veterans Service Organizations, and
should promote behavioral and mental health services to underserved
groups, including homeless veterans, rural veterans and female
veterans.
automatic enrollment in va for members of the guard and reserve
Mr. Cullinan and Mr. Bowers, in both of your prepared testimonies
you mentioned the importance of improving the hand off between the
Department of Defense and the VA. I am working on legislation that
would automatically enroll members of the National Guard and Reserve
into VA health and dental care while they are going through discharge.
This does not force these servicemembers to use the VA system but it
does cut down on the process of applying for VA care later and allows
VA care to be there if a veteran who doesn't think they need the care
realizes later in life that they want it. If the VA is meant to provide
care of these veterans, we should not make it so hard for them to sign
up for the care.
Question 2. Mr. Bowers, is this a proposal that the VFW IAVA could
support?
Response. Yes. IAVA fully supports any initiative that will
streamline the transition from Active Duty to Veteran status. When I
returned from my second deployment, my unit leadership proactively
encouraged all servicemembers returning from OIF to register with a VA
representative from the Washington DC area Vet Center that was present
during our demobilization process. By having all of our Marines
register with the VA before demobilizing it removed any individual from
falling through the cracks. This issue is addressed in our 2009
Legislative Agenda under item #3.4.
3.4 Smooth the Transition from the Military to the VA
Enrollment in VA health care should be required for all
troops leaving active-duty service, whether from the active or reserve
component, with the opportunity to opt out, rather than opt in.
Participation in the Benefits Delivery at Discharge program must be
mandatory.
Chairman Akaka. Thank you very much, Mr. Bowers.
Mr. Blake, your testimony.
STATEMENT OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR,
PARALYZED VETERANS OF AMERICA
Mr. Blake. Chairman Akaka, Ranking Member Burr, Members of
the Committee, on behalf of Paralyzed Veterans of America, I
would like to thank you for the opportunity to testify today.
As you know, PVA continues to work on issues that are
important to our members, specifically those veterans with
spinal cord injury or dysfunction, but also for all veterans.
With this mind, I would like to outline our priorities for
the 111th Congress. They include, first and foremost, advanced
appropriations for the VA health care system; elimination of
health care copayments for catastrophically disabled Priority
Group 4 veterans; proceeding with the construction of a
freestanding tertiary care hospital in Denver, Colorado, that
includes a spinal cord injury center in accordance with the
recommendations of the CARES commission; improving recruitment
and retention bonuses and incentives for nurses and allied
health professionals; an increase in the adaptive automobile
grant with an annual index to increase the value of the grant
with the cost of inflation.
Senator Sanders, I would like to thank you for your
leadership in trying to improve this benefit during the 110th
Congress, and we look forward to working on this again this
year.
Finally, but certainly not the least important,
improvements to the claims process, including through updated
information systems technology, and, of course, as mentioned by
my colleague from IAVA, smooth implementation of the GI Bill.
I would like to focus my attention on only a couple of the
issues that I mentioned.
Chairman Akaka, we were pleased that during the 110th
Congress you introduced legislation, the Veterans' Health Care
Budget Reform Act, S. 3527, that would reform the VA budget
process by providing advanced appropriations for VA health
care. The legislation was developed in consultation with the
Partnership for Veterans' Health Care Budget Reform, a group
that includes nine major veterans service organizations
including Paralyzed Veterans of America.
The Veterans' Health Care Budget Reform Act would ensure
that the goals of the partnership--sufficient, timely and
predictable funding--are met. Historically, advance
appropriations have been used to make a program more efficient
and effective, better aligned with funding cycles of the
program recipients or provide insulation from annual political
partisan maneuvering. By moving to advance appropriations,
veterans' health care programs would accrue all three of these
benefits.
Once again, we appreciate your support for this proposal
during the 110th Congress, and we look forward to the
introduction of similar legislation for the 111th, and we hope
to build a broader base of bipartisan support for the
legislation.
In 1985, Congress approved legislation which opened the VA
health system to all veterans. In 1996, Congress again revised
that legislation with a system of rankings establishing
priority ratings for enrollment. Within that context, PVA
worked hard to ensure that those veterans with catastrophic
disabilities would be placed in a higher enrollment category.
To protect their enrollment status, veterans with
catastrophic disabilities were allowed to enroll in Priority
Group 4 even though their disabilities were non-service-
connected and regardless of their incomes. However, unlike
other Priority Group 4 veterans, if they would otherwise have
been in Priority Group 7 or 8 due to their incomes, they would
still be required to pay all fees and co-payments, just as
others in those categories do now for every service they
receive from VA.
PVA believes this is unjust. VA recognizes their unique
specialized status on the one hand by providing specialized
service for them in accordance with its mission. The system
then makes them pay for those very same services.
Unfortunately, these veterans are not casual users of the VA
health care system. Because of the nature of their disabilities
they require a lot of care and a lifetime of services.
We were pleased that the House Committee on Veterans'
Affairs approved and the House of Representatives eventually
passed legislation, H.R. 6445, that would eliminate this
financial burden placed on catastrophically disabled veterans
during the 110th Congress. In fact, the House bill had a rare
triumvirate of bipartisan support of the House Democrats and
Republicans and the VA. Unfortunately, the Senate never took
action on the measure and the legislation was never enacted.
We hope that with your leadership, and Senator Burr's
efforts as well, we will finally be able to resolve this issue
during the 111th Congress.
Finally, Mr. Chairman, I would like to thank you and
Senator Burr for your efforts during the 110th. Veterans have
certainly realized a lot of successes legislatively, and we
look forward to working with you again.
Just as sort of a housekeeping note, I would like to inform
the Committee that The Independent Budget, which has already
been mentioned, for fiscal year 2010 will be available for
download on the Internet next Monday, February 2. The Web site
for that document will be www.independentbudget.org. We hope to
be able to deliver hard copies to the Committee staff and to
the individual Committee offices shortly thereafter. Many of
the issues discussed here by my colleagues today and that I
also discussed will be discussed in further detail in that
document.
This concludes my testimony, Mr. Chairman. I would be happy
to answer any questions.
[The prepared statement of Mr. Blake follows:]
Prepared Statement of Carl Blake, National Legislative Director,
Paralyzed Veterans of America
Chairman Akaka, Ranking Member Burr, and Members of the Committee,
on behalf of Paralyzed Veterans of America (PVA), I would like to thank
you for the opportunity to present our priorities for the 111th
Congress. We hope that the Senate Committee on Veterans' Affairs will
take our concerns under consideration as it prepares its legislative
and policy agenda this year. We appreciate the legislative successes
that veterans have realized under your leadership and we look forward
to continued success in the future.
PVA continues to work on issues important to our members, veterans
with spinal cord injury or dysfunction, specifically, and to all
veterans. With this in mind, I would like to outline our priorities for
the 111th Congress. They are:
Advance appropriations for VA health care.
Elimination of health care co-payments for
catastrophically disabled Priority Group 4 veterans.
Proceeding with the construction of a free-standing,
tertiary care hospital in Denver, CO that includes a spinal cord injury
center in accordance with the recommendations of the CARES commission.
Improving recruitment and retention bonuses and incentives
for nurses and allied health professionals.
Increase in the adaptive automobile grant and an annual
index to increase the value of the grant with the cost of inflation.
Improvements to the claims process, including through
updated information systems technology, and smooth implementation of
the 21st Century GI Bill.
advance appropriations
Chairman Akaka, we were pleased that in September of last year you
introduced legislation--S. 3527, the ``Veterans' Health Care Budget
Reform Act''--that would reform the VA budget process by providing
advance appropriations for veterans' health care. The legislation was
developed in consultation with the Partnership for Veterans Health Care
Budget Reform (Partnership)--a group that consists of nine major
veterans service organizations, including Paralyzed Veterans of
America. For more than a decade, the Partnership has worked to achieve
a sensible and lasting reform of the funding process for veterans'
health care. While the Partnership has long advocated converting VA's
medical care funding from discretionary to mandatory funding, there has
been virtually no movement in Congress in this direction.
The Veterans Health Care Budget Reform Act would ensure that the
goals of the Partnership--sufficient, timely, and predictable funding--
are met. Historically, advance appropriations have been used to make a
program function more effectively, better align with funding cycles of
program recipients, or provide insulation from annual partisan
political maneuvering. By moving to advance appropriations, veterans'
health care programs would accrue all three of these benefits.
To enhance the budget process even further, the proposed
legislation includes provisions to add transparency and oversight to
VA's internal budget forecasting model. Due to the complex nature of
VA's actuarially-based Model, S. 3527 would require GAO to conduct an
annual audit and assessment of the Model to determine its validity and
accuracy, as well as assess the integrity of the process and the data
upon which it is based. GAO would submit public reports to Congress
each year that would assess the Model and include an estimate of the
budget needs for VA's medical care accounts for the next two fiscal
years. Providing Congress with access to the Model and its estimates of
VA health care's resource needs, would provide greater confidence in
the accuracy of advance appropriations for veterans' medical care, as
well as validate future requests for emergency supplemental
appropriations. Once again, we appreciate your support for this
proposal during the 110th Congress, and we look forward to the
introduction of similar legislation and your continued support as we
try to advance this legislation during the 111th Congress.
elimination of co-payments for category 4 veterans
In 1985, Congress approved legislation which opened the VA health
system to all veterans. In 1996, Congress again revised that
legislation with a system of rankings establishing priority ratings for
enrollment. Within that context, PVA worked hard to ensure that those
veterans with catastrophic disabilities would be placed in a higher
enrollment category. To protect their enrollment status, veterans with
catastrophic disabilities were allowed to enroll in Priority Group Four
even though their disabilities were non-service-connected and
regardless of their incomes. However, unlike other Category Four
veterans, if they would otherwise have been in Category Seven or Eight,
due to their incomes, they would still be required to pay all fees and
co-payments, just as others in those categories do now for every
service they receive from VA.
PVA believes this is unjust. VA recognizes their unique specialized
status on the one hand by providing specialized service for them in
accordance with its mission to provide for special needs. The system
then makes them pay for those services. Unfortunately, these veterans
are not casual users of VA health care services. Because of the nature
of their disabilities they require a lot of care and a lifetime of
services. In most instances, VA is the only and the best resource for a
veteran with a spinal cord injury, and yet, these veterans, supposedly
placed in a higher priority enrollment category, have to pay fees and
co-payments for every service they receive as though they had no
priority at all.
We were pleased that the House Committee on Veterans' Affairs
approved and the House of Representatives eventually passed
legislation--H.R. 6445--to eliminate this financial burden placed on
catastrophically disabled veterans during the 110th Congress. In fact,
the House bill received unanimous support from Republicans and
Democrats as well as the VA. Unfortunately, the Senate never took
action on the measure and the legislation was never enacted. We hope
that with your leadership, we will finally be able to resolve this
issue during the 111th Congress.
denver/fitzsimmons va medical center
As you may be aware, there has been a great deal of controversy
concerning the VA plan for providing health care in the Denver/Rocky
Mountain region. The ongoing controversy surrounding the Department of
Veterans Affairs' decision to stop construction planning for a free-
standing replacement hospital in Denver, Colorado and, instead, lease
space from the University of Colorado Medical Center in a tower it
plans to construct continues to generate opposition. The long awaited
replacement facility which was to include a thirty bed spinal cord
injury center was first approved by VA in 2002 and planning and design
began in 2007 once Congress had appropriated funds.
