[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
THE U.S. DEPARTMENT OF VETERANS AFFAIRS
BUDGET REQUEST FOR FISCAL YEAR 2009
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
----------
FEBRUARY 7, 2008
----------
Serial No. 110-67
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Printed for the use of the Committee on Veterans' Affairs
THE U.S. DEPARTMENT OF VETERANS AFFAIRS
BUDGET REQUEST FOR FISCAL YEAR 2009
THE U.S. DEPARTMENT OF VETERANS AFFAIRS
BUDGET REQUEST FOR FISCAL YEAR 2009
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
FEBRUARY 7, 2008
__________
Serial No. 110-67
__________
Printed for the use of the Committee on Veterans' Affairs
----------
U.S. GOVERNMENT PRINTING OFFICE
41-367 PDF WASHINGTON : 2009
For sale by the Superintendent of Documents, U.S. Government Printing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800;
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Washington, DC 20402-0001
COMMITTEE ON VETERANS' AFFAIRS
BOB FILNER, California, Chairman
CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, Jr., South
Dakota Carolina
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
PHIL HARE, Illinois GINNY BROWN-WAITE, Florida
MICHAEL F. DOYLE, Pennsylvania MICHAEL R. TURNER, Ohio
SHELLEY BERKLEY, Nevada BRIAN P. BILBRAY, California
JOHN T. SALAZAR, Colorado DOUG LAMBORN, Colorado
CIRO D. RODRIGUEZ, Texas GUS M. BILIRAKIS, Florida
JOE DONNELLY, Indiana VERN BUCHANAN, Florida
JERRY McNERNEY, California VACANT
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
Malcom A. Shorter, Staff Director
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
__________
February 7, 2008
Page
The U.S. Department of Veterans Affairs Budget Request for Fiscal
Year 2009...................................................... 1
OPENING STATEMENTS
Chairman Bob Filner.............................................. 1
Prepared statement of Chairman Filner........................ 64
Hon. Steve Buyer, Ranking Republican Member...................... 3
Hon. Stephanie Herseth Sandlin, prepared statement of............ 65
WITNESSES
U.S. Department of Veterans Affairs, Hon. James B. Peake, M.D.,
Secretary...................................................... 5
Prepared statement of Secretary Peake........................ 65
______
American Legion, Steve Robertson, Director, National Legislative
Commission..................................................... 47
Prepared statement of Mr. Robertson.......................... 90
American Veterans (AMVETS), Raymond C. Kelley, National
Legislative Director........................................... 45
Prepared statement of Mr. Kelley............................. 87
Disabled American Veterans, Kerry Baker, Associate National
Legislative Director........................................... 42
Prepared statement of Mr. Baker.............................. 78
Iraq and Afghanistan Veterans of America, Paul Rieckhoff,
Executive Director............................................. 54
Prepared statement of Mr. Rieckhoff.......................... 105
National Coalition for Homeless Veterans, Cheryl Beversdorf, RN,
MHS, MA, President and Chief Executive Officer................. 58
Prepared statement of Ms. Beversdorf......................... 142
National Association for Uniformed Services, Rick Jones,
Legislative Director........................................... 60
Prepared statement of Mr. Jones.............................. 145
Paralyzed Veterans of America, Carl Blake, National Legislative
Director....................................................... 40
Prepared statement of Mr. Blake.............................. 75
Veterans for Common Sense, Paul Sullivan, Executive Director..... 56
Prepared statement of Mr. Sullivan........................... 107
Veterans of Foreign Wars of the United States, Dennis M.
Cullinan, Director, National Legislative Service............... 44
Prepared statement of Mr. Cullinan........................... 85
Vietnam Veterans of America, Richard F. Weidman, Executive
Director for Policy and Government Affairs..................... 48
Prepared statement of Mr. Weidman............................ 101
SUBMISSIONS FOR THE RECORD
Friends of VA Medical Care and Health Research, statement........ 150
Miller, Hon. Jeff, a Representative in Congress from the State of
Florida, statement............................................. 151
Mitchell, Hon. Harry E., a Representative in Congress from the
State of Arizona, statement.................................... 152
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to
Hon. James B. Peake, M.D., Secretary, U.S. Department of
Veterans Affairs, letter dated March 7, 2008, transmitting
questions from Chairman Filner, Hon. John J. Hall, and Hon.
Joe Donnelly, and VA Responses............................. 153
Hon. Steve Buyer, Ranking Republican Member, Committee on
Veterans' Affairs, to Hon. James B. Peake, M.D., Secretary,
U.S. Department of Veterans Affairs, letter dated February
27, 2008, and VA Responses................................. 174
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to
Carl Blake, National Legislative Director, Paralyzed
Veterans of America, letter dated March 7, 2008, and
response letter dated April 3, 2008, from representatives
of The Independent Budget: Raymond C. Kelley, National
Legislative Director, AMVETS, Joseph A. Violante, National
Legislative Director, Disabled American Veterans, Carl
Blake, National Legislative Director, Paralyzed Veterans of
America, and Dennis Cullinan, National Legislative
Director, Veterans of Foreign Wars of the United States.... 176
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, to
Kerry Baker, Associate National Legislative Director,
Disabled American Veterans, letter dated March 7, 2008, and
response letter dated April 12, 2008....................... 179
Report:
``The Independent Budget for the Department of Veterans
Affairs, Fiscal Year 2009,'' a Comprehensive Budget and
Policy Document Created by Veterans for Veterans........... 181
THE U.S. DEPARTMENT OF VETERANS AFFAIRS
BUDGET REQUEST FOR FISCAL YEAR 2009
----------
THURSDAY, FEBRUARY 7, 2008
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 1:00 p.m., in
Room 334, Cannon House Office Building, Hon. Bob Filner
[Chairman of the Committee] presiding.
Present: Representatives Filner, Brown of Florida, Snyder,
Michaud, Herseth Sandlin, Hall, Hare, Berkley, Donnelly,
McNerney, Space, Walz, Buyer, Moran, Brown of South Carolina,
Miller, Brown-Waite, Lamborn, Bilirakis, Buchanan.
OPENING STATEMENT OF CHAIRMAN FILNER
The Chairman. Good afternoon. And welcome to this meeting
of the House Committee on Veterans' Affairs.
Secretary Peake, we welcome you to your first meeting with
us in an official capacity and I know you have met with many of
us unofficially. We thank you for starting our relationship off
with good, positive notes and we look forward to your year in
office and your testimony today. Of course, if you do your job
right, we might be able to extend that.
So we certainly welcome you all. This is obviously one of
the most important hearings that we could have as we hear the
budget presentation from Secretary Peake.
We have other witnesses also who have a direct stake in the
U.S. Department of Veterans Affairs (VA) budget and we thank
all of you who have worked hard and have been diligent to
ensure the VA budget is sufficient to meet the needs of our
veterans.
Obviously the benefits, the services, the healthcare that
we provide for our Nation's heroes are our prime responsibility
and we must make sure that we provide the resources needed by
our servicemembers returning from Iraq and Afghanistan and
also, of course, we cannot forget the veterans from the
previous conflicts.
This will not be cheap, but the service that has been
rendered has been real and our VA budget must provide real
funding levels to meet the needs of all our veterans.
Part of the cost of war is the cost of treating our
veterans. I wish that you would talk to the President, Mr.
Secretary, that when you have a supplemental funding request
for the war, we need a supplemental for the warrior, too. The
President is leaving it to the regular budget process to try to
take care of those costs rather than provide for them in a
supplemental.
The budget you are presenting today, Mr. Secretary,
increases VA medical care by $2 billion, which is a 5\1/2\-
percent increase; and would just barely cover the increase in
inflation for healthcare in our Nation.
We are glad you increased that budget, but you are going to
have to get used to me waving this around. This is The
Independent Budget. I hope you have looked at it. I hope you
will look at it. The Independent Budget (IB), which we will
hear more about today, also asks for an additional $1.6 billion
over what you have asked for healthcare.
And although you have put in an increase for medical care
in the budget, seven out of the ten major accounts in the VA
budget you have decreased, including major construction
projects, minor construction projects, grants for State
cemeteries, grants for State homes, et cetera.
So although you have increased the healthcare budget, it is
at the expense of the rest of these accounts. We are
particularly concerned that in your 5-year budget estimates,
there is a $19 billion decrease over 5 years below the current
services budget. We have concerns about not only this year, but
how you are projecting for the future.
We are disappointed again that the VA has submitted a
budget, which assumes the continuation of the enrollment ban on
so-called Priority 8 veterans. Although you were not here, Mr.
Secretary, we were promised a detailed report by January of
this year listing the resources needed by the VA to lift this
ban and we still have not received that report and that
information.
The ability of the Secretary to deny enrollment to a group
of veterans was provided to the VA in order to address
unexpected and unforeseen circumstances in the short term. It
was never meant by Congress to provide the VA with the ability
to ban groups of veterans year after year after year.
Again, in this budget--as has been the case over all the
budgets from the Bush Administration--legislative proposals are
included to increase fees and co-payments for certain veterans.
Enrollment fees and increases in pharmacy co-payments have been
rejected year after year after year by this Congress and, yet,
they are back again.
So I would like to know, and I think this Committee wants
to know, why you have offered these proposals again and the
policy reasons for deeming the proposed receipts from these
proposals mandatory dollars.
We will seriously look at your budget proposal. We have
concerns, as I have mentioned, and we have incredible needs as
you well know.
We have hundreds of thousands of young men and women coming
back from Iraq and Afghanistan with post traumatic stress
disorder (PTSD) and traumatic brain injury (TBI). They are not
adequately diagnosed. They are not adequately treated. They are
like ticking timebombs in our society, and as you know, suicide
rates have reached Vietnam levels.
There was an incredible report in the New York Times about
PTSD veterans who have committed homicides. A third of those
diagnosed with PTSD seem to have felonies. This is a national
tragedy and it is up to us to deal with it. In fact, if we have
sufficient resources, we can deal with most of the problems we
see happening.
We hope the budget will take care of these needs. We see
already, as we see with Vietnam veterans, homeless Iraqi War
veterans. We cannot allow this to happen and we will be looking
at the budget to try to make sure that it does not.
I will recognize the Ranking Member, Mr. Buyer, for his
opening statement.
[The prepared statement of Chairman Filner appears on p.
64.]
OPENING STATEMENT OF HON. STEVE BUYER
RANKING REPUBLICAN MEMBER
Mr. Buyer. Thank you very much, Mr. Chairman.
I would like to welcome you, Secretary Peake, to your very
first testimony, this being the second session of the 110th
Congress. It is my pleasure to welcome you as our first
witness.
Secretary Peake is a retired Lieutenant General of the
United States Army Medical Corps. He is a combat-wounded
Vietnam veteran, a Silver Star recipient, and former Surgeon
General of the Army.
I know from my tenure on the Armed Services Committee that
Secretary Peake is a man of principle, who adheres to Army
values, and I am encouraged that our perspectives over the
years are similarly aligned with regard to serving America's
soldiers, sailors, airmen, Marine, Coast Guardsmen, and our
veterans and their dependents.
I also recognize as you move into this position, Mr.
Secretary, that you step into it with a pretty good team when I
look at Admiral Cooper and General Kussman and Mr. Tuerk, and
you have a champion to your right over there in Gordon
Mansfield.
Gordon has been around a long time. He knows a lot about
the systems and knows a lot about the personalities, the
players, knows a lot about the Veterans Service Organizations
(VSOs), knows who is substantive and who makes noise. I mean,
he knows. And so he can be very valuable to you in his candor.
He is a good man.
Mr. Secretary, when I read your written statement, I was
struck by some things. Number one, your top legislative
priority is to implement the recommendations of the Dole-
Shalala Commission. With the influx of thousands of returning
combat veterans from Iraq and Afghanistan, we must act promptly
to make the fundamental changes in the way VA and the U.S.
Department of Defense (DoD) compensate and assist veterans and
their survivors for disabilities and deaths attributed to
military service.
It is urgent that Congress, the VA, and DoD work together
in a decisive manner to implement such reform while the will to
do so exists. Otherwise, we will be merely passing the targeted
problems off to others.
Successful reform would make great strides toward our
mutually held goal of ensuring that veterans returning from
military service are able to make a smooth and easy transition
back to a productive life.
Mr. Secretary, I am heartened by some other provisions in
your budget proposal. I commend the legislative proposal to
expand the specialized residential care and rehabilitation in
VA and approve medical foster homes for TBI patients. However,
I do have some concerns with one of the other provisions.
Now, I differ with the Chairman when it comes to enrollment
fees and co-pays because these are very good management tools.
I personally agree with cost-sharing fees for higher income,
nonservice-connected veterans.
Now, in your proposal for the first time I have seen that
any funds collected would go to the Treasury. I think they
should stay within the VA. My gut tells me this Committee once
again will not accept an increase in co-pays or enrollment
fees. It is one of the massive errors that we made as a
Committee when we opened it up. We should have given these
tools to you and we did not. And you keep asking for them and
this Committee will not do it. And I will not belabor it.
Another issue, the claims backlog continues to be a looming
problem, but according to the budget proposal, you anticipate
with additional employees the backlog can be reduced by 24
percent. We are very optimistic and we will get into how you
can justify that.
I am also encouraged that the VA is perhaps finding a
foothold. However, I question how these remarkable efficiencies
can be achieved. You know, 24 is a big number, so I am pretty
eager.
We learned, not long ago, from Admiral Cooper with regard
to staff training as a challenge and the exams that you gave
and how many did not pass those exams. So we are interested to
hear how the training is going.
I also want to get into how you are making a better use of
the information technology (IT) to reduce the backlog problem.
I also understand you have an initiative underway and we want
to hear about that.
Also, any updates, Mr. Howard, you can give us with regard
to how the IT transition is going and what needs that you may
have. I see we have a bump up in our IT budget, so if you can
tell us what that is going toward, software, hardware, as you
implement your centralization model that is of great interest
to us.
And, Mr. Secretary, you mentioned in your written statement
that one of your highest legislative priorities is the
establishment of a new position to serve as the VA's Chief
Acquisition Officer. I have long been interested in procurement
reform at the VA and I look forward to discussing this and
other procurement reform initiatives. And I am not the only
one. The Chairman and others are very concerned about
procurement issues.
Also, in your budget, you are asking for $64 million for
seismic corrections to the main hospital building in San Juan,
Puerto Rico. Two years ago, we passed the law and we asked for
you, the VA, to explore options for construction of a new VA
medical facility in San Juan, so I am interested in the results
of that study.
With that, Mr. Secretary, we welcome you and we look
forward to your testimony.
And I yield back to the Chairman.
The Chairman. Thank you, Mr. Buyer.
Mr. Secretary, the floor is yours and we look forward to
hearing from you. We will have questions from Members after
your testimony.
Secretary Peake. With your permission, Mr. Chairman, I have
a written statement that I would like to submit for the record.
The Chairman. Without objection, so ordered. Thank you.
Secretary Peake. Thank you.
STATEMENT OF HON. JAMES B. PEAKE, M.D., SECRETARY, U.S.
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY HON. MICHAEL J.
KUSSMAN, M.D., MS, MACP, UNDER SECRETARY FOR HEALTH, VETERANS
HEALTH ADMINISTRATION; HON. DANIEL L. COOPER, VADM (RET.),
UNDER SECRETARY FOR BENEFITS, VETERANS BENEFITS ADMINISTRATION;
HON. WILLIAM F. TUERK, UNDER SECRETARY FOR MEMORIAL AFFAIRS,
NATIONAL CEMETERY ADMINISTRATION; HON. ROBERT T. HOWARD,
ASSISTANT SECRETARY FOR INFORMATION AND TECHNOLOGY AND CHIEF
INFORMATION OFFICER, OFFICE OF INFORMATION AND TECHNOLOGY; HON.
ROBERT J. HENKE, ASSISTANT SECRETARY FOR MANAGEMENT; AND HON.
PAUL J. HUTTER, GENERAL COUNSEL, U.S. DEPARTMENT OF VETERANS
AFFAIRS
Secretary Peake. Mr. Chairman, Congressman Buyer, ladies
and gentlemen of the Committee, I am honored to be here as the
sixth Secretary of Veterans Affairs now responsible for the
care of veterans. I appreciate the opportunity that the
President has given to me to make a difference.
With me today, Congressman Buyer has already introduced my
leadership team, and he is right about the quality, from my far
left, our General Counsel, Paul Hutter; Mr. Bill Tuerk, our
Under Secretary for Memorial Affairs; Mr. Bob Henke, our
Assistant Secretary for Management. From my far right is Bob
Howard, our Assistant Secretary for Information Technology;
Admiral Dan Cooper, our Under Secretary for Benefits; Dr.
General Mike Kussman, our Under Secretary for Health.
In my almost 2 months at the VA, I have seen both the
compassion and the professionalism of our employees. It is
frankly just exactly what I expected. The culture is one of
deep respect for the men and women that we serve. The group at
this table, and the VA at large, understands that America is at
war and it is not business as usual.
I appreciate the importance of and I look forward to
working with this Committee to build on VA's past successes,
but more importantly, to look to the future to ensure veterans
continue to receive timely, accessible delivery of high-quality
benefits and services earned through their sacrifices and
services and that we meet the needs of each segment of our
veterans' population.
The President's request totals nearly $93.7 billion, $46.4
billion for entitlement programs and $47.2 billion for
discretionary programs. The total request is $3.4 billion above
the funding level for 2008 and the funding level that I am
talking about is the funding level that includes the $3.7
billion plus-up from the emergency funding.
This budget will allow VA to address the areas critical to
our mission, that is providing timely, accessible, high-quality
healthcare to our highest-priority patients. We will advance
our collaborative efforts with the Department of Defense,
including progress toward secure, interoperable electronic
medical records system.
We will improve the timeliness and accuracy of claims
processing and ensure burial needs of veterans and their
eligible family members are met and maintain the veterans
cemeteries as national shrines.
Young men and women in uniform who are returning from Iraq
and Afghanistan and their families represent a new generation
of veterans. Their transition and reintegration into our
civilian society when they take that uniform off is a prime
focus. Those seriously injured must be able to transition
between the DoD and VA system as they move on their journey to
recovery.
This budget funds our polytrauma centers and sustains the
network of polytrauma care that Dr. Kussman and his team have
put in place. It funds the Federal recovery coordinators
envisioned by the report of the Dole-Shalala Commission and it
sustains the ongoing case management of all levels of our
system.
We know that prosthetic support must keep pace with the
newest generation of prostheses as our wounded warriors
transition into the VA system. In this budget, you will see a
10 percent increase in our budget for this.
In 2009, we expect to treat about 333,000 Operation
Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF)
veterans. That's a 14 percent increase. We are seeing already a
little bit of increase in the cost per capita of caring for
these and we have increased our budget projection 21 percent to
cover this. That is nearly $1.3 billion to meet the needs of
OIF and OEF veterans that we expect will come to the VA for
medical care.
This budget will sustain our outreach activities that range
from 799,000 letters that we have sent out to more than 205,000
engagements with our Vet Centers reaching out to National Guard
and Reserve units as part of the PDHRA, post deployment health
reassessment process. It does not mention the 8,154 military
briefings to about 300,000 veterans, service men and women that
the Veterans Benefits Administration (VBA) has conducted.
This is also part of seamless transition. With the
authority to provide care for 5 years for service-related
issues, we can, without bureaucracy, offer the counseling and
the support and care that might be needed to avert or mitigate
future problems. And we want these young men and women to get
those services.
Mental health from PTSD to depression to substance abuse
are issues that I know are of great concern to you and they are
of great concern to us. This budget proposes $3.9 billion for
mental health across the board. That is a 9 percent increase
from 2008. It will allow us to sustain an access standard that
says if you show up for mental health, you will be screened in
24 hours and within 14 days have a full mental health
evaluation if needed.
It will keep expanding the mental health access according
to a uniform mental health package, trained mental health
professionals and our community-based outpatient clinics, and
there are 51 new community-based outpatient clinics (CBOCs)
planned for 2009. And that is in addition to the 64 that are
coming in 2008.
Our Vet Centers will bring on yet an additional 100 OIF and
OEF counselors. And Dr. Kussman is prepared, as the need is
identified, to add additional Vet Centers.
We appreciate the issues of rural access in this arena and
our Vet Centers are budgeted for 50 new vans to support remote
access as well as expanding telemedicine into 25 locations.
But this budget and our mission is more than just about
these most recently returning men and women. We should remember
that 20 percent of VA patients who in general are older and
with more comorbid conditions than the general population have
a mental health diagnosis. In fiscal year (FY) 2007, we saw
400,000 veterans of all eras with PTSD.
This budget will sustain VA's internationally recognized
network of more than 200 specialized programs for the treatment
of post traumatic stress disorder to our medical centers and
clinics that serve all of our veterans.
We have a unique responsibility to those that have served
before and, you know, we still have one World War I veteran.
One died earlier this week actually. The World War II and Korea
veterans are recipients of our geriatric care and our efforts
at improving long-term, noninstitutional care where in this
budget we have increased funding 28 percent will make a huge
difference in their quality of life.
We currently have 32,000 people served by home telehealth
programs. This budget continues our work in this area and in
the expansion of home-based primary care.
Overall, the President's 2009 budget request has $41.2
billion for VA medical care, an increase of $2.3 billion over
the 2008 level, but that is more than twice the funding level
available at the beginning of the Bush Administration. With it,
we will provide quality care, improve access, expand special
services to the 5,771,000 patients we expect to treat in 2009,
1.6 percent above our current 2008 estimate.
In April of 2006, there were over 250,000 unique patients
waiting more than 30 days for their desired appointment date.
And you are right. That is not acceptable. As of January 1st,
we had reduced the waiting list to just over 69,000. With this
budget request, we believe we have the resources to virtually
eliminate the waiting list by the end of next year.
Information technology cross-cuts the entire Department and
this budget provides more than $2.4 billion for this vital
function, 19 percent above our 2008, and reflects the
realignment of all IT operations and functions under the
management control of our Chief Information Officer, Robert
Howard.
A majority, $261 million of that increase in IT funds will
support VA's medical care program, particularly VA's electronic
records system. I emphasize this here because it is so central
to what we do and to the care we provide and the care that is
touted in such publications as the book, Best Care Anywhere, as
the key to our quality that is lauded worldwide.
This IT budget also includes all the infrastructure support
such as hardware and software and communication systems for
those 51 CBOCs that I mentioned as an example. And there is $93
million for cyber security continuing us on that road to being
the gold standard.
IT will also be key as we move our claims model down the
road to paperless processes. It is an investment that we must
make. This budget sustains the work of VETSNET that is giving
us management data already to really get after our claims
processing and virtual VA, our electronic data repository.
In addition to IT, this budget does sustain a 2-year effort
to hire and train 3,100 new staff to achieve our 145-day goal
for processing compensation and pension claims in 2009. This is
a 38-day improvement, 21 percent in processing time than it was
from 2007 and that 24-day or 14-percent reduction from this
year.
This is important because the volume of claims received is
projected to reach 872,000 in 2009. That is a 51-percent
increase since 2000.
Can we show that slide, that graph up here? The active
Reserve and National Guard returning from OEF and OIF have
contributed to an increase in new claims and bring with them
really an increasing number of issues with each claim which you
can see the difference between the claims growth on the bottom
curve and the issues curve growth on the top curve. It is out
of proportion.
[The graph referred to is attached to Secretary Peake's
testimony, which appears on p. 75.]
And what you see also is that Dan Cooper has been able to
keep that time to complete, that average days to complete
relatively flat even with that growth. Each one of those issues
has to be separately adjudicated and judged and can really be
separately rated, if you will.
The President's budget includes seven legislative proposals
as has been mentioned totaling $42 million. One of those
proposals expands the authority to cover payment for
specialized residential care and rehab in VA approved medical
foster homes for OIF and OEF suffering from TBI.
We again do bring you a request for enrollment fees for
those who can afford to pay and for a raise in the co-pays.
Again, this does not affect our VA budget and I believe that is
the same as it was last year. The money would return to the
Treasury. That is $5.2 billion over a period of 10 years, not
in the short term, but it does reflect the matter of equity for
those veterans who have spent a full career in the military and
under TRICARE who do pay an annual enrollment fee for that
care.
The $442 million to support VA's medical and prosthetic
research program, though less than what we have had from the
augmented 2008 budget, is actually about 7.3 percent more than
what we received in 2007 or what we asked for in 2007 and 2008.
It does contain, however, $252 million devoted to research
projects focused specifically on veterans returning from
service in Afghanistan and Iraq, projects in TBI and polytrauma
and spinal cord injury and prosthetics and burn injury. In
fact, we anticipate with this Federal grants and other grants,
we will have a full research portfolio of about $1.85 billion.
This budget request includes just over $1 billion in
capital funding for the VA, with resources to continue to five
medical facility projects already underway in Denver, Orlando,
Lee County, Florida, San Juan, and St. Louis and to begin three
new medical facility projects at Bay Pines, Tampa, Florida, and
Palo Alto, two of which relate to our polytrauma rehab centers
and continue our priority in this specialized area of
excellence.
Finally, we will perform 111,000 interments in 2009. That
is 11 percent more than 2007. The $181 million in this budget
for the National Cemetery Administration (NCA) is 71 percent
above the resources available to the Department's burial
program when the President took office.
These resources will operationalize the six new national
cemeteries that will open this year, providing a VA burial
option to nearly a million previously unserved veteran
families, and will maintain our cemeteries as national shrines
that will again earn the highest marks in government and
private sector for customer satisfaction.
This budget of $93.7 billion, nearly double from 7 years
ago, and with a healthcare component more than twice what it
was 7 years ago, will allow us to make great progress in the
care of all of our veterans and will keep us on this quality
journey in health and the management of an extraordinary
benefit and ensuring the excellence of our final tribute to
those who shall have borne the battle.
It is an honor to be with you, and I look forward to your
questions.
[The prepared statement of Secretary Peake appears on p.
65.]
The Chairman. Thank you, Mr. Secretary.
We will begin the questions with the Chairman of our Health
Subcommittee, Mr. Michaud.
Mr. Michaud. Thank you very much, Mr. Chairman.
And I want to thank you, Mr. Secretary, and your staff for
coming here today to present the President's budget.
The 2009 budget submission for medical services is based
primarily on actuarial analysis founded on current and
projected veterans' population statistics, enrollment
projections of demand, and case mix associated with current
veteran patients.
Did that analysis include an increase in manpower
deployment to support the surge and the subsequent redeployment
back to the United States?
Secretary Peake. It did, sir. I understand that in a
previous year, we may have been a little bit low on that
projection and we, I think, made the appropriate adjustments
with that, working with DoD, understanding the Congressional
Budget Office (CBO) model and so forth. So that has been taken
into account with this projection of 333,000.
Mr. Michaud. Good. And did that analysis also include the
recent downturn in the economy and increased unemployment?
A lot of times, if you have a veteran who might be working,
they might be provided healthcare benefits at their job of
employment. But if they lose that job, then they are left in a
lot of cases without any healthcare provided, so they look
toward the VA. Did that include the downturn in the economy?
Secretary Peake. We did, I think, project the fact that we
have open access for the first 5 years now to be able to bring
them into our system and it does not matter whether they are
employed or not employed. If they have something that can be
related possibly to their involvement overseas, we can take
care of them.
Mr. Michaud. So did your projection include that
consideration of the downturn though? I know you can take care
of them. But if you have an influx because of the downturn and
you are not accounting for them, then that is going to be a----
Secretary Peake. Right. I cannot tell you specifically,
sir, if we looked at a rise in unemployment. I do not know if
that was in our model.
Mr. Michaud. If you can check and get back with the
Committee.
Secretary Peake. I will, yes.
Mr. Michaud. My next question deals with the enrollment
fee. With the enrollment fee that you are proposing, I believe
in 2007, it was estimated that that would result in
approximately 200,000 veterans leaving the system if they had
to pay an enrollment fee.
Under this, is there an estimate of how many veterans might
leave if the enrollment fee is introduced?
Secretary Peake. Again, it is an estimate. This does affect
just the Priority 8s really because so few of the Priority 7s
would fit into that. It would be on the order of folks that use
us of perhaps 140,000, which is really a relatively small
number, and that we also know that many of those also have
insurance and do not necessarily use VA as much anyway.
It gets to some of the management issues that Congressman
Buyer was talking about. You think about it. You put a little
skin in the game with an enrollment fee, they are perhaps more
likely to come to us and get the full benefit of what we can
offer them and we would be happy to do that.
Mr. Michaud. And could you provide the Committee, I asked
this the last time, the Department had proposed an enrollment
fee, and I never received the information if you submitted it,
but could you provide a breakdown on that enrollment fee, so,
say if someone makes $100,000, how many people are affected,
how much revenue that would produce? I would like to have a
further breakdown on that, how you came up with your numbers on
that enrollment fee, if you could provide that for the
Committee.
Secretary Peake. I will provide that for the record.
[The information was provided in the response to Question
5(a) in the Post-Hearing Questions posed by Mr. Filner and
Responses from VA for the Record, which appear on p. 155.]
Mr. Michaud. Okay. Thank you.
My last question deals with not only VA but also the Army.
There was a report in the news on January 29th, and I received
confirmation from VSOs from my area, where the Army actually
blocked VA staff from assisting transitioning soldiers because
the soldiers had been receiving higher rating in their medical
evaluation board.
What is the VA doing in regards to that?
And another area actually just brought to my attention
earlier this morning from the Ranking Member also deals with
the Army dealing with dental work. The Army more or less is
shifting that cost on to the VA and not taking care of the
soldiers.
Could you respond to both those?
Secretary Peake. Sure. Let me address those. First, we are
still trying to sort out who said what to whom on the issue of
the counseling at Fort Drum. I can tell you the first report to
me is that some of our people were actually helping write the
requirements that were within the military system.
Our folks are not really necessarily trained to do that,
but we clearly have a role of being there, advising
servicemembers on what their VA benefits might be and what
their ratings might be from the VA.
This actually talks to the issue of why we need to get
ahead and streamline this disability system so it is not so
confusing and it is not, oh, well, they are the VA and there is
the DoD. So, again, the Dole-Shalala recommendations give us a
road ahead on that and we need to sort out the details so we
get it right.
On the issue of dental care, that has been an issue for the
military and particularly for the Reservists for a long time. I
had to come up here and testify why we took out so many teeth
when we mobilized people in my previous life. So perhaps it
would be nice if the military were able to have that all taken
care of for the Reservists. But when they come rolling back in
and come back to their home station, at least when they come to
the VA, and I will give great credit to Dr. Kussman, we have
gone and we have purchased the care because we are authorized
to provide that dental care within what, 60 days or----
Dr. Kussman. Ninety days and we're going to 180.
Secretary Peake [continuing]. Ninety days and we are going
to 180 if the legislation is passed. And it will help the
soldier and it, I think, will improve medical readiness because
some of these people are still in the Reserves.
Mr. Michaud. Thank you very much.
And thank you, Mr. Chairman.
The Chairman. Thank you.
Mr. Lamborn, you are recognized for 5 minutes.
Mr. Lamborn. Thank you, Mr. Chairman.
And, Mr. Secretary, feel free to answer this question or
pass it on to one of your Under Secretaries.
But first I would like to say thank you, Chairman Filner
and Ranking Member Buyer, for your leadership and dedication to
the calls of our Nation's veterans.
I would also like to thank Chairman Hall for working with
me in a bipartisan manner on the Disability Assistance and
Memorial Affairs Subcommittee of which I am now the Ranking
Member.
Secretary Peake, I am pleased to see that the fiscal year
2009 VA budget request addresses the concerns of our veterans.
Ensuring that our national cemeteries are maintained as shrines
is emblematic of the VA's core beliefs. And I look forward to
working with you and Under Secretary Tuerk on this important
issue.
While I remain concerned about the disability compensation
claims backlog, I am encouraged that VBA plans to utilize
proven information technologies to decrease processing times.
As you know, I introduced two bills last year that would
authorize a pilot program to test the capabilities of an
automated claims processing system that helps VA employees
process claims faster and more accurately.
And, Mr. Peake, also, I would like to ask you that, this is
possibly something under the purview of Under Secretary Tuerk,
the budget mentions a request for $5 million for a new land
acquisition line item. I understand that this money is to be
allocated for those regions with the highest projected need in
the future for new cemetery space for existing cemeteries.
Based on the criteria used to assess this need, is it true
that Fort Logan National Cemetery in Denver, Colorado, will be
the next cemetery to reach capacity?
Secretary Peake. Perhaps Bill can offer the specifics. The
money is designed to allow us to get moving on acquisition when
the opportunity arises and so that we can ensure we do not have
to close cemeteries.
Mr. Tuerk. To answer your question specifically,
Congressman, as I look across the universe of our larger
cemeteries that are going to meet capacity, there is one
cemetery, Jefferson Barracks National Cemetery in St. Louis,
which would reach capacity before Fort Logan. But we already
have a plan in place to acquire land contiguous to the cemetery
from the medical center next door.
Based on the numbers that I have seen as recently as this
morning, it would appear that Fort Logan is the next large
cemetery that will reach capacity on the acreage that it
currently owns.
Mr. Lamborn. Thank you.
And as a followup, is it true that this land acquisition
needs to be completed prior to Fort Logan or another such
example reaching capacity because the process for acquiring
land to build a cemetery is time-consuming and sometimes
unpredictable?
Mr. Tuerk. Shall I?
Secretary Peake. Please.
Mr. Tuerk. Certainly the market, the catchment area if you
will, of Denver and Colorado Springs is currently served by
Fort Logan. We would not want to see that that area, which has
a significant number of veterans, certainly well beyond our
170,000 criterion--possibly twice as many veterans than that
criterion live within the catchment area of those two cities--
cease to be served. We would certainly want to begin planning
for a successor cemetery to Fort Logan before that cemetery
closes so there will not be a lapse in service for the veterans
on the eastern slope of the Rockies in Colorado. So in response
to your question, the answer is yes, we most definitely plan
to, intend to, and are beginning now to plan for, a successor
cemetery lest there be an interruption of service.
Mr. Lamborn. Okay. Thank you very much.
And I have a separate topic I would like to address briefly
if my 5 minutes are still going. Mr. Secretary, over the past
year, Members from both sides of the aisle have continued our
push to require VBA to move toward a paperless claims
processing system that uses rules-based technology.
This was something that was added to the Republican fiscal
year 2008 views and estimates and was included in my
legislation, H.R. 1884 and H.R. 3047.
I am happy to read about VBA's new paperless claims
processing initiative. What is the funding level for this
project and how much funding will be required over the next
several years to complete this project?
Secretary Peake. A request for information (RFI) was put
out for rules-based engines. That information is coming back.
And then we are planning on getting a systems integrator to
come in and look at all of the process that is put together.
And so we will have to find what that future cost is based on
the estimates that come out of these processes.
But I will assure you it is a high priority for me to get
us moving in that direction. All you have to do is walk through
the VBA mail room to make you believe that this is time to
change.
Mr. Lamborn. Thank you.
And I yield back.
The Chairman. Thank you, Mr. Lamborn.
The Chair of our Economic Opportunity Subcommittee, Ms.
Herseth Sandlin, is recognized for 5 minutes.
Ms. Herseth Sandlin. Thank you, Mr. Chairman.
Again, Mr. Secretary, welcome to the Committee. We look
forward to working with you on a whole host of issues. And
certainly Mr. Boozman and I look forward to working with you on
the range of issues in the jurisdiction of our Subcommittee.
And I do have a few questions for you about some of those
issues, but I also want to talk with you a little bit about
rural health and long-term care.
There was a handout that you had provided for the Veterans'
Affairs Committee staff on February 4th. And in that handout,
there was a chart as it relates to mandatory spending. And for
housing, it shows an appropriation fiscal year 2007 of $50
million, fiscal year 2008 of $815 million, and fiscal year
2009, $2 million for a percentage change of 100 percent based
on the fact that we are going, you know, less $813 million.
And I was just wondering if someone could explain that to
me a little bit further as to why there would be such a drastic
percentage change in the mandatory funding for the housing
programs administered by VA.
Secretary Peake. If I may, I will ask Mr. Henke to answer.
Mr. Henke. Yes, ma'am. There is a good reason for that. It
is no change from our previous practice. It relates to the
practice of credit reform legislation that we have had in place
since 1992, now for 15 years.
There is no change in the number of loans, 180,000 loans
that we are going to guarantee with the 2009 budget. It simply
reflects the way we account for the risk for those loans and it
is no different than we have done in the past.
Ms. Herseth Sandlin. So can you explain why then there was
the jump from $50 to $815 million from last year?
Mr. Henke. Because it is a projection for what is expected
in that year for loan costs related to all of the cohorts that
go back to 1992. What we projected in 2009 is the cohort from
2009.
Ms. Herseth Sandlin. Okay. Well, I think I will explore
this a little bit further with you in a different setting
because I want to get to some of the others.
On vocational rehabilitation loans, in the budget
submission, the VA claims that fewer vocational rehabilitation
loans will be provided in fiscal year 2009 than in fiscal year
2008. It is a difference of about $210 million or so.
And so I am just wondering what leads you to believe that
there will be fewer loans established given the increasing
numbers we are seeing, especially of OIF and OEF veterans
returning home. I anticipate that there might actually be a
greater need for these vocational rehabilitation loans.
Secretary Peake. Admiral Cooper.
Admiral Cooper. Those loans are used primarily to help
people while their claims are being processed. In other words,
if a person comes in and we can immediately qualify him or her
for vocational rehabilitation, we go ahead and do that. And, if
they need money immediately, we provide them loans. We felt as
we looked at the estimate that we were higher than we needed to
be right now. So we feel that the current estimate is a correct
estimate.
Ms. Herseth Sandlin. Is that based on actual numbers then
for fiscal year 2008?
Admiral Cooper. It is based on trends that we have seen
over the last few years and the number we expect to come in. We
feel that we do have a sufficient amount there.
Ms. Herseth Sandlin. Okay. Well, I will look forward to
working with you----
Admiral Cooper. Yes, ma'am.
Ms. Herseth Sandlin [continuing]. Admiral Cooper, because
we know there have been problems with the methodology in the
past. I know we have tried to make some improvements to that,
but we will look forward to pursuing that in a little bit more
detail as well.
Secretary Peake. If I may just add----
Ms. Herseth Sandlin. Yes.
Secretary Peake [continuing]. We are increasing the number
of vocational rehabilitation people in the field. We think this
is a great program. We think it is underused. We think that we
would like to see more people actually graduate from it. And so
that is one of the first briefings I asked to get because I
think it is a program that we really want to get behind.
Ms. Herseth Sandlin. Thank you, Mr. Secretary.
I do think that especially with, and this will relate to my
next question on rural health and rural veterans, when we have
so many folks coming home and because of the National Guard and
Reserve, many of them coming from rural areas, I think these
loans not just for veterans in rural areas but anywhere, but in
particular rural areas and the costs associated with
maintaining the training programs if they are living a further
distance and how much they are paying for other expenses just
to continue participating in the program. And, like you said,
increasing those rates of completion of the program is very
important.
The VA Office of Rural Health, I notice that the budget
submission is $1 million for one full-time employee. Given that
studies indicate that over 40 percent of the veterans returning
home from OEF and OIF come from rural communities, I am a
little concerned about whether or not this is enough given the
scope of the office in terms of conducting studies, developing
policies. I know that we have made tremendous progress with the
community-based outreach clinics. We have a number of them in
South Dakota.
But as it relates to again the rural veteran population and
the challenges that they face in getting care and the
additional challenges with a new generation of veterans, many
of whom are in rural areas, I am a little concerned about the
budget request.
Secretary Peake. Actually, we have two people and you say,
boy, is that enough? I am not sure it is if you just say, well,
that is the only two people interested in rural health in the
VA. I have asked the same question.
In fact, we have contract support that is the several
million dollars level. I do not recall that number off the top
of my head. And we have really an integrated effort.
When I sat down with this Office of Rural Health, the one
person, the second person, just joined, she was surrounded by a
lot of people from Dr. Kussman's team that are working
collaboratively. And so it is an area that I think is really
important.
You start looking at our numbers, about 38 percent of
veterans live in rural areas. About 1.7 percent live in highly
rural areas. When you look at where our CBOCs are, about 41
percent of our CBOCs are in rural areas. About 5 percent of our
CBOCs are in highly rural areas.
That is why I was excited to see the 50 vans focused with
our Vet Centers, so they can do that outreach and be the first
face of the VA there, and why I am excited about this issue of
telehealth and telemedicine and being able to reach out into
their homes even out there.
As a matter of fact, one of my first trips is going to be
to Montana because Senator Tester and I have had discussions
about rural health. And so I appreciate your concern about it
and I will assure you that we are paying some attention to it.
Ms. Herseth Sandlin. I appreciate that.
And, Mr. Chairman, I know I am over my time, but I know we
just mandated the creation of that office fairly recently,
within the last year or so. But I do hope that through the
course of the year----
Secretary Peake. A year is a year. I appreciate that.
Ms. Herseth Sandlin [continuing]. We can lay the groundwork
so that depending on the changes that are made to the budget as
we undertake that work and what that leads to for the request
for the next year, we hope we have more information going
forward.
And then, finally, Mr. Chairman, one of the things I want
to, because I have pursued this with previous Secretaries, is
the issue of long-term care. And I know that there is a
statutory requirement relating to the average daily census and
that the budget submission does not meet that.
And I am not going to beat anybody up about that. I would
rather engage in a longer conversation at some point about the
rebalancing that is needed across States, across regions,
across health systems to better address how long-term care has
evolved because that statutory obligation was put in in 1999.
And we have seen a lot of changes in long-term care since then.
So I just wanted to make mention of that, Mr. Chairman, for
a topic that I know others of us have been interested, and we
look forward to working with the Secretary on.
The Chairman. Thank you very much.
Mr. Brown, you are recognized for 5 minutes.
Mr. Brown of South Carolina. Thank you, Mr. Chairman.
Thank you, Mr. Secretary, for being here today and thank
you for your commitment to our veterans. And I enjoyed our
conversation the other day and I was going to ask some
continuing questions along those same lines.
Number one, there is a cemetery, a veterans' cemetery that
has been proposed for Columbia, South Carolina. I know there
has been some negotiation, I guess, with the Fort Jackson
system there.
But could you tell me where we are in that process? Has
there been some land exchanged between, you know, the Fort
Jackson and the cemetery?
Secretary Peake. Can I ask Under Secretary Tuerk to answer
that, please.
Mr. Tuerk. Yes, sir, Mr. Brown. We have reached an
agreement with the Department of the Army to transfer land from
Fort Jackson to us. That transfer has not yet been effected. It
is authorized by statute. We have reached an agreement with the
Army on the transfer, but lawyers are working out the details,
the title transfer, et cetera. And we expect actual title to
pass probably in September of this year. But, we are not
waiting for title to pass before we start designing the
cemetery. Indeed, we have already let contracts for the design
of that cemetery. I have already seen a master plan of that
cemetery in sketch form. And right now we are scheduled to
break ground in July even in advance of taking title with the
goal of opening that cemetery for burials before the end of
this year.
Mr. Brown of South Carolina. The next question is about the
VA Medical University Association in Charleston. I know in 2006
in the authorization bill, we actually put $38.6 million there
to start the design phase. The Medical University is already in
a construction mode now.
They have already built their first tower. And we were
hoping that by use of this $38.6 million or some portion
thereof to start some design for replacing the old VA hospital
with a new bed tower adjacent to the Medical University.
Could you give me an update on that, please.
Secretary Peake. Sir, as we discussed the other day, our
engineer and facilities folks suggest to me that there is a
longer life expectancy for that building than perhaps has been
considered, the current VA hospital there down on the grounds.
We are also looking at what the requirements might be to
support the veterans in that area and what kind of
collaboration we might be able to build with the university.
We have this week had an engineering team down with the
Navy looking at the old Charleston Naval Hospital to understand
whether that might well become a better site for us to invest
in to be able to provide really what we are looking at, almost
a new model of care where we have a really robust ambulatory
center that is capable of doing day surgery and those kinds of
things, ambulatory surgery, so that people do not have to
travel all the way down the peninsula.
And so I look forward to working with you, sir. And,
actually, just talking to the Ranking Member about going down
perhaps to visit and see you there and look on the ground. But
we are looking at how to best serve the needs.
I know we have the work up at Goose Creek going on as well.
So I think if we look really at the whole population area and
trying to make the decision as we move forward is what we would
like to be able to do.
Mr. Brown of South Carolina. Okay. I really do appreciate
the opportunity to show you physically on the ground the close
proximity of the VA and the Medical University and hoping that,
you know, maybe by giving you an oversight of where, you know,
the facilities are located, it might give you a little bit
closer view.
I know we have been working on, you know, consolidating
some services between the VA and some other hospital, not just
for the Charleston region but across the whole system. I think
it would be a whole lot of savings incurred there. And I know
we appreciate Dr. Kussman for his, you know, continuing
dialogue along those lines too.
So look forward to having you down in Charleston, and thank
you for coming today.
Secretary Peake. Thank you, sir.
The Chairman. Thank you, Mr. Brown.
The Chairman of our Disability Assistance and Memorial
Affairs Subcommittee, Mr. Hall, is recognized for 5 minutes.
Mr. Hall. Thank you, Mr. Chairman and the Ranking Member.
And, Secretary, thank you so much for you and your
associates for being here today and thank you for your service
to our country both in uniform and with the Veterans
Administration.
I wanted to start by asking in light of questions before
your tenure, the VA's budget submission in fiscal year 2007
estimated that we would see 109,000 OEF/OIF veterans and
current records now show that the VA instead saw 206,000.
In fiscal year 2008, the estimate was that VA would see
263,000, but now that number has risen to 293,000. So, in other
words, it is an 87,000 person increase over fiscal year 2007.
This year, you estimate that you will see 333,000 OEF/OIF
veterans in 2009, an increase of 40,000.
In light of the previous underestimating of that number,
what should this Committee honestly expect? Do you think that
40,000 is a realistic number when the previous numbers were off
by as much as 87,000?
Secretary Peake. Sir, I believe it is a legitimate number.
I will tell you we do not want to underestimate that number. My
understanding is that we have cranked in the right
considerations and the Kentucky windage to try to make sure
that we are coming in with a very legitimate number.
Mr. Hall. That is good. I am praying for that to be
accurate.
And I wanted to know what the impact on the budget would be
or if you know, if anybody in your team knows what the impact
would be if we had universal screening of all veterans who are
leaving active duty and separating from the service and
becoming veterans and coming under the VA's jurisdiction.
The reason I ask is because we have had testimony before
the Subcommittee on Disability Assistance and Memorial Affairs
and before the full Committee about veteran suicides
presumptively due to PTSD among other factors. And we know we
are facing a record number of suicides, not just among veterans
but among soldiers, active-duty men and women.
And it was suggested by one of the parents of a person who
took his life that it is too hard to self-identify, that the
veterans who are coming out, they are taught to be tough and
they do not want to have something on their record that might
hinder their advancement in the Guard or Reserve or hinder
their advancement in private business. So they stand in line
and do not go to door number five to see the psychiatrist or
whatever, you know, when they are told the opportunity is
there.
And this father said he would like us to look at screening
everybody. And the percentage coming back from Iraq and
Afghanistan with PTSD seems to be high enough that it might be
warranted anyway.
What are your thoughts about that and what do you think of
those budget-wise?
The Chairman. Mr. Secretary, before you answer, if you
would yield for a corollary question.
Most of you, when you testify, you use this little phrase.
You say, ``if you show up'' at the VA, you will get a full
screening. The problem is that, not everybody shows up. We have
to have far more universal screening because the percentages
are so high and you keep saying ``if you show up.'' We need to
go out and do it in cooperation with the Department of Defense.
Secretary Peake. Thank you, Mr. Chairman.
Mr. Chairman, I agree with your premise of ``if they show
up'' and that is why this outreach is so important. That is why
I tried to emphasize it in my opening remarks because I agree
with you. What we want, as I was trying to point out, is to
bring these people in.
Let me address your point, sir, a couple ways. One, in the
military, there is an attempt to do this. It is called the post
deployment health assessment. It is followed up at a later date
because we know if you hit them right away, they just want to
go home. And I mean, I have seen it. I do not even want to fill
out that form, just let me go home. Okay. I will fill it out,
boom, boom, boom.
And a paper that was published in November by the military,
Dr. Millican, said that what they found on the post deployment
health assessment, which again is sort of self-referral and
self-selection, you have to fill out the form and then you get
a face to face, is that there was a higher number of folks that
actually identified themselves as needing some help.
Our Vet Centers are putting people at those sites with the
Reserve components where they do that post deployment health
reassessment. So we are trying to do exactly what you say.
I will say also that anybody that comes to us, even if they
are not coming for mental health, come in for a sprained ankle
or, feeling bad or whatever, in Mike Kussman's whole arena, you
get screening for mental health, you get screened.
There are actually specific questions asked for PTSD, for
TBI, for suicide risk, because we do want to be sensitive to
those kinds of things, identify those people who are not
necessarily coming in for that even.
And that is one of the other reasons why we want mental
health people in our community-based outpatient clinics,
because we know that people show up for physical illnesses
because they have mental illnesses sometimes, mental issues.
And so it is not a very simple issue, but it is one that I
think we are dealing with on multiple fronts and we want to
continue to do that outreach.
Mr. Hall. Thank you, Mr. Chairman. I will submit more
questions for the record.
[Questions for the Record to VA from Mr. Hall appear on p.
163.]
The Chairman. Thank you.
Mr. Moran.
Mr. Moran. Mr. Chairman, thank you.
Mr. Secretary, pleasure to initially make this acquaintance
and look forward to having conversations with you in the
future.
I especially wanted to thank your colleague, Under
Secretary Tuerk, for his personal attention that he provided in
helping us resolve a cemetery issue, a lack of space at Fort
Riley. And everything I know is that that has been a good
outcome and I appreciate the personal attention, but also the
let us get it done attitude that he and his staff exhibited.
I offered an amendment. In fact, I have done it for 5 years
now since I have been in Congress and ultimately it became law.
We increased the amount of money available for medical mileage.
Mr. Secretary, I represent a district that has no VA
hospitals. It is 60,000 square miles and many World War II
veterans who live hours from a VA facility. I appreciate the
cooperation I have had with our VA system, our Veterans
Integrated Service Network (VISN) in CBOC opportunities.
But one of the things that has been a cause for me since I
came to Congress is trying to recognize that 30 years is a long
time to raise the medical mileage stuck at 11 cents.
As I understand it, the VA has reached the conclusion that
this 28\1/2\ cents mile--first of all, let me thank you for
implementing it what I would say is rather quickly and took a
long time to get there, but it seemed to me that the Department
responded in an appropriate timely fashion after the
appropriation bill was signed.
That money or that rate, 28\1/2\ cents a mile, I would like
for you to confirm. It is my understanding that the VA expects
that rate to continue into future years, that this is not a 1-
year 28\1/2\ cents mile and it drops back to 11 cents in the
future.
Secretary Peake. Sir, that is my intent. I would tell you
that we need to keep watching the price of gas.
Mr. Moran. As do our veterans.
Secretary Peake. Right.
Mr. Moran. And the $125 million was set aside for this
purpose and the VA concluded you were bound by law, that with
the increase in the mileage rate, you had to increase the co-
payments which, if that is the case, it seemed to me that the
estimate, the CBO estimate was a cost of $113 million.
So the language in our amendment talked about 28\1/2\ cents
a mile. You concluded that you had to raise the co-payments.
CBO says that increasing the mileage rate is $113 million.
There is a gap. It seems to me we picked the worst options for
our veterans as the co-payment has to be paid and we will not
increase the rate above the 28\1/2\ cents a mile that is in the
language, yet we had another $12 million to spend.
Secretary Peake. Sir, what went out with that guidance was
pointing out that that co-payment could be waived. So we are
expecting that to be the norm actually.
Mr. Moran. You are telling me something I do not know. Be
waived in certain circumstances?
Secretary Peake. My understanding is that we have not been
collecting the co-pays or, I am sorry, the deduction is what it
is actually.
Mr. Moran. The deduction, you do not intend to collect an
increased amount from the veterans even though the mileage rate
went up?
Secretary Peake. That is correct.
Mr. Moran. I am glad I asked this question because I was
expecting a different answer, but I am pleased with the answer.
Secretary Peake. The guidance was clear in the letter I
sent. As a matter of fact, it had to go out again.
Mr. Moran. So the deductibles will remain the same while
the mileage rate increases?
Secretary Peake. They are not paying the deductibles now. I
mean, they are----
Mr. Moran. That will be news to my veterans who complain to
me constantly about their mileage check being reduced by a
deductible. We will explore this, I guess, further.
Secretary Peake. Let me get with you separately on it and I
will address the issue.
Mr. Moran. Very good. I also would raise just two more
points in the 49 seconds that I have left. My impression of, in
fact I say that perhaps the greatest accomplishment of the 2007
year in Congress was the significant increase in healthcare
funding for our veterans.
But one of the things I have discovered is that despite the
increased funding, the VA has a significant challenge, as does
the private sector, in recruiting healthcare professionals.
And I would be interested in hearing at some point in time
about the efforts at the VA to increase the pool or the
opportunity that you have to recruit nurses, doctors, mental
health professionals, psychiatrists, psychologists. The message
I am getting from my VA employees back home is, it is great to
have more money, we appreciate that, but the end result is that
we may not be able to recruit to fill those positions.
Secretary Peake. Sir, it is geographically dependent in the
United States. It is a problem across the country. I think we
have been aided recently in the opportunity to pay more
competitive fees for healthcare providers. And that has made a
difference. As I have looked at some of the graphs already, you
can see some upturns in the number of providers that we have,
nurses and physicians specifically.
Mr. Moran. That is good to hear.
Secretary Peake. But there are areas where we do have
challenges with it.
Mr. Moran. And, finally, I just would remind you that I
think a priority for the Department of Veterans Affairs and
should be in the budget is the elimination of Priority or
Category 8. I wish that was a higher priority within the
Department and your budget process.
To me, our Priority 8 veterans deserve to be included, not
excluded. And my guess is that we disagree, me as a Member of
Congress, you as the Secretary of the Department of Veterans
Affairs.
As you prioritize your budget, I just would encourage you
that you have the authority to waive that and I wish it was
included in the request from the Administration on the budget.
Secretary Peake. Thank you, sir.
Mr. Moran. Thank you, Mr. Secretary.
The Chairman. Mr. Secretary, I would just like to remind
you when the question is asked from an individual, he is really
asking as a Member of the Committee and any information should
be provided to the whole Committee.
Secretary Peake. Absolutely.
