[House Hearing, 113 Congress] [From the U.S. Government Publishing Office] COMPLICATIONS OF GEOGRAPHY: FOCUSING ON VBA OUTREACH, ACCESSIBILITY, LEADERSHIP AND STAFFING EFFORTS TO MEET THE NEEDS OF VETERANS LIVING IN AREAS REMOTE FROM A REGIONAL OFFICE ======================================================================= FIELD HEARING before the SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS of the COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED THIRTEENTH CONGRESS FIRST SESSION __________ THURSDAY, NOVEMBER 7, 2013 FIELD HEARING HELD IN LAS VEGAS, NEVADA __________ Serial No. 113-43 __________ Printed for the use of the Committee on Veterans' Affairs [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] U.S. GOVERNMENT PRINTING OFFICE 85-868 WASHINGTON : 2014 ----------------------------------------------------------------------- For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800 DC area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC 20402-0001 COMMITTEE ON VETERANS' AFFAIRS JEFF MILLER, Florida, Chairman DOUG LAMBORN, Colorado MICHAEL H. MICHAUD, Maine, Ranking GUS M. BILIRAKIS, Florida Minority Member DAVID P. ROE, Tennessee CORRINE BROWN, Florida BILL FLORES, Texas MARK TAKANO, California JEFF DENHAM, California JULIA BROWNLEY, California JON RUNYAN, New Jersey DINA TITUS, Nevada DAN BENISHEK, Michigan ANN KIRKPATRICK, Arizona TIM HUELSKAMP, Kansas RAUL RUIZ, California MARK E. AMODEI, Nevada GLORIA NEGRETE MCLEOD, California MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas PAUL COOK, California TIMOTHY J. WALZ, Minnesota JACKIE WALORSKI, Indiana Jon Towers, Staff Director ______ SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS JON RUNYAN, New Jersey, Chairman DOUG LAMBORN, Colorado DINA TITUS, Nevada, Ranking GUS M. BILIRAKIS, Florida Minority Member MARK AMODEI, Nevada BETO O'ROURKE, Texas PAUL COOK, California RAUL RUIZ, California GLORIA NEGRETE MCLEOD, California Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined. C O N T E N T S __________ November 7, 2013 Page Complications Of Geography: Focusing On VBA Outreach, Accessibility, Leadership And Staffing Efforts To Meet The Needs Of Veterans Living In Areas Remote From A Regional Office 1 OPENING STATEMENTS Hon. Jon Runyan, Chairman, Disability Assistance and Memorial Affairs........................................................ 1 Hon. Dina Titus, Ranking Minority Member, Subcommittee on Disability Assistance and Memorial Affairs..................... 2 WITNESSES Willie Clark, Western Area Director, Veterans Benefits Administration, U.S. Department of Veterans Affairs............ 4 Prepared Statement of Mr. Clark.............................. 28 Accompanied by: Mr. Edward Russell, Director, Reno Regional Office, Veterans Benefits Administration, U.S. Department of Veterans Affairs Katherine Miller, Executive Director, Nevada Department of Veterans Services.............................................. 15 Prepared Statement of Ms. Miller............................. 30 Janet Synder, Legislative Chair, Society of Military Widows...... 18 Prepared Statement of Ms. Synder............................. 33 Bruce Hollinger, Adjutant Quartermaster, Veterans of Foreign Wars, Department of Nevada..................................... 19 Prepared Statement of Mr. Hollinger.......................... 34 COMPLICATIONS OF GEOGRAPHY: FOCUSING ON VBA OUTREACH, ACCESSIBILITY, LEADERSHIP AND STAFFING EFFORTS TO MEET THE NEEDS OF VETERANS LIVING IN AREAS REMOTE FROM A REGIONAL OFFICE Thursday, November 7, 2013 U.S. House of Representatives, Committee on Veterans' Affairs, Subcommittee on Disability Assistance and Memorial Affairs, Washington, D.C. The Subcommittee met, pursuant to notice, at 2:07 p.m., at 3rd Floor Conference Room, 495 S. Main Street, Las Vegas, NV, Hon. Jon Runyan [Chairman of the Subcommittee] presiding. Present: Representatives Runyan and Titus. OPENING STATEMENT OF CHAIRMAN RUNYAN Mr. Runyan. The oversight hearing of the Subcommittee on Disability Assistance and Memorial Affairs will now come to order. Usually when we hold our DAMA Subcommittee hearings, we are in a setting in Washington. Today I am honored and happy to be here with all of you in Las Vegas City Hall, in the district of my colleague and good friend, Ms. Titus. So, thanks for having us. Ms. Titus. Thank you, Mr. Chairman. Mr. Runyan. I would like to personally thank Ms. Titus for inviting me here to her district, and I would like to thank everyone for being with us today. Although we are far away from our normal hearing room on the Hill and the C-Span cameras that everybody loves so much, it is still an official congressional oversight hearing of the House Veterans' Affairs Committee, and hearing rules of conduct apply. Therefore, I would respectfully request that everyone be courteous to our witnesses and remain silent until the hearing is formally adjourned. Chairing the Subcommittee on Disability Assistance and Memorial Affairs, I have the opportunity to work on many issues that affect our Nation's veterans, whether they are in my home district in New Jersey or here in Nevada, or elsewhere across our Nation. From working on these issues, I have learned firsthand that veterans' experiences with the Veterans Benefits Administration can make a significant impact on the success of that veteran's disability claim. Although the folks at VA are working hard to move forward to move toward a national electronic claims processing model, the fact remains they have not fully achieved this transition yet. As a result, many veterans who do not live close to a regional office experience difficulty navigating the disability claims system. One of VA's primary outreach tools is the e-Benefits portal, which allows veterans to submit and receive their updated claim information from their home computer. Although this system is promising, many veterans still benefit from a face-to-face interaction with VBA employees and veterans services officers at the regional office for assistance with the questions they may have. Further, a number of elderly veterans simply do not feel as comfortable with technology as our newest generation of veterans do. Thus, although VA has recently put great emphasis on technology as the pathway forward for a disability benefits process, I want to again emphasize the need for VBA to remain ready to provide individual assistance and outreach to disabled veterans who may be in need of personalized attention. Accordingly, VBA's staffing and resource allocation must continue to accommodate intake sites and outreach facilities in its locations that are remote from the regional office, such as the intake center at the Las Vegas medical center that we had the opportunity to visit earlier today. So, that is why we are here today, to examine these issues not from afar in Washington, D.C., but right here in Las Vegas, Nevada, where veterans live approximately 450 miles from the regional office that serves them, which is located in Reno, Nevada. I would like to welcome our witnesses that have joined us here today to discuss this important topic. We hope that a thorough discussion and questioning such as will occur today can work collectively, not only to meet the challenges, but to exceed the standard. Today we will hear from Willie Clark, the Western Area Director for Veterans Benefits Administration, U.S. Department of Veterans Affairs, accompanied by Edward Russell, Director of the Reno Regional Office; Katherine Miller, the Executive Director of the Nevada Department of Veterans Services, accompanied by Bill Baumann, Chairman of the Nevada Veterans Services Commission; Janet Snyder, representing the Society of Military Widows of Southern Nevada, Chapter 34; and Bruce Hollinger, representing the Veterans of Foreign Wars Department of Nevada. With those introductions complete, I thank you all for being with us today, and I now yield to our Ranking Member, Ms. Titus, for her opening statement. OPENING STATEMENT OF HON. DINA TITUS Ms. Titus. Well, thank you, Mr. Chairman, and thank you for making the trip all the way out to Southern Nevada for this important hearing. This is, as you heard, to host a hearing to hear about what veterans have to deal with here in Southern Nevada when we are so far away from a regional office. I would like for you all to know that our Subcommittee and its focus on veteran benefits has been gathered by a strong sense of bipartisanship to ensure that veterans across the country get the benefits that they need in a timely fashion, and I credit our Chairman, Mr. Runyan, for making that possible. I am sad to tell you this, and you may have already heard it in the news, but that Mr. Runyan announced yesterday that he is not going to run for reelection. So I will miss seeing you on this Committee and in Washington, and I will miss working with you. Veterans across this country have greatly benefitted from the contribution you have made, and the terms that you have been there. So we all thank you for that. I, too, want to thank the witnesses who are with us today. You represent a large community, about 175,000 veterans here in Southern Nevada. So thank you for taking time to come and share some thoughts and some information with us. I also want to thank the people from City Hall, this great building, who have been willing to host us here, so that we could have our hearing. The concerns regarding the VA benefits backlog are front and center. We hear about them all the time. You experience them. This is certainly a priority. And since becoming Ranking Member of this Subcommittee, I have made it my priority to try to find some solutions, whether they are electronic or involving personnel or involving infrastructure, to these problems, so we can get rid of that backlog so people can get their benefits. I am glad to say that some progress has been made in this area, but we still have a lot of work to do. The 170,000 or so veterans--and we can't count them all; it is hard to count them, and we know many veterans are homeless, and they are especially hard to count--are served by the Reno Regional Office. This office is charged with serving veterans throughout the state, as well as several counties in California. So this is a very large area here in the Western United States that is served by that one office. The Reno office is probably one of the most challenged offices in the West. It currently has 5,813 claims pending. Of these, 56 percent are backlogged, which means, they have been pending for 125 days or longer. This translates to more than 3,200 claims pending, which is well beyond the VA's national goal. It is also concerning that the claims that have been completed are not being processed accurately. The rating decision accuracy is 89 percent, meaning roughly one in ten of the decisions that are handed down is incorrect and has to be redone, which further delays the process for veterans who are waiting for their benefits. In fact, the Reno office has struggled to the point that the VA was forced to send claims from Nevadans to other offices around the country. Had the VA not done this, the Reno office figures would have been even worse. Just this year, the Reno office sent 6,000 claims to other VAs in other parts of the country. That is the equivalent of the entirety of their current claims inventory. This means that the metrics for Nevada's veterans are worse than they just appear from looking at the numbers. Because of these performance issues, veterans are likely waiting longer for their decisions, up to one year or maybe longer on claims that are being worked on not even in Reno, not in Las Vegas, but not even in Reno, but are in South Carolina, Mississippi, Oregon and Idaho. Recent concerns have been raised regarding the staffing levels at the Reno Regional Office, and considering that the Reno VA is shipping at least half of its workload to other stations, I am concerned about that as well. However, while we need to maintain proper staffing levels, I am also concerned about the productivity of the station and the retention level of employees there, and I have voiced these concerns with Members of the VA, including the Secretary, Shinseki. Our Subcommittee staff, Justin and the Subcommittee staff and the whole Committee, visited the Reno VA Regional Office on Tuesday to learn more about what is happening there, and the VA leadership indicated that that office is properly staffed now to reach its monthly productivity goals. They learned that Reno's monthly and annual productivity goals, however, continue to be missed. Similarly sized regional offices in the West are exceeding similar goals with the same staffing levels. We want to figure out what the problem is. Local leadership indicated that they will soon begin to reach some of these goals, and I am hopeful that that will happen, but I promise you that I will carefully monitor the progress there, and ask the VA to keep me informed to be sure that that is happening. I want to thank Mr. Clark and Mr. Russell for coming to this hearing, and I want them to know that I am committed to working with them to help bring the Reno Regional VA Office up to speed, not just meet the standard, as the Chairman said, but to do even better than that, and if you will tell me what you need, I will be your strongest advocate in Washington, to be sure we get it, so our veterans can be served. I want to thank the Nevada Office of Veterans Affairs, as well as the VFW and the Society of Military Widows for all you do every day to help our veterans. We certainly appreciate it, and I am looking forward to hearing from you as well, and will appreciate your testimony. So thank you, Mr. Chairman. With that, I will yield back. Mr. Runyan. I thank the gentle lady. At this time, I would like to welcome our first panel to the witness table. Our first panel consists of Mr. Willie Clark and Mr. Edward Russell with the Veterans Benefits Administration. Your complete and written statements will be entered into the hearing record. Mr. Clark, you are now recognized for 5 minutes for your oral statement. STATEMENT OF WILLIE CLARK, WESTERN AREA DIRECTOR, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY EDWARD RUSSELL, DIRECTOR, RENO REGIONAL OFFICE, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS Mr. Clark. Thank you. Good afternoon, Chairman Runyan, and Members of the Subcommittee. Thank you for the opportunity to discuss services provided to veterans and their families throughout Nevada. Mr. Runyan. Could you move a little bit closer to the mic? Mr. Clark. I am accompanied today by Mr. Ed Russell, the Director of the Reno Regional Office. As the seventh largest state in the United States, Nevada encompasses approximately 110,000 square miles. It is home to more than 244,000 veterans who reside within the Reno RO's jurisdiction, with an additional 11,400 veterans residing in four California counties also served by the Reno RO. Of these, approximately 33,500 veterans receive VA compensation or pension benefits, and an additional 610 beneficiaries receive survivors' benefits. Over $38.5 million in compensation and pension