Unfortunately, in early 2008 the VA suddenly and without notice
stopped all development on a free-standing medical facility and began
planning to lease space in a new medical center to be built by the
University of Colorado, with financing by the VA. Moreover, the VA
jettisoned the plan for the recommended 30-bed spinal cord injury
center in Denver as outlined by the Capital Asset Realignment for
Enhanced Services (CARES) report. The VA has since made additional
changes to the plan for SCI care simply as a means to ease the concerns
of PVA.
However, we believe the VA will not be able to meet several
important benchmarks for SCI care while leasing in the new University
of Colorado tower. First, we believe the spinal cord injury unit will
not be created to meet VA's own design guidelines, including first
floor location in the proposed new tower and dedicated SCI/D parking.
Second, we do not believe that staffing requirements for the unit will
be consistent with the guidelines agreed to by VA and Paralyzed
Veterans of America. Third, we believe the new leasing arrangement will
prevent PVA from the same access afforded us in other VA spinal cord
injury centers to both counsel veterans and conduct site visits.
Finally, VA's guidelines call for the establishment of spinal cord
injury centers at a tertiary care hospital to ensure that the center is
supported by the full range of medical and ancillary health services.
We do not believe this new leased facility will support all the
necessary medical specialties and services with VA staff.
Veterans' organizations on the national level have joined with
their local affiliates in opposing this action by VA. In a letter sent
to the previous Secretary of Veterans Affairs, James Peake, national
veterans' organizations, including Paralyzed Veterans of America and
the union representing VA employees, articulated our opposition and
concerns and questioned whether this change in strategy was a first
step in altering how VA has historically provided care. Veterans are
rightly concerned that this may well be an approach that leads to
greater privatization of services and ultimately lead to a diminution
of VA and, specifically, its specialized services.
It is time for the VA to return to the previous long-term plan to
construct a free-standing, tertiary care hospital in Denver, CO that
includes a spinal cord injury center in accordance with the
recommendations of the CARES commission. In the meantime, we hope that
the Committee will monitor this situation closely so as to ensure that
the VA is not laying the groundwork in Denver for a long-term health
care delivery plan that could ultimately lead to lower quality of care
across the entire VA health care system.
recruitment/retention of nurses and allied health professionals
Given the VHA's leadership position as a health system, it is
imperative that VA aggressively recruit health-care professionals and
work within established relationships with academic affiliates and
community partners to recruit new employees. In order to make gains on
these needs, VA must update and streamline its human resource processes
and policies to adequately address the needs of new graduates in the
health sciences, recruits, and current VA employees. Today's health-
care professionals and other staff who work alongside them need
improved benefits, such as competitive salaries and incentives, child
care, flexible scheduling, and generous educational benefits. VA must
actively address the factors known to affect current recruitment and
retention, such as fair compensation, professional development and
career mobility, benevolent supervision and work environment, respect
and recognition, technology, and sound, consistent leadership, to make
VA an employer of choice for individuals who are offered many
attractive alternatives in other employment settings.
VA's ability to sustain a full complement of highly skilled and
motivated personnel will require aggressive and competitive employment
hiring strategies that will enable it to successfully compete in the
national labor market. VA's employment success within the VHA will
require constant attention by the very highest levels of VA leadership.
Additionally, Members of Congress must understand the gravity of VA
personnel issues and be ready to provide the necessary support and
oversight required to ensure VA's success.
adaptive automobile benefits
PVA believes that an increase in the adaptive automobile assistance
grant to an amount commensurate with the original intent of this
benefit is essential. VA provides certain severely disabled veterans
and servicemembers with grants for the purchase of automobiles or other
conveyances. This grant also provides for adaptive equipment necessary
for safe operation of these vehicles. When the grant was created,
Congress initially fixed the amount of the automobile grant to cover
the full cost of the automobile.
Because adjustments have not kept pace with increased costs, the
value of the automobile allowance has been substantially eroded through
the years. In 1946, the $1,600 allowance represented 85 percent of
average retail cost of a new vehicle and was sufficient to pay the full
cost of automobiles in the ``low-price field.'' For 2008, the National
Automobile Dealers Association confirmed that the average price of a
new car was $28,500. The current $11,000 automobile allowance
represents only about 39 percent of the average cost of a new
automobile. In accordance with the recommendations of The Independent
Budget, we recommend that the grant be increased to 80 percent of the
value of a new car. In order to achieve this level, the allowance
should be increased to $22,800. Furthermore, an automatic annual
adjustment must be established, similar to what was provided for the
Specially Adapted Housing grant in the Housing Recovery bill enacted
during the 110th Congress, in order to maintain the automobile grant's
purchasing power as well.
va claims process and the 21st century gi bill
Finally, we believe that a number of issues within the claims
process must be closely monitored as the VA seeks to update and
modernize the process. We were particularly pleased with the fact that
Congress appropriated significant increases in funding for VBA over the
last couple of years. Likewise, we appreciate the emphasis placed on
hiring many new claims adjudication personnel. We have long argued that
the only way to give the VA a fighting chance at overcoming the rapidly
growing claims backlog is to provide for adequate staffing.
However, it is important to note that simply hiring additional
staff is not enough. Equally important is to ensure proper training and
accountability of claims adjudication staff at all levels of the
process. While it is easy to blame first-line claims staff for improper
ratings decisions, much of the blame also has to fall to the management
within VBA. Performance measures for all levels of adjudication staff
have wrongly focused too much on quantity of claims decided rather than
quality.
PVA is also concerned that VBA is not really spending the new
funding Congress has provided in the last couple of years in the manner
that Congress intended and the veterans service organizations (VSO)
desired. Specifically, we believe that VA is spending too much of this
new funding on pilot projects and special programs rather than on basic
hiring and systemic needs.
Moreover, we believe that VBA must accelerate the progress toward
an electronic claims record system. As long as VA continues to use a
paper file shipped around the country, the claims and appeals process
will be done in an expensive and antiquated manner. Under the current
system, VA staff need the actual claims file to act on claims. In a
paperless, environment VA staff could act on claims without having to
access a claimant's actual claims file. Additionally, transition to a
paperless system will permit claims work to be seamlessly transferred
to any of VA's regional offices, allowing for quicker decisionmaking on
claims. As demonstrated by the Veterans Health Administration's
outstanding electronic medical record system, similar gains in access
to records can be realized in the claims and appeals process. We urge
Congress to accelerate funding of VA's transition to an electronic
claims record.
Recent hearings have demonstrated how far behind the VBA is in
using information technology in its claims adjudication process. While
we believe that the entire claims process cannot be automated, there
are many aspects and steps that certainly can. We have long complained
to the VA that it makes no sense for severely disabled veterans to
separately apply for the many ancillary benefits to which they are
entitled. Their service-connected rating immediately establishes
eligibility for such benefits as the Specially Adapted Housing grant,
adaptive automobile equipment, and education benefits. However, they
still must file separate application forms to receive these benefits.
Furthermore, certain specific disabilities require an automatic
rating under the disability ratings schedule. For example, it does not
take a great deal of time and effort to adjudicate a below knee single-
leg amputation. An advanced information technology system can determine
a benefit award for just such an injury quickly. We believe that it is
time for the VA to automate consideration of ancillary benefits and
specific ratings disabilities that are generally automatic.
Finally, we are very concerned about the implementation of the 21st
Century GI Bill, set to become available to eligible veterans and
servicemembers in August. Progress toward an effective implementation
plan began with much difficulty. While we believe that the VA is being
as proactive as possible to ensure that the benefit is available
accurately and on time, we remain concerned about whether the VA will
actually be ready to go when the effective date arrives. The VA has
continued to offer monthly updates on its progress and we believe
continued oversight by the veterans service organizations and Congress
will be critical throughout the spring and summer. In the end, any
problems that lead to inaccurate payment of benefits or delayed
payments will be unacceptable.
PVA appreciates the opportunity to provide our views on these
important issues that the Senate Committee on Veterans' Affairs will
address in coming months. If you need additional information on each of
the topics outlined here, they will be discussed in much greater detail
in the 23rd edition of The Independent Budget, which will be released
within the next two weeks. In the meantime, we will be happy to provide
you with any additional information that you request.
Finally, we recognize that paying for many of these improvements
will be difficult. However, we believe that this is a cost burden that
this country must bear as veterans who have served this Nation with
distinction and honor should be a top priority.
This concludes my testimony. I will be happy to answer any
questions you may have.
______
Response to Post-Hearing Questions from Hon. Daniel K. Akaka to Carl
Blake, National Legislative Director, Paralyzed Veterans of America
ptsd
Just this morning, the VA Inspector General issued a report on the
Temple, Texas situation. Many will recall that a psychologist at that
facility wrote a strangely worded email which set off a firestorm of
concern for those who are suffering from PTSD. In a word, the IG found
no systemic effort on the part of VA to reduce the number of PTSD
claims via inappropriate diagnosis.
Question 1. Is it your view that mental health issues, and
particularly PTSD, are receiving appropriate attention, in terms of
both compensation and care?
Response. It is apparent that the prevalence of mental health
concerns in the current generations of veterans is more serious than
ever before. While we believe that VA is making every effort to provide
timely and effective treatment, we realize that it will take time to
implement the level of care that is needed across the board. PVA does
believe that VA is moving in the right direction. However, one
hindrance to progress is the lack of training, compassion, and
understanding that was evidenced by the particular clinician that
created the need for the cited investigation. PVA has heard of cases
where some treating physicians just did not believe that Post Traumatic
Stress Disorder (PTSD) is a valid diagnosis, or that VA should be
compensating veterans for it. Education and training of clinicians, VA
disability evaluators, and other staff involved in working with
veterans with mental health issues is paramount. Every VA employee
should be held accountable for treating mentally ill veterans with the
same compassion, understanding, and care that is expected for the
physically disabled population.
As to the question of compensation for PTSD, PVA generally believes
that compensation does not go far enough for veterans being compensated
for serious disability, such as 100% total and permanent and those
veterans receiving Special Monthly Compensation. Our view holds for
veterans being compensated for physical disabilities, mental
disabilities, or both.
collaboration on the issues
Question 2. How can your organizations collaborate to address the
concerns of those who veterans who are returning after service in Iraq
and Afghanistan?
Response. As one of the four co-authors of The Independent Budget,
we have already begun incorporating the concerns of this newest
generation of veterans into the policy portion of our document. In
fact, in order to enlighten our discussion in the best way possible, we
have included representatives from the Iraq and Afghanistan Veterans of
America (IAVA) into the debate about what we will include in our
recommendations. Moreover, the Partnership for Veterans Health Care
Budget Reform has included IAVA in many of the discussions as we have
developed our main policy priority for the 111th Congress--advance
appropriations for VA health care.
Collaboration between groups such as IAVA, Student Veterans of
America, and the larger veterans' service organization community was
also critical in the passage of the Post-9/11 GI Bill. Throughout the
development of that legislation, these groups, and the current
generation of veterans that they represent, were turned to as the
subject matter experts for what the final legislation passed by
Congress should look like. In fact, we are currently in discussions
with these groups to make additional changes to the legislation that
was enacted to ensure that the best education benefit is available on
August 1, 2009.
vba staffing
In light of the increased funding for VBA staffing, there are high
expectations that VBA will improve the quality of claims decisions, and
to do so in a timely
manner.