The Chairman. Thank you.
Ms. Berkley, you are recognized for 5 minutes.
Ms. Berkley. Thank you very much, Mr. Chairman.
First, I also would like to welcome you. I think this
position is so very important in the cabinet. I view the
Secretary's role as being the primary advocate for the veterans
and not an apologist for the Administration. And I like a
Secretary that will fight the good fight for the vets and let
the chips fall where they may.
For me, the cost of veterans' care is the cost of doing
more and should be part and parcel. You cannot send young men
and women overseas to fight this Nation's wars without the
expectation that they are coming home and they are going to
need healthcare and other benefits, and we need to provide not
only as they leave, but when they come back as well.
I also want to compliment you on how well prepared you are.
I appreciate that and I think it shows a great sign of respect
for the Committee and also for your job. And so I thank you
very much for being so well prepared and being so new at the
same time. I do not think that has been lost on any of us.
I have a number of areas that I wanted to touch bases with
you. And, of course, all politics is local, so I am going to
localize my comments to you and my questions.
First of all, as you know, we have been very pleased that
we are in the process of building a VA medical complex in north
Las Vegas that will take care of the 200,000 plus veterans that
call southern Nevada home. This has been a long time coming,
but it is coming out of the ground.
And I was just there as recently as last month, had an
opportunity to walk the 147 acres with the two contractors that
have been selected. And I would love to have you come and see
for yourself.
A couple of questions that I have is, one, is I do not know
whether you realize Montana is very close to Nevada. So as long
as you are going to Montana, you might want to make a little
side trip down to Nevada and see what we are doing.
I would like to work with you and your Department to keep
this project on track. Right now we are up to 2011 and we
cannot wait too much longer. As you know, we have some serious
needs. So that is going to be an issue that, you know, as I
have said, if I have to go out with nail and hammer myself, I
am going to do this. But I think it would be much better if the
contractors did this and with your help, that will happen.
Also know that it is going to cost, I understand, about
$100 million to get this up and running after it is completed
with the technology and the furnishings and the equipment and
the hiring of the new personnel.
And I would appreciate some guidance on when we start
requesting those funds as well because it is not going to do us
very much good if we have state-of-the-art buildings and no
equipment or no personnel to actually provide the healthcare
services to my veterans.
There was something that I think we cleared up earlier, but
if you would not mind going on record. Let me find this. There
was something that was--let me find this. We asked the question
there was something in the budget regarding lowering the cost
of--diverting 50 percent of primary and mental healthcare from
the complex to ancillary sites. And you gave me a satisfactory
answer. I believe that someone from your office did.
But could you go on record and explain the diversion
because it is not actually a diversion, but I would like that
for the record.
Secretary Peake. The idea was rather than all of that care
being done at that complex that it would be providing for
community-based environments for primary care to support that
larger community. It would probably be more convenient, would
be less expensive for that project, but also more convenient
for the veterans, and it would be tied together electronically
and so forth. So it will be part of an integrated system.
Ms. Berkley. Okay. So it is not a diminution of funding?
Okay. I am glad we got that taken care of.
I am very concerned about something and I had a story, but
we do not have the time to. I go to Walter Reed and I visit our
wounded and one that was particularly touching to me, although
he did not live in my congressional district, he lived in
Arizona, was a young 24-year-old Lieutenant who had lost his
arm and his leg. Quite a remarkable young man that I have
gotten to know since my visit to Walter Reed even better, and
he came for a second honeymoon with his wife to Las Vegas when
he got out of Walter Reed. And we have kept in touch.
But why this is so significant is that was on a Thursday a
couple of years ago. And on Tuesday, when we came back and were
presented with the VA budget for the following year, there was
a cut of $12 million from prosthetic research. And now,
Republican and Democrat alike, we fought that and got the money
back in.
I notice in this budget, unless I am misreading it, there
is a $28 million cut in medical and prosthetic research. Is
that really where we want to be trying to balance our budget on
the arms and legs of these young men and women?
Secretary Peake. Well, first of all, for prostheses itself
and buying prosthetics and the things that go with that, it is
a 10 percent increase. From the research perspective, it is not
just prostheses. It is across the board. It is a medical
research piece. And we----
Ms. Berkley. Why are we cutting that?
Secretary Peake. We appreciate the plus-up from last year.
This really is consistent with what we have asked in the past.
We believe we can leverage that.
We also put, if you think about the operational moneys that
Dr. Kussman has in terms of the salaries of our investigators
and so forth, that is another $440 million contributing to it.
We also get Federal funds, Federal grants to the tune of
about $750 million, another $200 and some million from other
than Federal grants. So we will have a research portfolio of
about $1.85 billion.
And I think that we can meet the needs. Really our critical
needs are focusing on our veterans with that amount of money.
Ms. Berkley. I suspect that this Committee is going to
fight to restore those cuts and I think that would be an
appropriate role for the Committee.
May I take one more minute?
The Chairman. Yes.
Ms. Berkley. Thank you. Thank you.
There is another issue that I am kind of confused about and
let me set this up. The hardest call I had to make, and I call
everybody in the State of Nevada, everybody's family when we
lose someone, the hardest call I had to make was to a
grandmother who had raised her grandson who had killed himself
because he was so depressed. He was very depressed and
suffering from PTSD.
Another tragedy in my community was a man named Justin
Bailey who had a substance abuse problem when he returned and
his family, parents insisted that he go to a VA hospital and
get treated. The treatment exacerbated his situation because
they gave him more drugs and he eventually overdosed while in
the care of the VA hospital.
I have legislation pending, but I am a little concerned
when I read this budget. And it also has a proposed cut of $4
million to substance abuse research under designated research
areas. I would think that is one area that we would like to
plus-up rather than cut.
And I know I have a bill pending, ``The Mental Health
Improvement Act.'' There are other Members of this Committee
who have bills that deal primarily with PTSD and substance
abuse. I would like to see this plussed-up and not cut.
Secretary Peake. Thank you, ma'am.
Ms. Berkley. And with that, I have other questions, but I
know there are other Members of the Committee that wish to talk
to you.
Thank you for your courtesy, Mr. Chairman.
And thank you very much. And we all wish you great success.
The Chairman. Thank you, Ms. Berkley.
Mr. Buyer, you are recognized for 5 minutes.
Mr. Buyer. Thank you very much, Mr. Chairman.
And, Mr. Secretary, I have a 2:30 meeting with the
Ambassador of Panama, so I am going to run out to that and come
back. Ms. Brown-Waite is going to take the chair here.
General Howard, under the cyber security funding line, that
line item has been zeroed out, so I would like for you to
explain to me, when a breach of personal identifiable
information occurs requiring notification and a provision of
credit monitoring services goes to a veteran, where does that
funding come from?
Hold on to that. I am going to get the questions, so get
ready to answer that one. And tell me about that plus-up. Okay?
The other is with regard to San Juan. It is a candidate
site for a new VA medical center, so why would you want to
spend this large amount of money you are proposing on an
existing facility when proposing a replacement? So I would like
you to answer that one.
With regard to Charleston, we are going to have a side bar
conversation. I hope you and I can go to Charleston at a time
when I can be there with Mr. Brown. But if I cannot, please,
please go. There is a lot of push and pull on Charleston. You
have some who work for you saying, ``Oh, do not do that.'' We
have a different kind of an idea. We have created the
Charleston model. We tried to leverage it. We are trying to
catch the wave of the future here.
And so one of us has to be an agent of change and take on a
culture. And that is a side bar conversation that we will have.
The other I would like for you to know is about our
previous conversation regarding dental. I did not prompt that
question to the Chairman of the Health Subcommittee. I saw you
smile at me. He has had an equal concern because he is a bill
payor for Army Dental.
And if we, as a Congress, are going to embrace what General
Casey as the Chief and General Cody as the Vice are doing to
operationalize the force to include the Guard and Reserve, yes,
we pay on the front end on sending them, but then when they
come home, what are we doing? They are sending them to the VA
to pay for dental.
And you coming from your medical profession say, well, you
know what. At least somebody is taking care of them. But you
know what, General. The Army has to be doing that.
And so we tried to get them to do a study and they took a
look. They took care of the Sergeant Major's unit there, the
first of the 34th. When they came back, they did all those
dental exams and x-rays. You know why? Because I had them do
that survey. Now we are finding out that in my calculations,
they cooked the books.
I would like your reaction because I am not very happy. And
this is an issue that we have as a Committee, and I am going to
have some more conversations with the Chairman, we are going
down and we are going to flip the beds over here on the Army
Dental Corps because they told me 2 days ago that the
demobilization is not their mission. Can you believe that? The
Chief of the Army Dental Corps looks me in the eye and says not
our mission. Taking care of soldiers not your mission? I do not
get it.
So this is something that we, as a Committee, are going to
take on. We will coordinate with Ike Skelton and we want to
work with you. We opened up the access for the VA to take care
of soldiers, not to be a bill payor for DoD.
Now, if you want us to send the Army Dental Corps a bill, I
am sure Mr. Michaud would be more than happy to do that, would
you not? We will just send them a bill, because the more we pay
on them, see, they will cost shift more to us, right? Well,
wait a minute. Take care of your own. There are some
intangibles there about the Army taking care of the Army.
And I know you spent 40 years in the Army. And I know you
have to believe if we are going to move to operationalize the
force, that we have to take care of them when they come home,
especially with the Army Force Generation model. Would you not
concur?
Secretary Peake. Sir, we know that the dental care
deteriorates in the theater just because of the hygiene, the
Coca-Cola and everything else. But I agree that we need to get
them taken care of. And when we have the authority to do it, we
will keep doing it until it is done in a different way.
Mr. Buyer. Well, you are correct. I know that. We are going
to try to change that. We want the Army to embrace and take
care of their soldiers.
Secretary Peake. We will be happy to work with you and the
Army, sir.
Mr. Buyer. Thank you.
General Howard.
Mr. Howard. Sir, I believe I have two questions to answer.
The first one refers to the supplemental funding credit
protection being zeroed out. You see, there in the 2007
timeframe the $15 million. You know that was provided to us
through the supplemental.
To give you an estimate of how much it has cost us in 2007
for credit protection, the number is $6.5 million. So, in other
words, although we had set aside a large amount of money, we
have not used it all. As you know, the veterans opt in, to the
credit protection service, and that amount is $6.5 million.
Mr. Buyer. Okay.
Mr. Howard. The mailings associated with all that is about
$1.3 million. So during 2007, that whole activity cost us about
$8 million.
Why is it zero? Sir, we hope it is going to be zero in
fiscal year 2009, that it is not going to cost us anything. We
do not know how much to put in there and I hope it is nothing.
There is just no way to estimate what that number is going to
be.
But the fact of the matter is, whatever it is, is paid for
right now out of the cyber security. We have to absorb it
within that line item.
Mr. Buyer. What have you spent on notification? About $30
million?
Mr. Howard. The mailings cost about $1.3 million in 2007.
Mr. Buyer. I think we are probably going to have a problem.
We gave you breathing room because we know that as you move to
this new model that the chances of breaches are going to occur
because the Under Secretary knows full well that he asked for a
waiver. So we have a lot of docs out there with a lot of
laptops and not everybody ``as compliant.'' And so the chances
that one of those laptops can either be stolen or lost are
pretty real.
So if you have to do it, where do you go? What pot are you
going to go and say I zeroed it out because I believe we will
have no breaches this year, but if you have one, where are you
going to get the money?
Mr. Howard. Sir, first of all, the personal equipment can
be used. You are exactly right. The rules are very, very clear
about the use of that. You know, we have recently published our
handbook 6500, which augments the directive. The rules
associated with the use of personal equipment are very clear:
approval by the supervisor, the protection of the device, the
rules that if you are a physician using your own laptop, it
has----
Mr. Buyer. General Howard, I know that. If, in fact, a
violation occurs, where are you going to get the money? You
have zeroed out the account.
Mr. Howard. Right now out of cyber security, we have to
absorb it, whatever it happens to be.
Mr. Buyer. All right. You can answer the other questions
for the record.
Thank you, Mr. Chairman.
[The Post-Hearing Questions and Responses for the Record
from Mr. Buyer appear on p. 174.]
The Chairman. Ms. Brown, you are recognized for 5 minutes.
Ms. Brown of Florida. Thank you. It has been so long since
I have had the microphone.
Mr. Secretary, welcome. You will find that our Committee is
very bipartisan and we work really well together in trying to
do what we can for the veterans.
I have a general question and then I have a specific
question about my district. But the general question is, I know
that we have raised the issue about suicides and, of course,
many stories on television about the homeless. Mental health is
the nuts of the problem.
Are we working with community-based organizations? Are we
subcontracting and any way working with those organizations to
work with us with our veterans?
Secretary Peake. Yes, ma'am, we are. We do in our homeless
program, with our transitional housing. And I visited one of
our transitional housing units actually down in Richmond within
the first couple of weeks I was there. And we are increasing
that. I think there are 3,000 new beds that will come on with
that Grant Per Diem Program that we have.
In terms of the homeless folks, it is better than $1.6
billion worth of healthcare that we give to homeless people. I
have been to one of our homeless stand-downs. Actually, the one
out here at the Washington, D.C., VA Medical Center.
Ms. Brown of Florida. I participated in the one in
Jacksonville. But I am wondering, part of it has to be the
mental health though.
Secretary Peake. Yes, ma'am.
Ms. Brown of Florida. That has to be a part of it because
they are homeless. They are having problems.
Secretary Peake. You are exactly right. It is mental
health. It is substance abuse. I think those are the things
that really are big drivers to it.
And if you look at our domiciliary programs, they have
treatment programs built into those. And we are also going to
see a rise in the domiciliary beds. I think there were 11 new
domiciliaries that were approved in the last 3 years that will
be coming onboard and coming online. So I think that is a
positive story.
Ms. Brown of Florida. The Orlando Hospital has been in the
making for over 25 years. And I think we recently just signed
the contract for the land.
I mean, can we look at, and I spoke with you about this
when you first----
Secretary Peake. Yes, ma'am.
Ms. Brown of Florida [continuing]. Took the job, design
build. It should not take another 5 years. We have great people
in the area. I visited the Gainesville facility. I told you
that they are building a cancer hospital right next door to it.
It is a design build. It is going to be up in 16 months and we
are talking about years.
And the facility, they are trying to do a wrap-around in
Gainesville, the facility, but you have men five and six in a
room and the facility for showers is down the hall. Now, that
was great when I was in college, but that is not what our men
need in these facilities.
Secretary Peake. I went back and checked after your
conversation, ma'am. We are at 100 percent design, so the
design piece is not the holdup. And so we are moving.
I did also check about the hospital across the street and
there was really work back there in April of 2006. So I mean,
even though they may not be so visible, it has been on the
books a little bit longer than that 18 months. But these are
complex facilities, but there is no question, because I also
went back and looked to understand the need that you have in
Gainesville.
Ms. Brown of Florida. Yes.
Secretary Peake. So I have talked to our people about let
us see what we can do with the contractor to work to speed that
baby up. But the design build will not help us in this case
because we are at 100 percent design and you are fully funded
for it.
Ms. Brown of Florida. But it would help us in the Orlando
facility.
Secretary Peake. I will go back and look at that to see if
there is a way that would make a difference for it. I know we
are on the Orlando facility, the first thing going back to your
other point is the domiciliary is one of the first projects
that is going into that campus.
Ms. Brown of Florida. Now, on Tuesday, I am going to spend
the day in New Orleans with your people there on that hospital
there because I want to know what is the status, how can we
speed it up, how we can work with the community people.
And I am finding that people are great in the field, but I
want us to do our part. We are always talking about how we do
things, how we can speed up putting these facilities online
when we actually fund it here.
Secretary Peake. Yes, ma'am. For the New Orleans facility I
looked at the testimony last year, I think we are a little
further along. We are really working hard on the site that is
across from Louisiana State University. So I think we have the
downtown site and we are still crossing the Ts and dotting the
Is with the city and----
Ms. Brown of Florida. I will be meeting with the city and
with your people Tuesday.
Secretary Peake. I think we are getting ready to go there.
Ms. Brown of Florida. Good. Thank you, and welcome.
Secretary Peake. Thank you.
The Chairman. Thank you, Ms. Brown.
Ms. Brown-Waite.
Ms. Brown-Waite. Thank you, Mr. Chairman.
Welcome, Mr. Secretary. I am the Ranking Member on the
Oversight and Investigations Subcommittee. We recently held
several hearings and the Office of Inspector General (OIG) gave
us reports that were very relevant to the subject matter at
hand. One actually happened to be credentialing and
privileging.
And at this Subcommittee hearing, we were concerned that
the Inspector General whose budget was plussed-up could indeed
have his budget reduced. I think especially because the need is
there for additional oversight and investigation that the
Inspector General's Office performs a very valuable task. And I
see you shaking your head. Obviously you agree----
Secretary Peake. I do.
Ms. Brown-Waite [continuing]. Mr. Secretary. I know that it
was not your budget that actually cut back the funding for the
Inspector General's Office to reduce the 48 plus-up positions
that the appropriations for 2008 actually provided; is that
correct?
Secretary Peake. Well, this is my budget. I can tell you
that when I looked at that, I asked a question. And if you look
at it, we are about 8 percent more this year than what it was
the year before, before the plus-up.
I will tell you I do believe that the OIG is a very
important organ for us and for us collectively, we in the VA
and you in the Congress. And so I have not had specific
discussions with Mr. Opfer yet on if he feels like he has any
significant shortfalls here. But I do believe in the value of
the OIG.
Ms. Brown-Waite. Well, would this not in effect take the 48
positions that were added and eliminate them?
Secretary Peake. I know he does some of his work by
contract and I cannot tell you----
Ms. Brown-Waite. I believe it is 48 full-time equivalents
(FTE) that would be eliminated as a result of the budget
request. And I know that Members on both sides of the aisle and
on this Committee are committed to making sure that the
Inspector General's Office is adequately funded.
And I do not think adequately funded would translate into a
reduction of the number of people in the Inspector General's
Office. And so we had actually discussed this in the Oversight
and Investigations Subcommittee about how important it is that
the Members of this Committee support the increase from last
year and perhaps even plus it up more.
We want to make sure that that funding is there and that
staffing levels are appropriate for the needs of the VA. And
while the Office of Management and Budget (OMB) may have been
the entity that made that cut, I do believe that Members on
both sides of the aisle will support going back and restoring
that funding.
Let me ask you another question and that is on compensation
and pension. I see where you are talking about adding 700 new
FTE positions and if it takes I am told 3 years to train new
compensation and pension employees, how is this going to work
out to address the immediate need and the immediate backlog
that exists right now mainly because of the increasing number
of benefits being sought?
Secretary Peake. Well, it is a challenge and training is a
challenge. I know that Admiral Cooper and I have talked about
some of the things that he is doing to try to shorten that time
between bringing you on and making you effective to include
things like training them on some of the simpler things where
they can go back and unburden some of the more experienced
people in their work sites, allowing them to focus on the
harder claims, and then learning more on the job using more
electronics in terms of the computers to be able to train
people.
But I think the real answer is that we need to get after
change in the process and making a simpler process using these
rules-based engines--but that is going to take more time to
deal with the issue.
Ms. Brown-Waite. But you are looking at having them do the
more simpler tasks to free up the more experienced claims
rating----
Secretary Peake. And I would be happy to have Admiral
Cooper go in more detail if you would like.
Admiral Cooper. Yes, ma'am. Part of our plan is to more
effectively utilize new people earlier in their training by
having them process the simpler claims first. So we have
started doing that. In the month of January, we produced more
end products, the third most in the last 6 years. So we are
making progress.
But another important point is that we will have hired the
total number of people we expect for Compensation and Pension
(C&P) Service, 10,750, and we will have them onboard at the
beginning of the year. The buildup will be done by the
beginning of 2009, so we should be able to take greater
advantage of those assets that we have.
Ms. Brown-Waite. Thank you.
I yield back.
The Chairman. Thank you. And thank you for the concern over
the OIG budget.
Mr. Hare.
Mr. Hare. Thank you, Mr. Chairman.
Welcome, Mr. Secretary. Nice to meet you for the first
time.
Secretary Peake. Nice to meet you, sir.
Mr. Hare. Just a couple of things I would like to say
before a question or two for you. I want to commend Under
Secretary Tuerk. He came out to my district. We have the Rock
Island Army Arsenal Cemetery. And we spent a lot of time on a
very cold day. And you could just tell and so could the
veterans, Under Secretary Tuerk, how much and how honored you
were to be there and what a great job you did. So I just want
to give a complement to your boss here.
The other thing, too, and I want to thank the VA. I know
they are taking a look at, Mr. Secretary, the possibility of
getting a CBOC in Sterling, Illinois, which is in my
congressional district. And I understand that that information
that you are gathering might be completed by late summer and we
are hoping and praying in Sterling, Illinois, that that can
happen. It is certainly needed.
One of the top legislative priorities of most of the VSOs,
Mr. Secretary, is legislation that will require mandatory
funding for the VA. Thirteen out of the last fourteen VA
appropriations bills have been late in providing critical
funding for the Veterans Health Administration (VHA).
I have a bill that you are probably aware of. It is the
Assured Funding Bill that I have introduced and have about 130
co-sponsors to the bill.
You know, we heard a lot the other day on Super Tuesday
about who won and who lost. The veterans in my State actually
won. We had a referendum on most of the counties, with 102 in
Illinois. Ninety-seven percent of the people, Republicans,
Democrats, and everybody that voted, voted yes, so it was a
nonbinding, but it was a sense of where people wanted to go.
And the Lieutenant Governor mentioned this very issue of
assured funding and 97 percent of the people on both sides that
came out on a very cold and nasty day voted in support of this.
I was pleased to see that during your confirmation
hearings, you expressed an interest in looking more closely on
the issue of mandatory funding and would be interested to maybe
get some thoughts from you on that.
You know, I hear so much from so many people that it is
very difficult to figure out what you are going to spend when
you do not know and if you are not even going to get the money
in a timely fashion.
So I would like to maybe just ask you about your position
on that and would certainly love to, down the road obviously,
sit down and maybe have a conversation with you outside the
hearing on the matter, too, but kind of wanted to see where you
were at there.
Secretary Peake. Yes, sir. I will tell you that there is
concern and I share it about getting into some magic formula
when we have potentially changing needs that might come with
conflict or whatever. I think we have gotten much better with
our population models and our actuarial projections.
In fact, with Admiral Dunne and really a shop dedicated to
that, I think as I have looked at our numbers, we are getting
closer and closer to really being able to have good actuarial
projections that should be able to help us.
I apologize. I am not familiar with your bill. I have not
had a chance to study it, but will.
Mr. Hare. Thank you, sir.
Secretary Peake. I am certainly willing to look at it and
understand it about what ways we can have to get more
consistent funding. It is a problem when we do not get money
early on in the year or when it delays and those kinds of
things.
But I am not sure just a mandatory funding with a stock
formula tells us all we need to know about the changes in
medicine, the changes in technology, and those kinds of things.
But I am willing to explore it with you, sir.
Mr. Hare. Thank you, Mr. Secretary.
The other quickly, I know we talked about the disability
backlog. And my friend, Mr. Donnelly, from Indiana is sitting
here. We were having coffee one morning saying how, from just a
commonsense perspective, how can we possibly fix this. And, you
know, hiring other people is an idea and training them up and
everything.
But Joe said why don't we treat our veterans like we treat
people that pay their taxes. They put the form in and if they
have a refund coming, they get their refund. If they do not,
they do not. If there is something there they want to question,
they can audit it.
But to clear up the time and maybe erring on the side of
veterans. I have done a number of town meetings and I come from
a very rural district. And hopefully we can bump up, and I want
to throw this in quickly, the rural funding in the budget.
But, you know, veterans said, well, why does it take 177
days on an average to be able to get this. And I think it puts
them in a very--you know, they get angry. They are frustrated
with the system. And is there a way that we can err on the side
of the veteran, the presumption that the veteran's disability
claim is legitimate?
The vast majority, 99.99, I believe in my heart of hearts
that submit these are not going to try to pull one over on
anybody, to be able to really effectively get that backlog
caught up in some fashion other than just hiring people that is
going to take some time to get them trained up to do it. So I
just wanted to maybe throw that out as something to think
about, you know, down the road.
Secretary Peake. I have asked about that and some of the
numbers, about 49 percent of folks have issues that do not get
adjudicated, that are found not to be service connected. Now,
that is not a whole claim necessarily, but it is all those many
issues that we are starting to see within each claim. So I
think that there are some things that we should be able to look
at.
I am not sure just forgiving it off the top, you know,
blanketly is the right answer. Every time that we do give
somebody--I mean, we do have situations now, prestabilization
as an example, where we will adjudicate somebody at 50 percent
or 100 percent and then go back and check them later. And every
time we do and it goes down, it is a big problem because it
looks like we are being unfair to the veteran when really it
may be the fair thing.
So somehow we would have to figure out how to deal with
those kinds of issues because, otherwise, it will just go up
and up and up and growing when it is not necessarily
legitimate.
Mr. Hare. I know I am over on my time. Thank you, Mr.
Chairman.
And, Mr. Secretary, I wish you all the best.
Secretary Peake. Thank you.
Mr. Hare. And if there is anything that this freshman
veteran from Illinois can do to help or any ideas that you are
looking for, I would be more than willing to. I mean, you know,
veterans come first and foremost to me. So I thank you very
much.
Thank you, Mr. Chairman.
Secretary Peake. Yes, sir.
The Chairman. Thank you, Mr. Hare.
And just two things before you get too long into your
Secretaryship. I do not want you to have misconceptions about
mandatory funding. It does not mean a stock formula, as you put
it, because formulas can change. It is just a question of where
the funding comes from under the budget rules.
As you know, the history of the Department's formulas has
not been exemplary as shown by the fact that you forgot to plug
in the war a few years ago. So mandatory funding does not mean
that it is completely inflexible. Please keep that in mind.
And, on Mr. Hare's point about presumption of disability
claims, we are exploring the idea that if the disability claim
was prepared with the help of a VA certified service officer,
that we grant the claim. And we can take into account some of
the problems you brought up with the professional help, which
has been built up in the VSOs and the County Veteran Service
Organizations and certainly, in VAs all over the country.
Mr. Walz.
Mr. Walz. Thank you, Mr. Chairman.
And, Secretary Peake, I thank you and congratulations. I
cannot tell you how much I appreciate you taking this job.
I would also like to thank your team here. I have had the
pleasure to get to know and work with them and find that the
passion for our veterans and the expertise they bring to the
job is very encouraging. And these are all gentlemen that could
find work in the private sector and they have chosen to serve
our veterans.
And I see Mr. Mansfield here. I thank him also for the work
that he has done.
We also have a room full of people I would like to thank.
We have representatives from a lot of Veteran Service
Organizations that I have worked with over the years. I see a
lot of familiar faces.
I think I saw Rose Lee for a while from Gold Star Wives
there in the back. I have often thought that there probably
should be some chairs up front for the Gold Star Wives. We
might want to work on that one.
But the point being, this is the one place passions are
high and their passions are high for the right reason, for our
veterans. And it is the one place where I think you can hear
there is cooperation about one goal and whether they are
sitting here or sitting at the table or sitting out there,
trying to get better care for our veterans is the goal.
So I thank you for taking this. I think many of us are
very, very hopeful that your experience in DoD and then coming
over to VA to help bridge that gap will really help us.
I think a lot of us felt last year we made great strides.
We think that we did things for veterans that needed to be
done. We showed that it was a priority and we showed the
American public we could follow through with that. And I am
very, very proud of that.
And we are here today to discuss the budget a little bit
and to talk specifically on that. And the one thing I think it
is important to keep in my mind is constitutionally the
President's budget is a suggestion to us and I very much take
it as a suggestion.
And I see some of the things in here, whether it is fees or
co-pays. I have a 15-month-old son at home. My wife keeps
telling me stubbornness is a virtue. And so the President is
bringing them to us and we are going to be just as stubborn on
saying that there is a better way to do this.
But I appreciate the difficult situation you are in, but it
is one that you have taken on the challenge and we are very,
very hopeful for that.
I did want to just mention and go back to Ms. Brown-Waite.
I was in the same Subcommittee hearing on this issue of the OIG
and something came up in there that was quite troubling for me
for the reason that I think you and I, Secretary, share a
belief.
And I know one of your quotes was OIG operations provide a
return on investment of eleven to one. That is the type of
thinking that really makes me encouraged, that we are seeing
ways and that I think all of us know. When we are talking
budgeting and we are talking funding, it is not the panacea for
everything, but there are ways to target our funding to be
smarter about this.
And the OIG, and I have seen it time and time again, many
of us see the OIG as a critical component in ensuring care and
how we are taking care of our veterans.
But something came up last week that quite honestly I have
lost sleep over this comment because it is very disturbing. We
were having an Oversight and Investigations Subcommittee
hearing on the investigation of some deaths at the Marion,
Illinois, facility. And in there, we heard from a widow who
talked about her husband dying from what was substandard care.
And I will have to say, just like I told your predecessor, you
will not find a more staunch supporter and someone who is more
proud of the VA than me. But I will also be its harshest
critic. So we have problems. I want to know what the situation
was, as does everyone else here.
And I asked the representative from the Office of Inspector
General if they thought there was a correlation between
resources and their ability to perform their duty and stop
these problems from happening. And the OIG representative said
with more resources, we could have done more.
And I pressed on and I said, this was an exact quote, are
we falling into a conundrum where you are not getting the
resources you need to help stop patients' deaths and we are
turning into substandard care. And there was a silence, and
then a yes.
Now, there is a widow sitting there and an Inspector
General saying, had I had more resources in their professional
opinion, and I applaud this under oath and taking a stand like
that, because I think all of us know that case is far from over
and it is going to end up in a court of law where it rightfully
should be adjudicated, but the issue of this being that I
believe in the VA. I believe in the Inspector General. And I
had an Inspector General telling me that they felt the resource
issue led to substandard care and then I get the budget and I
see we are going down.
Now, I know you addressed it with Ms. Brown-Waite. It is 6
percent less than we had this year and 9 percent less than The
Independent Budget.
My question I guess to you, General, is how do I answer
that to that widow? She heard that and I do not believe it was
an OIG representative speaking out of turn.
Secretary Peake. I did not get that feedback from them, but
I will look at that. In the Marion instance, we asked the OIG
to go in afterward and take a look. The whole incident was
detected because of the processes that were in place to look at
quality and we would need to tighten those so that we maybe get
the flag a bit earlier. But I think Dr. Kussman and his team
immediately took aggressive action. It was not triggered by the
OIG. It was not triggered by an OIG inspection. And that is not
to argue at all about the importance of the OIG or whether or
not they need more resources.
But in Marion, just for the record to be clear, that was
picked up by our internal quality assurance policies and
procedures that I think are really remarkable and then led to
swift action by the leadership.
The other issue I absolutely will address for the OIG to
understand what their shortfalls are. And as I mentioned with
Ms. Brown-Waite, I have not had that discussion with them yet.
Mr. Walz. Okay. And I do appreciate that. And the issue
that did come up, and this is what is so difficult and I have
said it time and time again, this is a zero sum game. And the
investigation was started. But when that investigation was
ongoing, it was after the time that the investigation had been
initiated that Mrs. Shank lost her husband.
So it is one of those issues that we are going to have to
continue to get better. I know this team is committed to that.
Our question is, are we providing the resources? Are we getting
into a situation where we are focusing those resources to fix
it?
But, again, I thank you. You have given up an incredible
amount of your valuable time to come here and I hope you know
this Committee is here to do whatever we can to work with you
for our veterans.
I yield back and thank you, Mr. Chairman.
The Chairman. Thank you, Mr. Walz.
Mr. Snyder.
Mr. Snyder. Thank you, Mr. Chairman.
I feel like I should call you Secretary General because I
have never called anyone Secretary General before and you are
the first person that would qualify. But, General Peake, it is
good to see you----
Secretary Peake. It is good to see you again.
Mr. Snyder [continuing]. In your new role as Secretary. I
appreciate all the work you did.
I had to go and meet with our National Guard folks from
back home and then came back. I understand that Ms. Berkley, as
she often does, beats me to the punch on things. But I wanted
to pursue this issue of the research again, which I think I
have talked about every year for the last 10 years and probably
your staff told you about it.
But this is your document here and on page 2A2 in which you
discuss medical and prosthetic research, the VA's 2008 budget
estimate was that you could mobilize $769 million in Federal
resources from the National Institutes of Health (NIH) and
other Federal resources, correct?
The reality is that it is now looking, by your estimate
from your document, it is going to be $708 million which is $61
million less than the President's budget last year at this time
told us you would mobilize and other Federal resources,
leverage other Federal resources.
And, yet, now you are coming back with a budget this year
saying, hey, you know what, we think we can leverage $751
million. Well, you are a smart guy. You learn from the past. We
learn from the past. You did not do it last time. We told you
you would not do it last time. NIH budget is flat in the
President's budget this time again. He is not going to do it.
Why put this number out? I am curious, Secretary Peake. Do
you all know what the number was that you requested for
research for your Department? I suspect OMB has cut you off. I
am curious. What number did you request? I cannot imagine that
you all would have gotten together and said let us fail to
learn from our experience. Do you know what number you all
requested?
Secretary Peake. I do not know the number offhand, but as I
look at the kind of researchers that we have in the VA and the
academic affiliations that we have, I would hope that we would
be able to compete effectively for those dollars.
Mr. Snyder. Yeah, but you will not. You will not. That is
not the way this is going to work. I do not know why we are
going to expect other Federal agencies to pick up VA's
responsibility on research.
And this is not some, you know, pie in the sky kind of
thing. You are talking about, I suspect, I do not know, maybe
you can share with us sometime or inquire since you are new on
the job, I suspect you have an abundance of top-notch
researchers----
Secretary Peake. We do.
Mr. Snyder [continuing]. With research projects that would
speak right to the heart of some of the problems facing our
veterans today, whether it is prosthetics or prevention stuff
or vaccines or PTSD or whatever, all kinds of things, that
would benefit from additional funding.
And at this time in our history, I just do not understand
why we are not looking on this as an opportunity to say let us
do better than keep up with inflation. Let us recognize this,
that we are in for the long haul here with a new generation of
veterans.
Why not really pump some money into this at this point and,
by the way, let us make a commitment to recognize that good
research depends on not an annual budget cycle? Good research
and attracting good researchers, they need to know we are with
you for 3 to 5 years. I mean, you know that.
This is not new information for you and I suspect you are
part of the choir here. But when we see this, when we heard
from your predecessor we will be able to leverage dollars and
your own document right here says we failed to leverage dollars
by $61 million, but we are going to try it again, that is not
going to happen.
And it does a disservice to this Committee and to the
American people, but even greater, it does a disservice to
veterans that depend, you know, that they are hoping, they do
not know anything about these numbers, but they are hoping that
something better will happen in their medical conditions.
I wanted to ask a question involving claims. Who is our
claims guy? I toured our regional office last week. They have a
great team up there of personnel. In fact, they are doing some
of this training for their people there from Oklahoma and other
places, this training for new claims evaluators.
And then I toured their facility and they have a real
problem with storage, infrastructure, but they think they are
on the way to solving it. That is not what I wanted to ask
about.
This is the question I want to ask about. This Committee
has a lot of interest in going to computerized medical records
and computerized forms. And we think that is the direction
everything is going in the universe right now.
In fact, it appeared to me when it comes to applications
for disability claims, it is going in the wrong direction, that
veterans are going to the Internet and finding documentation
themselves or their advisors or whatever that say, hey, this
stuff is great, let us add this to the file. And then, in fact,
the claims, the paper trail on the claims, are getting longer
and longer and longer.
And so I went back in the file room and they were a bit
like canyons with three-volume files that were not like the
medical record, but attached documentation in nonelectronic
form and the canyons are getting higher. There is no room for
it in the drawers and the trend is for thicker, thicker files,
that veterans are being encouraged, and I would do the same,
attach all this documentation that you can find.
Now, why are we not moving in the direction of an
electronic filing? Why is that? Where am I off-base here,
because clearly the trend is we are running out of space,
whereas 10 years or 20 years ago for the same number of claims,
we would have been able to get everything in the file drawers
and we cannot now at a time when we think we can move to
computerized stuff?
Admiral Cooper. You are correct. We are overburdened with
paper. We are moving to become more paperless as the Secretary
mentioned before. We are doing everything we can, working with
IT to get to the point of using the Virtual VA system in place
of paper records.
Mr. Snyder. But do you agree with me that, in fact, per
file, per claim that the trend is actually going in the wrong
direction, that the files are actually getting bigger in paper?
Admiral Cooper. They are getting bigger because of all the
material that people are sending in, and also because of the
things we require today.
We started in the year 2000 with VCAA, ``Veterans Claims
Assistance Act,'' which was established, properly in my mind,
to ensure that we helped the veteran. But in doing that, we
also said there are certain things you have to provide and we
have to assist you in obtaining.
Since then, the courts have made several decisions which
have increased what we should try to get to ensure we
absolutely look at the claim and ensure that we do everything
we possibly can to adjudicate the claim right. But what that
has meant is more and more paper coming in. You are absolutely
correct. We are being overrun by that and trying to control
that, but we hope to process more claims in a paperless
environment within a couple years, and start doing away with
some of the paper. But the fact is, right now we have
requirements that we have to fulfill and, by sending letters
back and forth, we get a lot more information to support each
claim.
Mr. Snyder. I am sorry. My time is up.
Well, I do not have a problem with, you know, if there is a
lack in the file and you send a letter that says we are lacking
this. My issue is, why does that have to be done by paper? Why
can this not be done--just because I ask for more information
now than we did 5 years ago does not mean it has to be in hard
mail. I mean, in fact, if it came electronically, it would come
like that rather than have to go through the mail. I see
Secretary Peake is trying to get a word in here too.
Secretary Peake. Just that I am in agreement with you, sir.
Maybe one of these days we can travel to Winston-Salem or Salt
Lake City, Utah, where we have two pilot programs using
paperless rating of the BDD claims. We are also moving toward a
paperless environment in our new pension claims. So, we have
some pilots in there, but it is like walking back into the
1950s. I have been there.
Mr. Snyder. Yeah. And I am over my time, Mr. Chairman. But
I do not know if I am just the slowest kid on the block here,
but we have talked about this going to paperless stuff for some
time. I actually thought that we were kind of moving in the
right direction, although slower than we would want. In fact,
it is going the other way. And there may be a way we want to
follow that in terms of what is the actual number of paper
claims versus electronic claims and what is the number of pages
that are being submitted because we are not talking about the
difference between 30 and 60 pages. We are talking about the
difference between 50 pages and 3 or 4, 5 or 600 pages. And
they are sitting back there in volumes about to fall on our
staff.
Thank you.
The Chairman. Thank you. Could you get me a memo on that?
Thank you.
Mr. Secretary, thank you for being with us. Let me just ask
you a couple of questions before you leave.
One of the top priorities of this Committee this year is
going to be a GI Bill for the 21st century, and we are working
on that. I think I mentioned it when we met. In our view, the
bill will include an update in education benefits to take into
account the true cost of college and provide flexibility for
those payments. As you know, if you have a shorter course you
cannot apply that money to the whole tuition if it is a 3-month
course, and making the Guard and Reserve units who have seen
active duty eligible for that GI Bill. It will also include an
improvement to the housing program to meet the real needs out
there, such as inflation, and maybe include homelessness and
mental health.
But if we move in that direction, will you work with us and
try to find the funding?
Secretary Peake. I will.
The Chairman. As you know, nothing is mentioned in the
budget, obviously.
Secretary Peake. I will work with you on that. I think
education is important. I already commented on the emphasis I
would like to place on our vocational rehabilitation education
programs that already have a very good benefit for those that
have 20-percent disability from their service.
So I look forward to working with you. I know that the
Montgomery GI Bill was a peacetime bill and right now, as I
say, everybody here appreciates that we are in a war.
The Chairman. Well, we are going to take that very
seriously.
By the way, I had a forum with your people in the Home Loan
Program and its relationship to the current crisis that we are
in. And it just seemed to me, and from townhall meetings, that
the VA Home Program is sort of irrelevant to the crisis in that
the loan value is too low to help in California and a lot of
other places.
The refinancing cap is just meaningless given the crisis
that people have. The fees for refinancing are incredibly high
and make it basically useless for someone in this current
crisis. You have rules about condominiums that seem to be out
of date.
I have legislation to try to change all that. But it seems
to me that the VA can contribute right now to helping veterans
or active duty personnel actually deal with this crisis that
millions of people are facing.
I also believe that we should have a policy that says no
foreclosure for anybody on active duty because it is a crime if
somebody comes home and finds that they have to lose their
home.
Again, I hope you will work with us on that. We have to do
this right away, as part of the stimulus package we are doing.
The maximum mortgage amount is raised temporarily for Fannie
Mae and Freddie Mac and the FHA but not the VA. So I think we
have to do that and work with you on that----
Secretary Peake. Yes, sir.
The Chairman [continuing]. Because I think we can
contribute a little bit to solving that crisis.
I do not know if you were aware, when I mentioned in my
opening statement, that the Priority 8 study that we asked for
when we went through this with your predecessor, he said, well,
it is a lot more complicated than just giving you a figure for
how much it is going to cost. And I asked him to give us a
study. And we are still waiting to receive that. So I hope you
will----
Secretary Peake. Sir, I understand the study should be up
here in February.
The Chairman. Okay. Thank you.
In previous budget submissions, I believe that although we
may have had to drag it out of you instead of getting it from
the VA, there were some estimates around of how many veterans
would leave the VA healthcare system due to the increased
enrollment fees and pharmaceutical co-payments.
Did you do anything about that, your estimate of how many
people could not afford that and may leave the system?
Secretary Peake. Sir, what I understand the estimates are
is that about 440,000 enrollees of which about 144,000 that
actually use the VA would not pay the enrollment fee.
The other point that I understand is the majority of those
have other health insurance already that they would--and that
the 144,000 users are those who do not use us very much anyway
already. Those are the numbers as I understand.
The Chairman. How about the co-pays, the pharmacy co-pays?
Did you do any estimates on that?
Secretary Peake. I think that is included in that same
number.
The Chairman. Well, I hate to have you leave the VA with a
legacy of saying, oh, whatever it is, 140,000, 440,000, I did
not understand quite what you were saying there.
Secretary Peake. We have----
The Chairman. You know, they left the VA because they could
not afford it. You do not want that as your legacy, I do not
think. So we will take steps to make sure you do not have that
legacy. This is not a time to say that veterans should not be
served.
One last thing. I do not know if I will call it a sermon or
not. I think you and your staff will do better with this
Committee with honesty and a nondefensiveness about issues that
everybody knows are there, but never come up in your reports.
I did not see how many backlogged claims there were. Did
you put a number in there? Whether it is 600,000, 400,000 or
700,000, if you do not tell us and say, look, we are working on
this or here is what we need to do it, you look like you are
not confronting it and you are hiding it.
I went through this, I do not know if your staff told you,
with the head of your Mental Health Division with the suicides.
We had media estimates of 6,000 veterans a year or so dying
from suicide. And your guys were telling us how great a job
they were doing and now, there were 300 people who called in--
300 people we talked to. And I kept saying what about the
6,000.
We have to have honesty about these issues. We are not
holding you personally responsible. We just have to have an
understanding, a joint understanding between Congress, the
Executive Branch, and the public about what these issues are
because then we can work together to solve them.
But if we do not know about them, or you do not recognize
them, or you do not want to talk about them officially, it
creates the impression that you are hiding this, that you do
not really care and are not doing the job.
And we know how dedicated everybody is. But when those
official statements come to us and you did not tell us in your
paper that there is going to be a $19 billion decrease over the
next 5 years, I mean, why is that and what can we do with you
to avoid that from happening?
We are not trying, just to say ``got you''--we want to look
at the problems honestly and try to deal with them together.
That is the spirit in which I hope we can work together.
You have the floor for any final comments you would like to
make.
Secretary Peake. Sir, first of all, let me thank you all
for the hearing today. And I thank you for particularly that
last comment because I hope that you will find me and this
great team to be open. It is not about hiding anything. And
perhaps we sometimes err on the side of trying to tell the good
news story.
I think my predecessor said something about the VA being
the greatest story never told or something, so maybe we err on
that side. It is not to hide issues. There are issues that we
need to deal with.
In terms of that out-year projection, I understand that
that is just a placeholder for all agencies and they reflect no
policy decisions or VA demand. So, I mean, it is almost, as I
understand it, it is irrelevant to our future and what we----
The Chairman. I will tell the President that.
Secretary Peake. I have a year, I guess. But, you know, I
have been tremendously impressed with the quality of the people
here just as you say, sir. And I think that we all are
dedicated to the same thing. We have a common sense about the
importance of our veterans and there is probably not a time in
our recent past that it has been more important.
So I welcome the opportunity to work with this Committee
and with the other parts of Congress to make some progress
here.
The Chairman. Thank you, sir. Again, it is a pleasure to
have you here. It is a pleasure to be working with you.
We will let this panel go so you can go back to work on
behalf of our veterans. Thank you so much.
The second panel that we will hear from today is from the
four organizations that provide The Independent Budget; the
Paralyzed Veterans of America (PVA), the Disabled American
Veterans (DAV), the Veterans of Foreign Wars (VFW) of the
United States, and American Veterans (AMVETS). And in addition,
the American Legion and the Vietnam Veterans of America (VVA)
will be testifying on this panel.
We thank you for all the work that goes in The Independent
Budget. We look forward to working with you to make it a
reality. Each of you have 5 minutes. We have some new
technology you see that is in front of you. It tells you how
much time you have. And, of course, your complete statements
will be made an official part of our record.
Mr. Blake is with PVA and we welcome you here.
STATEMENTS OF CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR,
PARALYZED VETERANS OF AMERICA; KERRY BAKER, ASSOCIATE NATIONAL
LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; DENNIS M.
CULLINAN, DIRECTOR, NATIONAL LEGISLATIVE SERVICE, VETERANS OF
FOREIGN WARS OF THE UNITED STATES; RAYMOND C. KELLEY, NATIONAL
LEGISLATIVE DIRECTOR, AMERICAN VETERANS (AMVETS); STEVE
ROBERTSON, DIRECTOR, NATIONAL LEGISLATIVE COMMISSION, AMERICAN
LEGION; AND RICHARD F. WEIDMAN, EXECUTIVE DIRECTOR FOR POLICY
AND GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA
STATEMENT OF CARL BLAKE
Mr. Blake. Thank you, Mr. Chairman and Ranking Member
Buyer. On behalf of the four co-authors of The Independent
Budget, I would like to thank you for the opportunity to
testify today on the funding requirements for the Department of
Veterans Affairs' healthcare system for fiscal year 2009.
For fiscal year 2009, the Administration requests
approximately $41.2 billion for veterans' healthcare. This
includes approximately $2.5 billion from medical care
collections.
Although this represents another positive step forward in
achieving adequate funding for the VA, it still falls short of
the recommendations of The Independent Budget.
For fiscal year 2009, The Independent Budget recommends
approximately $42.8 billion for total medical care budget
authority, an increase of $3.7 billion over the fiscal year
2008 appropriated level and approximately $1.6 billion above
the Administration's request.
In order to properly reflect the Administration's change to
the medical services account and our recommendation, the
separate accounts for medical services and medical
administration must be added together.
With this in mind for fiscal year 2009, The Independent
Budget recommends approximately $38.2 billion for medical
services.
Our increase in patient workload is based on a projected
increase of approximately 120,000 new unique veterans,
including category 1A veterans and covered nonveterans. We also
estimate the cost of these new unique patients to be
approximately $792 million.
The increase in patient workload also includes a projected
increase of 85,000 new Operation Iraqi Freedom and Operation
Enduring Freedom veterans at a cost of approximately $253
million.
Our policy initiatives include $325 million for improved
mental health services and traumatic brain injury care on top
of what is already being provided, $250 million for long-term
care, $325 million for funding of the fourth mission which
encompasses homeland security and emergency preparedness, and
$100 million to support centralized prosthetics funding.
For medical facilities, The Independent Budget recommends
approximately $4.6 billion. This amount also includes an
additional $250 million for nonrecurring maintenance for the VA
to begin addressing the massive backlog of infrastructure
needs.
Although not proposed to have a direct impact on veterans'
healthcare, we are deeply disappointed that the Administration
chose to once again recommend an increase in prescription drug
co-payments from $8 to $15 and an index enrollment fee based on
veterans' incomes.
Although the VA does not overtly explain the impact of
these proposals, similar proposals in the past have estimated
that nearly 200,000 veterans would leave the system and more
than 1 million veterans will choose to enroll, notwithstanding
the discussion from the previous panel.
It is astounding that this Administration will continue to
recommend policies that would push veterans away from the best
healthcare system in America. Congress has soundly rejected
these proposals in the past and we call on you to do so once
again.
Finally, Mr. Chairman, as you know, the whole community of
National Veteran Service Organizations strongly supports
mandatory funding or an improved funding mechanism for VA
healthcare. However, if the Congress cannot support mandatory
funding, there are alternatives which could meet our goals of
timely, sufficient, and predictable funding.
We are currently working on a proposal that could change
VA's medical care appropriation to an advanced appropriation
which would provide approval 1 year in advance, thereby
guaranteeing its timeliness.
Furthermore, by adding transparency to VA's healthcare
enrollee projection model, we can focus the debate of the most
actuarially sound projection of veterans' healthcare costs to
ensure efficiency and sufficiency.
Under this proposal, Congress would retain its discretion
to approve appropriations, retain all of its oversight
authority, and, most importantly, there would be no PAYGO
implications.
We ask this Committee in your views and estimates for
fiscal year 2009 to consider and possibly recommend to the
Budget Committee either mandatory funding or this new advanced
appropriations approach to take the uncertainties out of
healthcare for all of our Nation's wounded, sick, and disabled
veterans.
This is a proposal that we began meeting with staff for
already and we would offer the opportunity to speak both with
your staff and Mr. Buyer's staff further on this issue.
Lastly, Mr. Chairman and Mr. Buyer, I would like to offer
my thanks for your staff allowing us the opportunity to get
together with them prior to the release of the President's
budget to discuss our recommendations and to kind of lay
ourselves bare.
The previous panel mentioned about not having anything to
hide and in the last couple of years, we have taken to briefing
the Committee staff in advance because in my honest opinion, we
have nothing to hide. And, in fact, it gives us an opportunity
to begin the debate with the key policymakers long before the
President's budget is actually submitted.
So with that, Mr. Chairman, I would like to thank you again
for the opportunity to testify. This concludes my testimony,
and I would be happy to answer any questions you might have.
[The prepared statement of Mr. Blake appears on p. 75.]
The Chairman. Thank you, Mr. Blake.
Representing the Disabled American Veterans is the
Associate National Legislative Director, Kerry Baker.
STATEMENT OF KERRY BAKER
Mr. Baker. Members of the Committee, thank you.
As agreed by the organizations, I will focus my testimony
on understaffing in VBA, the claims backlog, and a few other
related highlights from The Independent Budget.
The claims backlog is undeniably growing. By the end of
January, there were over 816,000 pending claims, including
appeals. In the 3 years since the end of 2004, pending claims
rose by an average of 63,000 cases per year.
Also, the number of cases with eight or more disabilities
increased well over 100 percent from 2000 to 2006. The complex
cases further slow down VBA's claims process.
Therefore, based on the estimated receipt of 920,000 claims
in fiscal year 2009, The Independent Budget recommends Congress
authorize 12,184 FTE for VA's C&P service in fiscal year 2009.
That number equates to successfully processing 83 cases per
year per each direct program FTE.
In addition to a staffing increase, we believe VA must
attack the claims backlog using new methods and policies,
especially when they follow the intent of the law, save
resources, and protect the rights of disabled veterans.
One example deals with VA's policy of requiring medical
opinions in cases where a claimant already submitted an opinion
adequate for rating purposes.
Congress rescinded VA's prior policy of verifying a private
physician's opinion with a VA examination prior to an award of
benefits. Yet, VA continues to refuse to render decisions in
cases where a claimant secures a private medical opinion until
after VA obtains its own opinion.
We believe these actions are an abuse of discretion, delay
decisions, and prompt needless appeals. Congress should mandate
the VA must decide cases based on a veteran's private medical
evidence when it is adequate for rating purposes.
This small change will preserve VA's manpower and budgetary
resources, reduce the backlog for needless appeals, and, most
importantly, better serve disabled veterans and their families.
The law requires VA to accept lay evidence as proof of a
service-connected disability if a veteran is a combat veteran.
VA accepts certain military documentations as proof of combat,
but only a fraction of combat veterans receive one of these
qualifying medals.
Military records do not document individual combat
experiences. As a result, veterans who suffer a disability in
combat are forced to wait a year or more while VA conducts
research to determine whether a veteran's unit engaged in
combat as claimed. This results in difficulty, even
impossibility in proving a veteran's personal participation in
combat by official military records.
Congress should clarify its intent by defining a combat
veteran for all purposes under Title 38 as one who during
active military service served in a combat zone for purposes of
112 of the Internal Revenue Code 1986 or predecessor law.
This amendment would reinforce the original intent of
Congress in liberalizing service connection for sick and
disabled veterans who served in combat.
On behalf of Independent Budget VSOs, I also want to call
the Committee's attention to issues involving the U.S. Court of
Appeals for Veterans Claims. The greatest challenge facing the
court today is similar to the VA's, the rising backlog of
appeals.
However, staffing is not the court's primary dilemma. The
court has shown a propensity to remand cases to the Board of
Veterans Appeals based on errors alleged by VA's counsel for
the first time on appeal. In this, the courts suggest that a
veteran is free to present their assignments of error to the
board even though that appellant may have already done so.
This leads the board to repeat the same mistakes that it
had made previously. Such remands reopen the appeal to
unnecessary development and further delays, overburden an
already backlogged system, and exemplify far too restrictive
judicial process.
Ignoring legal arguments that serve as the basis of an
appeal and remanding cases on technicalities a veteran may be
willing to waive merely adds to the claims backlog.
We believe solving this unacceptable situation would be
simple and cost effective. Congress should require the court on
a de novo basis to decide all relevant questions of law and
decide all assignments of error properly presented by the
appellant.
Mr. Chairman, I have only highlighted a few of the many
important issues contained in our Independent Budget for fiscal
year 2009. I commend the remainder to you, and I will be
pleased to answer any questions from the Committee. Thank you.
[The prepared statement of Mr. Baker appears on p. 78.]
The Chairman. Thank you, Mr. Baker.
Representing the VFW is the Director of their National
Legislative Service, Dennis Cullinan.