benefits are paid monthly. As you are aware, Nevada is comprised of 17 counties, of which Clark County is the largest, with a population of nearly 2 million, followed by Washoe County with a population of over 420,000, and Elko County with a population of nearly 50,000. The majority of the state's population, which is approximately 88 percent, resides in only two counties, with the remaining population scattered throughout the remaining counties. The smallest county, Esmeralda County, has a population of fewer than 800 people. Nevada is unique in that nearly 87 percent of the land is federally controlled, thus making the state an ideal location for those who enjoy rural living. However, one of the difficulties with rural living is limited accessibility to resources. The Reno RO processes claims for disability compensation benefits and provides vocational rehabilitation and employment services for our disabled veterans. The RO also provides claims assistance to over 600 veterans and family members per month. In addition, the RO has an out-based office in the newly opened VA Medical Center in North Las Vegas, approximately 450 miles from the main RO facility. The Las Vegas office primarily delivers vocational rehabilitation and employment services, placing rehabilitation counselors in the area where the majority of the jobs are located. This out-based office also has some limited claims processing capabilities and four intake specialists who assist over 2,150 visitors per month. The Reno office provides space for five Veterans Service Organizations, VSOs, and the North Las Vegas VA medical center provides space for nine VSOs. To overcome Nevada's geographical challenges, the RO collaborates with its stakeholders to provide outreach to our veterans residing in remote areas. In addition to VSOs, the stakeholders working in partnership with the RO include: Nevada's two VA medical centers; congressional offices; the Nevada Division of Veterans Services; the Nellis Air Force Base; the Fallon Naval Air Station; the Nevada National Guard; and the Air National Guard. The RO participates with these stakeholders in their veterans' events to extend outreach to veterans and their families experiencing geographical obstacles. The following are a few examples of the veterans' events held over the past year. The Reno VA medical center held an open house at the outpatient clinic in Winnemucca, Nevada. The population in the area is less than 7,500 and two-and-a-half hours away from the RO. The RO was there to provide information and services. In addition, the RO had representatives at VA medical center veterans' events in Susanville, California, and Pahrump, Nevada. The RO attended local conferences held by Native American tribes to provide updates on veterans' benefits, answer questions, and to provide direct assistance with claims. The RO also conducted outreach for local Native American tribes in partnership with the Reno VA medical center. The RO participated in Senator Heller's Veterans' Roundtable. Congressman Amodei held quarterly town hall meetings across the 2nd District. The RO had representatives at every town hall to include Elko, Winnemucca, Fallon, and Carson City. Congresswoman Titus held a workshop and training session on the Fully Developed Claims and the e-Benefits for veteran stakeholders in the North Las Vegas area. The RO continues to build strong relationships with the Nevada military bases at Nellis Air Force Base, Fallon Naval Air Station, and the Nevada National Guard. Collaboration with the VSOs has been invaluable in serving veterans in rural areas. Our VSO partners are knowledgeable about VA's benefit programs and the services provided by the RO. Two of VA's highest priority goals are to increase access for veterans and their families all across the country and eliminate the disability claims backlog in 2015. This concludes my statement. I would be pleased to answer any questions at this time. [The prepared statement of Willie Clark appears in the Appendix] Mr. Runyan. Thank you, Mr. Clark. We will begin a round of questions, and obviously, I think Ms. Titus' questions are going to be a little more detailed, because she tends to know the statistical analysis of the Reno RO a little more in-depth than I do. Obviously, I know my Jersey statistics well. I am sure she is not as up on them. But you stated in your statistics, with the actual RO being located in Reno, why do more VSOs have office space here in Las Vegas than they do actually at the Reno RO? Mr. Clark. Thank you for that question, Mr. Chairman. We do have more veterans in this area, and we placed the VSOs here, or the VSOs are placed here to meet the needs of those veterans, to offer that face-to-face opportunity that you spoke about earlier. We also have the four intake specialists here at the regional office to help assist take claims for the regional office in Reno. So we realize that we need to have individuals on-site for claims intakes, and working in collaboration with our VSOs, along with the claims intake specialists, we feel that we have ample resources here for claims intake. We scan all of our cases in, and the ratings are done at the Reno office. Mr. Runyan. As VA continues to emphasize its transition to the paperless process, this transition will be presumably increase productivity in terms of claims processing. But veterans living in remote areas do not have access to the Internet, so how is VA planning to assist veterans in remote areas with access to technology as a gateway to other VA services? Mr. Clark. Well, again, working in collaboration with the Nevada Department of Veterans Services, the VSOs, and then our outreach specialists, I spoke to earlier, all of the outreach events that Mr. Russell's staff attends. When we make visits at these events, when we have access to computers, we sign folks up for e-Benefits accounts. We do face-to-face meetings to explain veterans' benefits. So as you mentioned, our e-Benefits and VBMS, the Veteran Benefits Management System, will allow us to become more efficient. And as we conduct these outreach events in collaboration with all of our stakeholders, we provide training on being able to gain access to our benefits via the computer, but we are also there face-to-face to help them file claims and give an update on the status of their benefits. Mr. Runyan. I can tell you in my district, New Jersey being the most densely populated state in the country, but where I am at are out in the middle of the woods. People think we are in- between New York and Philadelphia, but our veterans, I can tell you, when you talk about access to care or access to an RO, can be 2 to 3 to 4 hours away even though they are under 100 miles away. You have individuals out there. I make that point just for this, our passion is not letting anybody fall through the cracks. There are people out there, there are veterans out there that are falling through the cracks that you may never reach. I just bring that up out of personal experience, because I deal with it every single day. I have one more question, and I am actually going to direct it to Mr. Russell. In the written testimony, the Reno RO is ``in a rebuilding stage.'' What specific steps is the RO taking to ensure this rebuilding results in higher morale at the office, which in turn will produce better decisions for the veterans? And why do you think the Reno RO has been plagued by staffing and leadership challenges to the extent that it has, when other ROs of similar size have not experienced the challenge? Mr. Russell. Yes, sir. Thank you for the question. We experienced a high turnover rate in Fiscal Year 2012, and what we learned from this was, people were not doing the job that they were best fit for, and it took time to move those people to do something else other than claims processing. What we learned from this was that the hiring metrics were not good there. We would bring people in off a cert, give them an interview, give them a job. Now we bring them into a recruitment orientation. We show them the jobs, tell them the expectations of the jobs. The coaches tell them this is a production job, high quality. So people know now what they are getting into in doing the job. Mr. Runyan. So that was a change in hiring procedure? Mr. Russell. It is not a change ---- Mr. Runyan. Not a change, but an emphasis? Mr. Russell. Yes, it is more of a screening process and making sure that people or candidates applying for the job are right for the job. We had success over the last year with this. We brought in eight people, and we have only lost one person, and we asked him why he quit after the orientation and everything, he said he just needed a job. But we only spent six months investing in his training and not two or three years. What we found in Fiscal Year 2012, when people realized--you know, this is a tough job. It is a very technical job. There is a lot of training involved in it. Mr. Runyan. With that, I will now recognize the Ranking Member, Ms. Titus, for her questions. Ms. Titus. Thank you, Mr. Chairman. Mr. Clark, in the past year, the Reno VA Regional Office, our VRO, met its monthly production goal only one time. And in six of the previous months, it missed its production goal by more than 30 percent. I wonder if you can tell us, is this monthly goal unrealistic? What is being done to address this problem? Are other regional offices having the same problem? Who is being held accountable? Would you address that for us? Mr. Clark. Thank you for the question, Congressman Titus. The Reno office is fully staffed to do their work. But as Mr. Russell just mentioned, when one hires new people, there are different expectations of output. So you may not know, but we call a journeyperson an individual who is fully trained that has been in that job for two years. And if we are holding folks accountable and saying that they must give us the requisite output, and we have to replace that individual, then the new person coming in is not giving us that requisite output. It takes time to get them up to speed. So the reason that he is not making goal is not because there is just a lot of underachievers. It is just that the level, the journeyperson level of the individuals that he has currently in place are not at the requisite output. Still, what we do for that office, we levy that office with an expected output, and if they can't make that output, then that is what we use. We have a system where we move work to other regional offices because what we are doing is, we are working our oldest cases. As Mr. Chairman spoke to earlier, we have initiatives underway. We work our oldest cases. We started with the oldest of the old. Anything over 2 years old, we work those cases. Reno doesn't have any. We are now working on the 1-year-old cases. And as we finish those, we are going to work our way back, and our goal is by 2015, there will be no case pending over 125 days, and the accuracy will be 98 percent without fail. We feel we can do that, and we certainly feel we can do that in Reno. Ms. Titus. So we can then start expecting them to meet their goals when? Mr. Clark. I will let Mr. Russell speak to that, but I am thinking next year he should be able to, here within the next 90 days to 180 days, they should be at--I am levying his station with approximately 600 claims per month, and there is an expectation that folks would work some overtime. We have an initiative right now for mandatory overtime. We can't continue that. That is too costly. But we do allow stations to work overtime when there are shortages in the output for varying reasons. Ms. Titus. Well, I hope you will keep me posted on that progress. My other question, you pointed out that Las Vegas has 2 million people. Reno has 400,000. Elko has 50,000. You have 75 people in the Reno office who are working on these claims. You have three people in the Las Vegas office who are working on claims. What is the logic of having an office in Reno, instead of having it here, where most of the veterans are? We have 175,000 veterans here. Why do we have to come here, go out to the hospital, deal with three people who then send the stuff to Reno, and then maybe it gets sent somewhere else, or maybe it gets addressed? What would it take to get an office here or move that office here, or create a new area? What would that take? Mr. Clark. Thank you for that question, Congressman Titus. Presently, the staffing here in Las Vegas is for claims intake. So their job is to take all incoming claims, and we get those cases scanned in. So they receive the claims, they provide the benefits briefing, and then we have individuals, the ratings specialists and the VSRs, mainly the rating specialists that make the decisions. So there are no decision-makers here, and they don't need to be here to make the decision. Who needs to be here are the individuals that can take the claim and explain the benefits and explain the decision that the ratings specialists make. So I understand that there are more veterans in this area. But again, what we need here, and which we think we are staffed adequately to do that is to receive the claims coming in. We have a great system that we showed some members today of how we triage folks when they come in. There is not long waiting. Additionally, we have VSOs that are in that same office. We work collaboratively together, and the job is for them to receive the claims and get them scanned in. So whether you are in Reno, the same thing applies. You bring that case in, you get it scanned in, and then it is worked by a ratings specialist. And in Reno, that ratings specialist just happens to be there, but they don't need to be in the same physical location. Ms. Titus. Well, why don't you put the three specialists up there for people to walk in and move those 75 people down here if they don't need to be there? Mr. Clark. Well, we need the folks to make the decisions. It is just that they don't have to be here. So again, what we need here are individuals for claims intake, and the individuals here do take--they are able to take all of the walk-ins. Ms. Titus. Well, it seems to me that the people in Reno can walk in the door and find somebody who is working on their claim and get a faster answer than somebody down here who then has to go to the 800 line or call my office, and then we have to call the Reno office and try to get the information. It seems to me three people for 175,000 veterans just doesn't make any sense. Mr. Clark. Well, again, ma'am, we look at our timeliness because we are getting calls right now--our backlog is dropping drastically. So you are getting calls, and that is why we are moving towards that 2015 goal of no cases pending over 125 days with a 98 percent accuracy. Ms. Titus. Excuse me. When you send those cases somewhere else, when you have gotten rid of half of your cases and sent them somewhere else, do you still track those for the veterans in Nevada, or then, are they just on their own to try to track them wherever they are in South Carolina? Mr. Clark. We track those cases. Ms. Titus. You still track those cases that you have sent out of