Question 3. What more do you believe Congress could do to assist in
decreasing the backlog, and at the same time, improving timeliness and
accuracy?
Response. While we appreciate the emphasis placed on hiring many
new claims adjudication personnel, it is important to note that simply
hiring additional staff is not enough. Equally important is to ensure
proper training and accountability of claims adjudication staff at all
levels of the process. While it is easy to blame first-line claims
staff for improper ratings decisions, much of the blame also has to
fall to the management within VBA. Performance measures for all levels
of adjudication staff have wrongly focused too much on quantity of
claims decided rather than
quality.
Moreover, we believe that VBA must accelerate the progress toward
an electronic claims record system. As long as VA continues to use a
paper file shipped around the country, the claims and appeals process
will be done in an expensive and antiquated manner. Under the current
system, VA staff need the actual claims file to act on claims. In a
paperless environment VA staff could act on claims without having to
access a claimant's actual claims file. Additionally, transition to a
paperless system will permit claims work to be seamlessly transferred
to any of VA's regional offices, allowing for quicker decisionmaking on
claims. As demonstrated by the Veterans Health Administration's
outstanding electronic medical record system, similar gains in access
to records can be realized in the claims and appeals process, as well
as significant cost savings as VBA and the BVA move toward a ``Virtual
VA.'' We urge Congress to accelerate funding of VA's transition to an
electronic claims record.
Recent hearings have demonstrated how far behind the VBA is in
using information technology in its claims adjudication process. While
we believe that the entire claims process cannot be automated, there
are many aspects and steps that certainly can. We have long complained
to the VA that it makes no sense for severely disabled veterans to
separately apply for the many ancillary benefits to which they are
entitled. Their service-connected rating immediately establishes
eligibility for such benefits as the Specially Adapted Housing grant,
adaptive automobile equipment, and education benefits. However, they
still must file separate application forms to receive these benefits.
That makes no sense whatsoever.
Furthermore, certain specific disabilities require an automatic
rating under the disability ratings schedule. For example, it does not
take a great deal of time and effort to adjudicate a below knee single-
leg amputation. An advanced information technology system can determine
a benefit award for just such an injury quickly. We believe that it is
time for the VA to automate consideration of ancillary benefits and
specific ratings disabilities that are generally automatic.
With this thought in mind, we believe that it is essential that VBA
expeditiously adjudicate claims that can be adjudicated quickly. By
tying into an advanced information technology system, the VA could
identify and decide claims that can be granted quickly. We have
observed through our national service officers in the field that
oftentimes the VA continues to develop evidence in cases where the
evidence already developed supports the grant of claimed benefits.
PVA also believes that centralized training better prepares ratings
specialists at all levels. Training of rating specialists was
historically conducted at the local level by the more senior staff. The
VA now provides centralized training at its Veterans Benefits Academy
located in Baltimore, Maryland and via the VA intranet. The
Compensation and Pension Service also issues Decision Assessment
Documents (DAD) in response to Court precedent opinions to inform staff
of these decisions. The VA should be lauded for these actions.
Furthermore, as we have called for in The Independent Budget, co-
authored by PVA, AMVETS, Disabled American Veterans, and the Veterans
of Foreign Wars, Congress should fully fund VA's training initiatives.
Improved and continued centralized training should help reduce
inconsistencies and disparities between Regional Offices and should
improve consumer confidence.
Meanwhile, we believe the VBA should use experienced adjudicators
to decide initial claims and to prepare Veterans Claims Assistance Act
(VCAA) notice letters. Rather that using its most inexperienced
adjudication staff to perform initial review of claims, VA should
employ more experienced adjudication personnel to review claims to
determine what information or evidence each claimant should submit to
VA in order to support their claims. After identifying the evidence or
information that is needed to substantiate each claim these more
experienced VA adjudication personnel should then have the
responsibility to prepare and send VCAA notice letters to each claimant
advising each claimant of the evidence or information they need to
submit to VA in order to substantiate their claims.
It also is important to realize that decisions made on appeal
require greater expertise and often involve more complex questions of
medicine and law. As such, it takes years to train a competent ratings
specialist. Trainees and other adjudications staff with little claims
rating experience should simply not be conducting appellate review due
to the complexity of these decisions. Increases in staffing today
should be seen as an investment in the future. Unfortunately, in the
end, staffing issues do not have a quick fix.
With regards to the VCAA notice letters, we believe that there is
much room for improvement in their quality and readability. The only
individuals impacted by what we deem to be substandard VCAA notice
letters are veterans. Current VCAA notice letters issued by the VA tend
to be long and contain complicated legal language that most average
veterans cannot comprehend. By simplifying VCAA notice letters,
claimants will have less confusion and will have a better understanding
of the information and evidence that the VA needs to grant their
claims.
We also believe that VA should not be reluctant to issue
regulations overruling court opinions that have required the VA to
provide unnecessary information in VCAA notice letters. VA often
complains that much of the delays that it experiences in developing and
adjudicating cases result from Court opinions ``interpreting'' the
nature and content of an adequate VCAA notice letter. Congress should
consider amending the law to direct VA to fill in the contours of an
adequate VCAA notice letter by regulation.
The VA and veterans' service organizations can also explore
opportunities to share resources for training. For example, PVA has
prepared a Guide for Special Monthly Compensation (SMC) that has been
adopted by the VA for use when training ratings specialists. This
information has been included on the VA's intranet. The PVA Guide has
also been distributed via BVA Special Monthly Compensation training.
PVA staff also interacts with other veterans' service organizations at
their training events. Moreover, Congress should require the VA to
provide greater access for veterans' service organizations to VA's
training modules.
We remain concerned that VA does not readily accept medical
statements and medical opinions prepared by private physicians.
Congress should enact legislation that requires VA to accept a medical
report or a medical opinion provided by a private physician unless VA
is able to articulate sound reasons for declining to accept the private
medical opinion. Experience seems to suggest that VA adjudicators are
disinclined to accept private physician statements or medical opinions
simply because the statements or medical opinions are prepared by
private physicians and not VA doctors. These actions occur regardless
of whether the private physicians' findings are sound. By refusing to
credit private medical statements or medical opinions, VA unnecessarily
delays adjudication in many claims.
The veterans' service organizations play an active role in
assisting veterans through their national service officer programs. As
such, in recognition of the professionalism and expertise of the
service officers who already work very close with VA staff, we believe
certain opportunities to assist veterans filing claims should be
expanded. First, Congress should authorize accredited veterans' service
organization representatives to file any type of claim for the veteran
without obtaining the veteran's signature. This will allow veterans to
access benefits that they may not know are available in an expeditious
manner. The VA should also authorize accredited service officers access
to VA computer systems to input important data such as updates to
personal information. This would relieve VA staff of some of the
minutia that accompanies their own job responsibilities. It will also
ensure that otherwise critical information impacting the claim filed by
a veteran is updated in a timely manner.
oif/oef illnesses
The Committee and, indeed, the full Congress, has focused a great
deal of attention on mental health and TBI matters. Yet, the most
common health condition of returning OEF/OIF veterans is not TBI or
mental illness, but instead muscle and joint pain.
Question 4. Do you have proposals on how to focus on this number
one health concern from those who have served in Iraq and Afghanistan?
Response. During the 110th Congress, PVA testified in support of
legislation--H.R. 6122 and S. 2160--introduced in the House and Senate
that would establish a system-wide pain care initiative within the VA.
PVA supported the suggestion that comprehensive pain care in not
consistently provided across the entire VA health care system. With
that in mind, we were pleased to see that Public Law 110-387, the
``Veterans' Mental Health and Other Care Improvements Act of 2008,''
included provisions that would require the VA to establish a
comprehensive national pain management policy. Now we would encourage
to the Committee to conduct extensive oversight to ensure that the VA
is following through on this requirement. With a comprehensive pain
care policy, the VA will be better prepared to meet the needs of those
veterans from Operations Enduring Freedom and Iraqi Freedom who present
with muscle and joint pain issues.
We have seen firsthand the benefits of pain care programs as each
VA facility that supports a spinal cord injury (SCI) unit also
maintains a pain care program. Veterans with spinal cord injury know
all too well the impact that pain, including phantom pain, can have on
their daily life. The pain care programs that SCI veterans have access
to have greatly enhanced their rehabilitation and improved their
quality of life.
outreach
Question 5. How are your organizations, individually or in some
cooperative fashion, working to outreach to veterans and encourage them
to take advantage of VA care and services?
Response. PVA is the only congressionally chartered veterans'
service organization that represents veterans with spinal cord injury
or disorders (SCI/D). Through National Office programs, our Veterans'
Benefits Department's Field Services Programs, and our Chapters located
throughout the country, we reach out to all veterans with spinal cord
injury or disorder, regardless of whether or not they are a veteran of
the current conflicts or previous eras.
PVA's Field Services program serves as the first point of contact
in our outreach efforts to veterans. Through one of our more than 60
National Service Offices throughout the Nation and Puerto Rico, we
contact veterans with SCI/D to introduce them to PVA and begin
providing them with all of the information and assistance they will
need to navigate the VA health care and benefits processes. We assist
veterans and their families through every stage of the VA's claim
process from initial filing of a claim for benefits to the Board of
Veterans Appeals. At the same time, our PVA chapters located in many of
the same locations provide peer support and counseling, particularly to
newly injured veterans.
PVA is also unique in that it maintains an active Sports and
Recreation program that serves as a different outreach arm. Through
this program SCI/D veterans learn about opportunities within the VA,
such as the National Veterans' Wheelchair Games and Winter Sports
Clinic, as well as other sports and recreation opportunities that are
available.
women veterans
Question 6. VA has said that sufficient programs and funding
already exist to care for women veterans. What would you point to as
specific problems or shortfalls with respect to women veterans and what
do you recommend that the Committee do to address these concerns?
Response. Women have played a vital part in the military service
throughout our history. In the last 50 years their roles,
responsibilities, and numbers have significantly increased. Current
estimates indicate that there are 1.8 million women veterans comprising
nearly 8 percent of the United States veteran population. According to
Department of Defense (DOD) statistics, women servicemembers represent
15 percent of active duty forces, 10 percent of deployed forces, 20
percent of new recruits, and are a rapidly expanding segment of the
veteran population.
Historically, women have represented a small numerical minority of
veterans who receive health care at Department of Veterans Affairs (VA)
facilities. However, if women veterans from Operation Iraqi Freedom/
Operation Enduring Freedom (OIF/OEF) continue to enroll at the current
enrollment rate of 42.5 percent, it is estimated that the women using
VA health care services will double in two to four years. Based on DOD
rosters received through May 2, 2008, there are a total of 868,717
military members who served in Iraq or Afghanistan and have since
separated from active duty. Women have served 195,000 tours of duty in
Iraq and Afghanistan; 89 percent were enlisted personnel who served in
almost equal numbers on active duty and National Guard/Reserve
components.