STATEMENT OF DENNIS M. CULLINAN
Mr. Cullinan. Chairman Filner, Ranking Member Buyer,
distinguished Members of the Committee, the VFW is responsible
for the construction portion of the IB, so I will limit my
remarks to that subject.
The Administration's fiscal year 2009 budget request for
major and minor construction is dramatically inadequate.
Despite hundreds of pages of budgetary documents that show a
need for millions of dollars in construction projects, the
Administration saw fit to halve the major and minor
construction accounts from the 2008 levels.
The President's request for major construction is a paltry
$581.6 million for 2009. This is a dramatic cut from last
year's funding level of $1.1 billion. While we appreciate that
this level covers eight medical facility projects, including
three new previously unfunded projects, the total level of
funding does not come close to meeting the IB's recommendation
of $1.275 billion in construction money.
Only $476.6 million of the Administration's request covers
Veterans Health Administration projects, significantly lower
than the $1.1 billion that the IB has called for.
While the eight major construction projects called for in
this budget may seem like a lot, the funding levels recommended
for them are a tiny blip in the overall cost.
Looking at just the partially unfunded projects, the
backlog, if you will, even $320 million aimed at them barely
scratches the surface. Only the Lee County, Florida, outpatient
clinic is funded to completion. The other four projects still
require a total funding level of $1.26 billion.
The funding for the three new projects total $776.8 million
out of a total construction estimate of $771 million. This is
important because it means that there will be a total
construction backlog of over $2 billion when the Administration
prepares its request for the following fiscal year.
Both the prior year and this year's budgets desperately
need funding beyond the Administration's request. These
projects are necessary to ensure VA reinvests in its aging
physical infrastructure.
We remain concerned about the unfulfilled promises of the
Capital Asset Realignment for Enhanced Services (CARES). Former
VA Secretary Anthony Principi testified before this Committee's
Health Subcommittee in July of 2004 that CARES reflects a need
for additional investments of approximately $1 billion per year
for the next 5 years to modernize VA's medical infrastructure
and enhance veterans' access to care.
According to VA's November 2007 testimony before that same
Committee, Congress has appropriated just $2.83 billion for
CARES projects, far below what is needed to which the Secretary
testified.
Further, this includes nearly $1 billion for rebuilding
facilities after the Gulf Coast hurricanes, amounts that we
have argued that the Congress should have provided as a
separate emergency funding outside of VA's regular planning
process. With the fiscal year 2008 appropriation, the total is
up to $3.9 billion. Better, but it is still lagging.
We are also greatly concerned about the Administration's
proposed slashing of the minor construction budget. As with the
major construction account, this cut is contrary to what is
indicated by the information the Department provides in its
budgetary documents.
For fiscal year 2009, the recommendation is just $329
million, $301 million below the fiscal year 2008 level and far
below the $621 million called for in the IB.
VA has a long list of minor construction projects targeted
for 2009. There is a list of 145 minor construction projects
listed on page 795 of the 5-year capital plan. Based on the
average cost for past years, VHA would require a budget of $812
million, nearly $500 million more than was actually requested.
We understand that VA has some carryover funding for minor
construction to offset that balance. But even if all $267
million of that are applied to this list of projects, VHA would
still require $545 million in funding instead of the $273
million the Administration has requested.
The minor construction request seems even more deficient
when you factor in its role with respect to maintenance of VA
facilities. VA says that 30 percent of all minor construction
is targeted to correct documented facility condition assessment
deficiencies.
Mr. Chairman, the IB is also concerned regarding
nonrecurring maintenance (NRM). Those same Facility Condition
Assessments reviews show the importance of NRM and that the $5
billion backlog shows how woefully deficient past NRM request
and appropriations have been.
For fiscal year 2009, we are pleased to see the President
request $802 million for NRM funding. This is in line with what
the IB has called for in the past and we also applaud the
allocation of a portion of these dollars outside of bureau.
This concludes my testimony, Mr. Chairman. Thank you.
[The prepared statement of Mr. Cullinan appears on p. 85.]
The Chairman. Thank you.
Just for the record, I would like to say that the Secretary
and his first panel are still with us and I appreciate that
very much. It shows a willingness to listen and respect that we
have not had before.
So, Mr. Secretary, and your staff, thank you for staying
for the panels that follow.
Representing AMVETS is the National Legislative Director,
Raymond Kelley.
STATEMENT OF RAYMOND C. KELLEY
Mr. Kelley. Thank you, Mr. Chairman, thank you, Ranking
Member Buyer, for holding this hearing today.
As co-author of The Independent Budget, AMVETS is pleased
to give you our best estimates on the resources necessary to
carry out the responsibilities of the National Cemetery
Administration.
First, I commend the NCA staff who provide the highest
quality service to veterans and their families in their time of
tremendous grief.
The Administration has requested approximately $181 million
in discretionary funding for operations and maintenance of NCA.
Of that number, $105 million is dedicated for major
construction, $25 million for minor construction, as well as
$32 million for the State Cemetery Grants Program.
In contrast, The Independent Budget recommends Congress
provide $251.9 million of the operational requirements of NCA,
a figure that includes $50 million toward the National Shrine
Initiative.
In total, our funding recommendations represents a $71
million increase over the Administration's request.
The National Cemetery System continues to be seriously
challenged. Adequate resources and developing acreage must keep
pace with the increasing workload.
Currently there are 15 national cemeteries in some phase of
development or expansion. The Administration's budget provides
funding for only three of these projects, while NCA expects
nearly 115,000 interments in 2009, an 8.7-percent increase over
the current year.
Congress must also address the need of gravesite renovation
and upkeep. Though there has been noteworthy progress made over
the years, the NCA is still struggling to remove decades of
blemishes and scars from military burial grounds across the
country.
To date, $99 million has been invested in restoring the
appearance of our national cemeteries, completing nearly 300 of
the 928 deficiencies identified in the 2002 study on the
improvements of veterans' cemeteries.
Therefore, The Independent Budget recommends a $50 million
commitment in fiscal year 2009 and we continue to recommend
Congress establish a 5-year, $250 million fund for the National
Shrine so NCA can fully restore the appearance of the national
cemeteries to reflect the utmost dignity and respect for those
who are interred.
The State Cemetery Grants Program is an important component
of NCA. It has greatly assisted States in increasing burial
services to veterans, especially those living in areas where
national cemeteries are underserved.
NCA admits only 80 percent of those requesting interment
meet the 170,000 veterans within the 75-mile radius threshold
the NCA has set for itself. This reemphasizes the importance of
the State Grants Program.
Since 1978, the VA has more than doubled the acreage
available and accommodated more than a 100-percent increase in
burials through these grants and this year, States have
indicated a plan to establish 14 new cemeteries within the next
4 years.
Therefore, to provide for these cemeteries and to reach
NCA's threshold goals, The Independent Budget requests $42
million for the State Cemetery Grants Program in fiscal year
2009.
Also, The Independent Budget strongly recommends Congress
to review the current burial benefits that has seriously eroded
in value over the years. While these benefits were never
intended to cover the full cost of burial, they now pay for
just 6 percent of what they covered when the program started in
1973.
The Independent Budget requests the plot allowance be
increased from $300 to $750, to increase the allowance for the
service-connected deaths from $2,000 to $4,100, and increase
the nonservice-connected burial benefits from $300 to $1,270.
This increase would proportionately bring these benefits back
to their original value.
The NCA honors more than 2.8 million with a final resting
place that commemorates their service to this Nation. Our
national cemeteries are more than a final resting place. They
are a memorial to those who died in our defense and hallowed
ground for those who survived.
Mr. Chairman, this concludes my testimony, and I will be
happy to answer any questions the Committee would have.
[The prepared statement of Mr. Kelley appears on p. 87.]
The Chairman. Thank you.
Representing the American Legion is its Director of the
National Legislative Commission, Steve Robertson. Welcome.
STATEMENT OF STEVE ROBERTSON
Mr. Robertson. Thank you, Mr. Chairman and Members of the
Committee, for allowing the American Legion to offer its views
on the President's budget request for fiscal year 2009.
Last September, National Commander Marty Conatser clearly
outlined the American Legion's budget recommendations for the
Department of Veterans Affairs. Since our complete written
testimony is submitted for the record, I will only address some
of the key concerns with the President's budget request.
The American Legion wants to thank you and your colleagues
for aggressively resolving both the fiscal year 2007 and 2008
VA budgets last session. Clearly initial fiscal year 2008
budget agreed to by both bodies exceeded or met every
recommendation made by the American Legion. Although it was not
the final budget agreed to, it clearly reflected the specific
funding needs identified by the veterans community.
The American Legion also appreciated the emergency funding
provided for in Public Law 110-161 and the President's request
for that additional funding.
Unfortunately, the American Legion does not believe that
the current President's budget request addressed several
factors that will adversely impact the budget request for 2009,
such as the normal rate of inflation, which absorbs a great
portion of what the President's increase recommends.
Also, as mentioned by Congressman Michaud, the change in
the economy, the increased unemployment rates, this may bring a
lot of veterans back to the system that were not using it last
year. The surge is another example of a large influx of
veterans that will be returning to the United States and going
to VA facilities.
The ``National Defense Authorization Act'' (NDAA) recently
signed extends access for OEF/OIF veterans from 2 to 5 years
and also the increased medical research and treatment need for
such combat-related medical conditions as traumatic brain
injury and post traumatic stress disorder.
The American Legion believes that each of these factors
will increase demand on VA in many areas and seriously
questions VA's ability to provide timely access to these earned
benefits and services.
Unfortunately, the veterans community is well aware of the
adverse impact of miscalculation and continue to urge Congress
to strive to achieve medical care funding that is timely,
predictable, and sufficient, not just once, but every year. The
American Legion looks forward to working with you and your
colleagues to achieve this goal.
Mr. Chairman, the American Legion remains adamantly opposed
to the President's legislative proposals to establish an annual
enrollment fee and increase pharmacy co-payments for Priority
Group 7 and 8 veterans.
The objective behind these proposals remains unclear,
especially when many of these veterans are already enrolled in
Medicare and VA is prohibited from receiving any third-party
reimbursements for their nonservice medical conditions. It also
does not exempt service-connected disabled veterans that are in
those groups. That seems unconscionable.
How many times does a veteran need to pay the Federal
Government for an earned benefit?
I am getting a little older, but my memory is still pretty
sharp. I do not remember any priority veterans in basic
training. I do not remember any priorities in honorable
discharges. I do not remember seeing any sign that refers to
the Department of Priority Veterans Affairs.
Some folks think that the veterans' community asks for a
lot, but it pales in what the Nation asks of its veterans.
Thank you very much, Mr. Chairman. That concludes my
remarks. I will accept any questions you have for us.
[The prepared statement of Mr. Robertson appears on p. 90.]
The Chairman. Thank you so much.
Representing the Vietnam Veterans of America is the
Executive Director for Policy and Government Affairs, Rick
Weidman.
STATEMENT OF RICHARD F. WEIDMAN
Mr. Weidman. Mr. Chairman, Mr. Buyer, thank you very much
for allowing VVA to share our views on the President's request
for the 2009 budget this morning or this afternoon.
Our recommendation overall is $3.1 billion more than the
Administration's request. Included in that would be $1.9
billion to restore Priority 8s to the system and to accommodate
what we believe is a gross underestimate of the number of
Global War on Terrorism veterans who will come in.
Every single year since the wars started in Afghanistan and
Iraq, the VA has underestimated the number of new OIF/OEF
veterans who will come into the system and we believe they have
done it again this year.
Secondly, we take it very seriously of leave no veteran
behind. Those who are separating from the military and have
separated within the last 5 years, once they are in, they are
in, even if they turn out to be Category 8 veterans. We see no
reason to cast aside those who served in an earlier era and
prevent them from entering the system until, until they become
indigent and/or service connected down the line.
There is no good study that we are aware of of the
migration from Priority 8 to Priorities 1 and 2 and to people
becoming indigent and, therefore, having access to the system.
We would ask that that be required by the fiscal process as
part of the 2009 appropriation to look at that and hopefully
the Secretary would respond and do that on his own without
being forced to.
An additional $500 million of that recommendation is for
additional mental health and substance abuse services over and
above the $3.9 billion that VA plans to spend in fiscal year
2009.
Additionally, it would be additional staff for the VA Vet
Centers, the most cost effective, cost efficient part of the VA
system that is really our forward aid stations. If you want to
get more veterans in and do the outreach, if you want to do
something about suicides, beef up the Vet Centers and it will
help more than any other single thing.
In addition to that, we believe that there ought to be
additional employment counselors hired in VA vocational
rehabilitation. I am not talking about vocational
rehabilitation counselors. What we are talking about is actual
placement. We frankly at this point do not have the faith that
the Veterans Business Outreach Program (VBOP)/Local Veteran's
Employment Representatives (LVER) system is doing what needs to
be done, particularly for our most profoundly disabled
veterans.
Blinded veterans with the additional moneys that we are
recommending could expand on what has already been done for the
blind and visual recovery centers. And in addition to that, put
together an education and, most importantly, a job placement
program for blind veterans.
It is my understanding from talking to our friends at the
Blinded Veterans of America that not a single one of the new
blind veterans was placed in unsubsidized employment last year.
We can do it. I have participated in a project with blind
veterans in the past where we did it.
Last but by no means least is R&D, research and
development. This is not the time to cut. This is the time to
make them focus and get that outfit to focus much more on the
wounds and maladies that accrue to individuals by virtue of
military service and, if anything, increase it. We recommended
$500 million. The Friends of VA Research recommended $555
million. But in any case, it needs to be increased and not
decreased as it was in the President's request.
Last but by no means least, we would ask that on a
bipartisan basis. The Chair and the Ranking Member, we thank
you very much for your efforts last year in getting the
appropriation bill for the current fiscal year to include a
requirement that the Administration have 90 days to deliver
unto you a plan about how they are going to complete the
already legally mandated National Vietnam Veterans Longitudinal
Study within 2 years.
That 90 days is up the end of March and we would hope that
you would schedule a briefing with the Secretary and his people
can come in and brief you on how within a 2-year period they
are going to deliver that completed report to you to understand
the last large generation of combat vets, what happens over
time to those people's health.
It is an invaluable tool for you to look for planning for
the future, fiscal policy, as well as otherwise for Vietnam
veterans for the rest of our lifetime, but it also will impact
on the planning for OIF/OEF veterans.
Once again, I thank you, and I would be pleased to answer
any questions you may have, sir.
[The prepared statement of Mr. Weidman appears on p. 101.]
The Chairman. Thank you.
And thank you all for your work and all the expertise that
you bring to these issues and your dedication to our veterans.
Mr. Buyer.
Mr. Buyer. Thank you.
Mr. Blake, who wrote the section on IT?
Mr. Blake. Well, it was not me, sir, but I could say that I
know who----
Mr. Buyer. Oh, I was ready for that.
Mr. Blake. Sir, I would be willing to take any questions
that you have and attempt to answer it. I anticipated a
question. Probably not the best person to answer it, but I will
certainly take on the question.
Mr. Buyer. Well, then I will tell you what. You find the
guy that wrote this and bring him to my office.
Mr. Blake. I will be glad to, sir.
Mr. Buyer. Okay. And I am going to bring General Howard
with me. Okay?
This was embraced in a bipartisan fashion, this entire
Committee. Okay? Now, I understand General Howard here is an
agent of change. And when you are the agent of change, you are
not the most popular guy in the room. You do not make friends
at all when you are the agent of change.
And the goal here, I just want to share it with you because
this is supposed to be the IB's position, the goal here is not
to have that IT person whether he is at the medical center or
at the VISN or at a central office, it is not his job to say
no.
So this has been written in a manner as though catastrophe
was about to happen. Oh, my gosh. No, it is not. This is not
catastrophic. Okay?
Their job is to say yes, but make sure whatever ideas, that
they work, that they are compatible. We do not want to chill
innovation. Okay? That is not the desire. I just want you to
know. We have gone through all of this. But I want to meet the
guy who wrote this.
Mr. Blake. I will be glad to, sir, and I will be there as
well.
Mr. Buyer. Good. All right. We will go to the next question
then.
I do not think I completely understand this, advanced
appropriation. So can you elaborate on the concept? How is that
going to work?
Mr. Blake. Well, I will be the first to admit, sir, that I
am learning because this was kind of driven by a process that
was worked up from the DAV, but we were all kind of learning as
we developed this approach.
The theory behind it, I believe, is all of the service
organizations obviously are in agreement that the process is
broken. That is not to say that the appropriation from 2008 was
a bad one in terms of dollars. I think we all agree that it was
a good appropriation. It does not change the fact that it was
appropriated in January in the end, so we are talking about
nearly 4 months late. So there is a significant issue with
timeliness.
The thought is that with an advanced appropriation which,
believe it or not, there is a portion of the Federal budget
albeit not a very large one when balanced against the entire
Federal budget that is done through an advanced appropriation
whereby the healthcare portion or whatever, you know, if
Congress was to accept this, it could be laid out in whatever
fashion, but I think the thrust at least as of this time is to
set the healthcare portion aside in a form of advanced
appropriations so that at this point in time, we would actually
be advocating for a funding level for the fiscal year 2010
portion of the healthcare budget of the VA.
That would certainly draw some immediate concerns maybe
about getting that farther away from the time period in which
we are talking about, things like that, but I think in the end,
we are still trying to overcome the problem with--I think
timeliness maybe stymies the VA in a lot of its abilities more
so than what the funding levels might be, although some people
disagree with me. I like to believe that even if the VA had an
insufficient budget, if they knew what the budget was----
Mr. Buyer. This is an IB motion?
Mr. Blake. Yes, sir. It actually is not in the policy
portion of the IB because this is actually kind of rolling out
even now as we speak. And we have met with some of the staff
from Mr. Filner's staff and we would be glad to meet with the
folks from your staff as well.
Mr. Buyer. I have not poured through this. Do you take an
official position on Dole-Shalala to implement----
Mr. Blake. I do not think we endorse full implementation of
the Dole-Shalala Commission, sir.
Mr. Buyer. Go ahead.
Mr. Cullinan. Mr. Buyer, I would speak to that just on
behalf of the VFW, although I suspect others here would agree
with me.
Dole-Shalala was created basically in response to what
happened at Walter Reed. It had what, about 4\1/2\ months it
was in existence. And originally, as we understand it, it was
intended to come up with some readily achievable, practical
fixes to transitioning from active-duty military to VA and
accessing VA.
It was not intended to come up with broad, sweeping
reforms, ideas for reform. And it certainly was not empowered,
as we understand it, to come up with ideas of completely
revamping the entire VA compensation system.
Now, what we would like to see is the Congress take a
closer look at the congressionally chartered VDBC, the
Veterans' Disability Benefits Commission, which had been in
existence almost 3 years, conducted over a thousand interviews,
the report bordering on 600 pages. I think it is 113 specific
recommendations. We do not agree with all of them. We think
that is what should be looked at first. Dole-Shalala, there are
some good things in Dole-Shalala for the most part that are
being enacted now as either part of the Wounded Warrior
legislation and the NDAA and also that VAs take it upon
themselves even without a legislative push.
So we think that is the way to go. Take a look at the VDBC
first. That is the meaty, substantive study.
Mr. Blake. Mr. Buyer, I would also say that we have also,
not to speak for the organizations, but I think we have taken
the position that it is not an all or nothing game with the
Dole-Shalala Commission.
The same would even be said with the VDBC. I mean, I do not
think we would want to see everything in the VDBC be legislated
immediately. I mean, there are some good things and there are
some bad things.
We had some kind of preliminary meetings with the
Committees and their staffs already. And I do not think we can
just jump off the side of the cliff quickly and think we can
implement this.
And I would certainly applaud the VA for the steps they
have already taken. They have addressed a number of the things
that we were principally concerned about. And there is a number
of legislative proposals dealing with it. And as Dennis
mentioned, the NDAA has already addressed some as well.
Mr. Buyer. If I may, Mr. Chairman.
One last question I have, we have struggled since the early
1990s on the issue of burial ceremonies. It is a never-ending
issue. And I thought that VSOs, that you had organizational
policies.
I had a circumstance. A World War II veteran landed at
Normandy, a Bronze Star recipient, prisoner of war for 9
months, he dies. He was a member of the American Legion. The
Legion's post then closed. He moved away, but then he wanted to
be buried where he grew up and had his business and the Legion
said you are not a member of our post and they would not do his
ceremony.
The President of their local auxiliary was very upset over
it. I contacted Marty Umbarger, who is Major General Umbarger.
He sends out a couple of soldiers. We fly a flag over the
Capitol for him.
A couple of your Legionnaires heard about it and they got a
couple of their buddies who are with the VFW. They put together
their own ad hoc honor guard and the President of the Legion
auxiliary came out and apologized to me. We put on the best
ceremony we could and we did it by putting together what we
thought would be the best ceremony to give him the honors.
I spoke, I spoke to the family, things that I would do,
things that they did. A chaplain came. We tried to do our very
best. But help me here because I helped write legislation on
how to do this. I just assumed, I just thought you guys had
policies. Are there? Help me out.
Mr. Robertson. Mr. Buyer, I will be more than happy to
field that because I went through the same thing when my father
passed away.
The American Legion post in our hometown was basically
defunct, so even the other VSOs in the community said, well, he
is not eligible for membership in our organization, therefore,
we are not going to do it. And I was able to put together a
group to provide my father's burial ceremony.
But the problem is that these are local community service
organizations. And if it is based upon the strength of that
local community, that is one of the reasons why we make such an
aggressive effort to enroll as many people that are veterans
that are eligible to join our organization to bring up the next
generation of pallbearers and color guards and et cetera. It is
a problem nationwide.
There are some places that it is outstanding and then there
are other places where it is lacking. When I was stationed in
North Dakota, some of the little communities in North Dakota,
you would see the burial detail would consist of whoever
happened to be not on the farm that day that was a veteran. And
some of them would be in uniforms and some of them would not.
But it was just the idea of meeting the need for the community.
From a national organization, we outline the procedures
that should be followed. But as far as putting boots on the
ground, it is a challenge, especially in rural parts of the
country.
Mr. Buyer. Now that I am learning this, I will go back and
take another look at the law. Let us take another look at what
we created because we created the procedures with regard to the
military and what they can do and what they do not have to do
and we rely then upon all of you. And maybe I need to go back
and take another look at this.
Mr. Robertson. Mr. Chairman, that law that you are talking
about, what it did was allowed reimbursement for the volunteer
organizations that were able to fill the billet that the Guard
and Reserve and the active duty was unable to fill.
Mr. Buyer. But my assumption is that if the active force
could not do it, that you will.
Mr. Blake. That it would happen.
Mr. Robertson. It is not----
Mr. Buyer. It was my error.
Mr. Robertson. It was purely a volunteer thing and we are
trying to meet that commitment.
Mr. Weidman. The issue in terms of national policy for
Vietnam Veterans of America is that we encourage our chapters
to do it. And most who have that capacity do it for any veteran
whether they are a member of VVA or not, Mr. Buyer.
But the issue is not so much policy or willingness. It is
organizational capacity to be able to do it. And that is often
what is lacking, that they want to and they simply do not have
the organizational capacity to field an honor guard or a firing
squad that would be appropriate during the time a funeral is
held.
Mr. Buyer. All right. Thank you.
The Chairman. Thank you, Mr. Buyer.
Mr. Weidman. May I comment on just one thing, Mr. Buyer, in
answer to your question earlier about the partnership looking
for forward funding?
In fact, other parts of the Federal Government are forward
funded. Obviously capital purchases by DoD are very forward
funded and you just adjust as you move closer to the target
based on the actual experience.
The United States Department of Labor, the money that they
ask for for fiscal year 2009 will not begin until program year
2009 which does not begin until July 1, 2009, as opposed to
October 1, 2008. In other words, it is forward funded by 9
months on the theory that they will do a better job of
planning.
Now, obviously that breaks down when it comes to the
Department of Labor, but we have faith that and great hopes
that at the VA, they will do a better job of actually, if they
have time to prepare, of getting a greater bang for the
taxpayer dollars, one, and, two, getting a budget on time,
therefore, you can shop for the best value.
And that is part of the theory behind it, whether it is 9
months forward funded or a complete fiscal year forward funded
in terms of getting the best value for that hard-earned dollar
that the taxpayer forks over to the Federal Government for
delivery of goods and services that are important to the whole
Nation.
The Chairman. We thank the panel.
Let me just say with the Secretary here, sometimes the
hearing format and process does not always enlighten to the
best extent possible. We have had some success over the last
year with putting together roundtables that include VA staff,
VSOs, and other stakeholders at the same table and having a
discussion, for example, on various parts of this budget.
I hope, Mr. Secretary, you can cooperate again and let us
have a discussion with you and your staff on different aspects
of this rather than solely in a hearing format. So we will try
to do that on certain parts of this budget in the future.
Again, thank you for all the work that you have done over
such a long time, and we will have our third panel testify now.
Again, the organizations that are with us for panel three
have done a lot of work in this area and we look forward to
hearing your testimony.
The Executive Director of the Iraq and Afghanistan Veterans
of America (IAVA), Mr. Paul Rieckhoff, is with us. Thank you.
You are recognized.
STATEMENTS OF PAUL RIECKHOFF, EXECUTIVE DIRECTOR, IRAQ AND
AFGHANISTAN VETERANS OF AMERICA; PAUL SULLIVAN, EXECUTIVE
DIRECTOR, VETERANS FOR COMMON SENSE; CHERYL BEVERSDORF, RN,
MHS, MA, PRESIDENT AND CHIEF EXECUTIVE OFFICER, NATIONAL
COALITION FOR HOMELESS VETERANS; AND RICK JONES, LEGISLATIVE
DIRECTOR, NATIONAL ASSOCIATION FOR UNIFORMED SERVICES
STATEMENT OF PAUL RIECKHOFF
Mr. Rieckhoff. Thank you, Mr. Chairman. Thank you, sir.
Thank you to the Members of the Committee. And on behalf of
IAVA, the Iraq and Afghanistan Veterans of America, and our
tens of thousands of members nationwide, I want to thank you
for the opportunity to testify today regarding the VA budget
request for 2009.
From 2003 to 2004, I served as the First Lieutenant and
Infantry Platoon Leader in Iraq. And when I returned home, I
quickly became concerned about the lack of real support for
returning troops and veterans.
In the early years of the wars, issues like traumatic brain
injury, post traumatic stress disorder, and homelessness
received far too little attention. But times have thankfully
changed.
Last year, this Congress showed tremendous commitment to
our Nation's veterans, providing the VA with its single largest
budget increase in 77 years. So on behalf of the millions of
veterans who rely on VA healthcare, including the almost
300,000 troops newly home from Iraq and Afghanistan, we hope
you will continue to show your support for veterans'
healthcare.
IAVA is one of over 60 organizations who have endorsed The
Independent Budget and we endorse it again for 2009.
As the War in Iraq continues into its fifth year, this
generation of troops and veterans face new and unique problems.
Today IAVA is releasing our annual legislative agenda. Our
2008 legislative agenda covers the entire war-fighting cycle,
before, during, and after deployment. It outlines practical
solutions to the most pressing problems facing Iraq and
Afghanistan veterans. And this agenda is available now on our
Web site, iava.org.
The cornerstone of this agenda is the new GI Bill. After
World War II, nearly 8 million servicemembers took advantage of
a GI Bill educational benefit. A veteran of World War II was
entitled to free tuition, books, and a living stipend that
completely covered the cost of education.
Today we have an opportunity to renew our social contract
with our service men and women and help rebuild our military.
IAVA supports reinstating a World War II style GI Bill that
would cover the true cost of education and will fairly reward
all veterans of Iraq and Afghanistan. And we have endorsed H.R.
2702.
Now, critics have said that the GI Bill is too expensive.
The fact is the GI Bill is a bargain. The current GI Bill cost
the Veterans Department $1.6 billion in 2004. Even if a World
War II style GI Bill were to double that cost, it would be
about what we spend in a week in the War on Terror.
And the GI Bill is more than a veterans benefit. It is also
an effective recruiting tool to stimulate the economy and
improve our military readiness.
The GI Bill also helped improve this country's economy
after World War II. A 1988 congressional study proved that
every dollar spent on educational benefits under the original
GI Bill added $7 to the national economy in terms of
productivity, consumer spending, and tax revenue. And many of
our Nation's strongest leaders got their start thanks to the GI
Bill, including Presidents Ford and Herbert Walker Bush,
Senators Bob Dole, George McGovern, and Pat Moynihan. The GI
Bill also educated 12 Nobel Prize winners and two dozen
Pulitzer Prize winners, including Joseph Heller, Norman Mailer,
and Frank McCourt.
Veterans of Iraq and Afghanistan, however, receive only a
fraction of the support offered to the greatest generation. For
many, including my good friend, Sergeant Todd Bowers, the
burdens of student loans and mounting debt can simply become
too great.
When Sergeant Bowers was activated for a second deployment
to Iraq, he was forced to withdraw from his classes at George
Washington University, racking up an extra semester of debt
without receiving credit for his coursework.
While he was deployed to Iraq, Bowers was wounded when a
sniper's round penetrated his rifle scope and sent fragments
into the left side of his face. He was awarded a Purple Heart,
a Navy Commendation Medal with V device for valor.
When Bowers returned home, he was not greeted as a hero by
his university and credit lenders. His student loans had been
sent to collection and his credit rating was ruined. Struggling
to keep up with his payments, Bowers was eventually forced to
leave school. But a new GI Bill does not just benefit Todd
Bowers. It would benefit our entire military.
It is an important recruitment tool. For years, the
military has been lowering recruiting standards and increasing
bonuses. We now spend more than $4 billion annually on
recruitment, yet are still struggling to meet goals.
The GI Bill is the military's single most effective
recruitment tool and the number one reason why civilians join
the military is to get money for college. A new GI Bill, one
that puts college within reach of a new generation of veterans,
would be a tremendous boom to the recruitment and also help
rebuild our military after years of war.
Above all, a World War II style GI Bill would thank this
generation of combat veterans for their service and their
sacrifice. As President Roosevelt said in his signing statement
to the original GI Bill, the GI Bill gives emphatic notice to
the men and women of our Armed Forces that the American people
do not intend to let them down.
For these reasons, IAVA is calling for a new GI Bill to be
funded in this year's budget. Thank you for your time and I
welcome your questions.
[The prepared statement of Mr. Rieckhoff appears on p.
105.]
The Chairman. Thank you.
Representing the Veterans for Common Sense (VCS), the
Executive Director, Paul Sullivan.
STATEMENT OF PAUL SULLIVAN
Mr. Sullivan. Thank you, Chairman Filner, for inviting
Veterans for Common Sense to testify about VA's 2009 budget. We
appreciate the many hearings you have held and your swift
action to pass the ``Dignity for Wounded Warriors Act.''
VCS begins our testimony with a quote from Associate
Supreme Court Justice Thurgood Marshall: ``Justice too long
delayed is justice denied.'' VCS believes that VA's budget is
dead on arrival because it denies justice to our Nation's 24
million veterans and their families. At a time of war, it is
unconscionable for VA to ask for fewer dollars to treat more
patients.
VA's budget does not address what we believe should be VA's
four highest current priorities for veterans, ending
homelessness, reducing suicide, providing free medical care to
Iraq and Afghanistan war veterans, and eliminating the VA
claims backlog.
First, VCS would like to ask Congress to establish a policy
of zero tolerance for homelessness. VCS believes that 200,000
homeless veterans on our streets every night is a national
disgrace. VA's budget should have contained an emergency plan
to end homelessness for our veterans plus prevent homelessness
among Iraq and Afghanistan war veterans.
Second, VCS asks Congress to establish a policy of zero
tolerance for turning away suicidal veterans. VCS believes that
the epidemic of suicides among veterans justifies an emergency
plan to guarantee that no suicidal veteran is ever again turned
away from VA.
Third, VCS asks Congress to enact mandatory full funding
for healthcare for all veterans so VA stops turning away
veterans and Iraq and Afghanistan war veterans. VCS believes
VA's budget should have contained a plan to guarantee 5 years
of free healthcare, a new law the President signed last month.
Instead of asking for more money to treat veterans, VA went
to court to fight against the new law and against free
healthcare for our new war veterans. VCS believes VA has
underfunded healthcare for Iraq and Afghanistan war veterans by
at least $1 billion. VA's budget spends an average of $7,100
per veteran who is already in the system. However, VA's budget
plan only spends about $3,900 per new veteran.
VA's budget request does not address VA's severe capacity
crisis either. VA's Inspector General reported that 25 percent
of all veterans waited more than 1 month to see a doctor. The
situation is worse for newer war veterans. VA's internal
reports leaked to a reporter showed 33 percent of Iraq and
Afghanistan war veterans waited more than 1 month to see a
doctor. No veteran should ever have to wait that long.
Fourth, VCS asks Congress to establish a policy of zero
tolerance for VA claim delays and VA claim errors. This year,
VA repeated their empty promise given every year to reduce the
claims backlog by processing claims in an average of 145 days.
The current average is 183 days.
VCS believes VA should have submitted a budget plan to
process claims accurately within 30 days. VA should
automatically approve all claims and we have much more detail
on that if you want it.
VA should also establish presumptions of service connection
for PTSD and TBI for our war veterans to make processing those
claims faster.
Finally, in this era of the all-volunteer Army, VCS appeals
once again for Congress to honor our Nation's obligation to our
veterans. We can end homelessness. We can reduce suicides. VA
can provide both prompt and high-quality medical care. We are
cheerleaders for VA. We like VA and we believe VA can provide
both prompt and accurate claims decisions.
We believe that if there is an unlimited budget for bullets
and bombs for war, then there must also be mandatory full
funding for our veterans' transition from the battlefield to
home.
We close with this quote from former Army General and VA
Administrator, Omar Bradley. I used to have this in my cube at
VA. ``We are dealing with veterans, not procedures, with their
problems, not ours.''
VA's reputation for high-quality medical care and excellent
employees is jeopardized by chronic underfunding and staff
shortages. Mandatory full funding for VA is the only way to
eliminate the smoke and mirrors that have plagued the VA's
budget process for decades. And we believe if Congress cannot
fix VA, then who will?
Thank you very much, Mr. Chairman. If you have any
questions, I will be more than happy to answer them.
[The prepared statement of Mr. Sullivan appears on p. 107.]
The Chairman. Thank you so much.
Representing the National Coalition for Homeless Veterans
(NCHV), the President and Chief Executive Officer, Cheryl
Beversdorf.
STATEMENT OF CHERYL BEVERSDORF, RN, MHS, MA
Ms. Beversdorf. Chairman Filner, Ranking Member Buyer, the
National Coalition for Homeless Veterans appreciates the
opportunity to submit testimony to the House Veterans' Affairs
Committee regarding the VA budget request for fiscal year 2009.
VA officials report the partnership between the VA and
community-based organizations has substantially reduced the
number of homeless veterans each night by more than 25 percent
since 2003, a commendable record of achievement that must be
continued if this Nation is to provide the supportive services
and housing options necessary to prevent homelessness among the
newest generation of combat veterans from Operations Iraqi
Freedom and Enduring Freedom.
Regarding VA's homeless veterans programs, Congress has
established a number of programs within VA to address
homelessness among veterans. The primary goal for these
programs is to return homeless veterans to self-sufficiency and
stable, independent living.
The major homeless veterans programs administered by VA
include the Homeless Providers Grant and Per Diem Program, the
HUD-VASH Program, which is the U.S. Department of Housing and
Urban Development and Veterans Affairs Supportive Housing, the
Multi-Family Transitional Housing Loan Guarantee Program, and
the Compensated Work Therapy Transitional Residence Program.
Homeless veterans also receive primary medical care, mental
health, and substance abuse services at VA medical centers and
community-based outpatient clinics through the Healthcare for
Homeless Veterans Program. Our testimony will focus on these
homeless veteran assistance initiatives.
Regarding Grant and Per Diem, it is the Nation's largest VA
program to help address the needs of homeless veterans. Last
September, the U.S. Government Accountability Office (GAO)
presented testimony before this Committee's Health Subcommittee
regarding homeless veterans' programs and reported an
additional 11,100 transitional housing beds are necessary to
meet the demands of the estimated number of homeless veterans
needing assistance.
Public Law 110-161 provided for $130 million, the fully
authorized level to be expended for the Grant and Per Diem
Program. Based on GAO's findings and VA's projected needs, NCHV
has concerns about the $138 million budget request for fiscal
year 2009 and believes that a $200 million authorization is
needed. An increase in the funding level for the next several
years would help ensure and expedite VA's program expansion
targets.
Regarding special needs grants, the VA provides these to VA
healthcare facilities and existing Grant and Per Diem
recipients to assist them in serving homeless veterans with
special needs. For these grants, Public Law 109-461 authorizes
appropriations of $7 million for fiscal year 2007 through
fiscal year 2011. But the increased risk of homelessness among
these populations, especially women veterans, warrants funding
for special needs grants above the currently authorized level.
Additional Grant and Per Diem Program funding would address
this need.
The HUD-VASH Program provides permanent housing and ongoing
treatment services to harder to serve homeless veterans with
chronic mental health and substance abuse issues. We were
pleased that Public Law 110-161 included $75 million to be used
for 7,500 Section 8 vouchers for homeless and disabled
programs. Under this program, the VA must provide funding for
supportive services to veterans receiving rental vouchers.
We believe the $7.8 million proposed in the current budget
was agreed upon before the dramatic increase in HUD-VASH
vouchers became law. Because each housing voucher requires
approximately $5,700 in supportive services, we estimate
approximately $45 million will be needed to adequately serve
7,500 or more clients in HUD-VASH housing units.
The Multi-Family Transitional Housing Loan Guarantee
Program authorizes the VA to guarantee 15 loans with an
aggregate value of $100 million for construction, renovation of
existing property, and refinancing of existing loans to develop
transitional housing projects for homeless veterans and their
families.
Since 1998, when the program was authorized, only two
projects have survived beyond the initial planning stages, one
in Chicago and one in San Diego, and only the Chicago project
has been developed.
While we believe this program seemed promising in original
design and intent, a much more practical and streamlined
program should be developed. We believe the resources earmarked
for this program might be better allocated to support projects
that can be developed and brought online more swiftly.
We are pleased to see additional funding provided for the
Compensated Work Therapy, Transitional Residence Program, in
the fiscal year 2009 proposed budget.
Regarding mental health programs, virtually every
community-based organization providing assistance to veterans
in crisis depends on the VA for access to comprehensive mental
health services. We believe VA's mental health strategic plan
has increased the number of services provided to veterans in
crisis and believe the budget will facilitate further
implementation of this plan.
We also strongly recommend more attention, and I think this
is of interest to you, Mr. Chairman, that there would be an
opportunity for simplifying and expanding access to community
mental health clinics for OIF/OEF veterans in communities that
are not well served by VA facilities.
In conclusion, I want to thank you for giving NCHV an
opportunity to testify for the American's veterans in crisis,
and we would be happy to answer any questions.
[The prepared statement of Ms. Beversdorf appears on p.
142.]
The Chairman. Thank you for all that you do.
Representing the National Association for Uniformed
Services (NAUS) is the Legislative Director, Rick Jones.
Welcome.
STATEMENT OF RICK JONES
Mr. Jones. Chairman Filner, Ranking Member Buyer, thank you
very much for the opportunity to appear here today to testify
on the Department of Veterans Affairs budget for fiscal year
2009.
First of all, we would like to thank you, Mr. Chairman, and
the leadership of this Committee and the House itself for the
years in which you pushed for The Independent Budget to be
appropriated.
Last year's budget, the current year we are in, was just an
extraordinary, astounding feat and we thank you so very much
for applying the money and directing the priorities to
veterans.
The VA budget, including the $3.7 billion, which was a
discretionary amount for the President's decision, was released
last January. And we appreciate all your effort.
As you approach issues this year, NAUS highly recommends
and commends the Veterans' Disability Benefits Commission
report. NAUS is pleased that its President, retired Army Major
General Bill Matz, actively served on the Veterans' Disability
Commission and that the final report of the VDBC has received
praise from most Veterans Service Organizations.
The National Association for Uniformed Services firmly
believes that the veterans healthcare system is an
irreplaceable national investment. It is critical to the Nation
and its veterans. The provision of quality, timely care is
considered one of the most important veterans' benefits
afforded.
Our citizens have also benefited from the advances made in
medical care through VA medical research and VA innovations
have also made a difference in the medical advancements in this
country.
We endorse The Independent Budget's recommendation for a
medical care budget of $42.8 billion. That is an increase of
$3.7 billion above this year's funding level and approximately
$1.6 billion more than the Administration's request. And we
endorse the IB recommendations for the VA research as well.
We ask that you reject the fees and new charges for
veterans and provide adequate resources as needed. Veterans
deserve the benefits they have earned, and they deserve them
because of the sacrifices they have made.
Never again should a situation occur in the VA healthcare
system as occurred over the past 2 years at the James A. Haley
VA Medical Center in Tampa. The National Association for
Uniformed Services is informed that the Haley Medical Center
was on divert status for critical patients 27 percent of the
time between January 1, 2006, and October 2007. That is the
equivalent of about 170 days.
VA figures were reviewed by the St. Petersburg Times that
showed the hospital had diverted all patients regardless of
condition 16 percent of the time over that period. Those
conditions should never exist again. And what you did last year
will help avoid that.
Current VA policy also should be overturned with regard to
Priority 8 veterans. We think the ban should be lifted. Current
VA policy allows enrollment of veterans returning from Iraq and
Afghanistan. Once enrolled in the VA healthcare system, they
are not disenrolled regardless of the category and priority
they might fall into following a certain period of time.
We agree with this decision, but we question why veterans
from prior conflicts or periods of service before the OIF/OEF
period are not afforded the same consideration. Veterans of
Korea, World War II should be allowed to have equal
consideration.
Funding in the currently operating fiscal year provides VBA
with the resources necessary to hire over 3,000 full-time
claims processors. At the close of January, however, VBA had
more than 650,000 compensation and pension claims pending. More
than 26 of those were pending over 180 days.
At a recent briefing of the budget roll-out, Admiral Cooper
expressed confidence that recent and continuing hiring and
training efforts will allow VBA to significantly reduce that
backlog. We hope the Under Secretary is correct in his
estimates and we encourage you to follow that progress because
the monetary benefits are important to the lives of disabled
veterans and their families.
Mr. Chairman, as staunch advocates of veterans, we again
thank you for the opportunity to testify and thank you for the
efforts you have made over the past year. And we look forward
to working with you in the new year for a robust budget for the
coming fiscal year.
[The prepared statement of Mr. Jones appears on p. 145.]
The Chairman. Thank you.
And thank all of you for your interest and your expertise.
We hope you will participate in the roundtables where we will
look at several pieces of the budget.
I just have a specific question, Cheryl. Do I understand it
right that the Per Diem Program applies to homeless shelters
that have a 75 percent or more veteran population? Is that the
law or is that policy?
Ms. Beversdorf. Yes. The requirement is for anyone to be
funded under the Grant and Per Diem Program that the veteran
population has to be at least 75 percent.
The Chairman. I am not sure of the rationale behind that.
Why not follow the veteran? We have shelters in San Diego, for
example, that may be 50 percent veteran or 20 percent veteran,
but they do not get any help from the VA. Is that correct?
Ms. Beversdorf. Well, that is why I mentioned non-VA
clinics in my testimony. I think the VA is interested in
introducing legislation that would provide supportive services
to homeless veterans in non-VA facilities. There could be a
contractual arrangement for veterans who are too far away from
a VA facility. Veterans could receive VA supportive services in
non-VA facilities and not have to pay for these services.
The Chairman. Thank you. And thank you for keeping this
issue in front of us at all times.
Ms. Beversdorf. Thank you.
The Chairman. And, Paul, thank you for your statements on
the GI Bill. We intend, as I said earlier, to make that a top
priority and look forward to working with you on that.
Mr. Buyer.
Mr. Buyer. Mr. Chairman, I remember the Sepulveda bill that
we had. I thought there was a requirement in that bill, though,
that it be 100-percent veterans homeless. Was that right? Was
there?
The Chairman. I do not think so. That was a contract to
serve a certain population.
Mr. Buyer. Stay on that land.
The Chairman. Yes.
Mr. Buyer. Okay. All right. Thanks. You are right. Thanks.
Mr. Jones, regarding the questions on the claims backlog
and claims processing, you commented on the number of
additional personnel.
Over the years, I think what is getting exhaustive to me is
this is not necessarily a problem that we can throw money at
and we can throw people at. And I think Admiral Cooper went
right at it when he started testing people and learned that
there was such a low rate of individuals who could pass these
tests.
And training is the issue. So if we have individuals in
here who are not qualified, there is no question as to why we
have so many appeals and so many backlogs. And we have a
training issue.
I do not want to throw more people in if we are not going
to get them adequately trained. And I think Admiral Cooper is
getting his arms around that one. Would you concur?
Mr. Jones. I agree fully. And the other element, of course,
is the IT element that you have been working so hard on over
the years. Hiring, training, and technology.
Mr. Buyer. Okay. I asked the other panel the question with
regard to the Secretary's testimony that his number one
priority is the implementation of Dole-Shalala. Do any of you
have comments with regard to the Secretary's testimony?
Mr. Jones. Well, the Dole-Shalala, I would comment, is very
narrowly focused. It was focused solely on combat-injured
veterans. There was comment on the previous panel, I believe,
about the Veterans' Disability Benefits Commission, which was
more broadly focused and in being more broadly focused, it
includes all veterans who are part of the effort in defending
freedom and ensuring that our way of life remains vital.
So we would like to have you more focused, although it is
very important on Dole-Shalala, we would like to have you more
focused on the Veterans' Disability Benefits Commission,
perhaps merging those areas that can be merged. There were some
disagreements between the two.
One of those disagreements was that on the age of 65,
benefits from VA would end from the Dole-Shalala. At that
point, Social Security benefits would take place. The Veterans'
Disability Benefits Commission disagreed with that and stated
that VA benefits should be for life.
So with regard to Dole-Shalala, it was a very narrowly
focused commission.
Mr. Buyer. Well, there are many ways to go about this. The
Chairman and I have had discussions. He believes in a
comprehensive approach and that is what you are talking about.
Mr. Jones. Yes, sir.
Mr. Buyer. And I would endorse an incremental approach, do
what we can. You know, we have an opportunity to strike and
hopefully we can proceed with something, you know.
Does anybody else have any comment?
Mr. Rieckhoff. I would agree with you, sir. I think it is
important to see what we can agree on and get things done, but
at the same time recognizing that we do face comprehensive
challenges and that we are facing mammoth generational
challenges that are unprecedented. And so I hate to see us
throw the baby out with the bath water, but I think there is
obviously going to be battles to be fought.
But to be honest with you, what I am encouraged by is the
fact that Dole-Shalala and the VDBC have created momentum in
this country of put veterans' issues on the front page and we
will hopefully give you all the support that you need to make
this a top tier priority. And I think that is critical at a
time where veterans are concerned about being pushed to the
back pages or not getting the attention that they deserve.
Mr. Buyer. You know, I can fully embrace and understand
Senator Dole's desire to address the combat veteran, right? It
is the dimension in which he sees the world. It is also part of
our warrior ethos of taking care of others who, you know, are
less well off than we are and we put them ahead of us. And I
can understand that.
I recall politically, and then I will talk about the other
side of this, when I chaired Personnel and I had $25 billion.
Okay? What am I going to do with $25 billion? And what did I
do? I knew exactly what to do, concurrent receipt. I said this
thing had not been done for a long time, so I blew the lid off
that and said we would do it for only the 100-percent combat
veteran.
And the following year, I was bastardized. I was attacked.
It was unmerciful that I did not do it for everyone, that there
was inequity. And so I have never forgotten that.
And I know what Senator Dole and Secretary Shalala have
asked of me and, yes, I want to do what we can. But, boy, I
have never forgotten what hell I went through because of my
desire only to help them and claims I did not care about
everybody else.
And I can see why doing the comprehensive approach protects
you against that type of thing. I mean, the veteran community
can be a pretty tough community, you know, when they get
together and how they can use language sometimes.
I am just speaking openly about our challenges and how we
want to proceed with it. Thank you for your testimony.
I yield back, Chairman.
The Chairman. Again, these issues are really important and
we are going to spend some time on each one of them in a
different kind of setting. I thank you all for being here. I
thank the VA for participating in the whole day's hearing. And
this Committee is adjourned.
[Whereupon, at 4:30 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Bob Filner
Chairman, Full Committee on Veterans' Affairs
Welcome everyone to the hearing on the Department of Veterans
Affairs Budget Request for Fiscal Year 2009.
This hearing marks the first time Secretary Peake has come before
this Committee, and I cannot think of a more important subject than the
VA's fiscal year 2009 budget request.
I would like to welcome our other witnesses, representing
organizations that have a direct stake in the VA's budget, and thank
you for your hard work and diligence in helping to ensure the VA's
budget is sufficient to meet the needs of our veterans.
Ensuring veterans are provided the benefits and services we have
promised them as a Nation is an issue that I, and the Members of this
Committee, take very seriously. We must make sure we provide the
resources needed by our servicemembers returning from Iraq and
Afghanistan, and we must make sure resources are available for our
veterans from previous conflicts. This is not cheap, but the service
and sacrifice of our veterans is real, and VA's budget must provide
realistic funding levels to meet these needs.
The VA has requested an increase for VA medical care of $2 billion,
for a total of $42.2 billion, including collections. We applaud this
increase, but we have serious concerns that this increase may not be
enough. The Independent Budget has recommended an additional $1.6
billion.
I believe that no veteran should have to wait for a healthcare
appointment simply because the VA does not have the resources to care
for that veteran. We must make sure there is sufficient funding in FY
2009 to meet the mental health needs of our veterans, and to
effectively deal with the issue of homeless veterans, which is a
national tragedy. We must also make sure the resources are available
for our women veterans, and to meet the unique needs of our returning
servicemembers.
We look forward to hearing how this budget will assist the VA in
working with the Department of Defense to make certain situations like
those found last year at Walter Reed do not occur again, and that
bureaucracies and jurisdictional issues do not serve as roadblocks in
getting the healthcare and benefits that our servicemembers and
veterans need.
I am, however, extremely disappointed that the VA has once again
submitted a budget that assumes the continuation of the enrollment ban
on Priority 8 veterans. We were promised a detailed report by January
1st of this year, listing the resources needed by the VA to lift this
ban. We are still waiting for this report, and this information.
The ability of the Secretary to deny enrollment to a group of
veterans was provided to the VA in order to address unexpected and
unforeseen circumstances--it was never meant by Congress to provide the
VA with the ability to ban groups of veterans year after year after
year.
I am also disappointed the VA has once again brought forward
legislative proposals to increase fees and co-payments for certain
veterans. The Administration's proposals to institute enrollment fees
and increase pharmacy co-payments have been rejected year after year by
Congress. I would like the VA to explain to this Committee why they
have offered these proposals again, and the policy reasons for deeming
the proposed receipts from these proposals ``mandatory'' dollars.
Although the Administration has requested an increase for medical
care, this increase has come at the expense of other VA programs. The
VA's FY 2009 budget recommends a 5.5-percent increase for medical care,
while recommending cuts in VA major and minor construction of nearly 44
percent; nearly 49 percent for grants for construction of State
extended care facilities; nearly 8 percent for VA medical and
prosthetic research; slightly more than 7 percent for the National
Cemetery Administration; 19 percent for grants for construction of
State veteran cemeteries; and 5 percent for the Office of Inspector
General. The VA's FY 2009 budget recommends an increase of nearly 6
percent in general operating expenses, the budget account that funds,
among other items, VA claims processors. The VA also requests an
increase in information technology systems of slightly more than 24
percent.
We must make sure that we are providing the resources needed to
address the claims backlog and speed up the process for veterans to
receive the benefits they have earned. We must also carefully consider
the VA's IT request to make certain these dollars are spent wisely.
This Committee will seriously weigh the VA's budget request for FY
2009 and will make our recommendations to the Budget Committee at the
end of this month. We will work closely with our colleagues on the
Appropriations Committee to ensure veterans get the benefits and
services they have earned, and we will work to ensure that the
veterans' funding achievements we accomplished last year are continued
this year.
We provided historic increases last year, and we will continue to
make sure our veterans are cared for in the coming years.
Prepared Statement of Hon. Stephanie Herseth Sandlin
Thank you to everyone for being here to discuss the Department of
Veterans Affairs budget request for fiscal year 2009.
I would like to take this opportunity to congratulate you Secretary
Peake on your recent appointment to lead the Department of Veterans
Affairs.
Mr. Secretary, as you may know, I am the Chairwoman of the Economic
Opportunity Subcommittee. I look forward to working with you to ensure
our service men and women have the benefits they have earned and
deserve to successfully transition to civilian life. Most notably, I
look forward to working with you to update the Montgomery GI Bill to
ensure educational benefits reflect the increased mission tempo and
high cost of a secondary education of the 21st century.
Although the President's budget provides increased funding for the
VA, I do not believe it is sufficient to meet the needs of our
veterans. In particular, I am worried that this budget is not honest in
its assessment of the cost associated with treating both the current
veteran population and the newest generation of veterans--many of whom
are returning home from the wars in Iraq and Afghanistan with PTSD,
TBI, and other injuries that will require a lifetime of care.
Finally, I am disappointed that the budget again proposes annual
enrollment fees and increasing pharmacy co-payments. We should not be
shifting the burden for veterans' healthcare to veterans themselves. I
look forward to working with my colleagues in a bipartisan manner
toward eliminating this tax on veterans and addressing the other
shortfalls of this budget proposal.
Again, I want to thank everyone for taking the time to be here to
discuss these important matters.
Prepared Statement of Hon. James B. Peake, M.D.
Secretary, U.S. Department of Veterans Affairs
Mr. Chairman and Members of the Committee, good afternoon. I am
happy to be here and I am deeply honored that the President has given
me the opportunity to serve as Secretary of Veterans Affairs. I look
forward to working with you to build on VA's past successes to ensure
veterans continue to receive timely, accessible delivery of high-
quality benefits and services earned through their sacrifice and
service in defense of freedom.
I am here today to present the President's 2009 budget proposal for
VA. The request totals nearly $93.7 billion--$46.4 billion for
entitlement programs and $47.2 billion for discretionary programs. The
total request is $3.4 billion above the funding level for 2008. The
President's ongoing commitment to those who have faithfully served this
country in uniform is clearly demonstrated through this budget request
for VA. Resources requested for discretionary programs in 2009 are more
than double the funding level in effect when the President took office
7 years ago.