the state? Mr. Clark. That is correct. Ms. Titus. Is that correct, Mr. Russell? Mr. Russell. Yes. They show up on our inventory and we can see where they are at, and I have directors call me every once in a while when they are having an exam problem at the hospital, and I track them for them and move them, get the exam back to them as quick as possible. Mr. Clark. Any cases within my jurisdiction, those cases are tracked, and if a case is not moving fast enough, then, wherever I have to call, I make those calls to make that happen. So there is no difference in timeliness between a person, the zip code where he or she, that veteran resides. That is what we are moving towards. We are making that seamless. Wherever you submit your claim shouldn't matter. If you served together in Afghanistan or in Vietnam, you didn't serve one person in one city in Nevada, and someplace, some person lives somewhere else, and now there is a difference in the timeliness of your claim. What we are doing, is to have a system where all claims are worked timely, and that is what we are doing. We are working our oldest cases, and we sincerely apologize and feel terrible about the backlog, but we are attacking that backlog, and we are getting it down, and we are going to continue until we reach that goal, and we will reach that goal. Ms. Titus. I know you are doing that. I know that 2-year claims have been resolved. This year, you are supposed to get through with the 1-year claims, and I support that goal. I just am concerned, in the meantime, that Southern Nevada veterans are getting short-changed because of what is happening in Reno, and they don't have enough access to their records, their progress, their help, despite all the good work that the volunteer associations do. Mr. Clark. Well, ma'am, as of right now, our next goal is any case that is pending over 334 days. That is our next goal. We did the 2-year, the 1-year, and we are just working our way back. We will get to the 125 days and 98 percent accuracy by 2015. And like we said, we set a goal over 2 years old; we met that. We set another goal for the over 1-year-old, and last month we met that. We are going to continue to walk this back until we get all of these cases done. Ms. Titus. Thank you, Mr. Chairman. I am going to ask Mr. Russell after he testifies, if that is okay. Mr. Runyan. I don't think Mr. Russell is testifying. Ms. Titus. Oh, you are not? I thought maybe he was going to give his little ---- Mr. Runyan. I will let you go, if you will yield one second to me. Ms. Titus. Of course. Mr. Runyan. Just for clarification purposes, when a claim leaves the Reno RO and is adjudicated elsewhere, does days pending count against your metrics? Mr. Russell. No, they do not. We are showing better tracking on the days pending. We just had this conversation yesterday about the stuff I send out, that it matches the proximity of each one of them. But as far as days to complete, the numbers--excuse me. It does count in my numbers. I am sorry. I am looking at two different things when I look at the regional office and the national scorecard. Those numbers are included in there. That is why I am still showing over 450 days to complete, because there are a lot of 1-year-old cases still out there that have not been completed that were brokered out. Mr. Runyan. I will give it back to the gentle lady. Ms. Titus. Thank you, Mr. Chairman. So, Mr. Russell, can you tell me how many current claims you have in the Reno office that are over 125 days? Mr. Russell. It is 56 percent from the 5,800 number. Ms. Titus. Fifty-six percent of 5,800? Mr. Russell. Yes. Mr. Clark. That is approximately 3,600, 3,800. We can get the exact numbers. Ms. Titus. Okay. How do you decide which claims get sent off somewhere? Mr. Russell. We are given a number of cases. Over the summer, we were given 4,300 cases to broker out to three different stations. What we did was look at the ones that we had in our filing system and went down the line that way and shipped those out. We had a short time period of getting them out the door, boxed up and FedEx out. So there was really no screening as far as what process or what stage of the process that claim was in at. Ms. Titus. So it is just whatever was on top of the pile? Mr. Russell. What was in the file. We have files that were at the medical center waiting for exams. We didn't send any of those out because it would just confuse the medical centers about where to send the case back. Mr. Clark. Congressman Titus, how we work that is, we look at the aggregate output for the entire Nation, and we go through--as an example, when we did our over 2-year-olds, we went through and every case that was over 2 years old we said, okay, this is our universe, and whatever that universe is, we split that out amongst all of the ROs, and everyone has a portion of those to work, including Reno. And when we did the 1-year, we got another set of universe, and we split that out evenly. So irrespective of where that claim came from, because again, we are serving veterans, not claim folders. So if you are in New York and there is a veteran that needs to be served and you have capacity, we are going to give that to you. So that is how we are working these cases. Unfortunately, we can't work them all at one time. We get our oldest cases, and then we meted those out. We send them to the stations and we give them a timeline that says, you have X number of cases, you need to undertake development and you need to rate those cases by this date. If you don't get that done, you have to answer to your boss. So Mr. Russell can tell you we had a lot of calls about the progress of each of the cases to make sure that they were in line and exams were being conducted and the proper development was being done. Now we are working on cases under a year, and we will keep walking it back. We will get to six months, and we will get to four months, and then down to the 125 days. Ms. Titus. Just one last question, Mr. Chairman. So when cases come to you, Mr. Russell, you process them just based on when they come in? You are not, like, doing the Reno ones first because they are close by and they can holler the loudest, and then the ones from Las Vegas go to the back of the list or anything? How does that work? Mr. Russell. No, ma'am. It is not based on where the person lives. It is based on a date of claim, when we get the claim in. As Mr. Clark mentioned, by now, we are working the oldest, not based on any place where the veteran lives. Ms. Titus. What about if a new claim comes in today from Las Vegas? Where does that go? Mr. Russell. The best way a new claim could come in would be fully developed, which we work with the service officers over the last year, and of course at your meeting that we held there. Those are the ones that move through the system a little quicker because everything is there that we need. But as far as a claim coming in from a veteran, it is brought in at the Las Vegas office, and it is sent up to Reno, and it is put in the date of claim order. Mr. Clark. And, Congresswoman Titus, a great question. Thank you for that question. But in addition to working the older cases, any new cases coming in, you have to work those as well. If you don't, everything gets old. So we have a two- pronged approach. Mr. Russell knows that everything that comes in the door every day, you have to look at that and undertake the proper development. That is the reason why all our stuff got old to begin with. We just didn't have--with a lot of initiatives previously, decisions that were made, which we all are in agreement with, Agent Orange and the economy, we had PTSD, relaxation of some stressors that created this big backlog for us. We got that down. But you have to work the new cases coming in, develop those properly, get an exam on them, as well as that portion of the old. So when I allocated Reno resources, they can do 600 cases, I say, okay, maybe 450 of those are old and 150 are new, and you kind of have to work both ends of the camel, if you will, to make sure that while you are taking care of the old stuff that has been around, you also have to work some of the newer cases. So we are working some newer cases, because if you work only old, then everything becomes old. Ms. Titus. Thank you, Mr. Chairman. Mr. Runyan. I thank the gentle lady. I think it is more systemic in the VA than anything else, and you just brought it up, Mr. Clark. You said that the 2-year initiative was divided and disbursed evenly, correct? The VA overall said there are this many in the backlog that are 2 years and older, and you said that they ---- Mr. Clark. Mr. Chairman, maybe I misspoke. When I said evenly, what we did was every ---- Mr. Runyan. You said you took the universe VA-wide. Mr. Clark. That is correct, because if we wanted to rid ourselves of all of the over 2-year-old cases, we had to get that universe of whatever that is, and send those out to the stations based upon their capacity to work them. But in addition to working their allocation of over 2-year-olds, Mr. Russell had more 2-year-old cases that he could work within that allotted timeframe. So he got his allocation of 2-year- olds, all of which were Reno or Nevada cases, and then the residual of those I had to send to other places. If not, I would have had to just wait until he finished all of those 2- year-olds and it would have taken forever. Mr. Runyan. No, and I get that. Obviously it is a huge problem, with the Reno office holding that many of them there. But I think systemically, when you look at VA, capacity and completion are two different things. Every regional office out there has a different rating on what they are able to accomplish. I mean, Mr. Russell has said here numerous times, and you said it yourself, there are times when you lack those journeymen people that can execute these. That is part of the equation. And I think when you look at the situation with VA saying, we will just give everybody the equal amount, well, not everybody has the personnel, the knowledge, the people that are trained with the ability to do it. I think it is shortsighted of VA, at the end of the day, to try to do that. Mr. Clark. Mr. Chairman, and again, I apologize. I misspoke. When I said even, we didn't take the universe and split it by 57 ROs. We gave an allocation based upon what Ed is able to work. So Mr. Russell is able to--as an example, I will use that 600 figure. So what I would have done is, I would have given him 500 of those 2-year-old cases and then said the other 100, you have to work some newer work, like that. So it is not a basic math thing. We know what his capacity is and should be, and using his available resources, using overtime, then it is incumbent upon each of the ROs to make those goals. That is the only way we are going to get it, is to hold people accountable, and it has been working. We are walking these cases back. We have the 2- year-olds, and we have done the 1-year-olds, and we will continue until we get to the 125, 98. Mr. Runyan. And I know Ms. Titus said this earlier, too: If you need help, don't be afraid to ask. That is all we ask of you. I don't think anybody on this Committee, both sides of the aisle, has ever said no to anything the VA has ever asked for. It is about being truthful. The next comment I really want to make, because you can hear the ruckus in here, and at the end of the day, you are in the customer service business. Mr. Clark. Yes, sir. Mr. Runyan. I know personally dealing with it, I know Ms. Titus does in her personal office also, dealing with veterans that have problems all the time, the lack of communication is about 80 percent of the frustration. I know we just passed a bill off the House floor the other day allowing the VSOs to go in and see basic tracking information, just to give some comfort to veterans to know where their claim is in the process. And when they ask for basic information like that, they feel they get the run-around a lot of times. I don't know if it is a lack of training, I don't know if it is a lack of leadership not being there saying, this needs to be something that we need to do, because we are losing the customer service battle at the end of the day. I just wanted to make that statement. If Ms. Titus has anything to add? Ms. Titus. Just one last thing. I know that Reno is not meeting its goal of 350 to 400 average, they are supposed to be doing 600, and you have said that somebody will be held accountable. But earlier, you said that if you hire a new person, then it takes them two years to meet a certain requirement. So I get the impression that sometimes it is better to keep on an old bad person than hire a new person, because they have to go through the training. So I don't know who is being held accountable. Do we need to do something about holding people more accountable who aren't delivering? Mr. Clark. That is a great question, and there are some managers who may think that it is better to keep a bad person than to take the steps to remove that individual, or first see if you can train them and find them the right position. But those folks--then I am not holding the directors accountable, and I believe in holding directors accountable. So, Mr. Russell, if we go back to an earlier part of the year, the last fiscal year, that is when the RO was not meeting goal as much, but they have been improving, because as those new people mature, then their output continues to increase, and we have mechanisms that we check on all of our stations to see what the output is for that individual based upon their maturation level. And if they are not giving us the output, then the question goes to the managers and leaders of that RO and to me, because I am accountable to the Secretary, to ensure that we are serving veterans right. We are not doing veterans favors when we rate their decisions timely. We are giving them what they deserve, and we are thankful--and I want to say this to the Chairman--that Congress has given us unprecedented budgets in the last several years, and we are thankful for that. That is why we are using these resources to update our IT systems, we are training folks, we have hired additional folks, and we will continue to do that because we are going to make the goal. We know we need to do it. That is our job, and that is what you expect of us, the American people expect, and that is what we are going to deliver. Ms. Titus. Thank you. Mr. Runyan. I thank the gentle lady and the gentlemen on behalf of the Subcommittee. I thank you for your testimony. We look forward to working with you on these important issues, and you are now excused, and we welcome the second panel to the witness table. Mr. Clark. Thank you, Mr. Chairman. Mr. Runyan. At this time, I would like to welcome our second panel, Ms. Katherine Miller from the Nevada Department of Veterans Services, accompanied by Bill Baumann; Janet Snyder with the Society of Military Widows of Southern Nevada; and Bruce Hollinger with the Veterans of Foreign Wars Department of Nevada. We appreciate all of your attendance today. Your complete and written statements will be entered into