As the population of women veterans undergoes exponential growth in
the next decade, VA must act now to prepare to meet the specialized
needs of the women who served. Overall the culture of VA needs to be
transformed to be more inclusive of women veterans and must adapt to
the changing demographics of its women veteran users--taking into
account their unique characteristics as young working women with
childcare and eldercare responsibilities. VA needs to ensure that women
veterans' health programs are enhanced so that access, quality, safety,
and satisfaction with care are equal for women and men. We see the need
for VA to reevaluate its programs and services for women veterans and
to increase attention to a more comprehensive view of women's health
beyond reproductive health needs to include examining cardiac care,
breast cancer, osteoporosis and colorectal cancer in women. A plan
should established that addresses the increased overall demands on
ambulatory care, hospital and long-term care, gender-specific services,
and mental health programs recognizing the unique and often complex
health needs of women veterans. Mental health integration into primary
care is also essential for provision of comprehensive women's health.
PVA would like to express our support for S. 252, the ``Veterans
Health Care Authorization Act of 2009,'' which includes provisions to
address women veterans' health care needs. Finally, we would encourage
you to review the extensive section on women veterans' health care
needs in the FY 2010 edition of The Independent Budget which outlines
significant recommendations that we believe can best address the needs
of women veterans.
paperwork
Question 7. What is your organization's opinion of VA's expanded
paperwork protection policy that came about as a result of the
Inspector General's audit which found that VA regional office personnel
had mishandled some claims documents--is VA's new policy on shredding
appropriate?
Response. We believe that the VA's rapid response to the
``Shredding'' issue has been more than adequate. Following disclosure
of these incidences, PVA received timely briefings from the
Undersecretary for Benefits and we were given an opportunity to provide
suggestions and ideas as to how to address the problem. While it is
atrocious and simply unacceptable that some claims adjudication staff
would deliberately destroy claims or evidence, we have seen that VA did
hold those individuals responsible and accountable for their actions.
One suggestion we would like to make is that accountability should
be made a standard for all operations in VA and that evidence that
accountability must be more commonplace. Accountability measures should
not be taken primarily as a reaction to a high visibility
investigation, as has been the case too often in the VA.
stimulus
Question 8. The Senate stimulus package includes appropriations for
VA, especially $3.7 billion included for VA infrastructure projects.
What are your views?
Response. PVA is pleased that the Senate chose to include a
substantial amount of funding in the stimulus package. We were
subsequently disappointed that funding for Major and Minor Construction
was removed from the compromise Stimulus bill. The legislation
identifies areas of significant need within the VA system, particularly
as it relates to infrastructure needs. As explained in The Independent
Budget, there is a significant backlog of major and minor construction
projects awaiting action by the VA and funding from Congress. We have
been disappointed that there has been inadequate follow-through on
issues identified by the Capital Asset Realignment for Enhanced
Services (CARES) process. In fact, we believe it may be time to revisit
the CARES process all together.
We are also pleased that the Stimulus bill identifies two areas of
particularly critical need--non-recurring maintenance (included in the
Medical Facilities account) and grants for state extended care
facilities. In the last couple of years, Congress has provided
substantial increases in funding for non-recurring maintenance. The VA
has historically not invested adequate funding into its maintenance
needs. In fact, the non-recurring maintenance accounts were often
cannibalized during periods of budget shortfalls. The funding included
in the stimulus bill should allow the VA to begin to break the logjam
of maintenance needs.
There is also a real demonstrated need for additional funding for
state extended care facility construction. Considering the rapidly
aging veterans' population and the growing demand for long-term care
services, it is imperative that state grant funding be increased to
better position the VA and states for the future.
______
Response to Post-Hearing Questions from Hon. Bernard Sanders to Carl
Blake, National Legislative Director, Paralyzed Veterans of America
extended and different hours for va services
As I mentioned in my opening remarks, I have heard from many
veterans who want to get to the VA for care but they can't make it
because of work. I believe we need to increase accessibility of the VA
to all types of veterans, including those with full-time jobs, by
providing evening and weekend hours so that people won't have to choose
between going to work and keeping a VA appointment. This could also
help reduce missed appointments which waste time and resources of VA
staff. My office is currently exploring what kind of authority VA needs
to begin providing extended hours on a one night a week and one weekend
day a week basis, possibly in the form of a pilot program.
Question. What do members of the panel think about this idea?
Response. In recent years, the VA has undertaken a process to
improve the management of patient access to care. This has been done
through the Advanced Clinic Access Initiative. Through this initiative,
the VA focuses on improving patient flow and demand which has a
significant impact on access.
In a report released in 2008 by Booz Allen Hamilton which the
Veterans Health Administration (VHA) contracted for, Booz Allen
conducted an independent review of VHA's scheduling process and metrics
in response to several VA Office of Inspector General (OIG) reports.
The OIG reports found outpatient waiting times reported by VHA to be
unreliable. In its final report, Booz Allen made a number of
recommendations including VA needing to take aggressive steps to use
fixed infrastructure more efficiently. The recommendations also
included providing services at off-peak hours, such as early mornings,
evenings, and Saturdays, when fixed assets are, currently, largely
unused.
PVA believes that expanding VA clinic hours to evening and weekend
schedules could certainly provide an excellent opportunity to address
patient demands on the VA. However, it is imperative that VHA be given
additional resources to account for this increase in workload.
Expanding access hours will certainly increase the overall cost to the
VA to provide health care.
Chairman Akaka. Thank you very much for your testimony.
Now we will hear from Mr. Cullinan.
STATEMENT OF DENNIS CULLINAN, DIRECTOR, NATIONAL LEGISLATIVE
SERVICE, VETERANS OF FOREIGN WARS
Mr. Cullinan. Thank you very much. Chairman Akaka, Ranking
Member Burr, distinguished Members of this Committee, on behalf
of the men and women of the Veterans of Foreign Wars, I want to
thank you for asking us to participate in today's hearing.
I also want to salute you for conducting it so early in the
legislative season. I think it is something that will allow us
to move forward together in a more cohesive and effective
manner, and we really appreciate your having done that.
I will just briefly touch upon some of our legislative
priorities, all of which have already been addressed by my
colleagues here at the time.
A sufficient budget for VA is the first thing I will talk
about. The necessity for that is something we all agree upon.
With respect to advance funding, that is something that we
now strongly support. With respect to that, this year's budget
is a highly sufficient budget and it arrived on time. That is
remarkable, not only in its sufficiency but in its rarity.
We do not think that VA funding is targeted for delay. It
simply gets caught up in the annual budgetary wrangling that
takes place, and that is why we continue to support advance
funding for VA. It takes the VA funding out of that annual
struggle and will allow the system to run more effectively and
efficiently, and everyone benefits from that.
Another issue with us is women veterans. We are very
pleased to learn that legislation introduced last year
providing women veterans' health care is included in this
year's S. 2552. We salute you for having done that.
Women veterans are still grossly under-represented in the
system, and I am sure there are a variety of reasons for that.
But this kind of legislation will provide not only better care,
but we think increased utilization by women.
We would also mention to you another. Minority veterans
need to be better cared for.
Rural veterans is something Senator Burr touched upon. With
urban veterans, they too seem to suffer their own form of
isolation at times. So that is a group that needs to be better
provided for.
VA benefits and compensation: We salute the Congress for
the additional resources and personnel that have put into the
system. At this juncture, probably what is best needed is
ongoing and stringent oversight by this Committee and the
Congress with respect to the utilization of these resources.
Another issue, of course, is retention. We and others have
talked about this before. Someone who is bright enough to be an
adjudicator and persistent enough--especially in a city such as
Washington as a great example--if they are able to do that type
of job, well, typically they can do something else for a lot
more money and a lot less stress in their lives. So, something
that has to be looked at is how we do we keep adjudicators on
board, given the rigors of their profession and the obvious
fiscal temptation to go elsewhere.
Seamless transition: We strongly support that. It is an
issue of medical records transferability between DOD and VA. It
also touches on such things as training, job procurement and,
of course, the implementation of the GI Bill. I think we all
stand as one on that particular issue.
Military quality-of-life is a key issue with us. We very
much appreciate the fact that there is money--additional money.
I think it was $3.75 billion in the stimulus package for VA
facilities, an additional in the billions amount for military
housing, facilities, that kind of thing. We salute the Congress
for having done that. It is very much needed.
And we would certainly maintain that it is shovel-ready in
a sense, that both institutions--both agencies, departments--
are in a state to spend the money right away. So it serves
veterans, serves active duty military and serves the purpose of
stimulating the economy.
Veterans employment: Again, things such as USERRA need to
be more stringently enforced. The provisions of USERRA need to
be more stringently enforced. There are still stories that we
hear of people not getting their jobs back. Veterans'
preference is another incident in hiring which needs to be
monitored more closely.
The last thing I would mention here today is the 3 percent
governmentwide procurement goal. Again, the Department of
Veterans Affairs meets this goal amply. However, I do not know
where else in the Federal bureaucracy--perhaps DOD--where that
actually takes place.
And with that, Chairman Akaka, thank you very much. I
appreciate your giving us this opportunity.
[The prepared statement of Mr. Cullinan follows:]
Prepared Statement of Dennis Cullinan, Director, National Legislative
Service, Veterans of Foreign Wars of The United States
Mr. Chairman and Members of the Committee: On behalf of the 2.4
million men and women of the Veterans of Foreign Wars of the U.S. (VFW)
and our Auxiliaries, we appreciate the opportunity to present our views
and concerns on this year's legislative priority goals for veterans.
va health care
The VFW calls on Congress to pass a sufficient budget for the
Department of Veterans Affairs so that it can properly care for all of
America's sick and disabled veterans.
The VFW urges funding for the Department of Veterans Affairs to be
sufficient, predictable and timely, ending the trend of the last decade
wherein VA's budget has been delivered months late.
Congress must ensure that the unique health care and benefits
challenges of OEF/OIF veterans are met, to include increased funding
for Traumatic Brain Injuries and other related disabilities, as well as
improved access to care, especially for veterans suffering from mental
illness and for the growing number of women veterans accessing the
system
The VFW calls on Congress and VA to increase priority given to
women veterans by providing adequate services by hiring specialized
health care providers and by providing training in gender-specific
issues to help address shortfalls in gender-specific care and mental
health care services for PTSD, Military Sexual Trauma and other needs.
The VFW urges the Department to improve outreach so that all
veterans are aware of the range of health care services and benefits
available to them, especially with female, minority and rural veterans,
who may be less aware of their rights than other groups of veterans.
va benefits and compensation
The VFW asks Congress to provide adequate resources to enable the
Veterans Benefits Administration (VBA) to reduce the current backlog of
claims.
To protect the needs of current and future veterans, the VFW
opposes any changes to the current definition of ``line of duty,''
structural changes to the programs for disability and survivors'
benefits, or curtailment of veterans' or beneficiaries' rights of
entitlement or to appeal benefit decisions.
seamless transition
The VFW demands a truly seamless transition for those men and women
serving in uniform who are transferring from the Department of Defense
to the Department of Veterans Affairs. We envision a system with a
truly integrated electronic medical record that travels wherever the
servicemember is stationed eventually to VA where it follows the
veteran to wherever he or she receives health care.
The VFW urges Congress and the Administration to improve the
transition services and benefits provided to our veterans to ensure a
steady and safe return to civilian life, including viable training,
employment and education programs that address the realities of the
current and future job markets to provide meaningful careers and not
just temporary jobs.
military quality of life
The VFW calls on Congress to fully fund all programs that enable
our troops to succeed in their mission. We must ensure our active duty,
guard and reserve members are provided increased pay, affordable health
care, and adequate housing and work facilities for themselves and their
families.
employment
The VFW calls on Congress to ensure that the provisions of the
Uniformed Service Employment and Re-Employment Rights Act (USERRA) are
strictly enforced.
