[Senate Hearing 112-116]
[From the U.S. Government Publishing Office]
S. Hrg. 112-116
PENDING LEGISLATION
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TWELFTH CONGRESS
FIRST SESSION
__________
JUNE 8, 2011
__________
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COMMITTEE ON VETERANS' AFFAIRS
Patty Murray, Washington, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Daniel K. Akaka, Hawaii Johnny Isakson, Georgia
Bernard Sanders, (I) Vermont Roger F. Wicker, Mississippi
Sherrod Brown, Ohio Mike Johanns, Nebraska
Jim Webb, Virginia Scott P. Brown, Massachusetts
Jon Tester, Montana Jerry Moran, Kansas
Mark Begich, Alaska John Boozman, Arkansas
Kim Lipsky, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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June 8, 2011
SENATORS
Page
Murray, Hon. Patty, Chairman, U.S. Senator from Washington....... 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 3
Boozman, Hon. John, U.S. Senator from Arkansas................... 5
Prepared statement........................................... 5
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 68
Begich, Hon. Mark, U.S. Senator from Alaska...................... 115
WITNESSES
Snowe, Hon. Olympia J., U.S. Senator from Maine.................. 6
Warner, Hon. Mark R., U.S. Senator from Virginia................. 8
Prepared statement........................................... 10
Whitehouse, Hon. Sheldon, U.S. Senator from Rhode Island......... 11
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 13
Prepared statement........................................... 15
Cardarelli, Michael, Principal Deputy Under Secretary for
Benefits, Veterans Benefits Administration, U.S. Department of
Veterans Affairs............................................... 16
Jesse, Robert L., M.D., Ph.D., Principal Deputy Under Secretary
for Health, Veterans Health Administration, U.S. Department
Veterans Affairs; accompanied by Walter A. Hall, Assistant
General Counsel; and Richard J. Hipolit, Assistant General
Counsel........................................................ 18
Prepared statement........................................... 20
Additional Views............................................. 36
Response to posthearing questions submitted by:
Hon. Patty Murray.......................................... 52
Hon. Richard Burr.......................................... 56
Response to request arising during the hearing by Hon.
Sherrod Brown.............................................. 69
McWilliam, John, Deputy Assistant Secretary, Veterans' Employment
and Training Service, U.S. Department of Labor................. 60
Prepared statement........................................... 61
Steele, Jeff, Assistant Director, National Legislative
Commission, The American Legion................................ 73
Prepared statement........................................... 74
Violante, Joseph A., National Legislative Director, Disabled
American Veterans.............................................. 81
Prepared statement........................................... 82
Kelley, Raymond C., Director, National Legislative Service,
Veterans of Foreign Wars of the United States.................. 96
Prepared statement........................................... 97
Ensminger, Jerome ``Jerry,'' MSgt. USMC (Ret.), Elizabethtown,
North Carolina................................................. 105
Prepared statement........................................... 108
Cox, J. David, R.N., AFGE National Secretary-Treasurer, on behalf
of the American Federation of Government Employees--AFL-CIO and
AFGE National VA Council....................................... 109
Prepared statement........................................... 110
APPENDIX
U.S. Department of Defense; prepared statement................... 119
Marquez, Mercedes, Assistant Secretary for Community Planning and
Development, U.S. Department of Housing and Urban Development;
prepared statement............................................. 122
Berry, Hon. John, Director, U.S. Office of Personnel Management;
prepared statement............................................. 125
Paralyzed Veterans of America; prepared statement................ 129
Tarantino, Tom, Senior Legislative Associate, Iraq and
Afghanistan Veterans of America; prepared statement............ 137
PENDING LEGISLATION
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WEDNESDAY, JUNE 8, 2011
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:29 a.m., in
room 418, Russell Senate Office Building, Hon. Patty Murray,
Chairman of the Committee, presiding.
Present: Senators Murray, Brown of Ohio, Begich, Burr, and
Boozman.
OPENING STATEMENT OF HON. PATTY MURRAY, CHAIRMAN,
U.S. SENATOR FROM WASHINGTON
Chairman Murray. Good morning and welcome to today's
hearing. Today we have a very ambitious agenda that really
reflects the hard work of the Members on both sides of the
aisle of this Committee.
We have numerous challenges to meet for our Nation's
veterans, and I am pleased that this Committee has worked and
will continue to work to develop legislation that substantially
improves their lives and the lives of their families,
especially during this time of war.
There is much on the agenda that is important, but I want
to speak briefly at the top here about one item, my Hiring
Heroes Act of 2011. Ensuring that our veterans can find
employment when they come home is an area where I believe we
have to do a lot more. For too long we have been investing
billions of dollars in training our young men and women to
protect our Nation, only to ignore them when they come home.
For too long we have patted them on the back and pushed them
into the civilian-job market with no support, and that is
simply unacceptable and does not meet the promise we made to
our men and women in uniform.
Our hands-off approach has left us now with an unemployment
rate in February of over 27 percent among young veterans coming
home from Iraq and Afghanistan. That is over 1 in 4 of our
Nation's heroes who cannot find a job to support their family
when they come home. Over 1 in 4 of our servicemen and -women
lack the stability that is so critical to their transition
home.
So last month, I introduced the bipartisan Hiring Heroes
Act of 2011, which now has 19 cosponsors. This legislation will
help us rethink the way we support our servicemembers as they
return home and search for living-wage jobs.
I introduced this critical legislation because I have heard
firsthand from the veterans for whom we have failed to provide
better job support. I have had veterans tell me they no longer
write that they are a veteran on their resume because they fear
the stigma they believe employers attach to the invisible
wounds of war. I have heard from medics who return home from
treating battlefield wounds 24/7 who cannot get certifications
to be an EMT or even drive an ambulance. These many stories are
heart-breaking and they are frustrating. But more than
anything, they are a reminder that we have to act now.
The Hiring Heroes Act would allow our men and women in
uniform to capitalize on their service while making sure the
American people capitalize on the investment that we made in
them. For the first time, it would require every servicemember
transitioning from active duty to participate in the Transition
Assistance Program. That is a program that supports our
servicemembers by providing them with broad job skills training
before they separate from service. It will also allow
servicemembers to begin the Federal employment process prior to
separation. And, it will require the Department of Labor to
take a hard look at what military skills and training should be
translatable to the civilian sector, which is a much needed
step toward making it simpler for veterans to obtain licenses
and certifications.
Finally, my legislation would allow for innovative
partnerships between VA, DOD, and organizations that provide
mentorship and training programs designed to lead to job
placements for veterans. All of these are real and substantial
steps to put our veterans to work, and they come at a pivotal
time during our economic recovery and for our servicemembers.
The second bill I want to quickly mention is the Veterans
Programs Improvement Act of 2011, which will allow the
Department of Veterans Affairs to continue the important work
of ending veterans' homelessness. It will improve the quality
of the fiduciary programs that are administered by the VA and
provide for a number of other VA enhancements.
VA has made some great strides in the effort to eliminate
homelessness. In a report released jointly by VA and HUD in
January 2010, VA estimated approximately 76,000 veterans were
homeless on any given night, down from 131,000 in the previous
year, but clearly we are not there yet. This bill will expand
assistance for homeless veterans by improving the Grant and Per
Diem Program, as well as providing health care services,
community resource centers, and case management for homeless
veterans. It will also direct the VA to provide further details
about its comprehensive plan to eliminate veterans'
homelessness. Finally, the bill addresses the needs of some of
Nation's most vulnerable veterans by improving oversight of
fiduciaries and by eliminating procedures that have
unnecessarily contributed to delays in claims filed on behalf
of incompetent veterans.
Last, all across the Nation, too many veterans and their
families continue struggling to make ends meet. The Veterans'
Compensation Cost-of-Living Adjustment Act of 2011, cosponsored
by all Members of this Committee, may provide some much-needed
relief. The bill increases the rates of compensation for
veterans with service-connected disabilities and the rates of
dependency and indemnity compensation for the survivors of
certain disabled veterans.
We know there is a lot to be done as we continue our work
on behalf of our Nation's veterans, and I am glad to see that
we are considering a wide array of bills to address these
challenges. I am eager for a productive discussion about the
items on this agenda. I look forward to hearing from all of our
witnesses, and I want to thank Senators in particular who are
here to talk about their legislation this morning. We will turn
to you both in just a minute, but first I will hear from the
Ranking Member, Senator Burr.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Good morning, Madam Chairman. I want to
welcome our witnesses and our colleagues first. I also want to
highlight one of our witnesses, Jerry Ensminger, from my
homestate of North Carolina. Jerry, welcome. Thank you for your
tireless advocacy for veterans and their families who lived at
Camp Lejeune and faced a water contamination problem.
Madam Chairman, I also want to note once again that the
Administration failed to submit testimony on time. Although the
VA made efforts to ensure the Committee had relevant
information ahead of time, we did not receive the views of the
Department of Labor until less than 24 hours ago. Madam
Chairman, this cannot be allowed to continue. It seems like it
occurs almost every time we have a hearing.
Before I discuss a few bills of interest to me, I want to
talk generally about the path forward. This legislative hearing
is one step in figuring out whether the 35 bills on the agenda
should be advanced by this Committee at a markup later this
month. These bills would collectively spend billions of dollars
to expand or modify existing veterans programs and in some
cases create new ones. As we examine each bill, I think it is
important to keep in mind that our Nation is faced with
staggering deficits and debt and is on a fiscal path that is
unsustainable.
At the same time, the GAO has been telling us that there is
duplication, fragmentation, and overlapping in Federal programs
governmentwide. According to GAO, reducing or eliminating
overlap could actually help agencies provide better services
and save billions of dollars each and every year.
So as we consider whether to create or expand veterans
programs, we should start by taking a serious look at what
programs already exist and in a novel way ask how well they
work. We should be looking at whether reducing any duplication
could make existing services more efficient and more effective.
This would help us narrow in on what legislative changes are
actually needed to improve benefits and services for veterans,
their families, and their survivors.
In addition, I hope it would help us avoid a situation like
we discussed in recent Committee hearings where efforts to
solve problems facing transitioning servicemembers seem to have
created more bureaucracy without improving services to our
Nation's wounded warriors.
Finally, we need to understand the cost of any legislative
changes and, more importantly, we must figure out how we would
pay for them. I will not shy away from providing those who have
served and sacrificed for our Nation with the benefits and
services they need--more importantly, that they were promised.
But I also want to make sure we pay for these benefits and
services by cutting other spending so that we do not continue
to saddle future generations of Americans with enormous
financial burdens.
Turning to today's agenda, I want to mention three bills I
have introduced. The first is the Caring for Camp LeJeune
Veterans Act of 2011. As we discussed at other hearings, the
water at Camp Lejeune was contaminated with known or probable
human carcinogens for decades. Unaware of danger,
servicemembers and their families drank, bathed, and cooked in
that water. Unfortunately, some of them have become seriously
ill or have died from devastating conditions like rare cancers.
Today we will hear one heart-breaking account of a child, Jerry
Ensminger's daughter, who was born at Camp Lejeune while the
water was contaminated and tragically died of leukemia at the
age of 9.
To try to provide some answers about why Jerry's daughters
and others have become sick, studies are underway to gauge how
much of the dangerous chemicals they were exposed to and how it
impacted their health. But those who were put at risk should
not have to wait for these studies before the VA provides them
with care. We should make sure that they get the treatments
they need now to combat any adverse effects from these toxins
we know they were exposed to.
To that end, this bill would allow veterans to get medical
care from the VA if they were stationed at Camp Lejeune when
the water was contaminated. It would also allow their families
who lived on the base to receive care for conditions that can
be associated with the contaminated water. After hearing
Jerry's painful story, I hope my colleagues will agree that
this is the right thing to do. Families like Jerry's have
already waited too long for answers they deserve and the help
they need.
Another bill, S. 423, would help deal with the backlog of
claims at the VA. If a veteran gathers up any necessary
evidence before sending the claim to the VA, the bill would
allow benefits to be paid for up to 1 year before that claim
was submitted.
Let me say that again. For veterans who send in fully
developed claims, we would actually give them 1 year's
additional benefits. This would ensure that veterans will not
lose out on any benefits while putting together a fully
developed claim and would allow the VA to provide faster
decisions on the claims backlogs they have got today.
Finally, S. 928 would ensure if VA realizes bid savings,
savings that we have made on bids that are outstanding on major
construction projects, there will be more Congressional
oversight as to how those funds are used. With the large
backlog of medical construction projects at the VA, it is
important to prioritize every available construction dollar
regardless of its source.
I look forward to discussing these bills and other bills
with our witnesses today. More importantly, I look forward to
working with my colleagues, the Administration, veterans
groups, and other stakeholders to improve the effectiveness of
existing veterans programs, to figure out what legislative
changes are truly needed, and to find the best ways to pay for
these.
Madam Chairman, I thank you for holding this legislative
hearing. I look forward to the exchange with our witnesses.
Chairman Murray. Thank you very much, Senator Burr. I do
agree there are a significant number of bills on the agenda. I
do think that reflects the tremendous needs of our servicemen
and -women and their families when they come home. It is a
reflection of the cost of war that we have to consider when we
are making policy decisions here, and I think it is important
that we do not lose sight of that in the broader conversation
we have coming in front of us.
I do want to say that my goal is to have either the VA or
CBO cost estimates on the legislation that this Committee will
present to the full Senate. And, in fact, our staff has been
working very closely with CBO to make sure we have cost
estimates for all these bills before we do a markup.
Senator Boozman, do you have an opening statement?
STATEMENT OF HON. JOHN BOOZMAN,
U.S. SENATOR FROM ARKANSAS
Senator Boozman. I think in the interest of time, I know
these folks are busy, so I will figure out a time to insert
that so we can go forward.
[The prepared statement of Senator Boozman follows:]
Prepared Statement of Hon. John Boozman, U.S. Senator from Arkansas
Madam Chair and Ranking Member, Thank you for arranging this
hearing so that we can examine ways in which to improve veterans'
benefits and evaluate ways in which we can address some of the concerns
that have been brought before the Committee during the hearings we have
had throughout the first half of the year.
As you all are aware, there are many bills on the agenda today, but
I would just like to express my support for those of which I am a
cosponsor, S. 894 and S. 491, and say that I look forward to working
with my colleagues who have legislation before us today to address the
needs of our Nation's veterans and their families.
I would especially like to thank you for providing us with the
opportunity to review and comment on legislation I have introduced,
S. 957, the Veterans' Traumatic Brain Injury Rehabilitative Services'
Improvements Act of 2011. I would also like to thank Senator Begich for
all of his hard work in helping me with this legislation as the Lead
Co-sponsor of the Bill
This common sense legislation seeks to ensure that our veterans who
have sustained Traumatic Brain Injuries are guaranteed the highest
quality of care and ensure the highest quality of life for them and
their families--a goal that I think every American can support.
These devastating and complex injuries are increasingly prevalent
on today's battlefield, and each one can be different from the next and
require unique treatment to ensure that our veterans make as full a
recovery possible
I am pleased about the steps that the VA and Congress has already
taken in the past to meet the needs of our wounded warriors suffering
from TBI, and I believe that my common sense legislation is just
another step in the right direction.
PANEL 1:
Thank you all for being here today and for everything you are doing
to help our veterans. Dr. Jesse, I am pleased to see you here today,
and I very much appreciate all of the hard work you have done as we
have worked to improve veterans' health care.
I appreciate your comments regarding the Veterans' Traumatic Brain
Injury Rehabilitative Services' Improvements Act of 2011 and hope that
we can work together to make this legislation serve our veterans in the
best way possible.
During your testimony, you mentioned concerns regarding definitions
in Section 2 of S. 957 that you found could possibly be ``unworkable''
or possibly ``exceed the VA's statutory mission.''
I would look forward to working with you and your staff in drafting
possible improvements to the bill that can ensure that it does not
create confusing or duplicative issues in the VA, or any other serious
problems, but also ensure that we preserve the spirit of the
legislation.
PANEL 2:
I would just like to say thank you to all of you for being here
today and for everything you are doing to serve our veterans and
address the needs of them and their families.
I would also like to thank the VFW, the DAV, and The American
Legion for their support of my legislation, S. 957.
I would also express my appreciation to the Wounded Warrior Project
for their support of the Veterans' Traumatic Brain Injury
Rehabilitative Services' Improvements Act of 2011, and for their
continued work on this issue.
Chairman Murray. Thank you for your consideration.
We have four Senators with us today who are presenting
legislation, and I appreciate the work all of you have done on
all of this. Senator Snowe, we will start with you and your
testimony.
STATEMENT OF HON. OLYMPIA J. SNOWE,
U.S. SENATOR FROM MAINE
Senator Snowe. Thank you very much, Madam Chairman, Ranking
Member Burr, and Members of this Committee for giving me the
opportunity to testify on the legislation that I have
introduced, the Sanctity of Eternal Rest for Veterans Act,
otherwise known as the SERVE Act, to protect the rights of
families to mourn the loss of a loved one at a military funeral
with the dignity and solemnity appropriate to the occasion.
Chair Murray, I certainly want to say at the outset
congratulations to you for being the first woman to chair the
Committee of Veteran's Affairs after being the first woman ever
to serve on the Committee. I appreciate your leadership and
that of Ranking Member Burr at a time in which we have so many
people who have served our country, who are serving both in
Iraq and Afghanistan and around the world.
Chair Murray, I also have joining me today one of my
constituents whom you met, Zach Parker, a senior at Searsport
District High School in Maine, who truly became a catalyst for
the introduction of this bipartisan bill. By the way, Zach is
graduating this week, on Sunday. He is in the middle of exam
week, so we appreciate the fact that he is spending 24 hours to
make the trip down here to hear this testimony.
I am pleased to report that this bill now has 25
cosponsors, equally divided between Democrats and Republicans.
As was reported in one Maine newspaper, Zach and his classmates
were each assigned to research a political or social issue and
then act upon it, and act upon it Zach did. On January 5th of
this year, to raise awareness about the imperative of proper
decorum and respect at military funerals--and this was when the
Supreme Court case was pending, Snyder v. Phelps--Zach arranged
a public seminar that drew 400 individuals on a cold Maine
night and garnered broad attention not just in Maine but
nationwide. So I want to personally thank you, Zach, for your
patriotic initiative and for being with us today. Your
inspirational love of country and vigilant advocacy for our
bravest and finest in uniform speak well not just of you and
your generation but the future of America.
Zach turned his classroom project into a strong statement
for citizen action against protests in close proximity to
military funerals. Sadly, as all of us here have attended
services for those who have perished in Iraq and Afghanistan.
Without question we would all agree that those who fight and
die serving our country in defense of our Constitution and the
principles we cherish, heroic men and women embodying the
noblest courage and boundless love of country, deserve our
deference, our reverence, and eternal gratitude. And for the
families they leave behind who are the linchpins in allowing
our brave men and women to perform the duties they have sworn
to our Nation, it is painful enough to lose a son or daughter
without then having to confront detestable and distasteful
protests that exponentially compound their agony and anguish.
Indisputably, these families have more than earned the
right to bury their loved ones in peace with the veneration the
ceremony commands. So it was beyond horrific what the family of
Lance Corporal Matthew Snyder was forced to endure in 2006 when
they were subjected to inhumane protestations just outside the
church where their one and only opportunity to say goodbye to
their beloved Matthew was taking place. That family had no
choice, no chance to fight back, no option to move to another
location, no recourse at a moment in time they could never,
ever recapture. But that family was determined not to let this
injustice stand, so they sued the protesters, and eventually
the case was heard by the Supreme Court.
Regrettably, the Court ruled in favor of the protesters,
citing free speech protection under the First Amendment. But
there should be no mistake. That decision does not mean that
preserving both freedom of speech and the sanctity of a
military funeral are mutually exclusive. To the contrary, the
ability to vigorously express opinions, an ideal for which our
soldiers have fought and died through centuries, need not and
should not come at the expense of families of those very
soldiers. In fact, the Supreme Court only addressed the right
to protest, leaving open the questions of where and when
protests may take place, and providing the genesis of our
legislation by further defining time and place where funeral
disruptions are not allowed.
What the SERVE Act does is to build off Federal law enacted
in 2006 that established buffer zones of 150 feet from the
service and 300 feet from the roads to and from a military
funeral. However, that law only covered funerals at federally
administered cemeteries, which had excluded the Snyder family's
funeral. That is why we provide a uniform zone of protection
around civilian as well as Federal locations where funerals are
taking place.
Specifically, based on a wide variety of statutory
provisions that are already in law in 43 States, our bill
increases quiet time before and after military funerals from 60
minutes to 120 minutes, increases the buffer around a military
funeral from 150 feet--which is approximately from here to the
end of the building on C Street, which is virtually no buffer
at all, so we increase it to 300 feet, and then increase from
300 to 500 feet the buffer around access routes to a funeral
service, which at least 20 States currently have in place.
Moreover, for the first time, we provide for civil penalties as
a deterrent and to allow immediate family members as well as
the U.S. Attorney General to sue violators for monetary damages
up to $50,000. What we do not do in our bill is dictate the
content of any speech.
Madam Chair, a military funeral is a one-time event for the
survivors. There are no do-overs for something so solemn and
heart-breaking for grieving families. That is why this bill has
been endorsed by 35 veterans service organizations, including
the Military Coalition, the Military Families United, who are
here today, the VFW, The American Legion, and Gold Star Wives.
As Zach has said, ``this is about the people who sacrificed
their lives to serve this country. I am going to fight the
fight and see what we can get accomplished.'' Well, Madam
Chairman, Ranking Member Burr, and Members of this Committee,
this is a battle that we should all feel obliged to wage, and I
hope this Committee would view this bill favorably with your
full support that honors America's true American heroes and
their families to whom we owe a debt of gratitude we can never,
ever repay but one we must never, ever forget.
Thank you.
Chairman Murray. Thank you, Senator Snowe.
Zach, welcome to the Committee, and thank you for your work
on this. It is great to have you here, and good luck on your
graduation this week.
Senator Warner?
STATEMENT OF HON. MARK R. WARNER,
U.S. SENATOR FROM VIRGINIA
Senator Warner. Thank you, Madam Chairman and Ranking
Member Burr, and Members of the Committee. I appreciate the
opportunity to testify, and I want to, though I am not on the
Committee, lend my support to Senator Snowe and her leadership
on this piece of legislation, and for Zach and the contribution
he has made.
I have a piece of legislation that I hope will be equally
as noncontroversial. It was last June when many people first
heard about some of the excesses and problems at Arlington
National Cemetery. I think all of us as Americans were shocked
to hear about some of the mismanagement and ineptitude that was
taking place at the cemetery.
On top of what had already been reported, earlier this year
there were media reports that there had been a practice going
on at Arlington Cemetery where the last two superintendents had
been, in effect, reserving gravesites for their friends. Now,
Army procedures since basically 1962 had been that when
somebody had fallen, they would go through an appropriate
burial procedure and they would, in effect, get the next slot.
Unfortunately, what was taking place was the superintendents
were going out and having a secret reservation list. Some
general might come in and say, ``I want that spot underneath
that tree over there,'' and because there were no record-
keeping techniques, that slot would be reserved. Astonishingly,
the Army's own Inspector General came up with a report in the
early 1990s that said this practice was ongoing, yet nothing
was done about it.
So in late March, I filed legislation in the Senate to once
and for all end the improper system of reserved gravesites at
Arlington. The legislation passed overwhelmingly in the House 3
weeks ago. I appreciate the support of House Chairman Runyon
and Ranking Member McNerney. Obviously, this is an issue that
knows no party and has no cost involved.
The legislation we are discussing will codify Army
regulations that ban reserving gravesites and provide
accountability and transparency to the process with a full
audit and report back to Congress. It will also direct the Army
to fully investigate and report back to Congress within 180
days on the number of plots that may have been set aside in
violation of Army policy.
What we are simply saying is that the Arlington managers
must follow the rules. Again, some general or somebody that is
a friend of the superintendent should not be able to jump the
line in front of any of our other brave servicemen and -women
who have served. I think this past procedure has been offensive
to not just veterans but to any American, and this small piece
of legislation will correct it once and for all.
I would only like to make one other comment. I know we have
got Senator Whitehouse. But, you know, this circumstance at
Arlington--and I know this Committee has looked at it and other
Committees have looked at it, but it really is still an ongoing
challenge. When we found the first reports not only of
misplaced remains, but in effect, that the record system was
three-by-five cards, and we were not only one fire but we were
one spilled cup of coffee away from destroying where all of the
records of the remains were at Arlington.
So, the Army said that they were going to work on this. We
took a separate approach. We actually contacted a lot of the
tech companies in Northern Virginia. There are about 300,000
remains. It is a challenge, but then you are thinking that it
is only about a recordkeeping system. So we got about 20
companies in the Northern Virginia Technical Council to come
together on a pro bono basis, and they spent thousands of hours
coming forward with a report to the Army on what would be a
step-by-step audit and process of how the Army ought to move
forward to correct this problem.
Secretary McHugh received our report and said they would
work with the tech community. It did not cost a dime; we did it
all pro bono. Well, the Army got this report about 120 days
ago, which included both short-term and long-term
recommendations for the cemetery, such as digitizing of records
system, improving handling procedures for the remains, work
flow charts for improving business practices, and basic
management techniques.
I would love to say that the Army in that 120 days has
implemented these actions. To our knowledge, they have made
small incremental improvements. But this is still an area of
concern to the Committee and all Members of Congress. This is a
disgrace.
Not quite the story of Zach, but let me just close on one
note. I want to also mention and salute the work done by a
Virginia high school student who is not graduating this year
because he's an 11th grader. His name is Ricky Gilleland. He is
a whiz kid computer student from Stafford County, which is due
south, just north of Fredericksburg. Ricky has succeeded in
doing something on his own that Arlington has not been able to
do. So he went out and, with his own little computer, started
to digitize where all of the remains for all the Iraq and
Afghanistan veterans were.
Now, the Army spent $8 million on IT contracts, and they
have not been able to accomplish this so far. Ricky, with his
computer and only access to public records has created the
Preserve andhonor.com Web site, and he has gotten some national
news that catalogues where all of these Iraq and Afghanistan
veterans are buried. So, if Ricky can do this in 11th grade
with his home computer, the Army ought to be able to do it with
millions of dollars of resources and appropriate management to
try to get this job done correctly once and for all so we never
again have to read about these kind of stories.
One small step we can take in that direction today is
making sure we put to rest this practice of jumping the line
and having the superintendent reserve a gravesite for a friend
or some ranking official. Both of those are blots on the honor
of Arlington.
We in the Commonwealth of Virginia are proud that for the
last 130 years we have been the site of what is truly hallowed
ground for our whole Nation, and my hope is that the Committee
will act upon this small piece of legislation.
I thank the Committee for your attention, and I apologize
for having to step out.
[The prepared statement of Senator Warner follows:]
Prepared Statement by Hon. Mark R. Warner, U.S. Senator from Virginia
Thank you Madam Chairman and Ranking Member Burr for the
opportunity to testify before the Committee today. I am very pleased
the Committee is marking up a bill today to move through the Senate as
a companion to the Senate legislation that I filed in late March. This
legislation will end the improper and unofficial system of ``reserved''
gravesites for VIPs at Arlington National Cemetery.
I know Chairman Murray and Ranking Member Burr care as deeply about
our Veterans and their families as I do and I think this shows that
this is an issue that crosses party lines and we are united in an
effort to get fix this problem.
Earlier this year, there were media reports about a practice of
reserving gravesites for VIPs at Arlington National Cemetery. As I dug
deeper into the issue, I found that this was not a one-time issue, but
a practice that had continued for many years with previous
superintendents. I was outraged that preferential treatment and setting
aside gravesites for the friends of the superintendent was common
practice, despite the fact that it was completely against Army
regulations.
Although the practice of reserving gravesites has been banned by
Army regulations since 1962, cemetery superintendents allowed selected
``senior officials'' to pick areas of the cemetery where they wished to
be buried. Astonishingly, the Army's own Inspector General identified
this practice as a serious violation of Army policy in the early
1990's, but nothing was done to stop the practice and the process
continued.
The legislation we are discussing today will codify Army
regulations that ban reserving gravesites and provide accountability
and transparency to the process, with a full audit and a report back to
Congress. It will also direct the Army to fully investigate and report
back to Congress within 180 days on the number of plots that may have
been set aside in violation of Army policy--which clearly states that
Arlington National Cemetery plots must be provided to any qualified
military veteran, without regard to rank or status.
It is a disgrace that back room deals apparently were being made
that allowed high-ranking officers and other VIPs to pre-select the
gravesites where they wished to be buried. It is offensive that this
improper reservation system could allow some general to trump the
Arlington burial rights of a fallen soldier from Iraq or Afghanistan.
What we're saying is Arlington managers must follow the rules. Some
general should not be able to say, ``See that plot under the tree with
the view? That's the one I want.'' I want to lend my support to Army
Secretary John McHugh and Superintendent Condon, who are trying to
clean up this mess after years of neglect.
This VIP reservation system is the latest in a series of problems
that have emerged over the previous management of Arlington. When
details first emerged about serious problems at Arlington National
Cemetery, I was appalled by the reports of chronic mismanagement and
requested detailed information from Secretary McHugh on Army plans to
correct the issues. When the Army IG briefed me, I sensed that there
could be a creative private sector solution to help fix Arlington.
I asked the Northern Virginia Technology Council for help, and they
responded the next day with a group of more than 20 leading IT
companies which perform data management, recovery, and digitization
work every day. These 20 companies offered to produce a report for the
Army pro bono, due to the historic and sacred nature of Arlington.
Secretary McHugh accepted our offer, and worked with NVTC leadership to
provide access.
NVTC subsequently produced a report which included both short-term
and long-term recommendations for the Cemetery. It detailed potential
paths to digitizing records and improvements in the way the Cemetery
handled some remains. This pro-bono assessment also included workflow
charts for improving business practices and suggestions on basic
management techniques.
Superintendent Condon has said that many of the recommendations in
the report already have been incorporated by the Army, including the
hiring of additional staff and creation of a call center to improve
communication with families on burial requests.
I also want to salute work I just became aware of--a project by a
Virginia high school student named Rickey Gilleland. Rickey is an 11th-
grade computer whiz from just down the road in Stafford County,
Virginia, who apparently has succeeded in creating something that $8
million in technology spending could not.
On his own, with his new Zoom tablet computer, Rickey created his
own digitized record of Iraq and Afghanistan veterans who have been
laid to rest at Arlington. His Web site, preserveandhonor.com,
catalogues the gravesites of these fallen heroes.
Now why would it be so hard for the Army to produce the same kind
of digital record and guide for all of the other heroes buried at
Arlington?
And finally, for nearly 130 years, the Commonwealth of Virginia has
proudly provided a final resting place for our Nation's military men
and women at Arlington National Cemetery. I look forward to continuing
our efforts to make sure that the men and women who have bravely served
our country are buried with honor and dignity.
I want to repeat my earlier calls to have the Army implement the
recommendations contained in the NVTC report. And if they need help, I
know a certain 11th grader who might have a few ideas. Thank you, Madam
Chairman.
Chairman Murray. Thank you very much, Senator Warner. I am
sure every parent here knows exactly who we should turn the
Nation's problems over to when it comes to technology. Tell
Ricky thank you.
[Laughter.]
Chairman Murray. Senator Whitehouse?
STATEMENT OF HON. SHELDON WHITEHOUSE,
U.S. SENATOR FROM RHODE ISLAND
Senator Whitehouse. Thank you, Chairman Murray and Ranking
Member Burr and Senator Boozman. I very much appreciate your
service to our veterans through the work of this Committee, and
I am very pleased to join Senator Snowe and Senator Warner,
having heard the legislation that they have come forward to
support today to protect the integrity and dignity of military
funerals and the integrity and dignity of the process through
which gravesites are allocated at Arlington. So I am honored to
be in their company today and, again, very much appreciate your
service.
I am here to speak about legislation to improve protection
for military families from losing their homes through wrongful
foreclosure. While operations in Iraq, Afghanistan, and around
the world have put tremendous demands on our brave men and
women in uniform, lenders at home have repeatedly disregarded
the laws that are designed to protect servicemembers and their
families from losing their homes when they deploy.
Just last month, the Department of Justice announced a $22
million settlement with lenders who had violated the
Servicemembers Civil Relief Act and wrongfully foreclosed on as
many as 175 servicemembers. In addition, thousands of military
families have been overcharged on their mortgages.
All of us have heard horror stories from our home states
about how badly some financial institutions have treated our
homeowners in distress. When these abusive mortgage practices
harm the men and women we send in harm's way to protect our
country, it deserves our attention. Not only are these
practices illegal and morally repugnant, they can also be a
dangerous distraction from our military mission. Servicemembers
overseas have enough to worry about without worrying about
their families being mistreated on the homefront.
Returning servicemembers have also been hit particularly
hard by the current economic downturn. As this Committee well
knows, in 2010 the unemployment rate for returning veterans
averaged 11.5 percent compared to a 9.4-percent national rate.
Furthermore, according to a recent comprehensive report on
veteran homelessness, veterans are 50 percent more likely to
become homeless than other Americans. These troubling
statistics underscore the difficulty of readjustment to life at
home. For our returning servicemembers who need time to get
back on solid financial footing, we should do everything we can
to accommodate their needs, especially during these difficult
economic times.
To better protect our men and women in uniform, I have
introduced the Protecting Servicemembers from Mortgage Abuses
Act, cosponsored by Senator Baucus, Senator Blumenthal, Senator
Boxer, Senator Durbin, Senator Feinstein, Senator Hagan,
Senator Lautenberg, Senator Leahy, Senator Merkley, Senator
Mikulski, Senator Nelson of Florida, Senator Pryor, Senator
Reed of Rhode Island, Senator Sanders, and Senator Tester. This
bill would double the maximum criminal and civil penalties for
violations of current foreclosure and eviction protections. It
would also extend and make permanent the period of foreclosure
protection coverage after military service has ended.
Under current law servicemembers have 9 months of
foreclosure protection after military service. However, this
provision is due to expire on December 31, 2012. Then
servicemembers will only get 90 days of foreclosure
protections. My bill would permanently extend the period of
foreclosure protection beyond 9 months.
I hope Senators on both sides of the aisle will come
together and join me in supporting this legislation, and I
thank you again for the opportunity to speak on this important
issue. I look forward to working with Chairman Murray, Ranking
Member Burr, and other Members of this Committee to pass this
legislation, which I believe will discourage loan servicers
from further violations and help to protect the financial and
emotional well-being of our military families.
Chairman Murray. Thank you very much, Senator Whitehouse,
and I would let all of you know, Senator Snowe, Senator Warner,
and Senator Whitehouse, that all of your provisions have strong
merit, and I hope to work with Senator Burr to include them in
the package that we will consider for our markup on the 29th of
this month. So thank you very much for your testimony.
I do not have any questions. Thank you very much. We really
appreciate it.
We will now move to our first panel, and if you would
please come up and sit at the witness table, I will introduce
you as you join us.
From the Department of Veterans Affairs, we have Michael
Cardarelli, Principal Deputy Under Secretary for Benefits, and
Dr. Robert Jesse, Principal Deputy Under Secretary for Health.
They are accompanied today by Walt Hall and Richard Hipolit,
both Assistant General Counsels.
With us from the Department of Labor is John McWilliam,
Deputy Assistant Secretary for the Veterans' Employment and
Training Service, and as they are being seated, I notice that
Senator Burr stepped out for just a minute, but I do want to
just address the issue that he mentioned in his opening
statement.
Mr. Cardarelli, Dr. Jesse, Mr. McWilliam, I understand from
my staff that your testimony was late, due in large part to a
hold-up at OMB, I recognize that none of you are responsible
for hold-ups at OMB. But I do want to emphasize for you and for
everyone who comes before this Committee that we do require
testimony to be received 48 hours before a scheduled hearing
because our Members need time to adequately prepare for the
hearing and make sure that the positions of your respective
departments are properly presented for this Committee. So I
will be following up with OMB directly to make sure that they
understand that delays in clearing testimony before this
Committee are simply unacceptable. So I join with my colleague,
Senator Burr, and we will be talking to OMB.
Before I turn to our first panel, I notice that Senator
Blumenthal has joined us, and I want to give him an opportunity
to give his testimony on the bill that he has presented before
the Committee. Senator Blumenthal?
STATEMENT OF HON. RICHARD BLUMENTHAL,
U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. Thank you very much, Senator Murray.
Thank you very much to you and Senator Burr for having me, and
I particularly want to thank you, Senator Murray, for your
leadership in this area. I have introduced a bill, S. 1060,
called the Honoring All Veterans Act, and S. 1147, the
Chiropractic Care Available for All Veterans Act, which very
much follows the leadership that you and other colleagues in
the Senate have provided, leaders who have really started and
carried forward this effort to keep faith with the men and
women who serve and sacrifice for our freedom.
The VA has taken some very strong steps toward the goal of
building a 21st century support system, but gaps in the system
remain, and they are debilitating and devastating for many of
our veterans. We can do better, and we must do more. And the
legislation I have introduced provides a comprehensive package
of 16 provisions aimed at better health care jobs, educational
opportunities, and streamlining and modernizing the VA.
I will submit for the record my full testimony. I very much
appreciate your giving me this opportunity to talk to the panel
today. But I just want to say that my experience, as I know
yours and other Members of this panel, is that we really need
to have a comprehensive approach to deal with the signature
wounds of the Afghanistan and Iraq conflicts, which are
Traumatic Brain Injury and Post Traumatic Stress, as well as
other injuries that veterans of prior conflicts have suffered.
And that comprehensive approach has to involve both the
Department of Defense and the Veterans Administration, for
example, providing effective diagnosis of these wounds. Right
now some 30 percent of them are undiagnosed and, therefore,
untreated. We need to provide treatment, not just diagnosis. We
need to make sure that information and medical information is
tracked and that care is transitioned between those agencies,
the Department of Defense to the Veterans Administration. The
legislation I have introduced would provide veterans leaving
the VA medical facilities to have a recovery plan for those
kinds of injuries. It would provide for qualified
psychiatrists, psychologists, and nursing professionals to work
in VA medical hospitals and outpatient clinics and access
graduates from the Uniformed Services University of the Health
Sciences, for example, in Connecticut and other kinds of
institutions.
On economic opportunity, veterans, like all Americans, are
striving to provide for their families and find jobs in a still
faltering economy. The Honoring All Veterans Act would build on
the work already initiated by this Committee to address the
issues, such as the recently expanded Post-9/11 GI bill. The
legislation would raise the statutory cap for the Vocational
Rehabilitation and Employment and Independent Living Programs
to welcome hundreds of additional veterans, and it would
authorize veterans to re-use the transitional program, the DOD
Transition Assistance Program, and meet with counselors at any
military installation for up to a year after their separation.
It also authorizes other measures such as a study of how best
to ensure that civilian employers and educational institutions
recognize veterans' military training, and it reauthorizes the
Veterans Education Outreach Program to provide for campus-based
outreach programs to veterans.
We need also measures for veterans who lack a job and lack
a home and need a roof over their heads, and those kinds of
facilities can be supported and funded through the Honoring All
Veterans Act and other measures that this panel is considering.
I am realistic about the difficulty of approving and
passing this kind of measure. I hope for bipartisan support. I
think that keeping faith with our veterans should command
support from both sides of the aisle, and I know that you have
worked very hard as Chairman of this Committee to muster that
kind of support, and I thank you for it. Thank you also for
giving me the opportunity to sponsor legislation, the
Chiropractic Care Available for All Veterans Act, modeled on
legislation that you have introduced in the past. It would
provide for the kind of musculoskeletal and connective system
injuries that so many of the returning Iraq and Afghanistan
veterans suffer from. They are one of the most frequent medical
diagnoses of this set of conflicts, and every veteran in the
Nation should have the same immediate access to chiropractic
care that Connecticut offers through the National Director for
the Veterans Health Administration's Chiropractic Service based
in West Haven, and that kind of care should be available to all
veterans. So the legislation would actually require the
Secretary of Veterans Affairs to provide chiropractic care at a
minimum of 75 VA medical centers by December 31, 2012, and at
VA medical centers by December 31, 2014.
Again, I thank you for your leadership and others on this
panel in supporting these kinds of measures, and I look forward
to working with you. Again, many thanks for giving me this
opportunity to talk today.
[The prepared statement of Senator Blumenthal follows:]
Prepared Statement of Hon. Richard Blumenthal,
U.S. Senator from Connecticut
INTRODUCTION
Members of the Committee, thank you for the opportunity to testify
before you in support of two needed pieces of legislation, namely
S. 1060, the Honoring All Veterans Act and S. 1147, the Chiropractic
Care Available for All Veterans Act.
I am honored to appear before my colleagues who lead the Senate in
making sure our Nation keeps faith with the men and women who serve and
sacrifice for our freedom. The VA has taken strong steps toward the
goal of building a 21st century support system, but gaps in the system
remain and they are debilitating and devastating for many veterans. We
can do better and we must do more. The legislation I have introduced,
the Honoring All Veterans Act of 2011, is a comprehensive package of 16
provisions. In my testimony, I would like to focus on two of the gaps
the legislation closes, first with providing comprehensive mental
health care services and second, helping veterans with the economic
challenges of rejoining civil society.
MENTAL HEALTH CARE SERVICES
I was recently privileged to join a group of veterans at the Vet
Center in Rocky Hill, Connecticut. They gather weekly to support and
help each other recover from Post-Traumatic Stress Disorder and
Traumatic Brain Injury. Their conversation dramatized to me again that
the treatment of veterans with PTSD or TBI requires a comprehensive
approach. The Honoring All Veterans Act requires the Department of
Defense to identify and then close the gap between screening and
treatment. More effective diagnosis is vital, but simply diagnosing a
warrior suffering from PTSD or TBI does not heal them. The legislation
targets both the DOD and VA to ensure that medical information is
tracked and care transitioned between the agencies, as a warrior
returns to civilian life. These problems must be addressed by both
agencies. The legislation requires veterans leaving VA medical
facilities to have a recovery plan that specifically includes
vocational rehabilitation and job training. It addresses the problem of
finding qualified psychiatrists, psychologists and nursing
professionals to work in VA medical hospitals and outpatient clinics by
accessing graduates from the Uniformed Services University of the
Health Sciences. The legislation also strengthens the Department of
Labor's existing programs to assist both veterans with TBI or PTSD in
the workplace and their employers.
ECONOMIC OPPORTUNITY
Like all Americans, veterans are striving to provide for their
families and find jobs in a still faltering economy. The Honoring All
Veterans Act builds on the work already initiated by this Committee to
address this issue, such as the recently expanded Post-9/11 GI Bill.
The legislation raises the statutory cap for the Vocational
Rehabilitation and Employment Independent Living program to welcome
hundreds of additional veterans. It authorizes veterans to reuse the
DOD Transition Assistance Program (TAP) and meet with counselors at any
military installation for up to one year after separation. It
authorizes a study of how best to ensure that civilian employers and
educational institutions recognize veterans' military training. It also
reauthorizes the Veterans Education Outreach Program to provide for
campus-based outreach services to veterans.
For those veterans who cannot find a job or a home, our Nation must
offer immediate help and support. Any skeptic about the value of such
programs should visit the East Hartford Veterans Homeless Shelter where
the pride of veterans in their service is reflected in every rack and
locker squared away to pass the toughest Gunny's inspection. The
Honoring All Veterans Act supports veterans' shelters in each of your
home towns, by revising the current per diem they receive to reflect
rising costs of care and regional variations in helping homeless
veterans.
I'm realistic about the prospects of enacting all these provisions.
I am committed to a sustained and consistent effort to honor all
veterans and open to the ideas from my colleagues on how to modify
these proposals. I am especially hopeful and determined that the effort
be bipartisan. I look forward to working with you to see its enactment.
Together we can resolve these challenges.
THE CHIROPRACTIC CARE AVAILABLE FOR ALL VETERANS ACT
I would also like to take this opportunity to commend to you
bipartisan legislation I introduced this week along with Senators
Moran, Whitehouse, Harkin and Grassley, and cosponsored by Senator
Tester, to expand access to chiropractic care at VA facilities.
As you are aware, one of the most frequent medical diagnoses
reported among Iraq and Afghanistan veterans are musculoskeletal and
connective system diseases. More than 197,000 Iraq and Afghanistan
veterans seeking VA care have been diagnosed with these conditions.
Yet, less than one-third of the VA medical centers offer chiropractic
care and services. Every veteran in the Nation should have the same
immediate access to chiropractic care that Connecticut offers through
the National Director for the Veterans Health Administration's
Chiropractic Service based at the West Haven Medical Center. They
should have the kind of resources available at the Nation's first
university-based college for chiropractic physicians at the University
of Bridgeport.
The legislation would require the Secretary of Veterans Affairs to
provide chiropractic care at a minimum of 75 VA medical centers by
December 31, 2012 and at all VA medical centers by December 31, 2014.
In introducing the legislation, I am following in the esteemed
footsteps of Chairman Murray and the Members of the Committee who have
been tireless advocates on this issue. Veterans would not have the
chiropractic care and support they have today without your leadership.
Thank you for the opportunity to testify and for holding this
hearing today.
Chairman Murray. Thank you very much, Senator Blumenthal,
and thank you for your comprehensive consideration of issues
very important to our men and women who serve the country.
Senator Blumenthal. Thank you.
Chairman Murray. Thank you very much.
With that, we will now move to our first panel. Thank you
very much for joining us today, and we will begin with Michael
Cardarelli.
STATEMENT OF MICHAEL CARDARELLI, PRINCIPAL DEPUTY UNDER
SECRETARY FOR BENEFITS, VETERANS BENEFITS
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS
Mr. Cardarelli. Yes, ma'am. Good morning, Chairman Murray,
Ranking Member Burr, and Members of the Committee. Thank you
for inviting us here today to present the Administration's
views. I apologize for the delay in delivering our testimony to
the Committee.
Joining me today is Richard Hipolit, Assistant General
Counsel. While VA's full written statement with views and
estimated costs has been submitted for the record, I would like
to briefly discuss eight bills that affect VBA and CA. After my
remarks, Dr. Robert Jesse, Principal Deputy Under Secretary for
Health, will discuss the Administration's views on the VHA-
related bills on today's agenda.
Chairman Murray, VA appreciates your efforts to improve
employment opportunities for returning servicemembers. VA
supports Sections 2 through 5 of your Hiring Heroes Act of
2011. S. 951, which would provide rehabilitative services and
assistance to certain severely disabled active-duty
servicemembers and expand VA's authority to pay employers for
providing on-the-job training to veterans, among other things.
We respectfully defer to the Department of Labor's witness,
John McWilliam, regarding Sections 8, 11, and 13 of the bill.
Although VA does not support Section 9 of this bill, we would
be happy to discuss our concerns with the Committee.
Let me assure you that VA's leadership shares your concern
about veterans' employment, and we are committed to working
with Congress to improve employment opportunities for our
Nation's veterans.
S. 536 would exempt individuals eligible for VA education
benefits under Chapter 35 from the 48-month limitation on the
use of educational assistance under multiple veterans and
related educational assistance programs. VA supports the intent
of S. 536 and favors enactment of the bill subject to Congress
finding offsetting savings.
S. 745 would protect certain veterans who are enrolled in
VA's Post-9/11 Veterans Educational Assistance Program as it
existed before the enactment of Public Law 111-377 who
otherwise would be subject to a reduction in educational
assistance benefits. VA has concerns with the proposed
legislation as written, including the timeline for implementing
it and the impact on existing beneficiaries. We will continue
working with the Committee to ensure that legislative changes
do not negatively impact education beneficiaries.
S. 894, the Veterans' Compensation Cost-of-Living
Adjustment Act of 2011, would mandate a cost-of-living
adjustment in the rates of disability compensation and
dependency indemnity compensation payable for periods beginning
on or after December 1, 2011. VA supports Chairman Murray's
bill and believes that our veterans and their dependents
deserve no less.
S. 780, the Veterans Pensions Protection Act of 2011, would
exclude certain payments from determinations of annual income
for purposes of determining eligibility for improved pension.
VA opposes excluding from countable income payments received
for pain and suffering because such payments do not constitute
a reimbursement for expenses related to daily living. This
provision of the bill would be inconsistent with a needs-based
program. VA does not oppose the remaining provisions of the
bill.
S. 423 would authorize a potentially retroactive award of
disability compensation to a veteran whose compensation
application was fully developed as of the date submitted to VA.
VA does not support this bill because it would result in the
inequitable treatment of veterans in litigation over whether a
claim was fully developed when it was submitted. Although VA
does not support S. 423, it appreciates the attempt to create
an incentive for veterans to file fully developed claims.
S. 815, the SERVE Act of 2011, would guarantee that
military funerals are conducted with dignity and respect. VA
supports its enactment because it would establish a unified
approach to preserve the dignity of funeral services and
reinforce the commitment to protect the privacy of attendees
during their time of bereavement. The bill would also ensure
the privacy and protection of grieving families during funeral,
memorial, and ceremonial services meant to honor those fallen
heroes who, through their service, paid the ultimate price.
Finally, VA notes that Chairman Murray's Veterans Programs
Improvement Act of 2011, S. 1184, carries many provisions
proposed by the Administration in its draft Veterans Benefits
Improvement Act of 2011. Although we have not had the
opportunity to review the bill closely, we offer here our
support of the general intent of the bill and VA's appreciation
for your introducing them for consideration. We believe they
are very worthy of the Committee's endorsement. We also look
forward to reviewing the other titles of the bill which address
VA's programs to combat homelessness as well as VBA's fiduciary
program.
Madam Chairman, this concludes my statement. Now Dr. Jesse
will discuss the Administration's views on the health-related
bills on today's agenda.
Chairman Murray. Thank you very much.
Dr. Jesse?
STATEMENT OF ROBERT L. JESSE, M.D., PH.D., PRINCIPAL DEPUTY
UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION,
U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY WALTER A.
HALL, ASSISTANT GENERAL COUNSEL; AND RICHARD J. HIPOLIT,
ASSISTANT GENERAL COUNSEL
Dr. Jesse. Thank you, Madam Chairman, Ranking Member Burr,
and Members of the Committee. I too appreciate the opportunity
to appear before you today and to provide comments on some of
the Veterans Health Administration-related bills on today's
agenda. I am accompanied by Mr. Walter Hall, who is the General
Counsel, and I too apologize for the tardiness of our oral
statements. I appreciate your indulgence.
VA supports S. 490, which would extend the eligibility for
health care coverage of children under the CHAMPVA program
until the age of 26. This would bring VA's health care benefits
program for children into line with coverage available via the
private sector under the Affordable Care Act, which was enacted
last year. This is an important program that would potentially
benefit almost 60,000 children of veterans.
We appreciate the intent of S. 666, the Veterans Traumatic
Brain Injury Care Improvement Act of 2011, which would require
the Secretary to submit a report on the advisability of
establishing a broader polytrauma presence in the Northern
Rockies or the Dakotas. We appreciate the concerns about making
these valuable services available in this area, and I am
pleased to report that based on the assessment we conducted
last year, we are expanding our services by establishing an
enhanced polytrauma support clinic team in Fort Harrison,
Montana. We expect it will have the staff in place to begin
providing these additional services by the end of the year.
We support the intent of S. 769 and have already taken
steps to address the concerns the bill would remedy. The
Veterans Equal Treatment for Service Dogs Act of 2011 would
prohibit the Secretary from excluding service dogs trained for
use by veterans from any VA facilities or property or any
facilities that receive funding from VA. In March, we published
VHA Directive 2011-013, which directs that veterans and members
of the public with disabilities who require the use of a
trained guide dog or service dog be allowed to enter VA
facilities. We will publish a regulation that will establish
criteria for service dog access to all VA facilities and
property that will ensure consistent standards while
maintaining a safe environment for patients, employees,
visitors, and service dogs.
We also support the intent of S. 696, which would allow VA
to provide beneficiary travel benefits to veterans using the
Vet Centers for readjustment counseling. This is an issue that
has had our attention for some time now, and we have begun an
assessment to develop more insight into the possible impact of
providing this benefit.
The privacy issue is particularly important to us as the
Vet Centers currently offer veterans confidential treatment,
and veterans would have to submit a claim for beneficiary
travel, which could diminish their faith that this treatment is
indeed confidential. Veterans have responded very positively to
the current Vet Center model, and any changes we make to the
service should not reduce the appeal of readjustment counseling
benefits to veterans. Because of this concern, we ask the
Committee to withhold action on this bill until we can provide
you with the results of our assessment later this year.
S. 957, the Veterans' Traumatic Brain Injury Rehabilitative
Services Improvements Act of 2011, seeks to improve our
programs by requiring rehabilitative services to be an integral
component of our health care services. We generally have no
objections to this. Indeed, we have been developing
individualized recovery plans for all enrolled veterans with
severe TBI for several years. Our primary aim for veterans with
serious or severe injuries has always been and always will be
to maximize a veteran's independence, health, and quality of
life. My written statement identifies two concerns with this
bill that essentially raise a question if the bill requires VHA
to provide benefits beyond health care.
Regarding S. 277, VA takes the Camp Lejeune matter very
seriously but has several significant concerns with the bill.
VA would be required to provide treatment for any condition
that cannot be specifically eliminated as related to the
contaminated water at Camp Lejeune. This would be a broader
authority for care than that conferred on Persian Gulf and
post-Persian Gulf veterans. We have concerns about the adequacy
of the scientific evidence available today, but ongoing
research by the Agency for Toxic Substances and Disease
Registry may provide a clearer view on what kinds of conditions
are associated with this exposure. There are other concerns
detailed in the testimony such as being able to identify those
who may have been at Camp LeJeune for very short periods of
time. At the same time, we are committed to continue to monitor
the research and respond appropriately to findings.
This concludes my prepared statement. My written statement
provides our positions on many of the other bills on the
docket, and we will provide views later for those that we are
unable to discuss at this time. Madam Chairman, I would be
pleased to respond to any questions you may have.
[The prepared statement of Dr. Jesse follows:]
Prepared Statement of Robert L. Jesse, M.D., Ph.D., Principal Deputy
Under Secretary for Health, Veterans Health Administration, U.S.
Department of Veterans Affairs
Good Morning Chairman Murray, Ranking Member Burr and Members of
the Committee: Thank you for inviting me here today to present the
Administration's views on several bills that would affect Department of
Veterans Affairs (VA) benefits programs and services. Joining me today
are Michael Cardarelli, Principal Deputy Under Secretary for Benefits,
Richard Hipolit, Assistant General Counsel, and Walter A. Hall,
Assistant General Counsel. We do not yet have cleared views on S. 411,
S. 491, S. 873, S. 874, S. 914, S. 1017, S. 1060, S. 1089, S. 1104,
S. 1123, S. 1124, and S. 1127 and the draft bill entitled ``Veterans
Programs Improvements Act of 2011.'' Also, we do not have estimated
costs associated with implementing S. 396, S. 666, S. 910, S. 935, and
section 9 of S. 951. We will forward the views and estimated costs to
you as soon as they are available.