The President's request for 2009 will allow VA to achieve
performance goals in four areas critical to the achievement of our
mission:
Provide timely, accessible, and high-quality healthcare
to our highest priority patients--veterans returning from service in
Operation Enduring Freedom and Operation Iraqi Freedom, veterans with
service-connected disabilities, those with lower incomes, and veterans
with special healthcare needs;
Advance our collaborative efforts with the Department of
Defense (DoD) to ensure the continued provision of world-class
healthcare and benefits to VA and DoD beneficiaries, including progress
toward the development of secure, interoperable electronic medical
record systems;
Improve the timeliness and accuracy of claims processing;
and
Ensure the burial needs of veterans and their eligible
family members are met and maintain veterans' cemeteries as national
shrines.
Ensuring a Seamless Transition from Active Military Service to Civilian
Life
One of our highest priorities is to ensure that veterans returning
from service in Operation Enduring Freedom and Operation Iraqi Freedom
receive everything they need to make their transition back to civilian
life as smooth and easy as possible. We will take all measures
necessary to provide them with timely benefits and services, to give
them complete information about the benefits they have earned through
their courageous service, and to implement streamlined processes free
of bureaucratic red tape.
We will provide timely, accessible, and high-quality medical care
for those who bear the permanent physical scars of war as well as
compassionate care for veterans who suffer from less visible but
equally serious and debilitating mental health issues, including
traumatic brain injury (TBI) and post traumatic stress disorder (PTSD).
Our treatment of those with mental health conditions will include
veterans' family members who play a critical role in the care and
recovery of their loved ones.
The President's top legislative priority for VA is to implement the
recommendations of the President's Commission on Care for America's
Returning Wounded Warriors (Dole-Shalala Commission). The Commission's
report provides a powerful blueprint to move forward with ensuring that
service men and women injured during the Global War on Terror continue
to receive the healthcare services and benefits necessary to allow them
to return to full and productive lives as quickly as possible. VA has
initiated studies to determine appropriate payment levels for quality
of life, transition assistance, and loss of earnings. The next step is
for Congress to pass the President's legislation, which will modernize
the disability compensation system. VA is working closely with
officials from DoD on the recommendations of the Dole-Shalala
Commission that do not require legislation to help ensure veterans
achieve a smooth transition from active military service to civilian
life.
For example, VA and DoD signed an agreement in October 2007 to
provide Federal recovery coordinators to ensure medical services and
other benefits are provided to seriously wounded, injured, and ill
active duty servicemembers and veterans. VA hired the first recovery
coordinators, in coordination with DoD, and they are located at Walter
Reed Army Medical Center, National Naval Medical Center, and Brooke
Army Medical Center. They will coordinate services between VA and DoD
and, if necessary, private-sector facilities, while serving as the
ultimate resource for families with questions or concerns about VA,
DoD, or other Federal benefits.
In November 2007, VA and DoD began a pilot disability evaluation
system for wounded warriors at the major medical facilities in the
Washington, DC area--Washington VA Medical Center, Walter Reed Army
Medical Center, National Naval Medical Center, and Malcolm Grow Medical
Center. This initiative is designed to eliminate the duplicative and
often confusing elements of the current disability processes of the two
Departments. Key features of the disability evaluation system pilot
include one medical examination and a single disability rating
determined by VA. The single disability examination is another
improvement resulting from the recommendations of the Dole-Shalala
Commission and is aimed at simplifying benefits, healthcare, and
rehabilitation for injured servicemembers and veterans.
VA will continue to work with Congress, DoD, and other Federal
agencies to aggressively move forward with implementing the Dole-
Shalala Commission recommendations.
Medical Care
The President's 2009 request includes total budgetary resources of
$41.2 billion for VA medical care, an increase of $2.3 billion over the
2008 level and more than twice the funding available at the beginning
of the Bush Administration. Our total medical care request is comprised
of funding for medical services ($34.08 billion), medical facilities
($4.66 billion), and resources from medical care collections ($2.47
billion). We have included funds for medical administration as part of
our request for medical services. Merging these two accounts will
improve and simplify the execution of our budget and will make it
easier for us to respond rapidly to unanticipated changes in the
healthcare environment throughout the year. We appreciate Congress
providing us with the authority to transfer funding between our medical
care accounts as this helps ensure we operate a balanced medical
program. We will evaluate the potential need for adjustments to our
medical accounts during 2008.
Information technology (IT) plays a vital role in direct support of
our medical care program and VA is requesting a significant increase in
IT funding in 2009, much of which will help ensure we continue to
provide timely, safe, and high-quality healthcare services. The most
critical component of our medical IT program is the continued operation
and improvement of our electronic health record system, a Presidential
priority which has been recognized nationally for increasing
productivity, quality, and patient safety. We must continue the
progress we have made with DoD to develop secure, interoperable
electronic medical record systems which is a critical recommendation in
the Dole-Shalala Commission report. The availability of medical data to
support the care of patients shared by VA and DoD will enhance our
ability to provide world-class care to veterans and active duty
members, including our wounded warriors returning from Afghanistan and
Iraq.
Workload
During 2009, we expect to treat about 5,771,000 patients. This
total is nearly 90,000 (or 1.6 percent) above the 2008 estimate. Our
highest priority patients (those in priorities 1-6) will comprise 67
percent of the total patient population in 2009, but they will account
for 84 percent of our healthcare costs.
We expect to treat about 333,000 veterans in 2009 who served in
Operation Enduring Freedom and Operation Iraqi Freedom. This is an
increase of 40,000 (or 14 percent) above the number of veterans from
these two campaigns that we anticipate will come to VA for healthcare
in 2008, and 128,000 (or 62 percent) more than the total in 2007.
Funding for Major Healthcare Initiatives
In 2009 we are requesting nearly $1.3 billion to meet the needs of
the 333,000 veterans with service in Operation Enduring Freedom and
Operation Iraqi Freedom whom we expect will come to VA for medical
care. This is an increase of $216 million (or 21 percent) over our
resource needs to care for these veterans in 2008.
The Department's resource request includes $3.9 billion in 2009 to
continue our effort to improve access to mental health services across
the country. This is an increase of $319 million, or 9 percent, above
the 2008 level. These funds will help ensure VA continues to realize
the aspirations of the President's New Freedom Commission Report, as
embodied in VA's Mental Health Strategic Plan, to deliver exceptional,
accessible mental healthcare. The Department will place particular
emphasis on providing care to those suffering from PTSD as a result of
their service in Operation Enduring Freedom and Operation Iraqi
Freedom. An example of our firm commitment to provide the best
treatment available to help veterans recover from these mental health
conditions is our increased outreach to veterans of the Global War on
Terror, as well as increased readjustment and PTSD services. Our
strategy for improving access includes increasing mental healthcare
staff and expanding our telemental health program that allows us to
reach about 20,000 additional patients with mental health conditions
each year.
Our 2009 request includes $762 million for non-institutional long-
term care services, an increase of $165 million, or 28 percent, over
2008. By enhancing veterans' access to non-institutional long-term
care, the Department can provide extended care services to veterans in
a more clinically appropriate setting, closer to where they live, and
in the comfort and familiar settings of their homes surrounded by their
families. This includes adult day healthcare, home-based primary care,
purchased skilled home healthcare, homemaker/home health aide services,
home respite and hospice care, and community residential care. During
2009 we will increase the number of patients receiving non-
institutional long-term care, as measured by the average daily census,
to about 61,000. This represents a 38-percent increase above the level
we expect to reach in 2008.
VA's medical care request includes nearly $1.5 billion to support
the increasing workload associated with the purchase and repair of
prosthetics and sensory aids to improve veterans' quality of life. This
is $134 million, or 10 percent, above the funding level in 2008. This
increase in resources for prosthetics and sensory aids will allow the
Department to meet the needs of the growing number of injured veterans
returning from combat in Afghanistan and Iraq.
Requested funding for the Civilian Health and Medical Program of
the VA (CHAMPVA) totals just over $1 billion in 2009, an increase of
$145 million (or 17 percent) over the 2008 resource level. Claims paid
for CHAMPVA benefits are expected to grow by 9 percent (from 7.0
million to 7.6 million) between 2008 and 2009 and the cost of
transaction fees required to process electronic claims is rising as
well.
Our budget request contains $83 million for facility activations.
This is $13 million, or 19 percent, above the resource level for
activations in 2008. As VA completes projects within our Capital Asset
Realignment for Enhanced Services (CARES) program, we will need
increased funding to purchase equipment and supplies for newly
constructed and leased buildings.
Quality of Care
The resources we are requesting for VA's medical care program will
allow us to strengthen our position as the Nation's leader in providing
high-quality healthcare. VA has received numerous accolades from
external organizations documenting the Department's leadership position
in providing world-class healthcare to veterans. For example, our
record of success in healthcare delivery is substantiated by the
results of the December 2007 American Customer Satisfaction Index
(ACSI) survey. Conducted by the National Quality Research Center at the
University of Michigan Business School and the Federal Consulting
Group, the ACSI survey found that customer satisfaction with VA's
healthcare system was higher than the private sector for the eighth
consecutive year. The data revealed that patients at VA medical centers
recorded a satisfaction level of 83 out of a possible 100 points, or 6
points higher than the rating for care provided by the private-sector
healthcare industry.
In December 2007 the Congressional Budget Office (CBO) issued a
report highlighting the success of VA's healthcare system. In this
report--The Health Care System for Veterans: An Interim Report--the CBO
identified organizational restructuring and management systems, the use
of performance measures to monitor key processes and health outcomes,
and the application of health IT as three of the major driving forces
leading to high-quality healthcare delivery in VA. In October 2007, the
Institute of Medicine released a report--Treatment of PTSD: An
Assessment of the Evidence--that states VA's use of exposure-based
therapies for the treatment of PTSD is effective. This confirms the
Department's own conclusions and bolsters our efforts to continue to
effectively treat veterans of the Global War on Terror who are
suffering from PTSD and other mental health conditions.
These external acknowledgments of the superior quality of VA
healthcare reinforce the Department's own findings. We use two primary
measures of healthcare quality--clinical practice guidelines index and
prevention index. These measures focus on the degree to which VA
follows nationally recognized guidelines and standards of care that the
medical literature has proven to be directly linked to improved health
outcomes for patients. Our performance on the clinical practice
guidelines index, which focuses on high-prevalence and high-risk
diseases that have a significant impact on veterans' overall health
status, is expected to grow to 86 percent in 2009, or a 1 percentage
point rise over the level we expect to achieve in 2008. As an indicator
aimed at primary prevention and early detection recommendations dealing
with immunizations and screenings, the prevention index will also grow
by 1 percentage point above the estimated 2008 level, reaching 89
percent in 2009.
Access to Care
In April 2006 there were over 250,000 unique patients waiting more
than 30 days for their desired appointment date for healthcare
services. As of January 1, 2008, we had reduced the waiting list to
just over 69,000. Our budget request for 2009 provides the resources
necessary for the Department to virtually eliminate the waiting list by
the end of next year. Improvements in access to healthcare will result
in part from the opening of 64 new community-based outpatient clinics
in 2008 and 51 more in 2009 (bringing the total number to 846).
The Department will expand its telehealth program which is a
critical component of VA's approach to improve access to healthcare for
veterans living in rural and remote areas. Other strategies include
increasing the number of community-based outpatient clinics and
enhancing VA's participation in the National Rural Development
Partnership that serves as a forum for identifying, discussing, and
acting on issues affecting those residing in rural areas. In 2009 the
Department's Office of Rural Health will conduct studies to evaluate
VA's rural health programs and develop policies and additional programs
to improve the delivery of healthcare to veterans living in rural and
remote areas.
Medical Collections
The Department expects to receive nearly $2.5 billion from medical
collections in 2009, which is $126 million, or more than 5 percent,
above our projected collections for 2008. About $8 of every $10 in
additional collections will come from increased third-party insurance
payments, with almost all of the remaining collections resulting from
growing pharmacy workload. We will continue several initiatives to
strengthen our collections processes, including expanded use of both
the Consolidated Patient Account Center to increase collections and
improve operational performance, and the Insurance Card Buffer system
to improve third-party insurance verification. In addition, we will
enhance the use of real-time outpatient pharmacy claims processing to
facilitate faster receipt of pharmacy payments from insurers and will
expand our campaign to increase the number of payers accepting
electronic coordination of benefits claims.
Legislative Proposals
The President's 2009 budget includes seven legislative proposals
totaling $42 million. One of these proposals expands legislative
authority to cover payment of specialized residential care and
rehabilitation in VA-approved medical foster homes for veterans of
Operation Enduring Freedom and Operation Iraqi Freedom who suffer from
TBI. Another proposal would reduce existing barriers to the early
diagnosis of human immunodeficiency virus (HIV) infection by removing
requirements for separate written informed consent for HIV testing
among veterans. This change would ensure that patients treated by VA
receive the same standard of HIV care that is recommended to non-VA
patients.
The 2009 budget also contains three legislative proposals which ask
veterans with comparatively greater means and no compensable service-
connected disabilities to assume a modest share of the cost of their
healthcare. They are exactly the same as proposals submitted but not
enacted in the 2008 budget. The first proposal would assess Priority 7
and 8 veterans with an annual enrollment fee based on their family
income:
------------------------------------------------------------------------
Family Income Annual Enrollment Fee
------------------------------------------------------------------------
Under $50,000 None
------------------------------------------------------------------------
$50,000-$74,999 $250
------------------------------------------------------------------------
$75,000-$99,999 $500
------------------------------------------------------------------------
$100,000 and above $750
------------------------------------------------------------------------
The second legislative proposal would increase the pharmacy co-
payment for Priority 7 and 8 veterans from $8 to $15 for a 30-day
supply of drugs. And the last provision would equalize co-payment
treatment for veterans regardless of whether or not they have
insurance.
These legislative proposals have been identified in VA's budget
request for several years. The proposals are consistent with the
priority system of healthcare established by Congress, a system which
recognizes that priority consideration must be given to veterans with
service-disabled conditions, those with lower incomes, and veterans
with special healthcare needs.
These proposals have no impact on the resources we are requesting
for VA medical care as they do not reduce the discretionary medical
care resources we are seeking. Our budget request includes the total
funding needed for the Department to continue to provide veterans with
timely, accessible, and high-quality medical services that set the
national standard of excellence in the healthcare industry. Instead,
these three provisions, if enacted, would generate an estimated $2.3
billion in revenue from 2009 through 2013 that would be deposited into
a mandatory account in the Treasury.
One of our highest legislative priorities is to establish the
position of Assistant Secretary for Acquisition, Logistics, and
Construction. The person occupying this new position would serve as
VA's Chief Acquisition Officer, a position required by the Services
Acquisition Reform Act of 2003. This will elevate the importance of
these critical functions to the level necessary to coordinate their
policy direction across the Department's programs and other government
agencies. An Assistant Secretary with focused policy responsibility for
acquisition, logistics, and construction would ensure these vital
activities receive the visibility they need at the highest levels of
VA. Legislation to accomplish this was introduced in the Senate on
October 4, 2007, as S. 2138. We would appreciate Congress' support of
this legislation.
Medical Research
VA is requesting $442 million to support VA's medical and
prosthetic research program. Our request will fund nearly 2,000 high-
priority research projects to expand knowledge in areas critical to
veterans' healthcare needs, most notably research in the areas of
mental illness ($53 million), aging ($45 million), health services
delivery improvement ($39 million), cancer ($37 million), and heart
disease ($33 million).
One of our highest priorities in 2009 will be to continue our
aggressive research program aimed at improving the lives of veterans
returning from service in Operation Enduring Freedom and Operation
Iraqi Freedom. The President's budget request for VA contains $252
million devoted to research projects focused specifically on veterans
returning from service in Afghanistan and Iraq. This includes research
in TBI and polytrauma, spinal cord injury, prosthetics, burn injury,
pain, and post-deployment mental health. Our research agenda includes
cooperative projects with DoD to enhance veterans' seamless transition
from military treatment facilities to VA medical facilities,
particularly in the treatment of veterans suffering from TBI.
The President's request for research funding will help VA sustain
its long track record of success in conducting research projects that
lead to clinically useful interventions that improve the health and
quality of life for veterans as well as the general population. Recent
examples of VA research results that have direct application to
improved clinical care include the use of a neuromotor prosthesis to
help replace or restore lost movement in paralyzed patients, continued
development of an artificial retina for those who have lost vision due
to retinal damage, use of an inexpensive generic drug (prazosin) to
improve sleep and reduce trauma nightmares for veterans with PTSD, and
advancements in identifying a new therapy to prevent or slow the
progression of Alzheimer's disease.
In addition to VA appropriations, the Department's researchers
compete for and receive funds from other Federal and non-Federal
sources. Funding from external sources is expected to continue to
increase in 2009. Through a combination of VA resources and funds from
outside sources, the total research budget in 2009 will be almost $1.85
billion.
General Operating Expenses
The Department's 2009 resource request for General Operating
Expenses (GOE) is $1.7 billion. Within this total GOE funding request,
nearly $1.4 billion is for the management of the following non-medical
benefits administered by the Veterans Benefits Administration (VBA)--
disability compensation; pensions; education; housing; vocational
rehabilitation and employment; and insurance. The 2009 budget request
provides VBA over two times the level of discretionary funding
available when the President took office and underscores the priority
this Administration places on improving the timeliness and accuracy of
claims processing. Our request for GOE funding also includes $328
million to support General Administration activities.
Compensation and Pensions Workload and Performance Management
A major challenge in improving the delivery of compensation and
pension benefits is the steady and sizeable increase in workload. The
volume of claims receipts is projected to reach 872,000 in 2009--a 51-
percent increase since 2000.
The number of active duty servicemembers as well as Reservists and
National Guard members who have been called to active duty to support
Operation Enduring Freedom and Operation Iraqi Freedom is one of the
key drivers of new claims activity. This has contributed to an increase
in the number of new claims, and we expect this pattern to persist at
least for the near term. An additional reason that the number of
compensation and pension claims is climbing is the Department's
commitment to increase outreach. We have an obligation to extend our
reach as far as possible and to spread the word to veterans about the
benefits and services VA stands ready to provide.
Disability compensation claims from veterans who have previously
filed a claim comprise about 54 percent of the disability claims
received by the Department each year. Many veterans now receiving
compensation suffer from chronic and progressive conditions, such as
diabetes, mental illness, cardiovascular disease, orthopedic problems,
and hearing loss. As these veterans age and their conditions worsen, VA
experiences additional claims for increased benefits.
The growing complexity of the claims being filed also contributes
to our workload challenges. For example, the number of original
compensation cases with eight or more disabilities claimed increased by
168 percent during the last 7 years, reaching over 58,500 claims in
2007. Over one-quarter of all original compensation claims received
last year contained eight or more disability issues. In addition, we
expect to continue to receive a growing number of complex disability
claims resulting from PTSD, TBI, environmental and infectious risks,
complex combat-related injuries, and complications resulting from
diabetes. Claims now take more time and more resources to adjudicate.
Additionally, as VA receives and adjudicates more claims, this results
in a larger number of appeals from veterans and survivors, which also
increases workload in other parts of the Department, including the
Board of Veterans' Appeals and the Office of the General Counsel.
The Veterans Claims Assistance Act of 2000 has significantly
increased both the length and complexity of claims development. VA's
notification and development duties have grown, adding more steps to
the claims process and lengthening the time it takes to develop and
decide a claim. Also, the Department is now required to review the
claims at more points in the adjudication process.
VA will address its ever-growing workload challenges in several
ways. For example, we will enhance our use of information technology
tools to improve claims processing. In particular, our claims
processors will have greater online access to DoD medical information
as more categories of DoD's electronic records are made available
through the Compensation and Pension Records Interchange project. We
will also strengthen our investment in Virtual VA, which will reduce
our reliance upon paper-based claims folders and enable accessing and
transferring electronic images and data through a Web-based
application. Virtual VA will also dramatically increase the security
and privacy of veteran data. The Department will continue to move work
among regional offices in order to maximize our resources and enhance
our performance. Also, this year we will complete the consolidation of
original pension claims processing to three pension maintenance centers
which will relieve regional offices of their remaining pension work. In
addition, we will further advance staff training and other efforts to
improve the consistency and quality of claims processing across
regional offices.
Using resources available in 2008, we are aggressively hiring
additional staff. By the beginning of 2009, we expect to complete a 2-
year effort to hire about 3,100 new staff. This increase in staffing is
the centerpiece of our strategy to achieve our 145-day goal for
processing compensation and pension claims in 2009. This represents a
38-day improvement (or 21 percent) in processing timeliness from 2007
and a 24-day (or 14 percent) reduction in the amount of time required
to process claims this year.
In addition, we anticipate that our pending inventory of disability
claims will fall to about 298,000 by the end of 2009, a reduction of
more than 94,000 (or 24 percent) from the pending count at the close of
2007. At the same time we are improving timeliness, we will also
increase the accuracy of the compensation claims we adjudicate, from 88
percent in 2007 to 92 percent in 2009.
Education and Vocational Rehabilitation and Employment Performance
With the resources provided in the President's 2009 budget request,
key program performance will improve in both the education and
vocational rehabilitation and employment programs. The timeliness of
processing original education claims will improve by 13 days during the
next 2 years, falling from 32 days in 2007 to 19 days in 2009. During
this period, the average time it takes to process supplemental claims
will improve from 13 days to just 10 days. These performance
improvements will be achieved despite an increase in workload. The
number of education claims we expect to receive will reach about
1,668,000 in 2009, or 9 percent higher than last year. In addition, the
rehabilitation rate for the vocational rehabilitation and employment
program will climb to 76 percent in 2009, a gain of 3 percentage points
over the 2007 performance level. The number of program participants is
projected to rise to 91,700 in 2009, or 5 percent higher than the
number of participants in 2007.
Funding for Initiatives
Our 2009 request includes $10.8 million for initiatives to improve
performance and operational processes throughout VBA. Of this total,
$8.7 million will be used for a comprehensive training package covering
almost all of our benefits programs. A little over one-half of the
resources for this training initiative will be devoted to compensation
and pension staff while nearly one-quarter of the training funds will
be for staff in the vocational rehabilitation and employment program.
These training programs include extensive instruction for new employees
as well as additional training to raise the skill level of existing
staff. Our robust training program is a vital component of our ongoing
effort to improve the quality and consistency of our claims processing
decisions and will enable us to be more flexible and responsive to
changing workload demands.
National Cemetery Administration
Results from the December 2007 ACSI survey conducted by the
National Quality Research Center at the University of Michigan and the
Federal Consulting Group revealed that for the second consecutive time
VA's national cemetery system received the highest rating in customer
satisfaction for any Federal agency or private sector corporation
surveyed. The Department's cemetery system earned a customer
satisfaction rating of 95 out of a possible 100 points. These results
highlight that VA's cemetery system is a model of excellence in
providing timely, accessible, and high-quality services to veterans and
their families.
The President's 2009 budget request for VA includes $181 million in
operations and maintenance funding for the National Cemetery
Administration (NCA), which is 71 percent above the resources available
to the Department's burial program when the President took office. The
resources requested for 2009 will allow us to meet the growing workload
at existing cemeteries by increasing staffing and funding for contract
maintenance, supplies, and equipment, open new national cemeteries, and
maintain our cemeteries as national shrines. We will perform 111,000
interments in 2009, or 11 percent more than in 2007. The number of
developed acres (7,990) that must be maintained in 2009 will be 8
percent greater than in 2007.
Our budget request includes an additional $5 million to continue
daily operations and to begin interment operations at six new national
cemeteries--Bakersfield, California; Birmingham, Alabama; Columbia-
Greenville, South Carolina; Jacksonville, Florida; Sarasota, Florida;
and southeastern Pennsylvania. Establishment of these six new national
cemeteries is directed by the National Cemetery Expansion Act of 2003.
We plan to open fast track burial sections at five of the six new
cemeteries in late 2008 or early 2009, with the opening of the cemetery
in southeastern Pennsylvania to follow in mid-2009.
The President's resource request for VA provides $9.1 million in
cemetery operations and maintenance funding to address gravesite
renovations as well as headstone and marker realignment. When combined
with another $7.5 million in minor construction, VA is requesting a
total of $16.6 million in 2009 to improve the appearance of our
national cemeteries which will help us maintain cemeteries as shrines
dedicated to preserving our Nation's history and honoring veterans'
service and sacrifice.
With the resources requested to support NCA activities, we will
expand access to our burial program by increasing the percent of
veterans served by a burial option within 75 miles of their residence
to 88 percent in 2009, which is 4.6 percentage points above our
performance level at the close of 2007. In addition, we will continue
to increase the percent of respondents who rate the quality of service
provided by national cemeteries as excellent to 98 percent in 2009, or
4 percentage points higher than the level of performance we reached
last year.
Capital Programs (Construction and Grants to States)
The President's 2009 budget request includes just over $1 billion
in capital funding for VA, $5 million of which will be derived from the
sale of assets. Our request for appropriated funds includes $581.6
million for major construction projects, $329.4 million for minor
construction, $85 million in grants for the construction of State
extended care facilities, and $32 million in grants for the
construction of State veterans cemeteries.
The 2009 request for construction funding for our healthcare
programs is $750.0 million--$476.6 million for major construction and
$273.4 million for minor construction. All of these resources will be
devoted to continuation of the Capital Asset Realignment for Enhanced
Services (CARES) program. CARES will renovate and modernize VA's
healthcare infrastructure, provide greater access to high-quality care
for more veterans, closer to where they live, and help resolve patient
safety issues. Some of the construction funds in 2009 will be used to
expand our polytrauma system of care for veterans and active duty
personnel with lasting disabilities due to polytrauma and TBI. This
system of care provides the highest quality of medical, rehabilitation,
and support services.
Within our request for major construction are resources to continue
five medical facility projects already underway:
Denver, Colorado ($20.0 million)--replacement medical
center near the University of Colorado Fitzsimons campus.
Lee County, Florida ($111.4 million)--new building for an
ambulatory surgery/outpatient diagnostic support center.
Orlando, Florida ($120.0 million)--new medical center
consisting of a hospital, medical clinic, nursing home, domiciliary,
and full support services.
San Juan, Puerto Rico ($64.4 million)--seismic
corrections to the main hospital building.
St. Louis, Missouri ($5.0 million)--medical facility
improvements and cemetery expansion.
Major construction funding is also provided to begin three new
medical facility projects:
Bay Pines, Florida ($17.4 million)--inpatient and
outpatient facility improvements.
Tampa, Florida ($21.1 million)--polytrauma expansion and
bed tower upgrades.
Palo Alto, California ($38.3 million)--centers for
ambulatory care and polytrauma rehabilitation center.
In addition, we are moving forward with plans to develop a fifth
Polytrauma Rehabilitation Center in San Antonio, Texas with the $66
million in funding provided in the 2007 emergency supplemental.
Minor construction is an integral component of our overall capital
program. In support of the medical care and medical research programs,
minor construction funds permit VA to address space and functional
changes to efficiently shift treatment of patients from hospital-based
to outpatient care settings; realign critical services; improve
management of space, including vacant and underutilized space; improve
facility conditions; and undertake other actions critical to CARES
implementation. Further, minor construction resources will be used to
comply with the energy efficiency and sustainability design
requirements mandated by the President.
We are requesting $130.0 million in construction funding to support
the Department's burial program--$105.0 million for major construction
and $25.0 million for minor construction. Within the funding we are
requesting for major construction are resources for gravesite expansion
and cemetery improvement projects at three national cemeteries--New
York (Calverton, $29.0 million); Massachusetts ($20.5 million); and
Puerto Rico ($33.9 million).
VA is requesting $5 million for a new land acquisition line item in
the major construction account. These funds will be used to purchase
land as it becomes available in order to quickly take advantage of
opportunities to ensure the continuation of a national cemetery
presence in areas currently being served. All land purchased from this
account will be contiguous to an existing national cemetery, within an
existing service area, or in a location that will serve the same
veteran population center.
Information Technology
The President's 2009 budget provides more than $2.4 billion for the
Department's IT program. This is $389 million, or 19 percent above our
2008 budget, and reflects the realignment of all IT operations and
functions under the management control of the Chief Information
Officer.
IT is critical to the timely, accessible delivery of high-quality
benefits and services to veterans and their families. Our healthcare
and benefits programs can only be successful when directly supported by
a modern IT infrastructure and an aggressive program to develop
improved IT systems that will meet new service delivery requirements.
VA must modernize or replace existing systems that are no longer
adequate in today's rapidly changing healthcare environment. It is
vital that VA receives a significant infusion of new resources to
implement the IT-related recommendations presented in the Dole-Shalala
Commission report.
Within VA's total IT request of more than $2.4 billion, 70 percent
(or $1.7 billion) will be for IT investment (non-payroll) costs while
the remaining 30 percent (or $729 million) will go for payroll and
administrative requirements. Of the $389 million increase we are
seeking for IT, 86 percent will be devoted to IT investment. The
overwhelming majority ($271 million) of the IT investment funds will
support VA's medical care program, particularly VA's electronic health
record system.
VA classifies its IT investment functions into two major
categories--those that directly impact the delivery of benefits and
services to veterans (i.e., veteran facing) and those that indirectly
affect veterans through administrative and infrastructure support
activities (i.e., internal facing). For 2009, our $1.7 billion request
for IT investment is comprised of $1.3 billion in veteran facing
activities and $418 million in internal facing IT functions. Within
each of these two major categories, IT programs and initiatives are
further differentiated between development functions and operations and
maintenance activities.
The increase in this budget of 94 full-time equivalent staff will
provide enhanced support in two critical areas--information protection
and IT asset management. Additional positions are requested for
information security: testing and deploying security measures; IT
oversight and compliance; and privacy, underscoring our commitment to
the protection of veteran and employee information. The increase in IT
asset management positions will bring expertise to focus on three
primary functions--inventory management, materiel coordination, and
property accountability.
Our 2009 budget request contains $93 million in support of our
cyber security program to continue our commitment to make VA the gold
standard in data security within the Federal Government. We continue to
take aggressive steps to ensure the safety of veterans' personal
information, including training and educating our employees on the
critical responsibility they have to protect personal and health
information. We are progressing with the implementation of the Data
Security--Assessment and Strengthening of Controls Program established
in May 2006. This program was established to provide focus to all
activities related to data security.
As part of our continued operation and improvement of the
Department's electronic health record system, VA is seeking $284
million in 2009 for development and implementation of the Veterans
Health Information Systems and Technology Architecture (HealtheVet-
VistA) program. This includes a health data repository, a patient
scheduling system, and a reengineered pharmacy application. HealtheVet-
VistA will equip our healthcare providers with the modern tools they
need to improve safety and quality of care for veterans. The
standardized health information from this system can be easily shared
between facilities, making patients' electronic health records
available to all those providing healthcare to veterans.
Until HealtheVet-VistA is operational, we need to maintain the
VistA Legacy system. This system will remain operational as new
applications are developed and implemented. This approach will mitigate
transition and migration risks associated with the move to the new
architecture. Our budget provides $99 million in 2009 for the VistA
Legacy system.
In support of our benefits programs, we are requesting $23.8
million in 2009 for VETSNET. This will allow VA to complete the
transition of compensation and pension payment processing off of the
antiquated Benefits Delivery Network. This will enhance claims
processing efficiency and accuracy, strengthen payment integrity and
fraud prevention, and position VA to develop future claims processing
efficiencies, such as our paperless claims processing strategy. To
further our transition to paperless processing, we are seeking $17.4
million in 2009 for Virtual VA which will reduce our reliance on paper-
based claims folders through expanded use of electronic images and data
that can be accessed and transferred electronically through a Web-based
platform.
We are requesting $42.5 million for the Financial and Logistics
Integrated Technology Enterprise (FLITE) system. FLITE is being
developed to address a longstanding internal control material weakness
and will replace an outdated, noncompliant core accounting system that
is no longer supported by industry. Our 2009 budget also includes $92.6
million for human resource management application investments,
including the Human Resources Information System which will replace our
current human resources and payroll system.
Summary
Our 2009 budget request of nearly $93.7 billion will provide the
resources necessary for VA to:
Provide timely, accessible, and high-quality healthcare
to our highest priority patients--veterans returning from service in
Operation Enduring Freedom and Operation Iraqi Freedom, veterans with
service-connected disabilities, those with lower incomes, and veterans
with special healthcare needs;
Advance our collaborative efforts with DoD to ensure the
continued provision of world-class healthcare and benefits to VA and
DoD beneficiaries, including progress toward the development of secure,
interoperable electronic medical record systems;
Improve the timeliness and accuracy of claims processing;
and
Ensure the burial needs of veterans and their eligible
family members are met and maintain veterans' cemeteries as national
shrines.
I look forward to working with the Members of this Committee to
continue the Department's tradition of providing timely, accessible,
and high-quality benefits and services to those who have helped defend
and preserve liberty and freedom around the world.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Carl Blake
National Legislative Director, Paralyzed Veterans of America
Mr. Chairman and Members of the Committee, as one of the four co-
authors of The Independent Budget, Paralyzed Veterans of America (PVA)
is pleased to present the views of The Independent Budget regarding the
funding requirements for the Department of Veterans Affairs (VA)
healthcare system for FY 2009.
PVA, along with AMVETS, Disabled American Veterans, and the
Veterans of Foreign Wars, is proud to come before you this year to
present the 22nd edition of The Independent Budget, a comprehensive
budget and policy document that represents the true funding needs of
the Department of Veterans Affairs. The Independent Budget uses
commonly accepted estimates of inflation, healthcare costs and
healthcare demand to reach its recommended levels. This year, the
document is endorsed by 54 veterans' service organizations, and medical
and healthcare advocacy groups.
Last year proved to be a difficult year for the appropriations
process. The year started with an incomplete appropriation for FY 2007.
Congress eventually completed the FY 2007 funding bills in February,
placing the Department of Veterans Affairs (VA) in a very difficult
position. While the funding levels provided for FY 2007 were very good,
the fact that the bill was not completed for nearly 5 months after the
start of that fiscal year is wholly unacceptable. Congress then
followed that action up by providing more than $1.8 billion in
supplemental funding for the VA.
Unfortunately, the FY 2008 appropriations process did not go any
smoother. Due to political wrangling over the Federal budget, the VA
did not receive its appropriation until December. We were very
disappointed that the VA was forced to endure this situation for the
13th time in the last 14 years. This was particularly disappointing in
light of the fact that the Administration guaranteed that the bill
would be signed into law and because the bill was completed before the
start of the fiscal year on October 1.
The appropriations bill was eventually enacted, but it included
budgetary gimmicks that The Independent Budget has long opposed. While
the maximum appropriation available to the VA would match or exceed our
recommendations, the vast majority of this increase was contingent upon
the Administration making an emergency funding request for this
additional money. Fortunately, the Administration recognized the
importance of this critical funding and requested it from Congress.
This emergency request provided the VA with $3.7 billion more than the
Administration requested for FY 2008.
For FY 2009, the Administration requests $41.2 billion for
veterans' healthcare. This included approximately $2.5 billion from
medical care collections. Although this represents another step forward
in achieving adequate funding for the VA, it still falls short of the
recommendations of The Independent Budget.
For FY 2009, The Independent Budget recommends approximately $42.8
billion for total medical care budget authority, an increase of $3.7
billion over the FY 2008 operating budget level established by P.L.
110-161, the Omnibus Appropriations bill, and approximately $1.6
billion above the Administration's FY 2009 request. It is important to
note that our budget recommendations reflect a distinct change from
past years as it reinforces the long-held policy that medical care
collections should be a supplement to, not a substitute for real
dollars. The Administration, year-after-year, chooses to include
medical care collections as part of its overall funding authority for
Medical Services. However, we believe that the cost of medical care
services should be provided for entirely through direct appropriations.
In order to develop this recommendation, we used the maximum
appropriation amount included in P.L. 110-161 for VA medical care and
added the projected medical care collections to that amount to
formulate our baseline.
The medical care appropriation in past years has included three
separate accounts--Medical Services, Medical Administration, and
Medical Facilities--that comprise the total VA healthcare funding
level. However, for FY 2009, the Administration's Budget Request
recommends consolidating Medical Services and Medical Administration
into a single account. In order to properly reflect this change in our
recommendations, the separate accounts for Medical Services and Medical
Administration must be added together. For FY 2009, The Independent
Budget recommends approximately $38.2 billion for Medical Services. Our
Medical Services recommendation includes the following recommendations:
Current Services Estimate $32,574,528,000
Increase in Patient Workload $ 1,045,470,000
Policy Initiatives $ 1,000,000,000
Medical Administration $ 3,625,762,000
------------------
Total FY 2007 Medical Services $38,245,760,000
In order to develop our current services estimate, we first added
the estimated collections for FY 2008 to the Medical Services
appropriation for FY 2008. This best reflects the total budget
authority that the VA will use to provide healthcare services. This
amount was then increased by relevant rates of inflation. We also use
the Obligations by Object in the President's budget submission in order
to set the framework for our recommendation. We believe this method
allows us to apply more accurate inflation rates to specific
subaccounts within the overall account. Our inflation rates are based
on 5-year averages of different inflation categories from the Consumer
Price Index--All Urban Consumers (CPI-U) published by the Bureau of
Labor Statistics every month.
Our increase in patient workload is based on a projected increase
of 120,000 new unique patients--Category 1-8 veterans and covered non-
veterans. We estimate the cost of these new unique patients to be
approximately $792 million. The increase in patient workload also
includes a projected increase of 85,000 new Operation Iraqi Freedom and
Operation Enduring Freedom (OIF/OEF) veterans at a cost of
approximately $253 million.
The policy initiatives include $325 million for improvement of
mental health services and traumatic brain injury care. This amount
represents the growing trend both within the Administration and the
Congress to enhance the mental health services within the VA.
Furthermore, it reinforces our belief that resources should be provided
to the VA to allow them to be the lead for providing these specialized
services, not outside healthcare organizations. We also recommend $250
million for long-term care services. The policy portion of The
Independent Budget further explains the shortfall that the VA has in
meeting the Average Daily Census mandated by the Millennium Health Care
Act. We also recommend that the VA be appropriated $325 million for
funding the fourth mission which encompasses homeland security and
emergency preparedness initiatives. Currently, the VA already spends
approximately this amount, but this funding is drawn directly out of
the Medical Services account. Finally, we recommend $100 million to
support centralized prosthetics funding.
As mentioned previously, our Medical Administration recommendation
must be added to our Medical Services recommendation to properly
reflect the format of the FY 2009 budget submission. As such, The
Independent Budget recommends approximately $3.6 billion for Medical
Administration for FY 2009.
Finally, for Medical Facilities The Independent Budget recommends
approximately $4.6 billion. This amount includes an additional $250
million for nonrecurring maintenance for the VA to begin addressing the
massive backlog of infrastructure needs.
Although The Independent Budget healthcare recommendation does not
include additional funding to provide for the healthcare needs of
Category 8 veterans being denied enrollment into the system, we believe
that adequate resources should be provided to overturn this policy
decision. During FY 2008, the VA estimated that a total of over
1,500,000 Category 8 veterans would have been denied enrollment into
the VA healthcare system. Despite the fact that we have not seen any
solid empirical data to substantiate this continued growth rate in
denied Category 8 veterans, the VA continues to project higher and
higher numbers of Category 8 veterans denied enrollment into the
healthcare system. Based on the projected increase in this population
of veterans over the last 5 years, The Independent Budget estimates
that more than 1,870,000 will have been denied enrollment by FY 2009.
Assuming a utilization rate of 20 percent, in order to reopen the
system to these deserving veterans, The Independent Budget estimates
that the actual total cost to reopen the system will be approximately
$1.4 billion in order to meet this new demand. For the sake of
discussion, if the projected collections for this group of veterans
were to be considered in this estimation, the actual cost in
appropriated dollars would be approximately $456 million. We believe
that the system should be reopened to these veterans and that adequate
funding should be provided in addition to our medical care
recommendation.
Although not proposed to have a direct impact on veterans'
healthcare, we are deeply disappointed that the Administration chose to
once again recommend an increase in prescription drug co-payments from
$8 to $15 and an indexed enrollment fee based on veterans' incomes.
These proposals will simply add additional financial strain to many
veterans, including PVA members and other veterans with catastrophic
disabilities. Although the VA does not overtly explain the impact of
these proposals, similar proposals in the past have estimated that
nearly 200,000 veterans will leave the system and more than 1,000,000
veterans will choose not to enroll. It is astounding that this
Administration would continue to recommend policies that would push
veterans away from the best healthcare system in the world. Congress
has soundly rejected these proposals in the past and we call on you to
do so once again.
For medical and prosthetic research, The Independent Budget is
recommending $555 million. This represents a $75 million increase over
the FY 2008 appropriated level established in the Omnibus
Appropriations Act and $113 million over the Administration's request
for FY 2009. We are particularly pleased that Congress has recognized
the critical need for funding in the medical and prosthetic research
account, and we urge Congress to again overrule VA's request, one that
will seriously erode VA's crucial biomedical research programs.
Research is a vital part of veterans' healthcare, and an essential
mission for our national healthcare system. VA research has been
grossly underfunded in contrast to the growth rate of other Federal
research initiatives. At a time of war, the government should be
investing more, not less, in veterans' biomedical research programs.
The Independent Budget recommendation also includes a significant
increase in funding for information technology (IT). For FY 2009, we
recommend that the VA IT account be funded at approximately $2.165
billion. This amount includes approximately $121 million for an
Information Systems Initiative to be carried out by the Veterans
Benefits Administration. This initiative is explained in greater detail
in the policy portion of The Independent Budget.
We remain concerned that the major and minor construction accounts
are significantly underfunded in the FY 2009 budget request. The
Administration's request slashes funding for major construction from
the FY 2008 appropriations level of $1.1 billion to $582 million. The
minor construction account is also significantly reduced from the
appropriated level of $631 million to only $329 million. These funding
levels do little to help the VA offset the rising tide of necessary
infrastructure upgrades. Without the necessary funding to address minor
construction needs, these projects will become major construction
problems in short order. For FY 2009, The Independent Budget recommends
approximately $1.275 billion for major construction and $621 million
for minor construction. The minor construction recommendation includes
$45 million for research facility construction needs.
Finally, Mr. Chairman, as you know, the whole community of national
veterans service organizations strongly supports an improved funding
mechanism for VA healthcare. However, if the Congress cannot support
mandatory funding, there are alternatives which could meet our goals of
timely, sufficient, and predictable funding.
Congress could change VA's medical care appropriation to an advance
appropriation which would provide approval 1 year in advance, thereby
guaranteeing its timeliness. Furthermore, by adding transparency to
VA's healthcare enrollee projection model, we can focus the debate on
the most actuarially-sound projection of veterans' healthcare costs to
ensure sufficiency.
Under this proposal, Congress would retain its discretion to
approve appropriations; retain all of its oversight authority; and most
importantly, there would be no PAYGO problems.
We ask this Committee in your views and estimates for FY 2009 to
recommend to the Budget Committee either mandatory funding or this new
advance appropriations approach to take the uncertainties out of
healthcare for all of our Nation's wounded, sick and disabled veterans.
In the end, it is easy to forget, that the people who are
ultimately affected by wrangling over the budget are the men and women
who have served and sacrificed so much for this Nation. We hope that
you will consider these men and women when you develop your budget
views and estimates, and we ask that you join us in adopting the
recommendations of The Independent Budget.
This concludes my testimony. I will be happy to answer any
questions you may have.
Prepared Statement of Kerry Baker
Associate National Legislative Director, Disabled American Veterans
Mr. Chairman and Members of the Committee:
I am pleased to have this opportunity to appear before you on
behalf of the Disabled American Veterans (DAV), one of four national
veterans' organizations that create the annual Independent Budget (IB)
for veterans programs, to summarize our recommendations for fiscal year
(FY) 2009.
As you know, Mr. Chairman, the IB is a budget and policy document
that sets forth the collective views of DAV, AMVETS, Paralyzed Veterans
of America (PVA), and Veterans of Foreign Wars of the United States
(VFW). Each organization accepts principal responsibility for
production of a major component of our Independent Budget--a budget and
policy document on which we all agree. Reflecting that division of
responsibility, my testimony focuses primarily on the variety of
Department of Veterans Affairs' (VA) benefits programs available to
veterans.
In preparing this 22nd Independent Budget, the four partners draw
upon our extensive experience with veterans' programs, our firsthand
knowledge of the needs of America's veterans, and the information
gained from continuous monitoring of workloads and demands upon, as
well as the performance of, the veterans benefits and services system.
Consequently, this Committee has acted favorably on many of our
recommendations to improve services to veterans and their families. We
ask that you give our recommendations serious consideration again this
year.
The Veterans Benefits Administration is Still Understaffed and
Overwhelmed
To improve administration of VA's benefits programs, the IB
recommends Congress provide the Veterans Benefits Administration (VBA)
with enough staffing to support a long-term strategy for improvement in
claims processing and for other programs under jurisdiction of the VBA.
Included in our recommendations are new resources needed for training
programs and information technologies; however, this testimony primary
focuses on solving VA's staffing shortages as well as other initiatives
to manage the increase in new claims and reduce the out-of-control
claims backlog. In total, if Congress accepts our recommendations, VBA
will be better positioned to serve all disabled veterans and their
families.
Understaffing and Claims Backlog
Mr. Chairman, the claims' backlog is unquestionably growing. Rather
than making headway and overcoming the protracted delays in the
disposition of its claims, VA continues to lose ground on its claims
backlog. According to VA's weekly workload report, as of January 26,
2008, there were 816,211 pending compensation and pension (C&P) claims,
which include appeals. Putting this number into perspective, at the end
of 2004, 2005, 2006, and 2007, the total number of pending claims was
620,926; 680,432; 752,211; and 809,707 respectively. Therefore, in the
3 years from the end of 2004 to the end of 2007, the total number of
pending C&P claims rose by 188,781 for an average of 62,929 additional
pending claims per year. The VA's pending claims rose by 6,504 just
from the end of 2007 to January 26, 2008--less than 1 month. At this
rate, VA's caseload will pass 1 million claims in 3 years. With the
wars in Iraq and Afghanistan still raging, together with the mass
exodus from military service that usually occurs following cessation of
combat operations, new and re-opened claims received by VA are more
likely to increase than decrease. A caseload topping 1 million claims
will truly be a demoralizing moment for America--the time to act is
now.
Throughout the foregoing years, many promises were made in public;
yet VBA staffing has essentially remained nearly flat at between 9,200
to 9,500 full-time employees (FTE)--9,287 in FY 2006; 9,445 in FY 2007;
and 9,559 in FY 2008. (The FY 2008 figure does not currently take into
account increased staffing levels authorized in the most recent
appropriations bill for 2008.) While we do not suggest additional
resources as the solitary answer to the claims backlog, the current VBA
staffing levels have proven year after year to be significantly below
the levels needed to halt the growth in the claims backlog, much less
sufficient to begin reducing the backlog. There is no proverbial silver
bullet to solving VA's challenges. Various policy changes can and
should be implemented that may collectively have a positive impact on
reducing VA's claims backlog while also improving services to VA's
clientele. Nonetheless, implementing any policy change will utterly
fail without a significant increase in VBA staffing that is at least on
parity with VA's increased receipt of new and reopened claims as well
as its ever-growing claims backlog,
Based on an estimated receipt of 920,000 claims in FY 2009,
Congress should authorize 12,184 FTE for FY 2009. That number equates
to 83 cases per year per each direct program FTE. The IB veterans'
organizations realize that 83 claims per FTE are below VA's historical
projections per FTE. Nonetheless, an infusion of new personnel into
VBA's workforce will inevitably result in a reduced output per FTE for
a significant length of time. These newly allotted employees will be
unable to process claims at rates equal to experienced employees.
Additionally, senior staff within VBA will be forced to frequently halt
production of their own workload in order to provide necessary training
to inexperienced employees. We nonetheless strongly encourage the VA to
provide adequate training to ensure that claims are decided properly
the first time. Therefore, the reduction in workload per FTE is
unavoidable.
Additionally, VBA's new claims per year continue to increase from
one year to the next despite VA's 2008 budget assertion that such
claims were going to decline. For example, VBA received 771,115 new
rating claims in FY 2004 and 838,141 new claims in FY 2007, equaling an
average increase of 16,756 additional claims per year. During this same
period, VA received the following Benefits Delivery at Discharge (BDD)
claims: 39,885 in FY 2004; 37,832 in FY 2005; 40,074 in FY 2006; and
37,370 in FY 2007, for a total 155,164 new beneficiaries that had never
before been on VA rolls. At this rate, the average number of new BDD
claims per year is 38,791 for a total of 232,746 new claims through the
BDD process by the end of FY 2009. These figures do not include
servicemembers filing claims through either the military's physical
disability evaluation systems, or those discharging via end-of-service
contracts who then come to VA on their own to files claims after
discharge.
The significance of these new beneficiaries is that large portions
of VA's workload increase via new claims each year are re-opened claims
rather than claims from veterans who have never filed for VA benefits.
Therefore, the increase in brand new beneficiaries into the system will
inevitably increase further the number of re-opened claims, ultimately
causing the total number of claims received by VA each year to continue
growing, contrary to VA's FY 2008 budget estimate. VA's 2009 budget
submission reveals the VA added 277,000 beneficiaries to its C&P rolls
in 2007, which further proves this point.
The complexity of the workload has also continued to grow. Veterans
are claiming greater numbers of disabilities and the nature of
disabilities such as post traumatic stress disorder (PTSD), complex
combat injuries, diabetes and related conditions, and environmental
diseases are becoming increasingly more complex. For example, the
number of cases with 8 or more disabilities increased 135 percent from
21,814 in 2000 to 51,260 in 2006.\1\ Such complex cases will only
further slow down VBA's claims process.
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\1\ Fiscal Year 2008 Budget Submission, Volume II, National
Cemetery Administration, Benefits Programs, and Departmental
Administration, Benefits Summary, Department of Veterans Affairs, Pg.
6A-2 (Retrieved Feb. 2, 2008, from ).
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We believe that adequate staffing is essential to any meaningful
strategy to get claims processing and backlogs under control. In its
budget submission for FY 2007, VBA projected its production based on an
output of 109 claims per direct program FTE. We have long argued that
VA's production requirements do not allow for thorough development and
careful consideration of disability claims, resulting in compromised
decisions, higher error and appeal rates, and ultimately more overload
on the system. In addition to recommending staffing levels more
commensurate with the workload, we have maintained that VA should
invest more in training adjudicators and that it should hold them
accountable for higher standards of accuracy. Nearly half of VBA
adjudicators responding to survey questions from VA's Office of
Inspector General admitted that many claims are decided without
adequate record development. (The Board of Veterans' Appeals (Board)
and the Court of Appeals for Veterans Claims' (Court's) remand rate
clearly demonstrate this.) The Inspector General saw an incongruity
between their objectives of making legally correct and factually
substantiated decisions, with management objectives of maximizing
output to meet production standards and reduce backlogs. Nearly half of
those surveyed reported that it is generally, or very difficult, to
meet production standards without compromising quality. Fifty-seven
percent reported difficulty meeting production standards while
attempting to ensure they have sufficient evidence for rating each case
and thoroughly reviewing the evidence. Most attributed VA's inability
to make timely and high-quality decisions to insufficient staff. In
addition, they indicated that adjudicator training had not been a high
priority in VBA.
Therefore, we believe it prudent to recommend staffing levels based
on an output of 83 cases per year for each direct program FTE. With an
estimated 920,000 incoming claims in FY 2009, that effort would require
11,084 direct program FTEs in fiscal year 2009. With support FTE added,
this would require C&P to be authorized 12,184 total FTE for FY 2009.
Adjudicating veterans' claims is a labor-intensive system of
personal decisionmaking, with lifelong consequences for disabled
veterans. During Congressional hearings, VA is routinely forced to
defend VBA budgets that it knows to be inadequate to the task. The
priorities and goals of Congress, the Administration, and the VA must
be on par with the necessity for a long-term strategy to fulfill VBA's
mission and confirm the Nation's moral obligation to disabled veterans.
Overdevelopment of Claims
Numerous developmental procedures in the VA claims' process
collectively add to the enormous backlog of cases. While many of these
procedures are mandatory, they are often over-utilized. This
unnecessarily delays claims for months--when this occurs in, or leads
to, the appeals process, claims are delayed for many years. There is no
single answer to solving the claims backlog. Therefore, in addition to
staffing increases, Congress and VA must attack the problem using
alternative methods, particularly when those alternative methods are
parallel with the intent of the law, work to save departmental
resources, and protect the rights of disabled veterans.
For example, rather than making timely decisions on C&P claims when
evidence development may be complete, the VA routinely continues to
develop claims. These actions lend validity to many veterans'
accusations that whenever VA would rather not grant a claimed benefit,
VA intentionally overdevelops cases to obtain evidence against the
claim. Despite these accusations, a lack of adequate training is just
as likely the cause of such overdevelopment.
Such actions result in numerous appeals, followed by needless
remands from the Board and/or the Court. In many of these cases, the
evidence of record supports a favorable decision on the appellant's
behalf yet the appeal is remanded nonetheless. These unjustified
remands usually do nothing but perpetuate the hamster-wheel reputation
of veterans' law. Numerous cases exemplify this scenario; a list can be
provided upon request. One such example is summarized in the IB
submission. For the sake of brevity, we will not repeat the summary
here, but urge the Committee to review the example titled Improvements
in the Claims Process, which can be found in the Compensation and
Pension section of the General Operating Expenses chapter.
This example deals with VA requesting unnecessary medical opinions
in cases where the claimant has already submitted one or more medical
opinions that are adequate for rating purposes. VA claimants desiring
to secure their own medical evidence, including a fully informed
medical opinion, are entitled by law to do so. If a claimant does
secure an adequate medical opinion, there is no need in practicality or
in law for VA to seek its own opinion. Congress enacted title 38,
United States Code, section 5125 for the express purpose of eliminating
the former 38 Code of Federal Regulations, section 3.157(b)(2)
requirement that a private physician's medical examination report be
verified by an official VA examination report prior to an award of VA
benefits. Section 5125 states:
For purposes of establishing any claim for benefits under
chapter 11 or 15 of this title, a report of a medical
examination administered by a private physician that is
provided by a claimant in support of a claim for benefits under
that chapter may be accepted without a requirement for
confirmation by an examination by a physician employed by the
Veterans Health Administration if the report is sufficiently
complete to be adequate for the purpose of adjudicating such
claim. [Emphasis added]
Therefore, Congress codified section 5125 to eliminate unnecessary
delays in the adjudication of claims and to avoid costs associated with
unnecessary medical examinations. Notwithstanding the elimination of
title 38, Code of Federal Regulations, section 3.157, and the enactment
of title 38 United States Code section 5125, VA consistently refuses to
render decisions in cases wherein the claimant secures a private
medical examination and medical opinion until a VA medical examination
and medical opinion are obtained. Such actions are an abuse of
discretion, which delay decisions and prompt needless appeals. When
claimants submit private medical evidence that is adequate for rating
purposes, Congress should mandate that VA must decide the case based on
such evidence rather than delaying the claim by arbitrarily and
unnecessarily requesting additional medical examinations and opinions
from the agency. Such enactment will preserve VA's manpower and
budgetary resources; help reduce the claims backlog and prevent
needless appeals; and most importantly, better serve disabled veterans
and their families.