the hearing record. And with that, Ms. Miller, you are now recognized for 5 minutes for your oral testimony. STATEMENTS OF KATHERINE MILLER, EXECUTIVE DIRECTOR, NEVADA DEPARTMENT OF VETERANS SERVICES, ACCOMPANIED BY BILL BAUMANN, NEVADA VETERANS SERVICES COMMISSION; JANET SNYDER, LEGISLATIVE CHAIR, SOCIETY OF MILITARY WIDOWS; BRUCE HOLLINGER, ADJUTANT QUARTERMASTER, VETERANS OF FOREIGN WARS OF THE UNITED STATES, DEPARTMENT OF NEVADA STATEMENT OF KATHERINE MILLER Ms. Miller. Good morning, or good afternoon, Chairman Runyan, Ranking Member Titus, and Members of the Subcommittee. My name is Katherine Miller, and on behalf of the Nevada Department of Veterans Services and the approximately 300,000 veterans we serve, I thank you for the opportunity to discuss veteran outreach. With me today is Mr. Bill Baumann, Chairman of the Nevada Veterans Services Commission. As a veteran with 34 years of military service, I am proud to be part of Nevada's drive to create opportunities for our veterans. The Nevada Department of Veterans Services assists veterans with claims for benefits, provides skilled nursing care, provides burial support at our state veterans' cemeteries, and help veterans successfully integrate into our communities. Our vision is that all Nevadans celebrate the legacy of America's heroes, and working together, we ensure that veterans can have access to opportunities that improve their lives. To realize that vision, we have invested significant effort developing initiatives to improve delivery of services to all of our veterans, wherever they may live. I will share some of these efforts with you today, as well as discuss the impact of several U.S. Department of Veterans Affairs initiatives. While most Nevada veterans live in the Las Vegas or Reno areas, 32,000 veterans call rural Nevada home. Many of these rural veterans find it impossible because of health or expense to come to cities for services. This reality has driven my agency to develop initiatives to bring services to veterans wherever they may live. I am going to discuss a few of those initiatives today. The first is our ROVER Program. This is a rural outreach program that sends traveling service officers, referred to as VSOs, to rural communities. They provide information relating to opportunities and help veterans prepare claims. ROVER is currently supporting 17 community clusters throughout our state. Last year, Governor Sandoval approved, and our legislature funded, five new VSOs which will allow us to travel to 12 more community clusters, providing complete state coverage. While ROVER does not touch as many lives as do our urban programs, often, the rural need is much greater, as is the lack of information regarding earned benefits. Next, I would like to mention our Nevada Green Zone Initiative, which has been identified as a best practice by the Joint Chiefs of Staff's Department of Warrior and Family Support. This initiative marshals and aligns all available resources in the areas of health, education, and employment, and improves service delivery through regional planning. A critical component of this initiative was the creation of the Green Zone Network. This free digital platform connects service providers with veterans. With the creation of the Green Zone Network, we have provided rural veterans and veterans in urban areas with a window through which to see and access services and opportunities. Nevada is also in the process of designing a second veterans nursing home to be located in Reno, Nevada. With only one nursing home located in Southern Nevada, veterans in rural northern and central Nevada must either move far from family to avail themselves of the quality of care associated with state veterans homes or live in other, often less nurturing, accommodations. Additionally, we are working with other state partners to develop a state Veterans Tracking System. Currently, public veterans' records are not stored in a central repository, which makes retrieval and analysis difficult. This system will help us identify where veterans live and help us provide them with information regarding their benefits. To support these initiatives, we are pursuing several VA grants, to include a rural transportation grant which, if approved, will provide rural veterans in eastern Nevada with transportation to VA medical appointments, and we have also applied for the Rural Veterans Coordination Pilot Grant to assist veterans transitioning to civilian life. If we receive this grant, we will expand our Green Zone Initiative, better targeting our rural and urban veterans. Much of what we do is assist veterans access the many available services. At no time in history have we seen such an outpouring of support, both nationally and locally. In fact, the Pentagon calls this unprecedented level of support the Sea of Goodwill. Because of this, the challenge often lies, not in the creation of new benefits, but with improved service delivery. Nowhere is this more evident than in the challenge associated with delivering VA services. We know that the professionals in the VA medical system and the VBA here in Nevada are dedicated to improving the lives of veterans. They work hard to develop innovative solutions. Several of their programs have had a positive impact on the lives of Nevada veterans. In the area of health care, the establishment of rural Community Based Outpatient Clinics has dramatically improved access. Often, however, our veterans must travel great distances to hospitals in Reno, Las Vegas or Salt Lake City to seek inpatient or specialty services available only at larger facilities. Most veterans understand that it would be difficult to offer these services in every small town. However, there is a desire for temporary housing options when they must seek care in a city. Local initiatives such as the Fisher House in Las Vegas or the Veterans Guest House in Reno help alleviate some of the stress and cost of travel, but needs would be better met if the VA had a program to help offset lodging and associated costs. Another beneficial development is the introduction of telemedicine options. The VA is now offering telemedicine services such as post-operative follow-ups, dermatology and podiatry consults, nutrition counseling, mental health counseling, just to name a few. And a final, important development has been the VA initiative to reimburse tribal health clinics for many primary services. They now reimburse the Indian Health Service for direct care services for eligible Indian veterans. This is another example of improved delivery service, and we applaud the VA's efforts to support our Nation's heroes living in tribal communities. Our partners at the Reno VBA have been working equally hard. Their efforts include training VSOs on initiatives such as Fully Developed Claims. They have also made available new technologies such as the Stakeholder Enterprise Portal that provides their partners access to VA web-based systems. They have supported every request we have made to provide personnel and materials at veterans' outreach events and have been very responsive to recommendations for improving services. We have also seen a dramatic improvement on the timeliness of claims, to include the eliminations of claims over two years old and the near elimination of claims over one year old. This effort, however, came at a cost. With finite resources, the VBA has not been able to keep pace with processing what are referred to as ``Non-Rated End Products'' or those actions that are not directly associated with disability claims. These actions include concurrent receipt claims, rating reviews, establishment of dependency and other requests. The backlog of Non-Rated End Products has risen to 3,400. It is my belief that the Reno VBA needs additional personnel if it is to keep up with the accelerated pace of processing Fully Developed Claims and processing all the other actions needed in a timely manner. Finally, while new technologies to help veterans file online claims may seem promising, I am concerned about the impact on claims quality. Our VSO are experiencing an upswing in requests for appeals as a result of claims improperly or incompletely filed online. Veterans sometimes make mistakes or fail to include all required evidence without the onsite support of a VSO or VA representative. If these claims were filed correctly with the assistance of an advocate, the filing of appeals, the resulting delay of benefits to veterans, and the added workload for the VBA would all be reduced. One suggestion that might help is that the VA provide sufficient and qualified telephone or synchronous online operators to assist rural veterans complete these applications. And not just rural veterans, all veterans using these online benefits. In summary, Mr. Chairman, Ranking Member Titus and Committee Members, it is a promising time to be a veteran here in Nevada. We have a long history of honoring and supporting our veterans and the servicemen and women who make their home here. Our motto, ``Battle Born,'' attests to our warrior heritage and the pride we take in the contributions of our military. While there is much work to be done, I am encouraged by the attention to these issues and the momentum achieved thus far. Thank you again for your support to our veterans and their families and your interest in the ongoing collaboration and cooperation between Nevada and the U.S. Department of Veterans Affairs. I appreciate the opportunity to appear before you today, and I am prepared to respond to any questions you may have. [The prepared statement of Katherine Miller appears in the Appendix] Mr. Runyan. Thank you, Ms. Miller. With that, I will recognize Ms. Snyder for 5 minutes for her testimony. STATEMENT OF JANET SNYDER Ms. Snyder. Thank you. Chairman Runyan, Congresswoman Titus, and Members of the House Disability Assistance and Memorial Affairs Subcommittee of the House Committee on Veterans' Affairs, it is an honor to testify at this hearing. Because of my involvement with various military widows organizations and the Military Officers Association of America and other veterans' organizations, I have heard many comments and have talked to everybody about their experiences with the VA in Reno. And most importantly, Mr. Vito Valdez, our local Army Survivor Outreach Services Support Coordinator, has been really wonderful in helping our military widows. He takes them, the ones that have been denied, and he helps them process the claim, and he has found that his experience with the Reno office has been great. That is what he told me, great. He said they process--he says he fills out the forms, he sends them in, they respond. He checks on them by the phone with the 800 number, and he says that the processing is good. He says he doesn't have any problems. After my husband passed in October 2010, I filled out my forms myself for VA Dependency Indemnity Compensation, and I received my DIC in six months, which everybody told me was the normal time to get it. Many widows don't want to fill out the forms themselves because they are not comfortable with it, and so they go to a VSO, and sometimes they have good experiences and sometimes they don't. I always encourage them that if they don't like the VSO, they need to go to a different one, because each one, you have a personality thing with them sometimes, and you need to get along with that person. But recently, one of my sister military widows and I went with--we took another member who wanted to get her aid and attendance from the VA. We met with Gene Kinofsky, who is from the VSO with the Jewish War Veterans. He sat with her. He took all of her information. He put it on the computer. After he finished, he gave her the form to take to her doctor. She got her benefits, her award letter, from the VA in Reno in over a month, just a little over a month. None of us could believe how quick it was. We thought it would take at least six months. But a little over a month, and then she got it. But the reason why is, we had a good VSO. She gave him all the information properly, and when she got the form for her doctor, the doctor answered all of the questions adequately and concisely, and I think that is the reason it was processed so quickly, I really do. Now, one of our military widows also had problems. She had problems in August of 2011, and I included that in the letter in my testimony. But even though it is 448 miles from Las Vegas to Reno, and it takes about seven-and-a-half hours to get there, there is really no reason to have to sit down with a person or talk to that person in Reno. If you fill out your forms properly, you mail them in, and then let the person in Reno do their job. That is the way I look at it, because when I filed my claim, I did that, and then later, I called that 800 number, and I never talked to someone in Reno because when you call that 1-800 number, you could get any VA office anywhere in the country. What they do and how they explained it to me, we put what your question is, we give you the answer, we type it in the thing, and Reno will see those notes. I wanted to ask what is the status of my claim. They tell me, and I knew exactly where it was. And so, I think if people have a problem, they need to, first of all, get a good VSO. Don't be discouraged if the claim is denied. Just answer all the rest of the questions, send it in, and get it adjudicated. And if you have problems, another thing I recommend is you go to your local congresswoman or your senator and you ask their office to help you, intercede for you, because sometimes when it has interceded with a Member of Congress, things happen a little quicker. But I didn't have to do that, and I don't think I was lucky. I just think it was the way it was. Thank you very much. [The prepared statement of Janet Snyder appears in the Appendix] Mr. Runyan. Thank you, Ms. Snyder. And with that, I will recognize Mr. Hollinger for 5 minutes for his testimony. STATEMENT OF BRUCE HOLLINGER Mr. Hollinger. Chairman Runyan--excuse me. Let me clear my throat. It has been a while since I have talked. Chairman Runyan, Congresswoman Titus, nice to see you again. Ms. Titus. You, too. Mr. Hollinger. On behalf of the men and women of the Veterans of Foreign Wars of the United States, and specifically for those that are in Nevada, I want to thank you for the opportunity to offer the VFW's perspective on how the VA is meeting the needs of veterans living in Nevada. I will not address the claims backlog. We are pleased it is being worked off, and it has been discussed here in detail, so I am going to focus on process, policy and procedures, that we would like to bring to your attention. First of all, I would like to thank Congress and the VA for the new VA Regional Hospital and the medical centers here in Las Vegas. You have made a lot of veterans very happy. They no longer have to go to San Diego or anywhere else because specialty care is being set up here. So they really like the new facility, and it has allowed us to see more patients locally and pull back in all the outreach they were doing and starting to do it at the hospital. So that we