S. 277, CARING FOR CAMP LEJEUNE VETERANS ACT OF 2011
S. 277 would amend title 38 to extend special eligibility for
hospital care, medical services and nursing home care for certain
Veterans stationed at Camp Lejeune during a period in which well water
was contaminated notwithstanding that there is insufficient scientific
evidence to conclude that a particular illness is attributable to such
contamination. It would also make family members of those Veterans who
resided at Camp Lejeune eligible for the same services, but only for
those conditions or disabilities associated with exposure to the
contaminants in the water at Camp Lejeune, as determined by the
Secretary.
VA takes the Camp Lejeune matter very seriously but has a variety
of significant concerns with this bill. For example, although we
believe that the intent of S. 277 is to provide these Veterans with the
same enrollment and treatment authority as for Persian Gulf and post-
Persian Gulf Veterans, the bill does not do so because it fails to
amend section 1710(e)(2) to address the new special eligibility
provision. As the legislation is written, VA would be required to
provide treatment for any condition that cannot be specifically
eliminated as related to the contaminated water at Camp Lejeune. This
bill would not make the special eligibility of these Veterans subject
to the limitation that care may not be provided ``with respect to a
disability that is found, in accordance with guidelines issued by the
Under Secretary for Health, to have resulted from a cause other than
the service or testing described in such subparagraph.'' As a result,
this bill grants these Veterans a broader special eligibility than that
conferred on Persian Gulf and post-Persian Gulf Veterans.
The Agency for Toxic Substances and Disease Registry (ATSDR) is
conducting ongoing research related to the potential exposures at Camp
Lejeune. Current ATSDR research is concentrating on refining
hydrological modeling to determine the extent of benzene contamination.
This information will then be used along with results from ongoing
population studies to determine if the potentially exposed population
at Camp Lejeune has experienced an increase in adverse health effects
such as birth defects, cancers, and mortality. VA will closely monitor
this research and will quickly consider the findings and take
appropriate action. In addition, VA will support these studies by
acting on ATSDR requests to confirm specific Veteran's health issues.
VA has a close working relationship with ATSDR which allows the
Department to stay informed about current research.
We are also greatly concerned that the Department of Defense (DOD),
and consequently VA, is unable to accurately identify those that may
have visited for short periods of time at Camp Lejeune and surrounding
areas during the period of potential exposure. While the legislation
provides that the Secretary in conjunction with ATSDR shall determine
the applicable period, discussion usually centers on the period of
1957-1987. DOD records have proven problematic in identifying all
potential beneficiaries, especially since the legislation does not
provide for any limitations as to how long an individual had to be on
base at Camp Lejeune. It is possible through the Defense Manpower Data
Center to identify Veterans assigned to Camp Lejeune. However, it is
impossible to identify those Veterans who visited Camp Lejeune for
temporary duty and many of the family members who resided at or visited
the base. We note that VA treatment of family members as prescribed by
S. 277 would be an unprecedented extension of VA's provision of care to
non-veterans.
Veterans who are part of this cohort may apply to enroll in VA
health care if they are otherwise eligible, and are encouraged to
discuss any specific concerns they have about this issue with their
health care provider. VA environmental health clinicians can provide
these Veterans with information regarding the potential health effects
of exposure to volatile organic compounds and VA's War-Related Illness
and Injury Study Centers are also available as a resource to providers.
Veterans are also encouraged to file a claim for VA disability
compensation for any injury or illness they believe is related to their
military service. Currently, Camp Lejeune disability claims are handled
on a case by case basis and significant weight is given to the opinions
provided by qualified medical examiners who are aware of the
contaminants and their potential long-term health effects. In an effort
to provide fair and consistent decisions based on service at Camp
Lejeune during the period of water contamination, VA has consolidated
claims processing at the Louisville Regional Office.
Because of these concerns and others about the adequacy of the
underlying scientific evidence, VA does not support this bill.
It is unclear exactly how many people were potentially affected by
the water contamination at Camp Lejeune, but some estimates place the
number at one million Veterans and family members. VA estimates that
the costs associated with this bill are $292 million in fiscal year
2012, $1.6 billion over five years, and $3.9 billion over ten years. In
addition, the Department anticipates that this legislation would result
in lost revenue associated with collections. VA estimates this loss of
revenue to be $19.5 million in fiscal year 2012, $110 million over five
years, and $213 million over ten years.
S. 396, MEETING THE INPATIENT HEALTH CARE NEEDS OF
FAR SOUTH TEXAS VETERANS ACT OF 2011
S. 396 would require the Secretary of VA to ensure that the South
Texas Veterans Affairs Health Care Center in Harlingen, Texas, includes
a full-service VA inpatient health care facility. If necessary, the
Secretary would be required to modify the existing facility to meet
this requirement. A report would also be required to be submitted,
within 180 days of enactment, outlining the specific actions the
Secretary plans to take to satisfy the requirements of the bill,
including a detailed cost estimate and a timeline for completion of any
necessary modification.
The Department has strong concerns about this bill. VA recognized
the need for enhanced access to care in the Lower Rio Grande Valley and
Coastal Bend areas of South Texas several years ago. In 2006 and 2007,
VA contracted Booz-Allen-Hamilton (BAH) to study options for expanding
access to ambulatory specialty and inpatient services in the region. VA
implemented their recommended option by converting the clinic at
Harlingen into a Health Care Center (HCC) to provide a broad array of
specialty services, and to contract with local hospitals in the area to
provide inpatient hospital and emergency care. BAH concluded that this
option solved secondary care access gaps in the Valley in a way that
was cost-effective and consistent with high quality patient care.
Actuarial projections from the 2007 BAH study were a key factor in
the Department's decision to expand the clinic at Harlingen into a
Health Care Center, and to contract for inpatient care and emergency
room services in the local community. In May 2010, in an effort to
determine whether this course of action continued to be the best way to
serve Veterans, VA reassessed the recommendations made in the BAH
study. This reassessment included examination of the most current
projections for inpatient utilization, as well as a review of
enrollment and actual utilization data for inpatient contracts over the
last 12 months. Following a comprehensive review of all available data,
we determined the best way to serve inpatient needs for Veterans in the
area was to continue using contract care at local hospitals. This
course of action will provide Veterans access to a broad array of high
quality inpatient services that would not be feasible in a smaller, VA-
run facility. In recognition of the significance of the growing Veteran
population in this area, we will continue to closely monitor and
compare the actual demand for inpatient and emergency room care at the
contract hospital systems with the demand identified in the actuarial
projections from the BAH study. Should evidence indicate a change in
course is required, the Department will consider all viable options.
VA is unable to estimate a cost for compliance with the
requirements of this bill at this time but will provide that
information in writing for the record. Expansion of the existing
facility or construction of a new facility would be necessary for VA to
provide inpatient care directly. If the bill is enacted, VA would
comply with section 3(b) which requires VA to report to Congress within
180 days on the actions the Secretary plans to take and the estimated
cost of such actions.
S. 423, PROVIDING AUTHORITY FOR A RETROACTIVE EFFECTIVE DATE FOR AWARDS
OF DISABILITY COMPENSATION IN CONNECTION WITH APPLICATIONS THAT ARE
FULLY-DEVELOPED AT SUBMITTAL
S. 423 would amend 38 U.S.C. Sec. 5110(b) to authorize a
potentially retroactive award of disability compensation to a Veteran
whose compensation application was fully developed as of the date
submitted to VA. The effective date of a compensation award based on
the submittal of a fully developed application would be ``fixed in
accordance with the facts found,'' but could not be earlier than the
date one year before the date the application was received by VA. The
bill would allow VA to prescribe what constitutes a fully-developed
claim for purposes of this provision.
VA does not support this bill because it would result in the
inequitable treatment of Veterans who cannot submit a ``fully-
developed'' claim. Currently, section 5110 authorizes a retroactive
compensation award in two instances, both based on the timing of the
application. VA may award compensation retroactively if VA receives the
application within one year from the date of a Veteran's discharge or
release from service or, in cases of increased compensation, if VA
receives the application within one year of the date that an increase
in disability is ascertainable. In either case, the timing of the
application, and hence the eligibility for a retroactive award, is
within a Veteran's control. The retroactive award S. 423 would
authorize, however, is based not on the timing of the application, but
rather on the nature of the claim and the evidence needed to decide the
claim, matters that are not within a Veteran's control. S. 423 would
essentially penalize Veterans who cannot submit an application with the
evidence necessary to decide the claim. The bill would result in
retroactive compensation awards to Veterans whose claims involve simple
factual issues or evidence within their possession or readily
obtainable, but not to Veterans whose claims involve complex factual
issues or evidentiary development, but are no less meritorious than the
simple claims.
In addition, S. 423 would likely result in litigation over whether
a claim was fully developed when submitted because VA's decision to
obtain or request further evidence would preclude a retroactive award.
Although VA does not support S. 423, it appreciates the attempt to
create an incentive for Veterans to file fully developed claims. VA
believes a more balanced approach would create that incentive. VA has
implemented a Fully Developed Claim (FDC) Program at all regional
offices as a result of the Veterans' Benefits Improvement Act of 2008,
Public Law 110-389, signed by the President on October 10, 2008. This
law required VA to assess the feasibility and advisability of
expeditiously adjudicating fully developed compensation or pension
claims. Under the FDC program, a Veteran who submits a formal claim for
benefits within one year from the date of VA's acknowledgement of
receipt of the Veteran's informal claim may be awarded benefits
effective from the date VA received the informal claim. Because the
acknowledgement letter will include information about the evidence
necessary to substantiate a claim for benefits, Veterans will be able
to facilitate the processing of their claim by submitting evidence in
conjunction with their formal claim. Thus, the timing of the
application, not whether a fully developed claim is received, is
determinative of whether retroactive benefits can be awarded. Further,
this extra time allows any claimant the opportunity to assemble his or
her claim package for submission, while still affording them the
benefit of the FDC program and the potential of an earlier effective
date.
VA estimates that enactment would result in benefit costs of $54.9
million for fiscal year 2012, $315.7 million over five years, and
$761.7 million over ten years.
S. 486, PROTECTING SERVICEMEMBERS FROM MORTGAGE ABUSES ACT OF 2011
S. 486 would extend the Servicemembers Civil Relief Act (SCRA)
period of protections relating to real and personal property from 9
months to 24 months. This bill would also change violations of SCRA
from a misdemeanor to a felony and increase civilian penalty amounts.
VA defers to the Departments of Defense and Justice regarding the
merits of this bill. We are unable at this time to provide cost
estimates associated with enactment of this bill, but will provide that
information in writing for the record.
S. 490, INCREASE THE MAXIMUM AGE FOR CHILDREN ELIGIBLE FOR CHAMPVA
VA supports S. 490, which would amend 38 U.S.C. Sec. 1781(c) to
extend eligibility for coverage of children under the Civilian Health
and Medical Program of the Department of Veterans Affairs (CHAMPVA)
until they reach age 26 so that eligibility for coverage of children
under CHAMPVA will be consistent with private sector coverage under the
Affordable Care Act . S. 490 would extend eligibility for coverage of
children under CHAMPVA regardless of age, marital status, and school
enrollment status up to the age of 26; and the bill would ensure that
CHAMPVA eligibility would not be limited for individuals described in
Sec. 101(4)(A)(ii) (individuals who, before attaining age 18, became
permanently incapable of self-support).
The amendments made by S. 490 would apply with respect to medical
care provided on or after the date of enactment of the bill. The
extension of eligibility to age 26 would not be limited to children who
are currently enrolled in or even those who are currently eligible for
CHAMPVA. This is because we read this bill to provide that a ``child
who is eligible for benefits'' under Sec. 1781(a) will still be
considered an eligible ``child'' until his or her 26th birthday,
notwithstanding the age limits in 38 U.S.C. Sec. 101(4). We offer for
the Committee's information that S. 490 would not extend eligibility
for children who, before January 1, 2014, are eligible to enroll in an
eligible employer-sponsored health plan (as defined in I.R.C.
Sec. 5000A(f)(2)). This means that the age, school status, and marital
status requirements in 38 U.S.C. Sec. 101(4) will, before 2014, apply
to children who are eligible to enroll in an eligible employer-
sponsored health plan and would not extend eligibility for coverage of
those individuals. This provision in the bill is thus in accordance
with the discretion provided to grandfathered health plans that are
group health plans in the private sector under the Affordable Care Act.
VA estimates the cost of implementing S. 490 to be $64.6 million in
fiscal year 2012, $390.5 million over five years, and $1.022 billion
over ten years.
S. 536, PROVIDE THAT UTILIZATION OF SURVIVORS' AND DEPENDENTS'
EDUCATIONAL ASSISTANCE SHALL NOT BE SUBJECT TO THE 48-MONTH LIMITATION
S. 536 would amend section 3695(a)(4) of title 38, United States
Code, to exempt individuals eligible for VA education benefits under
the chapter 35 Survivors' and Dependents' Educational Assistance (DEA)
program from the 48-month limitation on the use of educational
assistance under multiple Veterans' and related educational assistance
programs. This amendment would allow an individual to receive up to 45
months of benefits under the DEA program and up to 48 months of
benefits under other educational assistance programs administered by
VA. The amendment would take effect on the date of enactment of S. 536.
By its own terms, however, it would not revive any entitlement to
educational assistance under chapter 35 or any other provision of law
listed in section 3695(a) that terminated prior to that date.
Under current law, section 3695(a) limits to 48 months the
aggregate entitlement for any individual who receives educational
assistance under two or more programs. This provision applies, in part,
to the Montgomery GI Bill Active Duty (MGIB-AD/chapter 30), the Vietnam
Era Assistance Program (VEAP/chapter 32), the Post-9/11 GI Bill
(chapter 33), the Survivors' and Dependents' Educational Assistance
program (chapter 35), the Montgomery GI Bill Selected Reserve (MGIB-SR/
chapter 1606), and the Reserve Educational Assistance Program (REAP/
chapter 1607).
Beginning on the date of enactment of this bill, as noted above, VA
would not consider an individual's chapter 35 entitlement when applying
the 48-month limitation in section 3695(a). The amendment also would be
applicable to those individuals who, as of the day before enactment,
had not used a total of 48 months of benefits entitlement (regardless
of whether the 48 months included receipt of chapter 35 benefits).
Thus, those individuals with remaining entitlements under other
educational assistance programs administered by VA on the bill's date
of enactment would have their entitlement to such programs determined
without consideration of the benefits they used under chapter 35.
VA does not have the specific data necessary to cost this proposal.
While VA can determine the number of participants who used prior VA
training and the amount of entitlement used in previous programs, we
cannot extract the specific Survivors' and Dependents' Educational
Assistance program population affected by this proposal. The system
used to process chapter 35 claims stores and retrieves information for
beneficiaries using the Veteran's file number. Although information
specific to the individual is stored in the record, the system uses the
file number to search for multiple records. As a result, a query of the
chapter 35 file numbers would provide information on Veterans rather
than the beneficiaries of the Survivors' and Dependents Educational
Assistance program. Further, VA has no way of determining how many
servicemembers elected not to participate in the MGIB-AD program
because of prior chapter 35 benefits or how many individuals
potentially eligible for the Post-9/11 GI Bill are or were eligible for
chapter 35 benefits.
VA supports the intent of S. 536 and favors enactment of the bill,
subject to Congress finding offsetting savings. While we are unable to
extract a specific population and are unable to provide costs, we
estimate that a student who used 45 months of benefits under the
Survivors' and Dependents' Educational Assistance program would receive
an additional $51,336 for a full 36 months of training under the
Montgomery GI Bill--Active Duty program. Similarly, we estimate that a
student in receipt of benefits at the 100 percent eligibility tier
under the Post-9/11 GI Bill program would receive an additional $87,544
for 36 months of benefits.
S. 572, REPEAL OF THE PROHIBITION ON COLLECTIVE BARGAINING WITH RESPECT
TO MATTERS AND QUESTIONS REGARDING COMPENSATION OF EMPLOYEES OF THE
DEPARTMENT OF VETERANS AFFAIRS OTHER THAN RATES OF BASIC PAY
S. 572 would amend 38 U.S.C. 7422 by replacing the word
``compensation'' in sections (b) and (d) with the words ``rates of
basic pay.'' While we appreciate the many contributions collective
bargaining and the labor-management partnership make to VA's mission,
we strongly oppose S. 572.
VA would like to stress to the Committee that we deeply value the
contributions of our employees, and work to enjoy a collaborative,
positive working relationship with unions across the country. We hold
retention of employees as a critically important goal, and encourage
the management teams of VA facilities to offer professional development
opportunities and encourage personal growth.
This bill would repeal the prohibition on collective bargaining
with respect to compensation of title 38 employees. Currently, 38
U.S.C. 7422(b) and (d) exempt ``any matter or question concerning or
arising out of * * * the establishment, determination, and adjustment
of [title 38] employee compensation'' from collective bargaining. This
bill would replace the word ``compensation'' with the phrase ``rates of
basic pay.'' This change would apparently make subject to collective
bargaining all matters relating to the compensation of title 38
employees (physicians, dentists, nurses, et al.) over which the
Secretary has been granted any discretion.
In order to provide the flexibility necessary to administer the
title 38 system, Congress granted the Secretary significant discretion
in determining the compensation of VA's health care professionals. When
Congress first authorized title 38 employees to engage in collective
bargaining with respect to conditions of employment, it expressly
exempted bargaining over ``compensation'' in recognition of the U.S.
Supreme Court's ruling in Ft. Stewart Schools v. FLRA, 495 U.S. 641
(1990). In that case the Court held that the term ``conditions of
employment,'' as used in the Federal Service Labor-Management Relations
Statute (5 U.S.C. 7101), included salary, to the extent that the agency
has discretion in establishing, implementing, or adjusting employee
compensation. Id. at 646-47. Thus, Congress sought to make clear in 38
U.S.C. 7422(b) that title 38 employees' right to bargain with respect
to ``conditions of employment'' did not include the right to bargain
over compensation. Over the years, Congress has authorized VA to
exercise considerable discretion and flexibility with respect to title
38 compensation to enable VA to recruit and retain the highest quality
health care providers.
The term ``rates of basic pay'' is not defined in title 38.
However, the Department has defined ``basic pay'' as the ``rate of pay
fixed by law or administrative action for the position held by an
employee before any deductions and exclusive of additional pay of any
kind.'' VA Handbook 5007, Part IX, par. 5. Such additional pay includes
market pay, performance pay, and any other recruitment or retention
incentives. Id. Accordingly, S. 572 would subject many discretionary
aspects of title 38 compensation to collective bargaining. For example,
there are two discretionary components of compensation for VA
physicians and dentists under the title 38 pay system-market pay and
performance pay. Market pay, when combined with basic pay, is meant to
reflect the recruitment and retention needs for the specialty or
assignment of the particular physician or dentist in a VA facility.
Basic pay for physicians and dentists is set by law and would remain
non-negotiable under this bill, but the Secretary has discretion to set
market pay on a case-by-case basis. Market pay is determined through a
peer-review process based on factors such as experience,
qualifications, complexity of the position, and difficulty recruiting
for the position. In many cases, market pay exceeds basic pay. In those
situations, this bill would render a large portion or even the majority
of most physicians' pay subject to collective bargaining. The Secretary
also has discretion over the amount of performance pay, which is a
statutorily authorized element of annual pay paid to physicians and
dentists for meeting goals and performance objectives. Under this bill,
performance pay would also be negotiable. Likewise, pay for nurses
entails discretion because it is set by locality-pay surveys. Further,
Congress has granted VA other pay flexibilities involving discretion,
including premium pay, on-call pay, alternate work schedules, Baylor
Plan, special salary rates, and recruitment and retention bonuses. The
ability to exercise these pay flexibilities is a vital recruitment and
retention tool. It is necessary to allow VA to efficiently compete on a
cost-effective basis with the private sector and to attract and retain
clinical staff who deliver health care to Veterans. As described below,
this flexibility would be greatly hindered by the collective bargaining
ramifications of S. 572.
This bill would obligate VA to negotiate with unions over all
discretionary matters relating to compensation, and to permit employees
to file grievances and receive relief from arbitrators when they are
unsatisfied with VA decisions about discretionary pay. If VA were
obligated to negotiate over such matters, it could be barred from
implementing decisions about discretionary pay until it either reaches
agreements with its unions or until it receives a binding decision from
the Federal Service Impasses Panel. Stated differently, VA could be
prevented from hiring clinical staff and have decisions regarding
appropriate clinical staff subject to third party delay and retroactive
change. This could significantly hinder our ability and flexibility to
hire clinical staff as needed to timely meet patient-care needs.
Moreover, any time an employee was unsatisfied with VA's
determination of his or her discretionary pay, the union could grieve
and ultimately take the matter to binding arbitration. This would allow
an arbitrator to substitute his or her judgment for that of VA and,
with regard to physician market pay, to override peer review
recommendations. This bill would allow independent third-party
arbitrators and other non-VA, non-clinical labor third parties who lack
clinical training and expertise to make compensation determinations. VA
would have limited, if any, recourse to appeal such decisions.
Importantly, S. 572 would result in unprecedented changes in how
the Federal Government operates. It would permit unions to bargain
over, grieve, and arbitrate a subject--employee compensation--that is
generally exempted from collective bargaining even under title 5.
Although Congress has built much more Agency discretion into the title
38 compensation system both to achieve the desired flexibility and
because the system is unique to VA, permitting title 38 employees to
negotiate the discretionary aspects of their compensation would be at
odds with how other Federal employees are generally treated. Further,
collective bargaining over discretionary aspects of pay is unnecessary.
VA's retention rates for physicians and dentists are comparable to
private sector retention rates, while retention rates for VA registered
nurses significantly exceed those of the private sector, strongly
suggesting that the lack of bargaining ability over discretionary
aspects of pay has not negatively affected VA's ability to retain title
38 employees.
To address some of the concerns expressed by the unions, the
Secretary convened a group of union and management officials to
formulate recommendations to jointly explore and clarify the
implementation of the title 38 exclusions under section 7422.
This workgroup was a significant cooperative effort, spanning
multiple meetings, in person and via conference calls, from July 2009
through May 2010. The 7422 workgroup membership included field
clinicians, the Office of General Counsel, the Office of Labor
Management Relations, and the five national unions (American Federation
of Government Employees (AFGE); National Association of Government
Employees (NAGE); Service Employees International Union (SEIU); United
American Nurses (UAN) (now National Nurses United (NNU)); and, National
Federation of Federal Employees (NFFE). Assistant Secretary for HR&A,
John Sepulveda, participated in all face to face meetings of the
workgroup.
The final result of the workgroup was sixteen individual
recommendations, as well as concise position papers of the parties and
joint supporting documents. Included in the recommendations approved by
the Secretary in December 2010 was language to address union concerns
with the way section 7422, including the compensation exclusion is
implemented. Also in December 2010, Memorandum of Understanding (MOU)
with the approved recommendations was signed by the Deputy Secretary,
W. Scott Gould; the Under Secretary for Health, Robert A. Petzel, MD;
the Assistant Secretary for HR&A, John U. Sepulveda; and the leaders of
four of the five national unions. The Secretary has charged an
implementation team to work on further development of an action plan to
implement the 7422 working group's approved recommendations. A meeting
is scheduled for July 6-7, 2011, in Washington, DC. Additional meetings
will be scheduled to complete the implementation process. The MOU as
well as our actions to implement it show our commitment to collaborate
with the unions and make the passage of S. 572 unnecessary.
We are not able to estimate the cost of S. 572 for two reasons.
First, if VA is required to negotiate over compensation matters, and if
the Agency is unable to reach agreements with the unions, the final
decisions on pay will ultimately rest with the Federal Service Impasses
Panel. The Panel has discretion to order VA to comply with the unions'
proposals. Second, if pay issues become grievable and arbitrable, the
final decisions on pay will rest in the hands of arbitrators.
On the whole, our efforts to recruit and retain health care
professionals have been widely successful, and have not in any way been
impaired by the exclusion of matters concerning or arising out of
compensation from collective bargaining. We would be glad to share
applicable data with the Committee and brief the members on our
continuing efforts in this area.
S. 666, ``VETERANS TRAUMATIC BRAIN INJURY CARE IMPROVEMENT ACT OF
2011''
S. 666, the ``Veterans Traumatic Brain Injury Care Improvement Act
of 2011,'' would require the Secretary to submit to Congress a report
on the feasibility and advisability of establishing a Polytrauma
Rehabilitation Center or Polytrauma Network Site for VA in the northern
Rockies or the Dakotas.
VA shares the concern for providing treatment facilities for
polytrauma in this region. Consequently, in 2010, VA completed an
assessment of need and determined that an enhanced Polytrauma Support
Clinic Team with a strong telehealth component at the Ft. Harrison,
Montana, VA facility would meet the needs and the workload volume of
Veterans with mild to moderate Traumatic Brain Injury (TBI) residing in
the catchment area of the Montana Healthcare System. It would also
facilitate access to TBI rehabilitation care for other Veterans from
the northern Rockies and the Dakotas through telehealth. VA has
initiated hiring actions to fill additional positions needed to enhance
the Polytrauma Support Clinic Team at Fort Harrison. We anticipate
these positions will be in place by the end of 2011. However,
establishment of a Polytrauma Rehabilitation Center or Polytrauma
Network Site, which would focus on the treatment of moderate to severe
TBI, is not feasible or advisable in this area based on the needs of
the population served. Because of the action already being taken by VA,
this bill is not necessary, and we thus cannot support it.
The estimated cost of staffing the Polytrauma Support Clinic Team
at Ft. Harrison would be $1.5 million in the first year, $6.2 million
for five years, and $13.0 million over ten years. We do not have
estimated costs for implementing the bill but will provide them when
they are available.
Mr. Chairman, we would be pleased to provide the Committee with
more detailed information about our findings and decisions regarding
the northern Rockies and the Dakotas.
S. 696, TREATMENT OF VET CENTERS AS DEPARTMENT OF VETERANS AFFAIRS
FACILITIES FOR PURPOSES OF PAYMENTS OR ALLOWANCES FOR BENEFICIARY
TRAVEL TO DEPARTMENT FACILITIES
S. 696 would require VA to make beneficiary travel payments to
persons traveling to and from Vet Centers if those persons would
otherwise be eligible for these payments under VA's authority to pay
beneficiary travel. VA is very interested in the possibility of
expanding this benefit to include travel to and from Vet Centers, but
recommends that no action be taken on this bill at this time. In an
effort to better assess the various factors potentially affecting
implementation of such a travel benefit, VA began a 6-month analysis on
May 1, 2011 at three Vet Centers to identify a model process for
administering benefits. The analysis will: assess the likely
utilization of the benefit; identify issues associated with
administering this benefit; determine the potential impact this benefit
would have on the Vet Center culture and Veterans' privacy concerns;
develop a model that can determine the upper and lower bounds for
demand for this benefit; and create a behavioral model that can
estimate potential changes in Veteran utilization of Vet Center
services.
This analysis will include focus groups of Veterans utilizing Vet
Center services to assess various cultural variables, such as the
effect this benefit might have on the Vet Center environment and
services, as well as Veteran support for the implementation of this
program. VA will also survey Veterans receiving Vet Center services to
identify their interest, the average distance they travel to a Vet
Center, and the number of visits they typically make each month. VA
will also review data from the existing beneficiary travel program to
estimate economic and behavioral impacts on utilization rates. VA
believes this to be a prudent approach that will allow us to determine
the likely impacts of such a change, prepare for any changes in demand
for Vet Center services, and include a budget request sufficient to
support these benefits or any other changes resulting from enactment.
VA will provide an update to Congress at the end of this analysis with
its results, conclusions and recommendations.
Given available data, VA estimates the cost of S. 696 in fiscal
year 2012 to be $3.7 million, $23.3 million over five years, and $63.2
million over ten years. VA notes these estimates may change based on
the results of the aforementioned analysis, and VA will provide an
updated cost estimate to the Committee when we have completed this
analysis.
S. 698, CODIFYING THE PROHIBITION AGAINST THE RESERVATION OF GRAVESITES
AT ARLINGTON NATIONAL CEMETERY
S. 698 would limit to one the number of gravesites at Arlington
National Cemetery that may be provided to a Veteran or a Member of the
Armed Forces who is eligible for interment at that cemetery and the
Veteran's or Member's family members who are eligible for interment
there. The bill would also prohibit pre-need reservations of gravesites
at Arlington National Cemetery and would require the Secretary of the
Army to submit to Congress a report on reservations made at Arlington
National Cemetery.
VA defers to DOD regarding S. 698 because the Secretary of the Army
is responsible for the management and operation of Arlington National
Cemetery.
S. 745, PROTECT CERTAIN VETERANS WHO WOULD OTHERWISE BE SUBJECT TO A
REDUCTION IN EDUCATION BENEFITS
S. 745 would protect certain Veterans who were enrolled in VA's
Post-9/11 Veterans Educational Assistance Program (generally referred
to as the ``Post-9/11 GI Bill) as it existed before the enactment of
Public Law 111-377, the ``Post-9/11 Veterans Educational Assistance
Improvements Act of 2010,'' who otherwise would be subject to a
reduction in educational assistance benefits.
Prior to the passage of Public Law 111-377 on January 4, 2011,
individuals using benefits under the Post-9/11 GI Bill at a private
institution of higher learning were paid the lesser amount of the
established charges (the actual charges for tuition and fees which
similarly-circumstanced nonveterans enrolled in the program of
education would be required to pay) or the established in-state maximum
tuition-and-fee rate at a public institution within that state. With
the enactment of Public Law 111-377, individuals pursuing a program of
education at a private institution of higher learning for the academic
year beginning on August 1, 2011, would be limited to the actual net
cost for tuition and fees assessed by the institution, not to exceed
$17,500.
S. 745 would modify the amount of educational assistance payable to
specific beneficiaries to make an exception for those who are enrolled
in a private institution of higher learning in certain states. This
exception would apply to an individual entitled to educational
assistance under the Post-9/11 GI Bill, who, on or before January 4,
2011, was enrolled in a private institution of higher learning in a
state in which the maximum amount of tuition per credit hour in the
2010-2011 academic year exceeded $700. There are seven states that meet
this criterion: Arizona, Michigan, New Hampshire, New York,
Pennsylvania, South Carolina, and Texas. Beginning on August 1, 2011,
and ending on December 31, 2014, the amount payable under this proposed
legislation would be the lesser of (1) the established charges for the
program of education; or (2) for the academic year beginning on
August 1, 2011, an amount equal to the established charges payable
based on the Department of Veterans Affairs Post-9/11 GI Bill 2010-2011
Tuition and Fee In-State Maximums published October 27, 2010; or (3)
for the academic year beginning on August 1, 2012, and any subsequent
academic year, an amount equal to the amount for the previous academic
year beginning on August 1, as increased based on the average cost of
undergraduate tuition as determined by the National Center for
Education Statistics.
This legislation would have significant PAYGO costs requiring
offsets. In addition, VA has concerns with the proposed legislation as
written, including, in particular, the timeline for implementing it, as
described in detail below.
VA is working aggressively on its Long-Term Solution (LTS) for
processing Post-9/11 GI Bill claims. As of January 2011, VA and the
Space and Naval Warfare Systems Center Atlanta (SPAWAR) have developed
four releases for the LTS system. The enactment of Public Law 111-377,
which modifies aspects of the Post-9/11 GI Bill, has already impacted
VA's ability to deploy previously-planned functionality enhancing the
capability of the LTS. VA plans to implement changes to the Post-9/11
GI Bill mandated by Public Law 111-377 across three releases of the
LTS. The first release was deployed on March 5, 2011; future releases
are scheduled for deployment on June 6, 2011, and October 17, 2011. The
enactment of S. 745 would further hamper VA's LTS deployment efforts.
If it were enacted before completion of the aforementioned
releases, the proposed legislation would also have a negative impact on
service delivery for those students using benefits this fall. VA claims
processors would have to thoroughly examine each claim manually to
determine if it meets the new requirements of these provisions, which
would result in labor-intensive manual processing. This would lead to a
significant increase in the average number of days to process all
education claims.
VA has identified several other technical concerns with regard to
the bill text. For example, it is unclear if an individual must be
enrolled in the same school and program on or before January 4, 2011,
to be covered under this legislation. It is also unclear how the
legislation would apply to an individual who changes programs or
schools. We would be pleased to assist the Committee in addressing
these concerns.
While the amendments made by this legislation would take effect on
August 1, 2011, VA strongly recommends that language be added to allow
VA to begin making payments in accordance with these provisions no
later than August 1, 2012, to allow for necessary system changes and
reduce the impact on existing beneficiaries.
VA estimates that, if S. 745 is enacted, the cost to the
Readjustment Benefits account would be $13.9 million in fiscal year
2011 and a total of $57.8 million over the four years fiscal year 2011
through fiscal year 2014.
S. 769, VETERANS EQUAL TREATMENT FOR SERVICE DOGS ACT OF 2011
S. 769 would prohibit the Secretary from excluding from any VA
facilities or property or any facilities or property that receive
funding from VA, service dogs trained for use by Veterans enrolled in
the VA health care system who were provided service dogs for reasons of
hearing impairment, spinal cord injury or dysfunction or other chronic
impairment that substantially limits mobility, and mental illness
including Post Traumatic Stress Disorder.
VA acknowledges that trained service dogs can have a significant
role in maintaining functionality and promoting maximum independence of
Veterans with disabilities. VA recognizes the need for Veterans with
disabilities to be accompanied by their trained service dog on VA
properties consistent with the same terms and conditions, and subject
to the same regulations as generally govern the admission of members of
the public to the property. However, S. 769 is unnecessary. Under
existing statutory authority in 38 U.S.C. 901, VA can implement
national policy for all VA properties, and in fact did so for VHA
facilities and property on March 10, 2011 (VHA Directive 2011-2013),
directing that both Veterans and members of the public with
disabilities who require the assistance of a trained guide dog or
trained service dog be authorized to enter VHA facilities and property
accompanied by their trained guide dog or trained service dog
consistent with the same terms and conditions, and subject to the same
regulations that govern the admission of members of the public to the
property. We would be glad to provide a copy of the Directive for the
record. This Directive requires each Veterans Integrated Service
Network (VISN) Director to ensure all VHA facilities have a written
policy on access for guide and service dogs meeting the requirements of
the national policy by June 30, 2011. In addition, VA intends to
initiate rulemaking that will establish criteria for service dog access
to all VA facilities and property in a manner consistent with the same
terms and conditions, and subject to the same regulations as generally
govern the admission of members of the public to the property while
maintaining a safe environment for patients, employees, visitors, and
the service dog.
We note that VA's new Directive is much broader in scope than
S. 769 which would only apply to certain Veterans and not members of
the public. In particular, it would only apply to that subset of
Veterans who are enrolled in VA's health care system and who were
provided service dogs for reasons of hearing impairment, spinal cord
injury or dysfunction or other chronic impairment that substantially
limits mobility, and mental illness including Post Traumatic Stress
Disorder pursuant to 38 U.S.C. 1714. VA's policy allows not only all
Veterans with a disability that requires the assistance of a trained
guide dog or trained service dog, but also members of the public
including Veterans' families and friends with disabilities, to be
accompanied by their trained guide dogs or trained service dogs in VHA
facilities or properties.
The bill also prohibits the Secretary from excluding service dogs
from any facility or on any property that receives funding from the
Secretary. Such a prohibition is unnecessary because it duplicates
other statutes discussed below.
Any non-VA facilities and properties with which S. 769 is concerned
that are also owned or controlled by the Federal Government must under
current law at 40 U.S.C. Sec. 3103, admit on the same terms and
conditions, and subject to the same regulations, as generally govern
the admission of the public to the property, specially trained and
educated guide dogs or other service animals accompanying individuals
with disabilities. Other non-VA properties not otherwise owned or
controlled by the Federal Government, including but not limited to
professional offices of health care providers, hospitals, and other
service establishments, will almost certainly meet the definition of a
place of public accommodation or public entity under the Americans with
Disabilities Act of 1990 as prescribed in regulations at 28 CFR
Sec. Sec. 35.104 and 36.104, and therefore be required to modify their
policies, practices, or procedures to permit the use of a service
animal by an individual with a disability in accordance with 28 CFR
Sec. Sec. 35.136 and 36.302. We would note that VA facilities are not
subject to the Americans with Disabilities Act of 1990, but are subject
to the Rehabilitation Act. The Rehabilitation Act does not specifically
address the issue of service dogs in buildings or on property owned or
controlled by the Federal Government, but does prohibit discrimination
against individuals with disabilities, including those who use service
animals, in federally-funded or -conducted programs and activities. In
addition, as explained above, there are other existing authorities that
address the issue of bringing guide dogs and other service animals onto
VA property.
VA estimates that there would be no costs associated with
implementing this bill.
S. 780, EXEMPTING REIMBURSEMENTS OF EXPENSES RELATED TO ACCIDENT,
THEFT, LOSS, OR CASUALTY LOSS FROM DETERMINATIONS OF ANNUAL INCOME WITH
RESPECT TO PENSIONS FOR VETERANS AND SURVIVING SPOUSES AND CHILDREN OF
VETERANS
S. 780, the ``Veterans Pensions Protection Act of 2011,'' would
liberalize the existing exemption in 38 U.S.C. Sec. 1503(a)(5) by
excluding from determinations of annual income, for purposes of
determining eligibility for improved pension, two types of payments:
(1) payments regarding reimbursements for expenses related to accident,
theft, loss, or casualty loss and reimbursements for medical expenses
resulting from such causes; and (2) payments regarding pain and
suffering related to such causes.
The exemption for payments received to reimburse Veterans for
medical costs and payments regarding pain and suffering is an expansion
of the current exclusions. VA opposes excluding from countable income
payments received for pain and suffering because such payments do not
constitute a reimbursement for expenses related to daily living. This
provision of the bill would be inconsistent with a needs-based program.
Payments for pain and suffering are properly considered as
available income for purposes of the financial means test for
entitlement to improved pension.
VA does not oppose the remaining provisions of this bill, which
would exempt payments for reimbursement for accident, theft, loss,
casualty loss, and resulting medical expenses, subject to Congress
identifying offsets for any additional costs. Current law exempts from
income determinations reimbursements for any kind of ``casualty loss,''
which is defined in VA regulation as ``the complete or partial
destruction of property resulting from an identifiable event of a
sudden, unexpected or unusual nature.'' S. 780 would broaden the scope
of this exemption by including reimbursements for expenses resulting
from accident, theft, and ordinary loss.
VA cannot determine the potential benefit costs related to the
exemption for payments for pain and suffering related to accident,
theft, loss, or casualty loss because insufficient data are available
regarding the frequency or amounts of such payments to the population
of pension beneficiaries.
S. 815, SANCTITY OF ETERNAL REST FOR VETERANS ACT OF 2011 OR
THE SERVE ACT OF 2011
S. 815, the ``Sanctity of Eternal Rest for Veterans Act of 2011''
or the ``SERVE Act of 2011,'' would amend titles 18 and 38, United
States Code, to guarantee that military funerals are conducted with
dignity and respect. Section 2 of the bill would state the purpose of
the bill, to provide necessary and proper support for the recruitment
and retention of the U.S. Armed Forces and militia employed in the
service of the United States by protecting the dignity of their
members' service and the privacy of persons attending their members'
funerals. It would also state Congress' findings regarding the
constitutional authority for the bill. Section 3 of the bill would
amend title 18, United States Code, making it unlawful to engage in
certain activities within a certain distance from, and during a certain
period in relation to, any funeral of a member or former member of the
Armed Forces not located at a cemetery under the control of the
National Cemetery Administration (NCA) or a part of Arlington National
Cemetery. It would provide for punishment by fine or imprisonment or
both, give U.S. district courts jurisdiction to entertain suits for
enjoining violations of the provision and complaints for damages
resulting from conduct that violates the provision, authorize the
Attorney General to institute proceedings, and authorize suits to
recover damages. Although this section of the bill is inapplicable to
NCA cemeteries, VA supports its enactment because it would establish a
unified approach to preserve the dignity of funeral services and
reinforces the commitment to protect the privacy of attendees during
their time of bereavement.
Section 4 of the bill would make several changes to 38 U.S.C.
Sec. 2413 to make it align with the title 18 provisions applicable to
non-NCA cemeteries. Section 2413 currently prohibits certain
demonstrations: (1) on the property of an NCA-controlled national
cemetery or of Arlington National Cemetery without official approval;
and (2) during a period beginning one hour before and ending one hour
after a funeral, memorial service, or ceremony is held if any part of
the demonstration takes place within a certain distance of such a
cemetery, disturbs the peace, or impedes access to or egress from such
a cemetery. The effect of the amendment is to expand the time period
during which demonstrations are prohibited to begin two hours before
and end two hours after a funeral, and increase the distance
restriction for demonstrations from 150 feet to 300 feet of the
cemetery or a road, pathway, or other route of ingress or egress from
the cemetery. It would increase protections against willful conduct
which causes or assists in making noise or diversion that disturbs the
funeral or memorial service, or unauthorized conduct that impedes the
access to or egress from the cemetery by the funeral procession by
increasing the boundary limits for engaging in such prohibited conduct
from 300 feet to within 500 feet of the cemetery where the funeral is
held. The bill provides for punishment by fine or imprisonment or both,
gives U.S. district courts jurisdiction to entertain suits for
enjoining violations of the provision and complaints for damages
resulting from conduct that violates the provision, authorizes the
Attorney General to institute proceedings, and authorizes suits to
recover damages. The bill also contains a clerical amendment to revise
the heading for section 2413.
VA supports section 4 of this bill to ensure the privacy and
protection of grieving families during funeral, memorial and ceremonial
services meant to honor these fallen heroes who, through their service,
paid the ultimate price. If enacted, S. 815 would have no monetary
impact on NCA's current practice of coordinating with local law
enforcement and community supporters.
S. 894, VETERANS' COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2011
S. 894, the ``Veterans' Compensation Cost-of-Living Adjustment Act
of 2011,'' would mandate a cost-of-living adjustment (COLA) in the
rates of disability compensation and dependency indemnity compensation
payable for periods beginning on or after December 1, 2011. The COLA
would be the same as the COLA that will be provided under current law
to Social Security benefit recipients, which is currently estimated to
be an increase of 0.9 percent. This increase is identical to that
proposed in the President's fiscal year 2012 budget request to protect
the affected benefits from the eroding effects of inflation. VA
supports the bill and believes that our Veterans and their dependents
deserve no less. VA estimates that enactment would result in benefit
costs of $329 million for fiscal year 2012, $2.1 billion over five
years, and $4.6 billion over ten years. However, because COLA costs are
assumed in the baseline for Compensation and Pensions each year,
enactment of this bill does not result in PAYGO costs.
S. 910, VETERANS HEALTH EQUITY ACT OF 2011
S. 910 would amend Title 38, Part II, Chapter 17, of the United
States Code to include new section 1706A. Section 1706A would require
the Secretary to ensure that Veterans in each of the 48 contiguous
States have access to at least one full-service Department medical
center or to comparable hospital care and medical services through
contract with other in-State health care providers. Section 1706A would
define a full-service Department medical center as a facility that
provides medical services including, hospital care, emergency medical
services, and standard-level-complexity surgical care.
Additionally, the Secretary would be required to submit a report to
Congress within one year describing VA's compliance with these
requirements and how the quality and standards of care provided to
Veterans has been impacted.
VA opposes this legislation because it is unnecessary. VA engages
in an extensive analysis of factors in order to identify appropriate
locations to site VA health care facilities. These factors include, but
are not limited to, projected total Veteran population, Veteran
enrollee population, and utilization trends. VA analyzes this demand
projection data over a 20-year period and takes into account Veteran
access to various types of care and services. VA also utilizes its
access guidelines, which take into account an acceptable amount of time
a Veteran should reasonably travel to receive care depending upon
whether the Veteran resides in an urban, rural, or highly rural
community.
VA engages in population-based planning and seeks to provide
services through a continuum of delivery venues, including outreach
clinics, community-based outpatient clinics, and medical facilities or
hospitals. When it is determined that a full-service hospital is not
required, VA uses a combination of interventions to ensure the delivery
of high quality health care such as contracting for care in the
community, use of telehealth technologies and referral to other VA
facilities. VA improves Veteran access to health care by providing care
within or as close to the Veteran's community as possible, regardless
of state boundary lines.
To address the needs and concerns of the New Hampshire
constituency, VA is providing expanded acute care services to New
Hampshire Veterans through contracts with local health care providers.
This model has been used for more than a decade to provide VA-
coordinated care in a safe and cost effective manner.
Providing services in this manner ensures that Veterans who use the
Manchester VAMC have available locally the same level of acute care
services as other Veterans within the VA New England Healthcare System
and elsewhere. Patients who require tertiary care, such as cardiac
surgery or neurosurgery, and extended inpatient psychiatry will
continue to be referred to appropriate VA facilities for this care.
Current VA workload projection models reflect a 34 percent reduction in
Inpatient Bed Services for VA New England Healthcare System by 2021.
We are unable at this time to provide cost estimates associated
with enactment of this bill, but will provide that information in
writing for the record.
S. 928, LIMITING THE AUTHORITY OF THE SECRETARY OF VETERANS AFFAIRS TO
USE BID SAVINGS ON MAJOR MEDICAL FACILITY PROJECTS OF THE DEPARTMENT OF
VETERANS AFFAIRS TO EXPAND OR CHANGE THE SCOPE OF A MAJOR MEDICAL
FACILITY PROJECT OF THE DEPARTMENT
S. 928 would amend title 38, Section 8104(d)(2) of the United
States Code, to limit the authority of the Secretary of VA to use bid
savings on major medical facility projects of the Department, to expand
or change the scope of a major medical facility project of the
Department, and for other purposes. The Secretary would be required to
submit a notice to the Committees identifying the major medical
facility project that is the source of the bid savings, the major
medical facility project to be expanded or changed in scope, describe
the expansion or change in scope, and identify the amounts intended to
be obligated for the expansion or change in scope. The Secretary would
then be required to wait until legislation is enacted before making a
contract obligation. However, ample congressional notification
requirements for changes or expansions in scope are already in place.
VA thus opposes this legislation as unnecessary.
S. 935, VETERANS OUTREACH ENHANCEMENT ACT OF 2011
S. 935, the ``Veterans Outreach Enhancement Act of 2011,'' would
require the Secretary to establish a 5-year program of outreach to
increase Veterans' access, use, and awareness of, and their eligibility
for, Federal, State, and local programs that provide compensation and
other benefits for service in the Armed Forces. The bill would
authorize VA to enter into agreements with Federal and State agencies
to carry out projects under their jurisdictions and to enter into
agreements with certain authorities, commissions, and development
boards to provide technical assistance, award grants, enter into
contracts, or otherwise provide funding for projects and activities
that would: (1) increase outreach and awareness of benefit programs;
(2) provide incentives to State and local governments and Veterans
service organizations to increase Veterans' utilization of available
resources; (3) educate communities and State and local governments
about Veterans' employment rights; (4) provide technical assistance to
Veteran-owned businesses; and (5) promote Veteran-assistance programs
by nonprofit organizations, businesses, and institutions of higher
learning. This bill would also require the Secretary to submit to
Congress a comprehensive report on its outreach activities and would
authorize appropriations for this program of $7 million for fiscal year
2011 and $35 million for fiscal years 2012 through 2016.
VA supports the objective of S. 935, to improve outreach
initiatives. However, we believe VA's existing programs and authorities
are adequate in this regard.
VA continues to work to improve its outreach services. VA's program
offices and administrations are currently engaged in outreach
activities similar to those identified in S. 935. Because outreach is a
critical component of VA's mission, and in light of its current
efforts, VA would like to continue to build upon its current planned
strategies and activities to increase and improve its outreach
initiatives. VA has created a National Outreach Office (NOO), within
the Office of Intergovernmental and Public Affairs (OPIA), to help
standardize how outreach is being conducted throughout VA. These
efforts have resulted in considerable progress in obtaining information
essential to VA's analysis of its current programs and activities and
will enable OPIA and NOO to undertake a more efficient and effective
approach to conduct department-wide outreach in support of VA's major
initiatives.
Significant efforts are being made to ensure the effective
coordination of outreach efforts to Veterans in rural areas. Section
506 of Public Law 111-163, the Caregivers and Veterans Omnibus Health
Services Act of 2010, requires VA to provide outreach to Veterans and
their families about the availability of benefits and connect them with
appropriate care and benefit programs.
Through the efforts of OPIA, NOO, and various other VA offices and
administrations, we believe that VA continues to expand and develop its
outreach initiatives to reach out to all Veterans. We do not have a
cost estimate for implementing this bill but will provide it when it is
available.
S. 951, HIRING HEROES ACT OF 2011
Chairman Murray, we are pleased to provide our views on sections 2,
3, 4, 5, and 9 of your bill, S. 951, the ``Hiring Heroes Act of 2011,''
but respectfully defer to the views of DOD regarding sections 6, 7, and
12; the Department of Labor (DOL) regarding sections 8, 11, and 13; and
the Office of Personnel Management (OPM) regarding section 10.
Section 2 of the bill would extend through 2014 a provision enacted
in Title XVI of Public Law 110-181, known as the Wounded Warrior Act,
which authorizes VA to provide rehabilitative services and assistance
to certain severely disabled active-duty Servicemembers in the same
manner as provided to Veterans. VA proposed a similar provision in its
draft Veterans Benefits Improvement Act of 2011, transmitted to the
Senate on May 19, 2011. While the provisions differ in the length of
the extension, VA supports section 2.
Section 3 of the bill would amend section 3116(b)(1) of title 38,
United States Code, to expand VA's authority to pay employers for
providing on-job training to Veterans. Under current law, VA is
authorized to make payments to employers for providing on-job training
to Veterans who have been rehabilitated to the point of employability
in certain cases. By removing the requirement that Veterans be
rehabilitated to the point of employability before VA can make payments
to employers for providing on-job training, this section would allow VA
to make these payments to employers for providing on-job training to
many more Veterans. VA supports this provision. VA estimates benefit
costs to be $792 thousand for the first year, $4.2 million for five
years, and $9.1 million over ten years.
Section 4 of the bill would provide for additional rehabilitation
programs for persons who have exhausted rights to unemployment benefits
under state law. Under section 3102 of title 38, United States Code, as
amended by this section, a person who has completed a chapter 31
rehabilitation program would be entitled to an additional
rehabilitation program if the person meets the current requirements for
entitlement to a chapter 31 rehabilitation program and has, under State
or Federal law, exhausted all rights to regular compensation with
respect to a benefit year, has no rights to regular compensation with
respect to a week, and is not receiving compensation with respect to
such week under the unemployment compensation law of Canada. In
addition, the person must begin the additional rehabilitation program
within 6 months of the date of such exhaustion. Under this section, a
person would be considered to have exhausted rights to regular
compensation under a State law when no payments of regular compensation
can be made under such law because the person has received all regular
compensation available based on employment or wages during a base
period, or such person's rights to compensation have been terminated by
reason of the expiration of the benefit year.
Section 4 of the bill would also amend section 3105 of title 38,
United States Code, to limit the period of an additional rehabilitation
program to 24 months, and sections 3105 and 3695 to exempt Veterans
pursuing an additional rehabilitation program from certain limits.
Under current section 3105, a rehabilitation program may not be pursued
after 12 years after a veteran's discharge or release from active
service. Under current section 3695(b), assistance under chapter 31 in
combination with certain other provisions of law is limited to 48
months. Section 4 of the bill would amend sections 3105 and 3695(b) to
make these limitations inapplicable to an additional rehabilitation
program.
VA supports this provision because it would help VA serve more
Veterans in need of assistance. VA estimates benefit costs to be $51
thousand in the first year, $294 thousand for five years, and $724
thousand over ten years.
Section 5 of the bill would amend section 3106 of title 38, United
States Code, to require an assessment and follow-up on Veterans with
service-connected disabilities who participate in VA training and
rehabilitation. In addition, section 5 would require VA to ascertain
the employment status of a participating Veteran and assess his or her
rehabilitation program not later than 180 days after completion of, or
termination of, his or her participation in that program, and at least
once every 180 days thereafter for a period of one year. VA supports
this provision. We believe that providing follow-up is an important
endeavor. No benefit costs would be associated with this provision. VA
estimates administrative costs to be $4.7 million in the first year,
$24.2 million over five years, and $55 million over ten years. In
addition, VA estimates that $250 thousand will be needed in FY 2012 to
develop an IT solution to automate follow up activity.
Finally, section 9 of the bill would require VA, DOD, and DOL to
select a contractor to conduct a study to identify equivalencies
between skills developed by members of the military through various
military occupational specialties (MOS) and the qualifications required
for private sector civilian employment positions and report on the
results of the study. This section would also require Federal
Government departments and agencies to cooperate with the contractor.
VA, DOD, and DOL would be required to transmit the report with
appropriate comments to Congress.
Section 9 would also require DOD to use the results of the study
and other information to ensure that each member of the military
participating in the Transition Assistance Program (TAP) receives an
assessment of the various private sector civilian employment positions
for which the member may be qualified as a result the member's MOS. DOD
would have to transmit the individualized assessment to VA and DOL to
use in providing employment-related assistance in the transition from
military service to civilian life and to facilitate and enhance the
transition.
VA does not support this provision to enter into a joint contract
to identify civilian equivalencies of military jobs. Software
applications that analyze military occupational data and provide
equivalent civilian jobs currently exist. Therefore, VA believes a
contract to conduct a study to identify this information is not
necessary. VA is currently utilizing web software available in the
public domain that translates military skills to equivalent civilian
jobs. VA will continue to closely monitor the market place to identify
software that may improve our ability to identity civilian equivalents
of military jobs.
We do not have a cost estimate for implementing this section but
will provide it when it is available.
S. 957, VETERANS' TRAUMATIC BRAIN INJURY REHABILITATIVE SERVICES
IMPROVEMENTS ACT OF 2011
In 2008, Congress established several programs targeted at the
comprehensive rehabilitation of Veterans and members of the Armed
Services receiving VA care and services for Traumatic Brain Injuries
(TBI). In general, S. 957 seeks to improve those programs (established
by 38 U.S.C. Sec. Sec. 1710C-E) by requiring rehabilitative services,
as defined by the bill and discussed below, to be an integral component
of those on-going programs. With two exceptions, we have no objection
to S. 957.