Standard for Determining Combat Veteran Status
Title 38, United States Code, section 1154(b) requires VA to accept
lay or other evidence as sufficient proof of service connection of a
disease or injury if a veteran alleges that disease or injury occurred
in or was aggravated during combat. While VA recognizes the receipt of
certain medals as proof of combat, only a fraction of those who
participate in combat receive a qualifying medal. Further, military
personnel records usually do not document actual combat experiences. As
a result, veterans who suffer a disease or injury resulting from combat
are forced to provide evidence that may not exist or wait a year or
more while the VA conducts research to determine whether a veteran's
unit engaged in combat.
Congress should amend title 38, United States Code, section 1154(b)
to clarify military service as treatable service in which a member is
considered to have engaged in combat for purposes of determining
combat-veteran status. Such clarification would properly allow for
utilization of nonofficial evidence as proof of in-service occurrence
for service connection of combat-related diseases or injuries.
This type of legislation would remove a barrier to the fair
adjudication of claims for disabilities incurred or aggravated by
military service in combat zone. Under existing law, veterans who can
establish that they ``engaged in combat'' are not required to produce
official military records to support their claim for disabilities
related to such service. This legislation would not alter the law's
current requirement that a veteran confirm a disability through
official diagnosis. Further, it would not alter the requirement that a
veteran show a nexus between a claimed disability and military service.
The only alteration from current law would be a relaxed standard of
proof, consistent with Congress' original intent, required to establish
a veteran as one who engaged in combat. This relaxed standard of proof
would then only apply to those who serve in a combat zone.
Many veterans disabled by their service in Iraq and Afghanistan,
and those who served in earlier conflicts are unable to benefit from
liberalizing evidentiary requirements found in the current version of
section 1154(b). This results because of difficulty, even
impossibility, in proving personal participation in combat by official
military documents.
Impositions put forth by VA General Counsel opinion 12-99 require
veterans to establish by official military records or decorations that
they ``personally participated in events constituting an actual fight
or encounter with a military foe or hostile unit or instrumentality.''
Oversight visits by Congressional staff to VA regional offices found
claims denied under this policy because those who served in combat
zones were not able to produce official military documentation of their
personal participation in combat via engagement with the enemy. The
only possible resolution to this problem without amending section
1154(b) is for the military to record the names and personal actions of
every single soldier, sailor, airman, and Marine involved in every
single event--large or small--that constitutes combat and/or engagement
with the enemy on every single battlefield. Such recordkeeping is
impossible.
Numerous veterans have been and continue to be harmed by this
defect in the law. In numerous cases, extensive delays in claims
processing occur while VA adjudicators attempt to obtain official
military documents showing participation in combat: documents that may
never be located.
The Senate noted in 1941, in the report on the original bill that
the absence of an official record of care or treatment in many of such
cases is explained by the conditions surrounding the service of combat
veterans. Congress emphasized that the establishment of records for
non-combat veterans was a simple matter compared to the combat
veteran--either the veteran carried on despite his disability to avoid
having a record made lest he or she be separated from his or her
organization or, as in many cases, the records themselves were lost.
Likewise, many records are simply never generated.
Congress should clarify its intent by amending title 38, United
States Code, section 1154(b), with respect to defining a veteran who
engaged in combat for all purposes under title 38, as a veteran who
during active service served in a combat zone for purposes of section
112 of the Internal Revenue Code 1986 or a predecessor provision of
law.
Information Technology
Mr. Chairman, in addition to boosting its staffing, we believe VBA
must continue to upgrade its information technology infrastructure and
revise its training tools to stay abreast of modern business practices,
to maintain efficiency, and to meet increasing workload demands. With
the continually changing environment in claims processing and benefits
administration, anything less is a recipe for failure.
In recent years, however, Congress has actually reduced
significantly the funding for such VBA initiatives. In fiscal year
2001, Congress provided $82 million for VBA initiatives. In FY 2002, it
provided $77 million; in 2003, $71 million; in 2004, $54 million; in
2005, $29 million; and, in 2006, $23 million, despite VBA's undeniable
challenges.
With restored investments in its initiatives, VBA could complement
staffing increases for higher workloads with a support infrastructure
designed to increase operational effectiveness. VBA could resume an
adequate pace in its development and deployment of information
technology solutions, as well as upgrade and enhance training systems,
to improve operations and service delivery.
Court of Appeals for Veterans Claims
The Congressional mandate that VA claimants receive the benefit of
the doubt in appropriate cases is the cornerstone of veterans' benefits
derived from military service. Yet, the Court has ignored the intent of
Congress by creating a judicial roadblock that completely isolates
claimants from their statutory right to the benefit of the doubt.
Title 38, United States Code, section 5107(b) grants claimants the
benefit of the doubt as a matter of law with respect to any benefit
under laws administered by the Secretary of Veterans Affairs
(Secretary) when there is an approximate balance of positive and
negative evidence regarding any issue material to the determination of
a matter. Yet, the Court has been affirming any BVA denial when the
record contains only minimal evidence necessary to show a ``plausible
basis'' for such finding. This renders a claimant's statutory right to
the benefit of the doubt futile because claims can be denied and the
denial upheld when supported by far less than a preponderance of the
evidence.
Congress tried to correct this situation by amending the law with
the enactment of the Veterans Benefits Improvement Act of 2002 \2\ to
require the Court to consider whether Board findings were consistent
with the benefit-of-the-doubt rule. The intended effect of section 401
of the Veterans Benefits Act of 2002 has not been upheld by the
court.\3\
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\2\ Pub. L. No. 107-330, 401, 116 Stat. 2820, 2832.
\3\ Section 401 of the Veterans Benefits Act, effective December 6,
2002, amended title 38, United States Code, sections 7261(a)(4) and
(b)(1).
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Prior to the enactment of Veterans Benefits Act, the Court's case
law provided (1) that the court was authorized to reverse a finding of
fact when the only permissible view of the evidence of record was
contrary to that found by the Board, and (2) that a finding of fact
must be affirmed where there was a plausible basis in the record for
the Board's determination. However, Congress added new language to
section 7261(b)(1) that mandates the Court to review the record before
the Secretary pursuant to section 7252(b) of title 38 and ``take due
account of the Secretary's application of section 5107(b) of this
title. . . .'' \4\ The Secretary's obligation under section 5107(b), as
referred to in section 7261(b)(1), is as follows:
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\4\ See 38 U.S.C. Sec. 7261(b)(1).
(b) BENEFIT OF THE DOUBT--The Secretary shall consider all
information and lay and medical evidence of record in a case
before the Secretary with respect to benefits under laws
administered by the Secretary. When there is an approximate
balance of positive and negative evidence regarding any issue
material to the determination of a matter, the Secretary shall
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give the benefit of the doubt to the claimant.
Prior to enactment of Veterans Benefits Act section 401, the Court
characterized the benefit-of-the-doubt rule as mandating that ``when .
. . the evidence is in relative equipoise, the law dictates that [the]
veteran prevails'' and that, conversely, a VA claimant loses only when
``a fair preponderance of the evidence is against the claim.'' \5\
Nonetheless, such characterizations have historically proven to be
nothing more than meaningless rhetoric.
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\5\ Gilbert v. Derwenski, 1 Vet.App. 49, 54-55 (1990).
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Reading amended sections 7261(a)(4) and 7261(b)(1) together, which
must be done in order to determine the effect of the Veterans Benefits
Act section 401 amendments, reveals the Court is now directed, as part
of its scope-of-review responsibility under section 7261(a)(4), to
undertake three actions in deciding whether adverse Board findings are
clearly erroneous and, if so, what the court should hold as to that
finding. The plain meaning of the amended subsections (a)(4) and (b)(1)
require the Court (1) to review all evidence before the Board; (2) to
consider the application of the benefit-of-the-doubt rule in view of
that evidence; and (3) if after carrying out actions (1) and (2), the
Court concludes that an adverse Board finding is clearly erroneous and
therefore unlawful, to set it aside or reverse it.
Therefore, as the foregoing discussion illustrates, Congress
intended the Veterans Benefits Act section 401 amendments to
fundamentally alter the Court's review of Board decisions. This is
evident by the plain meaning of the amended language and the
amendment's unequivocal legislative history. Congress intended the
Court to take a more proactive and less deferential role in its
judicial review. For example, Congress specifically intended the Court
``to examine the record of proceedings--that is, the record on appeal--
before the Secretary and BVA. Section 401 also provides special
emphasis during the judicial process to the `benefit of the doubt'
provisions of section 5107(b) as the Court makes findings of fact in
reviewing BVA decisions. The combination of these changes is intended
to provide for more searching appellate review of BVA decisions, and
thus give full force to the benefit-of-the-doubt provision.'' \6,7\
This language is consistent with the existing section 7261(c), which
precludes the Court from conducting trial de novo when reviewing VA
decisions--receiving evidence not part of the record before the Board.
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\6\ 148 CONG. REC. S11334 (remarks of Sen. Rockefeller).
\7\ 148 CONG. REC. S11337, H9003 (daily ed. Nov. 18, 2002)
(explanatory statement printed in Congressional Record as part of
debate in each body immediately prior to final passage of compromise
agreement).
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Perhaps the most dramatic of the three Court actions directed by
section 401 was the mandate that the Court ``take due account of the
Secretary's application of section 5107(b),'' i.e., the ``benefit-of-
the-doubt rule.'' It is against this more relaxed standard of review
that, through the Veterans Benefits Act section 401, Congress has now
required the Court to review the entire record on appeal and to examine
the Secretary's determination as to whether the evidence presented was
in equipoise on a particular conclusion. The foregoing notwithstanding,
the Court's equipoise review is no better after the Veterans Benefits
Act section 401 than it was before section 401 was enacted. The Court
has ignored Congress' intent.
In light of this background, the section 401 mandate supersedes the
previous Court practice of upholding a factual finding unless the only
permissible view of the evidence is contrary to that found by the
Board. Likewise, section 401 overrules the requirement that a Board
finding of fact must be affirmed where there is a ``plausible basis''
in the record for the determination. Yet, the nearly impenetrable
``plausible basis'' standard continues to prevail to this very date as
if Congress never amended section 7261. The former Ranking Minority
Member of this Committee, spoke in strong support of this amendment and
explained that ``the bill . . . clarifies the authority of the [Court]
to reverse decisions of the [BVA] in appropriate cases and requires the
decisions be based upon the record as a whole, taking into account the
pro-veteran rule known as the benefit of the doubt.'' \8\
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\8\ 148 CONG. REC. H9003.
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Ultimately, the Board sits in near splendid isolation to
arbitrarily weigh evidence and unfairly determine its probative value.
Such determinations are the lynchpin in claims for benefits by disabled
veterans. Regardless of the quantity and quality of evidence in favor
of a claimant's case, a Board's conclusion that an infinitesimal amount
of unfavorable evidence, however much lacking in quality, outweighs and
is more probative than an immeasurable amount of high-quality evidence
is practically untouchable by the Court. Worse yet, it is the Court's
own doing. Essentially, when the Board renders this type of decision
that turns on the weighing of such evidence, the Court is precluded
from even considering the benefit-of-the-doubt rule. Evidence must
first be in equipoise, or balance, for the benefit of the doubt to
apply. As soon as the Board finds the slightest plausible basis that a
claimant's evidence preponderates against the claim, the favorable and
unfavorable evidence is no longer in balance. Unless the Court finds
such a ruling to be clearly erroneous, meaning there is no plausible
basis regardless of how trivial such basis may be, the Court cannot
overturn the ruling. Consequently, if the Court cannot overturn the
ruling, it can never reach a review of the Board's application of the
benefit of the doubt. The Court has therefore created a barrier between
itself and a VA claimant's statutory right to the benefit of the
doubt--a barrier moveable only by Congress.
Congress should not allow any Federal court to ignore its
legislative power, particularly one charged with the protection of
rights afforded to our Nation's disabled veterans and their families.
To ensure the Court enforces the benefit-of-the-doubt rule, Congress
should replace the clearly erroneous standard with a requirement that
the Court will reverse a factual finding adverse to a claimant when it
determines such finding is not reasonably supported by a preponderance
of the evidence.
Solving the Court's Backlog
The Board and the Court add substantially to the claims backlog by
needlessly and frequently remanding numerous cases on appeal. In many
of these appeals, the evidence of record fully supports a favorable
decision on the appellant's behalf, yet the appeal is remanded
nonetheless. These unjustified remands deprive the appellant, usually
for many additional years, to benefits awardable based on facts already
of record.
The greatest challenge facing the Court is identical to the VA--the
backlog of cases. The Court has shown a reluctance to reverse errors
committed by the Board. Rather than addressing an allegation of error
raised by an appellant, the Court has a propensity to vacate and remand
cases to the Board based on an allegation of error made by the VA's
counsel for the first time on appeal, such as an inadequate statement
of reasons or bases in a Board decision. Another example occurs when
the VA argues, again for the first time on appeal, for remand by the
Court because VA failed in its duty to assist the claimant in
developing the claim notwithstanding an express finding by the Board
that all development is complete and where the appellant accepts, and
does not challenge such finding by the Board. Such actions are
particularly noteworthy because the VA has no legal authority to appeal
a Board decision to the Court.\9\
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\9\ 38 U.S.C.A., Sec. 7252(a) (West 2002) (``The Court of Appeals
for Veterans Claim shall have exclusive jurisdiction to review
decisions of the Board of Veterans' Appeals. The Secretary may not seek
review of any such decision.'')
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Consequently, the Court will generally decline to review alleged
errors raised by an appellant that actually serve as the basis of the
appeal. Instead, the Court remands the remaining alleged errors on the
basis that an appellant is free to present those errors to the Board
even though an appellant may have already done so, leading to the
possibility of the Board repeating the same mistakes on remand that it
had previously. Such remands leave errors properly raised to the Court
unresolved; reopen the appeal to unnecessary development and further
delay; overburden an already backlogged system; exemplify far too
restrictive judicial restraint; and inevitably require an appellant to
invest many more months and perhaps years of his or her life in order
to receive a decision that the Court should have rendered on initial
appeal. As a result, an unnecessarily high number of cases are appealed
to the Court for the second, third, or fourth time.
In addition to postponing decisions and prolonging the appeal
process, the Court's reluctance to reverse Board decisions provides an
incentive for VA to avoid admitting error and settling appeals before
they reach the Court. By merely ignoring arguments concerning legal
errors rather than resolving them at the earliest stage in the process,
VA contributes to the backlog by allowing a greater number of cases to
go before the Court. If the Court would reverse decisions more
frequently, VA would be discouraged from standing firm on decisions
that are likely to be overturned or settled late in the process.
To remedy this unacceptable situation, Congress should amend title
38, United States Code section 7261 to require the Court on a de novo
basis, to: (1) decide all relevant questions of law; (2) interpret
constitutional, statutory, and regulatory provisions; and (3) determine
the meaning or applicability of the terms of an action of the
Secretary. The Court's jurisdiction should also be amended to require
it to decide all assignments of error properly presented by an
appellant.
General
The benefit programs are effective for their intended purposes only
to the extent VBA can deliver benefits to entitled veterans and
dependents in a timely fashion. However, in addition to ensuring that
VBA has the resources necessary to accomplish its mission in that
manner, Congress must also make adjustments to the programs from time
to time to address increases in the cost of living and needed
improvements. We invite your attention to the IB itself for the details
of those issues, but the following summarizes a number of
recommendations to adjust rates and improve the benefit programs
administered by VBA:
Cost-of-living adjustments for compensation, specially
adapted housing grants, and automobile grants, with provisions for
automatic annual increases in the housing and automobile grants based
on increases in the cost of living.
A presumption of service connection for hearing loss and
tinnitus for combat veterans and veterans who had military duties
involving high levels of noise exposure who suffer from tinnitus or
hearing loss of a type typically related to noise exposure or acoustic
trauma.
Removal of the provision that makes persons who first
entered service before June 30, 1985, ineligible for the Montgomery GI
Bill, along with other improvements to the program.
No increase in, and eventual repeal of, funding fees for
VA home loan guaranty.
Increase in the maximum coverage and adjustment of the
premium rates for Service-Disabled Veterans' Life Insurance.
Increase in the maximum coverage available in policies of
Veterans' Mortgage Life Insurance.
Legislation to restore protections for veterans' benefits
against awards to third parties in divorce actions.
Legislation to increase Dependency and Indemnity
Compensation for certain survivors of veterans, and to no longer offset
DIC with Survivor Benefit Plan payments.
We hope the Committee will review these recommendations and give
them consideration for inclusion in your legislative plans and will
support their funding in the Congressional Budget Resolution for FY
2009, as well as subsequent appropriations.
Mr. Chairman, thank you for inviting DAV and other member
organizations of The Independent Budget to testify before you today.
Prepared Statement of Dennis M. Cullinan, Director
National Legislative Service, Veterans of Foreign Wars of the United
States
MR. CHAIRMAN AND MEMBERS OF THIS COMMITTEE:
On behalf of the 2.4 million men and women of the Veterans of
Foreign Wars of the United States (VFW) and our Auxiliaries, I would
like to thank you for the opportunity to testify today. The VFW works
alongside the other members of The Independent Budget (IB)--AMVETS,
Disabled American Veterans and Paralyzed Veterans of America--to
produce a set of policy and budget recommendations that reflect what we
believe would meet the needs of America's veterans. The VFW is
responsible for the construction portion of the IB, so I will limit my
remarks to that portion of the budget.
The Administration's fiscal year 2009 budget request for major and
minor construction is woefully inadequate, especially in light of the
Administration's own supporting documents. Despite hundreds of pages of
budgetary documents that show a need for millions of dollars in
construction projects, the Administration saw fit to halve the major
and minor construction accounts from the FY 2008 levels, failing to
meet the future needs of our veterans. We look to you in Congress to
correct this, and to advance VA's construction priorities so that
future generations of veterans--those currently serving in the deserts
of Iraq and the mountains of Afghanistan--can have a first-rate VA
healthcare system that lives up to their needs.
MAJOR CONSTRUCTION
The President's request for major construction is a paltry $581.6
million for FY 2009. This is a dramatic cut from last year's funding
level of $1.1 billion. While we appreciate that this level covers eight
medical facility projects, including three new previously unfunded
projects, the total level of funding does not come close to meeting the
IB's recommendation of $1.275 billion in construction projects. Four
hundred seventy-six point six million dollars of the Administration's
request covers Veterans Health Administration projects, significantly
lower than the $1.1 billion that the IB has called for.
In determining our recommendations, we follow VA's prioritization
process as VA discusses in its annual 5-Year Capital Plan, which is
included in Volume III of the Department's budget submission.
VA determines its budget year priorities in two phases. First,
partially funded projects from previous years are ordered by fiscal
year and priority order. Second, newly evaluated projects from the
current budget year are listed in priority order. These are combined,
with the first category receiving priority over the second.
For the current year's process, VA had seven partially unfunded
projects at the top of the list and chose to provide funding for five
of those projects. They also began to provide funding for the top three
new projects as ranked in the current fiscal year: Bay Pines, FL;
Tampa, FL; and Palo Alto, CA. We certainly appreciate the progress on
new construction projects as last year's funding request did not call
for any new projects. We also appreciate the focus on construction and
improvements to VA's polytrauma centers. We believe, however, that more
can and must be done.
While the eight major construction projects might sound like a lot,
the funding levels recommended for them are a tiny blip in the overall
costs of those projects. If we look at just the partially unfunded
projects--the backlog, if you will--even the $320 million aimed at them
barely scratches the surface. Only the Lee County, Florida, outpatient
clinic is funded to completion. The other four projects still require a
total future funding level of $1.26 billion. The funding for the three
new projects totals $76.8 million out of a total construction estimate
of $771 million. This is important because it means that there will be
a total construction backlog of over $2 billion when the Administration
prepares its request for the following fiscal year. It is increasingly
unlikely that the top priority construction projects--likely to include
this year's number four priority project in Seattle, Washington, or
improvements in Dallas, Texas, or Louisville, Kentucky--will be funded
in future years while VA's meager construction budget is earmarked only
to prior projects, as was the case with last year's funding request.
I would refer you to the table on page 7-12 of VA's 5-Year Capital
Plan for the full list of projects VA considered funding in the current
year. The increase in funding that we are calling for could be applied
to those prior year projects we referred to previously, or to the FY
2009 scored projects. Both categories desperately need funding beyond
the Administration's request. Even an increase of about $31 million
would allow VA to begin the first stages of construction on priority
projects 4-6, which typically requires 10% of the total cost estimate.
These projects are necessary to ensure that VA properly reinvests
in its aging physical infrastructure. VA's facilities average over 50
years old, and VA has historically recapitalized at a rate far below
hospital industry standards. From 1996-2001, for example, VA
recapitalized at a rate of just 0.64% per year. This corresponds with
an assumed building life of 155 years, far beyond any reasonable
expectations. VA has made progress since then, but more clearly must be
done, especially if we are to live up to the promise of CARES and
modernize the system so that veterans now and into the future will have
first-rate healthcare in clean, safe, modern and comfortable
facilities.
We remain concerned about the unfulfilled promise of CARES. Upon
completion of the CARES decision document, former VA Secretary Anthony
Principi testified before the Health Subcommittee of the House
Committee on Veterans' Affairs in July 2004. His testimony noted that
CARES ``reflects a need for additional investments of approximately $1
billion per year for the next 5 years to modernize VA's medical
infrastructure and enhance veterans' access to care.''
According to VA's November 2007 testimony before that same
Committee, Congress has appropriated just $2.83 billion for CARES
projects, far below the need to which the Secretary had testified.
Further, this includes a sizeable amount for rebuilding facilities
after the Gulf Coast hurricanes--amounts we have argued that Congress
should have provided as separate emergency funding, outside of VA's
regular planning process. With the FY 2008 appropriation, the total is
up to $3.9 billion--better, but still lagging.
With just $581 million requested for major construction in FY 2009,
which is far below VA's demonstrated needs, it is clear that VA is
falling short. After that 5-year de facto moratorium on construction
while CARES was ongoing and without additional funding coming forth, VA
and veterans have an even greater need than they did at the start of
the CARES process. Accordingly, we urge action to live up to the
Secretary's words by making a steady investment in VA's capital
infrastructure to bring the system up to date with the 21st century
needs of veterans.
MINOR CONSTRUCTION
We also are greatly concerned with the Administration's proposed
slashing of the minor construction budget. As with the major
construction account, this cut is contrary to the information the
Department provides in the total budget document. For FY 2009, the
recommendation is just $329 million, $301 million below the FY 2008
level and far below the $621 million called for in The Independent
Budget.
Two hundred seventy-three million dollars of the request is
targeted for VHA facilities and $18 million--about 5 percent of the
total--is allocated for staff offices to accommodate the consolidation
of VA's information technology programs.
VA has a long list of minor construction projects targeted for FY
2009. There is a list of 145 minor construction projects listed on page
7-95 of the 5-Year Capital Plan. Although there is no cost specifically
associated with them, we can estimate the cost using the average cost
of the scored projects from FY 2008, which can be found on page 7-90.
For the FY 2008 projects listed, the average price per project is $5.6
million. If you multiply that cost per project by the 145 proposed FY
2009 projects, VHA would require a budget of $812 million, nearly $500
million more than they have actually requested. We understand that VA
has some carryover funding for minor construction to offset some of
that balance, but even if all $267 million of that were applied to this
list of projects, VHA would still require $545 million in funding
instead of the $273 the Administration has requested.
The minor construction request seems even more deficient when you
factor in its role with respect to the maintenance of VA's facilities.
Every medical center is surveyed at least once every 3 years and given
a thorough assessment of all component systems. These reviews comprise
the Facility Condition Assessment (FCA), and the scores are used, in
part, to produce the condition index of the facility, one of the
benchmark statistics in VA's Real Property Scorecard. The majority of
funding for projects and systems found to be deficient through the FCA
is nonrecurring maintenance (NRM), but VA says that 30% of all minor
construction is targeted to correct documented FCA deficiencies. In FY
2007, VA notes that its FCA backlog was well over $5 billion in
projects. Congress has done a good job to improve some of these
deficiencies--notably the $550 supplemental that was targeted toward
FCA problems--but more must be done if VA is going to properly maintain
its facilities.
NONRECURRING MAINTENANCE
Those FCA reviews show the importance of NRM, and the $5 billion
backlog shows how woefully deficient past NRM requests and
appropriations have been. It is sad that it took the unconscionable
situation at Walter Reed--a non-VA facility--to demonstrate the
importance of the account. We certainly applaud VA's efforts post-
Walter Reed to assess the maintenance of its infrastructure and
Congress' immediate response, but it should not have come to that. The
problems with the lack of NRM funding have been repeatedly pointed out
in The Independent Budget, and we continue to ask Congress and the
Administration to do more.
For FY 2009, we are pleased to see that the President has requested
$802 million for NRM funding. This is in line with what the IB has
called for in the past. For justification of our number, we continue to
cite the Price Waterhouse review of VA's facility management programs
that cited industry standards to claim that VA should be spending
between 2 and 4 percent of its plant replacement value on NRM. VA
accepted this recommendation and adopted it as part of its Asset
Management Plan. That VA document noted that VA's plant replacement
value was approximately $40 billion, and accordingly, the NRM budget
should be between $800 million and $1.6 billion.
With the near-$5 billion backlog in FCA-observed maintenance needs,
the proposed $802 million is surely on the low end. That amount would
allow VA to perform maintenance at current levels, but not to dip into
the backlog. Accordingly, we would like Congress to increase funding
for this account, as has been done in the past. We need to eliminate
the backlog to ensure that veterans have healthcare in clean, safe, and
efficient locations, and that VA properly cares for its infrastructure
to ensure that it lasts for years into the future.
Mr. Chairman, this concludes my statement. I would be happy to
answer any questions that you or the Members of the Committee may have.
Prepared Statement of Raymond C. Kelley
National Legislative Director, American Veterans (AMVETS)
Chairman Filner, Ranking Member Buyer, and Members of the
Committee:
AMVETS is honored to join our fellow veterans service organizations
and partners at this important hearing on the Department of Veterans
Affairs budget request for fiscal year 2009. My name is Raymond C.
Kelley, National Legislative Director of AMVETS, and I am pleased to
provide you with our best estimates on the resources necessary to carry
out a responsible budget for VA.
AMVETS testifies before you as a co-author of The Independent
Budget. This is the 22nd year AMVETS, the Disabled American Veterans,
the Paralyzed Veterans of America, and the Veterans of Foreign Wars
have pooled our resources to produce a unique document, one that has
stood the test of time.
In developing The Independent Budget, we believe in certain guiding
principles. Veterans should not have to wait for benefits to which they
are entitled. Veterans must be ensured access to high-quality medical
care. Specialized care must remain the focus of VA. Veterans must be
guaranteed timely access to the full continuum of healthcare services,
including long-term care. And, veterans must be assured accessible
burial in a State or national cemetery in every State.
The VA healthcare system is the best in the country and responsible
for great advances in medical science. VHA is uniquely qualified to
care for veterans' needs because of its highly specialized experience
in treating service-connected ailments. The delivery care system
provides a wide array of specialized services to veterans like those
with spinal cord injuries, blindness, traumatic brain injury, and post
traumatic stress disorder.
Looking at the numbers alone, the VA budget would appear to be one
that would garner only praise and be a model for years to come.
However, the budget was signed into law 5 months after the start of the
new fiscal year, marking the 13th time in 14 years the VA had to work
from continuing resolutions to maintain the system. Also, the budget
was contingent on $3.7 billion in emergency funding that was signed
into law less than 1 month ago. This is an unacceptable way of funding
a department that is as fluid in nature as the VA.
Mr. Chairman, as you know, we strongly support mandatory funding
for VA healthcare. However, if the Congress cannot support mandatory
funding, there are alternatives which could meet our goals of timely,
sufficient, and predictable funding.
Congress could change VA's medical care appropriation to an advance
appropriation which would provide approval 1 year in advance, thereby
guaranteeing its timeliness. Furthermore, by adding transparency to
VA's healthcare enrollee projection model, we can focus the debate on
the most actuarially sound projection of veterans healthcare costs to
ensure sufficiency.
Under this proposal, Congress would retain its discretion to
approve appropriations; retain all of its oversight authority; and most
importantly, there would be no PAYGO problems.
We ask this Committee in your views and estimates to recommend to
the Budget Committee either mandatory funding or this new advance
appropriations approach to take the politics out of healthcare for all
of our Nation's wounded, sick and disabled veterans.
As a partner of The Independent Budget, AMVETS devotes a majority
of its time with the concerns of the National Cemetery Administration
(NCA) and I would like to speak directly to the issues and concerns
surrounding NCA.
The National Cemetery Administration
The Independent Budget acknowledges the dedicated and committed NCA
staff who continue to provide the highest quality of service to
veterans and their families despite funding shortfalls, aging
equipment, and increasing workload. The devoted staff provides aid and
comfort to grieving veterans' families in a very difficult time, and we
thank them for their consolation.
The NCA currently maintains more than 2.8 million gravesites at 131
national cemeteries in 39 States and Puerto Rico. VA estimates that
about 24 million veterans are alive today. They include veterans from
World War I through the Global War on Terrorism, as well as peacetime
veterans. With the anticipated opening of the new national cemeteries,
annual interments are projected to increase from more than 105,000 in
2008 to 115,000 in 2009.
The NCA is responsible for five primary missions: (1) to inter,
upon request, the remains of eligible veterans and family members and
to permanently maintain gravesites; (2) to mark graves of eligible
persons in national, State, or private cemeteries upon appropriate
application; (3) to administer the State Grant Program in the
establishment, expansion, or improvement of State veterans cemeteries;
(4) to award a Presidential certificate and furnish a United States
flag to deceased veterans; and (5) to maintain national cemeteries as
national shrines sacred to the honor and memory of those interred or
memorialized.
NCA Budget Request
The Administration requests $181 million for the NCA for fiscal
year 2009. The members of The Independent Budget recommend that
Congress provide $252 million and 51 additional FTE for continuing
operations and workload increases of NCA. We recommend your support for
a budget consistent with NCA's growing demands and in concert with the
respect due every man and woman who wears the uniform of the United
States Armed Forces.
The national cemetery system continues to be seriously challenged.
Though there has been progress made over the years, the NCA is still
struggling to remove decades of blemishes and scars from military
burial grounds across the country. Visitors to many national cemeteries
are likely to encounter sunken graves, misaligned and dirty grave
markers, deteriorating roads, spotty turf and other patches of decay
that have been accumulating for decades. If the NCA is to continue its
commitment to ensure national cemeteries remain dignified and
respectful settings that honor deceased veterans and give evidence of
the Nation's gratitude for their military service, there must be a
comprehensive effort to greatly improve the condition, function, and
appearance of all our national cemeteries.
In accordance with ``An Independent Study on Improvements to
Veterans Cemeteries,'' which was submitted to Congress in 2002, The
Independent Budget again recommends Congress to fully fund the National
Shrine Initiative by providing $50 million in FY 2009 budget and a
commitment of $250 million over a period of 5 years to restore and
improve the condition and character of NCA cemeteries.
It should be noted that the NCA has done an outstanding job thus
far in improving the appearance of our national cemeteries, but
critical underfunding does not allow NCA to remove the backlog of
improvements that need to be met. To date, NCA has invested $99 million
to the initiative, making nearly 300 improvements. Additionally, $28.2
million will be invested in restoration in 2008. This money is the full
amount of supplemental funding that was given to NCA in FY 2008, a fact
that should be a wake-up call of the importance of the National Shrine
Initiative. Even with the funding that has been spent on these
improvements, new areas requiring restoration are identified. By
enacting a 5-year program with dedicated funds and an ambitious
schedule, the national cemetery system can provide veterans and their
families with the utmost dignity, respect, and compassion.
The State Cemetery Grants Program
The State Cemetery Grants Program (SCGP) complements the NCA
mission to establish gravesites for veterans in those areas where the
NCA cannot fully respond to the burial needs of veterans. Several
incentives are in place to assist States in this effort. For example,
the NCA can provide up to 100 percent of the development cost for an
approved cemetery project, including design, construction, and
administration. In addition, new equipment, such as mowers and
backhoes, can be provided for new cemeteries. Since 1978, the
Department of Veterans Affairs has more than doubled acreage available
and accommodated more than a 100-percent increase in burials through
this program.
To help provide reasonable access to burial options for veterans
and their eligible family members, The Independent Budget recommends
$42 million for the SCGP for fiscal year 2009. The availability of this
funding will help States establish, expand, and improve State-owned
veterans' cemeteries.
States have intentions of beginning construction of 24 new State
cemeteries in 2008. Many States have difficulties meeting the
requirements needed to build a national cemetery in their respective
State. The large land areas and spread out population in these areas
make it difficult to meet the ``170,000 veterans within 75 miles''
national veterans cemetery requirement. Recognizing these challenges,
VA has implemented several incentives to assist States in establishing
a veterans cemetery. For example, the NCA can provide up to 100 percent
of the development cost for an approved cemetery project, including
design, construction, and administration.
Burial Benefits
There has been serious erosion in the value of the burial allowance
benefits over the years. While these benefits were never intended to
cover the full costs of burial, they now pay for only a small fraction
of what they covered in 1973, when the Federal Government first started
paying burial benefits for our veterans.
In 2001 the plot allowance was increased for the first time in more
than 28 years, from $150 to $300, which covers approximately 6 percent
of funeral costs. The Independent Budget recommends increasing the plot
allowance from $300 to $745, an amount proportionally equal to the
benefit paid in 1973.
In the 108th Congress, the burial allowance for service-connected
deaths was increased from $500 to $2,000. Prior to this adjustment, the
allowance had been untouched since 1988. The Independent Budget
recommends increasing the service-connected burial benefit from $2,000
to $4,100, bringing it back up to its original proportionate level of
burial costs.
The nonservice-connected burial allowance was last adjusted in
1978, and also covers just 6 percent of funeral costs. The Independent
Budget recommends increasing the nonservice-connected burial benefit
from $300 to $1,270.
The NCA honors veterans with a final resting place that
commemorates their service to this Nation. More than 2.8 million
soldiers who died in every war and conflict are honored by burial in a
VA national cemetery. Each Memorial Day and Veterans Day we honor the
last full measure of devotion they gave for this country. Our national
cemeteries are more than the final resting place of honor for our
veterans; they are hallowed ground to those who died in our defense,
and a memorial to those who survived.
Mr. Chairman, this concludes my testimony. I thank you again for
the privilege to present our views, and I would be pleased to answer
any questions you might have.
Prepared Statement of Steve Robertson
Director, National Legislative Commission, American Legion
Mr. Chairman and Members of the Committee:
The American Legion would like to begin this hearing by expressing
our gratitude to you and your colleagues for your work on the FY 2008
budget for the Department of Veterans Affairs (VA). From the very
beginning of the 110th Congress, there was a great deal of fiscal work
to be accomplished. In essence, you and your colleagues had to put
together two VA appropriations budgets during the first session.
The American Legion supported the Budget Resolution for the first
time in many, many years. The American Legion supported the original
version of the Military Construction, Veterans' Affairs, and Related
Appropriations for FY 2008, passed overwhelmingly with bipartisan
support in both chambers; however, we were also very pleased when
President Bush requested the additional $3.7 billion provided in Public
Law 110-161. Needless to say, last year was an unusual appropriations
cycle.
The veterans' community continues to request an annual VA
appropriation that is timely, predictable, and sufficient to meet the
growing demands on VA. Every VA program is specifically designed to
address the various needs of America's veterans and their families.
Some programs date back to past proprieties of an earlier era of
veterans such as the greatest piece of social legislation ever enacted,
the Servicemen's Readjustment Act of 1944 (the GI Bill of Rights).
Newer areas of concern include improved diagnosis and treatment of
traumatic brain injury. Some programs are individual entitlements that
are funded through mandatory appropriations, while the balance are
subject to the annual discretionary appropriations battle in Congress.
But all represent the thanks of a grateful Nation.
The American Legion does not support the 2009 policy proposals
contained in the FY 2009 budget submission that seek to impose an
annual enrollment fee and practically double the current co-payment for
pharmaceuticals. The American Legion has opposed these proposals in the
past and we once again call on the Members of this Committee to join us
in defeating any proposal that seeks to balance the VA budget on the
backs of America's veterans.
Mr. Chairman, The American Legion welcomes the opportunity to
present recommendations on the FY 2009 VA appropriations and other
appropriations that fall under the jurisdiction of this Committee. The
American Legion appreciates the efforts of the Secretary of Veterans
Affairs and his capable leadership staff to produce a budget request
that reflects the fiscal needs of VA to provide timely access to the
earned benefits provided to those who served in the Armed Forces of the
United States. In a Nation of over 300 million citizens and a host of
visitors, only 24 million veterans have accepted the challenge of
military service. Some veterans were placed in harm's way, but all
accepted the oath of enlistment. All were prepared to give ``the last
full measure of devotion.''
Last September, The American Legion National Commander Marty
Conatser testified before you and your colleagues to outline budget
recommendations for FY 2009 and address some legislative concerns as
well. To briefly recap, here is a table that reflects the final VA
appropriations for FY 2008, The American Legion's budget request for FY
2009, and the President's budget request for FY 2009:
----------------------------------------------------------------------------------------------------------------
Final FY 2008 Legion's FY 09 President's
Discretionary Funding Programs P.L. 110-161 Request Request FY 09
----------------------------------------------------------------------------------------------------------------
Total Medical Care $36.7 billion $38.4 billion $38.7 billion
------------------------------------------------------------------------- -------------------
Medical Services $29.1 billion $34 billion
-------------------------------------------------------------------------
Medical Administration $3.2 billion
------------------------------------------------------------------------- -------------------
Medical Facilities $4.1 billion $4.6 billion
----------------------------------------------------------------------------------------------------------------
Medical/Prosthetics Research $480 million $476 million $442 million
----------------------------------------------------------------------------------------------------------------
Major Construction $1.1 billion $560 million $582 million
----------------------------------------------------------------------------------------------------------------
Minor Construction $579 million $485 million $329 million
----------------------------------------------------------------------------------------------------------------
CARES $1 billion
----------------------------------------------------------------------------------------------------------------
State Extended Care
Facilities Grants Program $165 million $275 million $85 million
----------------------------------------------------------------------------------------------------------------
State Veterans' Cemetery
Construction Grants Program $39 million $45 million $32 million
----------------------------------------------------------------------------------------------------------------
National Cemetery
Administration $195 million $228 million $181 million
----------------------------------------------------------------------------------------------------------------
General Operating Expenses $1.6 billion $2.8 billion $1.7 billion
----------------------------------------------------------------------------------------------------------------
Information Technology $2 billion $2.3 billion $2.4 billion
----------------------------------------------------------------------------------------------------------------
VETERANS AFFAIRS AND REHABILITATION
The American Legion breaks down its Veterans Affairs and
Rehabilitation testimony into three sections that mirror the major
organizational segments of the Department of Veterans Affairs (VA). In
these separate sections The American Legion will discuss our
legislative budget priorities regarding the Veterans Health
Administration (VHA), the Veterans Benefits Administration (VBA) and
the National Cemetery Administration (NCA).
Veterans Health Administration
The distinction of the VA as the Nation's leader in providing safe,
high-quality healthcare in the healthcare industry (both public and
private), has been recognized by several reputable sources:
The medical journal Neurology commented, ``The VA has
achieved remarkable improvements in patient care and health outcomes,
and is a cost-effective and efficient organization'' (2007).
Harvard University's Kennedy School of Government
presented VA with the highly coveted ``Innovations in American
Government'' for its advanced electronic health records and performance
measurement system (2006).
The Journal of the American Medical Association (JAMA)
noted VA's healthcare system has ``. . . quickly emerged as a bright
star in the constellation of safety practice, with systemwide
implementation of safe practices, training programs and the
establishment of four patient-safety research centers'' (2005).
The recent book by Phillip Longman entitled Best Care
Anywhere: Why VA Health Care is Better Than Yours (2007).
Veterans' Healthcare Benefit Enrollment Discrimination
All veterans eligible to receive benefits from VA should have
access to the VA healthcare system. The American Legion opposes any
enrollment policy that disallows any eligible veteran, who was prepared
to give his or her life for this country, access to what is often
described as the best healthcare in the Nation. Honorable military
service, whether for a single enlistment period or for a 30-year
career, is not merely another period of employment in an individual's
personal history. It is a defining portion of one's life.
Maintaining the quality of care that VA is currently known for
should be a national priority. But that quality of care is being denied
to an ever-increasing number of America's veterans. FY 2009 budget
request continues the suspension of enrollment of new Priority Group 8
veterans due to the increased demands for services. According to VA,
the number of Priority Group 8 veterans denied enrollment in the VA
healthcare system at the end of FY 2007 was 386,767. The American
Legion believes this number is significantly higher because it does not
include those veterans who have not attempted to use the VA because
they are aware of the suspension. Given the recruiting and retention
problems the armed forces face, it is clear that denying earned
benefits to eligible veterans does not solve the problems created by an
inadequate Federal budget.
As the Global War on Terrorism wages on, fiscal resources for VA
will continue to be stretched and this Nation's veterans will continue
to beg elected officials for moneys to sustain a viable VA. A viable VA
is one that cares for all veterans, not just the most severely wounded.
More importantly, VA is often the first experience veterans have with
the Federal Government after leaving military service. This Nation's
veterans have never let this country down; it is time for Congress to
do its best not to let them down.
All veterans, who are eligible to receive benefits from VA, should
have timely access to the VA healthcare system. Honorable military
service is evidence of an individual's commitment to this Nation. In
return for honorable military service, the thanks of a grateful Nation
should not simply be a conditional benefit that can easily be
restricted or denied by political or bureaucratic whim, but should be
regarded as an earned right in recognition for faithful service to this
country.
Quality, timely and accessible VA healthcare is the ongoing cost of
war. It is unconscionable to send the young men and women in the armed
forces to every corner of the globe and then limit the funding to take
care of their injuries suffered in service to this country. VA was
created to take care of the unique needs of a very specific population,
those veterans that wore the uniforms of the armed forces. Once those
uniforms are off, these veterans should be able to depend upon the VA
healthcare system for their healthcare needs--regardless of the type or
severity of their injuries. Many veterans will need healthcare for the
rest of their lives. The American Legion expects the VA healthcare
system to ensure and provide the very best healthcare for this Nation's
heroes. The American Legion strongly supports the reinstatement of
enrollment for Priority Group 8 veterans.
Mandatory Funding of VA Medical Care
The American Legion believes the time for mandatory funding for
veterans' healthcare is now. Congress should act to ensure that we, as
a Nation, will always provide the funding necessary to ensure veterans,
who seek timely access to quality healthcare through the VA healthcare
delivery system, are provided the healthcare they earned.
A new generation of young Americans is now deployed around the
world, answering the Nation's call to arms. Like so many brave men and
women who honorably served before them, these new veterans are fighting
for freedom, liberty and security of us all. Also like those who served
before them, today's veterans deserve the respect of a grateful Nation
when they return home.
Previous generations of wartime veterans were welcomed at VA
medical facilities until the 1980s. Unfortunately, without urgent
changes in healthcare funding, these new veterans will soon discover
their battles are not yet over. This Nation's newest heroes will be
fighting for the life of the VA healthcare system. Just as the veterans
of the 20th century did, they will be forced to fight for the care they
are eligible to receive.
The American Legion believes that the Veterans Health
Administration's (VHA) recurring fiscal difficulties will only be
solved when its funding becomes a mandatory appropriation item. As a
mandatory appropriation, law would guarantee VA healthcare funding for
all eligible enrollees--and it will be a patient-based, rather than a
budget-driven, annual appropriation.
The American Legion continues to support legislation that
establishes a system of capitation-based funding for VHA. This new
funding system would provide all of VHA's funding, except that of the
State Extended Care Facilities Construction Grant Program which would
be separately authorized and funded as a discretionary appropriation.
Although VHA continues to struggle to maintain its global
preeminence with a 21st century integrated healthcare delivery system,
it is handicapped by funding methods that were developed in the 19th
century for a now antiquated, inpatient delivery system. No modern
healthcare organization can be expected to survive with such an
inconsistent and inadequate budget process. The American Legion's
position on VA healthcare funding is that healthcare rationing for
veterans must end. It is time to guarantee healthcare funding for all
veterans seeking VA healthcare.
Third-Party Reimbursements
The Balanced Budget Act of 1997, P.L. 105-33, established the VA
Medical Care Collections Fund (MCCF). The law requires that money
collected or recovered from third-party payers after June 30, 1997, be
deposited into this fund. The MCCF is a depository for collections from
third-party insurance, outpatient prescription co-payments and other
medical charges and user fees. The funds collected may be used to
provide VA medical care and services and for VA expenses for
identification, billing, auditing and collection of amounts owed the
Federal Government.
The American Legion supported legislation to allow VA to bill,
collect and reinvest third-party reimbursements and co-payments.
However, The American Legion has adamantly opposed the scoring of MCCF
as an offset to annual discretionary appropriations because almost all
of these funds derive from the treatment of nonservice-connected
medical conditions. Historically, these collection goals far exceed
VA's ability to collect accounts receivable.
Once again, the President's budget request for FY 2009 raises the
bar on MCCF from $2.3 billion to $2.5 billion. VA's ability to capture
these funds is critical to its ability to provide quality and timely
healthcare to veterans. Miscalculations of VA required funding levels
results in real budgetary shortfalls. Seeking an annual emergency
supplemental appropriation is not the most cost-effective means of
funding the Nation's model healthcare delivery system.
Government Accountability Office (GAO) reports have described the
continuing problems in VHA's ability to capture insurance data in a
timely and accurate manner and have raised concerns about VHA's ability
to maximize its third-party collections. GAO visited three VA medical
centers and found the following concerns: VA lacked the ability to
verify insurance; VA could not accept partial payment as full payment;
VA had inconsistent compliance with collections followup; VA failed to
ensure documentation by VA physicians was sufficient; VA had
insufficient automation; and, VA had a shortage of qualified billing
coders. All of these concerns are key deficiencies contributing to the
collections shortfalls. VA should implement all available remedies to
maximize its collections of accounts receivable.
The American Legion opposes offsetting annual VA discretionary
funding by the arbitrarily set MCCF goal, especially since VA is
prohibited from collecting any third-party reimbursements from the
Nation's largest Federally-mandated health insurer, Medicare.
Medicare Reimbursements
Veterans contribute to the Medicare Trust Fund, as do most American
workers, without choice, throughout their working lives. Veterans also
paid these contributions when they served on active-duty. However, when
a veteran is treated at a VA medical facility, VA is prohibited from
collecting Medicare reimbursements for the treatment of allowable,
nonservice-connected medical conditions. Since over half of VA's
enrolled patient population is Medicare-eligible, this prohibition
constitutes a multi-billion dollar annual subsidy to the Medicare Trust
Fund. No other Federal healthcare provider is prohibited from receiving
Medicare reimbursements. The American Legion supports allowing Medicare
reimbursement to VHA to pay for the treatment of allowable, nonservice-
connected medical conditions of enrolled Medicare-eligible veterans.
Medical Construction and Infrastructure Support
Major Construction
The CARES process identified more than 100 major construction
projects in 37 States, the District of Columbia, and Puerto Rico.
Construction projects are categorized as `major' if the estimated cost
is over $7 million. Now that VA has a plan to deliver healthcare
through 2022, it is up to Congress to provide adequate funds.
The CARES plan calls for, among other things, the construction of
new hospitals in Orlando, FL, and Las Vegas, NV, and replacement
facilities in Louisville, KY, and Denver, CO, for a cost estimated to
be well over $1 billion for these four facilities. VA has not had this
type of progressive construction agenda in decades. Major construction
money can be significant and proper utilization of funds must be well
planned. Recently, Congress approved funding for a new Veterans Affairs
medical center in Denver. It is our hope that funding will be provided
for Louisville and Las Vegas as well.
In addition to the cost of the proposed new facilities are the many
construction issues that have been virtually ``put on hold'' for the
past several years due to past inadequate funding and the moratorium
placed on construction spending by the CARES process. One of the most
glaring shortfalls is the neglect of the buildings sorely in need of
seismic correction. This is an issue of safety. The delivery of
healthcare in seismically unsafe buildings cannot be tolerated and
funds must be allocated to not only construct the new facilities, but
also to pay for much needed upgrades at existing facilities. Gambling
with the lives of veterans, their families and VA employees is
absolutely unacceptable.
The American Legion believes that VA has effectively shepherded the
CARES process to its current state by developing the blueprint for the
future delivery of VA healthcare--it is now time for Congress to
adequately fund the implementation of this crucial undertaking.
The American Legion recommends $560 million for major construction
in FY 2009. Although the President's budget request for FY 2009 calls
for major construction to be $582 million, The American Legion also
recommends an additional $1 billion specifically designated for
approved CARES major construction.
Minor Construction
VA's minor construction program has also suffered significant
neglect over the past several years. Maintaining the infrastructure of
VA's buildings is no small task. Because the buildings are old,
renovations, relocations and expansions are quite common. When combined
with the added cost of the CARES program recommendations, it is easy to
perceive that a major increase over the previous funding level is
crucial and overdue.
The American Legion recommends $485 million for minor construction
in FY 2009.
Veterans Benefits Administration
The President's annual budget request is a detailed outline of the
mandatory and discretionary funding needed by the Veterans Benefits
Administration (VBA). Given VBA's many challenges and responsibilities,
which include the annual expenditures for compensation, pension, and
related benefit payments, it is imperative that Congress ensure that
VBA's programs have the personnel and other resources necessary to
operate efficiently and can provide quality and timely service. The
budget debate process and oversight hearings provide opportunities to
evaluate how well VBA is, in fact, performing its missions and whether
the needs and expectations of its stakeholders are being met.
For several years, VBA has endeavored to implement its long-term
strategic plans to hire and train a new cadre of adjudicators, to
continue the computer modernization program, and to institute a variety
of procedural and programmatic changes intended to improve the claims
adjudication process. However, external factors, such as the enactment
of legislation providing new benefits and medical care services and
precedent setting legal decisions by the Federal courts, continue to
play a major role in changing VBA's plans, policies, and operations.
VBA's efforts to address these varied and complex issues have profound
budgetary and operational implications.
One of the most significant challenges plaguing VBA is the sheer
size of the backlog of pending disability claims and appeals. These
claims are usually multi-issue cases arguing complex medical and legal
issues that must be resolved. The American Legion believes the backlog
is a symptom of unresolved systemic problems that adversely affect the
adjudication and appeals process. These unresolved problems further
contribute to the ever-growing backlog. These problems include:
frequent decisionmaking errors at all levels of the decisionmaking
process; failure by VA personnel to comply with the Veterans' Claims
Assistance Act of 2000 (VCAA); lack of personal accountability by VA
employees and managers; ineffective quality control and quality
assurance programs; inadequate personnel training; and, an unreliable
work measurement system. VBA is faced with a serious dilemma. While
endeavoring to address these thorny issues, it is also aggressively
trying to process claims faster. From the results, it does not appear
VBA has found a way to successfully balance these competing priorities.
As of January 5, 2008, there were more than 406,000 rating cases
pending in the VBA system. Of these, 105,693 (26 percent) have been
pending for more than 180 days. There are more than 163,000 appeals
pending at VA regional offices, with more than 147,000 requiring some
type of further adjudicative action. Additionally, there are currently
more than 30,000 appeals pending at the Board of Veterans' Appeals and
more than 19,000 remands pending at the Appeals Management Center.
As previously noted, The American Legion remains deeply concerned
by the problems arising from the VBA's general lack of compliance with
its `duty to notify' and its `duty to assist' requirements directed by
the VCAA. This legislation is one of the most significant, pro-veteran
improvements in the VA claims adjudication system in the past decade.
However, VBA continues to give only lip service to this law. While
claimants receive what VBA terms a VCAA letter, this letter, in fact,
is generally not very informative about what particular evidence is
needed by VBA to grant the benefit sought by the veteran. In addition,
these VCAA letters are usually long and confusing, not very specific to
the evidence needed from claimants, and written in bureaucratic
language instead of `plain English.' Rather than helping claimants with
the development of the claim, these letters frequently generate more
questions, more telephone calls, and more correspondence to veterans'
service officers or the VA regional office. Clearly, the VCAA letter
currently in use by VBA today only serves to delay rather than
facilitate the claims process.
The VBA's work measurement system may directly or indirectly affect
the VBA's failure to reduce the claims backlog. The VBA's work
measurement system is the means by which both individual employee and
station performance is tracked and evaluated. This system is also
relied upon in determining staffing needs at the station, region, and
service levels in support of VBA's annual budget request. A serious
problem can arise if the data developed by the work measurement system
is neither accurate nor reliable in reporting the actual amount of work
accomplished. This produces a distorted view of the way the VBA
adjudication process is operating and what the true staffing needs are,
both locally and systemwide.
The American Legion believes VBA's current work measurement system
is seriously flawed. It does not provide VBA and Congress the needed
information on how long it actually takes to properly process a claim
and how many staff are required to perform this process in a timely
manner. The American Legion advises that this work data is also subject
to frequent manipulation and abuse, thus, its accuracy and reliability
is open to serious question as are the conclusions and decisions drawn
from this work data. In the view of The American Legion, the
development and implementation of a new work measurement system should
be one of VBA's highest priorities. The American Legion fully
understands and appreciates the major challenges facing VBA in the
upcoming year, but as a major stakeholder in VBA's benefit programs we
are committed to ensuring that VBA provides the best quality and timely
service to our Nation's veterans and their families.
National Cemetery Administration
Approximately 24 million veterans are living today. Nearly 690,000
veteran deaths are estimated to occur in 2009. VA estimates that
approximately 111,000 will request interment in national cemeteries.
Considering the growing cost of burial services and the excellent
quality of service the National Cemetery Administration (NCA) provides,
The American Legion foresees that this percentage will be much greater.
Congress must therefore provide sufficient major construction
appropriations to permit NCA to accomplish its stated goal of ensuring
that burial in a national or State cemetery is a realistic option for
our Nation's veterans by locating cemeteries within 75 miles of 90
percent of eligible veterans. The American Legion recommends $228
million be appropriated for the National Cemetery Administration for FY
2009.