would like to give a big ``attaboy'' to the support from Congress to fund that and the VA to implement it. Even with the new facility, veterans still experience a long wait time for routine appointments. Primary care appointments can still take up to 90 days, and specialty care appointments can take even longer. We are hopeful that the new patient-centered community care program will assist in reducing those wait times. Scheduling for compensation and pension exams continues to be an issue for our veterans in Nevada. Exams are sometimes scheduled with only one or two days' notice. This does not provide time for the veteran to necessarily reschedule to make the exam. Anecdotal experience, one gentleman was on travel for a week. They called and he missed his exam because they gave him two days' notice. If exams are missed, VA then adjudicates the claim without the exam, usually to the detriment of the veteran. These are not practices or policies VA has in place for scheduling appointments, but unfortunately anecdotal experience says that they are not isolated instances in Nevada. VA must work to ensure that customer service standards are upheld and proper scheduling practices are conducted so the vet can be afforded the fullest opportunity to complete their compensation and pension exams and have all evidence necessary to adjudicate their claim. The VA is pleased with the Reno Regional Office program that allows veteran service representatives and decision review officers to contact veterans directly and ask for clarification on an issue that is preventing VA from successfully adjudicating the claim. This is a much more efficient process, effectively reducing the claims processing time in many cases by more than two months. Unfortunately, many veterans have told us that they are not provided a call-back number when VA leaves a message. VA must ensure veterans have the ability to respond to those calls. If contact is not made, VA must continue to send letters requesting the information. Fortunately, many VA employees contact the representative service officer when VA fails to reach the veteran. We encourage the VA to mandate that veteran service officers are notified when veterans they represented are called to make the process work. However, it does not provide a safety net for those thousands of unrepresented veterans. Paper claims continue to be misplaced or lost, and we believe the likelihood of loss is increased when claims are brokered to other regional offices. VFW service officers must have a personal identification verification card to access files within the VA database. However, VA has struggled in granting these cards to our service officers. This is not just a local issue. It is a national problem that prevents service officers from accessing the Stakeholder Enterprise Portal. In Nevada specifically, service officers have waited eight months to a year to receive their personal identification verification cards. Recently, a new manager of Change Management in the Reno Regional Office has begun working with the veteran service officer community to assure most expedited process for issuing those cards. The lack of access to the Stakeholder Enterprise Portal also prevents our service officers from filing original paperless claims. While VA has recently released a nationwide protocol for issuance of personal identification verification cards, our service officers report problems with the procedure and continue working without this essential tool. VA is making strides in the areas of care and outreach to veterans. However, these strides are overshadowed by lost documentation and poor customer service. All the issues mentioned in this testimony are fixable. We want to work with the VA to remedy those issues. Thank you again for the opportunity to testify before you today. The VFW looks forward to working with Congress and with VA in identifying issues and suggesting solutions to ensure our veterans receive the care and services their selfless sacrifice has entitled them to. This concludes my testimony, and I am happy to answer any questions the Committee may have. [The prepared statement of Bruce Hollinger appears in the Appendix] Mr. Runyan. Thank you, Mr. Hollinger. With that, we will begin the round of questions. My first question, probably two questions, are for Ms. Miller. First of all, I want to thank you and Mr. Baumann. I understand that you were kind enough to take my staff around to the Southern Nevada cemetery, veteran cemetery, and I appreciate you guys doing that, for your time. As to the VSOs who work within the ROVER Program, is there a training or a set protocol to ensure the consistency of the message and assistance being given at the 17 different clusters across the state? And what challenges do you still face with the ROVER Program? Ms. Miller. Mr. Chairman, thank you for the questions. There is a two-part answer to the training. We do have a very detailed, comprehensive training plan. It takes three years to fully train a veteran service officer. Quite frankly, we cherry pick. We go out and we find the best veteran service officers that are in other veteran service organizations, that are working as volunteers or working in posts and chapters, and we hire them. Very rarely, I can think of only one case in the recent past, since I have been here, that we have hired somebody that didn't have that strong background. So when we send somebody out into a rural area, they are good. On top of that, they are connected, where we can have them connected, via wireless, so they can call back to the office to answer any questions that need to be answered on- site. One of our challenges to getting to the rural areas, frankly, has been Internet access. There will be places that we go where we can't use--we can't upload, and we will have to do forms by hand and bring them back and file them. Another challenge has been actually identifying where all our veterans are. I mentioned in my testimony how we are working to develop a data warehouse so we can do a better job of finding where our veterans in Nevada are. The VA estimates 228,000 veterans in Nevada. Our studies show closer to 300,000. But because of the transient nature of our veterans, and because of some of the new industries or expanded industries with mining, some of the other issues, our veterans move around a lot. One of the things we are looking at is partnering with the VA to find out where they believe the veterans are, and instead of waiting for them to come to us, we start pushing information to them via any system we have, and that is why we hold great hopes out for the Green Zone Initiative and the Green Zone Network, which is really, if you will, a Facebook for veterans, where they can get on and find out about a lot of these opportunities. Mr. Runyan. Speaking of the Green Zone, along the same kind of questioning, how did you come across that plan or that idea? Ms. Miller. Mr. Chairman, the previous director of veterans services for the State of Nevada had seen similar programs that weren't quite statewide, but that offered those sorts of programs. He got with the Chairman of the Joint Chiefs of Staff. They had seen--they were looking for best practices also in the Warrior and Family Support Center, and between the two of them, the representative from there and the former director, they came up with the idea. Our governor loved it. The legislature supported it. The problem with any of these types of programs, it would be like Facebook in the first year, getting the word out, getting people online. And so these next couple of years, it is all about getting the word out so that more people are in the system, not only veterans but community members, those that have programs and opportunities for veterans. This is not a veterans problem. This is a community issue. So we need to get everyone in the community on that, which is why I mention Green Zone every time I get the chance. There are some postcards in the lobby that have the data and the Web site. [Laughter.] Ms. Miller. So I would highly encourage every one of you to take a copy of the postcard. Thank you for the question, Mr. Chairman. Mr. Runyan. And I think we understand that very well. I mean, we have all kinds of programs out there that people don't know that they are qualified for. Ms. Miller. It is very frustrating, Mr. Chairman, to link the veteran, the family member, the survivor, with the benefits that are there, and these aren't just Federal and state benefits. There is such an outpouring from the local communities, from non-profits, from individuals. I received a call the other day from someone who said I am a chaplain, I would like to marry veterans for free. So this is one of the things that the Green Zone gives us the opportunity to do, for folks to put their offerings out there, and then for our veterans to become aware of them. Mr. Runyan. Thank you. Next question is for Mr. Hollinger. I had a field hearing in my district in New Jersey with Mr. Walz last year, and C&P exams came up. We talked about wait time, and actually the House just voted to expand the private C&P exams to 15 ROs now. It was at 10, expanded to 15, because it was one of those examples that worked. Why do you think the VA only gives the veterans one or two days' notice on C&P exams? Mr. Hollinger. That is a good question, but I am not sure I know an answer to that question. I personally have not been involved in it. I just know that it occurs. We have several anecdotal experiences where the schedule could not be made by the veteran. It was very short notice. Mr. Runyan. Do you think it is an access to that provider issue? Mr. Hollinger. It very well could be. I don't know. If the opportunity comes up and it needs to be filled and the veteran has tried to be reached to make the appointment. But basically, whoever's fault it is, he doesn't make the appointment, all the penalty for not making the appointment falls on the veteran. Mr. Runyan. Something we could take a look at. But with that, I will yield to the Ranking Member, Ms. Titus. Ms. Titus. Thank you. I do appreciate that. I want to say, I also like the Green Zone. I brag about it, too. In fact, it inspired me to introduce legislation to create a grant program so every state can then have a version of the Green Zone aimed primarily at linking veterans with employers, that aspect of it. I know that is a big part of what you do. You also mentioned that there is a sea of goodwill out there. It seems like right now, everybody wants to help veterans. Veterans are kind of the charity du jour, and some of them do a really great job. U.S. VETS does, Veterans Village. But we have seen national news about organizations that will use the name ``veteran'' and then people will give to it because they want to support veterans, but then they are really just rip-off organizations that keep the money or pay the money to telemarketers or to the officers who run the organization, and the veterans see very little of that. So I want you to help me to keep a watch for those kind of groups so it is the legitimate groups that really get the support, and not some of these people who are trying to take advantage of the desire by the American public to be part of saying thank you to our veteran community. My question kind of has to do with perhaps we are creating a monster, and I say that in reference to the potential of creating a backlog in the appeals process. Some things that are happening now as we address the backlog in the claims process, maybe, are going to have some unintended consequences down the road. Some of the things that I heard you all mention as you were talking about some of the problems veterans are having is the lack of assistance dealing with the computer so that they can do the Fully Developed Claims and get away from paper and do it online. That has led to more mistakes because it is new technology. Some people aren't familiar with it. You don't have enough trained folks to help people file those. So those are mistakes that could cause the need for appeal. Also, I heard mentioned that as you ship cases out of the Reno office to other places--and this happens around the country, I just use this as an example--there is a greater likelihood for information to get lost or misplaced or never make it. That could lead to appeals. And finally, as the VA rushes to deal with all this backlog now in the cases in terms of the two years and the one year, and we want to get rid of those statistics that show such a backlog, it is likely that mistakes are going to be made which also will lead to more appeals. What do you think we can be doing, not only to address those problems, but to be proactive, so we don't come back in a year and say look at all this backlog of appeals now that we have solved the backlog of the original claims? I would ask any of you to comment. Mr. Baumann, you haven't said much. Do you want to be the first to weigh in on that? Mr. Baumann. Well, thank you very much for the question. One of the things you might consider is putting in a bank of computers and have an oversight group there, not where people are side by side where their questions would be shared, but separated enough that if you have a VSO there, that they could assist them. That would be one way that I would recommend you might do it. Ms. Titus. When you go into the veteran hospital where they have those three officers that help, are there computers there to help people file online, a kind of system like you are talking about, that could be built on to make it better? Mr. Baumann. I am sure there could, but I can't answer the question if that computer system is in there yet, that program. I don't know. Ms. Titus. Okay. Thank you. Can anybody else help us about the backlog, the appeals backlog that may be coming? Ms. Miller. Ma'am, Kat Miller, Nevada Department of Veteran Services. I have heard the VA say that it is really not a staffing issue, that they have adequate staffing, and the problem is more of a management issue, changing procedures to do things smarter. Any organization I have been in, obviously is reluctant to grow staff if it is not necessary. It is costly, and there is a tail to that. I just wonder if there has been any external reviews of staffing levels within the VBA to determine if they actually do have adequate staffing. Sometimes, it is hard to look at yourself and see what the right answer is. I know there have been plenty of reviews that talked about, that we have a problem here. I wonder if anyone has come in and actually looked at the staffing level and done those kinds of models outside of the VA to see if staffing is required. I will say that as we have gone out in Nevada, one of the things we have seen is the need for more computers, but that is not the largest issue that we have. The top five problems we have with online filing have nothing to do with access to the computers, and I would like to take a moment just to share a few of those problems we are finding with online filing. Number one, the veteran doesn't report all income or out- of-pocket medical costs because they just really don't