Currently, the provisions of 38 U.S.C. Sec. 1710C set forth the
requirements for an individualized rehabilitation and reintegration
plan that must be developed for each Veteran or member of the Armed
Forces receiving VA inpatient or outpatient rehabilitative hospital
care or medical services for a TBI. VA Handbook 1172.04, Physical
Medicine and Rehabilitation Individualized Rehabilitation and Community
Reintegration Care Plan, implements section 1710C.
Section 2(a) of S. 957 would amend some of the mandated
requirements in section 1710C. Specifically, it would clarify that the
goal of each individualized plan is to maximize the individual's
independence and quality of life. It would also require, as part of a
plan's stated rehabilitative objectives, the sustaining of improvements
made in the areas of physical, cognitive, and vocational functioning.
Section 2(a) of the bill would further require that each such plan
include rehabilitation objectives for improving and sustaining
improvements in the individual's behavioral functioning as well as
mental health.
These amendments would not alter VA's policy or operations in any
significant way, as VA's primary aim for Veterans with serious or
severe injuries has always been, and continues to be, maximizing their
independence, health, and quality of life. It is out of these concerns
that VA has developed robust rehabilitation therapy programs to help
them learn or re-learn skills and develop resources for sustaining
gains made in their rehabilitation.
Section 2(a) of the bill would require the individual plans to
include access, as warranted, to all appropriate rehabilitative
services of the TBI continuum of care. The law now requires these plans
to provide access, as warranted, to rehabilitative components of the
TBI continuum of care (which includes, as appropriate, access to long-
term care services).
Current law also requires that each individualized plan include a
description of the specific ``rehabilitation treatments and other
services'' needed to achieve the patient's rehabilitation and
reintegration goals. Section 2(a) of the bill would replace all
references to ``treatments'' in the affected provision with
``services.'' This would ostensibly broaden the scope of rehabilitative
benefits available to these patients beyond what is deemed to be
treatment per se.
It would also add to each plan the specific objective of improving
(and sustaining improvements in) the patient's behavioral functioning.
That addition, together with the existing rehabilitation objective to
improve a patient's cognitive functioning, would effectively encompass
all relevant mental health issues related to TBI. For that reason, we
believe the bill's other amendment to separately include a
rehabilitation objective for improving ``mental health'' would create
confusion or redundancy. We thus recommend that language be deleted.
Most notably, section 2(a) of S. 957 would establish a new
definition of the term ``rehabilitative services,'' for purposes of all
of VA's specially targeted, statutory programs for TBI-patients (i.e.,
38 U.S.C. Sec. Sec. 1710C-E). Such services would include not only
those that fall under the current statutory definition found in 38
U.S.C. 1701 but also ``services (which may be of ongoing duration) to
sustain, and prevent loss of, functional gains that have been
achieved.'' Plus, they would include ``any other services or supports
that may contribute to maximizing an individual's independence and
quality of life.'' This last definition is overly broad and could be
read to include services or items well beyond the field of health care.
It is also unworkable. What maximizes an individual's ``quality of
life'' is highly subjective, and, as such, the term defies consistent
interpretation and application. Quite simply, we believe enactment of
that last provision of the proposed new definition would conflict with,
and exceed, our primary statutory mission, which is to provide medical
and hospital care. It should therefore be deleted, leaving only the
first two prongs of the definition.
Next, as briefly alluded to above, the individualized
rehabilitation and reintegration plans required by section 1710C must
include access, where appropriate, to long-term care services. The
eligibility and other requirements of VA's mandated comprehensive
program of long-term care for the rehabilitation of post-acute TBI are
found in 38 U.S.C. Sec. 1710D. Section 2(b) of S. 957 would require the
Secretary to include rehabilitative services (as that term would be
defined by Sec. 2(a) of the bill) in the comprehensive program. It
would also eliminate the word ``treatment'' in the description of the
interdisciplinary teams to be used in carrying out that program. We
have no objection to this proposed revision.
Last, Congress authorized VA, under specified circumstances, to
furnish hospital care and medical services required by an
individualized rehabilitation and reintegration plan through a
cooperative agreement. (A cooperative agreement may be entered only
with an appropriate public or private entity that has established long-
term neurobehavioral rehabilitation and recovery programs.) This
authority is found at 38 U.S.C. 1710E. Section 2(c) of S. 957 would add
``rehabilitative services'' (again as defined by Sec. 2(a) of the bill)
to the types of services that may be provided under those agreements.
We have no objection to this proposed revision.
Section 2(d) of S. 957 is merely a technical amendment to correct a
typographical error in section 1710C(c)(2)(S) of title 38, United
States Code. We would also like to point out another technical issue.
Current law permits inclusion of ``educational therapists'' among the
TBI-experts responsible for conducting a comprehensive assessment of
each patient. (It is this assessment which serves as the basis for the
individualized plans discussed above.) This categorization of
professionals is no longer used in the field of medical rehabilitation.
Aside from the two (substantive) modifications discussed above
(deleting the phrase ``any other services or supports that may
contribute to maximizing an individual's independence and quality of
life'' from the new definition of the term ``rehabilitative services,''
and deleting the bill's amendment to separately include a
rehabilitation objective for improving ``mental health''), we have no
objection to S. 957, and no new costs would be associated with its
enactment.
S. 1148, THE VETERANS PROGRAMS IMPROVEMENT ACT OF 2011
On June 6, Chairman Murray introduced S. 1148, the Veterans
Programs Improvement Act of 2011. We note that the bill carries many
provisions proposed by the Administration, in its draft Veterans
Benefits Improvement Act of 2011, transmitted to the Senate on May 19,
2011. We have not had the opportunity to review the bill closely
regarding its technical aspects, but we offer here our support of the
general intent of those provisions, and VA's appreciation for your
including them for consideration. We believe they are very worthy of
the Committee's endorsement. We also look forward to reviewing the
other titles of the bill which address VA's programs to combat
homelessness as well as VBA's fiduciary program.
This concludes my prepared statement. Madam Chairman, we would be
pleased to respond to whatever questions you may have.
______
Additional Views from Hon. Eric K. Shinseki, Secretary,
U.S. Department of Veterans Affairs
______
The Secretary of Veterans Affairs,
Washington, DC, June 28, 2011.
Hon. Patty Murray,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Madam Chairman: The agenda for the Senate Committee on
Veterans Affairs' June 8, 2011, legislative hearing included a number
of bills that the Department of Veterans Affairs was unable to address
in our testimony. We are aware of the Committee's interest in receiving
our views on those bills in advance of the June 29 mark-up. By this
letter, we are providing our views and cost estimates on S. 411,
S. 491, S. 914, S. 1017, sections 202 and 305 of S. 1060, S. 1104,
S. 1127, and titles I and III of S. 1148. We will provide views on the
remaining bills in a separate letter.
This Office of Management and Budget advises that there is no
objection to the submission of this letter from the standpoint of the
Administration.
We appreciate this opportunity to comment on this legislation and
look forward to working with you and the other Committee Members on
these important legislative issues.
Sincerely,
Eric K. Shinseki
Enclosure.
Enclosure
VA Views
S. 411 ``HELPING OUR HOMELESS VETERANS ACT OF 2011''
S. 411 would authorize VA to enter into agreements with certain
entities to collaborate in the provision of case management services as
part of the HUD-Veterans Affairs Supportive Housing (HUD-VASH) program.
In addition, S. 411 would require the Department of Veterans Affairs
(VA), in consultation with the Department of Housing and Urban
Development (HUD), to ensure that the distribution of vouchers to
Veterans under the HUD-VASH program meets the needs of Veterans in
rural areas and underserved Veterans in metropolitan areas or on Indian
lands. This bill would expand VA's existing authority to provide case
management services and collaborate with other entities. VA supports
this bill, although we do have one technical comment and a suggestion
for improving this bill.
S. 411 specifically authorizes VA to enter into these agreements
with tribal organizations. However, tribal lands do not have public
housing agencies and because public housing agencies are the sole
mechanism for issuing section 8 Housing Choice Vouchers to Veterans,
S. 411 would not expand the HUD-VASH program to Veterans living on
Indian lands. We note that there are other HUD programs available to
Veterans on Indian lands.
In order to maximize care coordination and to implement and sustain
a shared case management model that supports permanent housing, VA
proposes including a provision in S. 411 to authorize VA to provide
Technical Assistance (TA) to community partners. TA would focus on
compliance with documentation and program evaluation standards,
implementing best practices strategies to coordinate with VA treatment,
and other supportive services that promote rapid access and sustainment
of permanent supportive housing. TA would also support site visits for
monitoring and promoting the coordination and creation of shared
learning communities, as well as the development of webinars that teach
shared best practices. TA would encourage a ``Housing First'' treatment
intervention for homeless Veterans by targeting the chronic homeless
and the most vulnerable Veterans. Money management and addressing unmet
health care needs of homeless Veterans are other essential components
that TA would further enhance. Through these efforts, VA will continue
to work with local public housing agencies and support interventions
with homeless Veterans in crisis by utilizing motivational interviewing
to promote treatment.
VA estimates that there would be no costs associated with
implementing S. 411. If S. 411 is amended to include a provision
authorizing VA to provide technical assistance, VA anticipates the cost
associated with this bill would be $300,000 in fiscal year (FY) 2012
and $750,000 over the next three fiscal years. VA only anticipates the
need for additional funds for technical assistance for the first three
fiscal years. After that, VA believes the costs could be rolled into
the homeless program's operating budget.
S. 491 ``HONOR AMERICA'S GUARD-RESERVE RETIREES ACT OF 2011''
S. 491 would add to chapter 1, title 38, United States Code, a
provision to honor as Veterans, based on retirement status, certain
persons who performed service in reserve components of the Armed Forces
but who do not have qualifying service for Veteran status under 38
U.S.C. 101(2). The bill provides that such persons would be ``honored''
as Veterans, but would not be entitled to any benefit by reason of the
amendment.
Under 38 U.S.C. 101(2), Veteran status is conditioned on the
performance of ``active military, naval, or air service.'' Under
current law, a National Guard or Reserve member is considered to have
had such service only if he or she served on active duty, was disabled
or died from a disease or injury incurred or aggravated in line of duty
during active duty for training, or was disabled or died from an injury
incurred or aggravated in line of duty or from an acute myocardial
infarction, a cardiac arrest, or a cerebrovascular accident during
inactive duty training. S. 491 would eliminate these service
requirements for National Guard or Reserve members who served in such a
capacity for at least 20 years. Retirement status alone would make them
eligible for Veteran status.
VA recognizes that the National Guard and Reserves have admirably
served this country and in recent years have played an important role
in our Nation's overseas conflicts. Nevertheless, VA does not support
this bill because it represents a departure from active service as the
foundation for Veteran status. This bill would extend Veteran status to
those who never performed active military, naval, or air service, the
very circumstance which qualifies an individual as a Veteran. Thus,
this bill would equate longevity of reserve service with the active
service long ago established as the hallmark for Veteran status.
VA estimates that there would be no additional benefit or
administrative costs associated with this bill if enacted.
S. 914 TO AUTHORIZE WAIVER OF COPAYMENTS FOR
TELEHEALTH AND TELEMEDICINE
S. 914 would add a new section to title 38, U.S.C., that would
authorize VA to waive copayment requirements for Veterans' telehealth
and telemedicine visits. VA opposes this legislation because it would
create an inequity in billing practices for services provided to
Veterans. We believe it would be inappropriate to waive copayments for
Veterans who receive telehealth services at a VA facility while
Veterans who see their VA provider in person in the same facility would
be charged a copayment.
Under existing authority, no Veteran is charged a copayment for
telephone calls, since in many cases they are used simply as a means to
check on the progress of a Veteran, not to deliver care. VA believes
the use of video consultation into the home is analogous to that of a
telephone call and that copayments for clinical video telehealth
services provided directly into a patient's home should be considered
for exclusion from copayments. VA plans under its existing authority
(38 U.S.C. 1710(g)) to exempt copayments for video consultations when
the Veteran is located at his or her home.
Recent VA experience demonstrates that copayments for home-
telehealth may have resulted in a reduced use of this intervention. To
ensure convenient and cost effective care to populations of patients
who will otherwise delay care and incur larger costs from emergency
room visits and hospital admissions, VA will take the appropriate
action to exempt copayments for in-home video telehealth care for
Veterans. Because VA already has the authority to waive or modify the
imposition of copayments for such care, legislation is not required.
If copayments are not collected for all telehealth or telemedicine
services, VA estimates a revenue loss of $2.2 million in FY 2012, $18.0
million over 5 years, and $72.9 million over 10 years.
S. 1017 ``DISABLED VETERAN CAREGIVER HOUSING ASSISTANCE ACT OF 2011''
S. 1017 would increase the amount of Specially Adapted Housing
(SAH) assistance available to disabled Veterans who reside temporarily
in housing owned by family members, and would also expand SAH
eligibility for the visually impaired. Provided Congress identifies
appropriate and acceptable offsetting PAYGO cost savings, VA supports
this legislation.
Section 2 of the bill would amend 38 U.S.C. 2102A, SAH assistance
for disabled Veterans and Servicemembers who reside temporarily in
housing owned by a family member. In general, subsection (a) would
increase, from $14,000 to $28,000, the amount of assistance available
for individuals eligible for SAH grants under section 2101(a), and
would increase the amount from $2,000 to $5,000 for individuals
eligible for SAH grants under section 2101(b). Subsection (b) would
eliminate the December 31, 2011, termination date currently in effect,
and make such assistance permanent. Subsection (c) would tie the newly
increased amounts to the same cost-of-construction index as that
authorized for grants made pursuant to sections 2101(a) and 2101(b),
meaning that the grants would adjust upwards with the costs of
inflation.
We note that both this section and sections 303 and 304 of S. 1148
would make similar improvements to section 2102A. The relevant sections
of S. 1148 would extend the authority of assistance for individuals
residing temporarily in housing owned by a family member through 2021
and would implement a cost-of-construction index. These provisions are
substantively the same as sections 306 and 307 of VA's draft bill, the
``Veterans Benefits Programs Improvement Act of 2011.'' VA supports
both of these provisions.
Section 3 would amend 38 U.S.C. 2101(b) to expand SAH eligibility
for the visually impaired. Under current law, an individual is not
eligible for what is commonly called a ``2101(b) grant'' unless his or
her visual acuity is 5/200 or less, an exceptionally stringent standard
in comparison to other areas of law. Many grant applicants who are
considered legally blind by other commonly-held standards are
ineligible for 2101(b) grants because their visual impairments, though
profound, are not severe enough to meet the standard set under current
law. For example, under the Social Security Administration's
eligibility standards for supplemental security income (SSI),
individuals are considered legally blind with visual acuity of 20/200
or less, or a peripheral field of vision of 20 degrees or less.
Additionally, VA's Servicemembers' Group Life Insurance Traumatic
Injury Protection Program's eligibility standard related to visual
acuity is ``20/200 or less.'' However, since the standard for
``blindness'' for the 2101(b) grant is ``5/200 visual acuity or less,''
a Veteran or Servicemember who is legally blind for purposes of SSI or
VA life insurance would not be eligible for a 2101(b) grant.
By establishing a qualifying degree of blindness at visual acuity
of 20/200 best-corrected visual acuity or less, or as a field of vision
subtending an angle of 20 degrees or less, the bill would bring the SAH
requirements in line with more commonly recognized standards. It would
also make the 2101(b) grant available to a wider range of Veterans and
Servicemembers, including those who use rehabilitative low-vision
adaptive medical devices.
Section 4 of S. 1017 would no longer count grants authorized under
38 U.S.C. 2102A (commonly referred to as ``TRA grants'') against the
aggregate dollar amount of SAH assistance available to eligible
individuals. Under current law, an eligible individual may receive up
to three grants of SAH assistance totaling in aggregate not more than
$63,780 for a 2101(a) grant or $12,756 in the case of a 2101(b) grant.
If an individual receives a TRA grant, the amount is subtracted from
the total amount of assistance available, leaving him or her with fewer
funds for future adaptations to a permanent residence.
If section 4 were enacted, a veteran who had previously adapted a
family member's residence using a TRA grant would be able to adapt his
or her own permanent residence as if the TRA grant funds had not been
used. Although the TRA grant would still count as one of the three
allowable uses, it would not reduce the amount of assistance available
for a grant authorized under section 2101(a) or 2101(b).
VA estimates benefits costs of enactment to be $3.4 million in the
first year, $13.0 million over five years, and $20.6 million over ten
years. VA does not identify any increase in General Operating Expense
(GOE) cost associated with these provisions.
S. 1060 ``HONORING ALL VETERANS ACT OF 2011''
Section 202
Section 202 would dramatically change VA's Grant and Per Diem (GPD)
program, which has been a key factor in reducing Veteran homelessness.
The GPD Program is designed to support transitional housing for
Veterans. VA generally supports the spirit of the section, but is
apprehensive that this legislation will result in policy problems and
lead to significantly higher costs.
Currently, payments to eligible programs receiving grants to
provide services to homeless Veterans are made on a per diem basis.
Section 202(a)(2)(A) would eliminate all references to ``per diem'' in
38 U.S.C. 2012 and change the basis of grants from the ``daily cost of
care'' to the ``annual cost of furnishing services.'' It would also
remove the prohibition on VA providing a rate in excess of the rate
authorized for State domiciliaries and grant the Secretary the
discretion to set a maximum amount payable to grant recipients.
Section 202(a)(2)(B) would direct the Secretary to adjust the rate
of payment to reflect anticipated changes in the cost of furnishing
services and take into account the cost of services in different
geographic areas. Section 202(a)(2)(C) would remove the requirement
that the Secretary consider other available sources of funding and
would leave it to his or her discretion. Section 202(a)(2)(E) would
require the Secretary to make quarterly payments based on the estimated
annual basis and would require recipients to declare the actual amount
paid by quarter for services and repay any outstanding balances if the
amount spent by the recipient is less than the estimated quarterly
disbursement. Similarly, if recipients spend more than the estimated
amount, determined on a quarterly basis, the Secretary would be
required to make an additional payment equal to that sum. It would
limit payment to recipients to the amount of the annual payment as
determined by the Secretary. Section 202(a)(3) would allow grant
recipients to use VA grants to match other payments or grants from
other providers. Finally, section 202(a)(4) would repeal a
``grandfather'' provision extending the time period for certain
grantees to satisfy applicable requirements of the Life Safety Code of
the National Fire Protection Association, as this provision expired in
December 2006.
Although VA is not opposed to the concept of making its per diem
authorities more flexible to better reflect the actual cost of
providing services, especially in different geographic regions, VA is
currently evaluating the impact of shifting from the ``per diem'' or
``daily cost of care'' approach to an ``annual cost of furnishing
services'' paid and reconciled on a quarterly basis. Though this change
may offer VA's partners needed capital and funds at the beginning of
the fiscal year to support their work, it would require significantly
more detailed auditing as well as increased direct oversight by VA.
Furthermore, the requirement in section 202(a)(2)(E), to reconcile
payments each quarter, would allow more immediate accounting of unpaid
balances and/or over-billings; however, this approach would impose
significant administrative burdens, requiring VA to monitor and process
GPD provider accounts nationwide. VA would welcome the opportunity to
discuss these issues with Congress but asks that section 202 be
deferred until VA can fully evaluate its impact.
VA does not oppose removing the existing rate cap pursuant to
section 202(a)(2)(B). Currently, the statute limits VA's GPD per diem
payments to the rate for state domiciliary care. The difference between
what VA pays and the actual cost of expenditures is absorbed by the
provider. Allowing the Secretary to establish the basis and the formula
for payment based on cost and geographic location would increase the
sustainability of community-based providers and promote increased and
more comprehensive services for Veterans.
Although section 202 would no longer require the Secretary to
consider the availability of other sources of income for grant
recipients, the Secretary would in all likelihood consider the
availability of other funds when evaluating a grant application. GPD
Program Office experience has shown that the availability of other
sources of income is often an indicator of a viable GPD project.
VA supports the authorization in section 202(a)(2)(D) for VA
operational payments to be used in conjunction with grants from other
federal programs. The purpose of the payment contained in 38 U.S.C.
2012 is to pay for operational costs for a specific program operation.
VA estimates the cost of this section to be $450.0 million in the
first year, $2.8 billion over 5 years and $6.9 billion over 10 years.
Section 305
Section 305 would authorize VA to disclose information about
Veterans and their dependents to State prescription monitoring programs
to the extent necessary to prevent misuse and diversion of prescription
medications. VA supports section 305 of this bill. It would enhance the
ability of VA clinicians to provide treatment to VA beneficiaries by
improving the visibility of both VA and non-VA prescriptions for
controlled substance medications. VA estimates the cost associated with
implementing this section would be $361,501 in FY 2012, $1.3 million
over 5 years, and $2.4 million over 10 years.
S. 1104 ``VETERAN TRANSITION ASSISTANCE PROGRAM AUDIT
ACT OF 2011''
S. 1104 would require the Department of Labor to contract for
audits of the Transition Assistance Program. We defer to the
Departments of Labor and Defense for views on this bill.
S. 1127 CENTERS OF EXCELLENCE FOR RURAL HEALTH RESEARCH, EDUCATION, AND
CLINICAL ACTIVITIES
Section 2(a) of S. 1127 would require the Secretary to establish
and operate at least one and not more than five centers of excellence
for rural health research, education, and clinical activities through
the Director of the Office of Rural Health. These centers would be
geographically dispersed and would be established to: 1) conduct
research on the furnishing of health services in rural areas; 2)
develop specific models to be used by the Department in furnishing
health services to Veterans in rural areas; 3) provide education and
training for health care professionals of the Department on the
furnishing of health services to Veterans in rural areas; and 4)
develop and implement innovative clinical activities and systems of
care for the Department for the furnishing of health services to
Veterans in rural areas. The activities of clinical and scientific
investigation at each center would receive priority in the award of VA
funds for medical and prosthetics research to the extent that these
funds are awarded to projects for research in the care of rural
Veterans. Section 2(c) would also recognize that there are Veterans
rural health resource centers which serve as satellite offices of the
Office of Rural Health.
VA supports section 2(c), but opposes section 2(a). The Office of
Rural Health (ORH) currently supports rural program resource centers
and implements research initiatives that are largely duplicative of the
activities proposed for the Centers of Excellence. Specifically, ORH
currently funds three Veterans Rural Health Resource Centers (VRHRC).
These Centers function as field-based clinical laboratories for
demonstration projects. A number of these projects are focused on
developing models of care, as well as the implementation of innovative
clinical practices and systems of care. VRHRC staff members also serve
as rural health experts for the field. They provide training and
education to VA and non-VA service providers caring for rural Veterans.
ORH also supports VISN Rural Consultants (VRCs). In each VISN, there is
a VRC who serves as the primary interface between ORH and VISN rural
activities. The VRCs work closely with internal and external
stakeholders to introduce, implement, and evaluate ORH-funded projects.
The VRCs are also instrumental in conducting outreach to develop strong
partnerships with community members, state agencies, rural health
providers, and special interest groups. Since being established, ORH
has funded well over 500 projects across the VA health care system.
These projects cover a wide range of areas, including education, home
based primary care, long-term care, mental health, case management,
telehealth, primary care, and specialty care.
ORH is funded by Medical Services appropriations, which cannot be
used to conduct research. Rather ORH supports demonstration and pilot
projects. ORH has established partnerships within VA, namely VA Health
Services Research & Development (HSR&D), to conduct relevant rural
health research.
ORH has already committed considerable resources to implementing
and evaluating models of care in rural areas, developing and providing
education to rural providers, and developing innovative clinical
activities and systems of care. Although ORH does not conduct research,
collaborations with HSR&D have allowed for ORH to be involved in rural
health research activities. Furthermore, HSR&D currently has a very
extensive rural health portfolio including studies on access, health
disparities, and developing new models of care appropriate for rural
areas. The research findings are then shared with ORH and are used to
form rural health policies and programs. Funding the proposed Centers
of Excellence would be duplicative of activities that are already being
addressed.
If this bill provision is passed, it would be more cost effective
to add this function in our existing VRHRCs rather than to establish
three new Centers of Excellence.
VA estimates the cost of adding a research component to each of the
three existing VRHRCs to be $3 million dollars per year. However, VA
estimates the cost of establishing three new independent and separate
Centers of Excellence to be $7.5 million dollars per year.
S. 1148 ``VETERANS PROGRAMS IMPROVEMENT ACT OF 2011''
TITLE I--HOMELESS VETERANS MATTERS
Section 101
Section 101(a) would amend 38 U.S.C. 2011(a) by expanding the kinds
of projects for which grants are available to include the new
construction of facilities. Section 101(a)(3)(A) would also amend
section 2011(c) to prohibit the Secretary from denying a grant
application based only on the fact that an entity proposes to use
funding from other private or public sources, as long as a private
nonprofit organization will provide oversight and site control for the
project. Section 101(a)(3)(B) would also define the term private non-
profit organization to include a for profit limited partnership or
limited liability corporation whose managing or general partner is a
non-profit as defined under this section.
Section 101(b) would also require the Secretary to conduct a study
of the method used to make per diem payments under 38 U.S.C. 2012 and
develop an improved method for reimbursing grants under section 2011.
The Secretary would be required to submit a report of the findings
within a year after enactment of this bill.
Last, section 101(c) would amend 38 U.S.C. 2013 to increase the
amount authorized to be appropriated to $250,000,000 for FY 2012 and
each fiscal year thereafter.
VA does not support the provisions of section 101(a)(3)(B) and has
concerns about section 101(c), but supports section 101(b). Section
101(a)(3)(B) would amend the definition of private nonprofit
organization, to include a private nonprofit organization ``that has
received, or has temporary clearance to receive, tax-exempt status
under * * * section 501(c) of the Internal Revenue Code of 1986 * * *''
as well as allow additional entities to become eligible for grants
under the Grant and Per Diem (GPD) Program.
VA believes that the ``temporary clearance'' proposed in this
subsection does not adequately ensure the capability of the grant
applicant to administer federal funds. This change would void the
reason for the final determination by the Internal Revenue Service
(IRS) as to organizational suitability for nonprofit status, increasing
the risk that unsuitable grant applicants would apply for GPD projects.
Furthermore, the ``temporary clearance'' provision is not needed
because the IRS can expedite applications for tax-exempt status.
Additionally, VA does not believe section 501(c)(2) entities should
be included in the definition of a private nonprofit organization. In
general, section 501(c)(2) provides a tax-free means of managing and
protecting real estate and other assets. Inclusion of a section
501(c)(2) organization in the definition of a ``nonprofit
organization'' does not seem necessary.
VA also finds the inclusion of sections 101(a)(3)(B)(ii) and
101(a)(3)(B)(iii) unnecessary and potentially burdensome. Under the
present statute, 38 U.S.C. 2011, eligible applicants include nonprofit
organizations, state or local government agencies, or Indian tribal
governments. Additionally, IRS rules allow under the definition of
organization, limited liability corporations to apply for section
501(c)(3) status. Consequently there is no need to specifically include
limited liability companies in the statutory definition of a
``nonprofit organization.''
VA has no objection to the section 101(b)'s requirement to conduct
a study and develop a payment method under 38 U.S.C. 2011 and 2012;
however, VA proposes that Congress grant VA more than one year to
conduct the study and provide the report to Congress. Based on past
program office experience, it is generally not feasible to analyze
findings, implement changes, draft findings, and report to Congress
within one year after the date of the enactment. VA estimates the study
proposed in section 101(b) would cost approximately $300,000.
VA supports in principle raising the authorized appropriation
amounts in section 101(c) but has concerns about the proposed annual
appropriation level. VA estimates that the proposed maximum annual
authorization level of $250 million would be inadequate for this
important program after fiscal year 2015. We recommend that a specific
authorization funding level be dropped from the statute.
VA estimates that there would be no additional costs associated
with this provision as the budget through FY 2013 includes the program.
Section 102
Section 102 would amend 38 U.S.C. 2061 by expanding eligibility for
the grant program to entities eligible for grants and per diem payments
under sections 2011 and 2012 of title 38. It would also broaden the
definition of homeless Veterans with special needs to include any
Veteran who cares for minor dependents, not just women. Last, this
section would allow recipients of grants under section 2061 to use
grant amounts to provide services directly to a dependent of a homeless
Veteran if the Veteran is receiving services from the recipient.
In principle, VA supports section 102 and agrees that modifications
are needed to fully realize the potential of special needs grants
through the GPD Program. Specifically, VA has no objection to the
inclusion of subparts (a), (b), and (c) in section 102. However, VA
believes the modifications as written are insufficient to adequately
meet the needs of the special needs population presently served by the
GPD Program.
VA respectfully suggests that the Committee consider the language
in sections 303 to 305 of VA's draft bill, the ``Veterans Health Care
Act of 2011,'' which was transmitted to Congress on June 7, 2011,
relating to GPD special needs grants. These provisions would amend 38
U.S.C. 2061 and also create a new section for establishment of per diem
programs for homeless Veterans with special needs. VA considers the
language in Title III, sections 303-305 of VA's draft bill an effective
way to meet the needs of the special needs population served by GPD
Program grants.
We will provide costs associated with implementing this section as
soon as they are available. If section 102 is amended to contain the
proposed special needs amendments in sections 303 through 305 of VA's
draft bill, the costs would be $15.2 million in FY 2012, $79.9 million
over 5 years, and $217.7 million over 10 years.
Section 103
Section 103 would amend 38 U.S.C. 2031(a) by authorizing VA to
provide services listed in section 2031 to homeless Veterans,
regardless of whether such Veterans suffer from serious mental illness
(SMI). VA fully supports the draft bill language in section 103. In the
drive to end homelessness among Veterans, VA recognizes the need to
provide homeless Veterans with emergency housing, case management
services, and outreach services. Consequently, VA fully supports
removing the requirement in 38 U.S.C. 2031 that a Veteran must have a
co-occurring SMI before receiving Health Care for Homeless Veterans
(HCHV) program services.
While co-occurring disorders such as SMI have traditionally been
the markers of homelessness among Veterans and have been well
documented in relevant research, conditioning the provision of services
on the existence of SMI unnecessarily limits the scope of services to
thoroughly address the condition of homelessness.
HCHV program field experience has shown that there are many
Veterans who are homeless for reasons other than mental health-related
issues. Therefore, expanding the scope of 38 U.S.C. 2031 would allow VA
to better reach and serve Homeless Veterans.
VA estimates the cost of this section to be $3.5 million in the
first year, $19.1 million over 5 years and $42.1 million over 10 years.
Section 104
Section 104 of S. 1148 would require VA to submit to Congress a
comprehensive plan to end homelessness among Veterans. VA does not
support this provision because VA has already formulated and is
presently implementing a comprehensive strategic plan to end Veteran
homelessness. VA's Plan to End Homelessness Among Veterans Initiative
is built upon six strategies: Outreach/Education, Treatment,
Prevention, Housing/Supportive Services, Income/Employment/Benefits and
Community Partnerships. These six strategies encompass a wide continuum
of interventions and services to prevent and end homelessness among
Veterans. Homeless Veterans will benefit from the expansion of existing
program capacity and treatment services, as well as the implementation
of new programs focused on homelessness prevention and increased access
to permanent housing with supportive services. Although the provision
of safe housing is fundamental, programming will include mental health
stabilization, substance use disorder treatment services, enhancement
of independent living skills; vocational and employment services, and
assistance with permanent housing searches and placement. VA does not
anticipate any additional costs associated with implementing section
104.
Section 105
VA fully supports section 105(a) that would extend authority for
the Health Care for Homeless Veterans (HCHV) Program through
December 31, 2014. The HCHV Program, as authorized by 38 U.S.C. 2031,
allows VA to provision care and services to homeless Veterans suffering
from serious mental illness (SMI). Specifically, the HCHV Program
provides emergency housing, outreach services, and case management
services. This authority has been extended several times since
November 21, 1997. The most recent extension of this authority was from
December 31, 2006 through December 31, 2011.
As an essential component of VA's Plan to End Homelessness Among
Veterans, VA fully supports any effort to extend this important
authority.
VA also supports section 105(b) that would amend 38 U.S.C. 2033 to
extend by an additional three years until December 31, 2014, VA's
authority to expand and improve benefits to homeless Veterans. Section
2033 authorizes VA, subject to appropriations, to operate a program to
expand and improve the provision of benefits and services to homeless
Veterans. The program includes establishing sites under VA jurisdiction
to be centers for the provision of comprehensive services to homeless
Veterans (also known as Community Resource and Referral Centers
(CRRCs)). This authority has been extended several times since
November 21, 1997. The most recent extension of this authority was from
December 31, 2006 through December 31, 2011. CRRCs are an important
component of VA's Plan to End Homelessness Among Veterans, and VA fully
supports any effort to extend this authority.
VA estimates there would be no additional costs associated with
these provisions.
Subsection (c) of section 105 would extend through December 31,
2014, the Secretary's authority to enter into agreements with non-
profit organizations for the purpose of selling, leasing, or donating
homes acquired through the guaranteed loan program. VA supports this
provision. Under current law, 38 U.S.C. 2041, this authority is set to
expire on December 31, 2011. The proposed extension would allow VA to
continue using homes acquired through the guaranteed loan program to
help provide shelter to homeless Veterans.
VA estimates that enactment of section 105(c) will result in no
additional costs.
Section 105(d) would amend 38 U.S.C. 2066 to extend Congressional
authority to continue the Advisory Committee for Homeless Veterans for
an additional two years until December 30, 2013. This Committee was
Congressionally-mandated by Public Law 107-95. The mission of the
Committee is to provide advice and make recommendations to the
Secretary on issues affecting homeless Veterans and determine if VA and
other programs and services are meeting the needs of homeless Veterans.
VA has implemented many of the Committee's recommendations through
policy and regulatory changes to enhance access and services for
homeless Veterans.
The costs associated with the Advisory Committee were $114,000 in
FY 2010 and we estimate an increase in 3 to 5 percent in the additional
two years of operation for hotel room, air travel, and meeting space.
Section 106
VA supports section 106 which would re-authorize appropriations for
the Department of Labor's (DOL) Homeless Veterans Reintegration Program
(HVRP) for fiscal years 2012 and 2013. HVRP is a grant program intended
to assist homeless Veterans rejoin the workforce. Grantees provide
homeless Veterans with job training and employment placement
assistance, as well as related supportive services such as transitional
housing, transportation and referral to treatment services. In Fiscal
Year 2011, DOL used HVRP funds to restart its Incarcerated Veterans
Transition Program (IVTP), under which grantees provide HVRP services
to Veterans reentering their communities from prison or jail. HVRP
grantees conduct regular outreach to identify homeless Veterans, and
often refer them to VA for health care. Veterans ineligible for
services from the Veterans Health Administration may often be able to
access needed services through HVRP. The HVRP program, especially the
IVTP component, is therefore an extremely valuable, complementary
resource for VHA Justice Program's staff. Reauthorization will
contribute to achieving VA's Plan to End Homelessness Among Veterans.
Reauthorization would be cost-neutral for VA. VHA Justice Programs
staff coordinate with HVRP grantees and serve the Veterans they refer
to VA, but these staff are funded under separate authority.
Section 107
Section 107 would amend 38 U.S.C. 2044(e) to extend VA's authority
to provide financial assistance to entities approved to provide and
coordinate the provision of supportive services for very low-income
Veteran families occupying permanent housing to fiscal year 2012.
Section 107 would also make available $100 million from the amounts
appropriated to the Department of Medical Services to carry out section
2044. Last, this provision makes a technical amendment to correct a
grammatical error in subsection 2044(e).
Although VA fully supports the reauthorization of appropriations
for the Supportive Services for Veteran Families (SSVF) Program under
section 107, VA respectfully suggests that the Committee consider the
language in section 306 of VA's draft bill, the ``Veterans Health Care
Act of 2011,'' which was transmitted to Congress on June 7, 2011.
Section 306 would extend Congressional authority to continue the SSVF
Program permanently. Additionally, beginning in fiscal year 2014, VA
would be authorized to fund the program with the amounts deemed
necessary. This modification would give VA maximum flexibility to
redirect resources to prevention efforts as the VA's Plan to End
Homelessness Among Veterans reduces the overall number of homeless
Veterans.
The current statute authorizes funding for the SSVF Program through
the end of fiscal year 2011. However, at the current level of funding,
VA can only provide approximately 85 grants nationwide, leaving
significant areas of the country, both urban and rural, without
services.
The SSVF Program is the only VA homeless program that is national
in scope that can provide direct services to both Veterans and their
family members. Recent Community Homelessness Assessment, Local
Education and Networking Groups (CHALENG) reports indicate that
homeless and formerly homeless Veterans consider family concerns as
their highest unmet need. Additionally, homeless prevention is one of
the key strategies in eliminating Veteran homelessness. Currently,
approximately 1.3 million Veterans live in poverty. Estimates from the
2009 Annual Homelessness Assessment Report (AHAR) indicate that ten
percent of all Veterans in poverty will become homeless at some point
during the year. Prevention services are critical to reducing this
incidence of homelessness. Continued authorization of the SSVF Program
would allow VA to serve over 20,000 Veteran families in FY 2012. As the
SSVF Program is one of the cornerstones of VA's Plan to End
Homelessness Among Veterans and the Federal Strategic Plan to Prevent
and End All Homelessness, its reauthorization at levels that allow for
national access is critical to the success of both efforts.
The cost of the SSVF program is contained in the current VHA
Homeless Veteran program budgets so there are no additional cost
associated with this section.
Section 108
Pursuant to 38 U.S.C. 2061, VA makes grants for homeless Veterans
with special needs to VA health care facilities and GPD providers. The
``grants'' to GPD providers are in the form of supplemental per diem
payments for additional operating expenses not covered by per diem
payments under the GPD program. The section 2061 grant authority
expires on September 30, 2011.
Section 108 which would amend 38 U.S.C. 2061 to extend by an
additional 2 years, until December 31, 2013, VA's authority to offer
grants to health care facilities and grant and per diem providers for
the development of programs for homeless Veterans with special needs.
Veterans with special needs are those who are: women, including women
who have care of minor dependents; frail, elderly; terminally ill; or
chronically mentally ill.
VA supports section 108, however respectfully requests that the
Committee consider adopting the language found in section 303 of VA's
draft bill, the ``Veterans Health Care Act of 2011,'' which was
transmitted to Congress on June 7, 2011, which would grant permanent
authority to offer capital grants for homeless Veterans with special
needs.
VA estimates the costs associated with this section to be $5
million for the first fiscal year and $10 million over two years.
TITLE III--OTHER ADMINISTRATIVE AND BENEFITS MATTERS
Section 301
Section 301 would amend 38 U.S.C. 3704(c) to allow a Veteran's
dependent child to satisfy the occupancy requirements of VA home loans.
Currently, only a Veteran or a Veteran's spouse may satisfy the
requirement, which means that a single parent on active duty may be
prevented from obtaining a VA-guaranteed loan. The proposed change
would make it easier for those serving in the Armed Forces to use their
VA home loan benefits.
VA supports section 301, noting it is identical to section 3 of
S. 874 and substantively the same as section 301 of VA's draft bill,
the ``Veterans Benefits Programs Improvement Act of 2011,'' which was
transmitted to Congress on May 19, 2011.
VA estimates that enactment of this provision would result in
additional loan subsidy costs of $370 thousand the first year, $3.9
million over the first five years and $10.8 million over ten years.
Section 302
Section 302 would amend 38 U.S.C. 3729(c) to allow an individual to
receive a fee waiver if, during a pre-discharge program, he or she
receives a disability rating for purposes of VA compensation based on
existing medical evidence, such as service medical and treatment
records. VA supports this provision, noting that it is substantively
the same as section 304 of VA's draft bill, the ``Veterans Benefits
programs Improvement Act of 2011,'' which was transmitted to Congress
on May 19, 2011. Under current law, the loan fee may be waived if the
Veteran receives a pre-discharge rating based on a VA examination and
rating. This provision would extend the waiver to individuals rated
eligible for VA compensation based on existing evidence.
VA estimates that there would be no additional costs associated
with implementing section 302.
Section 303
Section 303 would amend 38 U.S.C. 2102A(e) by extending, through
December 31, 2021, the Secretary's authority to provide Specially
Adapted Housing assistance to eligible individuals residing temporarily
with family members. VA supports this provision, noting that it is
substantively the same as section 306 of VA's draft bill, the
``Veterans Benefits Programs Improvement Act of 2011.'' Under current
law, the authority is set to expire on December 31, 2011.
VA estimates that there would be no additional costs associated
with implementing section 303.
Section 304
Section 304 would amend 38 U.S.C. 2102A(b) to provide that amounts
of assistance payable under that section to certain individuals who
reside temporarily in housing owed by family members be adjusted on an
annual basis based on a cost-of-construction index already in effect
for other Specially Adapted Housing grants authorized under chapter 21
of title 38, United States Code. The proposal is substantively the same
as section 307 of VA's draft bill, the ``Veterans Benefits Programs
Improvement Act of 2011.'' VA supports this provision to ensure that
seriously disabled Veterans temporarily living with family members may
have continued access to residences that suit the Veterans' day to day
needs.
VA estimates that there would be no additional costs associated
with implementing section 304.
Section 305
Section 305 of S. 1148 would extend eligibility for Presidential
memorial certificates to the survivors of any Servicemember who died in
active military, naval or air service. An alternate version of this
provision was introduced in S. 874, and section 305 is identical to a
provision the Secretary proposed on May 19, 2011. VA strongly supports
enactment of this provision.
Under current law, eligibility for a Presidential memorial
certificate is limited to survivors of Veterans who were discharged
under honorable conditions. Under the statutory definition of
``Veteran'' generally applicable to title 38, United States Code, an
individual who died in active service, including an individual killed
in action, technically is not a ``Veteran'' because the individual was
not ``discharged or released'' from service. Therefore, under current
law, the survivors of such an individual are not eligible for a
Presidential memorial certificate to honor the memory of the
individual. Section 305 would authorize VA to provide a Presidential
memorial certificate to the next of kin, relatives, or friends of such
individuals, who have made the supreme sacrifice for our country, and
express our country's grateful recognition of the individual's service
in the Armed Forces. We estimate that this eligibility expansion would
result in discretionary costs of $8,924 the first year, $44,436 over
five years, and $88,416 over ten years.
Section 306
Section 306 would amend 38 U.S.C. 7105 to incorporate an automatic
waiver of the right to initial consideration of certain evidence by the
agency of original jurisdiction (AOJ). The evidence that would be
subject to the waiver is evidence that the claimant or his or her
representative submits to VA concurrently with or after filing the
substantive appeal. Such evidence would be subject to initial
consideration by the Board of Veterans' Appeals unless the appellant or
his or her representative requests in writing that the AOJ initially
consider the evidence. Such request would be required to be submitted
with the evidence. The amendment made under this provision would become
effective 180 days after enactment of this provision. Section 306 is
very similar to section 204 of VA's draft bill, the ``Veterans Benefits
Programs Improvement Act of 2011,'' which was transmitted to Congress
on May 19, 2011. VA strongly supports its enactment.
Current law precludes the Board's initial consideration of evidence
submitted in connection with a claim, unless the claimant waives the
right to initial consideration by the AOJ. Evidence must first be
considered by the AOJ in order to preserve a claimant's statutory right
under 38 U.S.C. 7104 to one review on appeal, which the Board provides
on behalf of the Secretary. The requirement that the AOJ initially
consider all evidence, unless the claimant waives the right, frequently
delays the final adjudication of claims because claimants often submit
additional evidence after perfecting their appeals to the Board by
filing a substantive appeal. Under current procedures, each time a
claimant, after filing a substantive appeal, submits more evidence
without waiving the right to initial AOJ consideration, the AOJ must
review the evidence submitted and issue a supplemental statement of the
case that addresses it. If a claimant submits relevant evidence to the
Board without waiving the right to initial AOJ consideration, the Board
must remand the claim to the AOJ for initial consideration and
preparation of a supplemental statement of the case. The effect of the
bill would not be to deprive claimants of the right to initial
consideration by the AOJ. It would permit claimants to obtain initial
consideration by the AOJ by requesting such review in writing.
The establishment of an automatic waiver would necessarily improve
the timeliness of processing appeals as a whole. Because the Board
bases its decisions on a de novo review of all the evidence of record,
many more appeals could be more quickly transferred to the Board
following the receipt of a substantive appeal. AOJs would spend less
time responding to appellants who submit additional evidence following
the filing of a substantive appeal, and the Board would avoid time-
consuming remands in cases when the appellant submits evidence directly
to the Board. By presuming a waiver of AOJ review of new evidence, the
Board would be able to adjudicate claims without the delay of a remand,
thereby getting final decisions to Veterans more quickly and reducing
the increased appellate workload caused by the reworking of remanded
claims.
We anticipate that enactment of section 306 would have no
measurable monetary costs or savings. The potential benefits that would
result from enactment of the proposal include expedited adjudication of
claims on appeal and a reduction in the time spent processing appeals,
both at AOJs and the Board, allowing more time for deciding new claims.
Section 307
Section 307 would permit VA to continue to use income information
from other agencies in making certain benefits determinations by
extending the sunset provision for using income data from the Internal
Revenue Service (IRS) and the Social Security Administration (SSA) from
September 30, 2011, to September 30, 2016, and extending the sunset
provision for using income data from the U.S. Department of Health and
Human Services (HHS) from September 30, 2011, to September 30, 2021. VA
supports this provision, noting that it is substantively the same as
sections 502 and 503 of VA's draft bill, the ``Veterans Benefits
Programs Improvement Act of 2011.'' VA estimates that enactment of
section 307 would result in a net savings of $159 million over 5 years
with respect to the IRS/SSA extension and a net savings of $13 million
over 10 years with respect to the HHS extension.
Section 308
Section 308 would permit the VA Regional Office in Manila,
Philippines, to maintain its operations until December 31, 2012.
Section 504 of VA's draft bill, the ``Veterans Benefits Programs
Improvement Act of 2011,'' which was transmitted to Congress on May 19,
2011, proposed extending to December 31, 2016, the authority to
maintain a regional office in the Philippines. Although section 308
would provide a shorter extension, VA nevertheless supports enactment.
It is more cost effective to maintain the facility in Manila than it
would be to transfer its functions and hire equivalent numbers of
employees to perform those functions on the U.S. mainland. In addition,
VA's presence in Manila significantly enhances the ability to manage
potential fraud. For these reasons, there is no increased cost
associated with this provision.
______
Response to Posthearing Questions Submitted by Hon. Patty Murray to
U.S. Department of Veterans Affairs
Question 1. S. 1148, the Veterans Programs Improvement Act of 2011,
would automatically waive agency of original jurisdiction consideration
of new evidence. How many remands and how many days from the average
appeals processing period would this automatic waiver eliminate?
Response. In fiscal year (FY) 2010, the Board of Veterans' Appeals
remanded 2,146 cases to have the Department of Veterans Affairs (VA)
regional office prepare a Supplemental Statement of the Case. We
estimate that approximately 75 percent of these remands (1,610) were
appealed claims in which the appellant submitted additional evidence to
VA but failed to waive initial review at the VA regional office level.
In FY 2010, a remand added an average of 493 days to an appeal. Thus,
VA expects that S. 1148 would therefore eliminate an average of 493
days for each case that would have otherwise been remanded to allow for
VA regional office consideration of new evidence.
Question 2. Convenient access to care continues to be a
considerable challenge for many veterans throughout this country,
particularly in rural and remote areas. While VA has taken some steps
to address these issues, more clearly needs to be done. As you know, we
have several bills on the agenda dealing with the placement of medical
facilities. I believe some further background information would be
helpful for the Committee's consideration of these bills.
a. Please describe the process the Department uses to select sites
for medical facilities, and what factors are considered or not
considered in that process?
Response. All significant VA capital investments (including the
establishment of new and/or replacement medical facilities) must be
reviewed, prioritized and approved through the Department's Strategic
Capital Investment Plan (SCIP).
The intent of the SCIP process is to provide a comprehensive and
complete picture of VA's current inventory and outline the steps needed
to enable VA to continually improve the delivery of benefits and
services to Veterans, their families and their survivors.
The SCIP plan provides a rational, data-driven strategic framework
to ensure all capital investments are focused on the most critical
infrastructure needs first and funded in priority order.
VA assesses the need for projects based on space, condition,
access, safety, and utilization/workload gaps and determines the best
methods to resolve these gaps and identified backlogs. The first step
in deciding which projects (including medical facilities) should be
chosen (and the area in which they are to be located) is to establish
the type and level of the health care services needed and their
appropriate location(s). VA's Health Care Planning Model provides data
on the projected Veteran population, demographics, utilization, and
access that assist in this determination.
In the second step, capital and non-capital solutions are developed
to meet existing and project gaps over a ten-year period. For FY 2012,
over 1,100 business cases were prioritized and considered for funding.
In the third step, these capital projects are scored by the SCIP Panel,
which is a sub-group of the SCIP Board and is comprised of
representatives from across the Department.
The SCIP Panel and Board work within the VA Governance process. The
structure of governance begins with the SCIP Board, and proceeds
through the Senior Review Group/Strategic Management Council (SRG/SMC)
to the Veterans Affairs Executive Board (VAEB), with an increasing
level of authority at each step. The SRG/SMC is chaired by the Deputy
Secretary and is comprised of senior management representatives from
across VA. The VAEB is also comprised of a cross-Departmental group of
senior VA management officials, and is chaired by the Secretary. This
governance process culminates with the selection of capital projects
for inclusion in VA's annual budget request.
The decision methodology used to score projects is the Analytic
Hierarchy Process (AHP). The AHP provides a structure, or ``model,'' to
determine which projects contribute the most to addressing Departmental
priorities. The SCIP decision model is comprised of the major criteria,
sub-criteria, and their priority weights. Each project is scored on how
well it addresses the each of the criteria.
SCIP Decision Criteria 2012 Capital Projects were ranked based on
the following six criteria:
Improving Safety and Security;
Fixing What We Have (Making the Most of Current
Infrastructure/Extending Useful Life);
Increasing Access;
Right-Sizing Inventory;
Ensure Value of Investment; and
Major Initiatives.
More information on the 2012 decision criteria and the scoring
process can be found in the FY 2012 Budget Submission, Construction and
10-Year Capital Plan, Volume 4 of 4, February 2011, which can be found
at http://www.va.gov/budget/products.asp, pages 10-3, 10-5, and 8.2-1.
The highest priority SCIP projects are submitted in the VA budget
submission. Major construction projects must be approved through the
appropriation process, and medical facilities and leases must also be
specifically authorized by law.
Once a project is authorized and funded, a site can be selected for
a major medical facility construction, or a major medical facility
lease project pursuant to 38 U.S.C. Sec. Sec. 8103-8104. The site
selection process is a joint initiative with the requirement initiated
by the Veterans Health Administration (VHA) and executed by the Office
of Acquisition, Logistics, and Construction (OALC).
For authorized and funded major medical facility leases, once VHA
has determined the need to establish a new site of care within a
defined delineated area, OALC typically follows a standard two-step
process for procuring a built-to-suit lease-based medical facility, in
situations where procuring existing space may not be practical or
feasible. Step one involves obtaining an assignable option to purchase
a suitable site, and step two is the competitive procurement of a
developer.
Step one is the site selection process, which is initiated by the
predetermined delineated area. This area is used to determine the
location parameters within which VA will seek sites. This step has an
estimated completion timeframe of 4 to 6 months. The preferred site is
competitively selected within the delineated area, by a market survey
team composed of VA employees with experience in various disciplines,
such as real property, engineering, environmental issues, and clinical
or program management. The market survey team utilizes a standard set
of evaluation criteria, including expected enhancements to Veteran
access, access to amenities, site conditions, availability of
utilities, and other factors.
During this stage, VA also negotiates with the landowner(s), based
on the appraised determination of fair market value, to reach a
proposed purchase price. Once a price is agreed upon, VA and the
landowner(s) work to execute the necessary assignable option(s) to
purchase the site. Also, as part of this stage, VA is required to
conduct certain due diligence activities including those in the areas
of real estate (title, survey, geotechnical survey and appraisal);
environmental (compliance with the National Environmental Policy Act
and Comprehensive Environmental Response, Compensation and Liability
Act); and historic preservation (Section 106 of the National Historic
Preservation Act). The option to purchase is later assigned to the
developer selected in step two.
When all due diligence requirements are satisfied, the assignable
option and all due diligence documentation become part of the
Solicitation for Offers (SFO) package in step two.
Step two is the competitive procurement of a developer to purchase
the land and build the facility to VA specifications. This step has an
estimated completion timeframe of 9 to 10 months. This process is
conducted as a best value competition in accordance with the
Competition in Contracting Act, the General Services Administration
Acquisition Regulation, the Federal Acquisition Regulation, and other
applicable laws and executive orders. Every effort is made to obtain
the greatest amount of competition during the procurement process to
ensure reasonable rental rates. VA works with an Architectural/
Engineering firm and the local users to determine the specific
technical requirements of the clinic. These requirements are made
available to the offerors in the SFO. The offerors are typically
allotted 45 days to submit their proposals to VA. Once VA receives the
offers, VA establishes a Technical Evaluation Board (TEB), which
evaluates each offer according to a set of pre-determined criteria. VA
also conducts a price evaluation. Based on these evaluations, VA
establishes a competitive range, negotiates with those offerors within
the range, and requests Final Proposal Revisions from the developers.
The TEB then reconvenes to review any new technical data received from
the developers, before the Contracting Officer determines which offer
presents the best value to the government. Once VA has selected a
developer, VA proceeds to negotiate the lease with the developer. Once
those negotiations are completed, the proposed final lease is then
vetted through internal VA elements before the lease contract is
awarded.
b. How would the passage of these bills impact the Strategic
Capital Investment Plan and the prioritization of projects in other
states?
Response. VA has an established department-wide capital investment
process in place, the SCIP, which is utilized to make methodical
decisions on construction priorities. A hallmark of the SCIP process is
its objective data-driven approach, whereby the full extent of VA's
infrastructure and its gaps in services (access, utilization, space,
condition, energy, security and IT deficiencies) are captured, and a
long-range Departmental strategy is developed to address and/or correct
the identified gaps.
SCIP addresses the Department's highest needs first, including
those that best meet Veterans infrastructure needs in priority areas
that include Veteran/patient safety and security, expansion of
Veterans' access to services, right-sizing VA's inventory, mitigating
environmental impacts, and ensuring the value of investments. All
capital projects are considered in a uniform and consistent way, which
places emphasis on improving the delivery of services and benefits to
Veterans, streamlining operations, and investing responsibly for the
future.