National Cemetery Expansion
According to VA, it takes approximately 20 to 30 full-time
equivalents (FTEs), to operate a national cemetery (depending on the
size and workload at a particular facility) and it takes approximately
8 to 10 FTEs to operate a newly opened cemetery (cemeteries are opened
to interments long before completion of the full site). Thus, it seems
reasonable that at least 50 new FTEs will be needed to operate the six
new cemeteries NCA is planning to bring online in FY 2008. It is
likely, therefore, that these new cemeteries will need the full 20 to
30 FTEs in FY 2009. The average VA employee salary with benefits is
$63,709. The American Legion recommends that funding for an additional
120-150 employees be included in the FY 2009 budget.
National Shrine Commitment
Maintaining cemeteries as national shrines is one of NCA's top
priorities. This commitment involves raising, realigning and cleaning
veterans' headstones and markers to renovate their gravesites. The work
that has been done by VA so far has been outstanding; however, adequate
funding is the key to maintaining this very important commitment. The
American Legion supports NCA's goal of completing the National Shrine
Commitment within 5 years. This commitment includes the establishment
of standards of appearance for national cemeteries that are equal to
the standards of the finest cemeteries in the world. Operations,
maintenance and renovation funding must be increased to reflect the
true requirements of the NCA to fulfill this commitment.
VA has assessed burial sections and sites, roadways, buildings, and
historic structures and has identified 928 potential improvement
projects at an estimated cost of $280 million. October 2007 marked the
end of the 5-year plan, but still much work needs to be done. With the
addition of six new cemeteries and the addition of six more cemeteries
that are fast tracked to come online this year, resources will be
strained. The American Legion recommends that $52 million be
appropriated to the National Shrine Commitment in order to fulfill this
commitment to the Nation's veterans.
State Cemetery Construction Grants Program
This program is not intended to replace national cemeteries, but to
complement them. Grants for State-owned and operated cemeteries can be
used to establish, expand and improve on existing cemeteries. There are
60 operational State cemeteries and two more under construction. Since
NCA concentrates its construction resources on large metropolitan
areas, it is unlikely that new national cemeteries will be constructed
in all of the States. Therefore, individual States are encouraged to
pursue applications for the State Cemetery Grants Program. Fiscal
commitments from the States are essential to keep the operations of
State cemeteries on track. NCA estimates it costs about $300,000 per
year to operate a State cemetery.
Determining an ``average cost'' to build a new State cemetery or to
expand an existing one is very difficult. Many factors influence cost,
such as location, size and the availability of public utilities. The
American Legion believes States will increasingly use the State
Cemetery Grants Program to fulfill the needs of their veteran
populations that are still not well served by the ``75-mile service
area/170,000 veteran population'' threshold that currently serves as
the VA benchmark for establishing a new national cemetery. New State
cemeteries and expansions and improvements of existing State cemeteries
are therefore likely to increase. With increasing costs, especially
given the high cost of land in urban areas, and with increasing demand,
The American Legion recommends the amount of funding for the State
Cemetery Grants Program be substantially increased. The American Legion
recommends $45 million for the State Cemetery Grants Program in FY
2009.
ECONOMICS
THE GI BILL AND VETERANS' EDUCATION BENEFITS
The American Legion has a proud history of developing the
Servicemen's Readjustment Act of 1944 (Public Law 78-346), also known
as the GI Bill of Rights, which served to assist 18 million veterans of
WWII in gaining employment after military service and assisting in the
creation of the American middle class.
Accordingly, The American Legion supports passage of major
enhancements to the All-Volunteer Force Education Assistance Program,
better known as the Montgomery GI Bill (MGIB). The current make-up of
the operational military force requires that adjustments be made to
support all armed forces servicemembers. The American Legion supports
legislation that will allow members of the Reserve Components to earn
credits for education while mobilized, just as active-duty troops do,
and be able to use those credits after they leave military service. Two
of the top priorities of any veterans' education legislation are equity
and portability of benefits. However, it is also clear that the current
dollar value of benefits must be increased to meet the greater costs of
today's higher education.
In the 20 years since the MGIB went into effect on June 30, 1985,
the Nation's security needs have changed radically from a fixed Cold
War to a dynamic Global War on Terrorism. In 1991, the Active-Duty
Force (ADF) of the military stood at 2.1 million; today it stands at
1.4 million. Between 1915 and 1990 the Reserve Force (RF) was
involuntarily mobilized only nine times. Today the Nation's Reserve
Forces are no longer a strategic force but are an operational force
mobilized continuously and working side-by-side with active-duty units
all over the world.
The Department of Defense (DoD) reported as of August 2007 that in
support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom
(OEF) there have been:
2.4 million deployment events;
1.6 million servicemembers have been deployed;
540,000 servicemembers have had more than one deployment;
443,000 National Guard and Reservists have been mobilized
and deployed to Iraq or Afghanistan since 2001, for an average of 18
months per mobilization;
Out of 540,000 servicemembers with more than one
deployment, 103,909 are members of the Reserve Components; and
`Stop-loss' (a policy that prevents troops from leaving
the service when their enlistment end date has arrived) has been
imposed on more than 50,000 troops.
The American Legion recommends that the dollar amount of the
entitlement should be indexed to the average cost of college education
including tuition, fees, textbooks and other supplies for commuter
students at an accredited university, college or trade school for which
they qualify and that the educational cost index should be reviewed and
adjusted annually.
The American Legion supports a monthly, tax-free subsistence
allowance indexed for inflation as part of the educational assistance
package.
The American Legion recommends reauthorizing and funding State
Approving Agencies to assure current staffing and activities and to
assure that there is no harm to veterans receiving education payments.
STATE APPROVING AGENCIES
The American Legion is deeply concerned with the timely manner that
veterans, especially returning wartime veterans, receive their
education benefits. Annually, approximately 300,000 servicemembers
(90,000 of them belonging to the National Guard and Reserve) return to
the civilian sector and use their earned education benefits from the
VA.
Any delay in receipt of education benefits or approval of courses
taken at institutions of higher learning can adversely affect a
veteran's life. A recent GAO report entitled ``VA Student Financial
Aid; Management Actions Needed to Reduce Overlap in Approving Education
and Training Programs and to Assess State Approving Agencies'' (GAO-07-
384) focuses on the need to ``ensure that Federal dollars are spent
efficiently and effectively.''
GAO recommends that VA should require State Approving Agencies
(SAAs) to track and report data on resources spent on approval
activities, such as site visits, catalog review, and outreach in a
cost-efficient manner. The American Legion agrees. Additionally, GAO
recommended that VA establish outcome-oriented performance measures to
assess the effectiveness of SAA efforts. The American Legion fully
agrees. In response, VA Deputy Secretary Mansfield plans to establish a
working group with SAA to create a reporting system for approval
activities and develop outcome-oriented measures with a goal of
implementation in the FY 2009 budget cycle.
Finally, GAO recommended that VA should collaborate with other
agencies to identify any duplicate efforts and use the agency's
administrative and regulatory authority to streamline the approval
process. The American Legion agrees. VA Deputy Secretary Mansfield
responded that VA would initiate contact with appropriate officials at
the Departments of Education and Labor to help identify any duplicate
efforts.
SEC. 301 of P.L. 107-330 created increases in the aggregate annual
amount available for State approving agencies for administrative
expenses from FY 2003-FY 2007 to the current funding level of $19
million. The American Legion fully supports reauthorization of SAA
funding.
The American Legion strongly recommends keeping SAA funding at $19
million in FY 2009 to assure current staffing and activities.
VA HOME LOAN GUARANTY PROGRAM
Since the home loan program was enacted as part of the original
Servicemen's Readjustment Act of 1944 (the GI Bill), VA has guaranteed
more than 18 million home loans totaling nearly $914 billion for
veterans to purchase or construct a home, or to refinance another home
loan on more favorable terms. In the 5-year period from 2001 through
2006, VA has assisted more than 1.4 million veterans in obtaining home
loan financing totaling almost $197 billion. About half of these loans,
just over 730,000, were to assist veterans to obtain a lower interest
rate on an existing VA guaranteed home loan through VA's Interest Rate
Reduction Refinancing Loan Program.
The VA funding fee is required by law and is designed to sustain
the VA Home Loan Program by eliminating the need for appropriations
from Congress. Congress is not required to appropriate funding for this
program; however, because veterans must now `buy' into the program, it
no longer serves the intent of helping veterans afford a home. The
funding fee makes the VA Home Loan Program less beneficial when
compared to a standard, private loan, in some aspects. The current rate
for mortgages is approximately 5.7 percent. The funding fee would be in
addition to the rate given by the lender. A $300,000 loan would
generate a fee in addition to any rate the veteran would achieve. The
funding fee mandates the participant to buy into the program; however,
that goes directly against the intention of the law: to provide
veterans a resource for obtaining a home. Approximately 80 percent of
all VA Home Loan participants must pay the funding fee and the current
funding fee paid to VA to defray the cost of the home loan has had a
negative effect on many veterans who choose not to participate in this
highly beneficial program.
The American Legion supports the elimination of the VA Home Loan
funding fee and urges Congress to appropriate funding to sustain the VA
Home Loan Guaranty Program.
The American Legion reaffirms its strong support for VA's Loan
Guaranty Program. The American Legion also supports any administrative
and/or legislative efforts that will improve and strengthen the VA Home
Loan Guaranty Program's ability to serve America's veterans.
Homeless Providers Grant and Per Diem Program
In 1992, VA was given authority to establish the Homeless Providers
Grant and Per Diem Program under the Homeless Veterans Comprehensive
Service Programs Act of 1992 (P.L. 102-590). Grants from the Grant and
Per Diem Program are offered annually (as funding permits) by the VA to
fund community agencies providing service to homeless veterans. VA can
provide grants and per diem payments to help public and nonprofit
organizations establish and operate supportive housing and/or service
centers for homeless veterans.
Funds are available for assistance in the form of grants to provide
transitional housing (up to 24 months) with supportive services,
supportive services in a service center facility for homeless veterans
not in conjunction with supportive housing, or to purchase vans.
The American Legion strongly supports funding the Grant and Per
Diem Program for a 5-year period instead of annually and supports
increasing the funding level to $200 million annually.
Department of Labor Veterans' Employment and Training Service (DoL-
VETS)
VETS is and should remain a national program with Federal oversight
and accountability. The American Legion is eager to see this program
grow and especially would like to see greater expansion of
entrepreneurial-based, self-employment opportunity training.
The mission of VETS is to promote the economic security of
America's veterans. This mission is executed by assisting veterans in
finding meaningful employment. The American Legion believes that by
strengthening American veterans, we in turn strengthen America.
Annually, DoD discharges approximately 250,000 servicemembers. Recently
separated service personnel will seek immediate employment or,
increasingly, have chosen some form of self-employment.
In order for the VETS program to assist these veterans to achieve
their goals, it needs to:
Improve by expanding its outreach efforts with creative
initiatives designed to improve employment and training services for
veterans;
Provide employers with a labor pool of quality applicants
with marketable and transferable job skills;
Provide information on identifying military occupations
that require licenses, certificates or other credentials at the local,
State, or national levels;
Eliminate barriers to recently separated service
personnel and assist in the transition from military service to the
civilian labor market;
Strive to be a proactive agent between the business and
veterans' communities in order to provide greater employment
opportunities for veterans; and
Increase training opportunities, support and options for
veterans who seek self-employment and entrepreneurial careers.
The American Legion believes staffing levels for DVOP specialists
and LVERs should match the needs of the veterans' community in each
State and not be based solely on the fiscal needs of the State
government.
Contrary to the demands placed upon VETS, funding increases for
VETS since 9/11 does not reflect the large increase in servicemembers
requiring these services due to the Global War on Terrorism. In support
of this fact, the inflation rate from January 2002 to January 2008 is
15.93 percent and yet for State grants alone, funding has only
increased a meek 2.5 percent ($158 million to $162 million) in the same
timespan.
The President's budget request for FY 2009 will allow for an
increase of 1 percent for State grants, the mechanism for funding DVOPs
and LVERs. However, this does not meet the inflation rate and
approximately 100 positions have the potential to be eliminated again
next year.
More services and programs are needed and yet since 2002 the VETS
program has only received a modest 4-percent increase. Transition
assistance, education, and employment are each a pillar of financial
stability. They will prevent homelessness, allow the veteran to compete
in the private sector, and let our Nation's veterans contribute their
military skills and education to the civilian sector. By placing
veterans in suitable employment earlier, the country benefits from
increased income tax revenue and reduced unemployment compensation
payments, thus greatly offsetting the cost of Transitional Assistance
Program (TAP) training. The American Legion recommends full funding for
DoL-VETS.
Homelessness (DoL-VETS)
The American Legion notes that there are approximately 200,000
homeless veterans on the street each night. This number, compounded
with 300,000 servicemembers entering the private sector each year since
2001 with at least a third of them potentially suffering from mental
illness, requires intensive efforts. Numerous programs to prevent and
assist homeless veterans are available.
The Homeless Veterans Reintegration Program (HVRP) is a competitive
grant program. Grants are awarded to States or other public entities
and nonprofit organizations, including faith-based organizations, to
operate employment programs that reach out to homeless veterans and
help them become gainfully employed. The purpose of the HVRP is to
provide services to assist in reintegrating homeless veterans into
meaningful employment within the labor force and to stimulate the
development of effective service delivery systems that will address the
complex problems facing veterans. HVRP is the only nationwide program
focused on assisting homeless veterans to reintegrate into the
workforce.
The competition for these grants is intense as they have one of the
highest cutoff score thresholds to be in the competitive range for any
grant program. Amazingly, 243 grants did fall into the competitive
range but there was only enough funding to award 145 submissions. The
HVRP program could only award $39 million for FY 2007 but had to deny
98 fully qualified nominations. These 98 additional qualified programs
would require an additional $30 million. The American Legion recommends
$70 million for this highly successful grant program.
Training
The National Veterans' Employment and Training Services Institute
(NVTI) was established to ensure a high level of proficiency and
training for staff that provide veterans employment services. NVTI
provides training to Federal and State government employment service
providers in competency based training courses. Current law requires
all Disabled Veterans' Outreach Program (DVOP) and Local Veterans'
Employment Representatives (LVER) personnel to be trained within 3
years of hiring. The American Legion recommends that these personnel
should be trained within 1 year. The American Legion further recommends
$6 million in funding to NVTI.
Veterans Workforce Investment Program (VWIP)
VWIP grants support efforts to ensure veterans' lifelong learning
and skills development in programs designed to serve the most-at-risk
veterans, especially those with service-connected disabilities, those
with significant barriers to employment, and recently separated
veterans. The goal is to provide an effective mix of interventions,
including training, retraining, and support services, that lead to long
term, higher wage and career potential jobs. The American Legion
recommends $20 million in funding for VWIP.
Employment Rights and Veterans' Preference
The Uniformed Services Employment and Reemployment Rights Act
(USERRA) protects civilian job rights and benefits of veterans and
members of the armed forces, including National Guard and Reserve
members. USERRA also prohibits employer discrimination due to military
obligations and provides reemployment rights to returning
servicemembers. VETS administers this law, conducts investigations for
USERRA and Veterans' Preference cases, conducts outreach and education,
and investigates complaints by servicemembers.
Since September 11, 2001, nearly 600,000 National Guard and Reserve
members have been activated for military duty. During this same period,
DoL-VETS has provided USERRA assistance to over 410,000 employers and
servicemembers.
Veterans' Preference is authorized by the Veterans' Preference Act
of 1944. The Veterans' Employment Opportunity Act of 1998 (VEOA)
extended certain rights and remedies to recently separated veterans.
VETS was given the responsibility to investigate complaints filed by
veterans who believe their Veterans' Preference rights have been
violated and to conduct an extensive compliance assistance program.
Numerous Federal agencies and government contractors and
subcontractors are unlawfully circumventing Veterans' Preference. The
use of multiple certificates in the hiring process is unjustly denying
veterans opportunity for employment. Whereas figures show a decline in
claims by veterans of OIF/OEF compared to Gulf War I, the reality is
that employment opportunities are not being broadcast. Federal agencies
as well as contractors and subcontractors are required by law to notify
OPM of job opportunities but more often than not these vacancies are
never made available to the public. VETS program investigates these
claims and corrects unlawful practices.
The American Legion also supports the strongest Veterans'
Preference laws possible at all levels of government. The American
Legion is deeply concerned with the protection of the veteran and the
prevention of illegal and egregious hiring practices. Currently,
veterans are filing corrective action claims after the noncompliance
employment event occurs and therefore may become financially
disadvantaged. Concurrent measures and continuous oversight must be
emplaced to protect veterans from unfair hiring practices, not just
reactionary investigations. The American Legion recommends funding of
$61 million for program management that encompasses USERRA and VEOA.
Veteran/Service-Connected Disabled Veteran-Owned Businesses
The American Legion views small businesses as the backbone of the
American economy. It is the driving force behind America's past
economic growth and will continue to be the major factor for growth as
we move further into the 21st century. Currently, more than 9 out of
every 10 businesses are small firms, which produce almost one-half of
the Gross National Product. Veterans' benefits have always included
assistance in creating and operating veteran-owned small businesses.
The impact of deployment on self-employed National Guard and
Reservists is severe with a reported 40 percent of all veteran-owned
businesses suffering financial losses and in some cases bankruptcies.
Many other small businesses have discovered they are unable to operate
and suffer some form of financial loss when key employees are
activated. The Congressional Budget Office in its report, ``The Effects
of Reserve Call-Ups on Civilian Employers,'' stated that it ``expects
that as many as 30,000 small businesses and 55,000 self-employed
individuals may be more severely affected if their Reservist employee
or owner is activated.'' Additionally, the Office of Veterans' Business
Development within the Small Business Administration (SBA) remains
crippled and ineffective due to a token funding of $750,000 per year.
This amount, which is less than the office supply budget for the SBA,
is expected to support an entire nation of veteran entrepreneurs. The
American Legion feels that this pittance is an insult to American
veteran businessowners, undermines the spirit and intent of the
Veterans Entrepreneurship (TVC) and Small Business Development Act of
1999 (P.L. 106-50) and continues to be a source of embarrassment for
this country.
The American Legion strongly supports increased funding for the
Small Business Administration's Office of Veterans' Business
Development to provide enhanced outreach and community-based assistance
to veterans and self-employed members of the Reserves and National
Guard.
Additionally, the American Legion supports allowing the Office of
Veterans' Business Development to enter into contracts, grants, and
cooperative agreements to further its outreach goals. The Office of
Veterans' Business Development must be authorized to develop a
nationwide community-based service delivery system specifi-
cally for veterans and members of Reserve components of the United State
s military.
The American Legion further recommends that funding for the SBA
Office of Veterans' Business Development be increased to $2.3 million
in FY 2009.
CONCLUSION
The American Legion is extremely concerned about the budgetary
process when Congress does not pass appropriations bills before the
start of the new fiscal year. The failure to pass a proper budget has a
significant impact on the veterans' community and the healthcare
delivery provided to veterans. As a result of the failure of Congress
to pass VA appropriations in a timely manner, all long- and short-range
planning is adversely affected. VA medical facility administrators are
asked to use a ``crystal ball'' to make prudent management decisions--
not knowing when and how much funding they will have available to
finish the fiscal year. Such fiscal irresponsibility spawns gross
mismanagement decisions, rationing of care, and unacceptable delays and
backlogs across the program areas--medical care, facility maintenance,
administration, construction, and State grants programs. It is our hope
that Congress will move to quickly pass this budget so that we can
properly take care of our troops and our veterans.
The American Legion appreciates the opportunity to present its
views and estimates on programs that will affect veterans,
servicemembers and their families. We ask that this Committee take into
consideration the recommendations of The American Legion as your
colleagues formulate the FY 2009 Budget Resolution. We also ask the
Committee not to forget the sacrifices and contributions made by
America's veterans and their families as the budget priorities are
determined for FY 2009.
Prepared Statement of Richard F. Weidman
Executive Director for Policy and Government Affairs
Vietnam Veterans of America
Chairman Filner, Ranking Member Buyer and distinguished Members of
the Committee, on behalf of VVA National President John Rowan and all
of our officers, Board of Directors, and members, I thank you for
giving Vietnam Veterans of America (VVA) the opportunity to testify
today regarding the President's fiscal year 2009 budget request for the
Department of Veterans Affairs. VVA thanks each of you on this
distinguished panel, on both sides of the aisle, for your strong
leadership on issues and concerns of vital concern to veterans and
their families.
I want to thank you for recognizing that caring for those who have
donned the uniform in our name is part of the continuing cost of the
national defense. Caring for veterans, the essential role of the VA
and, for specific services other Federal entities such as the
Department of Labor, the Small Business Administration, and the
Department of Health and Human Services, must be a national priority.
This is poignantly clear when we visit the combat-wounded troops at
Walter Reed Army Medical Center and Bethesda Naval Hospital.
Mr. Chairman, I know you have been a long-time supporter of
legislation to achieve assured funding. You have always understood the
need for such a mechanism to correct the problems in the current system
of funding. As we have this discussion in regard to the FY'09 budget
for the VA, the readily apparent need for this legislation has never
been more pressing. We look forward to working with you to ensure its
enactment, or another reform measure that will move us toward our
common goal of predictable and timely funding for VA healthcare that is
sufficient to truly meet the needs of all veterans.
VVA wishes to note at the outset that the annual exercise of
debating the merits of the President's proposed budget is flawed.
Medical center directors should not have to be held in limbo as
Congress reworks and adjusts this budget and perhaps misses, yet again,
the start of the next Federal fiscal year. These public servants can be
more effective, more efficient, and better managers of the public trust
if they can properly plan for the funding they need to carry out their
mission of caring for their patients. We hope that this can be avoided
this year and ask that you seriously consider an immediate alternative
to the broken system we currently have and reaching our goal of assured
funding.
To rectify this situation, VVA and the other members of The
Partnership for Veterans' Health Care Budget Reform are developing a
proposal that would give the VA leeway its managers need to properly
plan for the requisites of their patient load. We will have more for
you as this proposal is tightened up.
Overview
Concerning the proposal at hand, the President's FY'09 budget for
the VA, we must again take exception to the attempt by the
Administration to tax Priority 7 and 8 veterans with an annual fee just
for signing into the VA healthcare system; and for almost doubling the
co-payment for prescription pharmaceuticals. To us this is further
evidence of the attempt to rid the system of as many ``higher income''
veterans as possible. We trust that you will see the folly in this, and
will reject outright any attempt to enact these measures into the law
of the land.
We are pleased, however, that the Administration has again
refrained from citing phantom ``management efficiencies'' in the
numbers in this budget proposal. Managers are in general well-paid.
Effective, caring managers should take rightful pride in the jobs they
do. Inefficient managers need to be sanctioned and, if necessary,
transferred or removed.
We are pleased, too, that this proposal calls for an increased
outlay for research and development. Traumatic brain injuries, or TBI,
needs to be better understood for treatment to be more effective. Other
mental health issues, too, that are afflicting too many of our
returning troops, need to be better understood. Research, for which VA
scientists and epidemiologists can be justifiably proud, benefit not
only troops who are forever changed by their experiences in combat but
the general populace as well.
We are less than sanguine, however, about the claim that ``one of
VA's highest priorities in 2009 will be to continue an aggressive
research program to improve the lives of veterans returning from
service in [Iraq and Afghanistan by devoting $252 million] to research
projects focused specifically on veterans returning'' from service in
these two hot spots. It is our understanding that data collecting on
maladies and diseases troops are returning with is not happening. It's
almost as if our government does not want to know about these ailments
so that it won't be burdened with Dependency Indemnity Compensation
(DIC) payments.
We are pleased that the spirit of cooperation between the VA and
the Department of Defense may actually be bearing fruit. In 2009, VA
and DoD will complete the pilot of a new disability evaluation system
for wounded returnees at major medical facilities in the Washington,
D.C. area. We hope that what results from this effort ``to eliminate
the duplicative and often confusing elements of the current disability
process of the two Departments'' will lead to less confusion and a
single, viable disability rating determined by the VA.
We are concerned, however, that there still will not be enough
resources to deal with the flood of troops and veterans returning to
our shores and presenting with a range of mental health issues. The VA
ramped down for several years the numbers of mental health
professionals it employed. Now, seeing the error of its ways, it is
hurriedly hiring clinicians. The question is: Will there be enough of
them to meet the challenge?
We are more than a little skeptical that, as the VA touts, the
budget will provide resources ``to virtually eliminate the patient
waiting list by the end of 2009.'' When have we heard this before?
On the benefits side of the ledger, we find it ludicrous to believe
that this budget ``will allow VA to improve the timeliness with which
compensation and pension claims are processed.'' Are VA planners
perhaps a bit overly optimistic that they can reduce the average time
it takes to process a claim to 145 days, 32 days quicker than the
average 177 days it currently takes? No, the Veterans Benefits
Administration requires a complete overhaul, one that introduces a new
way of thinking about vetting veterans who make claims for compensation
and pension benefits.
On the whole, this budget proposal is a better start than we have
had in many a year, but the overall request for additional resources is
just too low. With concerted work however it can be the most viable
budget and appropriations document we have had in many years, of which
we all can be proud.
Veterans Health Administration
Last year, VVA recommended an increase of $6.9 billion to the
expected fiscal year 2007 appropriation for the medical care business
line. Congress was very generous and we actually came close to that
figure if one includes the supplemental funding of about $1.8 billion
for veterans' healthcare. We recognize that the budget recommendation
VVA is making again this year is also extraordinary, but with troops
still in the field, years of underfunding of healthcare organizational
capacity, renovation of an archaic and dilapidated infrastructure,
updating capital equipment, and several cohorts of war veterans
reaching ages of peak healthcare utilization, these are extraordinary
times.
VVA asks that you continue ramping up the resources available to
rebuild the organizational capacity to the point where the VA can
really meet the needs of an increasing workload. Frankly, we believe
that VA has (again) underestimated the projected workload for the next
fiscal year. Instead of a growth of about 40,000 new veterans of the
Global War on Terror (GWOT), VVA estimates that the increase will be at
least equal to last year's increase of 90,000 new veterans entering the
system, and probably will be in excess of 100,000 new GWOT veterans,
particularly if the VA starts doing a better job of outreach, reduces
wait times as called for in their plan, and continues to make gains in
adding needed staff capacity.
In contrast to what is clearly needed, we believe the
Administration's fiscal year 2009 request for $2.34 billion more than
the FY 2008 appropriation is not adequate.
The increase the Administration has requested for medical care does
not quite keep pace with inflation (due to increased energy costs,
rising pharmaceutical costs, and other costs VA cannot control), but it
will not allow VA to continue the needed pace of enhancing its
healthcare and mental healthcare services for returning veterans,
restore needed long-term care programs for aging veterans, or allow
working-class veterans to return to their healthcare system. VVA's
recommendation of a $5.24 billion increase over FY 2008 would
accommodate these goals.
The advances of VA in recent years in improving the veterans'
healthcare system are well known, and often elucidated by all of us,
particularly VA officials. However, these advances have come with a
cost. For years, the veterans' healthcare system has been falling
behind in meeting the healthcare needs of some veterans. At the
beginning of 2003, the former Secretary of Veterans Affairs made the
decision to bar so-called Priority 8 veterans from enrolling. In most
cases, these veterans are not the well-to-do--they are working class
veterans or veterans living on fixed incomes who earn as little as
$28,000 a year. It is not uncommon to hear about such veterans choosing
between getting their prescription drug orders filled or paying their
utility bills. The decision to ``temporarily'' bar these veterans is
still standing, and it is still troubling to thoughtful Americans. As
of this week, VA officials estimated that as many as 250,000 additional
veterans are shut out of the system until they become indigent or
eventually are granted service connection for one or more of their
conditions that originated in military service. No one knows the size
of the ``migration'' from the wilderness of Priority 8 to a category
where these veterans can enter the system at some point when they are
much sicker and/or poorer, because the VA has not tried to track it (at
least not in a public way that we know of). However, VVA believes that
it is a significant number.
It is time to live up to the promise and obligation and to ``Leave
No Veteran Behind'' by restoring access to so-called Priority 8
veterans who are now on the outside and looking in. Of the recommended
increase, $1.3 billion is for restoration of the Priority 8 veterans by
the end of the second quarter of FY 2009. It will take VA at least 3 to
6 months to add the organizational capacity to ensure that the system
is not overwhelmed all at once.
Congress is to be commended for turning back many legislative
requests for enrollment fees and outpatient cost increases in the past,
which would have jeopardized access to care for hundreds of thousands
of veterans. Hard-fought Congressional add-ons, such as the $3.6
billion added to veterans' healthcare for fiscal year 2007, and the
more than $11 billion all told in calendar year 2008, now place us at a
position where it is not only feasible to re-open the system to all
veterans who have earned the right to access to this care, but it would
be wrong to continue to shut them out.
Medical Services
For medical services for fiscal year 2009, VVA recommends $44.3
billion including collections. This is approximately $3.1 billion more
than the Administration's request for fiscal year 2009. VVA is making
its budget recommendations based on re-opening access to the millions
of veterans disenfranchised by the Department's policy decision of
early 2003 that was supposed to be ``temporary.'' The former Ranking
Member of this Committee, Lane Evans, discovered that a quarter million
Priority 8 veterans had applied for care in fiscal year 2005. Similar
numbers of veterans have likely applied in each of the years since
their enrollment was barred. Our budget allows 1.5 million new Priority
7 and 8 veterans to enroll for care in their healthcare system. While
this may sound like too great a lift for the system, use rates for
Priority 7 and 8 veterans are much lower than for other priority
groups. Based on our estimates, it may yield only an 8% increase in
demand at a cost of about $1.9 billion to the system for additional
personnel, supplies and facilities.
The decade long diminishment of VA mental health programs that we
experienced in the 1990s leveled out by 2001, and VA slowly started to
rebuild capacity that has been accelerated in recent years. However, we
must continue to restore capacity to deal with mental disorders,
particularly with post traumatic stress disorder and the often
attendant co-morbidity of substance abuse. In particular, substance
abuse treatment needs to be expanded greatly, and be more reliant on
evidence-based medicine and practices that are shown to actually be
fruitful. The 21 day revolving door or the old substance abuse wards is
not something we should return to, but rather treatment modalities that
can be proven to work, and restore veterans of working age to the point
where they can obtain and sustain meaningful employment at a living
wage, and therefore re-establish their sense of self-esteem.
VVA also urges that additional resources explicitly be directed in
the appropriation for FY 2009 to the National Center for PTSD for them
to add to their organizational capacity under the current fine
leadership. The signature wounds of this war may well be PTSD and
traumatic brain injury and a complicated amalgam of both conditions.
VVA believes that if we provide enough resources, and hold VA managers
accountable for how well those resources are applied, that these fine
young veterans suffering these wounds can become well enough again to
lead a happy and productive life.
Up until recently, VA has not made enough progress in preparing for
the needs of troops returning from Iraq and Afghanistan--particularly
in the area of mental healthcare. In addition to the funds VVA is
recommending elsewhere, we specifically recommend an increase of an
additional $500 million over and above the $3.9 billion that VA now
says they will allocate to assist VA in meeting the mental healthcare
needs of all veterans. These funds should be used to develop or augment
with permanent staff at VA Vet Centers (Readjustment Counseling Service
or RCS), as well as PTSD teams and substance use disorder programs at
VA medical centers and clinician who are skilled in treating both PTSD
and substance abuse at the CBOC, which will be sought after as more
troops (including demobilized National Guard and Reserve members)
return from ongoing deployments. VVA also urges that the Secretary be
required to work much more closely with the Secretary of Health and
Human Services, and the States, to provide counseling to the whole
family of those returning from combat deployments by means of utilizing
the community mental health centers that dot the Nation. Promising work
is now going on in Connecticut and possibly elsewhere in this regard
that could possibly be a model. In addition, VA should be augmenting
its nursing home beds and community resources for long-term care,
particularly at the State veterans' homes.
To allow the staffing ratios that prevailed in 1998 for its current
user population, VA would have to add more than 15,000 direct care
employees--MDs, nurses, and other medical specialists--at a cost of
about $2 billion. This level, because the system can and should be more
efficient now, would allow us to end the shame of leaving veterans out
in the cold who want and are in vital need of healthcare at VA, and who
often have no other option.
Vet Centers
VA received an additional $20 million in the Supplemental
Appropriation for the war that was signed into law on March 7, 2007
specifically to increase the number of staff in the Readjustment
Counseling Service (RCS) by 250 FTEE. Whether it was VHA or OMB that
held these funds back, the funds were not released to the RCS to hire
additional staff for the VA Vet Centers until mid-August. The Vet
Centers are the most cost effective, cost efficient program operated by
VA, but which just plain does not have enough staff. Because of the
late arrival of the money the RCS could not hire any new staff, but
used the funds for other things, such as vehicles to do rural outreach.
The additional 250 staff members for the previously existing Vet
Centers are still very much needed, over and above the 100 peer
counselors and approximately 50 mental health professionals they have
already hired as additional staff in the past 2 years.
Medical Facilities
For medical facilities for fiscal year 2009, VVA recommends a level
of commitment that is at least equal to fiscal year 2008. Maintenance
of the healthcare system's infrastructure and equipment purchases are
often overlooked as Congress and the Administration attempt to correct
more glaring problems with patient care. In FY 2006, in just one
example, within its medical facilities account VA anticipated spending
$145 million on equipment, yet only spent about $81 million. VA
undertook an intensive process known as CARES (Capital Asset
Realignment to Enhance Services) to ``right size'' its infrastructure,
culminating in a May 2004 policy decision that identified approximately
$6 billion in construction projects. While for the reasons noted above
the VA has consistently underestimated future needs by using a fatally
flawed formula, thus far Congress and the Administration have only
committed $3.7 billion of this all-too-conservative needed funding. We
urge the Congress to continue the process of upgrading the physical
plant of medical facilities at least at the rate funding at the FY 2008
level for the next several years.
In a system in which so much of the infrastructure would be deemed
obsolete by the private sector (in a 1999 report GAO found that more
than 60% of its buildings were more than 25 years old), this has and
may again lead to serious trouble. We are recommending that Congress
provide an additional $1.5 billion to the medical facilities account to
allow them to begin to address the system's current needs. We also
believe that Congress should fully fund the major and minor
construction accounts to allow for the remaining CARES proposals to be
properly addressed by funding these accounts with a minimum of
remaining $2.3 billion.
Medical and Prosthetic Research
For medical and prosthetic research for fiscal year 2008, VVA
recommends $500 million. This is approximately $50 million more than
the Administration's request for fiscal year 2009. VA research has a
long and distinguished portfolio as an integral part of the veterans'
healthcare system. Research funding serves as a means to attract top
medical schools into valued affiliations and allows VA to attract
distinguished academics to its direct care and teaching missions.
VA's research program is distinct from that of the National
Institutes of Health because it was created to respond to the unique
medical needs of veterans. In this regard, it should seek to fund
veterans' pressing needs for breakthroughs in addressing environmental
hazard exposures, post-deployment mental health, traumatic brain
injury, long-term care service delivery, and prosthetics to meet the
multiple needs of the latest generation of combat-wounded veterans.
Further, VVA brings to your attention that VA medical and
prosthetic research is not currently funding a single study on Agent
Orange or other herbicides used in Vietnam, despite the fact that more
than 300,000 veterans are now service-connected disabled as a direct
result of such exposure in that war. This is unacceptable.
Mr. Chairman, finally I thank this Committee and the Appropriations
Committee for using the power of the purse in the FY 2008
Appropriations Act to compel VA to obey the law (Public Law 106-419)
and conduct the long-delayed National Vietnam Veterans Longitudinal
Study. VVA asks that you schedule a hearing and/or a Members briefing
for the second half of March for VA to outline their plan as to how
they are going to complete this much needed study for delivery of the
final results to the Congress by April 1, 2010, as a comprehensive
mortality and morbidity study of Vietnam veterans, the last large
cohort of combat veterans prior to those now serving in OIF/OEF.
Veterans Benefits Administration
The Veterans Benefits Administration (VBA) continues to need
additional resources and enhanced accountability measures. VVA
recommends an additional 300 over and above the roughly 700 new staff
members that are requested in the President's proposed budget for all
of VBA.
Compensation & Pension
VVA recommends adding 100 staff members above the level requested
by the President for the Compensation & Pension Service (C&P)
specifically to be trained as adjudicators. Further, VVA strongly
recommends adding an additional $60 million specifically earmarked for
additional training for all of those who touch a veterans' claim,
institution of a competency-based examination that is reviewed by an
outside body that shall be used in a verification process for all of
the VA personnel, veteran service organization personnel, attorneys,
county and State employees, and any others who might presume to at any
point touch a veterans' claim.
Vocational Rehabilitation
VVA recommends that you seek to add an additional 200 specially
trained vocational rehabilitation specialists to work with returning
servicemembers who are disabled to ensure their placement into jobs or
training that will directly lead to meaningful employment at a living
wage. It still remains clear that the system funded through the
Department of Labor simply is failing these fine young men and women
when they need assistance most in rebuilding their lives.
It is also unclear as to whether VA actually added several hundred
of these employment placement specialists for disabled veterans
specifically called for in last year's funding measure, and whether
they are effective in assisting disabled veterans, particularly
profoundly disabled veterans to obtain decent jobs.
VVA has always held that the ability to obtain and sustain
meaningful employment at a living wage is the absolute central event of
the readjustment process. Adding additional resources and much, much
greater accountability to the VA vocational rehabilitation process is
absolutely essential if we as a Nation are to meet our obligation to
these Americans who have served their country so well, and have already
sacrificed so much.
Accountability at VA
There is no excuse for the dissembling and lack of accountability
in so much of what happens at the VA. It is certainly better than it
used to be, but there is a long way to go in regard to cleaning up that
corporate culture to make it the kind of system that it can be with
existing resources, and even largely the same personnel as they
currently have onboard. It can be cleaned up and done right the first
time, if there is the political will to hold people accountable for
doing their job properly.
Thank you again, Mr. Chairman. We look forward to working with you
and this distinguished Committee to obtain an excellent budget for the
VA in this fiscal year, and to ensure the next generation of veterans'
well-being by enacting assured funding. I will be happy to answer any
questions you and your colleagues may have.
Prepared Statement of Paul Rieckhoff
Executive Director, Iraq and Afghanistan Veterans of America
Mr. Chairman and Members of the House Veterans' Affairs Committee,
on behalf of Iraq and Afghanistan Veterans of America and our tens of
thousands of members nationwide, I thank you for the opportunity to
testify today regarding the VA budget request for 2009.
From April 2003-February 2004, I served as a First Lieutenant and
Infantry Platoon Leader in Iraq. When I returned home, I quickly became
concerned about the lack of real support for returning troops and
veterans. In the early years of the wars, issues like traumatic brain
injury, post traumatic stress disorder, and homelessness received far
too little attention.
But times have changed. Last year, this Congress showed tremendous
commitment to our Nation's veterans, providing the VA with its single
largest budget increase in 77 years. On behalf of the millions of
veterans who rely on VA healthcare, including almost 300,000 troops
newly home from Iraq and Afghanistan, we hope you will continue to show
your support for veterans' healthcare. IAVA is one of the over 60
organizations who have endorsed The Independent Budget, and we endorse
it again for FY2009.
As the war in Iraq continues into its fifth year, this generation
of troops and veterans faces new and unique problems. Today, IAVA is
releasing our annual Legislative Agenda. Our Legislative Agenda covers
the entire war fighting cycle--before, during and after deployment--and
outlines practical solutions to the most pressing problems facing Iraq
and Afghanistan veterans. Our Legislative Agenda is available at IAVA's
Web site, www.iava.org.
The cornerstone of our 2008 Legislation Agenda is a new GI Bill.
After World War II, nearly 8 million servicemembers took advantage of
GI Bill education benefits. A veteran of WWII was entitled to free
tuition, books and a living stipend that completely covered the cost of
education.
Today we have the opportunity to renew our social contract with our
service men and women, and help rebuild our military. IAVA supports
reinstating a World War II-style GI Bill that will cover the true cost
of education and will fairly reward all combat veterans of Iraq and
Afghanistan. We have endorsed H.R. 2702.
Critics have said the GI Bill is too expensive. The fact is, a new
GI Bill is a bargain. The current GI Bill cost the Veterans' Affairs
Department $1.6 billion in 2004. Even if a World War II-style GI Bill
were to double that cost, it would be about what we spend in a week in
the War on Terror. And the GI Bill is more than a veterans' benefit. It
is also an effective tool to stimulate the economy and to improve
military readiness.
The GI Bill helped rebuild this country's economy after World War
II. A 1988 Congressional study proved that every dollar spent on
educational benefits under the original GI Bill added $7 to the
national economy in terms of productivity, consumer spending and tax
revenue.
Many of our Nation's leaders got their start thanks to the GI Bill,
including Presidents Gerald Ford, George H.W. Bush, and Senators Bob
Dole, George McGovern, and Pat Moynihan. The GI Bill also educated 14
Nobel Prize winners and two dozen Pulitzer Prize winners, including
authors Joseph Heller, Norman Mailer, and Frank McCourt.
Veterans of Iraq and Afghanistan, however, receive only a fraction
of the support offered to the Greatest Generation. For many, including
my good friend Sergeant Todd Bowers, the burden of student loans and
mounting debt can simply become too great.
When Sergeant Bowers was activated for his second deployment to
Iraq, he was forced to withdraw from his classes at George Washington
University, racking up an extra semester's debt without receiving
credit for his coursework. While he was deployed to Iraq, Bowers was
wounded when a sniper's round penetrated his rifle scope and sent
fragments into the left side of his face. He was awarded the Purple
Heart and Navy Commendation medal with ``V'' device for Valor. But when
Bowers returned home, he was not greeted as a hero by his university
and credit lenders. His student loans had been sent to collection, and
his credit rating was ruined. Struggling to keep up with payments,
Bowers was eventually forced to leave school.
The GI Bill is also an important recruitment tool. For years, the
military has been lowering recruitment standards and increasing
bonuses. We now spend more than $4 billion annually on recruitment, but
we're still struggling to meet recruiting goals. The GI Bill is the
military's single most effective recruitment tool; the number one
reason civilians join the military is to get money for college. A new
GI Bill, one that put college within reach of a new generation of
veterans, would be a tremendous boon to recruitment and would help
rebuild our military after years of war.
Above all, a World War II-style GI Bill would thank this generation
of combat veterans for their service and their sacrifice. As President
Roosevelt said in his signing statement to the original GI Bill: ``[The
GI Bill] gives emphatic notice to the men and women in our armed forces
that the American people do not intend to let them down.''
For all of these reasons, IAVA is calling for a new GI Bill to be
funded in this year's budget.
Thank you for your time.
Prepared Statement of Paul Sullivan
Executive Director, Veterans for Common Sense
I would like to thank Chairman Filner and Members of the Committee
for inviting Veterans for Common Sense to testify about the Department
of Veterans Affairs' budget request for fiscal year 2009. VCS
especially thanks this Committee for the dozens of hearings you held
last year, and for the prompt passage of the ``Dignity for Wounded
Warriors Act,'' a bill strongly supported by our VCS members.
As Associate Supreme Court Justice Thurgood Marshall said,
``Justice too long delayed is justice denied.'' With that quote in
mind, VCS believes VA's 2009 budget request falls far short because it
does not adequately seek to address what we believe should be VA's four
highest budget priorities:
1. Zero tolerance for homelessness. VA's budget does not provide
enough funding to reduce the number of homeless from 200,000 to as
close to zero as possible.
2. Zero tolerance for VA turning away suicidal patients.
3. Zero tolerance for turning away Afghanistan and Iraq war
veterans from free and prompt VA healthcare within 5 years of their
discharge from active duty.
4. Zero tolerance for VA claim delays and claim errors.
VCS believes VA suffers from a capacity crisis, and that our
veterans are unduly denied prompt access to VA services. Our veterans
earned and need prompt and high-quality medical care as well as prompt
and accurate claim decisions. VCS is outraged that government lawyers
argued against the new law mandating 5 years of free VA medical care
for our Iraq and Afghanistan war veterans.
VCS is concerned about three statements VA made about VA's 2007
budget:
VA Statement #1: Former VA Secretary Jim Nicholson said: ``The
President's 2008 budget request provides the resources necessary to
ensure that servicemembers' transition from active-duty military status
to civilian life continues to be as smooth and seamless as possible.''
Reality: VA's 2008 budget failed to meet this goal. The Walter Reed
scandal broke a few days after VA's comments, revealing the military
and VA were woefully underfunded and unprepared for unanticipated
patients. We thank this Congress for ignoring the Administration's
chronic underfunding and increasing VA's 2008 budget.
VA Statement #2: Current VA Under Secretary for Health Mike Kussman
said: ``With the resources requested for medical care in 2008, the
Department will be able to continue our exceptional performance dealing
with access to healthcare--96 percent of primary care appointments will
be scheduled within 30 days of patients' desired date. . . .''
Reality: While VA's Kussman claimed only 4 percent of patients
waited more than 30 days to see a doctor, VA's Inspector General
reported that 25 percent waited more than 30 days. This is six times
more than VA's claim. In Charleston, South Carolina, the
Charlottesville Observer reported that 93 percent of Iraq and
Afghanistan war veterans waited more than 30 days for medical care for
serious conditions such as TBI.
VA Statement #3: Former VA Secretary Nicholson said: ``We expect to
improve the timeliness of processing these claims to 145 days in 2008.
. . . In addition, we anticipate that our pending inventory of
disability claims will fall to about 330,000 by the end of 2008. . .
.'' In VA's press release dated February 4, 2008, VA once again
promised to cut the backlog to 300,000 claims and process claims in an
average of 145 days.
Reality: While VA would lead Congress to believe that VBA can
improve, the pending inventory of rating-related claims is 400,000, and
veterans wait an average of 183 days.
Important Facts: VCS used the Freedom of Information Act to obtain
documents providing incontrovertible evidence that VA's capacity crisis
requires more funding.
VA expects to treat 5.8 million patients this year, yet
VA's IG reported 25 percent, or nearly 1.5 million veterans, will wait
more than 1 month to see a VA doctor.
VA regional offices are still working on 650,000 claims
of all types, yet 26 percent, or 169,000 veterans, have already waited
more than 6 months.
Here are salient facts regarding Iraq and Afghanistan war veterans:
DoD already reports 68,000 non-fatal battlefield
casualties from the two wars, and VA expects to treat 333,000 veteran
patients during 2009.
VA hospitals already treated 264,000 unanticipated
patients, yet 33 percent, or 87,000 veterans, wait more than 1 month to
see a VA doctor.
VA's budget proposal spends more than $7,100 per
veteran on medical care, yet VA budgets only $3,900, for Iraq and
Afghanistan veterans, or 55% of the cost.
VA regional offices received 245,000 unanticipated
disability claims, yet 16 percent, or 39,000 veterans, are still
waiting, on average 6 months, for a VA claim decision.
DoD reported 20 percent, or potentially as many as
320,000, of our new war veterans are at risk for traumatic brain
injury, or TBI.
A recent West Virginia survey identified 36 percent, or
potentially as many as 600,000, of our veterans as having post
traumatic stress disorder, or PTSD.
Veterans who served in the National Guard and Reserves
are nearly three times as likely to have their claim denied than
veterans from regular active duty (14% v. 5%).
VA diagnosed 56,246 veterans with PTSD, yet approved
only 61 percent of the claims, or 34,138, for PTSD.
VA's failure to submit a budget to increase capacity and rectify
other systemic problems needlessly increased suffering among our
veterans. According to published reports, the number of broken homes,
unemployed veterans, drug and alcohol abuse, suicides, and homelessness
all rose--problems expected to worsen without immediate VA action.
As the Rev. Martin Luther King, Jr. said, ``Injustice anywhere is a
threat to justice everywhere.'' Our veterans earned and deserve better
from our government. The Administration's VA budget request is dead on
arrival because it does not deliver justice for our veterans in a
complete and timely manner.
Additional VA Budget Suggestions
VCS believes that VA should follow the role model of General Omar
Bradley, VA's Administrator after World War II. He said, ``We are
dealing with veterans, not procedures--with their problems, not ours.''
With that in mind, VCS solicited suggestions from our members, and they
were incorporated in the following additional VA budget suggestions.
VCS believes that VA's failures are caused by this Administration's
myopia at saving money and its inability to evolve. VA should not be
able to hide behind its failures to follow the law for decades as an
excuse not to begin a massive reform program to eliminate homelessness
among veterans, guarantee prompt and high-quality medical care, and
process disability claims accurately within 1 month.
VCS remains especially concerned that VA's inflexible leaders
continue to be unable to provide justice to our Nation's veterans,
especially during war when the needs of our veterans are most acute.
Here are some items that would bring justice to our veterans.
Patient Backlog. There is no Administration request for
mandatory full funding for all priority groups, thereby excluding
millions of uninsured veterans from VA hospitals and clinics. Currently
there is an unlimited military budget for bullets and bombs for our
military. Logically, there must also be mandatory full funding of VA's
budget for hospital beds and benefits for our veterans. In addition, VA
needs to stay open longer each weekday and consider being open on
weekends in order to increase capacity and thus meet the increase in
demand.
New Patients. The VA did not request additional funding
to provide the 5 years of mandatory free healthcare for our returning
Iraq and Afghanistan war veterans recently signed into law. Similarly,
there is no VA funding request to provide PTSD and TBI screening for
all 1.6 million servicemembers deployed to the war zone. In January
2008, a U.S. District Court ruled that our class action lawsuit against
VA will move forward. The Court ruled the 2 years of free medical care
is a spending mandate and rejected VA's view that spending on
healthcare for Iraq and Afghanistan war veterans was discretionary.
Congress should codify this ruling with mandatory full funding so no
future veterans wait for VA care.
Polytrauma. In 2007, VA planned more than 20 polytrauma
centers. VCS believes every VA medical center should be capable of
treating polytrauma patients in order to meet the growing demand that
more than 6 years of ongoing warfare requires. All VA medical centers
should have this ability so veterans can be treated near their homes
where family members and friends can provide comfort and support.
Suicide Epidemic. VA should fund a state-of-the-art
suicide data collection, reporting, and analysis office. The national
office should identify local, State, and Federal data about veterans
who attempted or committed suicide so VA can implement the best
policies to reduce suicide among all veterans, especially recent war
veterans. This should include monitoring of specific cohorts of
veterans by period of war, gender, race, number of deployments, length
of deployments, and use of VA healthcare.
Claims Backlog. In order to expedite claims and reduce
the backlog, the VA budget submitted by the President should have
sought new rules designed to create a presumption for a concussive
blast and/or a psychological stressor so that VA can more accurately
and quickly adjudicate claims for TBI and PTSD. Congress should mandate
automatically approving all VA claims within 30 days, for a period of
up to 1 year for deployed veterans' claims. VCS supports this bold
recommendation initially made by Harvard University Professor Linda
Bilmes.
Disability Claims. VA should make sure that VA employees
stationed at military facilities are authorized to assist with both
military and VA healthcare and claims paperwork, thus ending the turf
war preventing VA employees from assisting soon-to-be veterans. While
VA recently signed a contract to review adding ``quality of life'' to
the list of items considered when determining the amount of
compensation payments, VA has not sought additional authority to pay
such benefits.
Long-Term Planning. While there is increased funding for
information technology, there does not appear to be any funding for
increased staffing for data collection, reports, and analysis. These
are necessary so that VA does not repeat prior mistakes when VA
requested insufficient funding. Congress should enact H.R. 1354,
introduced by Rep. James Moran and Rep. Ray LaHood, which directs VA to
define the war zones, collect data, and prepare cost and benefit use
reports about the Iraq and Afghanistan wars. VCS also supports a
longitudinal study of Iraq and Afghanistan war veterans that starts
now. The Congress and the public must be fully and regularly informed
about the human and financial costs of the two wars.
Overhauling VA. VA does not appear to request money for a
desperately needed agencywide overhaul, as recommended by the Veterans
Disability Benefits Commission. VCS believes that our veterans and VA
employees will continue to suffer as long as VA fails to plan for
mandatory full funding and to plan to significantly expand timely
access to VA healthcare and claims. One component would be to implement
38 USC Section 5106, and thus require the military to automatically
provide VA full military and medical records on all servicemembers.
Another component would be to automatically enroll all servicemembers
into VA the first day the new servicemember enters the military.
Education Benefits. Transition and readjustment
assistance in the form of educational benefits are a meager fraction of
what they were when compared to the Post-World War II GI Bill. That is
why VCS strongly supports S. 22, introduced by Senator Jim Webb, ``The
Post-9/11 Veterans Educational Assistance Act of 2007,'' that
substantially increases payments to veterans.
Personality Disorder Discharges. There does not appear to
be any funding so VA can review the applications for healthcare and
disability benefits denied by VA on the basis of a personality disorder
discharge given by the military.
Ending Stigma. There is no funding to reduce the stigma
against people with mental health conditions. Military studies confirm
this stigma hinders many of our war veterans from seeking mental
healthcare.
Ending Employment Discrimination. Similarly, there is no
funding for public service announcements to combat illegal job
discrimination against veterans.
Vet Centers. Congress should enact legislation expanding
VA's highly successful Vet Centers so they can provide mental health
services to active duty servicemembers, either at existing facilities
or at new offices on military bases. This expanded service might first
be targeted at military installations that have shortages of mental
healthcare providers and bases expecting large redeployments from the
war zones. Congress should allow families to participate in the
readjustment counseling process at all Vet Centers.
Executive Bonuses. Congress should allow only modest
bonuses for VA executives, and these should be approved outside the
agency's normal chain of command. Furthermore, VCS strongly supports
performance-based incentives and bonuses for VA's rank-and-file
employees for ideas and actions made to improve the delivery of
healthcare and benefits to veterans.
Gulf War Veterans. Years of denial of the problem of
chronically ill Gulf War veterans is a tragic stain on the record of
the U.S. Government in caring for our veterans. VCS strongly supports
research to identify treatments for the 175,000 veterans of the 1991
Gulf War that VA estimates remain chronically ill, especially the $75
million for VA's program at the University of Texas Southwestern
Medical School. Another project that deserves close Committee attention
and support is actually funded by the military: VCS supports adding $30
million to the Department of Defense budget for competitive research in
the Congressionally Directed Medical Research Program since the
military has historically provided the majority of funding for this
research, but refuses to put it in its budget.