know what needs to be required. So then when the study is done later, if they are applying for a pension, they may not be eligible for it. The veteran is not reporting all dependents. The veteran reports inaccurate service dates, which may make them ineligible for certain service-connected determinations. And most often, the result is denied because of the lack of evidence, because the vet doesn't know what evidence is relevant for that claim. So they provide evidence, and they have more if they had known that that would be necessary, because they don't understand the nuances. This is not an easy task. And then there are some problems that are easier to fix. For example, the online form, you have to submit names and addresses of five previous employers, for example. But then you have to submit a separate claim or a separate document where you would list your employers. So some of the veterans say, oh, I have listed it on here, on the online claim, so I don't need to do that additional form. They don't have the additional form, and it is kicked back. So our biggest problem is, I don't know if you can dumb this down any more. It is a complex business, and there are some claims that just are not going to be suited for the online venue. We will get better as people get used to the technology. But as these are kicked back, it is just going to slow the system down. Thank you, ma'am. Ms. Titus. Thank you. Mr. Hollinger. May I add a comment to the idea of rushing the claims through will lead to a high rate of appeals? I am not sure you can forecast that, but I think we ought to have metrics set up to see if that is happening, and it ought to be made available to service organizations that are working with their veterans, because if the rush is actually increasing the appeals, we are going to have to find a balance between the two. You are never going to work appeals to zero. I know too many people who appeal for the sake of appealing. But if they started to grow, that might be a good indication, Congresswoman, that your suspicion may be, in fact, fulfilled. Ms. Titus. Thank you, Mr. Chairman. Mr. Runyan. I thank the gentle lady. I just have one thing, Ms. Miller. I want to tie this back to the comments Ms. Snyder made in her testimony in talking about information and the lack of it, because Ms. Snyder's example of a Fully Developed Claim changes the whole ball game. Ms. Snyder. That is right. Mr. Runyan. When a claim is fully developed, you usually end up with a satisfied customer and a quicker result. I just wanted to point that out because VA does have their initiative for Fully Developed Claims. The problem is a lot of times our VSOs, our veterans don't get there for one reason or another. But just to make sure that everybody is aware of that. Ms. Miller. Yes, Mr. Chairman. I will tell you the State of Nevada is a fan of the Fully Developed Claim, and we are using them. We have seen a 40 percent increase at the Reno VBA. I don't know if those numbers are still current, but as of about three months ago there was about a 40 percent increase in FDCs largely because of their training of the VSOs in the area and making sure we all understood how to use those claims and how to help the veterans file them. Ms. Titus. Mr. Chairman, thank you for mentioning that. I do want to thank the Reno office for coming down and doing a full day of training with our veterans groups to help them to help others file those online claims. We got good responses from them about that. So I appreciate you all doing that. One last question. As you help veterans in Nevada, have you noticed any difference or any difficulty with those whose cases have been sent out of state? Do you deal with other regional offices, or is it basically the same? Ms. Miller. Ma'am, I am sorry. I haven't done any analysis of the difference between sending out-of-state or in-state, but it is certainly something I am going to take a look at now to see if there is an issue. Our larger problem is veterans transferring, because we do have a rather transient population. The issue that was mentioned on exams, we have many, many cases of veterans who transfer here from another region. They were waiting for a long period of time for their exam. As soon as they get in the car and start driving here, that exam pops. We just had one that happened in Kansas. So they get here in time to find out that the decision has been made because they failed to make an appointment they never knew about. So that is one of the advantages of the VSO. They can help you in transit as you are moving from one place to another to monitor the status of the claim and keep you apprised of what is going on. Ms. Titus. As you all do that, will you keep us informed about what you find as you look at some of these things that have been brought up as issues today? Ms. Miller. Yes, ma'am, I will. Ms. Titus. That would be great. And again, I want to thank the Chairman for coming out today to have this hearing, and for you all's testimony, and for all of you being here. I can't think of a better way to kind of move into Veterans Day when we are supposed to be saying thank you to those who have sacrificed so much as a hearing like this, so we can find out what we can do to better serve. So I really appreciate you, Mr. Chairman, the staff, and all of you for participating. Thank you. Mr. Runyan. I thank the gentle lady. Ladies and gentlemen, on behalf of the Subcommittee, I thank you for your testimony, and you are excused. I want to thank everyone for being with us today. In closing, I want to say to the veterans of South Nevada that the House Committee on Veterans' Affairs and my Subcommittee will continue to listen to your needs and work to address the issues discussed here today. Ms. Titus, thank you for inviting me to your district today and for making this hearing possible. It has been a pleasure having you serve as the Ranking Member of the Subcommittee and working with you together in a bipartisan manner on behalf of our veterans. I know that the veterans of South Nevada certainly appreciate your active participation in our Subcommittee. I would like, once again to thank all of our witnesses for being here today. I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks and include any extraneous material. Hearing no objection, so ordered. Once again, it has been a pleasure to have all of you with us here today, and I wish to thank Ms. Titus again for having me here in this hearing. It is now adjourned. [Whereupon, at 3:36 p.m., the Subcommittee was adjourned.] A P P E N D I X ---------- Prepared Statement of Willie Clark Good afternoon, Chairman Runyan, and members of the Subcommittee. Thank you for the opportunity to discuss services provided to Veterans and their families throughout Nevada. I am accompanied today by Mr. Edward Russell, Director of the Reno Regional Office (RO). As the seventh largest state in the United States, Nevada encompasses approximately 110,000 square miles. It is home to more than 244,000 Veterans who reside within the Reno RO's jurisdiction, with an additional 11,400 Veterans residing in 4 California counties also served by the Reno RO. Of these, approximately 33,500 Veterans receive VA compensation or pension benefits, and an additional 610 beneficiaries receive Survivors benefits. Over $38.5 million in compensation and pension benefits are paid monthly. As you are aware, Nevada is comprised of 17 counties, of which Clark County is the largest with a population of nearly 2 million, followed by Washoe County with a population over 420,000 and Elko County with a population of nearly 50,000. The majority of the state's population (88 percent) resides in only 2 counties, with the remaining population scattered throughout the remaining 15 counties. The smallest county, Esmeralda County, has a population of fewer than 800 people. Nevada is unique in that nearly 87 percent of the land is federally controlled, thus making the state an ideal location for those who enjoy rural living. However, one of the difficulties with rural living is limited accessibility to resources. The Reno RO processes claims for disability compensation benefits and provides vocational rehabilitation and employment services for our disabled Veterans. The RO also provides claims assistance to over 600 Veterans and family members per month. In addition, the RO has an out- based office located in the newly opened VA Medical Center (VAMC) in North Las Vegas, approximately 450 miles from the main RO facility. The Las Vegas office primarily delivers vocational rehabilitation and employment services, placing rehabilitation counselors in the area where the majority of the jobs are located. This out-based office also has some limited claims processing capabilities and 4 intake specialists who assist over 2,150 visitors per month. The Reno office provides space for five Veterans Service Organizations (VSO). The North Las Vegas VAMC provides space for nine VSOs. To overcome Nevada's geographical challenges, the RO collaborates with its stakeholders to provide outreach to our Veterans residing in remote areas. In addition to VSOs, the stakeholders working in partnership with the RO include: Nevada's two VAMCs, Congressional offices, Nevada Division of Veterans Services, Nellis Air Force Base, Fallon Naval Air Station, Nevada National Guard, and the Air National Guard. The RO participates with these stakeholders in their Veterans' events to extend outreach to Veterans and their families experiencing geographical obstacles. The following are a few examples of the Veterans' events held over the past year:The Reno VAMC held an open house day at the Outpatient Clinic in Winnemucca, Nevada. The population in the area is less than 7,500 and 2\1/2\ hours away from the RO. The RO was there to provide information and services. In addition, the RO had representatives at VAMC Veterans' events in Susanville, California, and Pahrump, Nevada. The RO attended local conferences held by Native American tribes to provide updates on Veterans benefits, answer questions, and provide direct assistance with claims. The RO also conducted outreach for local Native American tribes in partnership with the Reno VAMC. The RO participated in Senator Heller's Veterans' Roundtable. Congressman Amodei held quarterly town hall meetings across the 2nd District. The RO had representatives at every town hall to include Elko, Winnemucca, Fallon, and Carson City. Congresswoman Titus held a workshop and training session on the Fully Developed Claims Program and eBenefits for Veteran stakeholders in the North Las Vegas area. The RO continues to build strong relationships with the Nevada military bases at Nellis Air Force Base and Fallon Naval Air Station, the Nevada National Guard, and the Air National Guard. These relationships have allowed VA to participate with Servicemembers prior to discharge. The RO has military service coordinators assigned to Nellis Air Force Base. The RO also provides monthly briefings on VA benefits in Las Vegas and Fallon, Nevada. After deployments, the Reno RO has VA representatives at the Nevada National Guard and Air National Guard, who work closely with Servicemembers and their families to ensure they are well-educated on the benefits available to them. Collaboration with the VSOs has been invaluable in serving Veterans in rural areas. Our VSO partners are knowledgeable about VA's benefit programs and the services provided by the RO. The Disabled American Veterans organization uses a mobile van to reach rural areas of the State. Because Nevada does not have county-based Veterans service officers in rural areas, the Nevada Division of Veterans Services is developing a plan to expand its services to rural areas to provide more outreach and increased accessibility for Nevada's Veterans. The RO is supporting the Nevada Division of Veterans Services with training and technology initiatives for their expansion project. Two of VA's highest priority goals are to increase access for Veterans and their families across all areas of the country and eliminate the disability claims backlog in FY 2015 . VA's transformation plan includes a series of technology initiatives designed to achieve end-to-end digital filing capability, expanding accessibility for Veterans who do not live in close proximity to an RO. A key component of VA's transformation plan to improve access to benefits and services is eBenefits, the joint VA and Department of Defense Web portal that provides Servicemembers and Veterans with immediate access to information and over 50 self-service options. Over 3 million Servicemembers and Veterans have already enrolled in eBenefits. Veterans can file their claims online through eBenefits, using a ``turbo tax'' like application that also allows Veterans to upload evidence to support their claims. Veterans also have access to VA's national call centers, which respond to over 12 million calls nationally per year - more than 7,500 of which are from Nevada's Veterans. Most recently, VA introduced the Stakeholder Enterprise Portal (SEP), which is a secure, web-based connection that complements eBenefits and gives VSOs and other authorized advocates access to assist Veterans in filing disability claims electronically. SEP will help VSOs to expand services to Veterans in rural areas. Training on use of this medium is underway at the Reno RO, and it is anticipated that the majority of our VSOs will be utilizing the portal by the end of the calendar year. With regard to leadership and staffing, the Reno RO has experienced challenges over the past few years as a result of retirements and transfers that have had an impact on performance. The RO is now in a rebuilding stage. The RO is allocated 93 full-time employees. At present, there are 90 full-time employees on board; however, the Veterans Service Center is fully staffed. To support its rebuilding, the Reno RO is utilizing all available technologies and tools to ensure consistent training is provided to employees across the RO and at the office in Las Vegas. Teleconferencing, videoconferencing, and in some cases, travel to the out-based office have been incorporated to ensure training needs are being met. The RO is making significant progress in improving the delivery of benefits and services. In April 2013, the Reno RO had over 1,100 pending claims that were over 2 years old; by September 30, 2013, all of these had been completed. In June 2013, the Reno RO had over 4,000 claims that had been pending more than 1 year; only 187 remain pending. Over 70 percent of Reno's employees are Veterans, and over 90 percent of the employees have a close relative who is a Veteran. These employees are dedicated to serving all Veterans residing in Nevada to the absolute best of their ability. As stated previously, the strong partnerships with the many stakeholders in Nevada are key to our success. We will continue our efforts to enhance and expand accessibility for Veterans and their families throughout the state. The leadership and employees of the Reno RO are fully engaged in serving our Veterans and their families, and we are dedicated to ensuring