Through the SCIP process, VA has formulated an objective, rational,
fair, and defensible plan to meet VA's capital investment needs. To
fund projects that are not consistent with SCIP goes against this
important principle, and would require VA to fund lower priorities in
place of the Department's highest priority needs.
VA is committed to updating this plan each year, in order to
capture changes in the environment, including evolving Veteran
demographics, newly-emerging medical technology, advances in modern
health care delivery, and improvements in construction technology, all
to better serve Veterans, their families, and their survivors.
VA does not support S. 928. As written, it may not allow the
Department to utilize existing funds or bid savings to carry out FY
2012 high priority major construction projects. Under 38 U.S.C.
Sec. 8104, VA already must comply with authorization and congressional
notification requirements for its proposed major construction projects,
including where VA is proposing to obligate funds toward a major
construction project in an amount that would exceed by more than 10%,
the total project cost specified in law. Also under Section 8104, VA
must, for major construction projects, notify the Committees of
proposed changes in scope that are not consistent with the
authorization received.
VA is concerned that S. 928 as currently written may lead to
unnecessary delays caused by VA's need to have projects reauthorized
for changes that should be considered within the projects original
purpose, such as improvements in building and/or medical technologies,
and in enhanced delivery of health care to Veterans. VA would be
inclined to support a revised bill that would allow projects to move
forward without changing VA's current authorization and congressional
notification requirements.
Question 3. S. 490 would expand the eligibility of dependent
children for CHAMP-V.A. to age 26. As you know, the Health
Administration Center processes claims for CHAMP-V.A. and has had
significant backlogs in those claims when elements of the program have
been expanded in the past. What additional resources would the
Department need to process the expected increase in claims if this
legislation were enacted?
Response. VA estimates that to fulfill the requirements of S. 490,
it would need to hire approximately 65 additional staff in FY 2012 to
process applications and benefits for the larger population of
beneficiaries. These employees would require additional program
support, particularly in FY 2012 when more resources would be necessary
for the initial processing of applications and for programmatic
expansion costs. VA estimates total costs (including medical costs for
beneficiaries) for FY 2012 to be $64.59 million, for FY 2013 to be
$70.06 million, with 5 year costs of $390.51 million and 10 year costs
of $1.022 billion.
Question 4. The Department's testimony on S. 935 discussed efforts
underway to implement section 506 of the Public Law 111-163. As you
know, that section creates pilot programs on outreach in rural areas.
Please provide the Committee with an update on the Department's
implementation of the outreach pilot programs required under Section
506 of Pub. L. 111-163.
Response. VA has completed staff recruitment for this initiative
and made initial determinations on several policy issues, which have
allowed VA subject matter experts to begin drafting and reviewing a set
of regulations that will be needed to administer this program. A draft
Notice of Funding Availability is currently in development as well, and
Grant Applications and Instructions are also in development. In
addition, VA is finalizing a plan for stakeholder and consumer input
through focus groups.
Question 5. S. 1089 would introduce pay-for-performance mechanisms
into contracts of VA CBOCs.
a. Please discuss whether the pay-for-performance approach been
more or less effective in increasing quality of care than other
approaches.
Response. The scientific evidence on the impact of pay for
performance on the quality of care delivered by individual physicians
is inconclusive. To date, there is no systematic evidence that this
approach improves performance above-and-beyond other quality
improvement activities, such as report cards and audits. There are
concerns that utilizing pay for performance may incentivize physicians
to avoid caring for patients with more complex medical problems, such
as individuals with serious mental illness. There are also logistical
concerns with this approach. VA notes that few contract physicians have
seen a sufficient number of Veterans from which the Department could
establish a base for reliable metrics of quality. VA currently includes
performance requirements directly into contract requirements so that VA
makes no payment in situations where substandard care is delivered.
b. DAV testified that pay-for-performance has a mixed record of
success in both the public and private sectors. Are you aware of these
concerns, and do you share them?
Response. VA's response above addresses some of the Department's
concerns with pay for performance incentives for health care delivery
in general.
Question 6. VA identified three Vet Centers to participate in a 6-
month analysis on the potential effects instituting travel
reimbursements could have on the culture of independence and privacy
fostered by the Vet Centers.
a. Does the Department expect, or has it identified, concerns with
this pilot program?
Response. As VA noted in testimony before the Committee on June 8,
2011, VA is attempting to identify Veterans views regarding their
interest in the benefit including the potential impact this benefit
would have on the Vet Center culture and Veterans' privacy concerns, as
well as administrative issues that may develop in delivering the
benefit. These potential concerns include the provision of financial or
other information required to determine eligibility that is not
currently needed to receive Vet Center services, recording of
appointments in the electronic database of the VA medical center that
would process travel reimbursement claims, and the requirement of
eligibility determination, travel claims and subsequent payments to be
processed by the support VA medical center (VAMC). The 6 month analysis
will help the Department develop a model that can determine the upper
and lower bounds for demand for this benefit and inform a behavioral
model that can estimate potential changes in Veteran utilization of Vet
Center services. In addition, the analysis will collect Veterans views
on this subject, considerations that will be reviewed are outlined
below in greater detail.
Considerations
1. Requires Veteran enrollment at the VAMC that would process
travel reimbursement claims.
2. Requires one of the following eligibility criteria be met:
a. Rated at 30 percent or more service connection.
b. Rated at less than 30 percent service connection but
receiving care in relation to the service-connected condition.
c. In receipt of a VA pension.
d. Income at or below VA pension level.
3. Requires provision of financial or other information required to
determine eligibility that is not currently needed to receive Vet
Center services.
4. Requires record of appointments in the electronic database of
the VA medical center that would process travel reimbursement claims.
This process would be outside of the Readjustment Counseling Service
separate system of records and would not be afforded the level of
confidentiality (records released with written informed consent) of Vet
Center records.
5. Would require eligibility determination, travel claims and
subsequent payments to be processed by the support VAMC. These are
additional administrative and budgetary requirements for both the Vet
Center and support VAMC not currently present. May create challenges to
the historic streamlined nature of the Vet Center program.
6. There has been an historical increase in the number of Veteran
claimants (approximately 30 percent) and travel claims (approximately
75 percent) when the mileage rate increased. This could affect the
service availability at the Vet Centers, which have relatively small
staffing levels compared to VA medical centers and community-based
outpatient clinics.
b. If so, what are you doing to mitigate these concerns?
Response. The 6-month analysis will address these considerations,
and a report for the Under Secretary for Health will be generated that
outlines all options to address these concerns. This report is expected
to be complete by the end of November 2011.
Question 7. What is the Department doing to expedite the hiring of
chiropractors given the high number of musculoskeletal injuries coming
out of the military?
Response. Decisions on hiring chiropractors are made at the
facility level based on local needs and resources. Chiropractic care at
VA facilities may be provided through appointment of, or contracts
with, licensed chiropractors, dependent upon the needs of the facility
(consistent with Public Law 107-135, Section 204(e)(1)). In the past
two fiscal years, VHA has added 6.5 new full time equivalent employee
(FTE) chiropractors, and added five new chiropractic clinics across VA.
Timely recruitment to fill VA health care positions, particularly
recruitment of independent and dependent providers, continues to be an
important goal of the Department. To support this goal, VA has
sponsored a national learning Systems Redesign Collaborative on Human
Resources Recruitment, over the past two fiscal years, which is
systematically analyzing the recruitment process and identifying
barriers to timely actions. This will result in shorter hiring
timelines for our health care occupations, including chiropractors.
Question 8. When VA decides to contract for case management
services for homeless veterans in the HUD-VASH program, what role--if
any--do community providers have in the discussion? If none, what would
be an appropriate role for them in the HUD-VASH process?
Response. VA bases the decision to contract for case management
services for homeless Veterans in the Department of Housing and Urban
Development-VA Supported Housing (HUD-VASH) program on several need-
based factors, including: whether there is a need to enhance
collaboration with community providers in delivering more comprehensive
and integrated services; and whether there is a need to offer
specialized services, such as housing location and placement, that are
already available in the local community and can promote more timely
access to permanent housing. In order to accurately determine these
need-based factors, VA Homeless Program staff and HUD-VASH case
managers are actively involved in the local Continuums of Care,
Homeless Summits held by each VA medical center and other community
partners. This collaboration allows VA staff to discuss community and
homeless Veteran needs and possible solutions, including whether
contract case management services are needed. Through these
discussions, community partners play a role in determining whether VA
should contract for case management services.
______
Response to Posthearing Questions Submitted by Hon. Richard Burr to
U.S. Department of Veterans Affairs
Question 1. In written testimony for the June 8, 2011, legislative
hearing, the Department of Veterans Affairs (VA) estimated that
enactment of S. 423 (which would allow up to a one-year retroactive
effective date for fully-developed claims) would ``result in benefit
costs of $54.9 million for FY 2012, $315.7 million over five years, and
$761.7 million over ten years.'' However, in October 2010, with regard
to identical legislation, VA stated that ``[w]e cannot estimate costs
without knowing how many fully-developed claims would be submitted and
the disability ratings awarded to these Veterans.''
a. In light of VA's 2010 statements, please explain how it was
possible to determine specific cost estimates in 2011.
Response. Each piece of proposed legislation is read and evaluated
to determine a plausible method of cost estimation. We build
assumptions that are based on program knowledge and actual experience.
Public Law 110-389 established the pilot program on expedited treatment
for fully developed claims (FDC). The pilot program was implemented in
10 VA regional offices nationwide in May 2010 and ended in
December 2010. When legislation identical to S. 423 was proposed during
the 111th Congress, the FDC pilot program was ongoing.
After reviewing S. 423, VBA determined there was applicable data
gathered from the FDC pilot program. Along with this data, VBA used
program judgment to determine caseload that allowed an adequate
estimate of potential costs associated with this legislation.
b. In developing the 2011 cost estimate, how many fully-developed
claims per year did VA assume would be filed and what was the basis for
that assumption?
Response. The estimated total number of fully developed claims in
FY 2011 is 17,756. Based on actual experience and program judgment,
approximately 2 percent of total workload presents as a fully developed
claim. Of those FDCs, 59 percent and 24 percent are reopened and
original claims, respectively. These percentages are based on the
percent of original and reopened claims that make up the compensation
program's total workload. Of those worked, it also assumed that 75
percent would result in a grant of benefits to Veterans. A similar
methodology was used to calculate the number of FDCs in the outyears
with the assumption that the number of FDC claims would increase by
five percent each year as more people became aware of the increased
benefits associated with filing FDC under this proposed bill.
c. In developing the 2011 cost estimate, what disability ratings
did VA assume would be awarded and what was the basis for that
assumption?
Response. The average combined degree of disability is 40 percent
for Veterans compensation, and was used to generate total obligations
for the original FDCs. We assumed reopened claims would increase by an
average of 10 percent.
d. In developing the 2011 cost estimate, how many months of
retroactive benefits did VA assume would be awarded for fully-developed
claims and what was the basis for that assumption?
Response. In developing the cost estimate, the monthly payment was
annualized to calculate the total obligations assuming Veterans would
receive a retroactive payment award for a 12-month period.
Question 2. The Caring for Camp Lejeune Veterans Act of 2011
(S. 277) would provide health care for veterans and their families who
may have been affected by the contaminants in the water while living on
Camp Lejeune. In testimony submitted to this Committee on June 8, 2011,
VA stated that the cost of implementing S. 277 would be $1.6 billion
over five years and $3.9 billion over ten years.
a. In general, please explain the metrics used in developing this
cost estimate.
Response. VA estimated that 500,000 Veterans would be eligible for
benefits under this program and that 500,000 family members would also
be eligible, based upon data from the Agency for Toxic Substances and
Disease Registry (ATSDR). Veterans meeting the criteria in the
legislation would be placed in Enrollment Priority Group 6 in a manner
similar to other special eligibility populations (recent Combat
Veterans, etc.). VA would need to establish a separate program to
provide care to family members eligible for benefits under this
authority. The family program design would be delivered in a manner
similar to the Spina Bifida Health Care Program for Children of Certain
Vietnam and Korean Veterans.
VA assumed that 25,000 family members would become beneficiaries
under this program. VA would need to hire an additional 50 full time
employees (FTE) to support the program based on a ratio of 1 FTE for
every 500 eligible beneficiaries. VA estimated a one percent annual
increase in the patient population; this is a conservative estimate
because the qualifying medical conditions have not been scientifically
established. VA estimated that medical costs per family member would
exceed the existing costs of beneficiaries participating in the
Civilian Health and Medical Program of the Department of Veterans
Affairs (CHAMPVA), but would be less than the medical costs for
beneficiaries under the Spina Bifida program described above. The
average annual cost of medical care per beneficiary is estimated to
fall somewhere between these programs because we assume beneficiaries
under S. 277 would require additional medical care as a result of a
covered condition. VA utilized an inflation rate of 5.3 percent
annually for medical costs for family members.
Based on VA population and enrollment data, VA assumed that
approximately 23 percent of Veterans nationally are users of VA health
care and that a similar proportion of the Camp Lejeune population would
be as well. This results in an estimated population of approximately
110,000 likely current users within the Camp Lejeune population. Based
on the current population of Priority Group 7 and 8 Veterans, VA
estimated that 29,700 of these Veterans are currently in Priority
Groups 7 or 8. If S. 277 became law, these Veterans would be moved into
at least Priority Group 6, resulting in the loss of copayments and
third party collections. VA also assumed that approximately five
percent of Veterans who were not previously eligible to enroll would be
able to do so under this new authority. VA estimated this population
would be 5,931 Veterans in FY 2012. VA's cost estimate included both
the revenue loss of Veterans no longer making copayments for care and
VA no longer securing third party reimbursement for care, as well as
from additional costs to provide currently non-qualifying Veterans with
care. VA conservatively estimated a one percent increase in workload
each year for this population.
b. How many veterans and family members did VA assume lived or
worked at Camp Lejeune during the contamination period?
Response. As noted in the previous response, VA estimates 500,000
Veterans would be eligible and 500,000 family members would be eligible
for this program.
c. How many veterans and family members did VA assume would receive
health care under this bill and what is the basis for that assumption?
Response. As noted in the response to Question 2(A), VA assumed
25,000 family members and 5,931 Veterans would be beneficiaries under
this program in FY 2012. VA also assumed 30,297 Veterans would move
from Priority Groups 7 or 8 into a Priority Group that would not allow
VA to collect revenue from third party sources.
Question 3. As requested at the hearing, please explain how much VA
spends on veteran outreach annually.
Response. VA created the National Outreach Office within the Office
of Public and Intergovernmental Affairs (OPIA) in FY 2010 to
standardize how outreach is being conducted throughout VA. While we are
not currently able to extract the total spending for outreach across
the department for FY 2010 and 2011, we are working diligently toward
that goal for FY 2012. VA has made considerable progress in researching
and analyzing VA's outreach programs and activities and have developed
a framework to guide us through creating a more efficient and effective
approach to conducting outreach department-wide, in support of VA's
major initiatives. Key to the final plan is building a process that
helps VA's administrations (Veterans Health Administration, Veterans
Benefits Administration and National Cemetery Administration) and
program offices:
Provide Veterans with high-quality products and activities
that are consistent;
Provide outreach coordinators with training;
Evaluate and measure the effectiveness of outreach
programs; and
Track costs associated with outreach programs.
Question 4. Section 103 of S. 1148, the ``Veterans Programs
Improvement Act of 2011,'' would expand the authority to contract
treatment and rehabilitation services under section 2031 of title 38,
United States Code, to include homeless veterans who are not seriously
mentally ill.
a. Under the current authority, please provide the number of
contract beds per Veterans Integrated Service Network (VISN).
Response. The table below provides the requested information for
each Veterans Integrated Service Network's contracted beds for the
Health Care for Homeless Veterans (HCHV) program, emergency housing,
and Safe Haven program.
----------------------------------------------------------------------------------------------------------------
VISN HCHV Emergency Housing Safe Haven Total
----------------------------------------------------------------------------------------------------------------
1............................... 29 26 0 55
2............................... 6 41 0 47
3............................... 93 40 40 173
4............................... 54 19 0 73
5............................... 16 40 0 48
6............................... 39 20 0 59
7............................... 140 20 0 160
8............................... 101 74 20 195
9............................... 39 0 0 39
10.............................. 6 48 0 54
11.............................. 109 73 0 182
12.............................. 82 0 0 82
15.............................. 97 47 0 144
16.............................. 214 36 0 246
17.............................. 95 0 0 95
18.............................. 31 86 0 117
19.............................. 93 93 0 186
20.............................. 17 20 0 37
21.............................. 107 86 0 193
22.............................. 27 17 0 44
23.............................. 26 30 0 56
----------------------------------------------------------------------------------------------------------------
b. Please provide a breakdown of contract beds available to each VA
medical center within VISN 6.
Response. The table below provides the requested information for
VISN 6, using the same conditions as described above.
----------------------------------------------------------------------------------------------------------------
Facility HCHV Emergency Housing Safe Haven Total
----------------------------------------------------------------------------------------------------------------
Asheville....................... 0 0 0 0
Beckley......................... 0 5 0 5
Durham.......................... 0 0 0 0
Fayetteville.................... 0 0 0 0
Hampton......................... 4 0 0 4
Richmond........................ 5 0 0 5
Salem........................... 15 0 0 15
Salisbury....................... 15 15 0 30
----------------------------------------------------------------------------------------------------------------
Question 5. The Government Accountability Office (GAO) has found
duplication, fragmentation, and overlap in Federal programs government
wide. GAO has also advised that reducing or eliminating overlap could
help agencies provide better services and save billions of dollars each
year.
Please provide a joint assessment of whether there is any
duplication among the veterans' programs administered by VA and the
Department of Labor and, if so, how it could be addressed.
Response. VA and the Department of Labor (DOL) provide services to
Veterans to improve employment outcomes for our Nation's Veterans
through the VA Education and VA Vocational Rehabilitation and
Employment (VR&E) programs and the DOL Veterans Employment and Training
(DOLVETS) program. Services provided by each of these programs
complement one another, maximizing service delivery to Veterans.
VR&E works with DOLVETS under a Memorandum of Understanding to
provide individualized, face-to-face services to Veterans with
disabilities. While VR&E's primary focus is disabled Veterans, DOLVETS
provides employment assistance services to all Veterans.
DOLVETS and VR&E adopted a team approach to job development and
placement activities, in which all Veterans entering a program of
vocational rehabilitation are informed of the employment assistance
available through the DOLVETS programs and are encouraged to register
with their State Workforce Agency. VR&E collaborates with the DOLVETS
Disabled Veterans Outreach Program (DVOP) Specialists and Local
Veterans' Employment Representatives (LVER) on the following services:
apprenticeship and on-the-job training programs, job referrals, work-
specific prosthetic devices, sensory aids, and other special equipment,
communication with community leaders and resources, and counseling and
testing services. Although the services that VA's VR&E and DOLVETS
provide Veterans have some similarities, working together maximizes the
employment services available to Veterans and increases the
opportunities for successful employment. VA's 87 employment
coordinators are VR&E's liaisons to the DOLVETS Specialists in their
respective jurisdictions, and they ensure seamless service delivery.
VA's Education programs provide payments for eligible students
pursuing college, apprenticeship programs, on-the-job training, and
vocational training programs. VR&E has authority to provide similar
benefits for disabled Veterans, but VR&E provides individually-tailored
services that include case management support, specialized assistance,
equipment, and accommodations.
In 2007, the Government Accountability Office issued a report
titled, ``VA Student Financial Aid: Actions Needed to Reduce Overlap in
Approval Activities.'' The report stated that, ``Many education and
training programs approved by state approving agencies have also been
approved by Education and Labor.'' However, Pub. L. 111-377, which
modifies the Post-9/11 GI Bill and other education benefit programs,
allows VA to accept registered apprenticeships for VA benefits without
additional reviews from state approving agencies. Based on that
legislation, VA believes any potential overlap pertaining to program
approval of VA education benefits has been addressed. VA will continue
to coordinate our programs with DOL to ensure effective and efficient
operation of these important programs.
Chairman Murray. Thank you very much.
Mr. McWilliam?
STATEMENT OF JOHN MCWILLIAM, DEPUTY ASSISTANT SECRETARY,
VETERANS' EMPLOYMENT AND TRAINING SERVICE, U.S. DEPARTMENT OF
LABOR
Mr. McWilliam. Chairman Murray, Ranking Member Burr, I am
pleased to appear today before the Committee to discuss
legislation pending in this Committee aimed at helping our
transitioning servicemembers and returning servicemembers
transition back to civilian life. I would like to comment on
two bills.
S. 951, Hiring Heroes Act of 2011. Section 11 would require
mandatory participation in the Transition Assistance Program.
We believe that all transitioning servicemembers who plan to
enter civilian employment would benefit from attending the DOL
employment workshop, but defer to the Department of Defense on
whether the program should be mandatory for all transitioning
servicemembers.
DOL supports the concept of the TAP follow-up contained in
Section 7, but believes that the metrics of our redesigned
employment workshop will make this requirement unnecessary. As
part of the redesign, a comprehensive follow-up program will be
implemented to track participants' success in entering the
civilian workforce. We believe that this program may provide
the information that the Committee desires, and we would like
to work with the Committee to provide additional information on
our initiative.
DOL believes that Section 8, the Competitive Grant Program
for Nonprofit Organizations, is unnecessary. We note that this
section seems to closely follow the parameters of the existing
Veterans' Workforce Investment Program. It is unclear whether
the intent of this section differs from the intent of the
Veterans Workforce Investment Program, or VWIP. Therefore, we
would like to work with the Committee to discuss the potential
overlap between these two areas.
DOL believes that Section 9, concerning identifying the
equivalencies between military occupational specialties and
civilian employment, duplicates existing processes that
currently provide the capability to crosswalk servicemember
skills to equivalent civilian occupations. We note that there
are several tools that allow the servicemember to do that, as
well as the redesign of the TAP employment workshop, which will
include practical exercises to assist participants in
translating their skills, as well as creating an Individual
Transition Plan.
The Department supports Section 11 but requests that the
time period be changed from 105 days to 15 weeks to coincide
with the end of a benefit week for the purposes of unemployment
compensation.
DOL supports the concept of Section 13 and believes the
credentialing and licensure of veterans is very helpful in
transitioning servicemembers to the civilian sector. We would
like to work with the Committee to help resolve the issues that
are existent in credentialing and licensure of veterans.
Addressing S. 1060, Honoring All Veterans Act of 2011, we
defer to the VA and the DOD for most sections of this bill, but
we point out that we believe Section 105 is unnecessary. The
Department created the America's Heroes at Work Program in 2008
to fulfill this need. We would propose to work with the
Committee to determine if our program needs further
enhancements.
I again thank the Committee for your commitment to our
Nation's veterans and for the opportunity to testify before you
today. We would be happy to work with your staffs to provide
technical assistance on any of these bills, and I would be
happy to respond to any questions.
[The prepared statement of Mr. McWilliam follows:]
Prepared Statement of John McWilliam, Deputy Assistant Secretary,
Veterans' Employment and Training Service, U.S. Department of Labor
Chairman Murray, Ranking Member Burr, and distinguished Members of
the Committee, I am pleased to appear before you today to discuss
legislation pending in this Committee aimed at helping our returning
Servicemembers transition back to civilian life.
The Veterans' Employment and Training Service (VETS) proudly serves
Veterans and transitioning Servicemembers by providing resources and
expertise to assist and prepare them to obtain meaningful careers,
maximize their employment opportunities and protect their employment
rights.
Secretary Solis has been an incredible source of guidance and
support, and has made Veterans and VETS one of her top priorities. Our
programs are an integral part of Secretary Solis's vision of ``Good
Jobs for Everyone'' and her unwavering commitment to help Veterans and
their families get into the middle class and maintain stability. We
strive to achieve this vision through four main programs:
Jobs for Veterans State Grants;
Transition Assistance Program Employment Workshops;
Homeless Veterans' Reintegration Programs; and
Uniformed Services Employment and Reemployment Rights Act.
Your letter of invitation seeks input on a significant number of
bills at this hearing, and you ask VETS to specifically provide input
on S. 951, the ``Hiring Heroes Act of 2011.'' We have done so in
subsequent portions of this testimony, in addition to providing
comments on the proposed ``Honoring All Veterans Act of 2011,'' which
would require the Department of Labor (DOL), through the Assistant
Secretary of the Office of Disability Employment Policy (ODEP), to
initiate a program providing technical assistance to employers of
Veterans who have a Traumatic Brain Injury or Post Traumatic Stress
Disorder.
As the remaining pieces of proposed legislation being addressed at
this hearing fall under the purview of other departments, VETS defers
to those departments and I will restrict my testimony to the
appropriate sections of S. 951, and the ``Honoring All Veterans Act of
2011'' that have a direct impact on DOL and the Veterans' Employment
and Training Service.
In addition to the invitation for today's hearing, VETS has
received a follow-up request to comment on Senator Casey's proposed
``Veteran Transition Assistance Program Audit Act of 2011.'' Due to
time constraints, VETS was unable to conduct a thorough review in time
for today's hearing, but we look forward to providing our comments for
the record and continuing to work with Senator Casey and this entire
Committee to ensure that our Servicemembers receive the best assistance
possible as they transition back to civilian life.
S. 951: ``HIRING HEROES ACT OF 2011''
Section 6: This section would require the mandatory participation
of members of the Armed Forces in the Transition Assistance Program
(TAP). We assume that this mandatory participation would include
participation in all segments of the TAP, to include the Department's
Employment Workshop.
We believe that all transitioning Servicemembers who plan to enter
civilian employment would benefit from attending the Employment
Workshop, but defer to the Department of Defense (DOD) as to whether
this program should be mandatory for all transitioning Servicemembers.
Section 7: This section would require DOL to follow-up on the
employment status of members of the Armed Forces who recently
participated in TAP. In particular, it would require that DOL contact
each participating Veteran no later than six months after their
completion of the program (TAP), and every three months thereafter for
the rest of the year in order to ascertain the Veteran's employment
status.
DOL supports the concept of the TAP follow-up, but believes that
the metrics of our redesigned Employment Workshop makes this
requirement unnecessary. As you may recall, we recently testified on
our current initiative to redesign and transform the Employment
Workshop. As part of this initiative, a comprehensive follow-up program
will be implemented to track participants' success entering the
civilian workforce. DOL believes that this program may provide the
information that the Committee desires, and we would like to work with
the Committee to provide additional information on this initiative.
Section 8: This section would: 1) establish a competitive grant
program for nonprofit organizations that provide mentoring and training
to Veterans; 2) require DOL and nonprofit organizations to collaborate
in order to facilitate the placement of Veterans in jobs that lead to
economic self-sufficiency; 3) require DOL to conduct an assessment of
grant performance no later than 18 months after enactment; and 4)
authorize appropriations of $4.5 million for Fiscal Years 2012 and
2013.
DOL believes that this section is unnecessary. We note that this
section seems to closely follow the parameters of the existing
Veterans' Workforce Investment Program (VWIP) established under section
168 of the Workforce Investment Act of 1998, and it is unclear whether
the intent of this section differs from the intent of the VWIP.
Therefore, we would like to work with the Committee to discuss the
potential overlap between this section and the VWIP.
Section 9: Among other things, this section would require DOL, DOD,
and the Department of Veterans Affairs (VA) to conduct a joint study to
identify any equivalences between the skills developed by members of
the Armed Forces through various military occupational specialties
(MOS) and the qualifications required for various positions of civilian
employment in the private sector.
Section 9 is unnecessary as it duplicates existing processes that
provide the capability to crosswalk Servicemember skills to equivalent
civilian occupations. We note that there are several tools that
partially meet the need for skill equivalencies for separating
Servicemembers, such as the Department's Occupational Information
Network (O*NET) and DOD's Credentialing Opportunities On-Line (COOL).
In addition, the TAP redesign will include practical exercises to
assist participants in translating their skills, abilities, experience,
and training on to a resume, as well as creating an Individual
Transition Plan. We would like to work with the Committee to explore
ways to strengthen these resources and improve the transition of
Veterans into civilian employment.
Section 11: This section would require the Department to conduct
outreach to recently-separated Veterans in receipt of unemployment
compensation for longer than 105 days in order to provide employment
assistance.
The Department supports this section, but requests that the time
period be changed from 105 days to 15 weeks to coincide with the end of
a benefit week for the purposes of Unemployment Compensation.
Section 13: This section would reauthorize and modify the
demonstration program for the credentialing and licensure of Veterans
contained in 38 U.S.C. 4114.
DOL supports the concept of this section and believes that the
credentialing and licensing of Veterans will be helpful in
transitioning Servicemembers into the civilian sector, but there
continue to be serious implementation issues with this provision. In
particular, licensure and credentialing is mostly a function of the
individual States, and to facilitate credentialing and licensure for
Veterans, the demonstration project would require DOD to align its
military training and assessments to more closely match States'
civilian licensing requirements. We also note that credentialing and
licensure requirements differ from State to State. We would like to
work with the Committee to help resolve these issues so that the
credentialing and licensure of Veterans can be more successfully
implemented.
DRAFT BILL: ``HONORING ALL VETERANS ACT OF 2011''
The stated purpose of this bill is to: ``improve education,
employment, independent living services, and health care for veterans,
to improve assistance for homeless veterans, and to improve the
administration of the Department of Veterans Affairs, and for other
purposes.'' Accordingly, we defer to VA and DOD for most of the
sections of the bill.
Section 105: This section would require the Secretary of Labor,
through the Assistant Secretary for the Office of Disability Employment
Policy, to initiate a program to provide technical assistance to
prospective employers, employers of covered Veterans and entities in
the workforce system to assist Veterans who have Traumatic Brain Injury
or Post Traumatic Stress Disorder in the area of employment.
DOL believes that this section is unnecessary. ODEP, in cooperation
with VETS, created the America's Heroes at Work (AHAW) program in 2008
to fulfill this need. We are currently in the process of transitioning
the leadership and funding for this program to our office, and propose
to work with the Committee to determine if AHAW needs further
enhancements.
CONCLUSION
We are reminded everyday of the tremendous sacrifices made by our
Veterans, Servicemembers and their families. Secretary Solis and the
Veterans' Employment and Training Service believe that America must
honor those sacrifices by providing the Nation's bravest with the best
possible programs and services that we have to offer. We look forward
to continuing our work with this Committee to do just that.
I again thank this Committee for your commitment to our Nation's
Veterans and for the opportunity to testify before you. We would be
happy to work with your staffs to provide technical assistance on any
of these or future bills, and I would be happy to respond to any
questions.
Chairman Murray. Thank you very much.
Mr. McWilliam, let me begin the questions with you. I note
that the Administration opposed several provisions in the
Hiring Heroes Act, and the goal of this legislation is to make
sure that our men and women in uniform really capitalize on
their service. The American people have invested a great deal
of money in training for these men and women as they go to
service, and we want to make sure that we get a benefit from
that and that.
Today we have an unemployment rate of 27 percent among our
veterans who are coming home from Iraq and Afghanistan, and I
think it is most telling to remind all of us that the Army
alone, just the Army, is paying out nearly $1 billion in
unemployment benefits every year. That is $1 billion because
these men and women are not at work. And we continue to hear
all the time from veterans who do not have the job support they
need when they leave the service.
So doing nothing is not the right approach, and I wanted to
ask you today what you propose.
Mr. McWilliam. Madam Chair, we believe that the redesigned
Transition Assistance Program is the real keystone to assisting
people as they leave the service. Our Assistant Secretary has
testified before this Committee in the past on the parameters
of that. We believe that the restructured and reengineered
program has great strengths in it that will allow transitioning
servicemembers to identify the skills that they need and how to
translate their skills, their military skills, into civilian
skills.
One of the really key unique aspects of that is the
Individual Transition Plan where each individual participant
will write out a plan to get them to their goals in moving to
that. We believe there are many tools currently available that
assist people in identifying that translation between skills,
both into the civilian workforce and into the Federal
workforce, and our program will strengthen the participants'
ability to take advantage of those.
Chairman Murray. I want to come back and ask you more
explicitly about that, but before I do, I want to turn to Dr.
Jesse, because recent work by the GAO uncovered some very
disturbing information about sexual assaults among veterans in
inpatient mental health and other programs. It is unacceptable
that our veterans, especially our most vulnerable veterans,
under the Department's supervision cannot be kept safe, and I
am very concerned that the VA police failed to inform
leadership about these many allegations.
I wanted to ask you today to tell us what is going on out
there and what VA is doing to address this situation to make
sure that our veterans are safe.
Dr. Jesse. Yes, ma'am. VA does take patient and employee
safety very seriously. Since General Shinseki was sworn in as
the Secretary, he has constantly reminded us that we have two
responsibilities: to accomplish the mission and to take care of
the people. And much of the Secretary's agenda has centered
around the safety of both veterans and employees.
One of the first things he did was to stand up the Office
of Security and Preparedness under Assistant Secretary Riojas,
which includes operationalizing in 2009 the Integrated
Operating Center, which gets reports from all of--aggregates
reports from all of the police departments at the VA and
provides the Secretary frequent briefings on what indeed is
going on. And we take any of these allegations very seriously.
We investigate them very seriously.
So we are in the process now of reviewing the GAO's
recommendations, and particularly where they have identified
critical areas where they point out that we may have issues for
improvement.
We also have in 2010, I believe, March 2010, issued VA
Directive 2010-014, I believe, which assigns a responsibility
to emergency departments in the VA for the appropriate
management of veterans who present with alleged sexual assault
to ensure that they get sensitive and appropriate treatment,
including treatment that meets all the standards that would
protect their legal rights. We think that was a very important
component of bringing this in place.
We will take steps to expand and improve our reporting of
allegations. We have two processes, as I mentioned: the IOC and
also Issue Brief process that comes up through the medical
centers themselves. I think we need to reconcile and make sure
that we have got coherence and clarity from both of those
directions. But the bottom line is that we do have a
responsibility to protect our veterans and to protect our
employees. And just as the veterans have protected us, we would
take that responsibility very seriously. I know we have
discussions next week to go into this in depth.
Chairman Murray. Well, this Committee is going to be
following this very closely because it is very disturbing, and
it is hard to believe that senior leaders in those facilities
did not know what was going on. The breakdown in communication
is a serious issue. You addressed it for a second there. But
just that these were happening and people did not feel safe
enough to tell people about it or follow up on it or report it
is extremely disturbing. So, Dr. Jesse, we want to keep this
conversation going, and we expect it to be followed by the VA.
Dr. Jesse. Yes, ma'am.
Chairman Murray. Mr. McWilliam, I want to return to you.
You talked about redesign of the TAP program. That actually
will work very well with our legislation, and I appreciate
that. But we have been waiting a long time for a redesign. When
do you expect to revamp TAP?
Mr. McWilliam. Madam Chair, our deadline, our objective is
to have this in place by this November, Veterans Day, to have
it in place worldwide and being taught at that point.
Chairman Murray. OK. November of this year.
Mr. McWilliam. Yes, ma'am.
Chairman Murray. All right. Well, as you know, DOD is
opposed to mandatory TAP, and you stated that all transitioning
servicemembers who plan to enter civilian employment would
benefit from attending the employment workshop. So how do you
explain the disconnect between the two agencies?
Mr. McWilliam. Madam Chair, I prefer not to speak on behalf
of the Department of Defense, but I believe it is the
definition of all members of the Armed Forces. I believe that
is their issue. And the mandatory issue perhaps includes people
such as people who are retiring who are not going into
employment, who are just strictly retiring. I believe their
concerns have to do with the demobilizing Guard and the Reserve
and the ability to bring them back for a full 2\1/2\-day
employment workshop.
Chairman Murray. OK. We will be following up with them as
well.
Senator Burr?
Senator Burr. Madam Chairman, we have got so much that
really does not pertain to the bills that we are here to talk
about that we could spend a day with just the VA alone.
Mr. Cardarelli and Dr. Jesse, I want to at least
acknowledge the fact that both of you apologized for not having
testimony here on time. I will note I did not hear either one
of you say this will not happen again. Now, we have rules in
the Committee, and I might say, Mr. McWilliam, I did not even
hear you apologize.
This may be a joke to some of you. I do not know. Maybe it
is the instructions not to have it here to where Committee
Members can thoroughly go through and dissect what an agency
says. Many of the bills we do not have views on. It is
impossible for me to believe that pieces of legislation that
have been introduced for some time you have no views on, that
you have no cost estimates on. It raises big questions when you
take lightly Committee rules about when testimony needs to be
here.
I guess I should not be bewildered that we cannot hit
deadlines that are statutory for claims processing or for other
things when there is no sense of a deadline being anything
other than a goal.
Now, the Chairman raised an issue I was not going to raise,
but I will chime in on it, and that is the GAO report. And let
me assure our VA witnesses, we will spend many hearings on
this. Let me just read to you the chart out of the GAO report.
In 2010, 14 rapes, 44 inappropriate touches, 3 forced
medical examinations, 5 forced inappropriate oral sex.
In 2009, 23 rapes, 66 inappropriate touches, 3 forceful
medical examinations, 3 forceful or inappropriate oral sex, 9
other.
Now, that is just since we set up a new center, and of the
67 rape allegations that were listed in 2007, 2008, 2009, and
2010, only 25 were sent to the Office of the Inspector General.
Of the 67 rape allegations, only 25 were referred to the Office
of the Inspector General. There is a breakdown that is
tremendous. I cannot imagine any company in America not
referring to their counsel or to outside counsel an allegation
by an employee or a customer of sexual charges. But it seems
like this is just another piece of business at the VA.
Let me assure you that I, and I believe the Chairman, will
raise this to the highest level. I have absolute confidence
that we will explore this in great detail.
Let me turn to our VA witnesses. In your testimony on my
bill, S. 277, Caring for Camp Lejeune Veterans Act, you
indicated the number of veterans and their families affected by
water contamination to be 1 million. In a preliminary cost
estimate provided to me by CBO, they put the number of affected
veterans at 650,000. CBO arrived at this number with
information provided to them by the Department of Defense on
the number of military personnel family members who lived at
Camp Lejeune during the affected period.
Can you describe the matrix that you used to identify 1
million affected veterans and family members?
Mr. Hall. Sir, I think our testimony reflects that we do
not have good numbers. We do not have numbers that we could use
to estimate the cost.
Senator Burr. Well, VA has estimated the cost in the past.
That is what drew the conclusion, I think, that they came to.
But can you account for the discrepancy in the two numbers?
That is 350,000 people.
Mr. Hall. No, sir, I cannot.
Senator Burr. OK. Mr. McWilliam, the TAP program is
currently undergoing a redesign, as you mentioned, with the
goal of rolling the new program out by Veterans Day. In your
testimony you indicated that the new TAP program will include a
comprehensive follow-up plan to track the progress of veterans
who took TAP while in the military.
Now, let me ask you, could you detail for us the
comprehensive follow-up plan?
Mr. McWilliam. Yes, sir. The plan is to collect metrics on
how well the program assisted the participant in entering
civilian employment. We plan to do it at three times--three
moments of truth--the first being when the person completes the
program while they are still in the military; the second being
while they are in job search mode looking for employment; and
then the third one being shortly after they enter employment
and have become a member of a civilian organization.
Senator Burr. Do these metrics check anything other than
the participant satisfaction?
Mr. McWilliam. Sir, it is supposed to look at satisfaction
and what portions of the program assisted them or what
additional parts of the program they would need to have done
better on their job search or to have done the on-boarding and
to become a new member of an organization.
Senator Burr. How long do you think it will take to collect
enough data to gauge the effectiveness and outcomes of the
redesigned TAP?
Mr. McWilliam. Sir, I do not know that I can put a
timeframe on that now. We plan to start doing this as soon as
we start teaching the new TAP. So I am assuming that during the
next fiscal year that we will begin gathering the data.
Senator Burr. OK. Mr. Cardarelli, as you know, I have a
bill on the agenda that would allow veterans with fully
developed claims to receive benefits for up to 1 year before
those claims are filed. Now, last year, the VA provided these
views on a very similar piece of legislation, ``The
availability of a retroactive effective date for an award of
disability compensation granted on a claim fully developed when
submitted would create an incentive for veterans to file fully
developed claims. Submission of more fully developed claims
would free up resources at VA regional offices to address the
claims backlog.''
Now, I will be honest with you. I am going to use the
testimony as my own words as to why people should vote for this
bill. I think the VA has made the greatest, simplest claim as
to why this bill ought to become law. So let me ask you: what
percentage of claims are now fully developed when submitted to
the VA?
Mr. Cardarelli. Right. Yes, sir. I appreciate your comments
about the backlog. I want to reassure you that the leadership--
my job--we live and breathe the backlog every day. We have many
initiatives, as you know, that we have put in place--some short
term, some very long term. We have some technology issues we
are doing. We are doing business processes.
One of the things is what we call a fully developed claim,
a program that we have where basically we incentivize sort of
along the lines of what you talked about, that if your case
comes complete to us, we will process it within 90 days, an
incentive modeled after the idea of a tax--if you complete your
tax----
Senator Burr. So how many fully developed claims do you
get?
Mr. Cardarelli. We have had less than 1 percent, so we put
into play----
Senator Burr. Working?
Mr. Cardarelli. Working. And what we realized----
Senator Burr. Is it working?
Mr. Cardarelli. Yes, sir. So what we realized----
Senator Burr. Is it working like you thought it would?
Mr. Cardarelli. Oh, no, sir. And so what happened is, as we
put it into use, we realized that one of the things that it
lacked was outreach to the veterans, making sure that they were
aware of this program, us reaching out to them. So we realized
we have an initiative, and what we want to do is make sure--
what we do not want to do is get inundated with so many that we
are working so many that we cannot focus. But we started with
this initiative, and then we realized as we started to assess
it, we were not getting the return that we wanted.
Senator Burr. Not limited to fully developed claims, how
much does the VA spend on veteran outreach annually?
Mr. Cardarelli. Sir, I do not know. I know that we in VBA
have put a priority on that because we realize the more
information we can get out to the veteran, the more
communication, it enhances our trust, our confidence. I know
you know this, but one of our biggest challenges as we process
claims is development, gathering all that information. And if
we can partner with the veteran to do that, that will help us
get better claims coming to us----
Senator Burr. Mr. Cardarelli, understand my frustration. We
are standing up a new national outreach office, yet you do not
know how much we currently spend on outreach. Outreach is the
reason that we are less than 1 percent on fully-developed
claims. I would be willing to bet that there is not a VSO--and
I will ask them at the next hearing how many of them know that
you have got an incentive program. I know it because I have
assessed that it is a failure. That is one of the reasons that
I have tried to create a new program that actually has a real
incentive which would say to VSOs it is worth us going out and
working with veterans to fully develop claims; it is worth it
to the veterans to understand it.
Currently what is the average time it takes to complete a
fully developed claim versus the average time it takes to
complete a not fully developed claim?
Mr. Cardarelli. Right. In our most recent statistics for
the month of April, it was taking approximately 160 days to
process a claim. A fully developed claim we could do in
approximately 100 days. So we realized--our goal was 90 days.
We are a little over that, but we realized we can cut the time
in half. What we are trying to do, going back to your point
about outreach, is working with the veterans, but also working
with the VSOs, letting them know that we have this capability
and encouraging them to, in fact, use it, to say, hey, this is
a great way--if you can collect your case and then bring it to
us, that is how much quicker we can actually adjudicate it.
Senator Burr. Well, I thank you for your optimism. As just
a personal observation, I have been through two Administrations
and multiple people who fill your role come in and share with
the Chairman and me the great plan that they had in effect to
reduce the backlog, yet annually I have seen the backlog
increase and increase and increase. Every year we have been
told about the new technology, and I have sat down with the
head of technology. I have got tremendous confidence in him.
But if it does not work, where are we? Isn't it time that we
focus on how we get claims in which reduce the amount of time
because it reduces the amount of time that an individual has to
spend finding the information that they need to make a decision
on a claim?
Mr. Cardarelli. Yes, sir.
Senator Burr. I hate to bring my business background into
this, but sometimes common sense has to trump trying to look
for some major breakthrough that is not being used.
The good news for veterans is we have damn near used every
excuse as to why the disability claims process is not working.
We are just about out of new suggestions, and it may be that if
technology does not work, then we have exhausted everything,
and we can all get on the same page and focus on what we do to
drastically change the outcome for our Nation's veterans.
I thank the Chair. She has been very patient with me.
Chairman Murray. Thank you very much, Senator Burr.
Senator Brown?
STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator Brown of Ohio. Thank you, Madam Chair, and thank
you for your leadership, the ambitious agenda of this
Committee, and the tremendous amount of work that you have all
done. I particularly appreciate your leadership on S. 894, the
Veterans' Compensation Cost-of-Living Adjustment Act, and the
Hiring Heroes Act of 2011. The focus of the Administration and
a major component of our focus on job creation should be about
veterans and what we can do in that direction. We can, I think,
perhaps more in this Committee than in any other, send a
powerful bipartisan message that veterans issues are more
important than partisan politics and that job creation among
veterans especially is important. As we spend so much money in
this country on defense and so many veterans are out of work,
something does not quite fit there.
Finally, Madam Chair, I hope the Committee will consider
S. 572, a bill to improve collective bargaining over pay
matters for VA doctors and nurses. In a moment I will ask Dr.
Jesse a question about that. The bill passed out of Committee
last year restored bargaining rights for VA clinical care
employees--bargaining rights that had been eroding over time.
The bill is not about bargaining over pay scales but about
giving employees the right to challenge violations of the VA's
own pay rules. It is about fairness and ensuring that VA
medical professionals have the same rights as other VA
employees, and doctors and nurses at other Federal facilities.
The bill is about holding VA accountable to those employees,
accounts about complying with its own pay rules. I look forward
to the testimony later of David Cox, the National Secretary-
Treasurer of the AFGE, the American Federation of Government
Employees, on this matter.
Dr. Jesse, a couple of questions about the reason for this
bill, if you will. Two questions. First, does the VA collect
data on how many medical professionals quit the VA over VA's
pay policy or the lack of bargaining rights over unfair pay
practices? And, second, in your opinion, is there a good chance
that a physician who was promised incentive pay to come to the
VA may leave when VA breaks that promise, and because of the
lack of collective bargaining the employee does not have the
recourse that she might have or he might have otherwise for
doctors and nurses? Dr. Jesse, if you would weigh in on both of
those.
Dr. Jesse. Sure. In response to the first question, I do
not know the answer offhand, so I would have to get back to
you, and we can look at that.
Response to Request Arising During the Hearing
Question. Sen. Brown of Ohio asked whether VA has data on the
number of physicians and nurses who have left VA service because VA
``reneged'' on a commitment to them to provide incentives or bonuses or
because their collective bargaining rights were limited.
Response. The Department of Veterans Affairs (VA) does not collect
or maintain data on employees who may have left VA employment due to
the failure of VA to fulfill a commitment to provide incentives or
bonuses. Moreover, data show that VA's recruitment and retention of
physicians and nurses has not been negatively impacted by limitations
on collective bargaining rights.
The number of physicians and nurses on VA rolls has steadily
increased over the past six fiscal years and the turnover rates for
these occupations have remained at very low levels (see data below).
VA's generous benefits packages and our title 38 pay systems, such as
the Physician and Dentist Pay System and the Nurse Locality Pay System,
have made VA more competitive and improved our ability to recruit and
retain physicians and nurses.
0602 Physicians
----------------------------------------------------------------------------------------------------------------
in fiscal years--
-----------------------------------------------------------------
06 07 08 09 10 11
----------------------------------------------------------------------------------------------------------------
Total Onboard................................. 15,472 16,440 17,876 19,249 20,173 20,558
Total Losses.................................. 1,436 1,385 1,467 1,433 1,556 662
Loss Rate..................................... 9.28% 8.42% 8.21% 7.44% 7.71% 3.22%
----------------------------------------------------------------------------------------------------------------
0610 Nurses
----------------------------------------------------------------------------------------------------------------
in fiscal years--
-----------------------------------------------------------------
06 07 08 09 10 11
----------------------------------------------------------------------------------------------------------------
Total Onboard................................. 39,713 42,162 46,983 50,309 52,428 53,603
Total Losses.................................. 3,325 3,388 3,242 2,786 3,289 1,825
Total Turnover/Loss Rate...................... 8.37% 8.04% 6.90% 5.54% 6.27% 3.40%
----------------------------------------------------------------------------------------------------------------
Dr. Jesse. The answer to the second question is that my
sense is we have done very well over the past several years in
both recruiting and maintaining the workforce, thanks to the
Congress for the physician pay bill that passed in 2006, I
believe. It was an extraordinary effort that really changed our
capability to get high-quality physicians both to come to the
VA and to stay there. And I can speak to that from a personal
sense, having been a chief of cardiology in Richmond and having
to recruit what are very competitive positions in both
interventional cardiology and electrophysiology. We have been
able to retain those physicians.
In terms of people leaving because we renege on performance
pay, my sense is, yes, they may. And it would be our loss that
they would because, frankly, these positions can get paid two,
three, or four times higher in the private sector than we pay
them. What we do offer them is a superb work environment that
is unencumbered by having to bill, unencumbered by having to
have their salary predicated on doing procedures that are--
well, I want to be careful about my words here, but that we can
do appropriate procedures, we can do the right things for
patients because we have a model of physician reimbursement
that supports doing the right thing for the patients. And that
work construct, the pay construct, the pay rates we have now
have been very beneficial in doing that. We do use retention
bonuses to keep particularly the more challenging positions,
which I would include interventional radiology, interventional
cardiology, electrophysiology, nuclear medicine, and some of
the surgical specialties. And I do not know that we have
suffered significant loss because we have reneged on them.
Senator Brown of Ohio. Are you acknowledging that you have
reneged on some of them?
Dr. Jesse. No. I do not know that we have.
Senator Brown of Ohio. OK.
Dr. Jesse. I mean, I sign off on moving them forward, but I
do not have visibility into ones where they may have reneged on
them. But I can find that out for you. I do not have that in
front of me. I have not heard it is a problem. I have not heard
complaints from physicians that they are leaving because they
had a pay agreement and were reneged upon. I do know that, you
know, people may move because we do not pay them the salary
that they want to get. But, frankly, the pay structure we have
in place now, thanks to the physician pay reform in 2006, makes
us able to compete for good, high-quality physicians. I am very
proud of that workforce.
Senator Brown of Ohio. I did not just make it up, so we
will talk about the reneging.
Dr. Jesse. OK, yes.
Senator Brown of Ohio. But I also do not have--we do not
have----
Dr. Jesse. I am sure there are incidents, but I just have
not seen them yet.
Senator Brown of Ohio. I accept that, and we do not--you
know, we just want to explore more. There are some physicians,
some of your most qualified physicians and nurses leaving
because of that, but we will pursue that. The point in part is
that collective bargaining, that legislation, will help work
that through so that there is some recourse for those doctors
and nurses, and in an environment that can be not all that
contentious to make it work in the best ways. We are having a
major fight in Ohio right now, a political fight on the whole
idea of collective bargaining for public employees, and people
that support taking away collective bargaining rights forget
that when people are talking that there is actually less
animosity and less anger and more resolution, and a political
agenda or an ideological fervor sometimes obscures that.
Thank you.
Chairman Murray. Thank you very much.
Dr. Jesse, as you know, there are a lot of reasons that
veterans become homeless. Sometimes it is the impact of
invisible wounds of war, breakup of a marriage, the loss of a
job--a lot of factors. Currently, VA can only contract for
emergency shelter care for homeless veterans who are seriously
mentally ill or have substance abuse issues.
One of the provisions in S. 1148, the Veterans Programs
Improvement Act, will allow VA to contract for emergency
shelter care for homeless veterans regardless of current
eligibility restrictions. I know you do not have cleared views
on the homeless sections of this bill, but can you talk
generally about how expanding the population of homeless
veterans who are eligible for emergency shelter would help the
VA accomplish its goals of eliminating homelessness?
Dr. Jesse. Sure. I would like to start off by saying that
your question is exactly on key. Our goal is not to reduce it.
The Secretary has been very frank and committed to eliminating
homelessness in veterans, and we do know that this is not an
issue of just providing a bed. It is an issue of health care,
it is an issue of education, it is an issue of working with the
courts to try to support veterans who might be otherwise in
trouble and need help. But it requires not just--it requires
this broad base of social services all woven together if we are
really going to accomplish this goal. So my sense is that
anything we can do to move that forward is useful toward
reaching that goal of eliminating homelessness.
I think we have made great strides. I think Ranking Member
Burr said we went from about 111,000 last year down to about
76,000. These are actually difficult numbers to get because it
is a population that actually is in flux. But I think the trend
at least is very promising, and I think we are moving that in
the right direction. I am extremely proud of the VA's
homelessness program. It has got some extraordinarily talented
people who have managed this in just remarkable ways in a
relatively short period of time.
Chairman Murray. OK. Mr. Cardarelli, I want to turn to you
because we heard recently about an employee of a fiduciary who
was recently charged with embezzlement of over $626,000 from
the estates of incompetent VA beneficiaries. As you know, I
have introduced legislation to improve VA's ability to actually
access the bank accounts of fiduciaries, and I wanted you to
comment on that today on whether or not the provisions of this
bill will allow the VA with direct access to fiduciary bank
accounts to better increase the likelihood of something like
that not happening.
Mr. Cardarelli. Yes, ma'am. One of the Secretary's major
concerns is fiduciary, realizing that these are among our most
vulnerable veterans, and he has emphasized that to the VBA
leadership, so we clearly take that very seriously.
One of the things we realized what we wanted to do was have
better oversight, better oversight within our organization and
also external to our organization. As you know, as members of
your staff know, we have done some reorganization in VBA that
allows us to do that. We created a senior executive position.
We are doing some consolidation of our fiduciaries into a few
less sites so that we could have better fidelity of our people
who do that. We think the bill that you introduced, what I know
of it, will give us more access and more oversight so that we
can look in and if there is potentially something going on that
does not look right, we could then raise that issue.
So whatever we can do to have better oversight and better
insight into a bank account or whatever will assist us in
providing better oversight of that program.
Chairman Murray. OK. I appreciate that.
I have a number of other questions that I am going to
submit for the record.
Senator Burr, did you have any more for this panel? Senator
Brown?
[No response.]
Chairman Murray. I note that Senator Begich has just
arrived, and before I dismiss this panel, do you have any
questions for this panel?
Senator Begich. No.
Chairman Murray. Alright, then we will submit questions for
the record. We want each of you to respond to those in a timely
manner. So, at this point I thank you very much for your
testimony. I would like to excuse this panel and move to the
second panel.
In order to be expeditious, I am going to introduce you as
you are coming up, so if everybody can keep their comments down
as you move around, that would be great.