Vietnam War Veterans. VCS continues to support research
and treatments for Vietnam War veterans poisoned by dioxin contained in
Agent Orange. VCS also supports outreach to veterans with diabetes,
prostate cancer, and other war-related medical conditions so they are
aware of new VA healthcare and disability benefits for those
conditions. VA must be prohibited from expending funds to block claims
by ``Blue Water'' veterans for VA healthcare and benefits related to
agent orange.
TSGLI. VA's Traumatic Servicemembers' Group Life
Insurance program office should hire additional staff to analyze
significant discrepancies in the outcomes of TSGLI claims. According to
VA, only half of the TSGLI claims were approved (2,075 approved out of
3,979 applications, or 52%). Furthermore, Active Duty veterans were 65
percent more likely to have their TSGLI approved than National Guard
and Reserve veterans (66% v. 40%). Currently, TSGLI is available only
to servicemembers deployed to the Iraq and Afghanistan war zones. VCS
believes Congress should expand TSGLI staffing and make TSGLI benefits
available to servicemembers involved in training-related accidents,
regardless of their location.
Travel Reimbursement. VCS believes people in our country
should be treated equally, and veterans should receive the full 70
cents per mile reimbursement for travel, the same amount that
Representatives and Senators receive, and not the 28 cents approved by
Congress that includes a deductible that increased from $6 to $15.
Due Process. VCS believes all veterans should be able to
retain an attorney at the initial stages of a VA healthcare or
disability benefit application in order to expedite and improve the
process as well as to save VA money developing the claim; as it stands
a veteran must wait until the initial VA determination is made and the
veteran filed a Notice of Disagreement. VCS wishes to strongly
emphasize the need for competent, unbiased, non-government legal advice
for veterans and family members when a veteran has a serious injury
(such as TBI or PTSD), as the most serious cases of VA healthcare and
claims negligence and difficulties often involve veterans with these
conditions.
Outreach. VCS supports lifting the current ban on VA
advertising and outreach, as described in the July 2002 memo authored
by the former VA official Laura Miller. VCS believes VA should
broadcast public service announcements describing VA services,
especially for members of the National Guard and Reserve, who are using
VA services less than their active duty peers. VCS believes Congress
should fund VA training and outreach to universities so law students
are encouraged to learn about laws designed to assist veterans, plus
ongoing education to remain current on changes in the laws. If the
military can spend billions recruiting new soldiers, then VA should be
able to spend some money making sure veterans and their families know
what they earned and making sure they can quickly receive it.
VCS respectfully requests the following documents be entered into
the hearing record:
``VA Facility Specific OIF/OEF Veterans Coded with
Potential PTSD,'' Aug. 27, 2007.
``VA Benefits Activity: Veterans Deployed to the Global
War on Terror,'' Nov. 14, 2007.
VA ``Analysis of Healthcare Utilization Among U.S. Global
War on Terror Veterans,'' Oct. 2007.
DoD ``Contingency Tracking System Deployment File for
Operations Enduring Freedom & Iraqi Freedom,'' Oct. 31, 2007.
VCS ``VA Fact Sheet,'' Feb. 4, 2008 and VCS ``DoD Fact
Sheet,'' Jan. 12, 2008.
``The Elusive `Seamless Transition','' Proceedings,
February 2008.
__________
VA Facility Specific OIF/OEF Veterans Coded with Potential PTSD
Through 3rd Qt FY 2007
I. Background
The Government Accountability Office (GAO) has requested VA to
enumerate the total number of OIF/OEF veterans who were diagnosed with
PTSD by VISN and VAMC using VA inpatient and outpatient records. GAO
also asked for this information to be aggregated with Vet Center
utilization data. VHA prepared an initial report in October 2004 for
the healthcare utilization during FY 2004. This eleventh report covers
the VA healthcare data from FY 2002 through 3rd Qt FY 2007.
II. Data Sources
OIF/OEF veteran roster
Since October 2003, the Department of Defense (DoD) Defense
Manpower Data Center (DMDC) has sent the Department of Veterans Affairs
(VA) Environmental Epidemiology Service (EES) a periodically updated
personnel roster of troops who participated in Operation Enduring
Freedom (OEF) and Operation Iraqi Freedom (OIF) who had separated from
active duty and become eligible for VA benefits. The roster was
originally prepared based on the pay records of individuals but in more
recent months it was based on a combination of pay records and
operational records provided by each branch of service. Based on the
latest DMDC file received on July 27, 2007, there are a total of
751,273 unique OEF/OIF veterans (excluding 3,638 who died in theater),
who have been separated as of May 2007 from active duty following the
deployment. For each veteran, his/her demographic (SSN, name, DOB,
gender, education, etc.) and military service specific data (branch,
rank, unit component, deployment dates, etc.) were included in the
record.
VHA healthcare utilization records
The roster was checked against VA's inpatient (PTF) and outpatient
(OPC) electronic patient records available through June 30, 2007 to
determine those who had sought treatment in VA facilities as well as
the ICD-9 diagnostic codes used to describe the visits. Thus, the data
we have was administrative data and not based on a careful review of
each patient record. For the purpose of this report, we searched his/
her healthcare utilization records during FY 2002, 2003, 2004, 2005,
2006 and through FY 2007 3rd Qt ending June 30, 2007 following his/her
first deployment in Iraq or Afghanistan theater. For identification of
a potential PTSD patient, we used ICD-9CM, 309.81.
The Vet Center counts were based on the data provided to EES on
August 17, 2007 by the Readjustment Counseling Service (RCS). The RCS
staff matched the same DMDC roster with Vet Center users' records
through FY 2007 3rd Qt.
III. Distribution of Veterans by Diagnostic Code and Facility
A veteran is counted only once in any facility specific
category. For example, a veteran, who received healthcare from two or
more medical centers within the same VISN, was counted once for that
VISN. Likewise, a veteran who used services across two or more VISN
facilities and a Vet Center was counted only once for the national
overall total.
The number for ``Primary'' indicates the total number of
unique veterans whose primary reason for the inpatient or outpatient
visit was for treatment or evaluation of PTSD.
The number for ``Any'' indicates the total number of
unique veterans coded with PTSD, whether or not the primary reasons for
the inpatient or outpatient visit was for treatment or evaluation of
PTSD.
Both ``Primary'' and ``Any'' categories may include a
suspected diagnosis.
IV. Summary
Recognizing the limitations of DMDC deployment roster and the
uncertainty of the final diagnostic data based on VHA's electronic
patient records, a query of VHA healthcare utilization databases using
the May 2007 DMDC separation roster yielded a total of 48,559 OEF/OIF
veterans coded with PTSD at a VA medical center and 14,655 veterans who
received Vet Center service for PTSD. Of these, 41,591 were seen only
at a VAMC; 7,687 only at a Vet Center; and 6,968 were seen at both
facilities. In summary, based on the electronic patient records
available through June 30, 2007, a grand total of 56,246 OEF/OIF
veterans were seen for potential PTSD at VHA facilities following their
return from Iraq or Afghanistan Theater.
Han K. Kang, Dr.P.H.
August 27, 2007
__________
Number of Unique OEF/OIF Veterans With PTSD Utilizing VA Facilities During FY 2002-3d Qt FY 2007
--------------------------------------------------------------------------------------------------------------------------------------------------------
Inpatients Outpatients Total Patients \1\ Vet Centers \4\
VISN--Facility --------------------------------------------------------------------------------------------------- Grand
Primary \2\ Any \3\ Primary \2\ Any \3\ Primary \2\ Any \3\ PTSD Sub-PTSD Other Total \5\
--------------------------------------------------------------------------------------------------------------------------------------------------------
1--BEDFORD 10 36 185 204 185 210 58 5 86 256
--------------------------------------------------------------------------------------------------------------------------------------------------------
1--BOSTON 29 84 574 672 578 691 311 25 519 834
--------------------------------------------------------------------------------------------------------------------------------------------------------
1--MANCHESTER -- -- 168 208 168 208 144 11 475 304
--------------------------------------------------------------------------------------------------------------------------------------------------------
1--NORTHAMPTON 30 39 181 192 182 193 92 2 1729 237
--------------------------------------------------------------------------------------------------------------------------------------------------------
1--PROVIDENCE 16 45 332 383 333 390 129 1 785 451
--------------------------------------------------------------------------------------------------------------------------------------------------------
1--TOGUS 3 18 275 319 275 321 265 87 595 475
--------------------------------------------------------------------------------------------------------------------------------------------------------
1--WEST HAVEN 6 18 513 559 513 561 234 22 856 663
--------------------------------------------------------------------------------------------------------------------------------------------------------
1--WHITE RIVER JCT 11 18 223 276 224 279 142 724 560 374
--------------------------------------------------------------------------------------------------------------------------------------------------------
99 236 2332 2662 2334 2684 1375 877 5605 3386
VISN 1
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
2--UPSTATE N.Y. HCS 47 96 1205 1330 1209 1335 290 32 2782 1502
--------------------------------------------------------------------------------------------------------------------------------------------------------
47 96 1205 1330 1209 1335 290 32 2782 1502
VISN 2
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
3--BRONX 15 28 233 265 235 271 39 8 98 294
--------------------------------------------------------------------------------------------------------------------------------------------------------
3--EAST ORANGE 13 30 533 583 533 586 317 30 2105 799
--------------------------------------------------------------------------------------------------------------------------------------------------------
3--MONTROSE VA, HUDSON HCS NY 13 22 183 201 184 203 15 -- 115 216
--------------------------------------------------------------------------------------------------------------------------------------------------------
3--N.Y. HARBOR HCS 13 36 590 671 593 676 267 7 819 837
--------------------------------------------------------------------------------------------------------------------------------------------------------
3--NORTHPORT 9 29 240 278 240 279 38 10 125 291
--------------------------------------------------------------------------------------------------------------------------------------------------------
59 136 1709 1916 1715 1926 676 55 3262 2328
VISN 3
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
4--BUTLER -- -- 85 97 85 97 -- -- -- 97
--------------------------------------------------------------------------------------------------------------------------------------------------------
4--CLARKSBURG 7 16 227 249 227 250 83 -- 819 296
--------------------------------------------------------------------------------------------------------------------------------------------------------
4--COATESVILLE 10 18 170 183 173 188 -- -- -- 188
--------------------------------------------------------------------------------------------------------------------------------------------------------
4--ERIE -- -- 142 166 142 166 89 18 127 209
--------------------------------------------------------------------------------------------------------------------------------------------------------
4--JAMES E VAN ZANDT VAMC -- 3 154 185 154 185 -- -- -- 185
--------------------------------------------------------------------------------------------------------------------------------------------------------
4--LEBANON 15 23 297 327 297 329 123 42 362 392
--------------------------------------------------------------------------------------------------------------------------------------------------------
4--PHILADELPHIA 20 33 569 674 569 675 124 1 274 736
--------------------------------------------------------------------------------------------------------------------------------------------------------
4--PITTSBURGH--UNIV DR 27 48 174 226 184 248 187 346 760 391
--------------------------------------------------------------------------------------------------------------------------------------------------------
4--WILKES BARRE 8 22 221 258 222 262 158 60 1082 384
--------------------------------------------------------------------------------------------------------------------------------------------------------
4--WILMINGTON -- 1 128 144 128 144 199 17 589 272
--------------------------------------------------------------------------------------------------------------------------------------------------------
84 155 2029 2348 2032 2363 963 484 4013 2926
VISN 4
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
5--BALTIMORE 9 35 336 387 336 392 119 4 371 456
--------------------------------------------------------------------------------------------------------------------------------------------------------
5--MARTINSBURG 14 23 368 395 368 395 96 1 26 436
--------------------------------------------------------------------------------------------------------------------------------------------------------
5--WASHINGTON 12 28 516 572 518 579 208 30 926 688
--------------------------------------------------------------------------------------------------------------------------------------------------------
35 80 1185 1311 1187 1320 423 35 1323 1531
VISN 5
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
6--ASHEVILLE-OTEEN 17 21 143 180 145 183 -- -- -- 183
--------------------------------------------------------------------------------------------------------------------------------------------------------
6--BECKLEY -- 4 166 177 166 177 123 2 112 236
--------------------------------------------------------------------------------------------------------------------------------------------------------
6--DURHAM 25 44 429 465 432 472 210 21 2943 583
--------------------------------------------------------------------------------------------------------------------------------------------------------
6--FAYETTEVILLE NC 14 39 650 760 654 768 85 -- 9293 810
--------------------------------------------------------------------------------------------------------------------------------------------------------
6--HAMPTON 9 17 379 422 380 424 48 49 2129 450
--------------------------------------------------------------------------------------------------------------------------------------------------------
6--RICHMOND 14 42 381 423 384 440 93 7 643 503
--------------------------------------------------------------------------------------------------------------------------------------------------------
6--SALEM 14 25 169 198 173 205 26 3 3 214
--------------------------------------------------------------------------------------------------------------------------------------------------------
6--SALISBURY 29 42 538 621 540 626 77 131 1545 673
--------------------------------------------------------------------------------------------------------------------------------------------------------
121 225 2758 3115 2771 3150 662 213 16668 3474
VISN 6
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
7--ATLANTA 29 49 554 614 556 620 159 21 1004 743
--------------------------------------------------------------------------------------------------------------------------------------------------------
7--AUGUSTA 21 74 365 449 366 467 -- -- -- 467
--------------------------------------------------------------------------------------------------------------------------------------------------------
7--BIRMINGHAM -- 21 405 489 405 494 97 8 1675 571
--------------------------------------------------------------------------------------------------------------------------------------------------------
7--CHARLESTON 11 18 333 404 336 409 189 26 3660 523
--------------------------------------------------------------------------------------------------------------------------------------------------------
7--COLUMBIA SC 9 21 567 623 569 626 226 3 1457 768
--------------------------------------------------------------------------------------------------------------------------------------------------------
7--DUBLIN -- 4 200 236 200 237 -- -- -- 237
--------------------------------------------------------------------------------------------------------------------------------------------------------
7--MONTGOMERY 45 64 694 771 706 785 -- -- -- 785
--------------------------------------------------------------------------------------------------------------------------------------------------------
7--TUSCALOOSA 15 28 433 451 436 455 -- -- -- 455
--------------------------------------------------------------------------------------------------------------------------------------------------------
126 264 3441 3901 3453 3934 671 58 7796 4340
VISN 7
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
8--BAY PINES 11 36 355 396 355 403 105 11 994 457
--------------------------------------------------------------------------------------------------------------------------------------------------------
8--MIAMI 9 30 432 486 432 489 479 20 1450 858
--------------------------------------------------------------------------------------------------------------------------------------------------------
8--N FL/S GA HCS 18 50 729 847 730 853 178 83 2116 955
--------------------------------------------------------------------------------------------------------------------------------------------------------
8--ORLANDO FL VAMC -- -- 334 386 334 386 128 23 746 457
--------------------------------------------------------------------------------------------------------------------------------------------------------
8--SAN JUAN PR 16 57 292 428 293 432 155 112 2672 491
--------------------------------------------------------------------------------------------------------------------------------------------------------
8--TAMPA 24 83 764 888 765 910 53 3 27 934
--------------------------------------------------------------------------------------------------------------------------------------------------------
8--W PALM BEACH 18 31 207 227 209 230 -- -- -- 230
--------------------------------------------------------------------------------------------------------------------------------------------------------
95 276 2820 3312 2824 3350 1098 252 8005 3967
VISN 8
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
9--HUNTINGTON -- 3 286 307 286 308 131 15 623 369
--------------------------------------------------------------------------------------------------------------------------------------------------------
9--LEXINGTON--LEESTOWN 21 42 273 334 279 344 48 5 317 370
--------------------------------------------------------------------------------------------------------------------------------------------------------
9--LOUISVILLE 15 33 219 257 223 265 27 29 638 277
--------------------------------------------------------------------------------------------------------------------------------------------------------
9--MEMPHIS 25 42 281 342 285 351 61 158 1290 378
--------------------------------------------------------------------------------------------------------------------------------------------------------
9--MOUNTAIN HOME 14 30 315 362 316 364 82 2 179 392
--------------------------------------------------------------------------------------------------------------------------------------------------------
9--VA MID TENN HCS NASH TN 39 85 528 633 536 655 122 270 975 728
--------------------------------------------------------------------------------------------------------------------------------------------------------
111 232 1867 2194 1886 2237 471 479 4022 2458
VISN 9
--------------------------------------------------------------------------------------------------------------------------------------------------------
10--CHILLICOTHE 11 23 169 195 169 199 -- -- -- 199
--------------------------------------------------------------------------------------------------------------------------------------------------------
10--CINCINNATI 10 24 256 278 258 284 57 11 846 309
--------------------------------------------------------------------------------------------------------------------------------------------------------
10--CLEVELAND--WADE PARK 11 48 544 626 544 638 46 16 1606 655
--------------------------------------------------------------------------------------------------------------------------------------------------------
10--COLUMBUS--IOC -- -- 205 242 205 242 123 14 156 320
--------------------------------------------------------------------------------------------------------------------------------------------------------
10--DAYTON 15 25 186 218 189 225 44 2 39 256
--------------------------------------------------------------------------------------------------------------------------------------------------------
47 118 1318 1504 1322 1526 270 43 2647 1663
VISN 10
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
11--ANN ARBOR HCS 7 19 215 252 216 256 -- -- -- 256
--------------------------------------------------------------------------------------------------------------------------------------------------------
11--BATTLE CREEK 26 36 313 354 317 360 102 -- 127 426
--------------------------------------------------------------------------------------------------------------------------------------------------------
11--DETROIT VAMC 5 23 150 215 152 220 108 16 526 294
--------------------------------------------------------------------------------------------------------------------------------------------------------
11--ILLIANA HCS DANVILLE IL 4 21 289 348 289 350 49 9 838 372
--------------------------------------------------------------------------------------------------------------------------------------------------------
11--INDIANAPOLIS--10TH ST 16 24 257 302 258 303 34 -- 500 327
--------------------------------------------------------------------------------------------------------------------------------------------------------
11--NORTHERN INDIANA HCS 2 8 137 178 137 179 61 16 415 223
--------------------------------------------------------------------------------------------------------------------------------------------------------
11--SAGINAW -- -- 227 292 227 292 -- -- -- 292
--------------------------------------------------------------------------------------------------------------------------------------------------------
58 126 1537 1871 1542 1881 354 41 2406 2089
VISN 11
--------------------------------------------------------------------------------------------------------------------------------------------------------
12--HINES 18 44 308 346 310 359 71 25 140 407
--------------------------------------------------------------------------------------------------------------------------------------------------------
12--ILLIANA HCS DANVILLE IL -- -- -- -- -- -- 35 -- 577 35
--------------------------------------------------------------------------------------------------------------------------------------------------------
12--IRON MOUNTAIN 1 1 72 88 72 88 -- -- -- 88
--------------------------------------------------------------------------------------------------------------------------------------------------------
12--MADISON 6 24 163 199 163 207 33 30 6639 228
--------------------------------------------------------------------------------------------------------------------------------------------------------
12--MILWAUKEE 17 45 366 431 370 441 34 12 245 464
--------------------------------------------------------------------------------------------------------------------------------------------------------
12--NORTH CHICAGO 8 23 167 218 170 227 56 14 322 259
--------------------------------------------------------------------------------------------------------------------------------------------------------
12--TOMAH 11 20 198 239 198 242 -- -- -- 242
--------------------------------------------------------------------------------------------------------------------------------------------------------
12--VA CHICAGO HCS 5 16 228 275 228 280 132 3 533 372
--------------------------------------------------------------------------------------------------------------------------------------------------------
64 165 1442 1716 1448 1754 361 84 8456 1981
VISN 12
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
15--VA HEARTLAND--E VH MO 36 76 673 785 678 794 151 41 1978 883
--------------------------------------------------------------------------------------------------------------------------------------------------------
15--VAMC HEARTLAND--W KANSAS MO 111 189 755 871 785 922 165 12 4047 1040
--------------------------------------------------------------------------------------------------------------------------------------------------------
146 263 1418 1645 1451 1702 316 53 6025 1907
VISN 15
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
16--ALEXANDRIA 10 32 188 244 193 253 -- -- -- 253
--------------------------------------------------------------------------------------------------------------------------------------------------------
16--FAYETTEVILLE AR 16 30 239 258 241 266 -- -- -- 266
--------------------------------------------------------------------------------------------------------------------------------------------------------
16--GULF COAST HCS 13 32 560 625 565 636 530 7 1288 1021
--------------------------------------------------------------------------------------------------------------------------------------------------------
16--HOUSTON 19 35 570 621 575 632 85 10 318 680
--------------------------------------------------------------------------------------------------------------------------------------------------------
16--JACKSON 4 24 145 206 146 211 22 38 273 219
--------------------------------------------------------------------------------------------------------------------------------------------------------
16--LITTLE ROCK 48 85 632 668 642 687 212 50 613 803
--------------------------------------------------------------------------------------------------------------------------------------------------------
16--MUSKOGEE 4 12 214 241 216 244 108 22 19 321
--------------------------------------------------------------------------------------------------------------------------------------------------------
16--OKLAHOMA CITY 15 37 360 424 363 436 63 36 328 464
--------------------------------------------------------------------------------------------------------------------------------------------------------
16--SHREVEPORT 14 30 264 301 266 307 118 187 2052 386
--------------------------------------------------------------------------------------------------------------------------------------------------------
16--SOUTHEAST LA HCS 3 5 357 396 357 396 71 173 12 447
--------------------------------------------------------------------------------------------------------------------------------------------------------
145 314 3436 3874 3463 3945 1209 523 4903 4705
VISN 16
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
17--DALLAS 24 56 613 689 616 699 144 54 656 809
--------------------------------------------------------------------------------------------------------------------------------------------------------
17--SAN ANTONIO 33 54 879 986 881 991 301 86 2114 1145
--------------------------------------------------------------------------------------------------------------------------------------------------------
17--VA CENTRAL TEXAS HCS 28 37 841 1013 843 1015 264 43 1304 1198
--------------------------------------------------------------------------------------------------------------------------------------------------------
85 145 2290 2639 2297 2656 709 183 4074 3086
VISN 17
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
18--AMARILLO HCS -- 2 154 178 154 179 64 64 98 216
--------------------------------------------------------------------------------------------------------------------------------------------------------
18--EL PASO HCS -- -- 185 204 185 204 24 1 1111 218
--------------------------------------------------------------------------------------------------------------------------------------------------------
18--NEW MEXICO HCS 18 45 584 634 586 640 243 15 321 738
--------------------------------------------------------------------------------------------------------------------------------------------------------
18--NORTHERN ARIZONA HCS 1 1 135 149 135 149 47 10 47 166
--------------------------------------------------------------------------------------------------------------------------------------------------------
18--PHOENIX 30 69 847 932 852 941 103 8 942 980
--------------------------------------------------------------------------------------------------------------------------------------------------------
18--SOUTHERN ARIZONA HCS 39 58 360 436 364 443 102 1 2475 499
--------------------------------------------------------------------------------------------------------------------------------------------------------
18--WEST TEXAS HCS -- 2 129 151 129 151 53 3 252 175
--------------------------------------------------------------------------------------------------------------------------------------------------------
86 171 2313 2588 2319 2606 636 102 5246 2877
VISN 18
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
19--CHEYENNE -- 2 129 144 129 145 107 22 575 215
--------------------------------------------------------------------------------------------------------------------------------------------------------
19--DENVER 50 73 772 903 778 911 232 5 3266 1031
--------------------------------------------------------------------------------------------------------------------------------------------------------
19--FORT HARRISON 2 12 328 393 328 394 234 15 674 539
--------------------------------------------------------------------------------------------------------------------------------------------------------
19--GRAND JUNCTION 1 2 76 88 76 88 -- -- -- 88
--------------------------------------------------------------------------------------------------------------------------------------------------------
19--SALT LAKE CITY HTHCARE 27 48 482 551 485 560 198 38 2074 685
--------------------------------------------------------------------------------------------------------------------------------------------------------
19--SHERIDAN 18 28 124 157 127 159 -- -- -- 159
--------------------------------------------------------------------------------------------------------------------------------------------------------
91 154 1848 2167 1856 2184 771 80 6589 2623
VISN 19
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
20--ALASKA HCS & RO -- -- 85 124 85 124 166 24 1206 242
--------------------------------------------------------------------------------------------------------------------------------------------------------
20--BOISE 4 16 157 199 160 203 79 88 1540 265
--------------------------------------------------------------------------------------------------------------------------------------------------------
20--PORTLAND 14 39 660 770 661 775 258 47 695 926
--------------------------------------------------------------------------------------------------------------------------------------------------------
20--PUGET SOUND HCS 105 137 956 1061 975 1087 397 53 6662 1333
--------------------------------------------------------------------------------------------------------------------------------------------------------
20--S. ORG REHAB WHITE CITY -- -- 67 77 67 77 37 2 82 103
--------------------------------------------------------------------------------------------------------------------------------------------------------
20--SPOKANE 6 15 212 244 212 248 103 18 1499 298
--------------------------------------------------------------------------------------------------------------------------------------------------------
20--VA ROSEBURG HCS 63 65 251 278 281 308 90 27 1710 355
--------------------------------------------------------------------------------------------------------------------------------------------------------
20--WALLA WALLA 4 4 136 158 136 158 -- -- -- 158
--------------------------------------------------------------------------------------------------------------------------------------------------------
185 259 2427 2798 2451 2834 1130 259 13394 3505
VISN 20
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
21--CENTRAL CALIFORNIA HCS 8 16 241 285 242 290 107 2 596 335
--------------------------------------------------------------------------------------------------------------------------------------------------------
21--HONOLULU 1 4 223 242 223 243 88 25 1853 301
--------------------------------------------------------------------------------------------------------------------------------------------------------
21--MANILA -- -- 14 14 14 14 -- -- -- 14
--------------------------------------------------------------------------------------------------------------------------------------------------------
21--NCHC MARTINEZ -- 2 535 775 535 777 352 44 1408 966
--------------------------------------------------------------------------------------------------------------------------------------------------------
21--PALO ALTO--PALO ALTO 28 88 501 586 508 616 125 3 1332 666
--------------------------------------------------------------------------------------------------------------------------------------------------------
21--SAN FRANCISCO 5 20 284 315 286 325 99 13 176 381
--------------------------------------------------------------------------------------------------------------------------------------------------------
21--SIERRA NEVADA HCS 5 16 160 175 160 177 57 3 153 202
--------------------------------------------------------------------------------------------------------------------------------------------------------
43 142 1898 2300 1904 2339 828 90 5518 2742
VISN 21
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
22--GREATER LA HCS 13 38 808 930 809 938 266 24 1451 1087
--------------------------------------------------------------------------------------------------------------------------------------------------------
22--LOMA LINDA 32 63 621 723 623 732 166 13 2827 823
--------------------------------------------------------------------------------------------------------------------------------------------------------
22--VA LONG BEACH HCS CA 5 16 508 595 508 598 163 10 568 743
--------------------------------------------------------------------------------------------------------------------------------------------------------
22--VA SAN DIEGO HCS CA 22 43 705 834 707 842 251 9 4673 974
--------------------------------------------------------------------------------------------------------------------------------------------------------
22--VA SOUTHERN NEVADA HCS 6 19 281 332 282 334 78 12 541 377
--------------------------------------------------------------------------------------------------------------------------------------------------------
77 174 2853 3311 2858 3334 924 68 10060 3867
VISN 22
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
23--FARGO 3 6 90 115 92 117 92 1 910 180
--------------------------------------------------------------------------------------------------------------------------------------------------------
23--FORT MEADE 3 4 119 156 119 157 34 8 359 180
--------------------------------------------------------------------------------------------------------------------------------------------------------
23--MINNEAPOLIS 13 61 316 378 318 400 74 61 1135 448
--------------------------------------------------------------------------------------------------------------------------------------------------------
23--SIOUX FALLS 3 15 151 216 152 219 91 83 1589 267
--------------------------------------------------------------------------------------------------------------------------------------------------------
23--ST CLOUD 6 14 185 205 186 209 -- -- -- 209
--------------------------------------------------------------------------------------------------------------------------------------------------------
23--VA NEB--WESTERN IA HCS 19 55 855 955 855 963 227 30 2135 1071
--------------------------------------------------------------------------------------------------------------------------------------------------------
47 153 1676 1971 1681 2000 518 183 6128 2279
VISN 23
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Unique Counts 1788 3721 41982 48148 42106 48559 14655 4194 128922 56246
--------------------------------------------------------------------------------------------------------------------------------------------------------
1. The ``total patient'' counts were generated by matching a cumulative roster of 751,273 unique OEF/OIF veterans, who had been separated from active
duty as of May 31, 2007, with VA inpatient (PTF) and outpatient (OPC) databases for FY 2002, 2003, 2004, 2005, 2006 and through 3rd Qt FY 2007. The
DoD Defense Manpower Data Center identified and provided the identity of these veterans to the VA Environmental Epidemiology Service on July 27, 2007.
2. The number for ``Primary'' indicates the total number of unique veterans whose primary reason for the inpatient or outpatient visit was for treatment
or evaluation of PTSD.
3. The number for ``Any'' indicates the total number of unique veterans with PTSD, whether or not the primary reasons for the inpatient or outpatient
visit was for treatment or evaluation of PTSD.
4. The Vet Center counts were based on matching the DMDC OEF/OIF roster with Vet Center user's record through 3rd Qt FY 2007.
5. The number for ``Grand Total'' (n=56,246) indicates the sum of ``Any Total Patients'' (n=48,559) and ``Vet Center PTSD'' (n=14,655) after excluding
known duplicates (n=6,968).
VA BENEFITS ACTIVITY
VETERANS DEPLOYED TO THE GLOBAL WAR ON TERROR
November 2007 Update
Prepared by VBA Office of Performance Analysis and Integrity
November 14, 2007
This report summarizes participation in VA benefits programs by
veterans identified by the Department of Defense as having been
deployed overseas in support of the Global War on Terror (GWOT).
Information is included for the following VA programs: Compensation,
Insurance, Home Loan Guaranty, Education, and Vocational Rehabilitation
and Employment.
This update provides data on VA program participation for 787.196
GWOT veterans separated from military service through July 2007.
It is important to understand that because many GWOT veterans had
earlier periods of service, the benefits activity identified in this
report could have occurred either prior to or subsequent to their GWOT
deployment (or both).
Chart #1 GWOT Veterans by Branch of Service
----------------------------------------------------------------------------------------------------------------
Branch of Service Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
Air Force 82,236 61,906 144,142
----------------------------------------------------------------------------------------------------------------
Army 265,597 155,062 420,659
----------------------------------------------------------------------------------------------------------------
Coast Guard 327 529 856
----------------------------------------------------------------------------------------------------------------
Marine Corps 28,601 70,634 99,235
----------------------------------------------------------------------------------------------------------------
Navy 23,171 92,969 116,140
----------------------------------------------------------------------------------------------------------------
Other 4 13 17
----------------------------------------------------------------------------------------------------------------
Unknown 2,226 2,102 4,328
----------------------------------------------------------------------------------------------------------------
Total matched to VA systems 402,162 383,215 785,377
----------------------------------------------------------------------------------------------------------------
Unable to match to VA systems 927 892 1,819
----------------------------------------------------------------------------------------------------------------
Total 403,089 384,107 787,196
----------------------------------------------------------------------------------------------------------------
Note: The veteran's branch of service was obtained from VA's BIRLS
system, which stores information for up to three periods of service.
The branch of service associated with the most recent service date was
used for the chart above.
Chart #2 Gender of GWOT Veterans
----------------------------------------------------------------------------------------------------------------
Gender Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
Female 42,054 43,499 85,553
----------------------------------------------------------------------------------------------------------------
Male 356,967 336,577 693,544
----------------------------------------------------------------------------------------------------------------
Unknown 3,141 3,139 6,280
----------------------------------------------------------------------------------------------------------------
Total matched to VA systems 402,162 383,215 785,377
----------------------------------------------------------------------------------------------------------------
Unable to match to VA systems 927 892 1,819
----------------------------------------------------------------------------------------------------------------
Total 403,089 384,107 787,196
----------------------------------------------------------------------------------------------------------------
Chart #3 Age of GWOT Veterans
----------------------------------------------------------------------------------------------------------------
Age Group Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
Under 20 157 280 437
----------------------------------------------------------------------------------------------------------------
20-29 135,492 247,911 383,403
----------------------------------------------------------------------------------------------------------------
30-39 119,465 74,040 193,505
----------------------------------------------------------------------------------------------------------------
40-49 105,658 51,996 157,654
----------------------------------------------------------------------------------------------------------------
50-59 35,909 7,400 43,309
----------------------------------------------------------------------------------------------------------------
60-69 4,662 277 4,939
----------------------------------------------------------------------------------------------------------------
Unknown 819 1,311 2,130
----------------------------------------------------------------------------------------------------------------
Total matched to VA systems 402,162 383,215 785,377
----------------------------------------------------------------------------------------------------------------
Unable to match to VA systems 927 892 1,819
----------------------------------------------------------------------------------------------------------------
Total 403,089 384,107 787,196
----------------------------------------------------------------------------------------------------------------
Note: Veterans' ages are calculated as the number of whole years
between the date of birth in the BIRLS system. Any veteran with a
missing or invalid date of birth, or where the calculated age was under
17 years or over 69 years, was placed in the ``Unknown'' age group.
Chart #4 Average Age of GWOT Veterans
----------------------------------------------------------------------------------------------------------------
Reserve Guard Active Duty
----------------------------------------------------------------------------------------------------------------
Average Age 36.0 years 30.0 years
----------------------------------------------------------------------------------------------------------------
Chart #5 Average Length of Service for GWOT Veterans Reserve
----------------------------------------------------------------------------------------------------------------
Reserve Guard Active Duty
----------------------------------------------------------------------------------------------------------------
Average Length of Service 3.7 years 7.7 years
----------------------------------------------------------------------------------------------------------------
Service-Connected Disability Compensation Program
VBA's computer systems do not contain any data that would allow us
to attribute veterans' disabilities to a specific period of service or
deployment. We are therefore only able to identify GWOT veterans who
filed a disability compensation claim at some point either prior to or
following their GWOT deployment. We are not able to identify which of
these veterans filed a claim for disabilities incurred during their
actual overseas GWOT deployment.
Many veterans file disability compensation claims for more than one
condition. The table below provides information on individual GWOT
veterans, not specific claimed disabilities.
Individuals included in the category ``Veterans Awarded Service-
Connection'' are those veterans who have at least one condition that
meets eligibility requirements for service connection under VA statutes
and regulations. For veterans who filed a claim for more than one
condition, this category contains veterans with a full grant of all
conditions as well as veterans with a combination of disabilities
granted and denied.
If none of a GWOT veteran's claimed conditions meet eligibility
requirements under VA statutes and regulations, these individuals are
included in the category ``Veterans Denied Service-Connection.''
Chart #6 C&P Activity Among GWOT Veterans
(Includes claims filed both prior to and following GWOT deployment)
------------------------------------------------------------------------
Reserves
Category Guard Active Duty Total
------------------------------------------------------------------------
Deployed Servicemembers 434,341 1,140,860 1,575,201
------------------------------------------------------------------------
Total GWOT Veterans 403,089 384,107 787,196
------------------------------------------------------------------------
Living GWOT Veterans 402,305 381,030 783,335
------------------------------------------------------------------------
GWOT In-Service Deaths 784 3,077 3,861
------------------------------------------------------------------------
Total GWOT Veterans with Claims
Decisions 74,017 142,051 216,104
------------------------------------------------------------------------
Veterans Awarded Service- 63,943 134,558 198,501
Connection
------------------------------------------------------------------------
Veterans Receiving Compensation 49,054 116,848 165,902
------------------------------------------------------------------------
Veterans Denied Service- 10,110 7,493 17,603
Connection
------------------------------------------------------------------------
Veterans with Pending Claims
(as of 10-31-07) 17,615 21,078 38,693
------------------------------------------------------------------------
Veterans with Pending Reopened 4,366 5,279 9,645
Claims
------------------------------------------------------------------------
Pending from First-Time Claimants 13,196 15,734 28,930
------------------------------------------------------------------------
Total GWOT Veterans Filing
Disability
Claims * 87,213 157,785 245,034
------------------------------------------------------------------------
* Includes ``Total GWOT Veterans with Claims Decisions'' and ``Pending
from First-Time Claimants.''
Disabilities are evaluated according to VA regulations, and the
extent of the disability is expressed as a percentage from zero percent
to 100 percent disabling, in increments of 10 percent. Veterans with
more than one service-connected disability receive a combined
disability rating.
The chart below includes GWOT veterans awarded combined service-
connected disability ratings from zero percent to 100 percent,
regardless of whether the veteran receives monetary compensation.
Chart #7 GWOT Veterans Awarded Service-Connection
(by Combined Degree of Disability)
----------------------------------------------------------------------------------------------------------------
Combined Degree Reserves Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
0% 12,043 16,192 28,235
----------------------------------------------------------------------------------------------------------------
10% 16,351 25,495 41,846
----------------------------------------------------------------------------------------------------------------
20% 9,015 19,179 28,194
----------------------------------------------------------------------------------------------------------------
30% 7,025 19,036 26,061
----------------------------------------------------------------------------------------------------------------
40% 6,109 17,029 23,138
----------------------------------------------------------------------------------------------------------------
50% 3,292 10,200 13,492
----------------------------------------------------------------------------------------------------------------
60% 3,702 11,012 14,714
----------------------------------------------------------------------------------------------------------------
70% 2,310 6,886 9,196
----------------------------------------------------------------------------------------------------------------
80% 1,684 4,671 6,355
----------------------------------------------------------------------------------------------------------------
90% 736 1,905 2,641
----------------------------------------------------------------------------------------------------------------
100% 1,676 2,953 4,629
----------------------------------------------------------------------------------------------------------------
Total 63,943 134,558 198,501
----------------------------------------------------------------------------------------------------------------
Note: Includes corporate data. Previous reports included CPMR only.
Chart #8 Ten Most Frequent Service-Connected Disabilities for GWOT Veterans
(Both Active Duty and Reserve/Guard)
----------------------------------------------------------------------------------------------------------------
Diagnostic Code Diagnosis Description Count
----------------------------------------------------------------------------------------------------------------
6260 Tinnitus 64,085
----------------------------------------------------------------------------------------------------------------
5237 Lumb56,633l or cervical strain
----------------------------------------------------------------------------------------------------------------
6100 Defective hearing 52,902
----------------------------------------------------------------------------------------------------------------
9411 Post Traumatic Stress Disorder 34,148
----------------------------------------------------------------------------------------------------------------
5260 Limi30,572
----------------------------------------------------------------------------------------------------------------
5271 Limi29,200tion of the ankle
----------------------------------------------------------------------------------------------------------------
5242 Degenerative arthritis of the spine 23,157
----------------------------------------------------------------------------------------------------------------
5299 Generalized, Elbow and Forearm, Wrist, Multiple 21,999
Fingers, Hip and Thigh, Knee and Leg, Ank , Foot,
Spine, Skull, Ribs, Coccyx
----------------------------------------------------------------------------------------------------------------
7101 Hypertensive vascular disease (essential arterial 21,931
hypertension)
----------------------------------------------------------------------------------------------------------------
5024 Tenosynovitis 20,582
----------------------------------------------------------------------------------------------------------------
Insurance Program Traumatic Injury Benefit
Traumatic Servicemembers' Group Life Insurance (TSGLI) is a
traumatic injury protection rider under Servicemembers' Group Life
Insurance (SGLI) that provides for payment to any member of the
uniformed services covered by SGLI who sustains a traumatic injury that
results in certain severe losses. Through October 31, 2007, 6,877
active duty servicemembers and veterans have applied for TSGLI. Of
those, 3,979 were filed by GWOT veterans, and 2,142 of those received
benefits.
Chart #9a GWOT Veterans Who Applied for TSGLI Benefits
(by Age)
----------------------------------------------------------------------------------------------------------------
Age Group Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
Under 20 -- 1 1
----------------------------------------------------------------------------------------------------------------
20-29 619 1,541 2,160
----------------------------------------------------------------------------------------------------------------
30-39 578 431 1,009
----------------------------------------------------------------------------------------------------------------
40-49 502 95 597
----------------------------------------------------------------------------------------------------------------
50-59 186 3 189
----------------------------------------------------------------------------------------------------------------
60-69 18 -- 18
----------------------------------------------------------------------------------------------------------------
Unknown -- 5 5
----------------------------------------------------------------------------------------------------------------
Total 1,903 2,076 3,979
----------------------------------------------------------------------------------------------------------------
Note: The totals above reflect veterans whose claims have been
approved, have been denied or are currently pending.
Chart #9b GWOT Veterans Who Received TSGLI Benefits
(by Age)
----------------------------------------------------------------------------------------------------------------
Age Group Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
Under 20 -- 1 1
----------------------------------------------------------------------------------------------------------------
20-29 335 990 1,325
----------------------------------------------------------------------------------------------------------------
30-39 242 272 514
----------------------------------------------------------------------------------------------------------------
40-49 135 54 189
----------------------------------------------------------------------------------------------------------------
50-59 42 -- 42
----------------------------------------------------------------------------------------------------------------
60-69 1 -- 1
----------------------------------------------------------------------------------------------------------------
Unknown -- 3 3
----------------------------------------------------------------------------------------------------------------
Total 755 1,320 2,075
----------------------------------------------------------------------------------------------------------------
Chart #10a GWOT Veterans Who Applied for TSGLI Benefits
(by Gender)
----------------------------------------------------------------------------------------------------------------
Gender Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
Female 99 53 152
----------------------------------------------------------------------------------------------------------------
Male 1,796 2,016 3,812
----------------------------------------------------------------------------------------------------------------
Unknown 8 7 15
----------------------------------------------------------------------------------------------------------------
Total 1,903 2,076 3,979
----------------------------------------------------------------------------------------------------------------
Note: The totals above reflect veterans whose claims have been
approved, have been denied or are currently pending.
Chart #10b GWOT Veterans Who Received TSGLI Benefits
(by Gender)
----------------------------------------------------------------------------------------------------------------
Gender Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
Female 25 33 58
----------------------------------------------------------------------------------------------------------------
Male 741 1,336 2,077
----------------------------------------------------------------------------------------------------------------
Unknown 2 5 7
----------------------------------------------------------------------------------------------------------------
Total 768 1,374 2,142
----------------------------------------------------------------------------------------------------------------
Home Loan Guaranty Program
VA's home loan guaranty program has been helping veterans purchase
homes for more than 60 years. VA guaranteed home loans are made by
banks and mortgage companies to veterans, servicemembers and eligible
reservists. With VA backing a portion of the loan, veterans can receive
a competitive interest rate without a down payment, making it easier to
buy a home.
This benefit can be used more than once if needed to (1) refinance
an existing VA guaranteed loan at a lower interest rate or (2) to
purchase a home that will again be used as the person's primary
residence (eligible to do this normally after paying off any previous
loans.)
Chart#11 HomeLoanGuarantyProgramParticipationbyGWOTVeterans
----------------------------------------------------------------------------------------------------------------
Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
GWOT Veterans with VA Loan 103,419 78,003 181,422
----------------------------------------------------------------------------------------------------------------
Total Loans Made to GWOT Veterans 159,613 115,161 274,774
----------------------------------------------------------------------------------------------------------------
Dollar Amount of All Loans to GWOT Veterans $18,111,753,284 $14,437,024,155 $32,548,777,439
----------------------------------------------------------------------------------------------------------------
Education Programs
The chart below reflects participation by GWOT veterans in VA
education benefit programs since September 11, 2001. Participants may
have been entitled to more than one benefit. For example, a reservist
may have received Chapter 1606 benefits until he or she became eligible
to receive Chapter 1607 benefits. This participant would be reported in
both columns in the chart below.
Chart #12 Education Program Participation Among GWOT Veterans Since September 11, 2001
----------------------------------------------------------------------------------------------------------------
Type of Training Chapter 30 Chapter 1606 Chapter 1607 Total
----------------------------------------------------------------------------------------------------------------
Graduate 6,509 5,867 3,292 16,711
----------------------------------------------------------------------------------------------------------------
Under Graduate 59,894 71,796 22,443 157,219
----------------------------------------------------------------------------------------------------------------
Junior College 73,355 47,657 12,111 134,166
----------------------------------------------------------------------------------------------------------------
NCD 17,213 6,920 2,426 27,027
----------------------------------------------------------------------------------------------------------------
Total 156,971 132,240 40,272 335,123
----------------------------------------------------------------------------------------------------------------
Montgomery GI Bill Active-Duty (Chapter 30) provides up to 36
months of education benefits for degree and certificate programs,
flight training, apprenticeship/on-the-job training, and correspondence
courses. Generally, benefits are payable for 10 years following release
from active duty.
Montgomery GI Bill Selected Reserve (Chapter 1606) provides up to
36 months of education benefits to members of the reserve elements of
the Army, Navy, Air Force, Marine Corps, and Coast Guard, and members
of the Army National Guard, and the Air National Guard. This benefit
may be used for degree and certificate programs, flight training,
apprenticeship/on-the-job training, and correspondence courses.
Benefits generally end the day a member separates from the Selected
Reserve or National Guard. For those who are activated, eligibility is
extended beyond separation for a period of time equal to time served on
active duty plus 4 months.
Reserve Educational Assistance Program (REAP) (Chapter 1607)
provides educational assistance to members of the Reserve components
called or ordered to active duty in response to a war or national
emergency as declared by the President or Congress. This new program
makes certain reservists who were activated for at least 90 days after
September 11, 2001, eligible for education benefits or eligible for
increased benefits.
Vocational Rehabilitation and Employment (VR&E) Program_Chanter 31
Chart #13 VR&E Activity Among GWOT Veterans
(Includes participation either prior to and following GWOT deployment)
----------------------------------------------------------------------------------------------------------------
Current Case Status Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
Applicant 376 881 1,257
----------------------------------------------------------------------------------------------------------------
Employment Services 134 370 504
----------------------------------------------------------------------------------------------------------------
Evaluation and Planning 1,025 2,326 3,351
----------------------------------------------------------------------------------------------------------------
Extended Evaluation 165 355 520
----------------------------------------------------------------------------------------------------------------
Independent Living 45 58 103
----------------------------------------------------------------------------------------------------------------
Interrupted 253 679 932
----------------------------------------------------------------------------------------------------------------
Rehabilitation to Employability 1,943 5,916 7,859
----------------------------------------------------------------------------------------------------------------
Unknown 86 24 110
----------------------------------------------------------------------------------------------------------------
Current Participants 4,027 10,609 14,636
----------------------------------------------------------------------------------------------------------------
Rehabilitated 696 733 1,429
----------------------------------------------------------------------------------------------------------------
Discontinued 290 294 584
----------------------------------------------------------------------------------------------------------------
Total VR&E Participants 5,013 11,636 16,649
----------------------------------------------------------------------------------------------------------------
Applicant: A veteran's case is assigned to applicant status when
the VA receives an application (VAF-1900) for services under Chapter
31.
Evaluation and Planning: Determination of feasibility of a
vocational goal and/or evaluation of the veteran's ability to function
independently within the veteran's family and community.
Extended Evaluation: Determine the current feasibility of the
veteran with a serious employment handicap to achieve a vocational
goal.
Rehabilitation to Employability: Services and training necessary
for entry into employment in an identified suitable occupational
objective.
Independent Living Program: Services that are needed to enable a
veteran to achieve maximum independence in daily living, including home
accommodations, counseling, and educational services, as determined
necessary.
Employment Services: Services to assist in obtaining and/or
maintaining suitable employment.
Rehabilitated: The goals of a rehabilitation/employment/independent
living program have been substantially achieved.
Interrupted: Temporary suspension of the program warranted due to a
veteran's individual circumstances.
Discontinued: All services and benefits are terminated.
Serious Employment Handicap: A significant impairment of a
veteran's ability to prepare for, obtain, or maintain employment, as
determined by a VA counselor.
Sources
DoD:
Defense Manpower Data Center (DMDC) East, cumulative
count of servicemembers deployed to OEF/OIF, from September 11, 2001
through July 2007.
DMDC West, extract of OEF/OIF servicemembers discharged
to civilian status from September 2001 through July 2007.
The DMDC list of 787,196 deployed GWOT veterans
represents 50% of the cumulative deployed GWOT servicemember population
of 1,575,201 through July 2007.
VBA:
Beneficiary Identification and Records Locator Subsystem
(BIRLS), as of the end of the month October 2007.
Compensation and Pension Master Record (CPMR), active
records (``A'' type) as of the end of the month October 2007.
CPMR, terminated records (``E'' type) as of the end of
the month September 2007.
Corporate records as of November 01, 2007.
Pending Issue File (PI F), as of the close of business on
October 31, 2007.
Vocational Rehabilitation and Employment Service Chapter
31 file, as of the end of the month September 2007.
Loan Guaranty data, as of November 05, 2007.
TSGLI file, as of October 31, 2007.
Education Service data, as of the end of September 2007.
Questions
Questions may be referred to the Office of Performance Analysis and
Integrity at (202) 461-9040.
__________
Analysis of VA Healthcare Utilization
Among U.S. Global War on Terrorism (GWOT) Veterans
Operation Enduring Freedom
Operation Iraqi Freedom
VHA Office of Public Health and Environmental Hazards
October 2007
Current DoD Roster of Recent War Veterans
Evolving roster development by DoD Defense Manpower Data
Center (DMDC)
In September 2003, DMDC developed an initial file of
``separated'' troops who had been deployed to the Iraqi and Afghan
theater of operations using proxy files: Active Duty and Reserve Pay
files, Combat Zone Tax Exclusion, and Imminent Danger Pay data.
In September 2004, DMDC revised procedures for creating
periodic updates of the roster and now mainly utilizes direct reports
from service branches of previously deployed OEF (Operation Enduring
Freedom) and OIF (Operation Iraqi Freedom) troops.
DMDC is actively addressing the limitations of the
current roster to improve the accuracy and completeness of future
rosters.
Latest update of roster
Provided to Dr. Kang, Veterans Health Administration
(VHA) Environmental Epidemiology Service, on July 27, 2007.
Qualifications of DoD's OEF/OIF deployment roster
Contains list of veterans who have left active duty and
does not include currently serving active duty personnel.
Does not distinguish OEF from OIF veterans.
Roster only includes separated OEF/OIF veterans with
out-of-theater dates through May 2007.
3,638 veterans who died in-theater are not included.
Updated Roster of OEF and OIF Veterans Who Have Left Active Duty
751,273 OEF and OIF veterans who have left active duty
and become eligible for VA healthcare since FY 2002.
48% (362,237) Former Active Duty troops.
52% (389,036) Reserve and National Guard.
Use of DoD List of War Veterans Who Have Left Active Duty
This roster is used to check the VA's electronic
inpatient and outpatient health records, in which the standard ICD-9
diagnostic codes are used to classify health problems, to determine
which OEF/OIF veterans have accessed VA healthcare as of June 30, 2007.
The data available for this analysis are mainly
administrative information and are not based on a review of each
patient record or a confirmation of each diagnosis. However, every
clinical evaluation is captured in VHA's computerized patient record.
The data used in this analysis are excellent for healthcare planning
purposes because the ICD-9 administrative data accurately reflects the
need for healthcare resources, although these data cannot be considered
epidemiologic research data.
These administrative data have to be interpreted with
caution because they only apply to OEF/OIF veterans who have accessed
VHA healthcare due to a current health question. These data do not
represent all 751,273 OEF/OIF veterans who have become eligible for VA
healthcare since FY 2002 or the approximately 1.5 million troops who
have served in the two theaters of operation since the beginning of the
conflicts in Iraq and Afghanistan.
Because VA health data are not representative of the
veterans who have not accessed VA healthcare, formal epidemiological
studies will be required to answer specific questions about the overall
health of recent war veterans.
Analyses based on this updated roster are not directly
comparable to prior reports because the denominator (number of OEF/OIF
veterans eligible for VA healthcare) and numerator (number of veterans
enrolling for VA healthcare) change with each update.
This report presents data from VHA's healthcare
facilities and does not include Vet Center data or DoD healthcare data.
The following healthcare data are ``cumulative totals''
since FY 2002 and do not represent data from any single year.
The numbers provided in this report should not be added
together or subtracted to provide new data without checking on the
accuracy of these statistical manipulations with VHA's Office of Public
Health and Environmental Hazards.
VA Healthcare Utilization from FY 2002 to 2007 (3rd QT) Among OEF and
OIF Veterans
Among all 751,273 separated OEF/OIF Veterans
35% (263,909) of total separated OEF/OIF veterans have
obtained VA healthcare since FY 2002 (cumulative total).
96% (253,730) of 263,909 evaluated OEF/OIF patients
have been seen as outpatients only by VA and not hospitalized.
4% (10,179) of 263,909 evaluated OEF/OIF patients
have been hospitalized at least once in a VA healthcare facility.
VA Healthcare Utilization for FY 2002-2007 (3rd QT) by Service
Component
362,237 Former Active Duty Troops.
36% (132,194) have sought VA healthcare since FY 2002
(cumulative total).
389,036 Reserve/National Guard Members.
34% (131,715) have sought VA healthcare since FY 2002
(cumulative total).
Comparison of VA Healthcare Requirements
The cumulative total of 263,909 OEF/OIF veterans evaluated by VA
over approximately 5 years from FY 2002 to FY 2007 (3rd QT) represents
about 5% of the 5.5 million individual patients who received VHA
healthcare in any 1 year (total VHA patient population of 5.5 million
in 2006).