they timely receive the benefits they have earned and deserve. This concludes my statement. I would be pleased to answer any questions at this time. Prepared Statement of Katherine N. Miller Introduction Good Afternoon Chairman Runyan and Ranking Member Titus. On behalf of the Nevada Department of Veterans Services and the approximately 300,000 Nevada veterans, family members, and survivors we serve, I thank you for the opportunity to discuss outreach to disabled veterans in rural Nevada. As a veteran with 34 years of military service, I am proud to serve with the Nevada Department of Veterans Services and be part of Nevada's drive to create opportunities for our veterans to thrive. Our agency provides vital and efficient support to and advocacy on behalf of veterans, their dependants, and survivors, and provides our community and partners the opportunity to contribute in these endeavors. Through our programs we assist veterans submit claims for benefits, provide skilled nursing care, provide burial support at our state veterans' cemeteries, and help veterans successfully integrate into Nevada communities. Overview Our vision is that Nevadans across our great state understand and celebrate the legacy of America's heroes--and working together we will ensure that veterans and their families understand and have access to opportunities that improve their lives. To realize our vision, we have invested significant effort developing initiatives to improve delivery of services to veterans in rural areas. I will share some of these efforts with you today, as well as discuss U.S. Department of Veterans Affairs initiatives that I believe have improved support to Nevada's rural veterans and areas that need additional attention. State of Nevada Rural Veteran Initiatives While most of Nevada's veterans live in the Las Vegas Metropolitan Area in southern Nevada or the Truckee Meadows area in northern Nevada, 32,000 veterans call rural Nevada home. Because of this geographical dispersion, delivery of services is difficult. Many rural veterans find it impossible because of health or expense to come to VA Veterans Benefit Administration (VBA) offices in Las Vegas and Reno. Additionally, even within urban areas there are home-bound, homeless, incarcerated, or infirm veterans that cannot visit VBA offices. This reality has driven the Nevada Department of Veterans Services to develop outreach programs that bring services to veterans wherever they may live. Today I will discuss several important initiatives that we have implemented or are implementing to improve rural area service delivery: 1) the Rural Outreach Veterans Enrichment and Resources (ROVER) Program; 2) the Green Zone Initiative; 3) the Northern Nevada Veterans Skilled Nursing Home; 4) the Veterans Tracking System; and 5) pursuit of VA grants supporting rural veterans. The ROVER Program sends traveling Veterans Service Officers (VSO) to communities in rural Nevada. As mandated by legislative statute, these VSO assist veterans, service members, and their families regarding any problem, issue or concern they may have. This includes providing information relating to veterans benefits and opportunities, and helping veterans prepare and submit claims, to include disability compensation, hospitalization, insurance, pension, training, education, or rehabilitation. With our help, and the help of other veterans organizations, the VBA can better reach rural veterans throughout Nevada. ROVER is currently supporting 17 community clusters throughout the state. Last year Governor Sandoval approved, and our legislature funded, five additional VSO which will allow us to travel to 12 more community clusters and provide complete state coverage. We are pursuing additional VSO to allow us to increase the frequency of visits to these areas. While the ROVER program does not touch as many lives as do our programs supporting urban Nevadans, often the rural need is much greater as is the lack of information regarding the benefits veterans have earned by serving their nation. Our Nevada Green Zone Initiative has been identified as a best practice by the Department of Warrior and Family Support, Office of the Chairman of the Joint Chiefs of Staff. Its purpose is to ensure the successful reintegration of Nevada's service members, veterans, and their families. The Green Zone Initiative marshals and aligns all available resources in the areas of health, education, and employment and improves service delivery through regional planning and coordination. One important component of the Green Zone Initiative was the creation of regional Veteran Community Councils. All but two of the 11 Councils are located in rural communities. These councils set local objectives and coordinate between local veterans, organizations, and service providers to connect veterans with needed services. They also identify gaps in services that cannot be filled locally and need to be addressed by state and federal providers. Another of the Green Zone Initiative's critical components was the creation of the Green Zone Network. The Green Zone Network is a free digital platform that connects organizations and service providers with veterans in the areas of employment, education, and wellness. With the creation of the Green Zone Network, we have provided rural veterans with a window through which to see the opportunities that they might access locally and through electronic delivery. Nevada is also in the process of designing a second veterans nursing home to be located in Reno, Nevada. Studies have shown that people generally do not move to nursing homes that are located farther than 90 miles from where they live. With only one nursing home, located in Southern Nevada, veterans in rural northern and central Nevada must either move far from family to avail themselves of the quality of care and quality of life associated with a state veterans home or live in other, often less nurturing, accommodations. We have submitted a grant request to the VA for construction and are working with state and federal officials to identify funding for the project. Additionally, we are working with other state partners, notably Utah, to develop a state Veterans Tracking System. This system creates a database of veterans' information gathered from many sources to include the veteran, the Department of Motor Vehicles, and state vital records. Currently these public records are not stored in a central repository which makes retrieval and analysis difficult. This system will help us identify where veterans live and enable us to provide them with information regarding state and federal benefits and opportunities. To support these initiatives, we are pursuing several VA grants, to include a Veterans Affairs Grant for Transportation of Veterans in Highly Rural Areas. This grant, if approved, will provide veterans in rural eastern Nevada with transportation to medical appointments at the VA's Community Based Outpatient Clinic in Elko, Nevada. We have also applied for the Rural Veterans Coordination Pilot Grant. This grant is intended to assist veterans and their families who are transitioning from military to civilian life in rural or underserved communities. If we receive this grant, we will be able to expand and improve our Green Zone Initiative to further increase access to benefits for veterans and their families living in rural communities. Of course, much of what we do in these outreach programs is assist our veterans access state, local, federal and community services. At no time in history have we seen such an outpouring of support; both nationally and locally. In fact, the Pentagon calls this unprecedented level of support offered our veterans the ``Sea of Goodwill.'' Because of the many available services, the challenge lies not necessarily in the creation of new benefits but with improved delivery of existing services and benefits. Nowhere is this more evident than in the challenges associated with delivery of services offered by the VA. U.S. Department of Veterans Affairs Support to Nevada Veterans The professionals assigned to the VA Medical System and the Veterans Benefits Administration here in Nevada are dedicated to improving the lives of Nevada's veterans. They have worked hard to develop innovative solutions to provide quality medical care and to provide benefits and services to veterans and their families. Several of their programs have a positive impact on the lives of our rural veterans. U.S. Department of Veterans Affairs Health Care In the area of health care, the establishment of Community Based Outpatient Clinics in rural areas has dramatically improved access to care. Often, however, our veterans must travel great distances to the VA hospital in Las Vegas, Reno, or Salt Lake City to seek inpatient or specialty services available only at larger facilities. Most veterans understand that it would be difficult to offer these specialty services in every small town. However, there is a desire for temporary housing options for these veterans and their families when they must seek care in a city. Local initiatives such as the Fisher House in Las Vegas or the Veterans Guest House in Reno help alleviate some of the stress and cost of this travel, but critical veteran's needs would be met if the VA had a program to help rural veterans offset lodging and other associated costs during their visits to urban medical facilities. Another beneficial development in the area of healthcare has been the introduction of telemedicine options for our rural veterans. The VA is now offering telemedicine services such as post-operative follow- ups, dermatology and podiatry consults, weight loss and nutrition counseling, neurosurgical evaluations, and mental health counseling, just to name a few. While these services were always available in the urban areas, advances in telemedicine have dramatically improved the delivery of health care services to rural veterans. A final, important development in the delivery of health services to rural Nevadans has been the VA initiative to reimburse tribal health clinics for many primary care services provided to Nevada's Indian veterans. VA now reimburses the Indian Health Service for direct care services provided to eligible Indian veterans. This is another example of the work being done to improve delivery of services to rural veterans and we applaud the VA's efforts to improve health care to our Nation's heroes living in tribal communities. U.S. Department of Veterans Affairs Benefits Administration Our partners at the Reno VBA Regional Office have been working equally hard to improve support to veterans, by improving timeliness and quality of claims processing. Their efforts include supporting and training VSO in order to extend their reach into rural Nevada through our office and through the work of service officers working for national service organizations. They have also made available and trained veterans service organizations on new technologies such as the Stakeholder Enterprise Portal, a secure entry portal that provides VA partner organizations and external stakeholders access to the web-based systems we need to assist veterans, reservists, national guard members, and their dependents. They have supported every request we have made to provide personnel resources and materials at veterans outreach events and have been very responsive to recommendations for improving services. We have also seen a dramatic improvement on the timeliness of claims, to include the elimination of the backlog of claims over two years old and the near elimination of claims over one year old. This herculean effort, however, came at a cost. With finite resources, the Reno VBA Regional Office has not been able to keep pace with processing what are referred to as ``Non-Rating End Products,'' or those claims that are not directly associated with disability claims. These claims include establishment of dependency claims, Freedom of Information requests, concurrent receipt claims, rating reviews, and income, estate, and election issues. The backlog of Non-Rating End Products has risen to 3400. It is my belief that the Reno VBA Regional Office needs additional personnel resources if it is to keep up with the accelerated pace of processing Fully Developed Claims and process in a timely manner the many other claims and requests they are responsible for. The workload is only likely to grow; with the success of our outreach programs, we are increasing the number of claims filed on behalf of Nevada's veterans. Finally, while the creation of new technologies to help veterans file claims online may be seen as a positive move for rural veterans, we are concerned about the impact on claims' quality. Our VSO are experiencing an upswing in appeals as a result of claims improperly or incompletely filed online. Veterans often make mistakes when filing on line or fail to include all required evidence to support a claim without the onsite support of a VSO or VA representative. As a result, the veteran can be dissatisfied with the result and seek to appeal a rating decision. If these claims were filed correctly with the assistance of an advocate, the filing of appeals, the resulting delay of benefits to veterans, and the added workload for the VBA would all be reduced. One suggestion that might help is that the VA provide sufficient qualified telephone or synchronous online operators to assist rural veterans complete these online applications. Summary In summary, Mr. Chairman and Ranking Member Titus, it is an exciting time to be a veteran in Nevada. Nevada has a long history of honoring and supporting its veterans and the service men and women who make their home here. Our Motto ``Battle Born'' attests to our warrior heritage and the pride we take in the contributions of our military. While there is much work to be done, I am encouraged by the attention to these issues and the momentum achieved thus far. As we improve delivery of service at all levels of government, more rural Nevadans are getting connected with the benefits and opportunities they earned through their service to this nation and its citizens. Be assured, the men and women in the Nevada Department of Veterans Services and Nevadans everywhere will continue to work with our federal partners to improve delivery of services to veterans wherever they may live. Thank you again for your support to our veterans, service members, and their families--and for your interest in the ongoing collaboration and cooperation between the State of Nevada and the U.S. Department of Veterans Affairs. I appreciate the opportunity to appear before you today, and I am prepared to respond to any questions you may have. Prepared Statement of Janet Snyder Chairman Runyan, Congresswoman Titus, and Members of the House Disability Assistance and Memorial Affairs Subcommittee of the House Committee on Veterans Affairs: It is an honor to testify at this hearing. As Legislative Chair of the National Society of Military Widows, President of the Society of Military Widows of Southern Nevada Chapter #34, President of the Las Vegas Valley Chapter of Gold Star Wives of