Support the National Committee for Employer Support of the Guard
and Reserve in its efforts to educate employers on the ever-increasing
importance of hiring National Guard and Reserve members and the
employer's responsibilities as mandated by USERRA.
Urge Congress to amend Public Law 106-50 to state that the three
percent governmentwide procurement goal for Service Disabled Veteran-
owned Small Businesses should be mandated and require agencies to
report their procurement levels and held accountable if they fail to
meet their three percent SDVOSB procurement requirement. We further
urge Congress to exercise oversight to ensure adherence to existing
laws related to SDVOSB and Executive Order 13360 with the goal of
meeting and exceeding the three percent government procurement
requirement for SDVOSBs.
We thank this Committee for the opportunity to share our views, and
we welcome any questions.
______
[The VFW failed to respond to post-hearing questions
submitted by Senators Akaka and Sanders prior to printing.]
Chairman Akaka. Thank you very much for your testimony, Mr.
Cullinan.
Now we will hear from John Rowan.
STATEMENT OF JOHN ROWAN, PRESIDENT,
VIETNAM VETERANS OF AMERICA
Mr. Rowan. Aloha, Senator Akaka and Senator Burr and the
other distinguished Members of this Committee.
Chairman Akaka. Aloha.
Mr. Rowan. And, especially to new Members, we welcome you
to the veterans community, which is really what we all are.
On behalf of the members of Vietnam Veterans of America and
our families, I am pleased to present to you our legislative
agenda for the 111th Congress and thank you for the work that
was done in the 110th Congress because we have made significant
strides; but still there is a lot of work left to be done.
Obviously, we continue to support, along with our
colleagues, the advance appropriations for the VA budget. As
has been mentioned, a lot of us have the same agenda. We kind
of get together on these things even though we have different
backgrounds.
We also obviously support the restoration of eligibility by
2012 for all Priority 8 veterans who choose to use the VA
system.
We are concerned about transforming the VHA, the Veterans
Health Administration, to an open evidence-based system that
would include taking a complete military history for each
veteran enrollee and using it in diagnosis and in treatment
modalities.
We are also concerned--and it is a little off the veterans
field--but there is a big movement now to create an electronic
medical health record for everybody in the United States, and
it is part of President Obama's new initiative and part of the
stimulus package. When they roll that out, we want to ensure
that the 80 percent of veterans in the United States who use
the private medical sector find about issues as well, and that
particular new electronic medical record system includes in the
patient history section significant questions about military
history.
And so, when they ask the question--which they have never
done before in my life, in my 30 years with my HMO--are you a
veteran, and they get my answer. When they ask, are you a
Vietnam veteran, and they get the answer, they should ask
further questions to make sure I get my prostate checked and
make sure I get my--I am a diabetic already. So I do not have
to get that checked anymore. But I mean they do not ask that
question, and it is very important.
If we roll this important new phenomenon into the rest of
the United States like we have in the VA, we need to make sure
that the veterans who are out there and are not in the VA
system get understood about what their health needs are. So,
for the Vietnam veterans with Agent Orange, the Persian Gulf
veterans with Gulf War Syndrome and the new veterans with God
knows what is going to pop out.
We also are concerned about finally getting the VA to do
the National Vietnam Veterans Longitudinal Study. We think that
there were so many questions about what has happened to Vietnam
veterans and why we are dying at such a fast rate, and,
frankly, we think higher than our peers who did not serve in
Vietnam. That study would have told us why, and we might find
some things out without waiting for the scientists to answer
all the questions.
And, obviously, we are concerned about the pension system
as well. I mean it is just ludicrous. I retired 8 years ago
from the city of New York, and I was a manager. I walked out of
there, working on a massive computer system, and I could read
1,500-page contracts online. Along with 10 other people reading
the same contract at the same time. I do not understand why the
VA cannot scan documents and set up a decent system.
We have a new proposal that we want to put on the table. We
believe that the VA should create a Veterans Economic
Independence Administration to be headed by an under secretary.
Such an entity would take responsibility for: the Center for
Veterans Enterprise; vocational rehabilitation services;
veterans preference (which is not done very well in the
government); and would be given functional control over the
Veterans Employment and Training Service, which currently
resides in the Department of Labor.
Frankly, as Dennis, I think, mentioned the 3 percent rule
as well, nobody in this government lives up to the 3 percent
rule, which says that service-disabled veterans and veteran-
owned businesses are supposed to get preference in contracting.
It does not happen, and we need to rectify that situation.
We think that if we created this entity inside the VA to
focus on the economic independence of the individual veteran--
whatever he or she wants to do, whether go to work, start a
business or a combination of both, whatever the case may be--to
focus on that aspect of the reintegration of people into
society. And so, we really urge you to take a look at that and
to consider that possibility.
We really do not even think it would cost very much. It
might even save some money. We are just talking about moving
people around and putting them under somebody. So you'd get a
new Under Secretary of VA Economic Independence. That might
cost a little bit, but we think it would be a worthwhile effort
and certainly goes along with a lot of what our other
colleagues have been talking about, particularly with the newer
veterans coming back and getting into a new life in many cases.
But I must tell you, even some of my old Vietnam veterans,
when they retire, often go into business because, frankly,
nobody can afford to live on what they retire on anymore and
especially in this economy. And so, that is a big component of
what we see happening in the future.
And so, we urge you to take a look at this proposal, and we
thank you for having this hearing, again, so early. I agree
with Dennis. We like the idea of getting a running head start
on this.
We look forward to working with everybody on the Committee,
and we look forward to answering any questions you may have.
Thank you.
[The prepared statement of Mr. Rowan follows:]
Prepared Statement of John Rowan, National President,
Vietnam Veterans of America
Good morning, Senator Akaka, Senator Burr, and other Members of
this distinguished Committee. On behalf of the members of Vietnam
Veterans of America and our families, I am pleased to present to you
VVA's main legislative priorities for the 111th Congress.
Too often, it seems to many that the government puts off dealing
with the healthcare problems of entire generations of veterans. For
instance, the Gulf War has been over almost twenty years and the
government is finally confronted with evidence that is difficult to
refute that there are real maladies associated with military service,
illnesses that do not constitute as ``syndrome'' but are real and
debilitating nevertheless. The government's actions are unacceptable.
Hence the need for legislative remedies. What follows are priorities
that, if enacted and enforced, will, it is our belief and our hope,
make the VA more efficient in caring for our Nation's veterans.
Enact legislation to provide Advance Appropriations to
fund veterans' health care. On this issue, VVA is in lockstep with the
other veterans service organizations that have come together in The
Partnership for Veterans Health Care Budget Reform. This is our main
priority. If legislation is enacted to make Advance Appropriations for
the Veterans Health Administration the law of the land, it will enable
VA managers, at VA medical centers and VISNs, to actually plan for the
next fiscal year while Congress debates the budget. And, while Congress
has been quite generous to veterans in the 110th Congress, as you are
well aware, Congress has been late 19 out of the past 22 years in
passing the budget. We believe that Advance Appropriations will solve
many of the problems encountered by the VHA, and will enable veterans
health care to realize a predictable, reliable, sufficient and, perhaps
most important, timely funding stream.
Legislation also should ensure the restoration of
eligibility by 2012 for all Priority 8 veterans who choose to use the
VA health care system. To ensure that the system can accommodate them,
we believe Congress should mandate that the VA increase the income
ceiling by $5,000 every six months. We do not advocate the wholesale
entry of Priority 8s into the system, as the system will be overrun.
But you will be wise to note that Priority 8 veterans, along with
Priority 7s, account for 40 percent of third-party reimbursements into
the VA's coffers. To a very great extent, they do pay for themselves.
Legislation may be needed to transform the VHA to an open,
evidence-based system. This should include taking a complete military
history for each veteran enrollee and using it in the diagnosis and in
treatment modalities. It would also include verifying that all VA
physicians and other clinicians complete each of the Veterans Health
Initiative curricula in the wounds, maladies, illnesses, and other
conditions that derive from military service, e.g., one's branch of
service; when one served; his/her M.O.S. (Military Occupational
Specialty); where one served and when; and what one actually
experienced. This should help transform the VHA into a wellness system
that focuses on prevention, early and effective interventions, and
innovative methods of motivating enrollees toward healthy lives as well
as innovation that evolves into better and more effective treatments.
Legislation is needed, again, to mandate that the VA
finally conduct the National Vietnam Veterans Readjustment Study
(NVVRS), which would illuminate the health status, both physical and
mental, of Vietnam veterans--men, women, minorities. The VA has
consistently refused to do this study, citing what we believe are
fallacious reasons. Congressional action, therefore, is very much
needed.
And congressional action is needed to ensure that the VA,
as well as the National Institutes of Health, ensure that research is
done on the health effects of exposure to Agent Orange, to dioxin. We
ask specifically for research into the potential intergenerational
effects of a parent's exposure on his/her children and grandchildren.
We receive far too many calls from these folks telling tales of birth
defects and learning disabilities that they were born with and that
have been passed down to their children and they wonder: Could these
health problems derive from a parent's exposure in Vietnam to Agent
Orange? We wonder this, too.
Additional legislation will be needed to revamp the VA's
compensation and pension system, stipulating the integration of state-
of-the-art IT to include artificial intelligence, competency-based
testing of all service representatives and adjudicators, and other
necessary reforms. Legislation also should be enacted to automatically
give veterans who file claims for benefits at least 30 percent if their
initial claim is not adjudicated within 90 days, or if their appeal is
not decided within 180 days from the time of filing. Additionally,
legislation should provide for an across-the-board 25 percent increase
in payments for all veterans receiving benefits, including DIC and non-
service pensions, to help them negotiate the economic realities in
these hard times.
Legislation is needed that would mandate the creation
within the VA of a Veterans Economic Independence Administration, to be
headed by an Under Secretary. Such an entity would take responsibility
for the Center for Veterans Enterprise, vocational rehabilitation
services, veterans preference, and would be given functional control
over the Veterans Employment and Training Service, which currently
resides in the Department of Labor.
The VA health care system has evolved principally on the
medical needs of the male veterans. However, according to figures
supplied by the Department of Defense (DOD), 20 percent of new recruits
are women, almost 15 percent of America's active duty military are
women, and nearly half of them have been deployed to Iraq and
Afghanistan. This has particularly serious implications for the VA
healthcare system because the VA itself projects that by 2010, over 14
percent of all veterans seeking VA health care services will be women,
compared with two percent in 1997. VVA is requesting congressional
legislation to bring into modern times, the delivery of the VA's
medical and mental health care for women veterans, which would also
ensure that the VA would eliminate disparities in care based on gender.
It would also ensure that the resources are appropriated to make steady
progress toward the goal of virtually eliminating veterans who are
homeless by 2012. Part of the need is for additional authorizing
legislation, and part of what is needed is full funding of programs
that have been proven to work, such as the DOL Homeless Veterans
Reintegration Program (HVRP, which is currently authorized at $50
million).
These represent our significant priorities. We have as well a wish
list of legislative actions that we will present to you shortly, that
focus on specific areas of concern.
Now, I thank you for your interest and consideration of these
issues, and I will be pleased to respond to any questions you may have.