I do understand that there were a lot of bills that some of
the panelists addressed in their written testimony, so I want
to thank you, all of you, for your participation. It really
benefits this Committee to know your comments.
We are going to be hearing from Jeff Steele, who is the
assistant legislative director at The American Legion; Joe
Violante, who is the national legislative director for the
Disabled American Veterans; Raymond Kelley, who is the national
legislative director for the Veterans of Foreign Wars; Jerry
Ensminger, who is a retired Master Sergeant of the U.S. Marine
Corps; and J. David Cox, who is the national secretary-
treasurer of the American Federation of Government Employees.
I thank all of you for coming before the Committee today
with your testimony. Mr. Steele, I am going to begin with you.
I see you just barely sat down, but are you ready to go? OK.
Thank you very much.
STATEMENT OF JEFF STEELE, ASSISTANT DIRECTOR, NATIONAL
LEGISLATIVE COMMISSION, THE AMERICAN LEGION
Mr. Steele. Chairman Murray, Ranking Member Burr, Members
of the Committee, thank you for this opportunity for The
American Legion to present its views on legislation pending
before the Committee. I will limit my remarks to three issues
we would like to highlight for today's hearing.
The American Legion supports S. 815, the Sanctity of
Eternal Rest for Veterans Act.
This bill would create a zone of protection around military
funerals by limiting any protests within 300 feet of such a
funeral for 120 minutes preceding or following a service at any
cemetery in the country. Additionally, the bill would extend
the zone to 500 feet for any memorial services at cemeteries
under control of the National Cemetery Administration and
Arlington National Cemetery.
The American Legion supports the freedom of speech
protected by the First Amendment to the U.S. Constitution which
all our members swore to protect and uphold. However, the
Supreme Court has made it clear that, and I quote, ``[e]ven
protected speech is not equally permissible in all places and
at all times.'' The choice of where and when to conduct
picketing is not beyond the Government's regulatory reach. It
is, again, quoting the Supreme Court, ``subject to reasonable
time, place, or manner restrictions.''
We embrace fully a world where groups espousing varied and
unpopular political messages have the ability to voice those
concerns in proper venues; however, in so doing it is not
necessary to harm the grieving families of our heroes. This
legislation will protect the families of our fallen soldiers
and help preserve the dignity of military funerals from those
who wish to disrupt and cause pain and suffering while
respecting the intent of the First Amendment to our
Constitution. Finally, it should be noted that there is no cost
to this bill, but it will be priceless for the families of our
fallen servicemembers.
S. 490 would expand eligibility requirements for children
who receive health care under the Civilian Health and Medical
Program of the VA, or CHAMPVA. The aim of this bill is to give
CHAMPVA the same benefits now available to other Americans
established by the Patient Protection and Affordable Care Act
signed into law last year. Prior to passage of this
legislation, concerns were raised that provisions extending
health insurance coverage to dependent children until age 26
did not extend either to TRICARE or CHAMPVA beneficiaries. The
fiscal year 2011 National Defense Authorization Act enacted
earlier this year gave the Defense Department the authority it
needed to extend TRICARE coverage to young adults. This leaves
only CHAMPVA beneficiaries without this extended eligibility.
It is only fair to afford children who are CHAMPVA
beneficiaries the same eligibility. Surely coverage for
veterans' family members in need should meet this new national
standard. The American Legion supports this bill.
S. 1104, the Transition Assistance Program Audit Act of
2011, calls for an independent third-party audit of the
Department of Labor's Transition Assistance Program, or TAP,
every 3 years to ensure that it is providing services that are
up-to-date and useful to servicemembers and their spouses
making the initial transition from military service to the
civilian workplace.
While acknowledging the current efforts underway to reform
the TAP program, the fact remains that it should not have taken
the Department of Labor nearly two decades to modernize this
program, and the Department should welcome the assistance that
would come from an independent audit with recommendations for
improving the effectiveness of the program at regular
intervals. The American Legion supports this bill. It would
recommend, however, that a sunset provision be added to the
bill.
This concludes my statement. I would be pleased to answer
any questions you or the Committee might have. Thank you.
[The prepared statement of Mr. Steele follows:]
Statement of Jeff Steele, Assistant Director, National Legislative
Commission, The American Legion
Chairman Murray, Ranking Member Burr, Members of the Senate
Veterans' Affairs Committee, thank you for this opportunity for The
American Legion to present its views on the following pieces of pending
legislation.
S. 277, CARING FOR CAMP LEJEUNE VETERANS ACT OF 2011
The purpose of this bill is to amend title 38, U.S.C., and to
furnish hospital care, medical services, and nursing home care to
veterans currently suffering from adverse health effects who were
stationed at Camp Lejeune, North Carolina, during the time the water
was contaminated by known human carcinogens and probable human
carcinogens.
The Camp Lejeune water contamination problem occurred at Marine
Corps Base Camp Lejeune from 1957 to 1987. During that time, United
States Marine Corps (USMC) servicemembers and their families living at
the base apparently bathed in and ingested tap water contaminated with
harmful chemicals. An undetermined number of former base residents
later developed cancer or other ailments, which many blame on the
contaminated drinking water. Victims claim that USMC leaders concealed
knowledge of the problem and did not act properly in trying to resolve
it or notify former base residents that their health might be at risk.
The American Legion favorably acknowledges an April 2011 letter
sent to the Navy wherein five Members of Congress, including Senators
Bill Nelson of Florida, Kay Hagan and Richard Burr and Representatives
Brad Miller of North Carolina, and John Dingell of Michigan, criticize
the service's continued behavior regarding the water contamination
issue. In the letter, the members accused the Navy of continuing to
mischaracterize a 2009 report by the National Academy of the Sciences'
National Research Council, which concluded there was no concrete link
between the chemicals trichloroethylene and tetrachloroethylene and a
host of ailments suffered by veterans and family. The Navy states the
report also assessed benzene exposure, which is false, according to the
letter. Also, the letter criticized the Navy for not agreeing to a
communications protocol with the Agency for Toxic Substances and
Disease Registry (ATSDR) to allow that agency to review all Navy public
relations material related to the contamination issue. The letter
pointed out that the Marine Web site with information on the
contamination did not contain direct links to the ATSDR Web site
documenting their study of the issue.
The American Legion supports this bill and the conducting of
further scientific studies of the residents who were affected by those
contaminants in order to finally resolve this long-standing issue.
S. 396, MEETING THE INPATIENT HEALTH CARE NEEDS OF
FAR SOUTH TEXAS VETERANS ACT OF 2011
This bill directs the Secretary of Veterans Affairs (VA) to: (1)
ensure that the South Texas Veterans Affairs Health Care Center in
Harlingen, Texas, includes a full-service VA inpatient health care
facility; and (2) if needed, modify the existing facility to meet this
requirement.
While The American Legion generally takes no position on the
specific placement of VA healthcare facilities, we are strongly
committed to seeing that veterans should not be forced to travel long
distances to access quality health care because of where they choose to
live. All veterans deserve convenient access to proper medical
attention. Earlier this year, VA did open a new $40 million Health
Center in Harlingen to accommodate the needs of South Texans. The
Health Center, which offers only outpatient care, can be seen as a
first step toward full-service health care to the region. Previously,
the closest VA facility was in San Antonio--a laborious trip for many
patients suffering from chronic conditions. VA has therefore recognized
the need for an expansion of veterans' health care services in Deep
South Texas.
We remained concerned, however, that VA's Major and Minor
Construction Programs continue to be targeted for reductions.
Acknowledging this Nation's present fiscal difficulties does not entail
that we as a nation are unable to meet the obligations to our veterans.
The American Legion understands VA is facing increasing issues with
regards to providing care and benefits to our returning servicemembers,
and the veterans of previous conflicts. But with more veterans coming
home from Iraq and Afghanistan, the costs of providing care and
benefits are going to have to continue to increase.
The American Legion recommends the President's budget request for
$590 million for Major Construction and $550 million for Minor
Construction in FY 2012 be increased to $1.2 billion for Major
Construction projects and $800 million for Minor Construction projects
to provide for additional facilities.
S. 411, HELPING OUR HOMELESS VETERANS ACT OF 2011
This bill would improve outreach to rural and underserved urban
veterans by authorizing and encouraging VA to partner with eligible
state and local governments, tribes, and community-based service
providers to ensure homeless veterans have access to the existing HUD-
Veterans Affairs Supportive Housing (HUD-VASH) program that provides
chronically homeless veterans with housing vouchers and case management
services, such as assistance accessing counseling and job training.
The President and VA Secretary are committed to eliminating
veteran's homelessness. The HUD-VASH program is a prominent part of the
five year plan developed to do so. VA has acknowledged in previous
congressional testimony it can't achieve this goal on its own. It
``will need the collaboration of Federal and State and community
partners and, of course, Congress,'' a VA representative said.
By allowing VA to collaborate with states and nonprofits on case
management service provision, the bill would help ensure distribution
of rental assistance and other services to veterans in rural areas and
underserved urban veterans where case management services are otherwise
not available. It should be noted the bill does not require additional
funding.
The American Legion supports this bill.
S. 423, A BILL TO AMEND TITLE 38, UNITED STATES CODE, TO PROVIDE
AUTHORITY FOR RETROACTIVE EFFECTIVE DATE FOR AWARDS OF DISABILITY
COMPENSATION IN CONNECTION WITH APPLICATIONS THAT ARE FULLY-DEVELOPED
AT SUBMITTAL, AND FOR OTHER PURPOSES.
One of many initiatives the Department of Veterans Affairs (VA) has
launched to help address the claims backlog has been the Fully
Developed Claims (FDC) Program. VA successfully piloted the program at
ten VA regional offices through which VA expedited FDC claims. Last
year, VA expanded the FDC process to all VA regional offices. This
legislation is designed to encourage the use of this program by
providing an incentive for veterans to file these fully-developed
claims by compensating them for a period up to one year prior to the
date the claim was filed.
Although VA already allows for the locking in of an earlier
effective date with an informal claim if a veteran needs time to gather
evidence for their FDC claim, not all who avail themselves of the FDC
claims process will know of or use an informal claim, thus losing the
benefit of an earlier effective date. This legislation would provide a
safety net for those veterans.
The American Legion supports this bill.
S. 486, PROTECTING SERVICEMEMBERS FROM MORTGAGE ABUSES ACT OF 2011
This bill encourages compliance with the Servicemembers Civil
Relief Act (SCRA) by doubling the maximum criminal penalties for
violations of its foreclosure and eviction protections. It would also
double civil penalties in cases where the Attorney General has
commenced a civil action. In addition, the bill will give
servicemembers the time they need after returning from deployment to
regain solid financial footing, by extending the period of foreclosure
protection coverage from 9 to 24 months after military service has
ended.
Earlier this year, when reports that one of America's largest banks
had been overcharging about 4,000 servicemembers on their home loans,
and had improperly foreclosed on the homes of 14 military families, we
wholeheartedly joined the chorus of justifiable outrage about this
shocking situation and called upon all financial institutions that
handle mortgages for military families to review policies and
practices, to make sure they are obeying Federal law.
While the bank involved has issued a mea culpa and made efforts to
reassure the men and women of our military their commitment to make
this right, the episode makes it clear that further strengthening of
the SCRA is called for. It is a national security imperative that
servicemembers be able to fight the Nation's wars without having to
worry about their rights being trampled at home. The tragic stories of
those who have been adversely affected by the failure of our financial
institutions to play by the rules further highlight the necessity of
enhancing the effectiveness of the legal and regulatory protections for
our servicemembers and veterans.
The American Legion supports this bill.
S. 490, THIS BILL WOULD EXPAND ELIGIBILITY REQUIREMENTS FOR CHILDREN
WHO RECEIVE HEALTH CARE UNDER THE CIVILIAN HEALTH AND MEDICAL PROGRAM
OF THE VETERANS AFFAIRS DEPARTMENT (CHAMPVA).
The aim of this bill is to give CHAMPVA the same benefits now
available to other Americans established by the Patient Protection and
Affordable Care Act (P.L. 111-148) signed into law last year. Prior to
passage of this legislation, concerns were raised that provisions
extending health insurance coverage to dependent children until age 26
did not extend either to TRICARE or CHAMPVA beneficiaries. The fiscal
2011 National Defense Authorization Act enacted earlier this year gave
the Defense Department the authority it needed to extend TRICARE
coverage to young adults. This leaves only CHAMPVA beneficiaries
without this extended eligibility. It is only fair to afford children
who are CHAMPVA beneficiaries the same eligibility. Surely coverage for
veterans' family members in need should meet this new national
standard.
The American Legion supports this bill.
S. 666, VETERANS TRAUMATIC BRAIN INJURY CARE
IMPROVEMENT ACT OF 2011
This bill directs the Secretary of Veterans Affairs to report to
Congress on the feasibility and advisability of establishing a
Polytrauma Rehabilitation Center or Polytrauma Network Site for the
Department of Veterans Affairs (VA) in the northern Rockies or the
Dakotas. It further requires the Fort Harrison Department of Veterans
Affairs Hospital in Lewis and Clark County, Montana, to be evaluated as
a potential location for such a Center or Site.
Again, The American Legion generally takes no position on the
specific placement of VA healthcare facilities, but we are strongly
committed to seeing that veterans should not be forced to travel long
distances to access quality health care because of where they choose to
live. Therefore, we support the establishment of additional Polytrauma
Rehabilitation Centers or Polytrauma Network Sites wherever a need for
them is apparent and petitions Congress to provide required operations
and construction funding to ensure proper healthcare is a realistic
option for veterans.
S. 696, A BILL TO AMEND TITLE 38, UNITED STATES CODE, TO TREAT VET
CENTERS AS DEPARTMENT OF VETERANS AFFAIRS FACILITIES FOR PURPOSES OF
PAYMENTS OR ALLOWANCES FOR BENEFICIARY TRAVEL TO DEPARTMENT FACILITIES,
AND FOR OTHER PURPOSES.
Readjustment Counseling Centers, also known as Vet Centers, assist
veterans through such services as individual, group or family
counseling to help overcome psychological problems. Trips to a Vet
Center are as important as trips to a VA clinic. But the latter earns
the patient mileage reimbursement, while a visit to the former does
not. This legislation corrects that inequity by treating Vet Centers
the same as other VA facilities for the purpose of reimbursements for
travel.
The American Legion supports this bill.
S. 745, THIS BILL MODIFIES ONE ASPECT OF THE MAJOR REVISION TO THE
POST-9/11 GI BILL SIGNED INTO LAW EARLIER THIS YEAR, I.E., THE POST-9/
11 VETERANS EDUCATION ASSISTANCE IMPROVEMENT ACT.
In an attempt to simplify the new GI Bill program, the new law
creates a less complex method for deciding tuition and fee
reimbursement for private institutions. Instead of setting a
reimbursement cap for each state, based on the highest in-state rates
for tuition and fees charged by a four-year public college or
university, the bill would create a flat-rate cap for the entire U.S.
of $17,500/yr for tuition and fees. Unfortunately, that cap could
result in a drop in benefits for people using the GI Bill in six to 10
states when the relevant provisions of the law go into effect this
fall. Over the past two years, however, many students chose a
particular school with the expectation the GI Bill program they began
with would still be there when they completed their degree. S. 745
would hold harmless current private school students from potential
drops in tuition and fee payments.
However, there are additional issues The American Legion would like
to see addressed in any legislation to further modify the new GI Bill
program. Three changes in particular are a priority. One involves
grandfathering those who attend out-of-state public universities who
also fall under the same $17,500 cap. A second change is aimed at a
cost-cutting measure in the law that severely restricts payment of
living stipends between school terms. Starting this fall, payments
between terms will be made only if there is a natural disaster or other
unexpected disruption in the term. Otherwise, living stipends cease at
the end of the term and don't begin again until the start of the next
term. However, these interval payments are important to full-time
students who do not have jobs and who may not have other sources of
income. Finally, the new law reduces the current role of the state
approving agencies by deeming certain educational programs and courses
as constructively approved when such courses are approved by other
Federal entities for programs under their jurisdiction. State approving
agencies will now assume a compliance and oversight role. This
Committee should reconsider the advisability of this change.
s. 769, veterans equal treatment for service dogs act of 2011
This bill will permanently close a loophole in VA policy that has
created hurdles to care for certain disabled veterans. Under current VA
policy, only seeing-eye and guide dogs are offered unrestricted access
to VA health care facilities. Veterans who utilize service dogs as VA-
sanctioned prosthetic devices for other physical or mental injuries can
still be denied access at the discretion of each VA medical center
director. While VA recently made an effort to close this loophole
through a directive on service dog access, a legislative solution will
offer the permanent equality in access that veterans deserve and save
VA the trouble of having to reissue the directive at future intervals.
The American Legion supports this bill.
S. 780, VETERANS PENSIONS PROTECTION ACT OF 2011
This bill would exclude from annual income, for purposes of
eligibility for pensions for veterans and their surviving spouses and
children, reimbursements resulting from: (1) any accident; (2) any
theft or loss; (3) any casualty loss; (4) medical expenses resulting
from any such accident, theft, or loss; and (5) pain and suffering
(including insurance settlement payments and general damages awarded by
a court) related to such accident, theft, or loss.
Currently, any money received from an insurance claim, court
judgment, or injury settlement counts toward a veteran's income when
the VA determines pension eligibility. This means low-income veterans
who are compensated even for small settlements risk losing their
pensions. The bill seeks to change the rules surrounding the income
eligibility rules. Veterans should not have to worry about losing their
pensions because they became victims by some other person's actions.
The American Legion supports this bill.
S. 815, SANCTITY OF ETERNAL REST FOR VETERANS ACT OF 2011
This bill would create a zone of protection around military
funerals by limiting any protests within 300 feet of such a funeral for
120 minutes preceding or following a service at any cemetery in the
country. Additionally, this bill would extend that zone to 500 feet for
any memorial services at cemeteries under control of the National
Cemetery Administration and Arlington National Cemetery.
The American Legion supports the freedom of speech protected by the
First Amendment to the U.S. Constitution which all of our members swore
to protect and uphold. However, ``[e]ven protected speech is not
equally permissible in all places and at all times.'' Frisby v.
Schultz, 487 U. S. 474, 479. The choice of where and when to conduct
picketing is not beyond the Government's regulatory reach--it is
``subject to reasonable time, place, or manner restrictions.'' Clark v.
Community for Creative Non-Violence, 468 U. S. 288, 293.
We embrace fully a world where groups espousing varied and
unpopular political messages have the ability to voice those concerns
in proper venues; however, in so doing it is not necessary to harm the
grieving families of our heroes. This legislation will protect the
families of our fallen soldiers and help preserve the dignity of
military funerals from those who wish to disrupt and cause pain and
suffering while respecting the intent of the First Amendment to our
Constitution.
The American Legion supports this bill.
S. 873, A BILL TO AMEND TITLE 38, UNITED STATES CODE, TO PROVIDE
BENEFITS FOR CHILDREN WITH SPINA BIFIDA OF VETERANS EXPOSED TO
HERBICIDES WHILE SERVING IN THE ARMED FORCES DURING THE VIETNAM ERA
OUTSIDE VIETNAM, AND FOR OTHER PURPOSES.
Under title 38, United States Code, Chapter 18, benefits are
currently payable to children of veterans that served in the Republic
of Vietnam during the period January 9, 1962, to May 7, 1975, and who
suffer from the birth defect spina bifida. Recent legislation has
extended the spina bifida benefits to include the children of veterans
who served in or near the Korean Demilitarized Zone during the period
of September 1, 1967, and August 31, 1971, and determined by the
Secretary of Veterans Affairs to have been exposed to herbicides during
such service. However, the children of veterans who served in locations
other than Vietnam and Korea who were possibly exposed to Agent Orange
would be denied entitlement to compensation for spina bifida under the
current statute and regulations. This inequity would be corrected by
this legislation.
The American Legion supports this bill.
S. 894, VETERANS COST-OF-LIVING ADJUSTMENT ACT OF 2011
The purpose of this bill is to increase, effective as of
December 1, 2011, the rates of compensation for veterans with service-
connected disabilities and the rates of dependency and indemnity
compensation for the survivors of certain disabled veterans. The amount
of increase shall be the same percentage as the percentage by which
benefit amounts payable under title II of the Social Security Act (42
U.S.C. 401 et seq.) are increased effective December 1, 2011.
The American Legion supports this annual cost-of-living adjustment
in compensation benefits, including dependency and indemnity
compensation (DIC) recipients. It is imperative that Congress annually
considers the economic needs of disabled veterans and their survivors
and provide an appropriate cost-of-living adjustment to their benefits,
especially should the adjustment need to be higher than that provided
to other Federal beneficiaries, such as recipients of Social Security.
S. 935, A BILL TO REQUIRE THE SECRETARY OF VETERANS AFFAIRS TO CARRY
OUT A PROGRAM OF OUTREACH TO VETERANS, AND FOR OTHER PURPOSES.
The American Legion believes that proper and thorough outreach is
essential to ensuring this Nation's veterans and their dependents are
fully informed and aware of all of the benefits to which they may be
entitled to receive based on their honorable military service to our
Nation.
S. 951, HIRING HEROES ACT OF 2011
This critical legislation will combat rising unemployment among our
Nation's veterans by requiring transition assistance for all
servicemembers returning home, modifying Federal hiring practices to
encourage the hiring of separating servicemembers and create new
programs aimed at improving the transition from servicemember to
civilian.
In 2010, more than one in four veterans aged 20-24 were unemployed.
Even as the civilian unemployment rate begins to decline, we continue
to see the new veteran unemployment rate rise month to month in 2011.
With less than half a percent of Americans fighting in the current wars
and only 8 percent of Americans having ever served in the military, it
is critical that we bridge the widening gap between the civilian
workforce and our Nation's veterans and this legislation has the
potential to help tackle this unacceptable problem.
The American Legion supports this bill.
S. 957, VETERANS' TRAUMATIC BRAIN INJURY REHABILITATIVE SERVICES'
IMPROVEMENT ACT OF 2011
This important piece of legislation will close gaps in both the
duration and types of services provided to our wounded servicemembers
who have sustained what are often profoundly debilitating Traumatic
Brain Injuries. Specifically, the bill would clarify that VA may not
prematurely cutoff needed rehabilitation services, and that these
veterans can get the support they need--whether health-services or non-
medical assistance--to achieve maximum independence and quality of
life.
Traumatic Brain Injury (TBI) represents one of the most complex and
potentially severe injuries incurred by servicemembers of the OEF/OIF
conflicts. Each Traumatic Brain Injury is unique. Those with severe TBI
may have such profound cognitive and neurological impairment that they
require long years of caretaking and specialized rehabilitation. While
many VA facilities have dedicated rehabilitation-medicine staff, the
scope of services actually provided to veterans with TBI can be
limited, both in duration and in the range of services VA will provide
or authorize. We must guarantee that our veterans are supported not
only in the acute phase of their recovery while they continue to make
rehabilitative and medical gains, but that they are supported in the
long term so that those gains are not lost.
Independent living and community reintegration are of the utmost
importance to this young generation of warriors. Yet the VA's
rehabilitation focus relies almost exclusively on a medical model that
doesn't necessarily provide the range of support a young person needs
to achieve the fullest possible life in the community. In contrast,
other models of rehabilitative care meet those needs through such
services as life-skills coaching, supported employment, and community
reintegration therapy. But these services are seldom made available to
veterans. Congress must close the gap to ensure veterans receive the
full range of services needed to live meaningful and independent lives
in their communities.
The American Legion supports this bill.
S. 1017
This bill would extend permanently VA's authority to provide to
eligible severely service-connected disabled veterans Temporary
Residence Adaptation (TRA) Grants when those veterans do not intend to
permanently reside in a residence owned by a family member; increase
the maximum grant from $14,000 to $28,000 for eligible veterans who
have a permanent and total service-connected disability as a result of
loss or loss of use of both lower extremities; increase the maximum
assistance from $2,000 to $5,000 for eligible veterans who have a
permanent and total service-connected disability rating due to
blindness in both eyes with 5/200 visual acuity or less; due to the
anatomical loss or use of both hands; or due to severe burn injury. In
addition, the legislation provides an annual adjustment based on the
residential home cost-of-construction index for the preceding calendar
year. Further, the proposed legislation would expand eligibility for
Special Adaptive Housing Assistance for veterans with vision impairment
to those veterans having a central visual acuity of 20/200 or less in
the better eye with the use of a standard correcting lens which is
consistent with other central visual acuity requirements elsewhere in
title 38, United States Code. Finally, the bill would assure the TRA
grant would no longer be counted against the Special Adaptive Housing
Assistance maximum grant.
Military personnel in Iraq and Afghanistan are surviving wounds in
numbers far greater than previous wars. Largely due to advances in body
armor and combat medicine as well as the rapidity of evacuation,
survival rates are close to ninety percent. However many wounded
servicemembers are surviving severe injuries which will require
sophisticated, comprehensive, and often lifelong care. Blasts,
especially those generated by IEDs are the cause of 65 percent of OEF/
OIF casualties. Explosive devices produce a characteristic pattern of
injuries: TBI, blindness, spinal cord injuries, burns, and damage to
the limbs resulting in amputation. Many military personnel are
sustaining more than one of these wounds.
Many of these wounded warriors will require constant care from a
family caregiver for years after they leave service. During this time,
they frequently reside in a home that is not their own and not a
permanent residence where they may live on their own after recovery.
Adaptations, like ramps and elevators, must often be made to their
permanent home and that of their caregiver while they are recovering
from their injuries. While the VA does provide grants for adaptive
housing, the benefit is largely based on the assumption that wounded
warriors are living in their permanent home. Section 2102A of Title 38
allows the VA to issue a separate grant to adapt the temporary homes of
recovering veterans; however, it is set to expire at the end of this
year. By extending this program permanently, Congress can show their
strong support for those veterans who have made extreme sacrifices for
our freedom. The other upgrades in the bill would also constitute a
necessary recognition by Congress of the evolving needs of these
wounded warriors.
The American Legion supports this bill.
S. 1060, HONORING ALL VETERANS ACT OF 2011
Senator Blumenthal is certainly to be praised for the priority he
is placing on this Nation's veterans by having the first piece of
legislation he is introducing since becoming a member of the Senate be
a veteran's bill.
We are particularly pleased that the legislation addresses a number
of Legion priorities, including helping unemployed veterans find
successful careers, assisting homeless veterans, meeting the behavioral
health needs of veterans and military families, and enhancing DOD/VA
collaboration to better institutionalize a truly seamless transition
for returning servicemembers.
The seamless transition from active service to civilian life is a
pressing concern for The American Legion. Every day in combat zones our
servicemembers face grueling obstacles and challenges; they should not
face these challenges as they return home and reintegrate into society
after defending their country. Because this legislation takes needful
steps toward making sure military skills and training are translatable
into the civilian sector, attending to the needs of veterans living
with Traumatic Brain Injury and/or Post Traumatic Stress Disorder, and
increasing the number of veterans who may participate in VA's
Vocational Rehabilitation and Employment Independent Living Program, we
find there is much we can approve of in it.
The American Legion supports this bill.
S. 1104, TRANSITION ASSISTANCE PROGRAM AUDIT ACT OF 2011
This bill calls for an independent third party audit of the
Department of Labor's Transition Assistance Program (TAP) every three
years to ensure that it is providing services that are up-to-date and
useful to servicemembers and their spouses making the initial
transition from military service to the civilian workplace.
While acknowledging the current efforts underway to reform the TAP
program, the fact remains that it should not have taken the Department
of Labor nearly two decades to modernize this program and it should
welcome the assistance which would come from an independent audit with
recommendations for improving the effectiveness of the program at
regular intervals.
The American Legion supports this bill.
S. XXXX, ALASKA HERO'S CARD ACT OF 2011
This bill establishes a pilot program under which veterans in the
State of Alaska may receive health care benefits from VA at non-VA
medical facilities.
While The American Legion generally takes no position on state
specific issues, we are concerned at the precedence this act may have
upon the overall quality of care for veterans. While Alaskans certainly
must wrestle with the challenges of rural health delivery as much if
not more so than the veterans of other states, even within Alaska,
shared resources with the Department of Defense, telemedicine and other
unique delivery models are being pioneered. Moreover, this program can
already be accomplished through the VA fee-basis program.
Allowing Alaskan veterans to access almost any medical facility
through use of a ``hero card'' negates the powerful resources of
electronic medical records, case management, and VA oversight that can
be offered through careful patient management. Furthermore,
implementation of this program in Alaska would provide an unparallel
benefit to one category of veterans not available to others in rural
areas of the western United States and elsewhere. Finally, it detracts
from the need of the VA to provide the necessary resources and
facilities, or access to these, to every veteran no matter where they
live.
The American Legion opposes this bill.
As always, The American Legion thanks this Committee for the
opportunity to testify and represent the position of the over 2.4
million veteran members of this organization. I would be happy to
answer any questions you may have.
Chairman Murray. Thank you very much.
Mr. Violante?
STATEMENT OF JOSEPH A. VIOLANTE, NATIONAL LEGISLATIVE DIRECTOR,
DISABLED AMERICAN VETERANS
Mr. Violante. Chairman Murray, Ranking Member Burr, Members
of the Committee, on behalf of the Disabled American Veterans,
I am pleased to be here today to present our views on the bills
under consideration. These bills impact almost every VA
business line as well as programs under the jurisdiction of
other departments. As requested, my oral remarks will focus on
the bills and issues with which we have the greatest interest
and concerns.
Many of the bills under consideration today address
important gaps in services to disabled veterans or enhance or
improve current programs. DAV delegates to our most recent
national convention in August 2010 passed numerous resolutions
mandating DAV's support for many of the issues under
consideration by this Committee, and I have identified DAV's
position in detail in my written statement. However, as
Congress considers authorizing new programs or enhancing or
expanding current programs, it is essential that they do so in
a manner that does not have negative effect on existing
programs and services.
In today's economic environment, VA cannot be all things to
all veterans, their families, and survivors without obtaining
substantially more resources which are dependable and stable.
If we are to increase the services VA must provide, we must
also allow VA the time and resources to properly plan how best
to deliver the services authorized by Congress to a deserving
veteran population.
Madam Chairman, DAV and our members are acutely aware and
grateful. Veterans programs have been benefited from generous
increases and have been spared from deep cuts facing other
Federal programs. However, we also realize that we are a Nation
at war and that war produces more sick, disabled, and wounded
veterans every day, thereby increasing the need for VA's
services for veterans.
As this Committee knows well, veterans' need do not end
when the shooting stops. VA is still caring for widows of World
War I veterans, veterans and families of World War II, and all
wars since. VA today is also confronted with a new generation
of war-disabled veterans with many complicated and expensive
needs that will continue for decades to come. All of this
demand puts extreme pressure on VA's current resources.
In the face of this ambitious legislative agenda, we ask
this Committee not to forget its responsibility to ensure that
when it mandates a new service in law or admits a new eligible
population to VA rolls that sufficient resources accompany that
mandate to assure the promise is kept. The creation or
expansion of a new benefit should not create the unintended
consequences of restricting, reducing, or limiting benefits or
services currently available. Authorizing new or expanded
current programs without providing new financial, human, and
capital resources will only force VA to slice their budget pie
into smaller pieces. And when relatively fewer resources are
available, VA is forced to ration services--an outcome that
should not be supported by this Committee.
Madam Chairman, while we share the goals of expanding
access to VA health care for all eligible veterans, including
those who live in rural, remote locations, DAV believes the VA
must first ensure that doing so will not diminish or threaten
the quality of care for enrolled veterans. Sustaining a robust
VA health care system capable of providing a full continuum of
high-quality, timely health care to all enrolled veterans
remains one of DAV's highest priorities.
We have concerns about proposals that seek to increase
access to VA health care but do not identify or guarantee new
funding to pay for expanded care. In particular, care provided
to veterans outside the VA system but paid for from within the
VA budget must be done in a judicious manner so as not to
endanger VA's ability to maintain a full range of specialized
inpatient and outpatient services for enrolled veterans. VA
must maintain a critical mass of capital, human, and technical
resources to promote effective, high-quality care for veterans,
especially those with complex health problems such as
blindness, amputation, spinal cord injury, Traumatic Brain
Injury, and mental health problems.
Madam Chairman, we have noted in our testimony the bills
that we support. I would like to note that we strongly support
passage of S. 894, which provides a cost-of-living adjustment
for disability compensation and other payments. However, we
oppose the continuing rounding down of that cost-of-living
adjustment. Veterans are the only Federal recipients who have
such a rounding-down.
Madam Chairman and Members of the Committee, this concludes
my statement, and I would be happy to answer any questions you
have.
[The prepared statement of Mr. Violante follows:]
Prepared Statement of Joseph A. Violante, National Legislative
Director, Disabled American Veterans
Chairman Murray, Ranking Member Burr and Members of the Committee:
On behalf of the Disabled American Veterans (DAV) and our 1.2 million
members, all of whom are wartime disabled veterans, I am pleased to be
here today to present our views on 34 bills under consideration today.
S. 277, CARING FOR CAMP LEJEUNE VETERANS ACT OF 2011
Section 2 of this bill would furnish Department of Veterans Affairs
(VA) hospital care, medical services, and nursing home care to veterans
who were stationed at Camp Lejeune, North Carolina during a period,
determined by the VA Secretary in conjunction with the Agency for Toxic
Substances and Disease Registry of the Department of Health and Human
Services, in which the water at Camp Lejeune was contaminated by
volatile organic compounds, including known human carcinogens,
notwithstanding that there is insufficient evidence to conclude such
illness is attributable to such contamination.
Section 3 of this measure would create a new section 1786 under
subchapter VIII of title 38, United States Code. Specifically, this
bill would require a family member of the above described veteran who
resided at Camp Lejeune during the same period, or who was in utero
during such period, to be eligible for the same VA hospital care,
medical services and nursing home care furnished by the Secretary for
any condition, or any disability that is associated with such
condition. The Secretary shall prescribe regulations that specify which
conditions and disabilities are associated with said exposure.
The delegates to our most recent National Convention in Atlanta,
Georgia, July 31-August 3, 2010, adopted two resolutions related to
this bill. Resolution No. 298 urges congressional oversight and Federal
vigilance to provide for research, health care and improved
surveillance of disabling conditions in veterans resulting from
military toxic and environmental hazards exposure. Resolution No. 278
calls for supporting legislation to provide for service connection of
veterans for disabling conditions resulting from toxic and
environmental exposures.
Accordingly, we support section 2 of this measure; however, we
recommend any medical care provided to veterans' dependents under
section 3 of this bill should be provided either under the military
TRICARE program, or if in VA, in the Civilian Health and Medical
Program of VA (CHAMPVA). We do not believe providing direct eligibility
for these dependents in VA health care facilities would be in the best
interest of either the VA system of care, or of the veterans who must
rely on that system. Without a significant infusion of new funding--
which this bill would not authorize--introducing a large, new treatment
population into direct VA health care would cause rationing of care for
those already enrolled in order for VA to generate the considerable
additional resources that would be needed for the care of a new,
unanticipated population. We would prefer that TRICARE be assigned this
responsibility as a more appropriate source of continuing Federal care
for this dependent population.
S. 396, MEETING THE INPATIENT HEALTH CARE NEEDS OF
FAR SOUTH TEXAS VETERANS ACT OF 2011
If enacted, this measure would require the Secretary of Veterans
Affairs to ensure that the South Texas Veterans Affairs Health Care
Center in Harlingen, Texas includes a full-service VA inpatient health
care facility--and, if necessary, shall modify the existing facility to
meet this requirement.
The author of the measure argues that given the veteran population
in the area, there is a high demand for VA medical services and that VA
is not meeting the current health care needs of veterans residing in
far south Texas. Additionally, it was noted that travel times in that
area can exceed six hours for certain veterans in need of acute
inpatient health care from VA, and they must seek that care in distant
cities such as San Antonio, Houston and Dallas.
DAV does not have a specific resolution from our membership on this
issue, nor does the national organization get involved in the placement
of VA medical facilities. However, we acknowledge that access to
inpatient services is a challenge for many veterans living in more
rural and remote areas and certain areas of the country where there is
only a minor community-based outpatient clinic (CBOC) available to deal
with primary health care needs. We note that in Public Law 108-170,
sections 223 and 224, Congress directed VA to establish a defined plan
to provide inpatient hospital care to veterans residing in far south
Texas and other rural, frontier and remote regions in need of a greater
VA bed presence. This act also gave VA a variety of new statutory tools
to accomplish that goal.
We believe that the Veterans Health Administration (VHA) Office of
Rural Health (ORH) is deeply engaged today in establishing better
access to care for rural and remote veterans. Since its inception, the
ORH has funded well over 500 projects/programs across the VA health
care system to accomplish its mission of increasing access and
improving the quality of health care for enrolled rural and highly
rural veterans. In the 2010-2014 ORH strategic plan, six major goals
are outlined:
1) Improve access and quality of care through the establishment of
new access points, by supporting new and ongoing transportation
solutions to VA facilities and by supporting initiatives such as the
home based primary care program
2) Optimize the use of available and emerging technologies such as
telemedicine, web-based networking tools, and the use of mobile devices
to deliver care to and monitor the health of rural and highly rural
veterans
3) Maximize utilization of existing and emerging studies and
analyses to impact care delivered to rural and highly rural veterans
4) Improve availability of education and training for VA and non-VA
health care providers to rural and highly rural veterans by supporting
initiatives such as the Graduate Medical Education Enhancement
Initiative for residents, nurse practitioners and social workers who
want specialized training in Rural Health
5) Enhance existing and implement new strategies to improve
collaborations and increase service options for rural and highly rural
veterans such as the recent Indian Health Service-VA Memorandum of
Understanding, which will improve health care delivery by sharing
programs, improving coordination of care, and increasing efficiency
through sharing contracts and purchasing agreements
6) Develop innovative methods to identify, recruit and retain
medical professionals and requisite expertise in rural and highly rural
areas.
In fiscal year (FY) 2011, ORH is supporting over 275 individual
projects across the country at a cost of over $500 million (this does
not include ORH-funded projects overseen by three Veterans Rural Health
Resource Centers). Many of these are in collaboration with other VA
program offices such as the Office of Mental Health, Geriatric and
Extended Care Office, and the Office of Telehealth Services.
We strongly concur that VA must work to improve access for veterans
that are challenged by long commutes and other obstacles in gaining
reasonable access to the full continuum of health care services at VA
facilities and explore practical solutions when developing policies in
determining the appropriate location and setting for providing VA
health care services. At a minimum, VA should include experts and
veterans service organization representatives from the areas in
question in decisions made regarding access to inpatient care services
to help VA consider alternative program and policy decisions that would
have positive effects on veterans who live in these areas.
DAV recommends the sponsors of this bill ask VA to provide them
with a current assessment of the veteran population in far south Texas
including the need for hospital services to see if adding an inpatient
capability is feasible and what methods if any VA intends to pursue to
achieve that goal.
S. 411, HELPING OUR HOMELESS VETERANS ACT OF 2011
Veterans living in rural areas, underserved metropolitan areas, or
Indian lands require an adequate share of targeted housing vouchers.
This legislation instructs the VA to ensure appropriate Housing and
Urban Development--Veterans Affairs Supportive Housing (HUD-VASH)
vouchers are distributed to these populated areas as well. Allowing
these services to be administered by local community organizations will
give underserved veterans greater access to this important program.
Inclusion of other partners into housing as part of case management is
an important step in moving forward on ending veteran homelessness.
This legislation supports our mission, which is to build better
lives for disabled veterans, their families and survivors. We support
this bill, in accordance with DAV Resolution No. 223, which calls for
sustained sufficient funding to improve services for homeless veterans.
It is projected that there will be a need for a significant increase in
services over current levels to serve veterans of all eras. The
Secretary of Veterans Affairs' campaign to end homelessness among
veterans through enhanced collaboration with other Federal and state
agencies, faith-based organizations, veterans' service organizations
and other community partners is essential. This legislation addresses
these issues by expanding case management services delivery through
nonprofits and state entities.
Accordingly, DAV supports S. 411.
S. 423, A BILL TO PROVIDE AUTHORITY FOR RETROACTIVE EFFECTIVE DATE FOR
THE AVAILABILITY OF COMPENSATION WITH THE SUBMISSION OF A FULLY
DEVELOPED CLAIM.
This bill would amend title 38, United States Code, section 5110(b)
to allow for a retroactive effective date up to one year earlier than
the date of submittal of a fully developed claim, based on the facts
found.
Although DAV does not have a resolution on this specific issue, DAV
Resolution No. 073 supports reform of the VA disability claims process.
DAV supports passage of this legislation, as it is in the best interest
of both the VA and veterans, it will improve the current claims process
and provide for the timely delivery of claims.
S. 486, PROTECTING SERVICEMEMBERS FROM MORTGAGE ABUSES ACT OF 2011
This bill amends the Servicemembers Civil Relief Act, extending the
period of protection from the current nine months to 24 months after
leaving military service against mortgage sale or foreclosure, as well
as the stay of proceedings, in the case of an obligation on real
property that originated before the period of military service. This
bill also increases criminal and civil penalties for mortgage abuses,
including felonies for unlawful eviction or distress or for unlawful
sale, foreclosure, or seizure.
While DAV does not have a resolution on this matter, we would not
be opposed to its favorable consideration.
S. 490, A BILL TO INCREASE THE MAXIMUM AGE FOR CHILDREN ELIGIBLE FOR
MEDICAL CARE UNDER THE CHAMPVA PROGRAM.
This measure would amend title 38, United States Code, section
1781(c) to increase the maximum age for children eligible for medical
care under CHAMPVA.
CHAMPVA was established in 1973 within the VA to provide health
care services to dependents and survivors of our Nation's veterans.
CHAMPVA enrollment has grown steadily over the years and, as of FY
2009, covers more than 336,000 beneficiaries.
Under current law, a dependent child's eligibility, which otherwise
terminates at age 18, continues to age 23 when such child is pursuing
an approved full-time course of education.
The landmark health care reform act that was enacted into law last
year includes a provision that requires private health insurance to
cover dependent children until age 26.
This is in line with DAV Resolution No. 201, supporting legislation
to extend eligibility for CHAMPVA until an eligible child's graduation
from an approved course of full-time education.
DAV therefore strongly supports this measure.
S. 491, HONOR AMERICA'S GUARD-RESERVE RETIREES ACT OF 2011
This bill would amend Chapter 12 of title 38, United States Code,
by conferring the designation of ``veteran'' on members of the Reserve
component of the Armed Forces who retired due to age. While the bill
does specify that these individuals are entitled to retired pay for
their nonregular service, they would not be entitled to benefits
provided to those who served on active duty.
DAV does not have a resolution on this matter. We are concerned,
however, that measures such as this, if enacted, may then lead to a
misunderstanding in the minds of the American public about those
veterans who earned the designation of veteran by virtue of their
active duty service, injury or deployment and those who have been
honored with the title veteran and a misunderstanding of what benefits
they receive or are entitled to receive.
S. 536, A BILL TO PROVIDE THAT UTILIZATION OF SURVIVORS' AND
DEPENDENTS' EDUCATIONAL ASSISTANCE SHALL NOT BE SUBJECT TO THE 48-MONTH
LIMITATION ON THE AGGREGATE AMOUNT OF ASSISTANCE UTILIZABLE UNDER
MULTIPLE VETERANS AND RELATED EDUCATIONAL ASSISTANCE PROGRAMS.
This bill amends title 38, United States Code, to remove the 48-
month limitation for survivors and dependents to use the aggregate
amount of assistance utilizable under multiple veterans and related
educational assistance programs.
DAV has no resolution, but is not opposed to its favorable
consideration.
S. 572, A BILL TO REPEAL THE PROHIBITION ON COLLECTIVE BARGAINING WITH
RESPECT TO MATTERS AND QUESTIONS REGARDING COMPENSATION OF EMPLOYEES OF
THE DEPARTMENT OF VETERANS AFFAIRS OTHER THAN RATES OF BASIC PAY.
This bill would restore some bargaining rights for clinical care
employees of the VHA that had been eroded. The bill would amend
subsections (b) and (d) of section 7422 of title 38, United States
Code, by striking ``compensation'' both places where the term appears
and inserting ``basic rates of pay'' in its place. The intent of the
bill would be to authorize employee representatives of recognized
bargaining units to bargain with VHA management over matters of
employee compensation other than rates of basic pay.
We understand recently VA has given Federal labor organizations
some indication of additional flexibility in negotiating labor-
management issues such as some features of compensation, and we are
hopeful that this change of heart signals a new trend in these key
relationships that directly affect sick and disabled veterans under VA
care.
DAV does not have an approved resolution from our membership on the
specific issues addressed by this bill. However, we would not oppose
its enactment, while continuing to hope that VA and Federal labor
organizations can find a sustained basis for compromise and resolution.
S. 666, VETERANS TRAUMATIC BRAIN INJURY CARE IMPROVEMENT ACT OF 2011
This bill would require VA to submit a report to Congress on the
feasibility and advisability of establishing a Polytrauma
Rehabilitation Center or Polytrauma Network Site for the VA in the
northern Rockies or the Dakotas.
DAV does not have a resolution on this particular issue, and we
therefore have no position.
S. 696, A BILL TO TREAT VET CENTERS AS DEPARTMENT OF VETERANS AFFAIRS
FACILITIES FOR PURPOSES OF PAYMENTS OR ALLOWANCES FOR BENEFICIARY
TRAVEL TO DEPARTMENT FACILITIES.
The legislation would amend title 38, United States Code, section
111, to allow for beneficiary travel benefits to eligible veterans who
receive care at Vet Centers as those who travel to VA health care
facilities.
Under current law, readjustment counseling authorized under title
38, United States Code, section 1712A is not considered part of VA's
medical benefits package under title 38, Code of Federal Regulations,
section 1738.
DAV believes adequate travel expense reimbursement is directly tied
to access to care for many veterans, and is not a luxury. DAV supports
this legislation based on DAV Resolution No. 214, and urge its
favorable consideration.
S. 698, A BILL TO CODIFY THE PROHIBITION AGAINST THE RESERVATION OF
GRAVESITES AT ARLINGTON NATIONAL CEMETERY.
This bill would amend title 38, United States Code, to codify the
prohibition against the reservation of gravesites at Arlington National
Cemetery, and for other purposes. It stipulates that no more than one
gravesite shall be provided at Arlington to a veteran or member of the
Armed Forces or family member who is eligible for burial. Additionally,
it specifies that no gravesite shall be reserved at Arlington before an
individual's death, except in the case of a request submitted to the
Secretary of the Army before January 1, 1962.
DAV does not have a resolution on this matter and, therefore, we
have no position on this measure.
S. 745, A BILL TO PROTECT CERTAIN VETERANS WHO WOULD OTHERWISE BE
SUBJECT TO A REDUCTION IN EDUCATIONAL ASSISTANCE BENEFITS.
This bill would amend title 38, United States Code, to protect
certain veterans who would otherwise be subject to a reduction in
educational assistance benefits, and for other purposes. This bill
would allow veterans who are using the Post-9/11 GI Bill and enrolled
at nonpublic institutions of higher education from August 1, 2011
through December 31, 2014, the lesser of: (1) the established charges
for that program; (2) the established charges payable under the VA's
maximum payments table published on October 27, 2010; or (3) the amount
for the previous academic year, increased by the authorized annual
percentage increase.
While DAV does not have a resolution on this matter, we are not
opposed to its favorable consideration.
S. 769, VETERANS EQUAL TREATMENT FOR SERVICE DOGS ACT OF 2011
This bill would ensure that the VA Secretary not prohibit the use
of service dogs provided by VA for veterans with a hearing impairment,
spinal cord injury/dysfunction or any other chronic impairment that
limits mobility in any facility or on any property of the Department or
in any facility or on any property that receives funding from the
Secretary.
Congress found that the usage of medical service dogs among
veterans is increasing. Likewise, VA currently allows seeing-eye dogs
in Department facilities and does not place any limitations on the
access of seeing-eye dogs to Department facilities. This legislation
would amend Section 1714 of title 38, United States Code, by adding a
new subsection--aimed to ensure that veterans with service dogs have
the same access in VA facilities as guide dogs for the blind.
The VHA published VHA Directive 2011-013 on March 10, 2011, related
to its policy on access of guide dogs and service dogs on VHA property.
The directive acknowledges that trained guide dogs and other trained
service dogs can play a significant role in maintaining functionality
and promoting maximal independence of individuals with disabilities.
Therefore, individuals with disabilities are authorized to enter VHA
facilities accompanied by their guide dogs or trained service dogs
consistent with the same terms and conditions, and subject to the same
regulations, that govern the admission of the general public to the
property.
VA does note that therapy animals, companion animals, emotional
support animals, and pets are not covered by this directive. The
directive further notes that VHA facility directors do have the
authority to make determinations regarding the entry of dogs into VHA
facilities or on VHA property. Furthermore, each facility director is
required to ensure there is a written published policy that addresses
the issue of VHA access for guide and service dogs. The policy states
that dogs are not permitted to roam free in VHA facilities and must be
on a leash, in a guide harness or under control at all times.
Although VA's directive on this issue is clear and addresses the
issue specifically--DAV has received information over the past year
that this policy directive may not be consistently applied at all VA
facilities. DAV has no specific resolution from our membership in
support of this measure; however, it appears the bill would clarify
current VHA policy on this matter and would be beneficial to a number
of service-disabled veterans. Therefore, we would not object to its
passage. We are aware that VA is engaged in a formal research project
dealing with the use of service dogs for patients with certain mental
health conditions. We believe the results of this research will better
inform VA policy on the management of service and guide dogs on VA
premises.
S. 780, VETERANS PENSIONS PROTECTION ACT OF 2011
This bill would amend title 38, United States Code, to exempt
reimbursements of expenses related to accident, theft, loss, or
casualty loss from determinations of annual income with respect to
nonservice-connected pension benefits.
Because this is outside of our mission, we do not have a resolution
on this matter; however, we would not oppose passage of this
legislation.
S. 815, SANCTITY OF ETERNAL REST FOR VETERANS ACT OF 2011
This measure would amend the Federal criminal code prohibition of
disrupting funerals, including those at national cemeteries, of members
of the Armed Forces or veterans, changing the time from one hour to two
hours before and after the burial. Such unlawful conduct would include
any disturbance or disruption occurring within 500 feet of the
residence of a surviving member of a deceased's immediate family. The
bill also provides civil remedies to include actual and statutory
damages.
While DAV does not have a resolution on this matter, we are not
opposed to its favorable consideration.
S. 873, A BILL TO PROVIDE BENEFITS TO CHILDREN WITH SPINA BIFIDA
This bill would amend title 38, United States Code, to provide
benefits for children with spina bifida of veterans exposed to
herbicides while serving in the Armed Forces during the Vietnam era
outside Vietnam.
Although we do not have a resolution on this, DAV would not oppose
passage of this legislation, since this benefit is currently provided
to children of veterans exposed to Agent Orange during service in the
Republic of Vietnam.
S. 874, A BILL TO MODIFY THE MONTH OF DEATH BENEFITS FOR SURVIVING
SPOUSES.
This bill would amend title 38, United States Code, to modify the
month of death benefit for surviving spouses of veterans who die while
entitled to compensation or pension; expands the eligibility for the
Presidential Memorial Certificates to include those individuals who die
while on active duty; and to improve housing loan benefits.
DAV does not oppose passage of this legislation.
S. 894, VETERANS' COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 2011
This bill would amend title 38, United States Code, to provide for
an increase, effective December 1, 2011, in the rates of compensation
for veterans with service-connected disabilities and the rates of
dependency and indemnity compensation. DAV supports passage of this
legislation; however, we oppose the rounding down to the next whole
dollar amount of the cost-of-living adjustment.
S. 910, VETERANS HEALTH EQUITY ACT OF 2011
This measure would require availability of at least one full-
service VA hospital or comparable services through contract, in each of
the 48 contiguous states.
Arguments have been made that New Hampshire was the only state that
did not have access to a VA full-service medical center and that the
most ill veterans in that state routinely had to drive or be
transported to Boston for more comprehensive health care services.
Members of Congress have stated they are particularly concerned that
the sickest and generally very elderly veterans with complex and
chronic health problems were subjected to having to first report to the
VA's Manchester facility--which could be up to a three-hour drive--and
then continue on for another hour to the Boston VA Medical Center
(VAMC) or other VA provider sites, in order to receive their care. It
was also noted by former Congresswoman Shea-Porter of New Hampshire,
that it may not be fiscally responsible, given the veteran population
in New Hampshire, to have VA provide a full continuum of hospital
services and that contracting for such services may be a better option.
Convenient access to comprehensive VA health care services remains
a problem for many of our Nation's sick and disabled veterans. While VA
must contract or use fee basis to provide care to some veterans, it
maintains high quality care and cost effectiveness by providing health
services within the system. According to VA, the Manchester VAMC in New
Hampshire provides urgent care, mental health and primary care
services, ambulatory surgery, a variety of specialized clinical
services, hospital based home care and inpatient long-term care. In
addition, CBOCs are located in Somersworth, Tilton, Portsmouth,
Littleton and Conway.
In light of the escalating costs of health care in the private
sector, to its credit, VA has done a remarkable job of providing high
quality care and holding down costs by effectively managing in-house
health programs and services for veterans. However, outside care
coordination is poorly managed by VA. When it must send veterans
outside the system for care, those veterans lose the many safeguards
built into the VA system through its patient safety program, evidence-
based medicine, electronic health records, and bar code medication
administration program (BCMA). The proposal in S. 910 to use broad-
based contracting for necessary hospital services in the New Hampshire
area concerns us because these unique internal VA features noted above
culminate in the highest quality care available, public or private.
Loss of these safeguards, which are generally not available in private
sector health systems, equate to diminished oversight and coordination
of care, and, ultimately, may result in lower quality of care for those
who deserve it most. However, we agree that VA must ensure that the
distance veterans travel, as well as other hardships they face in
gaining access, be considered in VA's policies in determining the
appropriate locations and settings for providing VA health care
services.
In general, current law places limits on VA's ability to contract
for private health care services in instances in which VA facilities
are incapable of providing necessary care to a veteran; when VA
facilities are geographically inaccessible to a veteran for necessary
care; when medical emergency prevents a veteran from receiving care in
a VA facility; to complete an episode of VA care; and for certain
specialty examinations to assist VA in adjudicating disability claims.
VA also has authority to contract to obtain the services of scarce
medical specialists in VA facilities. Beyond these limits and outside
certain ongoing rural health initiatives by VHA, there is no general
authority in the law to support broad-based contracting for the care of
populations of veterans, whether rural or urban.