America, and member of Auxiliary Member Advisory Committee of the Military Officers Association of America, I have met and talked with many veterans and survivors in Nevada about their experiences with the VA Regional Office in Reno. Vito Valdez, our local Army Survivor Outreach Services (SOS) Support Coordinator, has assisted several of our military surviving spouses in filling out forms to receive their Dependency and Indemnity Compensation (DIC). These military widows had been denied coverage in the past, had filed appeals, and received more denial letters. He told me that his experience with the VA Office in Reno has been great. With the number of claims (burial, DIC, PMC) he has submitted to them, they came back with a reply in a timely manner. The issue he has is our VA Office here in Las Vegas. He stopped going there because of their slow processing system. He can go directly to the Regional Office in Reno with a faster answer. Vito corresponds with them by postal mail, sending the hard copy applications to 5460 Reno Corporate Drive, Reno, NV 89511. He only calls the 800-827-1000 number once the application is in progress. Vito always tells his clients to be patient, especially when dealing with the VA or DFAS, and never gives them an exact date when they will start receiving their benefits. After my husband passed in October 2010, I completed the forms myself and sent them to the Reno office. In six months I received my DIC. Everyone told me that this was the usual time for processing the paperwork. Many military widows are unable to complete the forms themselves, so they went to the local VA Office in Las Vegas, and did not receive good assistance. Some were told that they didn't qualify for benefits, and they gave up. I always encouraged them to go to another Veterans Service Officer (VSO) to get help in completing the forms. Recently one of my sister military widows with the Society of Military Widows and I accompanied a member who wanted to apply for Aid & Attendance. We went to the new North Las Vegas VA Hospital on 6900 N. Pecos Road, and met with Gene Kanofsky, Veterans Service Officer with the Jewish War Veterans. Gene put all of her information into the forms on the computer and gave her the form to take to her Doctor to complete and mail to the VA. In a little over one month, she received her award letter from the VA Office in Reno. None of us could believe how fast the service was. We had expected it to take at least six months. All of us discussed it, and we decided that the reason was because Gene had completed the online application properly, and our friend's Doctor had answered all of the medical questions accurately and concisely. There were no mistakes in the application for benefits. Another sister military widow, whose husband was a Gulf War Veteran, was not as lucky. Following is Rosa Falu-Carrion's report about her experiences: October 25, 2013 RE: VA Regional Office My first encounter with the Reno office was in August of 2011. The office of the First Lady, Michelle Obama had sent a copy of an email I had sent to her office regarding how I was treated in the local offices in Las Vegas, following the unexpected death of my husband, Jose Vasquez Carrion. I received a call directly from the Congressional Liaison and was assured that I was a priority and would be taken care of quickly as she would report status updates to Mrs. Obama's office. However, only the first step of submitting the paperwork was the only step handled expediently. I never received mailed notification of receipt of the filed claim until I was advised by the Liaison to contact my district Congress person, Shelly Berkley's office. Shelly Berkley's office was also met with resistance and disrespect by the Reno office with rude emails and calls that were not returned for several weeks. Finally in early 2012 I received notification in my claim, but it was a denial claiming I wasn't married long enough to receive benefits. So the appeal process began through ``Notice of Disagreements'' that was lengthy, painful and unnecessary. All points could have been handled with one appeal. I called the White House, office of Michelle Obama and reported the problems I was facing with the VA even with specific instruction by the First Lady and help from my Congress Woman and the White House began an inquiry. Finally, at the end of November 2012, I received approval for DIC, however, my late husband was given a 20% service-connected rating, even though over 200-pages of doctors/hospital notes from civilian facilities beginning just a few months after he finished his active- duty service were submitted, not to mention the VA hospital notes, which included medical profiles and reports of the physical problems he was claiming. The VA-Claimed they could not locate my late husbands' service medical records in order to make a complete determination. I provided every duty station with copies of awards, certificates, even photos proving where he was stationed. The latest disappointment is the denial of ChampusVA medical benefits that I so desperately needed. If any further information is needed I would be happy to provide it. Sincerely, Rosa Falu-Carrion Korea, Vietnam, and current war veterans have told me that they would never have received their VA benefits without the tireless efforts of their Veterans Service Officers. They had become discouraged after receiving denial letters multiple times, and were encouraged to appeal with additional information. It is most important to u Find a good Veterans Service Officer (VSO) u Make sure you have included all forms, documents, and medical records required u Keep submitting claims and appeals, even if they are denied u Ask the Caseworker at the local office of your U.S. Representative or Senator to help you u Document every phone call, letter written, and make copies of all correspondence u Be sure to thank everyone who helps you It is 448 miles from Las Vegas to Reno. Driving time takes approximately seven and a half hours. Therefore, it is not convenient to visit the VA Regional Office. It is highly unlikely that a veteran or survivor will ever talk with someone from the Reno office. When you call the 1-800-827-1000 number, you can reach someone in any office from around the country. It was explained to me that notes would be typed into the computer file about the subject of my calls (questions about the status of my claim), and that these would be made available to my Reno regional office. In conclusion, I don't think it is a problem to have the VA regional office in a remote area. We are our own best advocates. Janet Snyder Legislative Chair Society of Military Widows Auxiliary Member Advisory Committee Military Officers Association of America Prepared Statement of Bruce Hollinger MADAM CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE: On behalf of the men and women of the Veterans of Foreign Wars of the U.S. (VFW) and our Auxiliaries, I would like to thank you for the opportunity to offer the VFW's perspective on how VA is meeting the needs of veterans living in Nevada. First, I would like to take a moment to discuss the new VA medical center here in Las Vegas. Veterans like the new facility. It has allowed VA to begin seeing more patients and provide more of the specialty care that in the past was conducted through an MOU with Nellis Air Force Base, at a VA hospital in either Arizona or California, or was provided under contract in the community. Even with a new facility, veterans still experience long wait times for appointments. Primary care appointments can take up to 90 days and specialty care appointments can take even longer. The VFW is hopeful the new Patient-Centered Community Care (PCCC) program will assist in reducing these wait times. The House Veterans Affairs Committee must use its oversight role to ensure our facility has the resources to hire needed medical staff to provide timely access for Nevada's veterans, to go along with the quality care provided by VA. The VFW has a full time service officer who works at the medical center; he has a good relationship with the Operation Enduring Freedom/ Operation Iraqi Freedom (OEF/OIF) care coordinator. When an OEF/OIF veteran walks into the medical center to take advantage of the five year access to medical care, the OEF/OIF Coordinator checks to see if a claim for benefits was previously filed. If it hasn't been, the coordinator refers the veteran to a Veteran Service Organization (VSO) service officer, who is co-located in the medical facility for help in filing a claim. One request local veterans have that would make finding the new facility easier is to have road signs identifying the exits that lead to the facility from the highway. Scheduling for Compensation and Pension (C&P) exams continues to be an issue. Exams are often scheduled with only one or two days of notice to the veteran. This does not provide veterans time to rearrange their schedule to make the exam. If exams are missed, VA then adjudicates the claim without the exam, to the determent of the veteran. This was a larger problem while VA was working to eliminate all claims over two years old, but continues to be an issue across the country. At this time the only recourse for veterans when this happens is to file a Notice of Disagreement (NOD) in an effort to have the exam rescheduled. VFW knows of a veteran being called by scheduling, who told the veteran that his exam would take place the next day. The veteran was out of town and could not make the exam. The veteran was told by the scheduler, ``if the appointment wasn't important, then why did you file a claim.'' There are other reports that a VA employee would tell veterans that she would reschedule the C&P exam if they stated they were unable to make the appointment. Unfortunately, she would not reschedule and the next letter the veteran would receive would be a notice of denial of benefits. These are not the practices or policies VA has in place for scheduling appointments, but unfortunately, here in Nevada these are not isolated incidents. It is difficult to determine if these practices are widespread, because the Veteran Service Representatives (VSR) orders the exam, then goes through scheduling to make the appointment. The doctor who is scheduled to give the exam and the VSR would not be aware of when, or under what conditions the exam was scheduled. If the appointment is missed, the doctor notates the veteran failed to make the appointment, which is cause for the VSR to adjudicate the claim with the evidence at hand. VA must work to ensure that customer service standards are upheld and that proper scheduling practices are conducted so veterans are afforded the fullest opportunity to complete their C&P exams, and have all evidence necessary to adjudicate their claim. The VFW is pleased with the Reno VA Regional Office (RO) program that allows VSR and Decision Review Officers (DRO) to contact veterans directly and ask for clarification on an issue that is preventing VA from successfully adjudicating the claim. This program gives VA the ability to gather that missing piece of evidence or clarify an issue, eliminating the need to send a letter requesting the information, and then wait sixty days for a response. This is a much more efficient process, effectively reducing the claims processing time by more than two months in many cases. Unfortunately, many veterans have told us that they are not provided a call-back number when VA leaves a message. Consequently, working veterans cannot respond to VA with the necessary information in a timely manner. There are reports from veterans who received two or three of these types of calls, but they were not able to respond, only later to have their claim decided without the opportunity to provide the missing evidence or clarification. VA must ensure veterans have the ability to respond to these calls, and if contact is not made via phone, VA must continue to send the letter requesting the information. This new policy will only work if veterans are afforded the opportunity to respond. Fortunately, many VA employees will contact the representing service officers when VA fails to reach the veteran themselves. In these cases, the service officer can work with the veteran to answer the questions that are preventing VA from accurately adjudicating the veteran's claim. While this practice is very positive, it isn't required, so not all VA employees take the time to contact the service officer for assistance, nor does it provide a safety net for the thousands of unrepresented veterans. VA must mandate that VSOs are notified when the veterans they represent are called to make this process work. Our service officers report that paper claims continue to be misplaced or lost, and the likelihood of loss is increased when claims are brokered to other regional offices. This is adding months and years to veterans' claims, often requiring veterans to resubmit some or all of their evidence. Our service officers have started making copies of all documentation for the veterans they represent as a safety net for when files are lost, allowing them to protect effective dates and quickly resubmit the claim. VFW services officers must have a Personal Identification Verification (PIV) card to access files within the VA database. However, VA has struggled in granting these cards to our service officers. This is not just a local issue, it is a national problem that prevents service officers from accessing the Stakeholder Enterprise Portal (SEP). In Nevada specifically, VFW service officers have waited eight months to a year to receive their PIV cards. Recently, a new manager of Change Management in the Reno RO has begun working with the VSO community to ensure a more expedited process for issuing the PIV cards. We are hopeful this issue can be quickly resolved. The lack of access to SEP also prevents our service officers from filing original paperless claims. Service officers want to file claims electronically, knowing the likelihood of a lost file is decreased and that claims can move though the system much quicker. With access being limited and our service officers are forced to file paper claims. While VA has recently released a nationwide protocol for issuance of PIV cards, our service officers report problems with the procedure and continue working without this essential tool. This is a source of frustration for our service officers that prevents them from assisting in VA's move to an all paperless claim process. VA is making strides in areas of care and outreach to veterans, however, these strides are overshadowed by lost documentation and poor customer service. All the issues mentioned in this testimony are fixable. We want to work with VA to remedy all of these issues. Thank you again for the opportunity to testify before you today. The VFW looks forward to working with Congress and VA in identifying issues and suggesting solutions to ensure our veterans receive the care and services their selfless sacrifice has entitled them to. This concludes my testimony, and I am happy to answer any questions the Committee may have. [all]