______
[VVA failed to respond to post-hearing questions submitted
by Senators Akaka and Sanders prior to printing.]
Chairman Akaka. Thank you very much for your statements and
your testimony.
Before we begin our questions, I want to inform our Members
and our witnesses that we expect an 11 a.m. vote, and our goal
is to try to get to that vote at 11. So, let's begin with the
questions.
My question is for the panel, and it has to do with health
care financing. You have all listed VA health care finance
reform and advance appropriations as a top legislative
priority. Given that the budget for the current fiscal year was
enacted on time and with a record-setting amount, what would
you say to those who say that advance appropriations is
therefore not needed?
Mr. Cullinan. Mr. Chairman, if I may, I will begin.
As I mentioned earlier, we very much appreciate what the
Congress accomplished with this particular budget package, but
it is absolutely no guarantee it is going to happen in the near
future. Undoubtedly, I think in our collective view, there will
be entanglements in the future with respect to funding. So the
need for advance appropriations is still there.
Mr. Blake. Mr. Chairman, I shared a document that I put
together with some other Appropriations Committee staff who had
asked us the very same question.
If you were to use the THOMAS Web site and go look at the
appropriations bills that go back as far as THOMAS goes, which
is 20 years, you would find that in those 20 years only 3 years
saw the appropriations actually passed prior to October 1. In
fact, in many cases, you will find that it was passed in
December, January and, in a couple of cases, February.
So, while we certainly appreciate everything that has been
done in the last 2 years, and the fact that the appropriations
bill was enacted prior to October 1 last year, I would say that
that suggests an anomaly, not the norm.
Chairman Akaka. Thank you.
Mr. Atizado. Mr. Chairman, if I may?
Chairman Akaka. Mr. Atizado.
Mr. Atizado. There is another issue I think has not been
addressed by my distinguished colleagues, and that is the other
provisions in the bill--in the bill which you introduced--which
includes a transparency of the budget process. I mean we just
received a GAO report a couple weeks ago talking about VA's
long-term care budget projections, which they found to have
some questionable data used to drive their budget proposal.
We believe that having that provision in the bill which you
introduced is another key feature that would help not only
foster a meaningful debate between Congress and the Department
as well as the veterans services organization, but to be able
to do so on equal footing--talking about the same kind of data,
apples-to-apples sort of things. I think that would go a long
way. That does not, I believe, currently exist now with the
current budget process.
Chairman Akaka. Thank you.
Any other comments?
Yes, Mr. Stoline.
Mr. Stoline. Yes, sir. Thank you.
We are concerned. It is the delivery of the health care we
are concerned about. From our field service representatives,
they are getting information from the various facilities that
they do not have the money soon enough to plan properly for the
hiring of personnel and for the provision of equipment, and so
that is our main concern.
While we appreciate the timeliness up here in the Congress
of the passage of the appropriation it has to be followed
through to the veteran who needs the service. That is why we
think with a budget known a year in advance the Congress can
hold the VA accountable for not providing those services in a
timely and efficient manner.
Mr. Bowers. Mr. Chairman, if I could just build off of that
also. We are finding that a lot of our membership, as they
return and get out of the military, are going to work for the
VA; and they act as a very effective conduit to let us know
what some of the issues are. Some of the problems that we have
found is that they have difficulties in regards to increased
hiring and also advancements of programs that provide direct
outreach to servicemembers. Every year, they basically are put
on pause for a few months until they find out what their
budgets are going to be.
So, it is the continuity of care that we are pursuing. By
having the advance appropriations, it will really help that
tremendously.
Chairman Akaka. Thank you.
Mr. Rowan. We concur.
Chairman Akaka. Thank you. Thank you very much, Mr. Rowan.
This is just a quick comment, Mr. Stoline. I appreciate The
American Legion's support of providing benefits to the Filipino
World War II veterans. It appears, though, that we have a
difference of opinion on the appropriateness of the offset that
would pay for these benefits. The validity of the Harkness
court decision will be revisited during a legislative hearing
later this session, and we look forward to working with The
Legion on the specifics of that decision.
So, I just wanted to make that comment. You did mention
that in your testimony.
Mr. Stoline. Thank you, sir. And we also provided in our
written testimony some alternative views on how that could be
paid for.
Chairman Akaka. Thank you. Thank you very much.
Let me then call on Senator Burr for his questions.
Senator Burr. Thank you, Mr. Chairman.
I think it is evident that high on the list of everybody's
priorities is the budget issue. Let me share something with
you.
We contacted the Congressional Research Service. They were
very specific. To go to an advance budget process does not
require legislation. The Congress has it in its power to adjust
the internal process to produce a budget that would pre-fund.
So the fact that we are all calling for legislation, it is not
required.
Congress can, tomorrow, determine that we are going to do
an advance budget for VA, and we have the power to do that. You
just have to convince the Chairman of the Budget Committee and
the Chairman of the Appropriations Committee. So it does not
require a legislative remedy.
I agree with all of you that timely, predictable,
sufficient budgets are absolutely essential, and I think most
of us at some time or another have complained about the fact
that VA budgets and VA appropriations are held hostage to the
overall appropriations process.
Let me share one concern that I have. I have yet to find a
piece of the Federal Government that can adequately predict
what an appropriate amount is for next year of any agency.
I would assume that if I asked all of you what gauge to use
to determine that budget in advance, you would probably suggest
the VA Enrollee Health Care Projection model.
Well, GAO, for the VA's 2005-2006 budget shortfalls, said
that that resulted from unreliable data. We all agree that the
data VA uses to process all their information is usually 2 to 3
years out of date. So, in essence, to do advance appropriations
we would rely solely on what we know is outdated data. That is
what I am hearing you ask for.
Let me pose a question to all of you and get you to
respond. If, in fact, we took a different approach and we said
this: that if the VA appropriations are not completed by
October 1, we would automatically put into place for that
year--regardless of who they are--the President's budget number
for the VA. Would that suffice?
Mr. Stoline. The American Legion has talked about that
issue, and we have concerns about it, that it would not
suffice. We do not think that the Congress should give up its
constitutional duties to appropriate funds to a Presidential
budget that might be politically driven and might actually
lower the amount of funds available, thus forcing us to accept
that amount.
I know you think it might be a form of mandatory
appropriations, but we do not see it that way.
Mr. Cullinan. Senator Burr, I would just add that what you
just described, that kind of concurrence would have to occur
annually, I assume, where the Congress would just go ahead and
say, all right, we will fund the VA in advance, lacking
legislation.
So, at least to my mind, that would amount to almost the
same thing as what we have. The Congress would have to say
every year, OK, we will go forward with this funding on time.
With respect to the President's budget, I cannot think of
an exception where we have not found the President's budget
submission--regardless of who it is, Democrat or Republican--
having been lacking. So, we have had to go to the Congress, and
the Senate especially has been terrific in answering the call,
the veterans' call for sufficient funding.
So you have two things. That kind of process that you just
described would be an annual process which is similar at least
to what we have already got. And, second, in the past, the
President's budget just has not been up to snuff with our
funding recommendation.
Mr. Blake. Senator, might I ask you a question?
Senator Burr. Sure.
Mr. Blake. In your proposal, would that be sort of the
short-term fix each year until the appropriations bill would
then be completed? Is that what you are suggesting?
Senator Burr. Clearly, we can pursue any avenue. What I
have tried to address is timely, predictable, sufficient.
I do not believe there is a President that is going to
propose, regardless of what party they come from, something
they perceive to be less than needed. It may not be everything
everybody wants, but not less than needed.
The Congress has the ability, as we have shown every year
since I have been in the U.S. Senate and I think the U.S.
House, that if there was a shortfall they stepped in with some
type of supplemental funds.
What I am trying to do is find some common ground where we
do not lock ourselves into a budget that is computed based upon
bad data which might have a bad outcome, meaning a shortfall,
where continually we are relied upon to go back and have to do
supplemental appropriations throughout the year. And I would
imagine every time we find some way to pay for it, there is
going to be an objection, possibly by somebody in the room if
not somebody in the country, because we are going to take their
money.
In fact, here is a way to get on October 1 the surety that
funding is in place, that planning can go on within the VA and,
if in fact for some reason, the Presidential budget was
insufficient the Congress has the ability to step in and do a
supplemental at that time.
If not, we have locked ourselves into a budget a year in
advance, potentially, only to get to the October prior to and
have everybody tell us that the amounts are insufficient.
So, either way, the likelihood is somebody or all of us
collectively will say they are insufficient. The remedy is the
same. We can choose collectively now to go with a pre-funded
budget by year or we could say let's punt. And, if, in fact,
Congress cannot do their business, if it is caught up in a
process where the VA is held hostage, then the President's
budget numbers trump and they take effect on October 1.
I just ask you all to think about it. My time is expired.
Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Burr.
Senator Sanders.
Senator Sanders. Thank you very much, Mr. Chairman.
I very much appreciated your testimony. What I find
exciting is I think we are pretty much on the same page. I
think we have made some progress in the last 2 years. I think
under President Obama we are going to make more progress, and
it is imperative that we continue to work together on many of
the issues that you have raised and Members of the Committee
have raised.
Let me just start off with Carl Blake.
Mr. Blake, can you tell the Committee why you think the
Automobile Grant Program needs to be updated and why is it an
important benefit; and would you support legislation to
increase the existing benefit from $11,000 to $22,500 and
include an index for annual adjustment of the benefit so that
it always covers 80 percent of the cost of a new car?
Why is this an important benefit and who utilizes it?
Mr. Blake. Well, Senator, in answer to the second part of
your question, we would absolutely support legislation as we
have done in the past. It is also outlined in great detail in
the Independent Budget as it has been in years past.
Interestingly, this benefit is tied to some degree to the
Specially Adapted Housing Grant. Both of these benefits are
meant to increase independence and help individuals who incur a
catastrophic disability to recognize things that they might not
otherwise be able to achieve. Those are: owning a home; and
independence through having their own automobile.
Last year, the Congress did improve the Specially Adapted
Housing Grant and I think achieved a level where it is not
likely you will hear us talking about that much further because
there was an index added to that.
We were disappointed that the Adapted Automobile Assistance
Grant did not include the same kind of an increase. Much like
the Adapted Housing Grant had done over the years, the value of
this particular grant has eroded significantly.
Senator Sanders. Very briefly, explain to everybody what
the Adaptive Automobile Grant is.
Mr. Blake. Well, it is basically a grant that allows an
individual, once they purchase a car, to then pay for
everything that is necessary to accommodate their disability--
any type of adaptive equipment, whether it be for hand
controls. In cases where an individual has a temperature
control issue, it could pay for air conditioning or a different
type of heating system or lifts.
Senator Sanders. In other words, what we have is veterans
coming home who do not have the capability to drive a normal
car, and what this does will upgrade or make the improvements
in their car so that they can get the transportation that they
need. We look forward to working with you on that.
Let me throw out to all of the VSOs a very simple issue,
and you tell me if I am missing something here. I have found in
Vermont that we have CBOCs--and I am a great fan of CBOCs. I
want to see CBOCs expanded. But, unfortunately, not everybody
gets sick or needs to go to a doctor, has the time to go to a
doctor Monday through Friday, 8:30 to whatever it may be, 5.
I have never understood why the clinics are not kept open
at least some evenings a week and maybe on Saturdays to
accommodate people who have time concerns, i.e., maybe they
work or something. Is that sensible?