DAV believes that VA contract care for eligible veterans should be
used judiciously and only in these authorized circumstances so as not
to endanger VA facilities' ability to maintain a full range of
specialized inpatient and outpatient services for all enrolled
veterans. VA must maintain a ``critical mass'' of capital, human, and
technical resources to promote effective, high-quality care for
veterans, especially those with complex health problems such as
blindness, amputations, spinal cord injury, Traumatic Brain Injury or
chronic mental health problems. Putting additional budget pressures on
this specialized system of services without making specific
appropriations available for new VA health care programs would only
exacerbate the problems currently encountered.
Nevertheless, after considerable deliberation, and in good faith to
be responsive to those who have come forward with legislative proposals
such as S. 910, to offer alternatives to VA health care, we have asked
VA to develop a series of tailored demonstration projects and pilot
programs to provide VA-coordinated care (or VA-coordinated care through
local, state, or other Federal agencies) in a selected group of
communities that are experiencing access challenges, and to provide to
the Committees on Veterans' Affairs reports of the results of those
programs, including relative costs, quality, satisfaction, degree of
access improvements, and other appropriate variables, compared to
similar measurements of a like group of veterans in VA health care. To
the greatest extent practicable, VA should coordinate these
demonstration pilots with interested health professions' academic
affiliates. We suggest the principles of our recommendations from the
``Contract Care Coordination'' section of the FY 2012 Independent
Budget be used to guide VA's approaches in this effort. Also, any such
demonstration pilot projects should be funded outside the Veterans
Equitable Resource Allocation (VERA) system, and their expenditures
should be monitored in comparison with VA's historic costs for care.
Veterans service organization representatives from the local areas
involved, and other experts need a seat at the table to help VA
consider important program and policy decisions, such as those
described here, that would have positive effects on veterans who live
in these areas. VA must work to improve access for veterans that are
challenged by long commutes and other obstacles in getting reasonable
access to a full continuum of health care services at VA facilities and
explore practical solutions when developing policies in determining the
appropriate location and setting for providing VA health care services.
As a final note, we believe VA must fully support the right of all
enrolled veterans to have reasonable access to health care and we
insist that funding for alternative care approaches and outreach be
specifically appropriated for this purpose, and not be the cause of
reductions in highly specialized VA medical programs within the health
care system.
S. 914, A BILL TO AUTHORIZE THE WAIVER OF THE COLLECTION OF COPAYMENTS
FOR
TELEHEALTH AND TELEMEDICINE VISITS OF VETERANS.
This measure would amend title 38, United States Code, section
1722A to provide VA the discretionary authority to waive collection of
copayments for VA telehealth and telemedicine.
The VA is recognized as a national leader in developing and using
telehealth and we applaud VA for publicly stating its intent to expand
use of cutting edge telehealth technology to broaden access to care
while improving the quality of health care services. Since its
implementation in 2003, VA's home telehealth includes monitoring of
patients with diabetes, heart conditions, hypertension, and depression.
Plans for this program include a doubling of unique veterans served in
FY 2010 from about 46,000 to 92,000 by FY 2012. Telehealth is also a
key initiative in collaboration with the Office of Rural Health to meet
the needs veterans residing in rural and remote areas.
Aided by the required expansion of telehealth services in VA's
CBOCs and readjustment counseling centers as authorized under Public
Law 109-461, the Department also uses clinical videoconferencing to
counsel patients suffering from mental health issues and polytrauma
injuries, and patients in need of rehabilitation. VA also has the
capability of store-and-forward telehealth for diabetic retinal imaging
and dermatology to provide a connection between patients and doctors to
distant specialists. However, we note the limited use of VA's store-
and-forward telehealth for diabetic retinal imaging and dermatology is
primarily used for the latter in cases such as wound care and lesion
diagnosis.
General outcomes of VA's telehealth programs indicate a reduction
in hospital admissions and increased patient satisfaction. Last fiscal
year alone, VA invested $121 million in telehealth and treated over
300,000 veterans.
However, while VA faces many issues to improve and further expand
telehealth, the success of these programs is contingent upon the
adoption of this type of care by the veteran patient population.
Eliminating copayments is one important tool that could facilitate VA's
success.
Accordingly, and with DAV Resolution No. 208 calling for the repeal
of medical copayments, DAV supports this legislation and looks forward
to its favorable consideration.
S. 928, A BILL TO LIMIT THE AUTHORITY OF THE SECRETARY OF VETERANS
AFFAIRS TO USE BID SAVINGS ON MAJOR MEDICAL FACILITY PROJECTS OF THE
DEPARTMENT OF VETERANS AFFAIRS TO EXPAND OR CHANGE THE SCOPE OF A MAJOR
MEDICAL FACILITY PROJECT OF THE DEPARTMENT.
This bill, if enacted, would provide for more efficient but
controlled use of bid savings from major medical facility construction
project contract awards by the Secretary of Veterans Affairs.
While we have no resolution from our membership dealing with this
specific issue, we would not object to enactment of this bill.
S. 935, VETERANS OUTREACH ENHANCEMENT ACT OF 2011
This bill would require the Secretary of Veterans Affairs to carry
out a program of outreach for veterans to increase the access and use
by veterans of Federal, State, and local programs providing
compensation for service in the Armed Forces and the awareness of such
programs by veterans and their eligibility for such programs.
Although we do not have resolution on this particular matter, DAV
currently provides such outreach to veterans and, therefore, we would
not oppose passage of this legislation.
S. 951, HIRING HEROES ACT OF 2011
This bill provides enhancements to several programs impacting
veterans. Section 10 modifies Federal hiring practices to encourage the
hiring of separating servicemembers and would allow them to begin the
Federal employment application process prior to separation. This is in
line with DAV Resolution 305, which supports veterans' preference in
public employment. The current Federal hiring process is slow and
cumbersome and the total number of Federal employees hired under
veterans' preference categories has shown only incremental increases
over the years. This legislative change could result in the substantive
improvement of recruitment and hiring of veterans generally and
service-disabled veterans specifically.
Section 2 provides a two-year extension, from December 31, 2012 to
December 31, 2014, of a program that provides rehabilitation and
vocational benefits to severely wounded members of the Armed Forces
under the Wounded Warrior Act.
This is line with DAV Resolution No. 307, which supports
strengthening of the Vocational Rehabilitation and Employment (VR&E)
program to meet the demands of disabled veterans.
Section 4 would provide up to an additional 24 months of vocational
rehabilitation and employment services to veterans who have exhausted
both these benefits and state-provided unemployment benefits.
Section 5 of the measure requires VA to engage, on a periodic
basis, with each veteran who has participated in its VR&E Program, to
determine whether the veteran is employed. This provision is in line
with DAV Resolution No. 307, which calls for VR&E to provide for
placement follow-up with employers for at least six months.
Section 6 of this measure would make participation in the
Transition Assistance Program (TAP) mandatory.
This provision is in line with DAV Resolution No. 230, which
recognizes the importance of TAP and the Disabled Transition Assistance
Program for those servicemembers transitioning to civilian status.
Section 8 creates a competitive grant program for nonprofit
organizations that provide mentorship and job training programs that
are designed to lead to job placements. Although DAV does not have a
resolution on this matter, we are not opposed to its favorable
consideration.
Section 9 requires that each servicemember receive an
individualized assessment of jobs they may qualify for when they
participate in TAP.
Although DAV does not have a resolution on this matter the
provision would greatly benefit transitioning servicemembers.
Therefore, we are not opposed to its favorable consideration.
Section 9 also requires the Department of Defense (DOD), the
Department of Labor (DOL) and VA to jointly contract for a study to
identify the equivalencies between certain military occupational
specialty (MOS)-related skills and civilian employment, and to
eliminate barriers between military training and civilian licensure or
credentialing for several military occupational specialties. This
provision is in line with DAV Resolution No. 100, which supports
efforts to eliminate employment barriers that impede the transfer of
military job skills to the civilian labor market.
Section 11 requires DOL to engage with each veteran on a periodic
basis to determine whether the veteran is employed or whether the
veteran might be interested in further assistance.
Although we have no applicable resolution regarding section 11, we
have no objection to the efforts proposed.
DAV strongly supports the passage of S. 951.
S. 957, VETERANS' TRAUMATIC BRAIN INJURY REHABILITATIVE SERVICES'
IMPROVEMENTS ACT OF 2011
This bipartisan and bicameral legislation would make improvements
to the so-called ``Wounded Warrior'' provisions of the National Defense
Authorization Act of 2008, Public Law 110-181, in that it would add
specificity and emphasis to preexisting requirements of VA's polytrauma
centers and other VA facilities that are treating and rehabilitating
brain-injured veterans from Iraq and Afghanistan. The language of this
bill is fully consistent with DAV's Resolution No. 215, which deals
with VA's treatment of Traumatic Brain Injuries (TBI).
Section 1710C(a), title 38, United States Code, as amended by the
Wounded Warrior provisions, requires VA to develop a rehabilitation
plan for each veteran being treated for TBI. If this bill is enacted,
that existing plan would need amendment to address expanded and
redefined rehabilitation, improved quality of life, and expressed
methods for the sustainment of improvements from rehabilitative
services provided by VA for TBI.
A new subsection (h) in section 1710C would redefine
``rehabilitative services'' for the purpose of sustaining these
improvements, promoting independence and advancing quality of life in
this severely injured population. While these concepts could be the
assumed or inherent goals of any physical rehabilitation plan, the bill
would make them explicit in the law, and would address cognitive and
mental health rehabilitation as well.
DAV strongly supports this bill, commends the sponsors in both
Congressional Chambers, and urges the immediate enactment of this
important legislation.
S. 1017, DISABLED VETERAN CAREGIVER HOUSING ASSISTANCE ACT OF 2011
This measure provides increased assistance for the Temporary
Residence Allowance (TRA) Grant program for disabled veterans living in
housing owned by a family member, and expands eligibility for Specially
Adapted Housing (SAH) grants for veterans with vision impairment from
blindness in both eyes, having only light perception, to those having
central visual acuity of 20/200 or less in the better eye with the use
of a standard correcting lens.
While the TRA Grant program has the potential to be an important
tool, a continued problem is that, should an eligible veteran choose to
participate in this program, the amount used is deducted from the
overall amount of the SAH Grant. The aggregate amount of assistance
available for SAH grants made pursuant to title 38, United States Code,
section 2101(a) is $63,780 throughout FY 2011. The aggregate amount of
assistance available for SAH grants made pursuant to section 2101(b) is
$12,756 during FY 2011. The TRA grant amounts are not indexed and
remain unchanged at $14,000 for grants administered under section
2101(a) and $2,000 for grants administered under section 2101(b).
The deduction of the TRA Grant from the overall SAH Grant alone may
cause many veterans to bypass this program and instead wait until they
have recuperated and use the SAH Grant to adapt their permanent
residence. While DAV does not have a resolution on this matter, we
believe Congress should decouple the TRA Grant from the SAH Grant so
the grant amount would not count against the overall grant for
permanent housing. The TRA grant amounts should also be indexed in the
same manner as the SAH Grant.
DAV supports the favorable consideration of this bill, since it
benefits severely disabled veterans living with their family members.
S. 1060, HONORING ALL VETERANS ACT OF 2011
This bill would improve education, employment, independent living
services, and health care for veterans, improve assistance for homeless
veterans, and improve the administration of the VA.
TITLE I, Education, Employment, and Independent Living Services for
Veterans, addresses a number of topics within our area of interest.
Section 101 increases the cap on the VA's Independent Living program
and Section 102 authorizes veterans to attend DOD TAP within their
first year of military separation. Section 103 requires the VA to
conduct a study on the recognition of military training and
qualifications of veterans by civilian employers and educational
institutions.
Section 103 requires the VA to conduct a study on the recognition
of military training and qualifications of veterans by civilian
employers and educational institutions. This is a critical area that
has been addressed on many occasions and numerous forums.
The provision is in line with DAV Resolution No. 100, which
supports efforts to eliminate employment barriers that impede the
transfer of military job skills to the civilian labor market. Based on
a review of both bills, DAV would encourage passage of S. 951, the
Hiring Heroes Act of 2011.
TITLE II, Assistance for Homeless Veterans, addresses repeal of
sunset on extension of enhanced protections for servicemembers relating
to mortgages and mortgage foreclosure under Servicemembers Civil Relief
Act in Section 201, and the modification for payment of services to
those providing services to homeless veterans in Section 202.
DAV has no resolution on these matters. We are not opposed to their
favorable consideration.
TITLE III, Health Care and Mental Health Services for Veterans,
addresses three areas of interest for the DAV.
Section 301 of this bill would require VA and DOD to establish a
mechanism for monitoring and reviewing the referral process of veterans
and servicemembers who are identified as having a potential mental
health condition based on DOD's post-deployment health assessment. The
review is to include identification and comparison of the number of
individuals who were referred to those who complete a course of mental
health treatment based on such referral.
Because VA and DOD share a unique obligation to meet the health
care needs, including mental health care and rehabilitation needs, of
veterans who are suffering from readjustment difficulties as a result
of wartime service, DAV supports this section based on DAV Resolution
No. 217, which supports program improvement and enhanced resources for
VA mental health programs, including its Vet Centers, to achieve
readjustment of new war veterans and continued effective mental health
care for all enrolled veterans needing such services.
Section 302 would amend title 38, United States Code, section 1710C
to require the individualized rehabilitation and reintegration plan
developed with the veteran or servicemember suffering from Traumatic
Brain Injury to include consideration for participation in the
Department's Independent Living Program and use of VA's employment
services provided through its Compensated Work Therapy Supported
Employment Services (CWT-SE) program. We also note that Section 101 of
this bill calls for an increase in the cap of the Independent Living
program.
The Independent Living program is aimed at veterans whose service-
connected disabilities are so severe they are currently unable to
pursue an employment goal under Chapter 31. The CWT-SE program has been
demonstrated to substantially increase competitive employment outcomes
for people who have severe disabilities and a demonstrated inability to
gain and/or maintain competitive employment.
Because the primary focus of the CWT-SE implementation is to
provide services to veterans diagnosed with Serious Mental Illness
(SMI), who, because of the severity of their disabilities, would not be
able to function independently in employment without intensive ongoing
support services, SMI veterans with psychosis constitute the majority
of participants in these programs. If this section is to be favorably
considered, we urge strong oversight by this Committee to ensure
programs services are adjusted to veterans suffering from the cognitive
and other adverse effects of Traumatic Brain Injury.
While DAV does not have a resolution on this matter, we are
concerned about the adequacy of the authorized participation rate for
the Independent Living program given the potential for expansion of
service to those suffering from Traumatic Brain Injury as well. The
solution is for Congress to eliminate the statutory cap. Otherwise, the
effect of the cap, with this anticipated increase in veteran demand for
services, is a delay in access to the Independent Living program by
severely disabled veterans.
Section 303 would authorize VA to provide the immediate family
members of a deployed servicemember consultation, professional
counseling, marriage and family counseling, training, and mental health
services necessary in connection with that deployment.
We are cognizant of and sensitive to the stresses on dependents of
servicemembers who are deployed; however, we question why such
authority should be afforded to the VA when such dependents have access
to mental health services under TRICARE.
TITLE IV, Administration of the Department of Veterans Affairs,
addresses two issues within our area of interest in Section 401 and
403.
Section 401 calls for monitoring of the DOD/VA Integrated
Disability Evaluation System (IDES). Specifically, it requires the
Secretaries of Defense and Veterans Affairs to jointly develop an IDES-
wide monitoring mechanism to identify and address issues following
collection and analysis of data on staffing levels at DOD and VA,
sufficiency of exam summaries and diagnostic disagreements. In
addition, they are to monitor data on caseloads and case processing
time by individual rating offices of the VA and the Physical Evaluation
Boards of the DOD as well as create a formal mechanism for agency
officials at local facilities to communicate challenges and best
practices to DOD and VA headquarters.
The President's Commission on Care for America's Returning Wounded
Warriors recommended that DOD and VA create a single, comprehensive,
standardized medical examination that the DOD administers. It would
serve DOD's purpose of determining fitness and VA's of determining
initial disability level. The Disability Evaluation System (DES) pilot
project premised on the commission's recommendation was launched by the
DOD and the VA in 2007. Using lessons learned from that pilot, the
legacy DES is transitioning to IDES in 2011 in a total of 140
locations, with the goal of expediting the delivery of VA benefits to
all out-processing servicemembers. Issues such as the sufficiency of
staffing levels and their training, adequacy of medical and mental
health exam summaries, the resolution of diagnostic disagreements,
caseloads and case processing time have been reported as having a
negative impact on the rollout of this program.
Initially, DOD and VA had indicated in their planning documents
that they had a target of delivering VA benefits to 80 percent of
servicemembers within the 295-day (active component) and 305-day
(reserve component) targets. The various rollout problems noted above,
however, have resulted in a reduction from the 80 percent to a 50
percent target.
DAV does not have a specific resolution on this matter, although
DAV Resolution No. 073 does address improvements in the VA claims
process. The steps laid out in Section 401 of the legislation are
essential to improving the IDES so benefits can be delivered closer to
the time veterans leave military service. Therefore, we support the
favorable consideration of this section of the bill.
Section 403 of this bill addresses treating certain misfiled
documents as ``motions for reconsideration'' of decisions by the Board
of Veterans' Appeals (Board). If an individual disagrees with a Board
decision, and has not filed a notice of appeal with the United States
Court of Appeals for Veterans Claims (Court) within the 120-day period
allowed, but files a document with the Board or the agency of original
jurisdiction not later than 120 days after the date of such decision,
which expresses disagreement with the Board's decision, such document
shall be treated as a ``motion for reconsideration.'' However, if the
Board or agency of original jurisdiction receives a document from an
appellant, which expresses the intent to appeal the Board's decision to
the Court, and the Board or agency of original jurisdiction must
forward such document to the Court within the 120-day appeal period
allowed, and it will be treated as a proper notice of appeal to the
Court
Section 403 of this bill is in line with the intent of DAV
Resolution 287, which supports legislation to ensure all veterans are
not prevented from filing timely appeals with the Court as a result of
sending the request for appeal to the wrong office or other good cause
reasons.
S. 1089, A BILL TO PROVIDE FOR THE INTRODUCTION OF PAY-FOR-PERFORMANCE
COMPENSATION MECHANISMS INTO CONTRACTS OF THE DEPARTMENT OF VETERANS
AFFAIRS WITH COMMUNITY-BASED OUTPATIENT CLINICS FOR THE PROVISION OF
HEALTH CARE SERVICES, AND FOR OTHER PURPOSES
Madam Chairman, we have not been afforded an opportunity to date to
examine the language specific to this bill; thus, we offer no
evaluative or definitive testimony on it during this hearing.
Nevertheless, we caution the Committee that ``pay for performance'' has
a mixed record of success in both the private and public sectors
(including in primary and secondary education), so we would be keenly
interested in closely examining this bill if its intent is to instill
similar incentives into VA's nearly 150 contract CBOCs. We understand
that historically, many of these mostly-rural and remote clinics
(including clinics in the Commonwealth of Kentucky) have expressed
concerns that they are significantly underpaid for the work they are
required to do under their variable contracts with VA Veterans
Integrated Service Networks (VISN) or individual VA medical centers.
While improving their contract pay rates would not necessarily be
objectionable to DAV on its face, any unintended effects of such a
policy (on supervising VA medical centers, other CBOCs within the
region or VISN, on labor relations, on cost control, and on veteran
patients themselves) need further scrutiny. Also, it should be noted
that VA's contractual methods for obtaining CBOCs are not uniform
throughout the VA system. As a partner organization of the Independent
Budget for Fiscal Year 2012, we have commented on this contract
variability and recommended the VISNs use a more uniform approach in
addressing their contract CBOC relationships. On this basis, and since
we have not examined the bill itself prior to today's hearing, we ask
that the Committee defer further consideration at this time on this
particular proposal.
S. 1104, VETERAN TRANSITION ASSISTANCE PROGRAM AUDIT ACT OF 2011
This bill requires the Secretary of Labor to conduct regular audits
of TAP, not less often than once every three years. These audits would
be done via a contractual relationship with a private organization not
affiliated with the program and the contractor would measure the
effectiveness of TAP, and identify any measures needed to improve the
effectiveness of the program.
The contractor will be required to submit its report to the
Secretary of Labor in conjunction with the Secretary of Defense, the
Secretary of Homeland Security, and the Secretary of Veterans Affairs,
as well as the Committees on Armed Services and the Committees on
Veterans' Affairs of the House and Senate. The Secretary of Labor, in
conjunction with the other Secretaries, will review the report and
implement any measures needed to improve the effectiveness of TAP.
This legislation is in keeping with the intent of DAV Resolution
230, by ensuring the TAP and Disabled Transition Assistance Program are
viable, up to date programs, helpful in the difficult task of
transitioning from military service to civilian life as well as
overcoming the many obstacles to successful employment.
DAV supports this bill.
S. 1123, ASSISTANCE TO VETERANS AFFECTED BY NATURAL DISASTERS ACT
This bill would amend title 38, United States Code, to improve the
provision of benefits and assistance under laws administered by the
Secretary of Veterans Affairs to veterans affected by natural or other
disasters, and for other purposes.
Section 1, Assistance to Veterans Affected by Natural Disasters,
would amend chapter 21 of title 38, United States Code, to allow the
Secretary of Veterans Affairs to award a grant to a veteran whose home
was previously adapted with assistance of a grant under this chapter in
the event the adapted home that the veteran occupied was destroyed or
substantially damaged in a natural or other disaster, as determined by
the Secretary. The amount of the grant that could be awarded may not
exceed the lesser of either the reasonable cost, as determined by the
Secretary, of repairing or replacing the damaged or destroyed home in
excess of the available insurance coverage on such home; or the maximum
grant amount the veteran would have been entitled under the applicable
section 2102 of this title had the veteran not obtained the prior
grant.
Grants should be available for special adaptations to homes
veterans purchase or build to replace an initial specially adapted
home. Further, an initial home may become too small when the family
structure changes or the nature of the veteran's disability changes,
necessitating a home configured differently and/or changes to the
special adaptations. In addition, technological changes occur rapidly
and additional modifications, after the initial housing grant, may
maximize the veteran's independence as well as improve the ability for
caregivers to provide medically necessary care. These evolving
requirements merit a second grant to cover the costs of adaptations to
a new home.
While DAV does not have a resolution on this matter, we are not
opposed to favorable consideration of this legislation.
This bill also provides for a two-month extension of subsistence
allowance for veterans completing vocational rehabilitation program.
Specifically, when the Secretary determines that a veteran
participating in VA's Vocational Rehabilitation program is displaced as
the result of a natural or other disaster, two months of additional
payments of subsistence allowance may be granted.
This measure would waive the cap on the Independent Living program
by amending Section 3120(e) of such title 38, United States Code, so
that such a cap shall not apply when the Secretary determines that a
veteran participating in the Independent Living program has been
displaced or otherwise been adversely affected by a natural or other
disaster.
This legislation also seeks to modify covenants and liens created
by public entities in response to disaster-relief assistance.
Specifically, the Secretary, in determining whether a loan is so
secured, may either disregard or allow for subordination to a superior
lien created by a duly-recorded covenant running with the realty in
favor of either a public entity that has provided or will provide
assistance in response to a major disaster as determined by the
President under the Robert T. Stafford Disaster Relief and Emergency
Assistance; or a private entity to secure an obligation to such entity
for the homeowner's share of the costs of the management, operation, or
maintenance of property, services, or programs within and for the
benefit of the development or community in which the veteran's realty
is located, if the Secretary determines that the interests of the
veteran-borrower and of the government will not be prejudiced by the
operation of such covenant.
Last, this bill proposes modification to section 3903 of title 38,
United States Code, covering automobiles and other conveyances for
certain disabled veterans and members of the Armed Forces. If enacted,
the Secretary would have the option of providing or assisting eligible
veterans with a second automobile or other conveyance. The Secretary
would require satisfactory evidence that the automobile or other
conveyance previously purchased with assistance under this chapter was
destroyed as a result of a natural or other disaster, as determined by
the Secretary. The loss of the vehicle would be no fault of the
eligible person; and the eligible person would not otherwise receive
compensation from a property insurer for the loss.
DAV has no resolution on these matters. However, we would not
oppose the favorable consideration of this legislation.
S. 1124, VETERANS TELEMEDICINE ACT OF 2011
This measure would require VA to provide teleconsultation for
mental health and Traumatic Brain Injury assessments and require VA
ensure each VISN has a teleretinal imaging program. VA would also be
required to increase the number of enrolled veterans in both programs
by five percent annually from FY 2010 to 2015.
DAV has no resolution to support this measure; however, we would
like to highlight those provisions we believe would be beneficial to
service-connected disabled veterans. This measure would require each VA
medical facility with an affiliate agreement to develop an elective
rotation to train in telemedicine. The bill would also require VA to
address its resource allocation system to act as an incentive for using
telehealth. DAV believes this is a critical component of this measure.
How health services are funded, whether through allocation or
reimbursement systems, plays a major role in determining how the
service delivery is organized. The VHA is no different in this respect.
VHA resources are allocated by a system known as VERA. This funding
mechanism has features that encourage the development of certain
services such as for non-institutional care and serious mental illness.
To ensure funding arrangements such as these are targeted to the
intended patient populations, there are eligibility criteria for
patients and requirements that must be met.
The evolution of VERA over the years did not reflect the growing
access and utilization of telehealth services. Since at least 2008,
telehealth workload is reported for program evaluation and meeting
performance standards but there is no VERA credit to allow for proper
allocation of resources. DAV is concerned that little has been done to
address this glaring flaw.
While it is not clear whether correcting VERA to give credit to
telehealth would increase telehealth workload, increasing resources to
those facilities providing telehealth, and thus providing the means to
provide greater access, DAV believes it would at minimum address the
resistance to telehealth by VA providers.
S. 1127, VETERANS RURAL HEALTH IMPROVEMENT ACT OF 2011
This bill would establish authority for the Secretary to form and
operate from one to five new ``Centers of Excellence for Rural Health
Research, Education, and Clinical Activities,'' modeled on legislation
that authorizes VA Mental Illness Research, Education and Clinical
Centers (MIRECC) and Geriatric Research, Education and Clinical Centers
(GRECC). Based on DAV Resolution No. 221, calling for improvements in
rural health, we support this bill and urge its enactment. We believe
both the MIRECC and GRECC model programs are effective in organizing
resources and concentrating energy to solve myriad issues in mental
illness, geriatrics and gerontology, and we would anticipate similar
results from implementation of this new authority to address deficits
in rural health. We appreciate the sponsor's intentions and strongly
endorse the bill.
DRAFT BILL, VETERANS PROGRAMS IMPROVEMENTS ACT OF 2011
Draft legislation entitled the ``Veterans Programs Improvement Act
of 2011'' would amend title 38, United States Code, to improve the
provision of assistance to homeless veterans and the regulation of
fiduciaries who represent individuals for purposes of receiving
benefits under laws administered by the Secretary of Veterans Affairs,
as well as other administrative and benefit matters.
TITLE I, Homeless Veterans Matters, addresses a number of issues,
including an update on the campaign to end homelessness among veterans
through enhanced collaboration with other Federal, state, faith-based,
veterans service organization and community partners that was launched
by the Secretary of Veterans Affairs in 2009.
This provision is in line with DAV Resolution 223, which supports
strengthening the capacity of the VA Homeless Veterans program.
TITLE II, Fiduciary Matters, focuses on appointment of caregivers
and persons named under durable power of attorney as fiduciaries for
purposes of benefits and access to financial records of individuals
represented by fiduciaries and receiving benefits under laws
administered by VA and other issues.
DAV has no resolution on these matters, and therefore, we take no
position.
TITLE III, Other Administrative and Benefits Matters, touches on
several areas. Of interest to DAV is Section 302, which would provide a
waiver of loan fees for individuals with disability ratings issued
during pre-discharge programs. This section would partially fulfill DAV
Resolution 074, which supports repeal of funding fees for VA home loans
for all veterans.
DAV also supports Section 306, automatic waiver of agency of
original jurisdiction review of new evidence. This is in line with DAV
Resolution No. 073, which calls for reform of the Veterans Benefits
Administration disability claims process to significantly reduce the
claims backlog.
DRAFT BILL, ALASKA HERO'S CARD ACT OF 2011
This bill would establish a new pilot program under which, in the
most remote locales in Alaska, service-disabled veterans (at any level
of disability) would be issued an ``Alaska Hero Card'' by the
Department of Veterans Affairs. Issuance of the card would entitle the
possessor to obtain unlimited health care (hospital care and medical
services) at no out-of-pocket cost for any condition from a private
provider, if the private provider were eligible to receive payments
under Medicare or the military TRICARE program. The Secretary would be
required under the bill to take measures to ensure care received under
the pilot program was of equal quality to that which would be obtained
directly from VA; and that providers were qualified, accredited and
credentialed to provide the care needed by these veterans.
We have long been concerned about the use of non-VA purchased
health care. While our members are major users of both the fee-basis
and contract hospitalization programs under current statutory
authority, we have criticized those programs as expensive,
uncoordinated, and even of questionable quality, safety and value to
these disabled veterans. Despite those problems we continue to believe
that current legal authorities are sufficient to meet most needs of
service-disabled veterans if certain improvements were made by VA in
how these programs are administered. We have discussed these concerns
and needs for improvement on multiple occasions in testimony and in the
Independent Budget for Fiscal Year 2012.
In good conscience we could not support this proposal for Alaska
veterans without also advocating a similar program for veterans in all
rural and remote regions. We have noted in prior testimony our concern
that there must be a balance in using non-VA services to avoid the
slippery slope of replacing VA as a direct provider and substitutes an
insurance function in its place. Absent exclusive funding outside the
Medical Services appropriation, this shift has the potential to erode
VA's congressionally mandated specialized medical programs, and may
diminish care for all veterans. Thus, we cannot offer our support for
this pilot program.
We note that the Office of Rural Health is conducting multiple
pilot programs (funded separately by Congress) to extend access to care
for veterans who live in frontier areas, including in Alaska. We urge
the sponsor of this measure to work closely with that office to address
the problem identified by the purposes of this bill.
Madame Chairman and Members of the Committee, this concludes my
statement and I would be happy to answer any questions you may have.
Chairman Murray. Thank you very much.
Mr. Kelley?
STATEMENT OF RAYMOND C. KELLEY, DIRECTOR, NATIONAL LEGISLATIVE
SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES
Mr. Kelley. Madam Chairman, Ranking Member Burr, Members of
the Committee, thank you for the opportunity to allow me to
testify today and on behalf of the 2.1 million members of the
Veterans of Foreign Wars and our auxiliaries. I am going to
limit my remarks to just a handful of the bills that are on the
table today.
The VFW supports the concept of the Caring for Camp Lejeune
Veterans Act of 2011. While we believe the Government has a
moral obligation to provide care for those affected by
contaminated water at Camp Lejeune, we would emphasize that the
burden of care provided for those family members affected
should be on the Department of Defense.
The VFW supports S. 411. Homelessness can best be reduced
with local solutions. The bill will allow VA and local
communities to partner together to help reach a goal of
eradicating veterans' homelessness.
The VFW admires the concept of S. 423 but has reservations
and will withhold support for this legislation. A veteran could
provide all the medical evidence available, making the claim
appear to be fully developed, but further medical tests could
be needed to determine the severity of the disability. The VFW
also believes that this could lead to new types of appeal. If
the veteran feels they submitted a fully developed claim and VA
decides to do additional but unnecessary development, should
the veteran be allowed to protest or appeal the additional
development or appeal the effective date?
Also, the fully developed incentive is not limited to
initial claims. Simple claims that are being reopened for an
increase that take little to no development would qualify for
the retroactive payment, as would claims for certain
hospitalized veterans who would rate temporary 100 percent
rating. All these veterans would need is a report of
hospitalization with an entry and discharge date, a diagnosis,
and they would qualify for 1 year of retroactive pay at 100
percent rating. The VFW does not believe that this is the
intent of the legislation but identifies them as patient
unintended consequences.
The VFW also sees an impact on veterans service officers
who help veterans file claims. If a service officer pronounces
a claim fully developed and VA then develops the claim further,
liability on the service officers and the VSOs could increase
when the veteran sues them for the loss of the retroactive
payment because the VSO stated it was fully developed.
The VFW supports S. 745. This legislation would protect
students who are currently enrolled in a degree-seeking program
for any possible negative effect of changes that were made in
the post-9/11 GI bill last year. These students chose their
degree program with the expectation that the Yellow Ribbon
Program they began with would still be there until they
completed their degree. We must keep up our end of the bargain.
The VFW supports S. 815, the SERVE Act. We fully support
any legislative effort that emphasizes that the right of free
speech does not trump a family's right to mourn in private.
Those who use the First Amendment as both a shield and a sword
to harm their fellow citizens need to have limits on such
abuse, and S. 815 provides those limits.
The VFW supports S. 951, the Hiring Heroes Act of 2011. I
would like to highlight a few of the provisions in the bill.
TAP must be mandatory for all servicemembers leaving the
military. The VFW also believes that consultation with the VA
should be included in all TAP programs.
Direct hiring authority for Federal agencies and offering
citizen work experience for potential civil service employees
while on terminal leave will cut down on red tape for veterans
seeking careers within the Federal workforce.
The intent of voc rehab is to ensure that veterans who are
disabled in the line of duty would be trained and employable in
a new career field. If a veteran has used their voc rehab
benefits yet remains unemployed, then their initial voc rehab
program clearly has failed. Adding an additional 2 years of
VR&E benefits to those veterans will greatly assist them in
finding employment.
Madam Chairwoman, this concludes my oral remarks, and I
look forward to any questions the Committee may have.
[The prepared statement of Mr. Kelley follows:]
Prepared Statement of Raymond C. Kelley, Director, National Legislative
Service, Veterans of Foreign Wars of the United States
Madam Chairwoman and Members of this Committee: On behalf of the
2.1 million members of the Veterans of Foreign Wars of the United
States and our Auxiliaries, the VFW would like to thank this Committee
for the opportunity to present its views on these important veterans'
bills.
S. 277, CARING FOR CAMP LEJEUNE VETERANS ACT OF 2011
The VFW supports the concept of the Caring for Camp Lejeune
Veterans Act of 2011, which would require the Department of Veterans
Affairs (VA) to provide health care to servicemembers, veterans, and
their family members who have experienced adverse health effects as a
result of exposure to well water contaminated by human carcinogens at
Camp Lejeune.
Thousands of Navy and Marine veterans and their families who lived
on Camp Lejeune have fallen ill with a variety of cancers and diseases
believed to be attributable to their service at the base before the
Environmental Protection Agency (EPA) designated it a Superfund site in
1988. Additionally, the National Research Council recently reported
numerous adverse health effects associated with human exposure to the
chemicals known to have been in water at the installation.
This legislation would allow a veteran or military family member
who was stationed at Camp Lejeune during the time the water was
contaminated to receive needed health care at a VA facility. While we
believe the government has a moral obligation to provide care for those
affected by contaminated water at Camp Lejeune, we would emphasize that
the burden for care provided to those family members affected should be
on the Department of Defense (DOD). DOD should allow TRICARE to cover
the cost and services of any health care given family members who were
stationed on base at the time of the exposure.
If DOD is unwilling to provide care then they should at the very
least reimburse VA for any care provided through CHAMPVA services. We
applaud the Committee's work on this legislation but note that many
years have gone by with no solution for those suffering. Providing
health care benefits to those who were exposed at Camp Lejeune is the
right thing to do and we hope that there is a positive conclusion this
year.
S. 396, MEETING THE INPATIENT HEALTH CARE NEEDS OF
FAR SOUTH TEXAS VETERANS ACT OF 2011
VFW does not hold an opinion regarding this legislation. The bill
calls for the expansion of the Harlingen VA Outpatient Clinic to a
full-service, inpatient care facility. VFW would suggest that VA asses
South Texas' access and utilization gaps to ensure that veterans in
that region are receiving a full continuum of care without the burden
of excessive travel, and if there are gaps, prioritize the need and
have it added to SCIP.
S. 411, THE HELPING OUR HOMELESS VETERANS ACT OF 2011
The VFW supports this legislation to give VA more tools to
eliminate homelessness among our veterans. Not only does a veteran
living on the streets indicate a break of trust and a deeply flawed
system of care, it also represents missed opportunities and big
challenges to help these men and a growing number of women get their
lives back on track. We firmly believe that veterans should have every
opportunity to lead productive and fulfilling lives in the manner and
location of their choosing, and this legislation is an important step
in that direction.
Provisions in the bill would allow VA to expand partnerships with
community and local government entities, which we believe will improve
options to rural and underserved urban veterans. Critical measures to
ensure quality are embedded in the legislation along with essential
case management services including employment, financial and family
counseling among others. Community groups receiving grants from VA will
be given an opportunity to provide formal recommendations to improve
the process; a positive development VFW believes will enhance the
partnerships between VA and the local community.
S. 423, RETROACTIVE PAY FOR ``FULLY-DEVELOPED'' DISABILITY CLAIMS
SUBMITTED BY VETERANS
VFW admires the concept, but has reservations and will withhold
support for this legislation. S. 423 would provide authority to
retroactively award veterans with an additional year of disability
compensation for submitting a ``fully developed'' claim; however, VFW
believes there are potential problems that could arise from enacting
the bill in its current form.
Defining fully developed will be critical. A veteran could provide
all the medical evidence available, making the claim appear to be fully
developed, but further medical tests could be needed to determine the
severity of the disability. This could be defined as not fully
developed leaving the veterans feeling that the process of doing VA's
job was disingenuous. VFW also believes that this could lead to a new
type of appeal. If the veteran feels they submitted a fully-developed
claim and VA decides to do additional but unnecessary development
should the veterans be allowed to protest, appeal the additional
development, or appeal the effective date?
Also, the fully developed incentive is not limited to initial
claims. Simple claims that are being reopened for an increase that take
little to no development would qualify for retroactive payment, as
would claims from veterans who are hospitalized in a VA facility for
treatment of a service-connected disability for more than 21 days who
are entitled to a temporary 100-percent disability rating. All these
veterans would need is a report of hospitalization with an entry and
discharge date, and a diagnosis and they would qualify for one year of
retroactive pay at a 100-percent rating. VFW does not believe this is
the intent of the legislation, but identifies them as potential
unintended consequences.
VFW also sees an impact on veterans' service officers who help
veterans file claims. If a service officer pronounces a claim fully
developed and VA then develops the claim further, liability on the
service officer and the VSOs could increase when a veteran sues them
for the loss of the retroactive payment because the VSO stated it was
fully developed.
S. 486, PROTECTING SERVICEMEMBERS FROM MORTGAGE ABUSES ACT OF 2011
The VFW supports S. 486 which would extend SCRA mortgage
protections from the current nine months to 24 months after military
service is completed. At a time when the housing market is in crisis
and many homeowners are in foreclosure, it is critical that we help
protect those who have served. Long deployments, injuries and illness
often contribute to financial difficulties of many deployed
servicemembers. We believe that they should not have to worry about a
possible mortgage foreclosure, eviction and/or seizure of their home.
This legislation would offer some time for servicemembers and their
families to get their finances in order and explore viable options so
that they can keep their homes. We hope the Committee will consider
this legislation and enact it soon.
S. 490, A BILL AMEND TITLE 38, UNITED STATES CODE, TO INCREASE THE
MAXIMUM AGE FOR CHILDREN ELIGIBLE FOR MEDICAL CARE UNDER THE CHAMPVA
PROGRAM, AND FOR OTHER PURPOSES.
The VFW strongly supports this legislation to extend the age limit
for coverage of veterans' dependents through the Civilian Health and
Medical Program of the Department of Veterans Affairs (CHAMPVA) to the
level set by the Patient Protection and Affordable Care Act.
The health care reform legislation, passed in early 2010, allowed
families with private health insurance coverage to keep their children
on their plans until age 26. Left out of that change was TRICARE and
CHAMPVA recipients. Thanks to responsible leaders in Congress, TRICARE
coverage has been guaranteed to this age group. Unfortunately, CHAMPVA
beneficiaries have not been afforded the same privileges. This program,
which was established in 1973 and has more than 330,000 unique
beneficiaries, comprised of dependents and survivors of certain
veterans, should in no instance ever receive less than the national
standard. This legislation would provide equity to CHAMPVA
beneficiaries and rectify this outstanding issue.
S. 491, THE HONOR AMERICA'S GUARD-RESERVE RETIREES ACT
The VFW strongly supports this legislation, which would give the
men and women who choose to serve our Nation in the Reserve component
the recognition that their service demands. Many who serve in the Guard
and Reserve are in positions that support the deployments of their
active duty comrades to make sure the unit is fully prepared when
called upon. Unfortunately, some of these men and women serve 20 years
and are entitled to retirement pay, TRICARE, and other benefits, but
are not considered a veteran according to the letter of the law.
Such men and women have answered the call just like their active
duty comrades have- with distinction and honor- but have fallen subject
to certain types of orders and other administrative stumbling blocks.
In recent years, Congress has enhanced material benefits to the members
of the Guard and Reserve and this bill does not seek to buildupon those
provisions; it simply seeks to bestow honor upon the men and women of
the Guard and Reserve to whom it is due. After much work on this
legislation in recent years, we can say with confidence that there will
be no unintended material benefits garnered by anyone through the
language of this bill, and we are proud to support its passage.
S. 536, A BILL TO AMEND TITLE 38, U.S.C., TO PROVIDE THAT UTILIZATION
OF CHAPTER 35 EDUCATIONAL ASSISTANCE SHALL NOT BE SUBJECT TO THE 48-
MONTH LIMITATION WHEN UTILIZING MULTIPLE VA EDUCATIONAL PROGRAMS.
VFW supports S. 536 which would amend Section 3695 of title 38 to
remove the 48-month limitation on the use of Chapter 35 and any other
qualifying educational benefits. There are approximately 100
servicemembers per year who, because of their military service, quality
for other educational benefits.
S. 572, A BILL TO AMEND TITLE 38, UNITED STATES CODE, TO REPEAL THE
PROHIBITION ON COLLECTIVE BARGAINING WITH RESPECT TO MATTERS AND
QUESTIONS REGARDING COMPENSATION OF EMPLOYEES OF THE VA OTHER THAN
RATES OF BASIC PAY AND OTHER PURPOSES.
THE VFW HAS NO POSITION ON THIS BILL.
S. 666, THE VETERANS TRAUMATIC BRAIN INJURY CARE IMPROVEMENT ACT OF
2011
The VFW supports the legislation to require a report on
establishing a Polytrauma Rehabilitation Center or Network site in the
northern Rockies or Dakotas. Polytrauma care is provided to veterans
and returning servicemembers with injuries to more than one physical
region or organ system that could be life threatening and/or result in
a physical, cognitive, psychological, or psychosocial impairment. The
vast majority of polytrauma patients have been on active duty and
sustained a traumatic injury while in combat. Most of these patients
are then discharged and receive very specialized follow-up care at a
Polytrauma Network Site or other VA facility.
VA's Polytrauma System of Care (PSC) includes four Polytrauma
Rehabilitation Centers and 21 Polytrauma Network Sites. The area that
this bill would require VA to study--North Dakota, South Dakota, Idaho,
Montana, eastern Washington and Wyoming--have no PSC coverage, and yet
have among the highest per capita rates of veterans with injuries from
military service in Iraq and Afghanistan. The importance of providing
every treatment option to polytrauma patients cannot be overstated, and
we will look closely at any and all research related to the provision
of such treatment for these veterans.
S. 696, A BILL TO AMEND TITLE 38, UNITED STATES CODE, TO TREAT VET
CENTERS AS VA FACILITIES FOR PURPOSES OF PAYMENT OR ALLOWANCES FOR
BENEFICIARY TRAVEL TO DEPARTMENT FACILITIES AND FOR OTHER PURPOSES.
This legislation would provide veterans with a travel reimbursement
for trips to Vet Centers that is equal to what they currently receive
for travel to VA health centers. Veterans seeking help at Vet Centers
will be able to receive mileage reimbursement without having to reveal
their identity beyond current VA policies, a point of particular
concern for privacy purposes. VFW supports this bill and believes that
not only will it ease some of the costs incurred by the veteran; it may
encourage more veterans to seek out the unique counseling offered at
the centers.
S. 698, A BILL TO CODIFY THE PROHIBITION OF GRAVESITES AT ARLINGTON
NATIONAL CEMETERY, AND FOR OTHER PURPOSES.
This legislation is long overdue. It will finally prohibit, in law,
the insider practice of allowing certain high-ranking military members
and other YIPs to pre-select their gravesites. This practice was banned
by Army policy in 1962--nearly 50 years ago--yet cemetery
administrators continued to arbitrarily allow some to skirt the rules.
Burial at Arlington National Cemetery is a tremendous honor that
depends on honorable service, not rank. It is obvious that greater
accountability and transparency is needed, so we appreciate language in
this bill that requires a full audit and a report back to Congress.
S. 745, A BILL TO PROTECT CERTAIN VETERANS WHO WOULD OTHERWISE BE
SUBJECT TO A REDUCTION IN EDUCATIONAL ASSISTANCE BENEFITS, AND FOR
OTHER PURPOSES.
The VFW supports this legislation. It would protect students who
are currently enrolled in a degree seeking program from any possible
negative effects of changes that were made to the Post-9/11 GI Bill
last year. Those changes established a nationwide cap on tuition at
private institutions and for students seeking a degree from a public
institution at a state other than the one in which they reside. Many of
these students could potentially be saddled with debt or out-of-pocket
expenses as a result of these changes in tuition payment rates set to
take effect this August because the changes did not exempt students who
were already enrolled into a degree program.
These students chose their degree program with the expectation that
the Yellow Ribbon Program they began with would still be there until
they completed their degree, and we must keep up our end of the
bargain. S. 745 would only apply to students who were already enrolled
before last year's changes, and would sunset in December 2014. This is
sound policy and the VFW supports it.
S. 769, VETERANS EQUAL TREATMENT FOR SERVICE DOGS ACT
The use of medical service dogs among veterans is increasing, and
many of our newest veterans who are returning home from war with mental
and physical disabilities have a particular need for their services. We
believe that trained dogs play a significant role in helping provide
independence to individuals with disabilities, and research shows they
can lessen symptoms associated with depression, PTSD and other mental
illnesses.
Currently VA allows seeing-eye dogs to enter medical facilities
without limitations. Senator Harkin's legislation would allow all
service dogs into facilities that receive VA funding. VFW is happy to
lend our support to a benefit that is often overlooked and can go a
long way toward helping an individual with a disability that may not be
able to perform a task independently.
S. 780, VETERANS PENSIONS PROTECTION ACT OF 2011
The VFW appreciates the intent of this legislation, but believes it
will impose an undue burden on VA. It would require VA to make further
determinations regarding replacement values in cases of insurance
settlements thus reducing resources available to the timely processing
of other pension claims. These additional decisions will further delay
and complicate a relatively simple benefit. We urge the Committee to
craft a less burdensome method for accomplishing this laudable goal.
S. 815, SANCTITY OF ETERNAL REST FOR VETERANS ACT OF 2011
The VFW is proud to support the SERVE Act to strengthen and extend
protections already provided by Section 1388 of title 18, United States
Code by including civilian cemeteries in the law. It would also double
the ``No Protesting'' window to two hours before and after funerals,
increase protest distances for those grieving and toughen penalties to
two years in jail and/or a $250,000 dollar fine, and permit family
members and the U.S. Attorney General to sue violators for monetary
damages.
We fully support any legislative effort that emphasizes that the
right of free speech does not trump a family's right to mourn in
private. Those who use the First Amendment as both a shield and a sword
to harm their fellow citizens need to have limits on such abuse and
S. 815 provides those limits.
S. 873, TO AMEND TITLE 38, UNITED STATES CODE, TO PROVIDE BENEFITS FOR
CHILDREN WITH SPINA BIFIDA OF VETERANS EXPOSED TO HERBICIDES WHILE
SERVING IN THE ARMED FORCES DURING THE VIETNAM ERA.
VFW strongly supports S. 873, legislation that would allow all
children of veterans exposed to herbicides with spina bifida to receive
medical service and benefits at VA. As stipulated in Chapter 18, Sec
1821 of title 38, U.S.C., a child of a veteran who was exposed to
herbicides used in Korea is currently covered for all health care,
vocational rehabilitation and other benefits, as if the veteran had
served in qualifying areas in and around Vietnam. That authority,
however, does not extend to those claimants that may have been outside
of Korea but were also exposed to herbicides during the Vietnam era and
whose children were then born with birth defects or abnormalities like
spins bifida. This legislation expands coverage and includes those
children. The VFW has long supported entitlements for conditions caused
by herbicide exposure, and we believe this bill will correct an
inequity in the current law.
S. 874, TO AMEND TITLE 38, UNITED STATES CODE, TO MODIFY THE PROVISION
OF COMPENSATION AND PENSION TO SURVIVING SPOUSES OF VETERANS IN THE
MONTHS OF THE DEATHS OF THE VETERANS, TO IMPROVE LOAN BENEFITS FOR
VETERANS, AND FOR OTHER PURPOSES.
The VFW supports all the provisions in this bill. Although we find
merit in Section 1 which liberalizes current law, we do have concerns
that it does not address those veterans who may be receiving
compensation but who are seeking an increased evaluation because of
increased disability. Under this legislation, it appears that VA would
only pay the amount of current compensation and not that which would
have been payable but for the untimely death of the veteran. We urge
the Committee to amend this bill to include those veterans who die
while a claim for increased compensation is pending.
S. 894, THE VETERANS' COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF
2011
The VFW supports this legislation. Veterans have not received a
COLA increase in two years, but are still paying more at the grocery
store, pharmacy, gas pump, and elsewhere. We are encouraged that recent
data shows a 2.9-percent increase in the CPI-W over the 2008 COLA base,
the last base to result in a COLA increase. We are hopeful that
veterans and survivors will see a corresponding increase in their
pensions and other compensation, such as DIC, in the coming year. This
legislation is the vehicle to ensure that takes place.
S. 910, THE VETERANS HEALTH EQUITY ACT OF 2011
The VFW supports an access evaluation for regions with an ever-
growing veterans' population, as we do find it noteworthy that a state
in the contiguous United States would not have a full-service VA
Medical Center. We view the VA's Strategic Capital Investment Plan
(SCIP) to prioritize capital investments favorably, but remain
concerned that funding levels do not suggest such matters are high
priority for VA. Unless the out-years are funded much more aggressively
than the current years, VA will not be able to meet demands, facilities
will require more maintenance funding, and the priority list will
continue to grow. At this time, VFW cannot support the legislation to
mandate facilities in each of the contiguous 48 states, but we would
support an evaluation to determine the need of underserved locales like
Manchester, N.H.
S. 914, A BILL TO AMEND TITLE 38, UNITED STATES CODE, TO AUTHORIZE THE
WAIVER OF THE COLLECTION OF COPAYMENTS FOR TELEHEALTH AND TELEMEDICINE
VISITS OF VETERANS, AND FOR OTHER PURPOSES.
The VFW strongly supports this legislation, which would exempt
disabled veterans from paying copayments for telehealth and
telemedicine visits. By waving copayments we encourage the use of a
range of convenient and cost-effective services that connect care
providers to the veteran using modem telecommunications applications.
The VFW applauds VA for their pioneering efforts in this new area
of health care. Telehealth leverages new technologies to make
diagnoses, manage care, perform check-ups, and actually provide care to
veterans. The use of video technologies makes it possible for veterans,
many of whom live in rural or remote areas, to come to VA's community-
based outpatient clinics and connect to a specialist or other
practitioner who may be in a hospital hundreds or even thousands of
miles away. Offering these services is a wise stewardship of limited
resources. They provides a great return on investment and can expedite
care to veterans while reducing some of the hassles and headaches
associated with travel for routine or intensive services. Therefore, we
are pleased to offer our support for this legislation.
S. 928, A BILL TO LIMIT THE VA SECRETARY'S AUTHORITY TO USE BID SAVINGS
TO EXPAND OR CHANGE CAPITAL PROJECTS.
The VFW supports this legislation to limit the Secretary of VA's
authority to use bid savings from major construction projects as long
as the savings will be reinvested in other construction projects.
Congress must authorize construction spending; therefore it is logical
that Congress be made aware of how the savings will be utilized.
However, VFW must insist that any bid savings that occur must be
reinvested in construction to help reduce the every growing backlog of
construction projects.
S. 935, VETERANS OUTREACH ENHANCEMENT ACT OF 2011
The VFW supports this legislation that would require VA to carry
out a program of outreach to veterans by reaching out to Federal and
state agencies as well as veterans service organizations (VSO) to
provide information about VA benefits and services available.
Section 3 is critical in filling a gap in our most rural and
economically challenged areas. VA will be required to enter into
agreements with the Appalachia Regional Commission, the Delta Regional
Authority, the Denali Commission, the Northern Great Plains Regional
Authority and other areas of historically high poverty, unemployment,
substandard housing, low educational levels, and poor health care
services. Many within the military/veteran population living in these
areas are unaware of the benefits provided by VA or other local, county
and state veterans' services. Combine that with scant access to care,
varying support services and problems finding transportation to VA
appointments and we can all agree more outreach is needed in these
isolated areas. We look forward to working with the communities
mentioned in this bill and encourage Congress to appropriate adequate
funding to be able to continue offering comprehensive education and
outreach to rural veterans.
However, the VFW does have concerns over the language in Section 2
regarding potential grants and contracts for VSOs and small businesses.
VFW understands that the section may be designed to encourage outreach
to veterans eager to start small businesses in underserved communities,
but in its current form, VFW believes the language creates the
potential for businesses to take advantage of Federal grants.
S. 951, HIRING HEROES ACT OF 2011
The VFW supports S. 951, the Hiring Heroes Act of 2011, and
considers this bill a critical and overdue piece of legislation that
will help our Nation's heroes reenter and remain competitive in the
workforce. During recent difficult economic times, young veterans of
the wars in Iraq and Afghanistan have been disproportionately affected
by a stagnant job market, which is why VFW believes Congress should
take every step necessary to ensure that our Nation's heroes have
viable careers available to them when they leave the military. VFW
generally supports the provisions of S. 951, but we would like to focus
on several of the bill's sections in our testimony.
First, VFW agrees that TAP must be mandatory for all servicemembers
leaving the military. This is a missed opportunity to ensure that all
servicemembers have a viable baseline from which to work once they
reenter the civilian workforce. The VFW also believes that consultation
with VA should be included in all TAP programs, ensuring that veterans
transitioning out of the military are at least aware of the benefits
and services to which they are entitled.