Who wants to comment on that?
Mr. Rowan. Yes, I will jump in.
I think that we have agreed and then talked about that idea
in previous testimonies years ago, about the idea of expanding
the hours of all the clinics in the VA system, period--not just
the CBOCs, but also the clinics associated with the hospital
systems.
Senator Sanders. Right.
Mr. Rowan. We are still seeing some problems with
timeliness and the problems with the ability, even within the
hours that we are constrained to, of getting appointments.
Senator Sanders. Right.
Mr. Rowan. And I can give you an example. I had to cancel
an appointment I had yesterday because I had to come to D.C.
for a meeting, and my next appointment--because the first
available appointment from my primary care doctor, and this was
just a visit to check on my test scores--will be in March; well
over a month.
Senator Sanders. Right.
Mr. Rowan. And so, yes, I fully concur with the idea of
getting more people into the system, more people and more
hours, especially for those who are still working.
Senator Sanders. What about Saturday hours, maybe even
Sunday and evening hours? Does that make sense to people?
Mr. Rowan. Use the facilities.
Mr. Atizado. Senator Sanders?
Senator Sanders. Mr. Atizado.
Mr. Atizado. Thank you, sir.
I believe VA had, I am not sure if it was in testimony or
as a press release, had mentioned extending clinic hours. The
question at this point is how many and to what extent, because
any increase in operation hours may not necessitate an increase
in their manpower. And it is obviously a great idea.
I mean, as my colleague here had mentioned, there is a
capacity issue in VA. I think it is a reasonable tool to have.
Senator Sanders. Other thoughts?
Mr. Stoline. The American Legion would support more access
for health care for veterans, and that would be one way to
provide it.
Senator Sanders. Do we know? I am just raising this
question to anybody. Is there any reason now why a CBOC or a
medical facility in any State in the country could not have
extended hours other than budgetary issues?
I suspect there is not any. They could do it or they could
not? Yes, they could. OK. So it is basically a budgetary issue.
OK. My time is expired. Thank you very much, Mr. Chairman.
Chairman Akaka. Senator Johanns.
Senator Johanns. Mr. Chairman, thank you.
And thanks for your testimony. I appreciate it.
I have one question. I am not exactly certain who wants to
respond to it, but let me put it out there.
We have a rehabilitation hospital in Lincoln called
Madonna. It is first class. I know people who have been
serviced there or served there, and it just really is
outstanding.
As I understand it, there is a relationship with Madonna in
the Western Iowa and Nebraska Regional VA System. They
contracted for services out of this facility.
I would like to hear your thoughts about this approach,
kind of a public-private sort of approach, especially in areas
like my State where you have a lot of rural area and somewhat
limited services. Do you see more of this happening?
Is it a good idea? Is it something we should be pursuing?
Mr. Cullinan. Senator, speaking for the VFW, we support
providing care on a contract basis when it is necessary in
situations where the care in rural remote areas where a VA
provider simply isn't available. In situations where certain
types of specialty care isn't available, that happens quite a
bit.
One concern of ours, and I believe of the rest of the group
here, is that contract care not somehow supplant VA. That is
something that goes back as long as I have been around, which
is quite a while, that VA is a national treasure, that it be
protected, that the resources that it offers veterans continue
to be provided. In order to do that, the system has to stand as
a piece, as a whole.
But there are certainly instances where it is appropriate,
and we recommend that.
Mr. Rowan. Senator, I would concur with that. I mean one of
the things that is very clear, all the VA hospitals are
associated with major medical facilities, and that is where
they get most of their staffing from, frankly.
So if there is a situation, even where there is not a
distance issue, if there is just, if you got the better brain
surgeon in the hospital next door, send that person to that
doctor. I mean that happens on occasion. You see that, and we
fully support that kind of program.
We really think it is an issue with the mental health
facilities where there is just not enough folks in the VA
system to go around. I go back to the days in the Vietnam era
when we had fee-basis provider stuff, particularly where some
veterans really needed one-on-one counseling and not group
therapy, which is the basis of the Vet Center program. And so,
we fully concur with that idea.
But, again, with my colleague, we have a VA system for a
reason, and we want to continue to support that VA system. We
have watched it change and become more accessible. We fully
concur with that idea.
Mr. Bowers. One of the recommendations that we made was
that the Secretary of the VA design and implement national
guidelines to instruct VA facilities when it is appropriate to
contract with local community health care providers. The reason
being: that in working with a lot of our membership, we found
that rural veterans--which the Iraq and Afghanistan conflicts
have relied heavily on--fell into these gaps, fell into these
problems.
We have not been able to identify sort of a nationwide
ruling that really gives clarity to this process. By
establishing that process, whether it be through a report or
study, really could answer a lot of these questions right off
the bat.
Senator Johanns. That is all I have, Mr. Chairman, other
than to say I really appreciate your approach to this because I
agree with you.
The VA is a treasure. We want to protect that, enhance it
and do everything we can to improve it. But there are
circumstances where that facility is there, and it provides the
kind of service you need, and we should look at that. So I
appreciate your thoughts on it.
Thank you, Mr. Chairman.
Chairman Akaka. Thank you, Senator Johanns.
Senator Tester.
Senator Tester. Thank you, Mr. Chairman.
I want to start by saying I appreciate what each one of
your folks' organizations do in helping fill in the gaps and
addressing families and issues. I do not take that lightly. I
really appreciate each and every one of you folks and what your
organizations do for veterans in this country.
The Chairman and Ranking Member both talked about advance
funding with their first questions, and I think almost every
one of you guys put it in the top three when you were talking.
Just a clarification, Dennis, I am going to pick on you for
a second. When you were all talking about advance funding, I
interpreted that as mandatory funding. Can you tell me the
difference?
Mr. Cullinan. Carl could actually do a better job. Let me
take a stab at it.
Senator Tester. Well, he can as well.
Mr. Cullinan. Mandatory funding is basically funding VA in
accordance with a formula. You establish a base line, say the
current fiscal year. You adjust it by, say, 20 to 30 percent,
and every year you adjust it on a percentile basis, basically.
Advance funding is a situation where you say, OK, once it
is set in motion, the funding, not for the immediately upcoming
fiscal year but the one after that, gets adjudicated by the
Congress. It is decided upon and, OK, it is ready to go.
Senator Tester. OK.
Mr. Cullinan. So that is the difference in a very simple
way.
Senator Tester. That is all I needed. Thank you.
I want to jump to a different area that probably was not
addressed in any of your testimony, but its something that I
have been hearing more and more about, mainly because of PTSD
and TBI and other mental health conditions leading to lasting
physical and psychological problems. We have veterans that
suffer these injuries and go undiagnosed and, unfortunately,
untreated. We end up with disruptive acts, depression,
substance abuse. The list goes on and on and on.
Several States have recognized this by setting up
specialized courts and sentencing procedures to assist veterans
of nonviolent crimes. Is there a need for veterans' courts
nationally?
Go ahead.
Mr. Rowan. Yes, to be simple about it.
Actually, in Buffalo, New York, one of my national board of
directors members is the County Commissioner for Veterans
Affairs up there, and he was very heavily involved in
establishing the veterans' court in Buffalo. It has proved to
be very useful in the short period of time that they have
utilized it.
And what they have been able to do is nip in the bud the
problems of exactly what you talked about, that those of us
that go back to the Vietnam era remember, which is the usual
deterioration that starts off usually with drug abuse or simple
assault nonsense, which then, of course, escalates into
something much more horrible, which puts people in
incarceration for the next 40 years.
So, we fully support the idea of this. We have asked. We
have watched a number of people. I have just talked to some,
and Wisconsin apparently is going to try to do it Statewide. We
have heard other States that are looking at it, and it has been
particularly helpful when you find that the chief judge or the
DA is a Vietnam vet.
Senator Tester. That is good.
Do all the rest of you support that idea of a veterans'
court? And, if any of you have any negatives toward it, could
you tell me?
Mr. Stoline. Well, The American Legion is a resolution-
based organization, and I do not believe we have one on that
particular issue. But on the standpoint of diverting a veteran
from the criminal justice system and take care of his problem,
we would be supportive of that issue.
Senator Tester. What role do you think the veterans
organizations would play in a veterans' court?
Mr. Rowan. I can actually talk about that. In Buffalo,
again, my local VVA chapter there, we actually utilized their
members as mentors for the folks who come into the court
system, so that they not only have to go through the mandatory
counseling and other programs, but they get assigned somebody
to be able to sit and take them through the rest of the whole
nonsense that everybody has to deal with coming back.
Senator Tester. OK. What role would the Veterans
Administration itself play in veterans' courts, if any?
Mr. Rowan. Well, again, we are really going to the VA as
the primary care provider for both physical issues and mental
health issues.
Senator Tester. All right. I just want to tell you that
there is a wealth of information you folks have put in your
testimony, both written and verbal, and I think there is some
good stuff that we can take away from this hearing.
Thank you very much for being here.
Chairman Akaka. Thank you very much, Senator Tester.
Senator Begich.
Senator Begich. Probably 1 or 2 minutes, I will be very
quick.
I actually would be interested, and I am going to say it to
you but actually to Senator Tester. We have wellness courts in
Alaska--mental health courts that have been very, very
successful in dealing from the veterans' end up. We try to
guide them over there--especially returning veterans--when
there is an early situation. So the idea has worked very
successfully.
It is more expensive, but the end result is it is holistic.
And it is not just about the veterans; it is about their family
and other situations that occur. So, I think it is a very good
idea.
I want to ask a general question, well, two questions.
First, do you all--and this is as a new Member to the Senate,
as a new Member here on this Committee--do you have a regular
process that you, as organizations working with members, work
with the VA; not as individual organizations, but where you sit
down as a working group and try to streamline or talk about
their systematic problems?
Because that is a lot of what I hear about the VA. I think
there is a great service they provide, but they have major
systematic problems, that delivery of service is pretty
limited.
Do you have a formal process or is it just whoever can get
to them that week gets to them?
Mr. Atizado. Senator, I do not believe there is an actual
formal process. If I am hearing you correctly, something like a
working group?
Senator Begich. Yes.
Mr. Atizado. To deal with the hot topic of the week or the
month or whatever.
Senator Begich. Because as we come and go, it is the
systematic issues that we want to make sure happens--the long-
term care.
Mr. Chairman, I always forget how the bells work. So you
have to guide me. I am sure staff will grab me any second here.
Would that be of interest if there was a formal process
that you as organizations collectively work?
Mr. Cullinan. Senator, I would just add that on the part of
the VFW, we have our National Veterans Service, and they
interact with VA on a regular basis. They attend meetings. They
participate in these meetings. So, there is a regular
interaction.
Additionally, we have our Independent Budget for VA which
represents a group of veterans organizations getting together,
working together in a systematic way to address not only
funding issues but policy issues as well. So all the
organizations interact with VA, participate in these meetings,
and additionally we have our Independent Budget. We have the
partnership we refer to in support of funding.
Mr. Rowan. Senator, I was just checking with my staff. My
understanding is that the Secretary of the VA meets on almost a
monthly basis with a lot of the leaders of all major
organizations--on a regular basis--to either bring up new
issues or talk about problems. Like with the GI Bill: when they
were moving forward with that and wanted to propose to contract
it out, we nipped that in the bud. So, I mean those.
We do have a continual interaction with them, I believe. It
is not as formal perhaps as you may be discussing.
Senator Begich. Right. OK. Mr. Chairman, because of time I
will stop at that point.
Again, your testimony has a lot of good detail into it. I
will probably have some questions. Through my staff, I will get
back to you based on some conversations that have occurred
here.
Chairman Akaka. Thank you very much, Senator Begich.
I want to thank the panel very much for your testimony. You
have given us a better understanding of your organization's
legislative priorities, and this is what the hearing was for
today.
I have additional questions, and I am sure that other
Members of the Committee also have questions. I will submit,
and they will submit their questions for the record. Perhaps we
will do that as quickly as we can.
We do have that 11 a.m. vote, as I said, which you have
heard on the clocks.
So, again, I want to thank you very much for your
testimony, and we look forward to working with you this year.
As you can tell, we have much to do and we have to take the
time to do it as quickly as we can. Again, thank you very much.
This hearing is adjourned.
[Whereupon, at 11:03 a.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of LTG Theodore G. Stroup, Jr., USA (Ret.),
Vice President, Association of the United States Army
Mr. Chairman and Members of the Committee: Thank you for the
opportunity to present the views of the Association of the United
States Army (AUSA) concerning veterans' issues. Both in personal
testimony and through submissions for the record there exists a long-
standing relationship between AUSA and the Senate Committee on
Veterans' Affairs. We are honored to express our views on behalf of our
members and America's veterans.
The Association of the United States Army is a diverse organization
of over 105,000 members--active duty, Army Reserve, Army National
Guard, Department of the Army civilians, retirees and family members.
An overwhelming number of our members are entitled to veterans'
benefits of some type. Additionally, AUSA is unique in that it can
claim to be the only organization whose membership reflects every facet
of the Army family. Each October, at our Annual Meeting, our membership
has the opportunity to express its views through the consideration and
approval of resolutions for the following year. These resolutions
provide the base upon which the Association's leadership builds its
legislative agenda.
Each year, the AUSA statement before the Committee stresses that
America's veterans are not ungrateful. Much of the good done for
veterans in the past would have been impossible without the commitment
of many who serve on the Committee and the tireless efforts of its
professional and personal staffs.
The inherently difficult nature of military service has never been
more self-evident than during the current conflict. While grateful for
the good things done for veterans, AUSA reminds our elected
representatives that we consider veterans benefits to have been duly
earned by those who have answered the Nation's call and placed
themselves at risk.
AUSA is heartened that Congress has expressed a commitment to
support America's veterans. Despite this, many are concerned that the
declining number of veterans in Congress might in some way lessen the
value this institution places on veterans and their service to the
Nation. We, at AUSA, do not share this opinion. AUSA is confident that
you--well-intentioned, patriotic men and women--will faithfully
represent the interests of America's veterans during fiscal
deliberations.
As elected representatives, you must be responsible stewards of the
Federal purse because each dollar emanates from the American taxpayer.
AUSA emphasizes that the Federal Government must remain true to the
promises made to her veterans. We understand that veterans' programs
are not above review, but always remember that the Nation must be there
for the country's veterans who answered the Nation's call.
Veterans seldom vote in a block, despite their numbers. This is one
reason AUSA seeks this forum to speak for its members about veterans'
issues. Our veterans have lived up to their part of the bargain; the
Congress must live up to the government's part.
Those who have volunteered to serve their country in uniform
deserve educational benefits that support their transition to civilian
life. AUSA applauds Congress for enacting the Post-9/11 Veterans
Educational Assistance Act of 2008. This landmark legislation will help
educate a new generation of veterans by allowing them to enroll as a
full-time students and to focus solely on education--as it funds
tuition at an amount equal to the highest in-state tuition rate charged
by a public college in a state, as well as providing stipends for
housing and for books and other educational costs.
In conjunction with the New GI Bill, AUSA urges the Congress to
increase Survivors and Dependents Educational Assistance (DEA) a
minimum of 20% to match the increases in Montgomery GI Bill benefits
Congress passed in 2008 as well as ensuring that the benefits in the
DEA program be adjusted proportionally whenever Congress raises MGIB
and New GI Bill benefits.
Also, AUSA believes that the monthly stipend issued under the
Vocational Rehabilitation and Employment (VR&E) program should be
increased to reflect the basic allowance for housing (BAH) payments
under the New GI Bill. VRE helps equip disabled veterans to transition
back into the work force.
AUSA strongly encourages Congress to raise education benefits for
National Guard and Reserve servicemembers under Chapter 1606 of Title
10. For years, these benefits have only been adjusted for inflation.
Currently, Reserve GI Bill benefits have fallen to less than 25 percent
of the active duty benchmark giving them much less value as a
recruiting and retention incentive. This also sends a signal to Reserve
Component personnel that their service is undervalued. Further, a
transfer of the Reserve MGIB-Select Reserve authority from Title 10 to
Title 38 will permit proportional benefit adjustments in the future.
AUSA also believes it is time to revisit the need to dock volunteer
force recruits $1200 of their first year's pay for the privilege of
serving their country on active duty. Government college loan programs
have no upfront payments; thus, it is difficult to accept any rationale
for our Nation's defenders to give up a substantial portion of their
first year's pay for MGIB eligibility.
That said, perhaps a better solution would be to consolidate and
deconflict the MGIB and New GI Bill into one educational benefits
program for active and reserve components. The coexistence of the MGIB
alongside the New GI Bill is causing considerable confusion. Benefits
available in the MGIB such as pilot training, licensure/certification
tests and distance (online) course work are not available in the New GI
Bill, while a tuition reimbursement indexing mechanism, housing
benefits, and a book stipend are available in the New GI Bill but not
the MGIB.
Members of the National Guard called to active duty under Title 32
in support of the current crisis do not receive veteran's status for
their active duty military time. Those called to active duty under
Title 10 do receive veteran's status. This inequity must be addressed.
Your support in allowing Guard members to earn veterans' status on
equal footing with their active duty and Reserve counterparts will send
the message that National Guard personnel are part of the Total Force.
Veterans' medical facilities must remain expert in the specialties
which most benefit our veterans. These specialties relate directly to
the ravages of war and are without peer in the civilian community.
Demand for VA health care still outpaces the capacity to deliver care
in a timely manner. That said, a way must be found to build on the
inclusion of more Category 7 and 8 veterans this year, so that
ultimately all Category 7 and 8 veterans can receive care from the VA.
AUSA believes that full funding should occur through modifications to
the current budget and appropriations process that would authorize a
two-year advance appropriation for the VA health care system, by using
a mandatory funding mechanism or by some other changes in the process
that achieve the desired goal.
AUSA applauds the unprecedented and historic legislation which
authorized the unconditional concurrent receipt of retired pay and
veterans' disability compensation for retirees with disabilities of at
least 50 percent and the legislation that removed disabled retirees who
are rated as 100 percent from the 10-year phase-in
period. However, we cannot forget about the thousands of disabled
retirees left out by this legislative compromise. The principle behind
eliminating the disability offset for those with disabilities over 50
percent is just as valid for those 49 percent and below. AUSA urges
that the thousands of disabled veterans left out of previous
legislation be given equal treatment and that the disability offset be
eliminated completely.
Another critical area needs to be addressed. For chapter 61
(disability) retirees who have more than 20 years of service, the
government recognizes that part of that retired pay is earned by
service, and part of it is extra compensation for the service-incurred
disability. The added amount for disability is still subject to offset
by any VA disability compensation, but the service-earned portion (at
2.5 percent of pay times years of service) is protected against such
offset.
AUSA believes that a member who is forced to retire short of 20
years of service because of a combat disability must be ``vested'' in
the service-earned share of retired pay at the same 2.5 percent per
year of service rate as members with 20+ years of service. This would
avoid the ``all or nothing'' inequity of the current 20-year threshold,
while recognizing that retired pay for those with few years of service
is almost all for disability rather than for service and therefore
still subject to the VA offset.
Fortunately, legislation provided in previous defense bills extends
Combat Related Special Compensation (CRSC) to retirees with less than
20 years of service with combat or operations-related disabilities.
Unfortunately, retirees with non-combat disabilities forced to retire
short of 20 years of service still have to fund their VA compensation
dollar-for-dollar from their disability retirement from DOD.
AUSA supports legislation that establishes a presumption of service
connection for veterans with Hepatitis C (HCV).
The rules for interment in Arlington National Cemetery (ANC) have
never been codified in public law. Twice the House has passed
legislation to codify rules for burial in Arlington National Cemetery.
However, the legislation has not passed in the Senate. AUSA supports a
negotiated settlement of differences between the House and Senate
concerning codification of rules for burial in Arlington National
Cemetery. Further ``gray area'' reservists eligible for military
retirement should be included among those eligible for interment at
Arlington National Cemetery.
AUSA remains opposed to the imposition of an annual deductible on
veterans already enrolled in VA health care and any increase in the co-
payment charged to many veterans for prescription drugs. AUSA urges
Congress to continue to oppose such fees.
AUSA supports continuing congressional efforts to help homeless
veterans find housing and other necessities, which would allow them to
re-enter the workforce and become productive citizens.
Terminally ill veterans who hold National Service Life Insurance
and U.S. Government Life Insurance should, upon application, be able to
receive benefits before death, as can holders of Servicemembers Group
Life Insurance and Veterans Group Life Insurance. AUSA supports
legislation to amend the U.S. Code appropriately.
Much more needs to be done to ensure that returning combat
veterans, as well as all other service men and women who complete their
term of service or retire from service receive timely access to VA
benefits and services. This issue encompasses developing and deploying
an interoperable, bidirectional and standards-based electronic medical
record; a ``one-stop'' separation physical supported by an electronic
separation document (DD-214); benefits determination before discharge;
sharing of information on occupational exposures from military
operations and related initiatives. AUSA strongly recommends
accelerated efforts to realize the goal of ``seamless transition''
plans and programs.
We encourage the positive steps toward mutual cooperation taken
recently by the Department of Defense (DOD) and the VA. The closer we
can come to a seamless flow of a servicemember's personnel and health
files from service entry to burial, the more likely it will be that
former servicemembers receive all the benefits to which they are
entitled. AUSA supports closer DOD/VA collaboration and planning
including billing, accounting, IT systems, patient records, but not
total integration of facilities nor of VA/DOD healthcare systems.
AUSA strongly supports preservation of dual eligibility of
uniformed service retirees for VA and DOD healthcare systems. We
applaud Congress' opposition to ``forced choice'' in the past and
encourage you to hold the line in the future.
AUSA recognizes that significant progress has been made in reducing
the unacceptably high numbers of backlogged disability claims. The key
to sustained improvement in claims processing rests on adequate funding
to attract and retain a quality workforce supported by investment in
information management and
technology.
The Committee safeguards the treatment of America's veterans on
behalf of the Nation. AUSA knows that you take this responsibility
seriously and treat this privilege with the gratitude and respect it
deserves. Although your tenure is temporary, the impact of your actions
lasts as long as this country survives and affects directly the lives
of a precious American resource--her veterans. As you make your
decisions, please do not forget the commitment made to America's
veterans when they accepted the challenges and answered the Nation's
call to serve.
Thank you for the opportunity to submit testimony on behalf of the
members of the Association of the United States Army, their families,
and today's soldiers who are tomorrow's veterans.