VFW also agrees that direct hiring authority for Federal agencies
and offering civilian work experience for potential civil service
employees while on terminal leave will cut down on red tape for
veterans seeking careers in the Federal workforce. Allowing qualified
veterans a direct path to a civil service career also helps Federal
agencies fulfill their obligations to employ veterans.
Finally, VFW supports offering two additional years of VocRehab
benefits for unemployed veterans who have exhausted all of their state
and Federal benefits. The intent of VocRehab is to ensure that veterans
who were disabled in the line of duty would be trained and employable
in a new career field. If a veteran has used their VocRehab benefits,
yet remains unemployed, then their initial VocRehab program clearly
failed. To VFW, VA is obligated to ensure that veterans who participate
in the program truly receive the job skills they need to remain
competitive in the civilian workforce.
VFW also has a suggestion for improving S. 951. Section 9 of the
bill has the right objective; making the transition from military to
civilian life easier by allowing servicemembers to apply the skills
learned from military to their MOS to the civilian workforce. The
problem with Section 9 is the approach; calling for a study and report
requiring coordination between the secretaries of Defense, Veterans
Affairs, and Labor. This approach wastes time on bureaucracy, rather
than helping to place the servicemember in a civilian occupation.
Replacing Section 9 with an ongoing private sector initiative, one of
which is already being tested at Fort Bragg, would streamline this
transition by cutting out bureaucracy. Some of these initiatives
already utilize mathematical algorithms through which servicemembers
can simply enter their MOS to populate a list of viable civilian
careers, and industry experts continue to develop ways to translate
this data into usable information to guide veterans on their
educational and professional training needs. VFW is eager to discuss
this idea further with Members of the Committee following this hearing.
VFW believes that the private sector already has the capacity bring the
departments of Defense, Labor and Veterans Affairs into the 21st
century through these ongoing initiatives without wasting additional
resources on a duplicative study.
S. 957, THE VETERANS' TRAUMATIC BRAIN INJURY REHABILITATIVE SERVICES'
IMPROVEMENTS ACT OF 2011
The VFW supports this legislation to significantly improve and
expand the plan for rehabilitation and reintegration of TBI patients.
This legislation would ensure that, when providing care to help
veterans recuperate after a brain injury, VA must take into account and
provide treatment that improves a veteran's independence and quality of
life. It expands objectives for the rehabilitation of veterans
suffering from a TBI to include behavioral and mental health concerns.
As a result of this bill, the phrase ``rehabilitative services'' takes
precedence over mere treatment in pertinent areas of the United States
Code, thereby conforming it to the prevailing wisdom that TBI patients
deserve more than mere treatment of their injuries, because we all know
they deserve ongoing evaluation and additional intervention where
necessary to ensure a full recovery. We believe the changes in this
bill would make it easier for veterans struggling with the aftermath of
a TBI to receive such coverage. Finally, this bill would also support
TBI patients by associating sections of the law related to TBI
rehabilitation and community reintegration to a broader definition of
the term ``rehabilitative services'' in title 38 that comprises a range
of services such as professional counseling and guidance services. This
bill would help to ensure our response to Traumatic Brain Injuries
consists of more than just healing the physical wounds of war. Our
veterans deserve every chance to lead productive lives, which is why
the VFW believes that VA and DOD should look into any and all potential
rehabilitation and treatment models for veterans who suffer from TBI.
S. 1017, DISABLED VETERAN CAREGIVER HOUSING ASSISTANCE ACT OF 2011
The VFW is happy to support S. 1017. In 2006, The Veterans' Housing
Opportunity and Benefits Improvement Act authorized VA to allow
adaptive housing assistance grants to disabled veterans temporarily
living in a home owned by a family member, known as Temporary Residence
Adaptation (TRA), but the benefit often leaves needs unmet in the
veteran community.
To date the number of veterans using the benefit has been low.
According to a recent report by the Government Accountability Office
(GAO-l0-786, July 15, 2010), VA has only processed 18 TRA grants
through April 2010. This legislation increases the benefit without
allowing it to go against future adaptive grants which would encourage
more use of the program. We would also add that VA should be encouraged
to strengthen its outreach by providing more information about who is
eligible for the grants which we believe would boost the number of
grants awarded in the future.
DRAFT BILL, HONORING ALL VETERANS ACT OF 2011
The VFW supports this legislation which provides a number of
important improvements to services that are currently not meeting the
needs of our veterans. To improve the livelihood of those who have
experienced a Traumatic Brain Injury, this legislation directs the
Secretary of Labor to assist veterans as they transition to the
civilian workplace. It also improves their health by directing VA to
use all applicable programs in a more comprehensive manner to assist
their long-term care and rehabilitation. It raises the statutory cap
for Vocational Rehabilitation and Employment Independent Living program
participants, and increases pension for married couples who are both
disabled veterans receiving aid and attendance payments.
To help veterans who have misfiled documents with the Veterans
Appeals Board by spurring new and needed reforms, the bill provides
assistance to homeless veterans by modifying the Servicemembers Civil
Relief Act and applying changes to VA homeless programs that would
allow payments to better reflect housing costs where a particular
veteran resides. It also builds on the growing consensus that military
skills should have broad recognition in the civilian world by
authorizing a study to help employers understand how military skills
apply in the open market.
DRAFT BILL, VETERANS PROGRAMS IMPROVEMENTS ACT OF 2011
VFW supports draft legislation that would enhance many benefit
programs within the Department of Veterans Affairs (VA). We especially
applaud Title I of the bill which would improve upon existing homeless
veterans programs. This bill greatly expands the availability of
resources needed by homeless veterans, while including provisions that
encourage treatment facilities providing care to homeless veterans to
use the available funding effectively. It also allows male homeless
veterans with children to be eligible for grant and per diem services;
and requires VA to provide a comprehensive plan on how it plans to
prevent and end homelessness in coordination with other Federal
programs with cost estimates and benchmarks that have proven effective.
Title II closes several loopholes with regard to fiduciaries. Most
importantly it protects our most vulnerable veterans by allowing a
caregiver or primary custodian of an impaired veteran to file a claim
in the name of the veteran. It also would allow VA to monitor fiduciary
activities or unresponsive fiduciary accounts by having direct access
to those veterans' financial institutions. VA would also have the
authority to direct the fiduciary, in the event of the death of the
veteran, to make final payments to the veteran's dependents in order of
precedence. This offers family members who may have incurred medical or
burial expenses on behalf of the veteran some reimbursement for costs.
We would also like to add that we believe the VA should require
increased audits if there is any irregularities in the fiduciaries
accounting.
Title III reauthorizes and extends several programs beneficial to
veterans.
The VFW applauds the Committee for making changes like those found
in Section 301 which would allow a guardian that may be taking care of
children while a servicemember is gone for many months on active duty
to remain in their family home without the threat of losing the home;
and Section 306 which would help streamline and shorten the time it
takes for an appeal to be resolved by the Board of Veterans Appeals by
eliminating duplication of efforts. We look forward to the passage of
all the provisions in this extensive bill.
DRAFT BILL TO IMPROVE THE PROVISION OF BENEFITS AND ASSISTANCE UNDER
LAWS ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS TO VETERANS
AFFECTED BY NATURAL OR OTHER DISASTERS, AND FOR OTHER PURPOSES.
The VFW supports this legislation, which would help veterans who
have suffered loss at the hands of a natural disaster such as an
earthquake, flood, tornado, or other types of disasters receive
critical VA assistance more quickly. Currently, when a veteran's home
or automobile needs to be replaced as a result of such an event,
Congress must step in and authorize the Secretary of Veterans Affairs
to come to the aid of disaster-stricken veterans. This legislation
would give the Secretary discretion to designate events as natural or
other disasters, and would convey the authority to provide for the
remediation of previously granted benefits. Among other things, it
would also allow the Secretary to extend subsistence allowances for
veterans undertaking a vocational rehabilitation program when disaster
strikes. Allowing the Secretary to act in these situations
independently of explicit Congressional approval will undoubtedly
expedite the process and help veterans who are victims of natural
disasters to get back on their feet.
Madam Chairwoman and Members of the Committee again, thank you for
allowing us to present our views on this legislation, I would be happy
to answer any questions you may have.
DRAFT BILL TO ESTABLISH A PILOT PROGRAM UNDER WHICH VETERANS IN THE
STATE OF ALASKA MAY RECEIVE HEALTH CARE BENEFITS FROM THE DEPARTMENT OF
VETERANS AFFAIRS AT NON-DEPARTMENT MEDICAL FACILITIES, AND FOR OTHER
PURPOSES.
While we understand the good intent behind this effort, the VFW
cannot lend its support to this legislation. The bill would establish a
new pilot program with the goal of providing certain Alaskan veterans
in the most remote locations with what would be known as the ``Alaska
Hero Card.'' This card would essentially serve as an insurance card,
enabling veteran cardholders to acquire unlimited health care at no
out-of-pocket cost from any doctor who participates in the TRICARE
network, the Indian Health Service, or Medicare.
One concern VFW has with this well-meaning proposal is that VA
could provide the same benefit to these veterans under existing law and
practice. We also recognize that Alaska, though perhaps the most
poignant example, is not the only state in the union that grapples with
the issue of extremely rural and remote populations. Finally, because
the VA is already conducting pilot programs to study the improving
access to care for all rural veterans regardless of state, on its face
we see this effort as duplicative. VFW would strongly prefer VA focus
on existing pilots to find solutions for all rural veterans, and work
quickly to ensure that Alaska's highly rural and underserved
populations have access to quality health care by leveraging existing
VA policies.
Chairman Murray. Thank you very much.
Mr. Ensminger?
STATEMENT OF JERRY ENSMINGER, MSGT USMC (RET.), ELIZABETHTOWN,
NORTH CAROLINA
Mr. Ensminger. Good morning. My name is Jerry Ensminger. I
served our Nation faithfully for nearly a quarter of a century
in the U.S. Marine Corps. I want to personally thank you, Madam
Chairman and Senator Burr, the Ranking Member and senior
Senator from my homestate of North Carolina, for providing me
this opportunity to testify in support of S. 277, the Caring
for Camp Lejeune Veterans Act of 2011.
I became deeply involved researching the history of the
water contamination at Camp Lejeune nearly 13 years ago after I
learned that my daughter, Janey, was exposed to the base's
contaminated drinking water. My daughter, Janey, was the only
one of my four daughters to have been conceived, carried, or
born while living aboard Camp Lejeune. When Janey was 6 years
old, our entire world was turned upside down after she was
diagnosed with acute lymphoblastic leukemia, or ALL.
Janey fought a valiant battle against her malignancy for
nearly 2\1/2\ years, but she ultimately lost that war. We
watched Janey go through hell during her illness, and all who
loved her went through hell with her. She succumbed to her
disease on 24 September 1985. She was only 9-years old.
Unlike the tragic stories of combat troops who have died in
the past decade overseas or come home with broken bodies and
painful memories, the human tragedies caused by this massive
contamination incident have been going on for many, many
decades in private homes and hospital rooms in every State and
territory of our Nation. Many of the sick have been virtually
bankrupted by the expense of the medical care and therapies
required to combat the catastrophic illnesses which are
inherent to the exposures to the chemicals that have been found
in the water at Camp Lejeune. Two known carcinogens--benzene
and vinyl chloride, TCE, which will soon be classified as a
human carcinogen by our EPA, and PCE, a probable human
carcinogen--were present in our tap water. Those of us who
lived and worked at Camp Lejeune never gave a moment's thought
that we and our families were being poisoned by the very water
we drank and bathed in. I along with many other Marines and
their family members have devoted years of our lives and our
money to comb through the historical record of Navy and Marine
Corps documents to find the truth about how this contamination
was allowed to continue despite the repeated warnings given to
them by analytical laboratories.
My 13-year journey has taken me and my allies down many
paths, and it has led us to numerous revealing and very, very
troubling discoveries related to this issue. I must say that
some of the most troubling discoveries have been the Department
of the Navy and the U.S. Marine Corps' own documents which
clearly reveal their leadership's knowledge that our tap water
was contaminated for nearly 5 years before they took any action
to locate the sources or to stop it from flowing.
Another disturbing revelation has been the discovery of
Navy and Marine Corps regulations, some dating as far back as
1963, that required a protective standard of care for the
base's drinking water systems. Had these regulations and orders
been followed, most of this tragedy more than likely would have
been averted.
Last, as a career Marine, the most audacious realization
has been a lack of honesty and transparency demonstrated by the
Department of the Navy and Marine Corps relating to this issue,
a problem that continues to this very day and reaches the
highest levels of leadership.
The documents we have uncovered indicate there have been
many obfuscations, half-truths, and outright lies disseminated
by these two organizations and their leaders through statements
to the press, in correspondence to the affected community
members, in brochures issued to Congress, and, yes, even in
Congressional testimony. The examples of these
mischaracterizations are too numerous for me to list here today
in this testimony, but I would be more than willing to provide
examples today if the Committee is interested, and I will
gladly sit down with any Senator or their staff members to
point these things out. I would encourage everyone to visit our
Web site and view the timeline of events linked to our home
page. Our timeline of events is interactive; the reader can
click on the ``blue'' document numbers embedded in each entry
to access the Department of the Navy and the U.S. Marine Corps'
own documents. This was done to assure the reader that we do
not speculate and that our timeline is factual.
Senator Burr's bill, S. 277, is a step in the right
direction in rectifying this tragic situation. Some of you may
not know this, but Camp Lejeune is the largest documented DOD
environmental contamination incident on record. I know that
some Members of Congress and a couple of national veterans
service organizations have expressed a lack of support for
S. 277 when it was introduced as S. 1518 in 2009, but much has
come to light since then. In the past year and a half,
significant discoveries of previously undisclosed documents
show that the Navy estimated that the contamination on the base
was far greater than imagined in 2009. One Navy document states
that the total fuel loss from underground storage tanks on the
base could have reached beyond 1 million gallons and caused
massive amounts of benzene, a known human carcinogen, to have
infiltrated the ground water used by the base's drinking water
systems. I would think that anyone here today who found out
that the water they had been drinking contained gasoline would
find that a little alarming.
There are currently over 170,000 members of the Camp
Lejeune community who have registered with the Marine Corps
since 2008. They come from every State in the Nation. I have
heard their stories over the years as I have criss-crossed the
country looking for information and meeting veterans and their
families who lived on the base. In the past 2 years alone, we
have discovered over 70 men who lived at Camp Lejeune who now
have male breast cancer, a rare disease which afflicts only
about 2,000 men a year in the entire United States.
This issue is the subject of an award-winning documentary
titled ``Semper Fi: Always Faithful,'' which will be shown the
evening of 23 June 2011 in the Capitol Visitor Center. I hope
the Senators on this Committee will take a closer look at this
issue and seriously consider the scope and severity of the
contamination and the duty we owe those veterans, their loved
ones, and the thousands of civilian employees who were exposed
at Camp Lejeune. I ask each of you to see the film or send a
member of your staff to do so. This very real story is finally
being told after years in the shadows, and the people whose
lives are directly affected by it need help. S. 277 is the
first step toward doing the right thing.
Thank you. I look forward to your questions, and thank you
for bearing with me in my overage on time.
[The prepared statement of Mr. Ensminger follows:]
Prepared Statement of Jerome Ensminger, USMC (Ret.), North Carolina
Good morning! My name is Jerry Ensminger. I served our Nation
faithfully for nearly a quarter century in the United States Marine
Corps. I want to personally thank you Madam Chairman and Senator Burr,
the Ranking Member and senior Senator from my home state of North
Carolina, for providing me this opportunity to testify in support of
S. 277, the Caring for Camp Lejeune Veterans Act of 2011.
I became deeply involved researching the history of the water
contamination at Camp Lejeune nearly 13 years ago after I first learned
that my daughter, Janey was exposed to the base's contaminated drinking
water. My daughter, Janey, was the only one of my 4 daughters to have
been conceived, carried, or born while living aboard Camp Lejeune. When
Janey was 6 years old, our entire world was turned upside down after
she was diagnosed with acute lymphoblastic Leukemia (ALL).
Janey fought a valiant battle against her malignancy for nearly
2\1/2\ years, but she ultimately lost the war. We watched Janey go
through hell during her illness and all who loved her went through hell
with her, but she succumbed to her disease on 24 September 1985, she
was only nine years old. Unlike the tragic stories of combat troops who
have died in the past decade overseas or come home with broken bodies
and painful memories, the human tragedies caused by this massive
contamination incident have been going on for many decades in private
homes and hospital rooms in every state and territory of our Nation.
Many of the sick have been virtually bankrupted by the expense of the
medical care and therapies required to combat the catastrophic
illnesses which are inherent to the exposures to the chemicals found in
the water at Camp Lejeune. Two known carcinogens-benzene and vinyl
chloride, TCE, which is soon to be classified as a human carcinogen by
the EPA, and PCE a probable human carcinogen were present in our tap
water. Those of us who lived and worked at Camp Lejeune never gave a
moment's thought that we and our families were being poisoned by the
very water we drank and bathed in. I, along with many other Marines and
their family members have devoted years of our lives and our money to
comb through the historical record of Navy and Marine Corps documents
to find the truth about how this contamination was allowed to continue
despite the repeated warnings given by analytical laboratories.
My 13-year journey has taken me and my allies down many paths and
led us to numerous revealing and very troublesome discoveries related
to this issue. I must say that some of the most troubling discoveries
have been the Department of the Navy (DoN) and the United States Marine
Corps' (USMC) own documents which clearly reveal their leadership's
knowledge that our tap-water was contaminated for nearly five years
before they took any action to locate the source(s) and stop it from
flowing. Another disturbing revelation has been the discovery of Navy
and Marine regulations, some dating as far back as 1963, that required
a protective standard of care for the base's drinking water systems.
Had these regulations and orders been followed, most of this tragedy
more than likely would have been averted. As a career Marine, the most
audacious realization has been a lack of honesty and transparency
demonstrated by the Department of the Navy and Marine Corps relating to
this issue, a problem that continues to this day and reaches the
highest levels of leadership.
The documents we have uncovered indicate there have been many
obfuscations, half-truths, and outright lies disseminated by these two
organizations and their leaders through statements to the press, in
correspondence to the affected community, in brochures for Members of
Congress, and even in congressional testimony. The examples of these
mischaracterizations are too numerous for me to list in this testimony,
but I would be more than willing to provide examples today if the
Committee is interested and I will gladly sit down with any Senator or
staff member and point them out. I would also encourage everyone to
visit our Web site www.tftptf.com and view the time-line of events
linked to our home page. Our time-line of events is interactive; the
reader can click on the ``blue'' document numbers embedded in each
entry to access the DON/USMC's own documents. This was done to assure
the reader that we don't speculate and that our time-line is factual.
Senator Burr's bill, S. 277 is a step in the right direction in
rectifying this tragic situation. Some of you may not know this, but
Camp Lejeune is the largest documented domestic DOD environmental
contamination incident on record. I know that some Members of Congress
and a couple of national Veterans Service Organization (VSO's) groups
have expressed a lack of support for S. 277 when it was introduced as
S. 1518 in 2009, but much has come to light since then. In the past
year and a half, significant discoveries of previously undisclosed
documents show the Navy estimated that the contamination on the base
was far greater than imagined in 2009. One Navy document states the
total fuel loss from underground tanks on the base could have reached
beyond one million gallons and caused massive amounts of benzene, a
known human carcinogen, to have infiltrated the ground water used by
the base. I would think that anyone here today who found out the water
they had been drinking contained gasoline would find that alarming!
There are currently over 170,000 members of the Camp Lejeune
community who have registered with the Marine Corps since 2008, they
come from every state in the Nation and I have heard their stories over
the years as I have criss crossed the country looking for information
and meeting veterans and their families who lived on the base. In the
past two years alone, we have discovered over 70 men who lived at
Lejeune who now have male breast cancer, a rare disease which afflicts
only about 2,000 men a year in the entire US.
This issue is the subject of an award winning documentary titled
``Semper Fi: Always Faithful'' which will be shown the evening of
23 June 2011 in the Capitol Visitor's Center. I hope the Senators on
the Committee will take a closer look at this issue and seriously
consider the scope and severity of the contamination and the duty we
owe to those veterans, their loved ones and the thousands of civilian
employees who were exposed at Camp Lejeune. I ask each of you to see
the film or send a member of your staff to do so. This very real story
is finally being told after years in the shadows and the people whose
lives are directly affected by it need help. S. 277 is the first step
toward doing the right thing.
Thank you and I look forward to your questions.
Chairman Murray. Thank you very much, Mr. Ensminger. I
really appreciate your continued diligence and work on this
very, very important issue.
Mr. Cox?
STATEMENT OF J. DAVID COX, R.N., AFGE NATIONAL SECRETARY-
TREASURER, ON BEHALF OF THE AMERICAN FEDERATION OF GOVERNMENT
EMPLOYEES--AFL-CIO AND AFGE NATIONAL VA COUNCIL
Mr. Cox. Chairman Murray, Ranking Member Burr, and Members
of the Committee, thank you very much for the opportunity to be
here today TO testify on S. 572 on behalf of the American
Federation of Government Employees, the largest employee
representative of Federal employees, including over 80,000 VA
title 38 medical professionals.
Chairman Murray, this is my first opportunity to testify
before you as a Chairman, and I join with Senator Snowe in
commending you in your field and being Chairman of this
Committee. As a man who spent 40 years being a registered
nurse, I applaud you as Chair of this Committee today and look
forward to your leadership.
S. 572 provides a small, commonsense fix to Section 7422 of
Title 38, the law that gives VA medical professionals the right
to grieve and negotiate over routine pay matters. The VA must
be accountable for its own pay policies. Amending the law is
the only way to get that accountability. How can anyone oppose
making the VA abide by its own pay rules?
Last year, Secretary Shinseki acknowledged the widespread
abuse of VA's pay rules at VA medical facilities, and he pulled
back the Under Secretary's authority to make 7422
determinations. Now all 7422 cases go before the Secretary.
You may hear from opponents that S. 572 creates new rights
and gives VA clinicians more rights than other Federal
employees. This is simply not true. Medical professionals who
work for the Department of Defense and Bureau of Prisons can
grieve and negotiate agency violations of pay rules. All this
bill does is restore the same rights as their counterparts in
the VA.
Under VA's current policies on compensation bargaining,
registered nurses working weekends have no recourse when
management refuses to provide weekend premium pay even though
premium pay is required by the VA's own pay regulations. VA's
own management officials have acknowledged that they could not
run their hospitals if they did not apply the same pay rules as
every other health care provider. However, the VA found an
unexpected loophole in the law to ignore its own pay rules: the
compensation exclusion in Section 7422.
VA's broad interpretation of this exclusion prevents the
enforcement of nurse pay provisions in the 2010 Caregiver Act
as well as other nurse and physician pay laws passed in recent
years to keep VA pay competitive.
It is clear that Congress intended to provide VA medical
professionals with full bargaining rights, the same rights as
other employees in the VA and the rest of the Federal
Government. Congress enacted Section 7422 in a direct response
to a Federal Court decision that the VA had the right to refuse
to bargain with a group of Colorado nurses. The plain language
in Section 7422 confirms that the only compensation matters
that are off the bargaining table are establishment,
determination, and adjustment of employee compensation. That is
because Congress sets Federal pay scales, and the VA has never
been able to come up with an example of a union trying to
bargain over pay scales.
Even in the face of this clear intent and VA's past
agreement to apply a narrow interpretation of the law, the VA
continues to refuse to bargain over many types of pay disputes
that have nothing to do with setting pay scales. This is why
the law needs to be tweaked, to clarify what Congress intended
and what is common sense in the health care workplace.
The VA's interpretation of Section 7422 may be permissible
under the laws of statutory interpretation, but it is
definitely not preferable. VA's current policies divert time
and money away from direct veteran services through protracted
labor-management disputes and the cost of losing nurses and
doctors and other clinicians to other employers. We all vote
with our feet when it comes time to getting paid properly for
the work we do. In short, S. 572 restores what Congress
intended, saves VA health care dollars that should be spent on
veterans, boosts workplace morale, and helps the VA remain an
employer of choice in the health care marketplace.
Thank you very much, and I would be glad to take any
questions.
[The prepared statement of Mr. Cox follows:]
Prepared Statement of J. David Cox, R.N., AFGE National Secretary-
Treasurer on Behalf of American Federation of Government Employees,
AFL-CIO and the AFGE National VA Council
Chairman Murray, Ranking Member Burr and Members of the Committee:
The American Federation of Government Employees (AFGE) and the AFGE
National VA Council (NVAC) (hereinafter ``AFGE'') appreciate the
opportunity to testify today on S. 572.
AFGE represents over 200,000 employees in the Department of
Veterans Affairs (VA), more than two-thirds of whom are Veterans Health
Administration (VHA) employees who are on the front lines at VA
hospitals, clinics and nursing homes caring for our Nation's veterans.
S. 572 does not create new bargaining rights. Rather, this bill
restores equal bargaining rights over routine compensation matters that
were previously afforded to the following medical professionals covered
by the VA's Title 38 personnel system: registered nurses (RN),
physicians, dentists, physician assistants, optometrists, podiatrists,
chiropractors and expanded-duty dental auxiliaries.
Until 2003, VA's Title 38 medical professionals had the same
compensation bargaining rights as VHA employees covered by Title 5
bargaining rights and medical professionals at military hospitals and
other Federal facilities. Over the past eight years, the VA has
interpreted the Title 38 bargaining rights law--Section 7422--to single
out Title 38 medical professionals and deprive them of basic rights to
grieve and negotiate over routine pay matters such as nurse overtime
pay and physician incentive pay. The VA has also used Section 7422 to
block complaints arising out of violations of rights under other
Federal laws.
How can anyone oppose making the VA abide by its own pay rules?
Last year, Secretary Shinseki acknowledged the widespread abuse of VA's
pay rules at many VA medical facilities. In fact, he determined that
this problem was significant enough to pull back the Undersecretary of
Health's authority to determine when Section 7422 prohibits bargaining.
Now, all 7422 disputes must be decided by the Secretary.
Contrary to the VA's past assertions, S. 572 will not interfere
with the role of Congress and the Secretary in setting rates of pay.
The bill specifically excludes from bargaining the ``establishment,
determination, or adjustment of rates of basic pay.'' In contrast, VA
medical professionals--like other Federal employees--must have the
right to bargain over whether a pay rule is applied fairly and
accurately.
The VA has argued that this bill will give VA medical professionals
more rights than other Federal employees. This assertion is also
completely untrue. The plain language of S. 572 is unambiguous: it
would only restore the same rights to bargain over routine pay matters
as those afforded to Federal employees covered by Title 5. We also note
that the VA has never offered this Committee a single example of a VA's
employee's attempt to bargain over a pay scale.
VA's 7422 policy seems especially arbitrary because it singles out
one group of VHA employees while affording full compensation bargaining
rights to others working in the same hospitals and clinics. For
example, a VA registered nurse cannot grieve over overtime pay while a
VA licensed practical nurse can. Similarly, a VA psychiatrist cannot
grieve over the loss of incentive pay while a VA psychologist can. It
seems equally arbitrary for a DOD physician treating active duty
personnel to have greater bargaining rights than a VA physician
treating veterans. This disparate treatment also harms the VA's ability
to attract and retain medical professionals.
S. 572 is consistent with the clear intent of Congress to provide
VA medical professionals with equal bargaining rights. Congress enacted
Section 7422 shortly after a Federal appeals court held that the VA did
not have to bargain with a group of Colorado nurses. In addition, the
plain language of the 1991 law makes clear that bargaining is only
prohibited in matters involving the ``establishment, determination, or
adjustment of employee compensation.'' Surely, Congress did not
contemplate that the VA would invoke Section 7422 to block complaints
about the application of nurse premium pay rules, access to wage survey
data, pay discrimination or denial of workers compensation--but that is
exactly what the VA did in past 7422 Undersecretary determinations.
VA's current interpretation of the law also directly contradicts
its own position in the VHA labor management agreement in place from
1995 to 2002 that stated: ``Left within the scope of bargaining and
arbitration are such matters as: procedures for analyzing data used in
determining scales, alleged failure to pay in accordance with the
applicable scale, rules for earning overtime and for earning and using
compensatory * * * ''
S. 572 provides a commonsense solution for reducing costly,
demoralizing disputes between VHA managers and employees. The number of
``7422'' compensation cases increased significantly after the 1995
labor management agreement was nullified.
VA's wasteful and counterproductive policies on compensation
bargaining are best illustrated by the case involving operating room
nurses at the Asheville, North Carolina VA Medical Center. AFGE waged
an unsuccessful seven year fight to secure premium pay for nurses
working night and weekend shifts. The dispute arose out of a basic pay
rule in place at virtually every public and private sector hospital:
nurses earn a higher hourly rate when they work evenings and weekends.
When the arbitrator ruled in favor of the nurses, and ordered back pay,
the VA invoked the 7422 compensation exclusion to refuse to pay. The VA
continued to assert the 7422 loophole to for the next six years to
refuse to provide back pay, and get the case dismissed for lack of
jurisdiction. The D.C. Circuit court stated that while the VA's ability
to invoke Section 7422 to get a case dismissed ``may be inconsiderate
or even unfair,'' the VA's interpretation of the law was permissible as
currently written.
Therefore, to ensure basic fairness and equal treatment for VA's
medical professionals, and restore Congressional intent, the law must
be changed. We urge the Committee to support the small fix in S. 572 to
clarify the scope of the law and hold the VA accountable for its own
pay rules.
Thank you.
Chairman Murray. Thank you very much to all of you for your
testimony.
Mr. Steele, let me start with you. In supporting our Hiring
Heroes Act of 2011, you stated that it is critical that we
bridge the gap between military service and the civilian
workforce. So I wanted to ask you today if you could share with
this Committee what you think the biggest challenges are facing
our young veterans when they try to get a job when they come
home.
Mr. Steele. Thank you for your question, Senator. The
biggest challenge is the job market itself. We have suffered in
2007 and 2008 a massive financial crisis that has led to a
large overhang. This is an overhang that will take years to
work off. Therefore, acknowledgment of that fact will--and this
is in deference to Senator Burr--limit what we can expect to
do. There is only so much you can do. It makes it important
that we acknowledge that, that we maybe target certain programs
only for the time that it takes to recover instead of making
open-ended programs forever. This is trying to balance both
Senators' concerns.
The one other thing I would note is, in my opinion, young
veterans will always appear initially to be lagging behind
those of the same age who never served for several reasons. I
believe that in time, though, they will hold their own in the
job market, and given that time, they will prove their worth.
Thank you.
Chairman Murray. Mr. Violante or Mr. Kelley, what are the
biggest challenges facing our veterans coming home today trying
to seek employment?
Mr. Violante. Well, I think one of the things that you have
pointed out in your bill is the fact that the Government spends
millions of dollars training these individuals, and it is
difficult when they come out to get the licenses that they need
to continue to practice the work they have been trained for.
That is one of the biggest obstacles. If we could eliminate
that, I think we would see more military flowing into civilian
jobs a lot easier.
Chairman Murray. Mr. Kelley?
Mr. Kelley. I think it is cultural. The military has a
culture, civilian life has a culture, and they do not mesh.
Military personnel, especially if they are enlisted, have
probably never done a job interview. They have never had to go
out and fill out a resume. They had a recruiter come find them
when they were in high school and say, ``Please join the
military.'' They take a little test. Then they get to choose
what job they want. They go into the military, and they get all
the training that they need. When they leave, they are not
prepared because of the way the military has worked. Everything
has been presented to them. Now they do not understand how to
work in that civilian environment. Providing them with
reculturation, having them understand the process of getting a
civilian job, what is important to say, how to present
yourself, how to have a quality resume that does not look like
it is a military transcript, I think those are the key issues.
Chairman Murray. Part of that TAP requirement.
Mr. Kelley. Yes.
Chairman Murray. Yes, OK. I have heard a lot from veterans
about their frustration with having to wait years for the Board
of Veterans Appeals to issue a decision on their appeal. On the
agenda today is my legislation that seeks to reduce the delay
by changing the way that new evidence is considered. For the
VSOs at the table, do you agree we need to streamline and
expedite the appeals process?
Mr. Violante. That is one of DAV's goals. We certainly
support that. We believe that your legislation would help us do
that.
Mr. Steele. The American Legion agrees.
Mr. Kelley. The VFW also agrees.
Chairman Murray. Very good. Thank you.
Mr. Cox, VA's testimony refers to a joint work group with
unions and the VA. Is it your view that the work of that group,
which is ongoing now, reduces the need for Senator Brown's
collective bargaining bill?
Mr. Cox. No, ma'am, I do not agree with that whatsoever.
The work group has concluded. There were unions that came to an
agreement with the VA. AFGE, which is the largest union, and VA
did not come to an agreement with the final product that the
Secretary offered. There was consensus in the work group from
the VA officials who came to the work group, and everyone
agreed. Then it went back to the Secretary, and he pared down
what the work group had consensus on, and AFGE could not agree
to those things.
So I believe the legislation is very important. It is
nothing more than the VA gets to decide the pay, all the rules,
all the regulations. If they write them, they should be willing
to live by them. All AFGE is asking is for them to live by
their own rules and for a way to enforce that.
Chairman Murray. OK. Thank you very much. I appreciate it.
I do have more questions I will submit to all of you for
answers in writing.
I will turn to Senator Burr for any questions he may have.
Senator Burr. Thank you, Madam Chairman.
Let me give all of you an easy one. I mentioned earlier
that I am committed to providing veterans and their families
with the benefits they need and they deserve, but I want to
make sure we pay for those benefits and the services by looking
at other programs and looking at cuts so that we can continue
to provide the benefit without saddling future generations of
Americans with enormous debt.
I want to ask any that would like to, to submit to me
current programs that you think could be eliminated because of
the lack of usefulness of them--maybe their time has run out;
programs that have overlap or duplicative functions where you
believe consolidation into a program would actually be cheaper
but, more importantly, more effective. Any suggestions that any
of the VSOs can provide, I would be interested in and I am sure
the Committee would be interested in too.
David, let me ask you, in March 1995, Dr. Kenneth Kizer,
then the Under Secretary for Health at the time at VA, wrote
``Vision for Change.'' That introduced the concept of
restructuring the Veterans Health Administration into VISNs
around the country. In his paper, Dr. Kizer anticipated that
each VISN headquarters would range between 7 and 10 full-time
employees. Have you noticed a significant growth in the number
of employees in the VISN?
Mr. Cox. Well, it has been 5 years since I worked for the
VA. I would suspect that number is higher than 10, Senator. I
am sure the VA could give you exact numbers on how many are
working and employed by the VISNs now.
Senator Burr. Well, so far they have ignored the e-mail
request to talk to them about the numbers, but do you have any
idea what the total number of employees is at the VISN
headquarters?
Mr. Cox. No, sir, I do not. I know that it is significantly
higher than 10. I am very certain that it is higher than 10.
Senator Burr. Does AFGE have a position on what would be a
suitable amount of staff for a VISN?
Mr. Cox. That is a very broad statement, Senator, to ask
because part of it, the way they have consolidated services to
VISNs, that as such, many things that were done in individual
medical centers are now done in a collective whole for the
whole VISN. So the employees and how they operate, those vary
from VISN to VISN. So I do not think we have come at a number.
We would certainly be interested in the number of
administrative employees that work in VISN offices and the VISN
management level, but actually, you know, the worker bees that
are getting all the veterans care out there in the medical
centers is a whole different story.
Senator Burr. When I get those numbers and the breakdown of
how much of it is administrative, I will share it with you.
Mr. Cox. Thank you very much, sir. Maybe you can get them
to pay us properly, too.
Senator Burr. One of the consolidations, by the way--and I
do not think you will find this shocking--is that the medical
facilities report to the VISNs sexual abuse claims, and it
might enlighten us to some degree about the layers of
bureaucracy we have now put in between the medical center and
the IG.
Jerry, listen, you and I have talked many times, and for
some Members they are just now hearing the story of Camp
Lejeune marines and their families. You have had an opportunity
to really cover the country, and I have stated in the past that
I perceive that it is problematic for the Committee to have the
Department of Defense, specifically TRICARE, be the provider to
this population. I am not going to go back through my case. I
will make it at the appropriate time. But you have been out
with Marines. You have been out with their families. What do
they think? Do they want to be under DOD and TRICARE, or do
they want to be under the VA?
Mr. Ensminger. Thanks for asking me that, Senator Burr,
because the general consensus is that everybody I speak to--
and, you know, I would ask anybody--anybody who recommends that
we be turned back over to the Department of Defense--the very
people that were responsible for poisoning us--for our health
care, those who say we should trust them when today they are
still denying that they did anything wrong, I have to ask them
how would that work out? I mean, I am sorry. DOD still has not
stepped up to the plate on this issue. They are still in
denial, and they are fighting and scratching at every inch to
deny and obfuscate this situation, like I said in my testimony.
So why would anybody even ask us to trust the Department of
Defense with our health care? And that is the way, Senator
Burr, most of the victims feels.
Senator Burr. Jerry, in the last panel, somebody referred
to ATSTR. Some members know that that is the agency within CDC
that is charged statutorily with the investigation of the level
of contamination. We had to do some rather threatening things
in the last 18 months to get the Department of the Navy to
actually pay for what the law required them to pay for from the
standpoint of studies that ATSTR were doing.
Share with everybody what the level of cooperation is today
between the Department of the Navy and the Corps with the ATSTR
investigation.
Mr. Ensminger. Well, Senator, thank you. Like I said in my
testimony: there have been many obfuscations, half-truths, and
total lies distributed by the Department of the Navy and the
Marine Corps relating to this issue, and one of them was a
letter that they sent out to every member that was registered
on their Web site. In that letter it stated that the National
Research Council report had done an evaluation of exposures to
certain chemicals in the water at Camp Lejeune and their
expected negative health outcomes, and that one of the
chemicals they said that the NRC assessed was benzene, which is
a known human carcinogen. The NRC never assessed benzene. If
they would have, the effects of it would have been in the top
category in their report. Yet the Department of the Navy and
the Marine Corps persist in saying that they did assess
benzene. That misinformation was distributed to everybody that
was registered on their Web site.
Senators Burr, Hagan, Senator Nelson from Florida,
Congressman Brad Miller, and Congressman John Dingell all sent
a letter in April to the Secretary of the Navy asking him to
rectify this mischaracterization of that NRC report. Their
response was the Secretary of the Navy went to the NRC and had
the director of the NRC answer a letter that was written last
October by the director of ATSTR. I am sorry, I mean, this is
just a vicious circle.
Senator Burr. Jerry, thank you for that. The Chairman has
been very kind and lenient with me on the time, and I have gone
over again, but I thank the Chair.
Chairman Murray. Important questions. Thank you very much.
Senator Begich?
STATEMENT OF HON. MARK BEGICH,
U.S. SENATOR FROM ALASKA
Senator Begich. Thank you, Madam Chair.
I just want to address Mr. Steele, Mr. Kelley, and Mr.
Violante. I want to talk about the Alaska Heroes Card. I want
to describe it because sometimes there is--I have read your
testimony in detail, and your concerns are: equal treatment,
fairness, and reimbursements. Let me describe Alaska for a
second.
First off, I was just there on Memorial Day in Kwig, AK,
which, to get to it, you have to fly from Anchorage to Bethel;
then you have to fly from Bethel to Kwig in a four-seater
plane, if they have one available and the weather is good.
There is no road. That total trip took 2\1/2\ hours of travel
time, air time.
In our State we have the premier Indian Health Services in
the country. Why? To be frank with you, Indian Health Services
does not run it. We run it. It is the tribal consortium. Our
tribal communities in Alaska took control of the Indian Health
Services because they wanted to deliver health care the right
way.
So we have veterans in Kwig. In order to get to Anchorage
to the VA center, it costs $2,000 in air transportation. Who
pays for that? The Veterans Administration. Yet there is a
clinic right across the street--or road, because there are no
streets, a trail--which is run by the Indian Health Services,
by our tribal consortium, providing incredible health care.
In Nome, AK, we are building a $170 million state-of-the-
art Indian Health Services care facility. But, again, if a
veteran is there, they will not be able to use that facility.
They will have to get on a plane, because they cannot drive
because there are no roads within 80 percent of our
communities. There is no State like this.
As I read your testimony, I know you want to try to keep
everything--there is no State like this. There is no State
where you can drive to another clinic, yet there is a high-
quality-run facility right there. And what we are trying to do
here--if you read this, I understand your commentary and how
you have written some of your testimony. The key part is
roadless communities in Alaska. That is pretty narrow.
We have more and more veterans living in rural communities
in this country, but I can tell you right now, in Alaska, with
77,000 veterans, the highest per capita of any State, we have a
high percentage in rural Alaska. We want to provide them the
best care, and we believe this piece of legislation will
actually lower the cost to the VA. When an individual has to
fly to Anchorage and then sometimes to Seattle--because we have
no VA hospital. Let me make sure we are clear on that, too. We
do not have a hospital. We have a clinic and some CBOCs. That
is it. So when they have to get the service, they have got to
fly, thousands and thousands of dollars, and away from their
families, which, as you know, for a veteran in need of care it
is critical to be closer to families, to be able to have
access.
So I want to work with you folks. Your concerns are easy to
be met by, I think, clarification. But I want your response
to--it is hard to understand Alaska until you have been to one
of these small villages and met with a veteran who told me and
the Secretary of the VA, in order for him to get his care, the
flight alone was $2,000. Well, that means someone down here in
the Lower 48 is not going to have $2,000 worth of care because
that is going for an airline ticket. It does not seem right.
So can you give me some comments? I have given you--it is a
statement, but I want your comments so you understand where we
are coming from. It is not Montana, it is not Utah, it is not
North Carolina, it is not Washington. It is very different. Any
one of you three want to comment?
Mr. Violante. Senator, I am not an expert on VA health
care. I have staff that focuses on that. But I do think your
question should be directed to VA. They have the authority to
provide fee-based care----
Senator Begich. I am going to interrupt you for a second.
We did that for years. It did not work. That is the problem.
And the reality is we have a fully federally funded Indian
Health Services sitting right there run by a tribal consortium
delivering equal or in some cases, to be very frank with you,
higher quality than what can be achieved in the VA system at
times in Alaska. So I understand that question, but you have
opposed--or you have questions on mine, so I am asking you, how
do we----
Mr. Violante. I mean, our concern is that VA has the
authority. They can provide community care or contract care
when necessary, and I do not understand--and maybe they have
explained to you why they would want to spend $2,000 to fly a
veteran somewhere when they could go to a clinic, you know,
nearby. I mean, to me that does not make sense, and I would
like to know VA's answer to that, because with the authority
they have, they should be able to take care of those veterans.
And if they are not, then maybe what should be happening is
some oversight by this Committee, getting VA in here to find
out why they are not doing that.
My deputy just went to our department convention in West
Virginia, and a veteran came up to her and said that he has
been on fee basis for years. He has a service-connected
disability rated higher than 50 percent. VA told him they did
not have funds to continue to do that.
Now, this is the same VA that this year said they have a
$1.1 billion carryover and would like to split it up between
2012 and 2013. Things are not making sense, and our concern is
VA needs to be doing what they should be doing, and I agree
with Senator Burr that we need to be looking at ways for them
to do it better. I just am not comfortable with your bill and
what it means to other veterans also around the country who may
not be in such severe situations but still in need of health
care when VA has the authority to take care of most of this.
Mr. Kelley. I believe Joe stated it very articulately. I do
not believe I have a whole lot to add. It is my understanding,
though, that VA and Indian Affairs is working to try to figure
out a single-pay method. I would like to understand that a
little bit better, where that is going, and if that would be an
effective alternative to a veterans card that would allow them
to use Indian Affairs.
Senator Begich. Madam Chair, I know we are over time, but
if I can just make one quick comment. They have an MOU, and it
is basically driven by our efforts here, because this kind of
crystallized it. The one thing we do not want to do with
veterans is have them constantly worry about how to get
service. We had testimony here 3 weeks ago or 4 weeks ago with
individuals talking to us about how they pass facilities to go
to those fee-based places because of some arrangement they had.
In Alaska, you do not get to drive by those facilities. There
are no fee-based. There is no doctor, no other doctor. It is
Indian Health Services, and every single village in Alaska has
a clinic. There is no place like it, which is because we have
to deliver health care in a very different way. So, why they
are doing the MOU is because they know something like this is
necessary or at least they are aware that we have to figure
this problem out because the current fee-based system does not
work in Alaska because of the way the system is. It is a
Federal Government facility and another Federal Government
facility. It is not a private doctor sitting out there
providing the service. It is a different situation. And that is
why it is a draft.
I am going to work with you folks because every time I go
to a veterans organization in Alaska, when I mention this--and
we go do a lot of speeches as Senators and we get applause at
the end. This issue, when I bring it up the way I just
described to you, we get not just applause, but standing
ovation because Alaskan veterans understand this is the care
and how they can access it, because they have tried the other
ways, which do not work.
So I just want you to have an open mind. Hopefully I have
described Alaska a little. I would love to take you to Kwig and
drive on that road that is really a boardwalk and fly into that
airport that is a dirt road and a pad. That is what we are
trying to accomplish here, so I will work with you folks. I
understand your global picture, but I really think this has--
for Alaska it is so critical that these veterans get the care
that is, you know, sitting 50 feet away from them but they
cannot touch it. I will leave it at that.
Chairman Murray. Thank you very much, Senator Begich.
Senator Boozman?
Senator Boozman. Thank you, Madam Chair.
Very quickly, I just want to apologize for having to leave.
We had a markup on a telecommunications bills with our first
responders, and I just got done with that. I want to thank
Senator Begich for his help with the bill that we have
introduced. And we appreciate you, Madam Chair, for allowing us
to bring that forward.
I also appreciate you guys as always for all that you do in
pushing these things forward and your support of that bill. So,
again, we appreciate you and appreciate all that you represent,
and I will put my statement in the record, if it is OK with
you.
Chairman Murray. All right.
Senator Boozman. I yield back. Thank you.
Chairman Murray. Thank you very much.
I want to thank all of our panelists for being here today.
We will have more questions that we will submit for the record,
and I want all the Committee Members to know I look forward to
working with you as we develop legislation based on today's
hearing for our markup, which is currently scheduled to take
place on Wednesday, June 29.
I want all of you to know that as Chair of this Committee I
am going to continue to make sure that this Committee does all
it can to ensure that our veterans receive the benefits and
services they have earned through their service to this Nation.
Thank you very much, and with that, this hearing is
adjourned.
[Whereupon, at 11:43 a.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of the U.S. Department of Defense
Chairman Murray, Ranking Member Burr, and Members of this
distinguished Committee thank you for extending the invitation to the
Department of Defense to address pending legislation that would
significantly affect our Servicemembers: S. 277, the proposed ``Caring
for Camp Lejeune Veterans Act of 2011;'' S. 486, the proposed
``Protecting Servicemembers from Mortgage Abuses Act of 2011;'' S. 491,
the proposed ``Honor America's Guard-Reserve Retirees Act of 2011;''
S. 698, the proposed bill to amend title 38, United States Code, to
codify the prohibition against the reservation of gravesites at
Arlington National Cemetery, and for other purposes; S. 951, the
proposed ``Hiring Heroes Act of 2011.''
The Department has no comment on S. Con. Res. 4, the concurrent
resolution expressing the sense of Congress that an appropriate site on
Chaplain's Hill in Arlington National Cemetery should be provided for a
memorial in memory of the Jewish chaplains who died while on active
duty in the Armed Forces of the United States since this resolution
recently passed the Senate and has now been referred to the House
Committee on Veterans Affairs and the House Armed Services Committee.
The Department does not support S. 277 and shares some comments.
The Department supports the proposed bill S. 486 as drafted, with
one caveat: the mortgage protections of section 533 should only be
extended to 12 months rather than to the proposed 24 months.
The Department is working with VA to develop an Administration
position on S. 491, the ``Honor America's Guard-Reserve Retirees Act of
2011.'' S. 491 would amend title 38, United States Code, by creating a
new section that would honor as Veterans certain persons who performed
service in the reserve component, while providing no additional
benefits.
The Department recommends modifying S. 698 according to details
provided in this testimony.
The Department recommends modifying S. 951 and the Department's
comments are limited to sections directly impacting the Department.
The Department defers positional comment to the Department of Labor
(DOL) on S. 1104. The Department looks forward to our continued strong
collaborative partnership with DoL's Veterans Employment and Training
Service (VETS) and will work together for the best interest of those
who have served.
The Department defers to the VA on S. 1060. DOD does not have any
specific concerns.
SUMMARY OF THE DEPARTMENT'S VIEWS ON PENDING LEGISLATION
S. 277
The Department does not support S. 277. S. 277 would furnish
hospital care, medical services, and nursing home care implemented and
funded by VA to veterans who were stationed at Camp Lejeune ``while the
water was contaminated,'' as well as family members who accompanied
them. As explained in testimony by the Department of Veterans Affairs
(VA), there is insufficient medical evidence to support this approach.
In addition, the Marine Corps notes that this bill creates
inequities between veterans, family members, civilian employees, and
government contractors. Section 2(a) of S. 277 provides that veterans
who were stationed at Camp Lejeune during the applicable period (to be
determined by the VA Secretary in consultation with Agency for Toxic
Substances and Disease Registry) would be eligible for hospital care,
medical services, and nursing home care from the VA ``for any illness,
notwithstanding that there is insufficient medical evidence to conclude
that such illness is attributable'' to water that was contaminated by
volatile organic compounds (VOCs). Section 2(b) of S. 277 states that
family members of veterans who resided at Camp Lejeune during the
applicable time would be ``eligible for hospital care, medical
services, and nursing home care'' from the VA for any condition or
disability associated with exposure to contaminants in the water. The
legislation makes no provision for civilian employees and government
contractors.
S. 486
The Department of Defense (DOD) supports the proposed bill S. 486
as drafted, with one caveat: the mortgage protections of section 533
should only be extended to 12 months rather than to the proposed 24
months.
Although DOD hesitates to recommend against any protection extended
to Servicemembers, we believe that a three-month extension more fairly
balances the equities of all parties, including the lending industry,
and would help ensure that no backlash against the Servicemember--
perhaps in the form of decreased credit opportunities--is ever
considered.
An extension to 12 months would align the foreclosure protections
of section 533 with the current 12-month interest rate cap of section
527 (for pre-service mortgage obligations). This would help reduce
confusion over the current, unevenly-extended protections.
S. 491
S. 491 would amend title 38, United States Code, by creating a new
section that would honor as Veterans certain persons who performed
service in the reserve component. With enactment of this legislation,
members of the National Guard and Reserve who qualify for retirement
after 20 years of service, but did not serve on a period of active duty
of sufficient duration to satisfy statutory requirements for Veteran
status, will be acknowledged as a Veteran for honorary purposes. The
bill would not convey any additional benefits to these members not
already provided in statute. The Department is coordinating with VA to
develop an Administration position on this bill.
S. 698
S. 698 would amend title 38, United States Code, to codify the
prohibition against the reservation of gravesites at Arlington National
Cemetery. As drafted, S. 698 would prohibit more than one gravesite per
eligible veteran and would also prohibit gravesite reservations prior
to the time of need with an exception for written ``requests'' for a
reserved gravesite made prior to January 1, 1962 regardless of current
eligibility requirements. Current Army regulations establish a ``one-
gravesite-per-family'' policy. This rule has been in effect since 1961.
One important element of Army policy is that the Army may allow
exceptions to the ``one-gravesite-per-family'' policy when strict
adherence to the policy is not feasible. This policy is set forth at 32
CFR Sec. 553.18(a) and Army Regulation 290-5 Sec. 2-5(a). S. 698, as
drafted, does not, but in the Department's view should, provide the
Secretary of the Army with the requisite authority to make an
appropriately justified exception to the ``one-gravesite-per-family''
policy. The Department recommends modifying S. 698 accordingly.
Similarly, the Army currently prohibits reserving gravesites prior
to time of need and does not honor gravesite reservations unless (1)
the reservation was made in writing before the ``one-gravesite-per-
family'' policy was established, (2) an eligible person was interred
before the one-gravesite-per-family policy was established, and (3) the
person holding the reservation for the adjacent gravesite is eligible
for interment at Arlington National Cemetery under current Army
eligibility rules. This policy is set forth at 32 CFR Sec. 553.18 and
Army Regulation 290-5 Sec. 2-5. This exception to the prohibition on
reservations is necessary because prior to the ``one-gravesite-per-
family'' policy, individuals were not interred at depths that would
accommodate two or three subsequent burials in the same gravesite like
they are today.
As drafted, proposed section 2410A(b) in S. 698 reflects the Army's
current policy prohibiting reservations. Section 1(c)(2) of S. 698,
however, creates an exception to the prohibition on reservations for
those who have a ``written request for a reserved gravesite [that] was
submitted to the Secretary of the Army before January 1, 1962.'' This
exception would alter current Army policy by allowing reservations for
those with only a reservation request rather than an approved
reservation before 1962. The requirement for a valid reservation, not
just a request, is necessary to implement S. 698. The Department has no
objection to the reporting requirement contained in section 1(d) of
S. 698.
S. 951
The Department's comments on S. 951 are limited to sections
directly impacting the Department.
Section 2: The Department is not opposed to the provisions of
section 2 that would extend Section 1631(b)(1) of the National Defense
Authorization Act (NDAA) for 2008 (Public Law 110-181) through
December 31, 2014. Section 1631(b)(1) allows Servicemembers, with a
severe injury or illness to receive vocational, rehabilitation and
employment benefits (but not compensation) from the Secretary of
Veterans Affairs to facilitate their recovery and rehabilitation while
still a member of the Armed Forces. Extending this benefit provides
Servicemembers with disabilities assistance in identifying the training
requirements and resources needed to achieve their rehabilitation and
employment goals.
Section 6: The Department does not support section 6 as written. In
FY 2010 there were approximately 155,000 active component retirements/
separations with an 82.5 participation rate in the Department of Labor
(DOL) employment workshops. Section 6 will require mandatory
participation in the DOL Employment Workshop for all transitioning
Servicemembers and does not allow any exceptions. As written, this
section would require the following personnel to be retained on active
duty until they have completed this TAP component: Unanticipated losses
(i.e., administrative discharges), approximately 57,000; Demobilizing/
deactivating Guard/Reserve Component Servicemembers to complete the
same program as their active duty counterparts, approximately 100,000;
and several thousand Individual Mobilization Augmentees (IMA).
This provision also assumes increased TAP participation will
correlate with an increase in transitioning Servicemembers obtaining
employment. DOL is currently revamping its 2\1/2\-day employment
workshop and will have the new workshop in place in November 2011. The
Department recommends an analysis of the impact of the new workshop on
employment before mandating this component of TAP for all transitioning
personnel.
There is also an unknown, but potentially huge resource requirement
that is currently not addressed in the President's budget, which would
result from extending the previously noted categories of Servicemembers
on active duty in order to be in compliance with mandatory TAP
requirements. This would require an in-depth cost analysis, showing the
impact of extending personnel on active duty to provide TAP counseling/
briefings as well as to determine the impact on existing facilities
(i.e., adequate classrooms, additional counselors/coaches,
administrative support staff, IT support, equipment/computers, and IT
infrastructure). A mandatory TAP requirement would also be a huge
increase on costs for demobilizing National Guard and Reserves, to
include post-deployment follow-up for up intervention for employment
assistance. Such costs would also need to be part of an in-depth cost
analysis.
In lieu of mandatory employment workshop participation for all
separating Servicemembers, the Department recommends considering
mandatory participation for Servicemembers with 10 or fewer years of
active duty service (if the goal is to impact the group with the
highest unemployment rate) with an ``opt out'' provision for all
others. The Department also recommends having TAP components provided
no later than 6-9 months before discharge and allow Servicemembers
access to partnership programs with private employers or methods to
develop/refine job skills prior to discharge
Section 9: The Department believes that section 9 is unnecessary as
it duplicates existing processes that provide the capability to
crosswalk Servicemember skills to equivalent civilian occupations, and
therefore opposes section 9 of S. 951.
During mandatory (required by statute) preseparation counseling,
Servicemembers are informed about the Occupational Information Network.
The revised DD Form 2648, Preseparation Counseling Checklist for Active
Component (AC), Active Guard Reserve (AGR), and Reserve Program
Administrator (RPA) Servicemembers, states, ``counselors will provide
information on civilian occupations corresponding to Military
occupations (see Occupational Information Network (O*Net Web site) at
www.online.onetcenter.org/crosswalk and related programs * * *.''
The Occupational Information Network (O*NET) is under the
sponsorship of the US Department of Labor/Employment and Training
Administration. The O*NET program is the Nation's primary source of
occupational information. Central to the project is the O*NET database,
containing information on hundreds of standardized and occupation-
specific descriptors. The database is continually updated by surveying
a broad range of workers from each occupation. O*NET OnLine contains
crosswalks between the O*NET-Standard Occupational Classification (SOC)
and the Classification of Instructional Programs (CIP), Dictionary of
Occupational Titles (DOT), Military Occupational Classification (MOC),
Registered Apprenticeship Partners Information Data System (RAPIDS),
and Standard Occupational Classification (SOC).
Additionally, the Department of Labor's Employment and Training
Administration has a long-standing record of assisting transitioning
Servicemembers with O*NET.
Another program is the United States Military Apprenticeship
Program (USMAP), a partnership between Secretary of Labor, Secretary of
Navy and Secretary of Transportation. Out of 300 enlisted Military
Occupational Specialties (MOS's), 257 are covered under USMAP trades/
occupations employing apprenticeship. Occupations offered through USMAP
cross over into several civilian industries, including servicing,
manufacturing and construction, and transportation/utilities.
Section 10: The Department opposes section 10. The authority under
this section is too broad in its application and scope. It would appear
the language would simply allow veterans to be non-competitively
appointed to the GS system within 180 days of discharge. There appears
to be no provision on how we would establish qualifications. Given we
have a myriad of hiring authorities for veterans, we do not see what
problem this language is trying to solve. Further, it runs the risk of
making it extremely difficult for someone who is not a veteran to gain
entry level employment in light on this authority. We run the risk of
inadvertently giving veterans preference that is far overreaching and
will likely be challenged by the Merit Systems Protection Board.
Section 12: The Department is not opposed to the provisions of
section 12 which would allow the Department to establish a pilot
program to provide separating Servicemembers, who are on terminal
leave, work experience with civilian employees and contractors of the
Department of Defense to facilitate the transition of those members
from service in the Armed Forces to employment in the civilian labor
market. The Department realizes the value of programs that improve the
employment outcomes for our transitioning servicemembers, such as those
that provide exposure to the civilian work environment while working
for the Department. The Department of Labor, Veterans Affairs, and
Homeland Security all jointly develop and contribute to the Transition
Assistance Program, and we look forward to working with them to improve
transition outcomes by using new and creative ideas, such as the one
provided in this section.
______
Prepared Statement of Mercedes Marquez, Assistant Secretary for
Community Planning and Development, U.S. Department of Housing and
Urban Development
S. 411, HELPING OUR HOMELESS VETERANS ACT OF 2011
Chairman Murray, Ranking Member Burr, Distinguished Members of the
Senate Committee on Veterans' Affairs, I am pleased to be able to
submit this testimony on behalf of the U.S. Department of Housing and
Urban Development (HUD) regarding S. 411, Helping our Homeless Veterans
Act of 2011.
BACKGROUND
This bill proposes two amendments to U.S. Code Title 38: Inserting
section 2045, allowing the VA to ``enter into agreements with eligible
entities to collaborate in the provision of case management services''
as part of the HUD-VA Supportive Housing (HUD-VASH) program; and
section 2046, which calls for ``the distribution of rental vouchers to
veterans in rural areas and underserved veterans in metropolitan areas
or on Indian lands in each region of the United States.''
HUD and the Administration share the goal of this legislation to
better meet the needs of homeless veterans. One year ago this month,
the President released Opening Doors: The Federal Strategic Plan to
Prevent and End Homelessness, which calls for ending veteran
homelessness by 2015, and includes strategies to help achieve the goal.
HUD is working closely with the Department of Veterans Affairs to
ensure our programs are coordinated to effectively and efficiently meet
the needs of homeless veterans. One of the key successes, to date, is
the HUD-VASH program. This program combines rental assistance provided
by HUD with services and health care provided by VA. By jointly working
to improve the program, the ability to more swiftly identify and house
homeless veterans has been greatly enhanced.
GEOGRAPHIC DISTRIBUTION
S. 411 seeks to ensure that resources are provided to homeless
veterans who reside in rural communities--some of whom may be in areas
that are long distances from VA medical centers. The current allocation
methodology uses relative need and performance to distribute vouchers,
and provides vouchers to many rural areas that demonstrate relative
need via data provided to HUD and VA. While HUD agrees that there
should be geographic diversity in the distribution of vouchers, it
should be noted HUD and VA data show that the most significant need
remains in urban centers. On the other hand, the Administration is
committed to addressing veterans' homelessness wherever it exists, and
a more efficient way to meet rural veterans' needs may be through HUD's
Continuum of Care programs. As part of the Administration's funding
request for the new Homeless Emergency and Rapid Transition to Housing
(HEARTH) Act, HUD included in its FY 2012 budget funding to implement
the Rural Housing Stability Assistance Program (RHSP). This would
provide assistance in rural areas to individuals and families
(including veterans) who are homeless, in imminent danger of losing
housing, or in worst case housing situations. The HEARTH Act also
authorizes the new Emergency Solutions Grant (ESG) program, which
provides funding for homelessness prevention, shelter, and rapid re-
housing services. HUD looks forward to working with the Committee and
our Administration partners to determine the most effective ways of
addressing homelessness among veterans in urban and rural areas.
CONTRACTING
One component of the bill that we believe could have a significant
positive impact on assisting homeless veterans involves the provision
of services through VA contracts with local non-profits and other
agencies to provide case management and to connect to HUD housing
resources. As demonstrated by the success of the HUD-VA--U.S.
Interagency Council on Homelessness (USICH) Washington, DC. Pilot
Initiative, contracting and collaborating with local providers can
greatly enhance the provision of needed services in some communities.
Through a joint effort between Washington, DC's Department of Human
Services and the D.C. Housing Authority, the eligibility process was
streamlined and as a result, vouchers were allocated at a substantially
faster pace and clients with vouchers were quickly housed. These very
positive, initial results from the first pilot suggest that this model
should be looked at further in other communities that the Departments
deem appropriate.
TARGETING
We have learned through our HUD-VASH efforts in recent years that a
key to success in ending veteran homelessness is effective targeting.
Therefore we have concerns about the potential impact of this bill on
those targeting efforts. While the title of the bill indicates that the
targeted population will be homeless veterans, the text of the bill in
a number of cases uses the term ``underserved veterans,'' suggesting
that the program could be modified to serve more than veterans who are
homeless. The current HUD-VASH assistance is designed to house the
neediest veterans, many of whom are chronically homeless. We would
argue in favor of keeping that targeting to this population as a
priority at this time.
CASE MANAGEMENT
The bill includes a broad definition of case management services,
which could complicate the efforts of HUD, the VA, and organizations
that would be contracted to provide needed services to homeless
veterans. For example, the bill includes activities such as rental
assistance, legal assistance, and mental health or substance abuse
counseling as part of case management. HUD looks forward to working
with the Committee and VA to clarify the definition of case management
in the legislation in order to help improve coordination and
efficiency, as well as oversight.
TRIBAL LANDS
HUD recognizes the need for improved housing and services for
veterans on Tribal Lands, and we are eager to explore options for
helping to achieve this goal. While persons living in tribal areas are
individually eligible for HUD-VASH, under current law the tribal areas
themselves are not eligible for any Housing Choice Voucher (HCV)
program (including HUD-VASH), or for McKinney-Vento Act/homeless
programs. However, it should be noted that the Native American Housing
Assistance and Self-Determination Act (NAHASDA) authorizes assistance
to Indian Tribes or their Tribally Designated Housing Entities (TDHE)
through the Indian Housing Block Grant (IHBG). IHBG can be used to
develop rental assistance programs similar to HCV. We believe it is
important to take into account these mechanisms for providing services
to veterans on Tribal Lands as part of the effort to consider what
changes to the existing system make sense. And, again, we look forward
to discussing these matters with Members of the Committee.
CONCLUSION
The HUD-VASH model has served as a vital tool for ending veteran
homelessness, and HUD is encouraged that Senator Klobuchar and the
Committee continue to seek ways to improve the program. HUD looks
forward to working with the Committee to further discuss how the intent
of the S. 411's provisions can best be realized.
______
Prepared Statement of Paralyzed Veterans of America
Chairman Murray, Ranking Member Burr, and Members of the Committee,
Paralyzed Veterans of America (PVA) would like to thank you for the
opportunity to present our views on the broad array of legislation
impacting the Department of Veterans Affairs (VA) pending before the
Committee. These important bills will go a long way toward improving
the lives of veterans and their families.
S. 277, THE ``CARING FOR CAMP LEJEUNE VETERANS ACT OF 2009''
While PVA believes the intent of this legislation is good, we
cannot support S. 277, the ``Caring for Camp Lejeune Veterans Act of
2011,'' as introduced. The intent of this legislation is to provide
hospital care, medical services, and nursing home care to veterans and
family members who were stationed at Camp Lejeune, NC, while the water
was contaminated by volatile organic compounds, including known human
carcinogens and probable human carcinogens, for any illness, to include
a child who was in utero at the time. These servicemembers and their
families have been suffering for decades and should be entitled to care
and compensation.
However, the legislation places the burden for providing this care
upon the Department of Veterans Affairs (VA) health care system. Caring
for dependents in particular, is not the principal mission of the VA;
whereas, the Department of Defense (DOD) healthcare system is
specifically designed to care for servicemembers and their families.
Moreover, since these families exposure is directly related to service
at Camp Lejeune, we believe that the burden to take care of the
servicemember's dependents falls to the DOD.
S. 396, THE ``MEETING THE INPATIENT HEALTH CARE NEEDS OF
FAR SOUTH TEXAS VETERANS ACT OF 2011''
Paralyzed Veterans of America supports S. 396, the ``Meeting the
Inpatient Health Care Needs of Far South Texas Veterans Act of 2011.''
This bill would ensure that the Department of Veterans Affairs (VA) has
the resources and capacity to meet the health care needs of veterans
living in the Far South Texas area. Specifically, this bill will
require the VA medical center in Harlingen, Texas, to provide ``full-
service'' inpatient health care for veterans in Far South Texas. This
legislation improves access to VA health care for approximately 117,000
veterans.
S. 411, THE ``HELPING OUR HOMELESS VETERANS ACT OF 2011''
PVA supports S. 411, the ``Helping Our Homeless Veterans Act of
2011.'' This legislation will improve outreach to rural veterans,
underserved urban veterans, and Native American Veterans, by creating
partnerships to help extend essential services to homeless veterans. By
strengthening the successful HUD-Veterans Affairs Supportive Housing
(HUD-VASH) program this legislation will provide housing vouchers along
with case management to this underserved population. The VA will
provide counseling for these veterans that will also include employment
training for some veterans. This employment training along with
continued support from the VA will insure the participating veterans
can become productive members of the community.
S. 423
This legislation would amend Title 38, United States Code, Section
5110(b) to allow for a retroactive effective date of a claim up to one
year prior to the date of submittal of a fully developed claim. Current
law fixes the effective date of claim at the date that the claim was
submitted. PVA fully supports this legislation as proposed. We believe
that this legislation could incentivize veterans and their service
representatives to prepare well-developed, ready-to-rate claims prior
to submittal, offering the opportunity for expedited claims processing.
S. 486, THE ``PROTECTING SERVICEMEMBERS FROM MORTGAGE ABUSES ACT OF
2011''
This legislation will increase the existing protection for
servicemembers that is provided by the Servicemembers Civil Relief Act
(SCRA) against mortgage lenders. It extends the period of protection
against mortgage sale or foreclosure from the current nine months to
twenty- four months after an individual separates from the service.
Some of the Nation's largest mortgage lenders have recently
demonstrated unscrupulous acts of denying the established Federal
Governments 6 percent interest rate cap on preexisting loans for
servicemembers and illegally foreclosing on homes owned by
servicemembers.
This legislation will ease concerns over financial situations at
home for the men and women that serve this country. PVA supports this
necessary legislation.
S. 490
Paralyzed Veterans of America fully supports S. 490, a bill to
increase the maximum age for children eligible for medical care under
the CHAMPVA program. S. 490 increases the child beneficiary age for
CHAMPVA health care benefits from 22 to 26 years of age.
Public Law 111-148, the ``Patient Protection and Affordable Care
Act,'' extended the eligibility age for dependent children being
carried on their parents' health insurance policies to 26 years old.
Unfortunately, this benefit was not initially provided to TRICARE and
CHAMPVA beneficiaries. The extension was subsequently provided to
dependent children of military personnel (those on TRICARE) by P.L.
111-383, the ``National Defense Authorization Act (NDAA) for FY 2011.''
Currently, the children of 100 percent service-connected disabled
veterans who are 23 years of age or older do not qualify for CHAMPVA
benefits. By increasing the maximum age for CHAMPVA beneficiaries,
these children will be afforded the same health care protections as
other children of military personnel.
S. 491, THE ``HONOR AMERICA'S GUARD-RESERVE RETIREES ACT OF 2011''
PVA supports S. 1780, the ``Honor America's Guard-Reserve Retirees
Act.'' This bill incorporates ``veteran'' into the Guard and Reserve
community. PVA supports recognizing and honoring all servicemembers,
including the National Guard and Reserve components, for their faithful
and honorable service in defending the United States of America.
Serving in a volunteer force should be credited to the servicemember
and not discounted, through no fault of their own, because they were
not activated.
S. 536
PVA supports S. 536, legislation to insure that utilization of
survivors and dependents education assistance shall not be subject to
the 48-month limitation on the aggregate amount of assistance under
multiple veterans' educational assistance programs.
S. 572
Paralyzed Veterans of America (PVA) supports S. 572, a bill to
repeal the prohibition on collective bargaining with respect to
compensation of Department of Veterans Affairs (VA) employees other
than rates of basic pay. Eliminating the prohibition on collective
bargaining would be a positive step in addressing the recruitment and
retention challenges the VA faces when hiring quality professionals,
particularly in the area of health care.
S. 666, THE ``VETERANS TRAUMATIC BRAIN INJURY CARE IMPROVEMENT ACT OF
2011''
Paralyzed Veterans of America supports S. 666, the ``Veterans
Traumatic Brain Injury Care Improvement Act of 2011.'' As a result of
the growing use of Improvised Explosive Devices (IED), Traumatic Brain
Injury (TBI) has become a signature wound of the current wars in
Afghanistan and Iraq. Today, we still do not fully understand the
impact or gravity of TBI. In April 2008, the RAND Corporation Center
for Military Health Policy Research completed a comprehensive study
titled Invisible Wounds of War: Psychological and Cognitive Injuries,
Their Consequences, and Services to Assist Recovery. RAND found 57
percent of those reporting a probable TBI had not been evaluated by a
physician for brain injury.
S. 666 will require the Department of Veterans Affairs (VA) to
produce a report on the establishment of a VA Polytrauma Rehabilitation
Center or Polytrauma Network Site in the Northern Rockies or Dakotas,
thus increasing veterans' access to care and evaluation for TBI. PVA
believes that this legislation will serve as a starting point for
ensuring that health care and support programs are available to
veterans and their families in the Northern Rockies and Dakotas to help
them manage the challenges associated with a brain injury.
S. 696
Paralyzed Veterans of America supports S. 696, a bill to treat Vet
Centers as Department of Veterans Affairs (VA) facilities for purposes
of payments or allowances for beneficiary travel to Department
facilities. During the past year, VA Vet Centers provided readjustment
counseling services in more than 260 community-based centers and
approximately 50 mobile centers, and veteran enrollment for such
services continues to increase. Vet Centers often serve as the only
outlet for veterans to receive ``veteran-specific'' qualified
professional counselors, peer support, and confidential services that
are unreportable to military line commanders or VA medical authorities.
As such, the expenses associated with traveling to Vet Centers should
not discourage veterans from seeking the aforementioned support and
services. If enacted, S. 696 will improve the availability of
readjustment counseling services for veterans seeking assistance.
S. 698
PVA does not oppose S. 698, legislation that would codify the
prohibition against the reservation of gravesites prior to death at the
Arlington National Cemetery. This bill would also prohibit multiple
gravesites from being reserved for a servicemember or veteran who is
eligible for interment.
S. 745
PVA supports S. 745, a bill to protect certain veterans who would
otherwise be subject to a reduction in educational assistance benefits.
This legislation will restore fairness for some veterans that are
enrolled in a program of higher learning at a nonpublic institution for
the period of August 1, 2011 through December 31, 2014. Recent changes
in the Post-9/11 GI Bill have resulted in this particular group of
veterans owing more for their tuition and fees than they originally
anticipated. This legislation corrects this oversight for these
enrolled veterans and allows veterans enrolled in such programs to pay
the lesser of; the charges for that program, the charges payable under
the VA's maximum payments table, or, the amount for the previous year
including an annual percentage increase.
S. 769
PVA supports S. 769, the ``Veterans Equal Treatment for Service
Dogs Act of 2011.'' While we believe this legislation should be
unnecessary based on the provisions of Section 504 of the Rehab Act,
the actions of the VA clearly demonstrate the need for this
legislation. If the VA is unwilling to make the regulatory change to
accomplish the intent of S. 769, then we hope Congress will move
quickly to enact this important legislation.
S. 780
PVA supports S. 780, legislation that would exempt reimbursements
of expenses related to accident, theft, loss, or casualty loss from
determinations of annual income with respect to pensions for veterans
and surviving spouses and children of veterans. Our Nation's veterans
should not have to claim incidental insurance compensation as income
that would inadvertently reduce their pension payment. This is a common
sense amendment to current law.
S. 815, ``SANCTITY OF ETERNAL REST FOR VETERANS ACT OF 2011''
PVA supports S. 815, the ``Sanctity of Eternal Rest for Veterans
Act of 2011.'' This legislation would amend the Federal criminal code
concerning the prohibition on disruptions of funerals of members or
former members of the Armed Forces to increase the period covered under
such prohibition from one to two hours before and after a military
funeral. This includes within such unlawful conduct any disturbance or
disruption occurring within 500 feet of the residence of a surviving
member of a deceased immediate family. This legislation also provides
remedies, including actual and statutory damages and makes identical
changes under Federal veterans' provisions concerning the prohibition
on certain demonstrations and disruptions at national cemeteries,
including Arlington National Cemetery.
PVA believes all veterans' and military servicemembers' funerals
should be afforded the highest honor and conducted with the dignity and
respect that they deserve.
S. 873
This legislation would amend Title 38 U.S.C., to provide benefits
for children with spina bifida of veterans exposed to herbicides while
serving in the Armed Forces during the Vietnam era outside Vietnam. PVA
supports this legislation as it would align with benefits currently
provided to children with spina bifida of veterans exposed to Agent
Orange during service in Vietnam.
S. 874
PVA supports S. 874, legislation that would modify the provision of
compensation and pension to surviving spouses of veterans in the months
of the deaths of the veterans to include prohibiting requests for
return of certain checks and payments, and to improve housing loan
benefits for veterans. This bill also enhances eligibility for
Presidential memorial certificates of individuals who die while serving
in the active military, naval, or air service while serving under
honorable conditions and protects liens created by public entities in
response to disaster-relief assistance on home loans.
S. 894, THE ``VETERANS COST-OF-LIVING ADJUSTMENT ACT OF 2011''
PVA supports S. 894, the ``Veterans' Compensation Cost-of-Living
(COLA) Adjustment Act of 2011,'' that would increase, effective as of
December 1, 2011, the rates of compensation for veterans with service-
connected disabilities and the rates of dependency and indemnity
compensation (DIC) for the survivors of certain disabled veterans. This
would include increases in wartime disability compensation, additional
compensation for dependents, clothing allowance, and dependency and
indemnity compensation for children. PVA continues to oppose the
provision of this legislation that would round down any benefit to the
next lower whole dollar amount.
For the past two years, there has been no increase in compensation
or DIC rates due to the Social Security index not increasing. While our
economy continues to falter, veterans' personal finances have been
affected by rising costs of essential necessities to live from day to
day maintaining a certain standard of living.
S. 910, THE ``VETERANS HEALTH EQUITY ACT OF 2011''
PVA is unable to support S. 910, the ``Veterans Health Equity Act
of 2011.'' S. 910 proposes to require that veterans have access to at
least one full-service Department of Veterans Affairs (VA) medical
center in each of the 48 contiguous states, or receive comparable
services provided by contract in their state. Under this legislation,
if a VA medical center is not a full-service facility, ``does not
provide hospital care, emergency medical services, and surgical care
that is rated by the Secretary as having a surgical complexity level of
`standard,' '' veterans may utilize contracted services from private
health care providers in their state. While this legislation is an
attempt to address issues involving access to health care, PVA believes
that if enacted, S. 910 will lead to diminution of VA health care
services, and increased health care costs in the Federal budget. This
legislation would turn VA's current fee-basis policy, which allows VA
to purchase care from a private provider when VA medical care is not
``feasibly available to veterans,'' into a permanent treatment plan.
While access is indeed a critical concern for PVA, we believe VA is
the best health care provider for veterans. Providing primary care and
specialized health services is an integral component of VA's core
mission and responsibility to veterans. Unfortunately, funding for VA
health care in the past has had difficulty keeping pace with the
growing demand. Even with the passage of Advance Appropriations and
record budgets in recent years, funding is not guaranteed to be
sustained at those levels and PVA is concerned that contracting health
care services to private facilities is not an appropriate enforcement
mechanism for ensuring access to care. In fact, it may actually serve
as a disincentive to achieve timely access for veterans seeking care.
PVA is also concerned about the continuity of care. The VA's unique
system of care is one of the Nation's only health care systems that
provide developed expertise in a broad continuum of care. Currently,
VHA serves more than 8 million veterans, and provides specialized
health care services that include program specific centers for care in
the areas of spinal cord injury/disease, blind rehabilitation,
Traumatic Brain Injury, prosthetic services, mental health, and war-
related polytraumatic injuries. Contracting out to private providers
will leave the VA with the difficult task of ensuring that veterans
seeking treatment at non-VA facilities are receiving quality health
care. The quality of VA's health care and ``veteran-specific''
expertise cannot be adequately duplicated in the private sector.
For these reasons, PVA does not support S. 910, and strongly
believes that VA remains the best option available for veterans seeking
health care services.
S. 914
Paralyzed Veterans of America (PVA) supports S. 914, a bill that
would authorize the waiver of the collection of copayments for
telehealth and telemedicine visits of veterans. Telemedicine has proven
to be a cost effective service that connects the specialist via
telecommunications to the veteran. It has been particularly useful in
the rural setting. This is a new era of health care delivery and PVA
believes that this bill will help VA do its part in keeping up with
technological advances to provide innovative solutions to the health
care needs of veterans.
S. 928
S. 928 would limit the authority of the Secretary of Veterans
Affairs to use bid savings on major medical facility projects of the
Department of Veterans Affairs to expand or change the scope of a major
medical facility project of the Department. PVA is concerned that this
bill, as proposed, would lead to conflicting priorities for
construction projects, those identified by Congress and those
identified by VA.
The VA manages a wide portfolio of capital assets across the Nation
and prioritizes projects to be authorized for funding by Congress. This
list is compiled based on VA's data-driven assessment of the current
and future construction needs for the Department. Under S. 928, VA
would be required to report a major medical facility project that is
the source of bid savings, and provide notice, and a description of
those major medical facility project(s) that will be expanded or
changed in scope. PVA understands that the general intent of S. 928 is
to efficiently utilize bid savings for priority construction projects
that are in need of funding by ensuring that limited construction funds
are only allocated for and within the scope of authorized projects.
Nonetheless, we believe that the aforementioned requirements have the
potential to jeopardize timely completion of construction projects and
result in bid savings going to various projects that are not in the
order of priority as identified by VA. These requirements are of
particular concern to PVA since the proposed legislation does not
outline proceedings that will take place after VA reports and proposes
usage of bid savings to Congress.
To address these concerns, PVA recommends including text that would
require VA to use bid savings on major medical facility projects that
have been previously authorized by Congress for funding, and such
funding should also be allocated based on the VA's priority list of
projects. Additionally, PVA strongly encourages the author(s) of this
bill to include text that requires any designated savings resulting
from construction of spinal cord injury (SCI) centers to be redirected
toward other SCI construction projects.
S. 935, THE ``VETERANS OUTREACH ENHANCEMENT ACT OF 2011''
Witnesses testifying at recent hearings before the Senate and House
Committees on Veterans' Affairs have indicated that many servicemembers
returning to the civilian world often have limited, or no knowledge of
the programs, benefits, and assistance available for them based on
their active military service. This legislation, S. 935, the ``Veterans
Outreach Enhancement Act of 2011'' will help communicate the
information to all veterans, including veterans in rural areas. This
will authorize the Secretary to develop and carry out a program of
outreach which may include collaborating with state and local
governments to help perform this outreach.
PVA has a concern that the VA may designate portions of this
outreach responsibility to the states through each states' Local
Veterans' Employment Representatives (LVER) and Disabled Veterans'
Outreach Program (DVOP) specialists. Although some states may excel at
helping veterans through these federally funded programs, traditionally
these programs do not fulfill the responsibilities of placing veterans
in employment, or informing veterans of benefits. Therefore, PVA
believes allocating more funds to individual states through these
programs will not increase the VA's outreach efforts. Most states have
a department of veterans' affairs. Like the state employment programs,
these vary widely in their responsibilities and performance. For the VA
to designate and rely on these offices to fulfill the VA's outreach
responsibilities would require oversight of these offices.
In some locations local nonprofit and veterans service
organizations may currently be active with assisting and advising
veterans. Since they would have the regular contact with local
veterans, this may be another source for the VA to conduct the outreach
responsibility.
S. 951, THE ``HIRING HEROES ACT OF 2011''
PVA supports S. 951, the ``Hiring Heroes Act of 2011.'' With
veterans' national unemployment rate higher that civilian unemployment
for all age categories and recently estimated over 27 percent among
young veterans coming home from Iraq and Afghanistan, the Federal
Government must assist these men and women as they try to assimilate
back into the civilian world. The ``Hiring Heroes Act of 2011'' is a
proactive effort by the various agencies, VA, DOL, and DOD, to actively
assist the newly discharged servicemember to identify a career path,
prepare for that career, and assist the veteran in obtaining employment
they desire. The ``Hiring Heroes Act of 2011'' is the first legislation
of its kind to require broad job skills training for all servicemembers
returning home.
Military service to the Nation could also be a program for
preparing individuals for the civilian work opportunities. Today most
military occupations do not offer that benefit since many are
nontransferable skills. If all provisions included in ``Hiring Heroes
Act of 2011'' are fully developed, properly executed, and available to
all servicemembers, this effort instead of an additional burden for the
military, will provide a strong recruitment tool for all branches of
service.
S. 957, THE ``VETERANS TRAUMATIC BRAIN INJURY REHABILITATIVE SERVICES'
IMPROVEMENTS ACT OF 2011''
PVA fully supports S. 957, the ``Veterans Traumatic Brain Injury
Rehabilitative Services' Improvement Act of 2011.'' If enacted, S. 957
would ensure that long-term rehabilitative care becomes a primary
component of health care services provided to veterans who have
sustained a TBI. Specifically, this legislation would change the
current definition of ``rehabilitative services'' to include
maintaining veterans' physical and mental progress and improvement, as
well as maximizing their ``quality of life and independence.'' As
previously mentioned, Traumatic Brain Injury (TBI) is one of the most
common and complex injuries facing veterans returning from the current
wars in Afghanistan and Iraq. This bill will address the intricacies
associated with TBI and help veterans and their families sustain
rehabilitative progress.
S. 1017, THE ``DISABLED VETERAN CAREGIVER HOUSING ASSISTANCE ACT OF
2011''
PVA members and other veterans with service-connected disabilities
that impede mobility will benefit from S. 1017, as they use this
temporary grant for the purpose of modifying an existing home of a
family member to meet their adaptive needs. It is not unusual for newly
injured veterans who qualify for the VA Specially Adaptive Housing
(SAH) grant to also require assistance with daily living activities
from a family member upon discharge from the hospital. These post-
hospital individuals may live with a family member temporarily while
continuing their rehabilitation and adjusting to the civilian world.
This bill will increase the amount of funds available through the
Temporary Residence Adaptation (TRA) grant to veterans to make the
necessary modifications in a temporary residence.
The Independent Budget for FY 2012 recommends an increase for the
TRA grant from the current $14,000 to $28,000 and for the companion
grant for other qualified veterans from $2,000 to $5,000. S. 1017 meets
the IB's recommendations.
This bill also qualifies veterans with severe vision impairments
and, severe burns, for the TRA grant. Both conditions restrict
mobility, and the last decade of military conflict has produced a large
increase in veterans that suffer from these conditions.
S. 1017 will make the temporary grant a regular benefit without a
cap on total grants available. The legislation also eliminates the
deduction from total funds available when applying for the standard SAH
grant. This legislation will increase the use of TRA grants which, as
intended, will provide more accessibility for newly injured veterans.
S. 1060, ``HONORING ALL VETERANS ACT OF 2011''
PVA supports S. 1060, the ``Honoring All Veterans Act of 2011''
that would significantly improve aid and services to veterans in the
areas of employment, housing, education and health care.
The unemployment rate of veterans who served in Iraq and
Afghanistan doubled from 2007 to 2010 and the Department of Labor
estimates that approximately one in four veterans in their early
twenties were unemployed at the beginning of the year, twice the rate
of their non-veteran peers.
Title 1 of the legislation would increase the number of
participants in independent living programs that allow veterans to
participate in family and community life, and increase their potential
to return to work. The bill also provides funding for outreach on
campuses to help veterans maximize their ability to study and gain
employment. It also authorizes a Department of Defense study of how
best to ensure that civilian employers and educational institutions
recognize veterans' military training and qualifications. The military
recruits the most talented men and women in America to serve and
invests heavily in their professional development. Enabling the
transfer of certificates and licensed skills from the military to
civilian jobs would ensure that training accrued during service is not
lost. The legislation also directs the Department of Labor to assist
employers hire veterans suffering from Traumatic Brain Injury (TBI) or
Post Traumatic Stress Disorder (PTSD).
Title 2 would assist homeless veterans by reforming the per diem
program to take account of service costs and geographic disparities. It
also assists military families who are on the verge of losing their
home, by permanently extending their foreclosure protection.
Title 3 of this legislation assists veterans with health care and
mental health services by directing the Department of Defense (DOD) and
the Department of Veterans Affairs (VA) to monitor referrals for mental
health care to ensure that individuals receive care. The bill also
directs the VA to ensure that all TBI and PTSD patients leave VA
medical treatment with a plan for their long-term care needs that
utilizes a ``one-VA'' approach to capture and employment and vocational
services that can assist in long-term care and rehabilitation. Under
this section, there is authorization for VA medical facilities to
provide counseling to family members of deployed servicemembers and
authorizes the VA to access state prescription monitoring programs to
address substance abuse.
Title 4 of S. 1060 directs DOD and VA to establish a monitoring
mechanism to identify and address challenges as they arise in all DOD
and VA facilities and offices involved in the single separation
physical process. This section of the bill also increases the pension
for disabled veterans married to one another who require aid and
attendance and reforms the Board of Veterans Appeals process to help
veterans with misfiled documents.
S. 1104, TRANSITION ASSISTANCE PROGRAM (TAP)
PVA supports S. 1104, which would require regular audits of the
Transition Assistance Program. The TAP program is one of the most
important one-day or at some military facilities two-day, informational
programs the transitioning servicemember will receive. The current TAP
program presented to servicemembers has been in place for nineteen
years. This year the TAP program is being completely updated and
reformatted with state-of-the-art illustrations and support material
for the participating servicemembers. The Department of Labor, Veterans
Employment and Training Service (VETS) program will release the new TAP
by November 11, 2011. As this rollout occurs, PVA believes this program
should be mandatory for all services. Currently the Marine Corp is the
only service that requires TAP.
PVA supports regular audits of TAP in various locations including
the TAP programs provided by contracted sources outside of the United
States. With the development of a new TAP program the audits required
by this legislation will be essential to insuring the servicemembers
are receiving the instructions they need.
S. 1123, THE ``ASSISTANCE TO VETERANS AFFECTED BY NATURAL DISASTERS
ACT''
PVA supports the provisions of S. 1123, the ``Assistance to
Veterans Affected by Natural Disasters Act.'' This legislation is
particularly timely in light of the horrific circumstances that have
befallen the many veterans and their families that reside in the
Midwest, as well as the South and Southeast, that have been affected by
the historic flooding and devastating storms this spring.
Section 1(a) of this legislation would Chapter 21 of Title 38, to
allow the Secretary of Veterans Affairs to award an additional
Specially Adapted Housing (SAH) grant to a veteran whose home was
previously adapted through use of the SAH and whose adapted home that
the veteran occupied was destroyed or substantially damaged in a
natural or other disaster, as determined by the Secretary. The amount
of the grant that could be awarded may not exceed the lesser of either
the reasonable cost, as determined by the Secretary, of repairing or
replacing the damaged or destroyed home in excess of the available
insurance coverage on such home; or the maximum SAH grant amount the
veteran would have otherwise been entitled.
This is an issue that is particularly close to PVA and its members.
Our members are the highest users of this invaluable benefit.
Authorizing the VA to provide a second SAH grant to veterans and their
families devastated by natural disasters would be a welcome relief for
these veterans struggling with their circumstances. This section
closely reflects a recommendation included in The Independent Budget
for FY 2012 which calls for the establishment of a second SAH grant to
be made available for eligible veterans.
The proposed legislation also provides for a two-month extension of
subsistence allowance for veterans completing vocational rehabilitation
program. Specifically, when the Secretary determines that a veteran
participating in VA's Vocational Rehabilitation program is displaced as
the result of a natural or other disaster, two months of additional
payments of subsistence allowance may be granted. Moreover, the
legislation would waive the current cap on the Independent Living
program so that veterans participating in the program who are adversely
affected by a natural or other disaster shall not be forced out of
these critical services.
PVA also fully supports the last provision of S. 1123 which would
allow the Secretary of the VA to provide a second adaptive automobile
grant to eligible veterans whose previously adapted automobile we
significantly damaged or destroyed as a result of a natural or other
disaster. Much like the SAH grant, PVA members are high end users of
this particular benefit. When these severely disabled veterans are
faced with overwhelming challenges as a result of catastrophic events
it will provide a measure of relief for them to know that the VA will
be there to support them in obtaining a new, adapted vehicle that will
afford them some measure of independence once again.
S. 1124, THE ``VETERANS TELEMEDICINE ACT OF 2011''
Paralyzed Veterans of America supports S. 1124, the ``Veterans
Telemedicine Act of 2011,'' which proposes to improve the utilization
of teleconsultation, teleretinal imaging, telemedicine, and telehealth
coordination services. This legislation will make teleconsultation
available for medical facilities within the Department of Veterans
Affairs that are not able to provide remote mental health and Traumatic
Brain Injury (TBI) assessments. These consultations will give veterans
the opportunity to utilize the VA's expertise in the area of mental
health and the veteran-specific experience. Ultimately, S. 1124 will
establish clinical care standards for telemedicine within VA which will
increase facility utilization and enrollment of veterans.
S. 1127, THE ``VETERANS RURAL HEALTH IMPROVEMENT ACT OF 2011''
Paralyzed Veterans of America supports S. 1127, the ``Veterans
Rural Health Improvement Act of 2011. This legislation would establish
centers of excellence for rural health research, education, and
clinical activities, and to recognize the rural health resource centers
in the Office of Rural Health.
PVA recognizes that there is no easy solution to meeting the needs
of veterans who live in rural areas. The need to determine methods to
provide for these more dispersed rural veterans is a challenge.
Establishing Centers of Excellence for rural health research, education
and clinical activities may be a way to develop better ideas for rural
veteran care and help shed light on how best to provide services in
rural areas.
However, while these paths may show promise, they should still all
fit within policies that promote the use of VA facilities and should
not be used as a method or course to eliminate VA facilities. PVA
believes that the greatest need is still for qualified health care
providers to be located in rural settings. Only significant incentives
and opportunities for these professionals will bring them to these
often remote areas. PVA fully supports S. 1127 and believes that
continued outreach is needed to improve the quality of life for rural
veterans.
THE ``ALASKA HERO'S CARD ACT OF 2011''
PVA is strongly opposed to this proposal. While we realize that
there are significant challenges in delivering health care services to
veterans in extremely remote regions of Alaska, we believe that the
unintended consequences of this legislation could be very harmful to
the VA health care system. This legislation would certainly be the most
dangerous of slippery slopes. A program such as the one proposed by
this legislation could become the template for broad based contract
care. Undoubtedly, advocates for veterans in other states, as well as
other Members of Congress, would argue that what is good for Alaska
veterans should be good for their veterans as well. Meanwhile, the
critical mass of patients that the VA is dependent on to maintain the
highest quality and broadest range of health care services would erode
resulting in the degradation of the overall quality of care.
Furthermore, what this legislation proposes to do is exactly what
the fee basis program of the VA is intended for. In fact the
regulations specifically authorize fee basis in cases of ``geographic
inaccessibility.'' It seems unnecessary to create a new program to
allow for the delivery of care to veterans in remote areas when we
fully believe that fee basis can and should meet their needs. We do
believe that the VA's fee basis program can be improved and delivering
care to rural Alaska veterans could provide the template for broader
fee basis reform in the case of veterans who live in ``geographically
inaccessible'' areas.
We note that the Office of Rural Health is conducting multiple
pilot programs (funded separately by Congress) to extend access to care
for veterans who live in frontier areas, including in Alaska. We urge
the sponsor of this measure to work closely with that office to address
the problem identified by the purposes of this bill.
THE ``VETERANS PROGRAMS IMPROVEMENTS ACT OF 2011''
PVA supports the ``Veterans Programs Improvement Act of 2011.''
This legislation addresses many existing issues that impede veterans
from receiving the help from the VA that they earned.
Title I makes enhancements in current legislation that addresses
the issue of homeless veterans. It allows the existing grants to be
used for new construction, along with the current designation of
renovating existing facilities. It specifies that the grant recipient
shall be a nonprofit organization with the sole purpose of assisting
homeless veterans. The legislation also allows the recipient (sponsor)
to receive additional funding from public and nonprofit sources. This
is beneficial for a housing development since many existing government
programs for housing prohibit additional outside sources.
The legislation reauthorizes appropriations for financial
assistance for supportive services for very low-income veterans'
families in permanent housing at the amount of $100 million for FY
2012. This authorized funding will help provide the needed services for
the 1.5 million veteran families that live at or below the Federal
poverty level including the estimated 634,000 veteran families that
live at, or below 50 percent of the Federal poverty level. PVA supports
this effort to enhance Secretary Shinseki's goal of eradicating
homelessness among America's veterans.
This concludes PVA's statement for the record. We would be happy to
answer any questions for the record that the Committee may have.
______
Prepared Statement of Tom Tarantino, Senior Legislative Associate,
Iraq and Afghanistan Veterans of America
Madam Chairwoman, Ranking Member, and Members of the Committee, on
behalf of Iraq and Afghanistan Veterans of America's two hundred
thousand members and supporters, thank you for allowing me to submit
testimony sharing our members' views of on these important issues.
My name is Tom Tarantino and I am the Senior Legislative Associate
with IAVA. I proudly served 10 years in the Army beginning my career as
an enlisted Reservist, and leaving service as an Active Duty Cavalry
Officer. Throughout these ten years, my single most important duty was
to take care of other soldiers. In the military they teach us to have
each other's backs. And although my uniform is now a suit and tie, I am
proud to work with this Congress to continue to have the backs of
America's servicemembers and veterans.
IAVA would like to thank this Committee for its work on several
critical issues facing new veterans this year, and would like to offer
our comments on several of the bills that the Committee is currently
considering.
------------------------------------------------------------------------
Bill # Title/Description Sponsor Position
------------------------------------------------------------------------
S.277 Caring for Camp Lejeune Veteran Act Burr Support
of 2011
S.411 Helping Our Homeless Veterans Act of Klobuchar Support
2011
S.423 Protections for Fully Developed Burr Support
Claims
S.486 Protecting Servicemembers from Whitehouse Support
Mortgage Abuses Act of 2011
S.490 Increased Dependant Eligibility for Akaka Support
CHAMPVA
S.491 Honor America's Guard-Reserve Pryor Support
Retirees act of 2011
S.536 Enhanced Eligibility for Survivor Webb Support
Education Benefits
S.696 Improved Health Care Payments to Tester Support
Veterans
S.745 Post-9/11 GI Bill Grandfather Clause Schumer Support
S.769 Total Access for Service Dogs on VA Harkin Support
Property
S.780 Veterans Pension Protection Act of Tester Support
2011
S.815 Sanctity of Eternal Rest for Snowe Support
Veterans Act of 2011
S.874 Benefits and Protections for Akaka Support
Surviving Spouses
S.894 Veterans Cost-of-Living Adjustment Murray Support
Act of 2011
S.910 Veterans Health Equity Act of 2011 Shaheen Support
S.914 Waiver for Co-pays on Telehealth and Begich Support
Telemedicine
S.935 Veteran's Outreach Enhancement Act Brown Support
of 2011
S.951 Hiring Heroes Act of 2011 Murray Support
S.957 Veterans TBI Rehabilitative Services Boozman Support
Improvement Act of 2011
S.1017 Disabled Veteran Caregiver Housing Sanders Support
Assistance Act of 2011
S.1060 Honoring All Veterans Act of 2011 Blumenthal Support
S.1104 Veteran Transition Assistance Casey Support
Program Audit Act of 2011
S.1123 Assistance to Veterans Affected by Brown Support
Natural Disasters Act
------------------------------------------------------------------------
S. 277--CARING FOR CAMP LEJEUNE VETERANS ACT OF 2011
IAVA supports S. 277. This bill provides hospital care and medical
treatment for all veterans, spouses or dependents that were stationed
at Camp Lejeune and exposed to volatile organic compounds, and then
developed related illnesses. All veterans and military families deserve
safe living conditions--especially if stationed at a military
installation. We believe this bill is a significant step in regaining
the trust of the men and women of the USMC and USN whose family, or who
they themselves, now face ravaging illnesses, and subsequent medical
fees.
S. 411--HELPING OUR HOMELESS VETERANS ACT
IAVA supports S. 411, which authorizes the Secretary of Veterans
Affairs to partner with state and local governments, tribal
organizations, and non-profit organizations to in an effort to address
the housing crisis affecting veterans. S. 411 will broaden the net of
organizations that can provide case management, supported housing
services, and outreach to veterans. This is particularly important in
rural areas and tribal lands where the VA does not have facilities or
staff in close proximity to veterans who need housing assistance. It is
equally important in urban areas where veterans may already be homeless
and outreach by local governments and nonprofits already in touch with
those veterans may be more prompt.
S. 423--PROTECTIONS FOR FULLY DEVELOPED CLAIMS
IAVA supports S. 423, which would protect the filing date for
disability claims if the veteran chooses to file a fully developed
claim. IAVA applauds the VA for implementing its Fully Developed Claims
program, but we are concerned that a veteran who (rather than leaving
it to the VA) chooses to develop their own claim may loose out on
benefits during the development process. This bill helps address this
problem by allowing veterans to protect their effective date while
gathering the evidence they need to develop their claim.
S. 486--PROTECTING SERVICEMEMBERS FROM MORTGAGE ABUSES ACT OF 2011
IAVA supports S. 486. Veterans have been particularly vulnerable in
our current housing crisis, often because they are deployed and unable
to assert their rights. Less than one month ago, a $22 million
settlement was reached between 180 veterans a Bank of America
subsidiary and Saxon Mortgage Services for violating the Servicemembers
Civil Relief Act by foreclosing on the servicemembers' homes. IAVA
believes that our servicemen and women, especially those who are
deployed, need the strongest possible protection.
S. 490--INCREASED DEPENDENT ELIGIBILITY FOR CHAMPVA
IAVA supports S. 423. This bill ensures veterans can help provide
for the medical needs of their loved ones by extending the eligible age
of coverage for dependent children from 23 to 26 under CHAMPVA,
regardless of the child's marital status. This bill brings CHAMPVA in
line with recent changes to TRICARE and civilian health reform.
S. 491--HONOR AMERICA'S GUARD-RESERVE RETIREES ACT OF 2011
IAVA supports S. 491, which grants full veteran status to members
of the reserve components who have 20 or more years of service and do
not otherwise qualify under current laws. This legislation expands the
definition of the word veteran to recognize servicemembers who served
their country honorably for over two decades in the Guard and Reserve
but were never called to active duty. IAVA believes when someone takes
the oath to defend this country, wears the uniform and serves that oath
faithfully they have earned the right to be considered a full veteran
and the recognition that goes with it.
S. 536--ENHANCED ELIGIBILITY FOR SURVIVOR EDUCATION BENEFITS
IAVA supports S. 536 that would remove the 48-month limit on
educational benefits for survivors. Our country owes a debt to the
fallen that can never be repaid. We should provide their survivors with
the best opportunity for a first class future. Enhancing educational
benefits for survivors is the least we can do to appreciate the supreme
sacrifices that military families have made.
S. 696--IMPROVED HEALTHCARE PAYMENTS TO VETERANS
IAVA supports S. 696. America's veterans deserve the best possible
healthcare and the easiest possible access to that healthcare. We
should strive to make this goal a reality and S. 696 does this by
expanding the number of treatment facilities for which veterans may be
qualified to receive reimbursement for treatment and travel. IAVA
strongly supports any efforts to ensure benefits are fair and
accessible.
S. 745--POST-9/11 G.I. BILL GRANDFATHER CLAUSE
Although improvements to the Post-9/11 G.I. Bill expanded benefits
for over 400,000 veterans, it also stands to affect thousands of
veterans in 7 specific states that are currently using their New G.I.
Bill benefits at private schools. IAVA strongly supports the S. 745
Post-9/11 G.I. Bill ``Grandfather Clause'' because it would ensure that
these specific beneficiaries, who enrolled in school on or before
January 4, 2011, would be ``grandfathered'' into the original rates
established for the Post-9/11 G.I. Bill. However, IAVA also believes
that the deadline for inclusion should be changed from January 4, 2011
to April 1, 2011 in order to include all beneficiaries who already
registered for school up to the date of enactment of this act.
S. 769--TOTAL ACCESS FOR SERVICE DOGS ON VA PROPERTY
IAVA supports S. 769, ensuring that service dogs have access to all
VA treatment facilities. Service dogs are increasingly recognized as an
invaluable part of treatment and rehabilitation for veterans. Service
dogs are used for rehabilitation and treatment of a broad spectrum of
conditions ranging from mental health to physical issues. These include
Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD).
IAVA is committed to fighting to provide access to health care for all
veterans and strongly endorses the passage of S. 769.
S. 780--VETERANS PENSION PROTECTION ACT OF 2011
IAVA supports S. 780 which would expand the amount of
reimbursements that veterans and their dependents are forced to claim
as income relating to eligibility for pension claims. The VA should not
punish law-abiding veterans that have had the misfortune of suffering a
severe physical trauma or emotional loss, but have had the good fortune
of being financially compensated, by having their earned benefits
denied.
S. 815--SANCTITY OF ETERNAL REST FOR VETERANS ACT OF 2011
IAVA strongly supports passage of S. 815. IAVA is committed to
advocating for the rights of veterans and there is no more important
right than to be laid to rest in peace. After making the ultimate
sacrifice in defense of the rights of others, veterans and their
families should be allowed the right to peacefully say goodbye.
S. 874--BENEFITS AND PROTECTIONS FOR SURVIVING SPOUSES
IAVA supports S. 874. This bill ensures that the VA does not recoup
any pension or benefit checks issued in the month of the veteran's
death. Additionally, this bill allows surviving spouses to be awarded
any moneys from a pending claim that was submitted by the veteran
before their death, but not approved until after their death. If the
money was due to the veteran, IAVA believes that a surviving spouse is
rightly entitled to receive it in the wake of the death of their
veteran.
IAVA approves of S. 874's modification of home occupancy
requirements for veterans who secure home loans through the VA. In a
time where Armed Forces members have to prepare for the possibility of
several and frequent deployments, it is not feasible to insist that a
veteran constantly occupies a home in order to secure the low-rate loan
they are entitled to. This new provision will allow occupancy
requirements to be met by a veteran's spouse, dependents, or the legal
guardian of the veteran's dependent child.
Last, IAVA recognizes the importance of S. 874 addressing veteran
mortgage security. By ``authorizing the VA to guarantee a veteran's
housing loan regardless of whether such loan is subordinate to a lien
created in favor of a public entity that provides assistance in
response to a major disaster,'' legislators are ensuring that the
veteran foreclosure rates do not continue to rise.
S. 894--VETERANS COST OF LIVING ADJUSTMENT ACT OF 2011
Veterans receiving benefits from the VA have not seen a Cost of
Living (COLA) Increase in benefits since 2008. Each year, Congress must
reauthorize these increases, something it has failed to do for the last
2 years. This bill will mandate increases to Veterans Benefits that are
tied to the COLA index.
S. 910--VETERANS HEALTH EQUITY ACT OF 2011
IAVA supports S. 910 ensuring that each of the 48 contiguous states
has a VA facility, or, more importantly, that every eligible veteran
who does not have access to a VA facility be given comparable care to
that received at a VA facility. By passing the Veterans Health Equity
Act of 2011, we can help veterans in rural or underserved areas get the
medical care they need and deserve.
S. 914--WAIVERS OF CO-PAYS FOR TELEMEDICINE
IAVA supports this bill, which would prohibit the VA from
collecting copayments for telehealth and telemedicine visits. Since it
is impossible for the VA to place brick and mortar buildings near every
veteran in the United States, veterans who live in rural areas should
not be charged if a medical professional could not see them in person.
S. 935--VETERANS OUTREACH ENHANCEMENT ACT OF 2011
IAVA strongly supports S. 935 as it works to develop a five-year
program to improve knowledge of benefits and services available to
veterans and their families, especially in rural areas. Over half of
all Iraq and Afghanistan veterans have not reached out tot the VA. Many
veterans either do not understand or know of the benefits and services
that they are entitled to. By reaching out to different Federal and
state agencies, the VA can also get help developing additional programs
that might ease this dissemination of information.
S. 951--HIRING HEROES ACT OF 2011
This critical legislation will combat rising unemployment among our
Nation's veterans by requiring transition assistance for all
servicemembers returning home, modifying Federal hiring practices to
encourage the hiring of separating servicemembers, studying the gaps
and overlaps between military and civilian jobs, and create new
programs aimed at improving the transition from servicemember to
civilian.
S. 957--VETERANS TRAUMATIC BRAIN INJURY REHABILITATIVE SERVICES
IMPROVEMENT ACT OF 2011
IAVA strongly supports S. 957, creating a better and more
individualized program of care for veterans with TBI. This bill seeks
to change care for TBI from simple medical treatment to long-term,
sustainable rehabilitative services. IAVA feels this is a tremendous
step in improving help to those veterans who have suffered invisible
injuries in their service to this country.
S. 1017--DISABLED VETERAN CAREGIVER HOUSING ASSISTANCE ACT OF 2011
IAVA supports S. 1017. For the thousands of veterans returning home
from Iraq and Afghanistan with severe injuries, the recovery process is
often long and arduous. Many of them require constant care from a
family caregiver for years after they leave service. During this time,
they frequently reside in a home that is not their own and not a
permanent residence where they may live on their own after recovery.
Adaptations, like ramps and elevators, must often be made to their
permanent home and that of their caregiver while they are recovering
from their injuries. By modestly increasing allowances for disabled
vets living with or in housing provided by a family member, S. 1017
works to ease the burden on disabled veterans and their families.
S. 1060--HONORING ALL VETERANS ACT OF 2011
IAVA supports S. 1060. This bill recognizes and seeks to remedy
problems veterans face in regards to employment, housing, and mental
health to include mandating TAP, increasing SCRA protections for
homeowners, improved mental health screening.
S. 1104--VETERAN TRANSITION ASSISTANCE PROGRAM AUDIT ACT OF 2011
IAVA strongly supports S. 1104 as a means of improving the
effectiveness of the Transition Assistance Program (TAP). Often, an
outside perspective is required when addressing flaws in current
systems and processes. By requiring the Secretary of Labor to contract
an independent private organization to regularly audit TAP, we gain an
unbiased opinion of the methods currently used to teach military
personnel the best methods for making themselves viable in today's
workforce. Recommendations for improvement can make the transition from
military to civilian life smoother and faster for our veterans, and the
family members who depend on them.
S. 1123--ASSISTANCE TO VETERANS AFFECTED BY NATURAL DISASTERS ACT
IAVA supports S. 1123 ensuring that disabled veterans affected by
natural disasters are not excessively financially burdened. This bill
allows disabled veterans to be made whole in the event of a disaster by
meeting the cost of replacement not meet by private insurance and
allows disabled veterans to continue to lead productive lives.