Frequency Distribution of OEF and OIF Veterans According to the VISN Providing the Treatment
----------------------------------------------------------------------------------------------------------------
OEF-OIF Veterans
Treated at a VA
Treatment Site Facility *
---------------------
Frequency %
----------------------------------------------------------------------------------------------------------------
VISN 1 VA New England Healthcare System 12,336 4.7
----------------------------------------------------------------------------------------------------------------
VISN 2 VA Healthcare Network Upstate New York 7,460 2.8
----------------------------------------------------------------------------------------------------------------
VISN 3 VA New York/New Jersey Healthcare System 10,255 3.9
----------------------------------------------------------------------------------------------------------------
VISN 4 VA Stars & Stripes Healthcare System 12,709 4.8
----------------------------------------------------------------------------------------------------------------
VISN 5 VA Capital Healthcare System 6,981 2.7
----------------------------------------------------------------------------------------------------------------
VISN 6 VA Mid-Atlantic Healthcare System 14,437 5.5
----------------------------------------------------------------------------------------------------------------
VISN 7 VA Atlanta Network 18,941 7.2
----------------------------------------------------------------------------------------------------------------
VISN 8 VA Sunshine Healthcare Network 22,107 8.4
----------------------------------------------------------------------------------------------------------------
VISN 9 VA Mid-South Healthcare Network 15,527 5.9
----------------------------------------------------------------------------------------------------------------
VISN 10 VA Healthcare System of Ohio 7,310 2.8
----------------------------------------------------------------------------------------------------------------
VISN 11 Veterans in Partnership Healthcare Network 9,462 3.6
----------------------------------------------------------------------------------------------------------------
VISN 12 VA Great Lakes He16,031re Sy6.1m
----------------------------------------------------------------------------------------------------------------
VISN 15 VA Heartland Network 9,310 3.5
----------------------------------------------------------------------------------------------------------------
VISN 16 South Central VA Healthcare Network 22,950 8.7
----------------------------------------------------------------------------------------------------------------
VISN 17 VA Heart of Texas Healthcare Network 16,181 6.1
----------------------------------------------------------------------------------------------------------------
VISN 18 VA Southwest Healthcare Network 13,586 5.2
----------------------------------------------------------------------------------------------------------------
VISN 19 VA Rocky Mountain Network 11,176 4.2
----------------------------------------------------------------------------------------------------------------
VISN 20 VA Northwest Network 15,249 5.8
----------------------------------------------------------------------------------------------------------------
VISN 21 VA Sierra Pacific Network 12,050 4.6
----------------------------------------------------------------------------------------------------------------
VISN 22 VA Desert Pacific Healthcare Network 21,559 8.2
----------------------------------------------------------------------------------------------------------------
VISN 23 VA Midwest Healthcare Network 14,903 5.7
----------------------------------------------------------------------------------------------------------------
* Veterans can be treated in multiple VISNs. A veteran was counted only once in any single VISN but can be
counted in multiple VISN categories. The total number of OEF-OIF veterans who received treatment (n = 263,909)
was used to calculate the percentage treated in any one VISN.
Demographic Characteristics of OEF and OIF Veterans Utilizing VA Healthcare Percent OEF/OIF Veterans (n =
263,909) Sex Male 88
Female 12 Age Group <20 5
20-29 52
30-39 23
40 20 Branch Air Force 12
Army 65
Marine 12
Navy 11 Unit Type Active 50
Reserve/Guard 50 Rank Enlisted 92
Officer 8
Diagnostic Data
Veterans of recent military conflicts have presented to
VHA with a wide range of possible medical and psychological conditions.
Health problems have encompassed more than 8,000 discrete
ICD-9 diagnostic codes.
The three most common possible health problems of war
veterans were musculoskeletal ailments (principally joint and back
disorders), mental disorders, and ``Symptoms, Signs and Ill-Defined
Conditions.''
As in other outpatient populations, the ICD-9 diagnostic
category, ``Symptoms, Signs and Ill-Defined Conditions,'' was commonly
reported. It is important to understand that this is not a diagnosis of
a mystery syndrome or unusual illness. This ICD-9 code includes
symptoms and clinical finding that are not coded elsewhere in the ICD-
9. It is a diverse, catch-all category that is commonly used for the
diagnosis of outpatient populations. It encompasses more than 160 sub-
categories and primarily consists of common symptoms that do not have
an immediately obvious cause during a clinic visit or isolated
laboratory abnormalities that do not point to a particular disease
process and may be transient.
Frequency of Possible Diagnoses Among OEF and OIF Veterans
------------------------------------------------------------------------
(n = 263,909)
Diagnosis (Broad ICD-9 Categories) ----------------------------
Frequency * Percent
------------------------------------------------------------------------
Infectious and Parasitic Diseases (001-139) 28,665 10.9
Malignant Neoplasms (140-208) 2,193 0.8
Benign Neoplasms (210-239) 9,129 3.5
Diseases of Endocrine/Nutritional/Metabolic
Systems
(240-279) 50,968 19.3
Diseases of Blood and Blood Forming Organs 5,086 1.9
(280-289)
Mental Disorders (290-319) 100,580 38.1
Diseases of Nervous System/Sense Organs 83,273 31.6
(320-389)
Diseases of Circulatory System (390-459) 39,633 15
Disease of Respiratory System (460-519) 49,464 18.7
Disease of Digestive System (520-579) 81,427 30.9
Diseases of Genitourinary System (580-629) 25,561 9.7
Diseases of Skin (680-709) 38,791 14.7
Diseases of Musculoskeletal System/
Connective System
(710-739) 117,424 44.5
Symptoms, Signs and Ill Defined Conditions 93,093 35.3
(780-799)
Injury/Poisonings (800-999) 48,736 18.5
------------------------------------------------------------------------
* These are cumulative data since FY 2002, with data on hospitalizations
and outpatient visits as of June 30, 2007; veterans can have multiple
diagnoses with each healthcare encounter. A veteran is counted only
once in any single diagnostic category but can be counted in multiple
categories, so the above numbers add up to greater than 263,909.
Frequency of Possible Mental Disorders Among OEF/OIF Veterans Since 2002
*
------------------------------------------------------------------------
Total Number of GWOT
Disease Category (ICD 290-319 code) Veterans **
------------------------------------------------------------------------
PTSD (ICD-9CM 309.81) 48,559
------------------------------------------------------------------------
Nondependent Abuse of Drugs (ICD 305) 40,320
------------------------------------------------------------------------
Depressive Disorders (311) 32,815
------------------------------------------------------------------------
Neurotic Disorders (300) 25,746
------------------------------------------------------------------------
Affective Psychoses (296) 18,069
------------------------------------------------------------------------
Alcohol Dependence Syndrome (303) 8,062
------------------------------------------------------------------------
Sexual Deviations and Disorders (302) 4,550
------------------------------------------------------------------------
Special Symptoms, Not Elsewhere Classified (307) 4,581
------------------------------------------------------------------------
Drug Dependence (304) 3,613
------------------------------------------------------------------------
Acute Reaction to Stress (308) 3,130
------------------------------------------------------------------------
* Note--These are cumulative data since FY 2002. ICD diagnoses used in
these analyses are obtained from computerized administrative data.
Although diagnoses are made by trained healthcare providers, up to one-
third of coded diagnoses may not be confirmed when initially coded
because the diagnosis is ``rule-out'' or provisional, pending further
evaluation.
** A total of 100,580 unique patients received a diagnosis of a possible
mental disorder. A veteran may have more than one mental disorder
diagnosis and each diagnosis is entered separately in this table;
therefore, the total number above will be higher than 100,580.
This row of data does not include information on PTSD from VA's
Vet Centers and does not include veterans not enrolled for VHA
healthcare. Also, this row of data does not include veterans who did
not have a diagnosis of PTSD (ICD 309.81) but had a diagnosis of
adjustment reaction (ICD-9 309).
81% of these veterans (32,700) had a diagnosis of tobacco use disorder
(ICD-9 305.1).
Summary
Recent OEF and OIF veterans are presenting to VA with a
wide range of possible medical and psychological conditions.
Recommendations cannot be provided for particular testing
or evaluation--veterans should be assessed individually to identify all
outstanding health problems.
Thirty-five percent of separated OEF/OIF veterans have
received healthcare from VA since 2002 compared to 35% in the last
quarterly update. Although the percentage of war veterans seen by VA
remained the same in this quarter, the percentage of OEF/OIF veterans
receiving healthcare from VA and the percentage with any type of
diagnosis will tend to increase over time as these veterans continue to
enroll for VA healthcare and to develop new health problems, as true
for other cohorts of military veterans.
Because the 263,909 OEF and OIF veterans who have
accessed VA healthcare were not randomly selected and represent just
18% of the approximately 1.5 million recent OEF/OIF veterans, they do
not constitute a representative sample of all OEF/OIF veterans.
Reported diagnostic data are only applicable to the
263,909 VA patients--a population actively seeking healthcare--and not
to all OEF/OIF veterans.
For example, the fact that about 38% of VHA patients'
encounters were coded as related to a possible mental disorder does not
indicate that approximately 1/3 of all recent war veterans are
suffering from a mental health problem. Only well-designed
epidemiological studies can evaluate the overall health of OEF/OIF war
veterans.
High rates of VA healthcare utilization by recent OEF/OIF
veterans reflect the fact that these combat veterans have ready access
to VA healthcare, which is free of charge for 2 years following
separation for any health problem possibly related to wartime service.
Also, an extensive outreach effort has been developed by VA to
inform these veterans of their benefits, including the mailing of a
personal letter from the VA Secretary to war veterans identified by DoD
when they separate from active duty and become eligible for VA
benefits.
When a combat veteran's 2-year healthcare eligibility
passes, the veteran will be moved to their correct priority group and
charged all co-payments as applicable. If their financial circumstances
place them in Priority Group 8, their enrollment in VA will be
continued, regardless of the date of their original VA application.
Follow-Up
VA will continue to monitor the healthcare utilization of recent
Global War on Terrorism veterans using updated deployment lists
provided by DoD to ensure that VA tailors its healthcare and disability
programs to meet the needs of this newest generation of OEF/OIF war
veterans.
__________
Contingency Tracking System (CTS) Deployment File for Operation Enduring Freedom & Iraqi Freedom
As of: October 31, 2007
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number of
Total Number of Members with Number of Members with Total Number of Members
Deployment Only One Deployment \1\ More Than One Deployment Members Ever Currently
Events \2\ Deployed Deployed
--------------------------------------------------------------------------------------------------------------------------------------------------------
Army Active Duty 747,160 309,604 184,861 494,465 138,185
--------------------------------------------------------------------------------------------------------------------------------------------------------
Army National Guard 234,214 164,358 31,694 196,052 23,864
--------------------------------------------------------------------------------------------------------------------------------------------------------
Army Reserve 137,415 88,651 21,513 110,164 12,143
--------------------------------------------------------------------------------------------------------------------------------------------------------
Army Total \3\ 1,118,789 562,613 238,068 800,681 174,192
--------------------------------------------------------------------------------------------------------------------------------------------------------
Navy Active Duty 417,409 178,716 98,210 276,926 35,894
--------------------------------------------------------------------------------------------------------------------------------------------------------
Navy Reserve 38,984 21,258 6,198 27,456 4,244
--------------------------------------------------------------------------------------------------------------------------------------------------------
Navy Total \4\ 456,393 199,974 104,408 304,382 40,138
--------------------------------------------------------------------------------------------------------------------------------------------------------
Air Force Active Duty 401,918 134,669 99,415 234,084 23,612
--------------------------------------------------------------------------------------------------------------------------------------------------------
Air National Guard 116,638 29,142 28,952 58,094 3,079
--------------------------------------------------------------------------------------------------------------------------------------------------------
Air Force Reserve 82,788 16,585 16,260 32,845 1,690
--------------------------------------------------------------------------------------------------------------------------------------------------------
Air Force Total \5\ 601,344 180,396 144,627 325,023 28,381
--------------------------------------------------------------------------------------------------------------------------------------------------------
Marine Corps Active Duty 271,164 104,786 73,547 178,333 27,953
--------------------------------------------------------------------------------------------------------------------------------------------------------
Marine Corps Reserve 34,372 26,712 3,686 30,398 4,439
--------------------------------------------------------------------------------------------------------------------------------------------------------
Marine Corps Total \6\ 305,536 131,498 77,233 208,731 32,392
--------------------------------------------------------------------------------------------------------------------------------------------------------
DoD Active Duty Total 1,837,651 727,775 456,033 1,183,808 225,644
--------------------------------------------------------------------------------------------------------------------------------------------------------
DoD National Guard Total 350,852 193,500 60,646 254,146 26,943
--------------------------------------------------------------------------------------------------------------------------------------------------------
DoD Reserve Total 293,559 153,206 47,657 200,863 22,516
--------------------------------------------------------------------------------------------------------------------------------------------------------
DoD Total 2,482,062 1,074,481 564,336 1,638,817 275,103
--------------------------------------------------------------------------------------------------------------------------------------------------------
Coast Guard Active Duty 3,463 2,439 423 2,862 274
--------------------------------------------------------------------------------------------------------------------------------------------------------
Coast Guard Reserve 232 205 10 215 3
--------------------------------------------------------------------------------------------------------------------------------------------------------
Coast Guard Total \7\ 3,695 2,644 433 3,077 277
--------------------------------------------------------------------------------------------------------------------------------------------------------
Active Duty Total 1,841,114 730,214 456,456 1,186,670 225,918
--------------------------------------------------------------------------------------------------------------------------------------------------------
National Guard Total 350,852 193,500 60,646 254,146 26,943
--------------------------------------------------------------------------------------------------------------------------------------------------------
Reserve Total 293,791 153,411 47,667 201,078 22,519
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total 2,485,757 1,077,125 564,769 1,641,894 275,380
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Two or more deployment events with overlapping participation dates are considered a single deployment.
\2\ For purposes of counting ``deployments'' by member, location is not considered. Breaks between deployments or ``dwell times'' of less than 21 days
are considered to be a single deployment in CTS. This is done in order to account for legitimate breaks in a deployment such as R&R or emergency
leave.
\3\ Army Source: Joint Personnel Theater Database (JPTR), Deployed Theater Accountability System (DTAS) & Defense Finance and Accounting Service (DFAS)
submissions for members earning Combat Zone Tax Exclusion (CZTE) or Imminent Danger Pay (IDP).
\4\ Navy Source: Individual Tempo (ITEMPO) & DFAS submissions for members earning CZTE or IDP.
\5\ Air Force Source: Deliberate Crisis Action Planning & Execution Segment (DCAPES) & DFAS submissions for members earning CZTE or IDP.
\6\ Marine Corps Source: Marine Corps Total Force System (MCTFS) Crisis File & DTAS.
\7\ Coast Guard Source: DFAS submissions for members earning CZTE or IDP.
Veterans for Common Sense
Post Office Box 15514
Washington, DC 20003
(202) 491-6953
www.VeteransForCommonSense.org
VA Fact Sheet: Impact of Iraq and Afghanistan Wars
Department of Defense Deployments, as of Oct. 31, 2007:
Cumulative U.S. servicemembers deployed: 1,641,894
Still remaining in the military: 854,698 (52%)
Veterans eligible for VA healthcare and benefits:
787,196 (48%)
Veterans Health Administration (VHA), as of Dec. 21,
2007:
Patients treated: 263,909 (34% of veterans)
Diagnosed with a mental health condition: 100,580 (38%
of patients)
Diagnosed with PTSD: 56,246 (21% of patients)
Counseled at Vet Centers: 242,000 (31% of veterans)
Veterans Benefits Administration (VBA), as of Nov. 14,
2007:
Filed a disability claim: 245,034 (31% of veterans)
Still waiting for an answer: 38,693 (16% of claims
filed)
Approved for a PTSD claim: 34,138 (65% of VHA patients)
Average wait time for BVA to process a claim: More than
6 months
Comparison of Active Duty with National Guard and
Reserve:
Veterans who served on Active Duty: 384,107 (49%)
Veterans activated for Guard/Reserve: 403,089 (51%)
Active Duty veterans with claims filed: 157,785 (41%)
Guard/Reserve veterans with claims filed: 87,213 (22%)
Active Duty veterans with claims rejected by VBA: 7,
493 (5%)
Guard/Reserve veterans with claims rejected by VBA:
10,110 (14%)
40 Year Estimate of War Costs by Harvard University, Jan.
2007:
New veteran patients: 700,000
New veteran claims: 700,000
Financial cost to U.S. taxpayers: $350 billion to $700
billion
---------------------------------------------------------------------------
Veterans for Common Sense is a nonpartisan organization providing
information and advocacy on policies related to national security,
civil liberties, veterans' healthcare and veterans' disability
benefits. VCS is registered with the IRS as a nonprofit 501(c)(3)
organization, and donations are tax deductible.
__________
Veterans for Common Sense
Post Office Box 15514
Washington, DC 20003
(202) 491-6953
www.VeteransForCommonSense.org
DoD Fact Sheet: Casualties From Iraq and Afghanistan Wars
DoD Reports 72,043 Battlefield Casualties Among 1.6 Million Deployed Since 2001
----------------------------------------------------------------------------------------------------------------
Afghanistan War Total of Both
Casualty Category (OEF) Iraq War (OIF) Wars
----------------------------------------------------------------------------------------------------------------
Oct. 7, 2001- Mar. 23, 2003- Through
Dates Jan. 5, 2008 Jan. 5, 2008 Jan. 5, 2008
----------------------------------------------------------------------------------------------------------------
Total Deaths 471 3,901 4,371
----------------------------------------------------------------------------------------------------------------
Total Wounded, Injured, and Ill 8,264 59,407 67,671
----------------------------------------------------------------------------------------------------------------
Total War Casualties 8,735 63,308 72,043
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Deployment to War Zones Dates Servicemembers
----------------------------------------------------------------------------------------------------------------
Cumulative Number Deployed Sep. 2001-Oct. 31, 2007 1,641,894
----------------------------------------------------------------------------------------------------------------
Deployed Twice or More Sep. 2001-Oct. 31, 2007 564,769
----------------------------------------------------------------------------------------------------------------
Source: Department of Defense
Afghanistan War (OEF): http://siadapp.dmds.osd.mil/personnel/CASUALTY/WOTSUM.pdf
Irag War (OIF): http://siadappdmdc.osd.mil/personnel/CASUALTY/OIF-Total.pdf
The Elusive `Seamless Transition'
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Copyright 2008, Proceedings, U.S. Naval Institute, Annapolis,
Maryland
(410) 268-6110 www.usni.org.
Many wounded servicemembers discharged after serving in Iraq or
Afghanistan must cope with confusing--and often conflicting--systems.
In moving from 000 medical care and disability benefits to those
provided
by the VA. For some veterans, it can be a nightmare.
By Art Pine *
In a perfect world, it would be a seamless transition. Severely
wounded troops returning from Iraq and Afghanistan and discharged from
the service would be able to get medical care and disability
compensation payments--and a full range of benefits--from the
Department of Veterans Affairs immediately. Red tape would be minimal.
Counselors would help servicemember's cope with the paperwork and
arrange for appointments. The veterans' military medical records would
be waiting at VA facilities when they got there. Help for families
would be readily available. Ideally, the entire transition would take
no more than a month.
---------------------------------------------------------------------------
* Mr. Pine, a former naval officer, is a veteran journalist who has
worked as a Washington correspondent for the Baltimore Sun, Washington
Post, Wall Street Journal, and Los Angeles Times. He is a frequent
contributor to Proceedings.
---------------------------------------------------------------------------
Instead, over the past 4 years, many returning Soldiers and
Marines--a good number having lost arms or legs or suffered from
traumatic brain injury (TBI) or post traumatic stress disorder (PTSD)--
have run into a bureaucratic nightmare. Confusing regulations have
mandated separate physical examinations by the Department of Defense
(DoD) and the VA, often with differing outcomes involving a
servicemember's disability rating. The waiting time for VA compensation
checks and other benefits frequently has ranged from 6 months to 2
years--and appeals can prolong the process even more. The VA's own
rulings have sometimes been inaccurate or inconsistent. And veterans,
some of them unable to battle the bureaucratic dragons, have often come
out the losers.
Not surprisingly, the ``seamless transition'' problem, as it has
come to be known, has exploded into a major controversy. A series of
articles in the Washington Post a year ago, which highlighted the
problems facing outpatients at Walter Reed Army Medical Center in
Washington, has spawned several high-level investigations--including an
independent review ordered by Defense Secretary Robert M. Gates and the
separate Dole-Shalala report, written by a bipartisan commission--to
look into the problem and make recommendations. Congress just passed
legislation designed to fix some of the glitches.
Under pressure from all sides, DoD and the VA have begun working
together to correct some of the problems. Over the past few months, the
two Departments have hired more counselors and ombudsmen to guide sick
and wounded veterans through the transition process. They have
established a pilot program that would provide for a single physical
examination that would serve both the military and the VA. And they
have placed VA-DoD ``recovery coordinators'' at major military
installations to improve cooperation between the Departments.
But some veterans' groups are skeptical that such efforts will
solve the problem anytime soon. Paul Sullivan, a former VA official who
now serves as executive director of Veterans for Common Sense, a
Washington-based advocacy group that has focused on the seamless
transition problem, argues that while the situation ``is getting
better,'' it will take years--even decades--for the glitches to be
fixed.
``The veterans don't have that kind of time,'' Sullivan says.
``They should not have to wait.''
A Major Overhaul Needed
Sullivan, a Gulf War veteran with 15 years' experience in dealing
with the VA, advocates a major overhaul of the Department to
significantly simplify its regulations and procedures, greatly enlarge
its staff and make veterans' benefits a full-fledged entitlement
program--much like Social Security--that isn't vulnerable to political
whims. He also wants the VA to upgrade the qualifications of the
counselors who help veterans apply for benefits, many of whom are
retired senior enlisted personnel without legal training or college
degrees.
The congressional watchdog agency, the Government Accountability
Office (GAO), also has called repeatedly for a major overhaul of VA
procedures for determining disability compensation.
By any standard, overhauling the current system wouldn't be cheap.
Although no one seems to have firm figures on how much it would take to
erase the problems, estimates range to tens of billions of dollars over
the next few years. ``You have a systemic problem that can only be
solved by simplifying the system,'' says Linda Bilmes, a Harvard
University government expert who did a study on the seamless transition
problem last year. ``It's inevitably going to take a long time to
resolve.''
Although the waiting time for VA medical care often is long, by far
the lion's share of the complaints about the transition stem from the
extended length of time it takes to obtain VA compensation benefits. On
the whole, returning troops seem satisfied with the military medical
care they receive, which is considered of high quality. And the
separate VA healthcare system is readily available to newly discharged
combat veterans, and is top-notch to boot. ``I don't think I ever got a
complaint about the VA's medical care,'' says John F. Sommer Jr.,
national executive director of the American Legion, reflecting an
upsurge in the Department's performance over the past decade. ``There's
little problem with the quality of healthcare once people get into the
system.''
The frustrations stem not just from the VA, but also from the whole
gamut of procedures and delays, starting with the military's own
medical discharge procedures. The combination has created a
bureaucratic obstacle course--and, often, a financial hardship for Iraq
and Afghanistan veterans who try to make the shift. ``The problem is
that veterans have to navigate among four separate systems--military
medicine, military disability pensions, VA healthcare, and VA
disability compensation benefits,'' says Sullivan of Veterans for
Common Sense. ``It's terribly confusing for almost everybody.''
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
``The problem is that veterans have to navigate among four separate systems--military medicine, military
disability pensions, VA healthcare, and VA disability compensation benefits,'' says Paul Sullivan of Veterans
for Common Sense. ``It's terribly confusing for almost everybody.''
----------------------------------------------------------------------------------------------------------------
The Nuts and Bolts
Here's how the system works.
Under longstanding regulations, seriously wounded troops are
returned to one of a handful of military hospitals for medical
treatment and recovery--primarily Walter Reed Army Medical Center in
Washington, the National Naval Medical Center at Bethesda, Maryland,
and Brooke Army Medical Center in San Antonio. After surgery or other
treatment, they're put into rehabilitation programs for a while and
then kept on as outpatients. Eventually, the military services' own
physicians decide they've essentially done all they can for the medium-
term, and it's time to decide whether the servicemember should remain
in the military or be discharged or retired.
When that time comes, physicians on a medical evaluation board, or
MEB, from the individual's service review the case and decide whether
they think the servicemember involved is fit for duty. If he (or she)
is deemed fit, he's kept on active-duty and transferred back to a
``Warrior Transition Unit'' that helps manage his rehabilitation
schedule and prepares him for another duty assignment. If he's not
deemed fit, the board recommends that he be separated from the service.
For those who are considered unfit, the next step is to decide whether
the servicemember should be ``medically retired'' or merely discharged.
Physicians on a physical evaluation board, or PEB, decide how disabled
the servicemember has been made by the single specific injury that made
him unfit for duty--a loss of limb or a serious head wound, for
example. If it's 30 percent or more, the servicemember is offered
retirement status, with a lifetime package that includes a pension,
medical treatment for himself and his family, commissary privileges,
and an array of other benefits.
Those given disability ratings of zero to 20 percent are not
offered retirement but instead are discharged, and given a lump-sum
severance payment. DoD often informally advises these servicemembers to
apply to the VA for medical care and compensation, where they have a
prospect of receiving a higher disability for a servicemember who is
suffering from mild traumatic brain injury or from PTSD, the process is
especially daunting, Beck says. It's hard enough to navigate the system
when your mental faculties are in place, but having a mental disability
that makes it difficult for you to concentrate, for instance, makes
following the process almost impossible, she says. Family members
rarely have the expertise or familiarity with the system to be of much
help. As a result, some veterans end up cash-strapped for months until
the cash payments begin to flow. Others fall through the cracks
entirely.
Not Always Easy
But doing that isn't always easy. Although veterans of Iraq and
Afghanistan are entitled to temporary VA medical care without
conditions, they must undergo a separate physical exam to decide how
much, if anything, they'll receive in compensation and benefits from
the VA's Veterans Benefits Administration. They have to fill out
significant amounts of paperwork. They must submit their complete
medical records from the military, which often are incomplete or even
illegible. And they are responsible for keeping their appointments with
physicians, clinics, and bureaucrats, no matter what their physical or
mental condition.
Bewildering for many veterans is that the VA's own medical
examination uses different criteria for assigning a disability rating
than do the military's physical examination boards, and each of the
four services has its own individual standards. DoD's physical
evaluation is concerned only with the single specific injury (such as
the loss of a limb) that has made the servicemember unfit for duty. By
contrast, the VA examination looks at all the veteran's physical and
mental ailments to determine the extent to which all of his service-
connected impairments have limited his capacity to function in the
civilian workforce and thus what his lifetime compensation payments
ought to be. So while the PEB might score a Soldier or Marine at 20
percent, the VA could assign a score of 80 percent. To add to the
problem, the just-discharged veteran faces an often-dizzying array of
potential problems.
The VA uses an electronic recordkeeping system, but until recently
DoD medical records were largely kept on paper. Thus information can't
be transferred between the two Departments automatically. In most
cases, newly discharged servicemembers must carry their paper records
to the VA by hand. If the records aren't complete, it's often difficult
for an individual veteran to obtain the missing portions. If he
overlooks a report--or doesn't know that it exists--he may never find
out about the omission.
The menu of VA and other government benefits including education
grants and Social Security disability payments--is so large and complex
that even experienced veterans' advocacy groups have trouble coping
with it. The application form alone that veterans must fill out to
obtain VA benefits is 26 pages long; the program descriptions and
regulations fill a book half an inch thick; and the manual that
staffers use to compile disability ratings is 2 inches thick.
Time-Consuming Process
The process of making appointments with physicians, lab
technicians, counselors, and bureaucrats is time-consuming and requires
frequent followup by the veteran, particularly for those with multiple
impairments, which involve several specialists and rehabilitation
clinics. Dealing with the bureaucracy also is a problem. Veterans'
organizations say their constituents too often receive letters that are
contradictory or in error. It often takes hours of work and attention
to straighten things out.
``It's like being on the phone with your health insurance company
all day, every day,'' says Meredith Beck, national policy director for
the Wounded Warrior Project, an advocacy group based in Jacksonville,
Florida, that has focused on the seamless transition problem.
For a servicemember who is suffering from mild traumatic brain
injury or from PTSD, the process is especially daunting, Beck says.
It's hard enough to navigate the system when your mental faculties are
in place, but having a mental disability that makes it difficult for
you to concentrate, for instance, makes following the process almost
impossible, she says. Family members rarely have the expertise or
familiarity with the system to be of much help. As a result, some
veterans end up cash-strapped for months until the cash payments begin
to flow. Others fall through the cracks entirely.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
NEW SECRETARY Retired Army Lieutenant General James Peake, a physician, was sworn in as Secretary of Veterans
Affairs on 20 December 2007. Here he takes his first tour of the new rehabilitation facilities at Walter Reed
Army Hospital and talks to Marine Lance Corporal Josh Bliell. Officials of both the VA and the various services
are seeking to simplify and accelerate the transition of wounded troops from one organization to the other.
----------------------------------------------------------------------------------------------------------------
Both the GAO and veterans groups say the system isn't equipped to
handle claims involving TBI, PTSD, and other mental problems
efficiently. Critics say there's such a stigma attached to mental
illnesses in the military that many returning soldiers won't report
them.
What Went Wrong
The roots of the whole seamless transition problem go well back
into bureaucratic history. The DoD and VA procedures that have created
it have been in force for decades--some dating back to the end of World
War II. But the volume of returning veterans wasn't sufficient to clog
the system then, and even during the Vietnam War the problem didn't
come to public attention. Many seriously wounded Soldiers and Marines
simply died on the battlefield, and the ones who did come home and were
discharged, rather than retired, were sent to VA hospitals, where they
were treated as inpatients.
The post-9/11 attack on Afghanistan and invasion of Iraq (in 2001
and 2003, respectively) changed all that dramatically. To begin with,
the conflicts have gone on far longer than most top policymakers
anticipated. In both wars, expectations were for a quick military
victory, followed by a handover of power to the countries' own
governments. A lengthy occupation, opposed by insurgents using IEDs,
car bombs, and suicide bombers--and, eventually, extended and repeat
deployments--weren't even on the drawing boards. Top U.S. generals and
senior Bush Administration officials spoke of a quick campaign of
``shock and awe'' in Iraq, followed by a prompt withdrawal of American
troops.
At the same time, improvements in military medicine have enabled a
far greater share of seriously wounded troops to survive and return
home for treatment. Better body armor protects more U.S. warfighters
against explosions and bullets. Today's highly skilled medics can treat
battlefield injuries more successfully, using new techniques such as
one-handed tourniquets and clotting bandages. And rapid evacuation by
helicopter is a matter of course. Today, only 10 percent of those
wounded in battle ultimately die, compared to 30 percent in Vietnam. At
the same time, the proportion of those losing arms or legs has doubled
to 6 percent, from 3 percent before.
To add to the strain on stateside facilities, the combination of
near-miracle medical technology and heightened pressures for cost
cutting has changed the way American medicine treats such cases--and
perversely contributes to the seamless transition problem. Where
previous generations of wounded veterans had been treated almost
entirely in hospitals, now they're released to go home and return for
medical attention solely as outpatients.
Finally, the long occupation and the frequency of injuries from car
bombs, IEDs, and suicide bombers have brought a sharp increase in cases
of TBI and PTSD that the military had little experience in recognizing
and treating in previous conflicts. (Those who suffered from PTSD
during the Vietnam War were discharged and sent to VA hospitals.) It
often compounds the physical wounds that the troops who served in Iraq
and Afghanistan bring home.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
The rival and often lethargic DoD and VA bureaucracies showed little real enthusiasm for cooperating with one
another to help fix the problems. And no one at the top--anywhere in government-- was pushing for a major
overhaul.
----------------------------------------------------------------------------------------------------------------
Overwhelming the System
The combination of factors quickly overwhelmed both the military
and the VA--and seriously exacerbated the glitches in the transition
process. Before 2001, the year that the United States attacked
Afghanistan, the number of pending claims for disability compensation
stood at 69,000, and only a third of them had been in process for more
than 6 months. By Fiscal Year 2007, which ended 30 September, the
number had soared to 392,000 pending claims, and the VA was taking an
average of 181 days to process them. For servicemembers who choose to
appeal the VA's initial decision, the average time taken to resolve the
case topped 650 days.
``It's too long, no doubt about it--much longer than I would
like,'' concedes retired Navy Vice Admiral Daniel L. Cooper, the VA
Under Secretary who heads the Department's Veterans Benefits
Administration, the VA branch that deals with compensation and
benefits. He says the Department hopes to bring processing time down in
coming months.
By early 2004, the potential magnitude of the seamless transition
problem was clearly apparent. Veterans' groups were reporting
increasing numbers of serious problems. The GAO was issuing reports
pointing out significant failures in the system. And lawmakers were
regularly expressing outrage about cases involving their constituents.
Once the war in Iraq began, in March 2003, there were other
pressures that made tackling the seamless transition problem elusive.
With the conflict already proving more difficult than Washington had
anticipated, the Bush Administration was reluctant to spotlight the
greater-than-expected casualties. At the same time, the Federal Office
of Management and Budget, faced with mushrooming domestic spending and
a push for a smaller military, was leaning on departments and agencies
to hold down nonmilitary spending. The VA sharply underestimated its
own needs in FY 2006 and 2007, and had to seek billions of dollars in
supplemental appropriations. The rival and often lethargic DoD and VA
bureaucracies showed little real enthusiasm for cooperating with one
another to help fix the problems. And no one at the top--anywhere in
government--was really pushing for a major overhaul.
Slow Start
As might be expected, the government's reaction--in the VA, DoD,
the White House, and Congress--wasn't instantaneous. In August 2003,
then-VA Secretary Anthony Principi formally recognized the problem and
put together a ``Seamless Transition Task Force'' to tackle it within
the Department. The group eventually issued a report, but little was
done by the time Principi left at the end of 2004.
What changed the equation was the February 2007 Washington Post
series on Walter Reed, written by Dana Priest and Anne Hull. The
articles became best known for exposing the dilapidated, mold-infested
temporary housing units in the medical center's Building 18, in which
severely wounded servicemembers and their families were living, but the
most telling part of the series described the bureaucratic run-around
they had received from hospital personnel who had been tasked with
arranging for outpatient rehabilitation care, military disability
ratings, and VA benefits.
``The Post series was about Walter Reed, but it described the same
kinds of symptoms that exist in the seamless transition problem,'' says
retired Lieutenant General Charles H. Roadman II, a former Surgeon
General of the Air Force who later served on an independent DoD-
appointed commission charged with investigating conditions at Walter
Reed.
Walter Reed ``brought the problem into the national consciousness''
and led to a speedup in efforts to deal with the problem, says Paul
Rieckhoft, executive director and founder of Iraq and Afghanistan
Veterans of America, a New York-based advocacy group that has focused
on the seamless transition problem.
The horror stories are legion. Newspapers all over the country have
been running articles about returning Soldiers and Marines who have
experienced serious difficulties in obtaining medical care and
compensation benefits, which often leave them in a major financial
bind, and seriously depressed.
Federal officials contend that some of the difficulties nationally
may have been exaggerated. Although the United States has sent 1.6
million combat troops to Iraq and Afghanistan since hostilities began,
there have been 66,000 cases over that period in which servicemembers
have been wounded, injured, or taken ill on the battlefield. The total
number of Iraq and Afghanistan veterans who have lost a limb is about
730--much lower than popular perceptions suggest. Indeed, there's a
serious dispute over how big the seamless transition problem is. The
VA's Vice Admiral Cooper estimates that after eliminating those wounded
and severely ill Iraq and Afghanistan veterans who are granted medical
retirements--and thus receive pensions from the military--the number
adversely affected by the lack of a seamless transition to the VA
amounts to fewer than 2,000 a year.
But Sullivan of Veterans for Common Sense argues that that
definition is too narrow--and misleading. ``It's true that there are
about 2,000 servicemembers a year who are in the `very seriously
wounded' category,'' he says, ``but the VA is now treating some 264,000
veterans of the two conflicts,'' and even those who qualify for
military medical care may apply for VA disability compensation
payments, which particularly benefit those in lower ranks. ``The VA
didn't prepare for this massive influx of claims,'' he says. ``It's
trying to narrow the definition so they can say there's no problem.''
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Critics question whether what is being done is really enough. Retired Air Force Major General Charles H.
Roadman II cautions that the pilot projects, if successful, must be expanded rapidly, without the usual
bureaucratic delays. `There's a tendency to ``pilot'' things to death,' he notes.
----------------------------------------------------------------------------------------------------------------
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
COMMAND INTEREST Defense Secretary Robert M. Gates and Admiral Edmund Giambastiani, then Vice Chairman of the
Joint Chiefs of Staff, meets with wounded troops at Walter Reed Army Medical Center in February 2007 to discuss
problems at the hospital expanded to include severe difficulties encountered by servicemembers moving from the
military medical system to VA healthcare.
----------------------------------------------------------------------------------------------------------------
Taking It Seriously
In the wake of the Washington Post series, all sides have begun
taking the problem more seriously. The Bush Administration has ordered
three separate investigations of the system by bipartisan commissions
that have released reports this year--a special Independent Review
Group named by Defense Secretary Gates, which looked into the situation
at Walter Reed and Bethesda; the President's Commission on Care for
America's Returning Wounded Warriors, known popularly as the Dole-
Shalala Commission; and the Veterans' Disability Benefits Commission
set up by Congress with members appointed by the President.
Together, they have recommended a number of steps designed to ease
the strain on the system: DoD and the VA should work together to
streamline procedures for determining disability compensation,
collaborate on providing more assistance to help returning veterans
cope with the transition, bolster support for families, work toward
making their electronic recordkeeping systems compatible with one
another, and do more to identify and treat post traumatic stress
disorder and mild traumatic brain injury.
Congress has stepped into the fray, passing legislation, called the
Wounded Warriors Act, last December designed to write some of the
Commissions' recommendations into law. They range from streamlining and
standardizing the procedures for calculating disability compensation
and benefits to requiring DoD and the VA to develop joint policies on
managing servicemembers' healthcare, including developing fully
interoperable electronic health records. The law also mandates the
development of a comprehensive DoD-VA policy to deal with TBI and PTSD.
And it extends to 5 years the period for which newly discharged combat
veterans can receive free medical care from the VA. Under previous law,
the limit was 2 years.
The VA and DoD also have begun working together to fix the process
on their own. Secretaries of the two Departments have been meeting
every Tuesday as part of a special joint Senior Oversight Group to
hammer out proposals for streamlining their procedures and providing
more help to severely wounded or ill veterans. In November, the two
Departments announced a pilot project in the Washington, DC, area that
will experiment with a single medical examination that can be used both
by the military services and by the VA. Physicians from the VA will
perform examinations that embrace the services' own standards, and
military boards will use the data to determine whether a servicemember
is fit for duty and whether he should be discharged or retired. The VA
hopes to cut in half the time it takes to go through the physical
examination process.
The Army and Marine Corps have established Warrior Transition units
for returning troops, in which a team of physicians, nurses, and case
managers watches over each servicemember's care and helps him with the
recovery process. The DoD and VA have set up early application Benefits
Delivery at Discharge programs under which soon-to-be-discharged troops
can begin applying for VA benefits 2 to 6 months before their
discharge, enabling them to start receiving benefits within a month
after their separation. They've hired special coordinators and
ombudsmen to help smooth the bureaucratic process for newly separated
veterans.
``We are taking this very, very seriously,'' says retired Navy Rear
Admiral Patrick W. Dunne, the VA's assistant secretary for policy and
planning, in an assurance that's repeated frequently by officials in
DoD and the VA alike.
And authorities are about to launch a feasibility study on how to
make the DoD and VA computer systems interoperable so that medical
records can easily be transferred from one Department to the other. A
big problem in the past has been bureaucratic inertia, but the two
systems also have serious structural differences that make it difficult
to integrate them. After some initial improvements, VA and DoD
physicians can read each other's records, look at x-rays and peruse
reports, but they can't enter information of their own or search for a
specific result or entry. Both agencies agree that more must be done.
Uncertain Outcome
It's difficult to judge whether what's already on the books or in
policymakers' sights will be sufficient to solve the problem. Stephen
L. Jones, the principal deputy assistant secretary of defense for
healthcare and a former Capitol Hill staffer, asserts that there still
is enough impetus from last year's political brouhaha over the
transition issue to keep the momentum going for the foreseeable future.
``I hope that some of the system's critics are noticing the improvement
already,'' he says.
But critics question whether what is being done is really enough.
Roadman, the former Air Force Surgeon General, for one, cautions that
the pilot projects, if successful, must be expanded rapidly, without
the usual bureaucratic delays. ``There's a tendency to `pilot' things
to death,'' he notes. There also is the risk that the momentum may be
interrupted by political events--the lame-duck year of the current
Administration, the 2008 election, and the months of organizational
efforts in any new Administration.
``My fear is that something big will happen to distract Congress
and the public from focusing on the problem,'' says Beck of the Wounded
Warrior Project. ``This is a difficult situation. It's not as clearly
fixable as the mold on the wall of Building 18 at Walter Reed.''
How quickly and how well the current plethora of steps--many of
them substantial by any measure--will bring the disability benefits
system closer to seamless transition for veterans returning from Iraq
and Afghanistan still isn't clear. Much will depend on whether all the
players involved can maintain the momentum between now and the time the
new Administration is in place. The VA has a new secretary, retired
Army Lieutenant General James B. Peake, a physician and decorated
Vietnam War veteran, who will play a key role between now and then.
__________
Bureaucratic Nightmares: A Sampler
The Gunny's Run-Around
When Marine Corps Gunnery Sergeant Tai Cleveland was injured during
his deployment for Operation Iraqi Freedom 4 years ago, it wasn't
supposed to be all that serious. ``At your age, everybody has back
pain,'' a military physician told him.
Thrown by a comrade during a hand-to-hand combat training exercise
in August 2003, Cleveland landed on his back wearing a full field pack
and armor, striking his head in the process. Doctors prescribed Motrin
and Valium, but the pain only
worsened, and the Gunny suffered chronic headaches. He began walking wit
h a limp.
Shipped back to the States, Cleveland was sent to Walter Reed Army
Medical Center in Washington, D.C., where an MRI revealed that he had
several fractured vertebrae, previously undetected. By November 2004,
he could hardly walk. Surgeons performed a spinal fusion, but the
bracing rod became undone and lodged in his spinal canal, so they had
to perform the operation again. Even so, ``You're going to walk
again,'' doctors assured him.
But the Gunny's condition worsened rapidly. The back pain and
headaches persisted, and Cleveland became paralyzed from the waist
down. As his wife, Robin, tells it, he also had begun to experience
emotional difficulties--frequent loss of memory and flashes of anger at
ordinary happenings or smells. And he began blaming everyone he saw.
After 2 years as an inpatient at Walter Reed and confinement to a
wheelchair, the Marine Corps began pressuring him to take retirement.
``Everything was setting him off','' Mrs. Cleveland recalls.
He finally was separated from the Marines in January of last year,
with a pen- sion--based on rank and time-in-service--
that was well below what he had expected.
The disappointments continued when Tai Cleveland applied for VA
benefits, his wife says. VA officials wouldn't approve any compensation
payments for months because they said he wasn't really retired and
couldn't qualify for benefits. The Department sent its letters and
notices to the wrong mailing address, and the Clevelands never received
them. VA physicians in Richmond seemed not to take the case seriously,
Mrs. Cleveland says. (One physician told the Gunny, ``There's nothing
wrong with your arms. I'll have you back to work in 2 weeks or so.'').
And while the VA finally assigned Gunny Cleveland an 80 percent
temporary disability rating, by December of last year he still hadn't
received his final disability determination, which presumably will
fully take into account his TBI and other impairments.
Meanwhile, Mrs. Cleveland says, the toll on the entire family has
been enormous. Even apart from the strains you'd expect when a father
comes home in the Gunny's condition, the financial and personal
hardships were enormous. Mrs. Cleveland, an accountant who ran her own
business in Alexandria, Virginia, had to shut down her firm to care for
her husband, now 42, and take him back and forth to medical
appointments--losing $45,000 worth of income that had been earmarked to
help pay college tuition for two of her children. The Clevelands
depleted their savings. And they eventually had to ask a service-
related charity for help. ``Tai took the brunt of it, but the family
took the collateral damage,'' Mrs. Cleveland says.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
__________
The Strung Out Corporal
In July 2005, Marine Corporal Kevin Blanchard returned from Iraq on
a gurney.
A combat engineer, he'd been hit by a roadside bomb and taken to a
nearby field hospital. Filled with shrapnel, and with his left leg
amputated below the knee, he was flown back to Washington for
treatment. During a year at the National Naval Medical Center in
Bethesda and Walter Reed Army Medical Center, he underwent surgery 30
times, along with treatment for mild traumatic brain injury, and spent
weeks on end in rehabilitation. He was finally medically retired in
July 2006. In line with standard procedures, he received a relatively
small pension based on only his most critical ailment--loss of his
leg--and on his rank and time-in-service.
It took yet another year for Corporal Blanchard, now 25, to get his
full disability compensation benefits from the VA, which would reflect
his full array of service-connected ailments and would be linked to his
limited ability to work in the civilian world without regard to his
rank and years of service.
``I didn't receive any response to my VA application for 2 full
months,'' he says. ``Then I called my VA case manager, and it took
another 3 months to get an appointment'' for initial processing. The
various stages of the processing procedure were ``spaced out over 4
more months,'' he says, with a temporary lower-level payment until the
full 100 percent disability was approved. In the meantime, Corporal
Blanchard says, he drew down the savings he'd managed to put away while
he was still on active duty.
``They should have been able to do something [to expedite his
claim] right there at the hospital [Bethesda or Walter Reed],'' he
says.
__________
The Confused Marine
Marine Corporal Ruben Ramirez knew he wasn't himself when he left
Iraq in 2004 for his next duty station in Japan, but he brushed it off
as inconsequential. It was only when he got back to the United States
in May 2005 that he realized just how sick he'd been. Plagued by
nightmares, anxiety attacks, and frequent thoughts of suicide, he would
lock himself in his room and struggle with bouts of severe depression.
After leaving the service in mid-2005, Mr. Ramirez went to the VA
for a checkup, and came out with a diagnosis that jolted him--severe
post traumatic stress disorder, liver damage, bilateral hearing loss,
and tinnitus (permanent ringing in the ears). After some time in a VA
psychiatric center, he applied for medical care and compensation
payments. Unable to work, he was hoping that a Federal check each month
would help pay the bills.
But 2 years later the VA denied his entire claim for disability
compensation payments, Mr. Ramirez said--contending that he had
contracted these ailments before he joined the Corps in 2001, and
leaving him without any disability benefits at all. They also sent him
a bill for part of his physical exam. He says he can't afford to get
private care and isn't eligible for military medical care. He's on the
last of his medicine now. (Ironically, the Social Security
Administration, using the same military medical records, later awarded
him a modest disability pension, a small fraction of what VA might have
approved.)
``I don't understand,'' he says. ``I know I didn't have these
problems before I joined the Corps, or I never would have been able to
sign up in the first place. Their own doctor said they were real. You
don't get PTSD without going to Iraq or some other war zone. We saw
enough there to make it stay with you for a good long time.''
Prepared Statement of Cheryl Beversdorf, RN, MHS, MA
President and Chief Executive Officer,
National Coalition for Homeless Veterans
The National Coalition for Homeless Veterans (NCHV) appreciates the
opportunity to submit testimony to the House Veterans Affairs Committee
regarding the U.S. Department of Veterans Affairs (VA) budget request
for Fiscal Year 2009.
Established in 1990, NCHV is a nonprofit organization with the
mission of ending homelessness among veterans by shaping public policy,
promoting collaboration, and building the capacity of service
providers. NCHV is the only national organization wholly dedicated to
helping end homelessness among veterans.
The majority of NCHV members, which includes nearly 280
organizations in 48 States, the District of Columbia, Puerto Rico and
Guam, provide the full continuum of care to homeless veterans and their
families, including emergency shelter, food and clothing, primary
healthcare, addiction and mental health services, employment supports,
educational assistance, legal aid and transitional housing.
In 2007, VA reported that about 196,000 veterans are homeless on a
given night and 400,000 veterans experience homelessness at some time
during the year. The VA reports its homeless veteran programs serve
100,000 veterans annually, and NCHV member community-based
organizations (CBOs) serve another 150,000.
VA officials report that the partnership between the VA and
community-based organizations has substantially reduced the number of
homeless veterans each night by more than 25 percent since 2003--a
commendable record of achievement that must be continued if this Nation
is to provide the supportive services and housing options necessary to
prevent homelessness among the newest generation of combat veterans
from Operations Iraqi Freedom and Enduring Freedom (OIF/OEF).
FY 2009 VA Budget--Homeless Veteran Programs
Congress has established a number of programs within VA to address
homelessness among veterans. The primary goal for these programs is to
return homeless veterans to self-sufficiency and stable independent
living. The major homeless veterans programs administered by the VA
include the Homeless Providers Grant and Per Diem (GPD) program, which
includes transitional housing, supportive services centers, special
needs grants, GPD program liaisons, and Stand Down support; the HUD-
Veterans Affairs Supported Housing (HUD-VASH) program; the Multifamily
Transitional Housing Loan Guarantee Program; and the Compensated Work
Therapy Transitional Residence program. Homeless veterans also receive
primary medical care, mental health and substance abuse services at VA
medical centers and community-based outpatient clinics (CBOCs) through
the Health Care for Homeless Veterans (HCHV) program.
The landmark Homeless Veterans Comprehensive Assistance Act of 2001
(P.L. 107-95) established new program authorities and reauthorized
longstanding homeless programs within the VA. While the authorization
law set explicit funding levels for many of the VA homeless programs
and authorities, actual annual spending levels are set by the VA
Secretary via allocation of funds from the VA medical services account,
which are appropriated by Congress.
VA homeless veteran programs function not only as a safety net for
homeless veterans unable or hesitant to access emergency shelter,
transitional housing or supportive services organized for the general
population, they also function as a safety valve when other VA programs
fail to reach veterans at a high risk of homelessness, such as veterans
with chronic mental illnesses, addictions and extreme economic
hardships.
Our testimony will focus on these homeless veteran assistance
initiatives, most of which owe their effectiveness and successes to the
leadership of this Committee. We have testified many times about the
need for transitional housing and services for veterans in crisis, and
celebrate the reduction in homelessness among these deserving men and
women during the last 5 years. As we continue that legacy, we must also
provide supports that will prevent homelessness among OIF/OEF veterans
returning from war.
Homeless Provider Grant and Per Diem Program
The Homeless Provider Grant and Per Diem Program (GPD) is the
Nation's largest VA program to help address the needs of homeless
veterans and supports the development of transitional, community-based
housing and the delivery of supportive services. The program's goals
are to help homeless veterans achieve residential stability, increase
their skill levels and income, and achieve greater self-determination.
The GPD program provides competitive grants to community-based, faith-
based and public organizations to offer transitional housing and
service centers for homeless veterans. The GPD program is an essential
component of the VA's continuum of care for homeless veterans, assuring
the availability of social services, employment supports and direct
treatment or referral to medical treatment. The program also funds GPD
liaisons who provide program oversight, inspections and outcomes
reporting essential to the success and efficiency of grant recipients.
In September 2007 the General Accountability Office (GAO) presented
testimony before the Subcommittee on Health of this Committee regarding
homeless veterans programs, and reported that an additional 11,100
transitional housing beds are needed to meet the demand presented by
current VA estimates of the number of homeless veterans in need of
assistance. This need does not yet include the increased requests for
services expected from OIF/OEF veterans over the next 3 to 5 years.
The Consolidated Appropriations Act of 2008, which became Public
Law 110-161 on December 26, 2007, provided for $130 million, the fully
authorized level, to be expended for the GPD program. Based on GAO's
findings and VA's projected needs for additional GPD beds, NCHV has
concerns about the $138 million authorization for FY2009 and believes a
$200 million authorization is needed. An increase in the funding level
for the next several years would help ensure and expedite VA's program
expansion targets. It would provide critical funding for service, or
drop-in, centers--the primary portal that links veterans in need with
the people who can help them. It would guarantee continued declines in
veteran homelessness, and provide for scaling back the funding as
warranted by the VA's annual Community Homelessness Assessment, Local
Education and Networking Group (CHALENG) reports. The GPD program has
evolved into a homelessness prevention network as much as a proven
intervention care and treatment collaborative partner with the VA.
Special Needs Grants
The VA provides grants to VA healthcare facilities and existing GPD
recipients to assist them in serving homeless veterans with special
needs including women, women who have care of dependent children,
chronically mentally ill, frail elderly and terminally ill veterans.
Initiated in FY 2004, VA has provided special needs funding to 29
organizations totaling $15.7 million. The VA Advisory Committee on
Homeless Veterans 2007 report states the need and complexity of issues
involving women veterans who become homeless are increasingly
unexpected. Recognizing women veterans are one of the fastest growing
homeless populations, the Committee recommended future notices of
funding availability target women veteran programs including special
needs grant offerings. P.L. 109-461 authorizes appropriations of $7
million for FY 2007 through FY 2011 for special needs grants. The
increased risks of homelessness among each of these populations
warrants funding for special needs grants above the currently
authorized level. Additional funding for the Grant and Per Diem Program
would address this need.
HUD-VASH
The joint HUD-VA Supported Housing Program (HUD-VASH) provides
permanent housing and ongoing treatment services to harder-to-serve
homeless veterans with chronic mental health, emotional and substance
abuse issues. NCHV was pleased that P.L. 110-161 included $75 million
to be used for 7,500 Section 8 vouchers for homeless and disabled
programs. Under this program, VA must provide funding for supportive
services to veterans receiving rental vouchers. The FY2009 VA budget
must reflect a significant increase in funding these services.
We believe the $7.8 million in the FY2009 VA budget proposal was
agreed upon before the dramatic increase in HUD-VASH vouchers became
law. Based on historical data that shows each housing voucher requires
approximately $5,700 in supportive services--such as case management,
personal development and health services, transportation, etc.--we
estimate approximately $45 million will be needed to adequately serve
7,500 or more clients in HUD-VASH housing units. Rigorous evaluation of
this program indicates this approach significantly reduces the
incidence of homelessness among veterans challenged by chronic mental
and emotional conditions, substance abuse disorders and other
disabilities.
Multifamily Transitional Housing Loan Guarantee Program
This initiative authorizes VA to guarantee 15 loans with an
aggregate value of $100 million for construction, renovation of
existing property, and refinancing of existing loans to develop
transitional housing projects for homeless veterans and their families.
First authorized in 1998, only two projects have survived beyond the
initial planning stages--in Chicago and San Diego--and only St. Leo's
in Chicago has been developed.
While we believe this program seemed promising in its original
design and intent, the real-life difficulties in long-term coalition
building, planning and economic hardships developers have encountered
to date strongly suggest a much more practical and streamlined program
should be developed to address the critical supportive housing needs of
homeless veterans and those at serious risk of homelessness due to
chronic health problems and poverty.
A congressionally mandated analysis of 2000 U.S. Census data in
FY2006 revealed approximately 1.5 million veterans are living below the
Federal poverty level. The GAO and VA's own reports indicate an
immediate need for more than 11,000 additional transitional housing
beds for homeless veterans. And combat veterans from and--now in the
fourth year of their repatriation--are requesting assistance in
increasing numbers at VA and community-based service providers. The
need for increased service capacity is immediate, and many community-
based providers have successfully developed additional transitional and
longer term residential opportunities for their clients. We believe the
resources earmarked for the Multifamily Transitional Housing Loan
Guarantee Program might be better allocated to support projects that
can be developed and brought online more swiftly.
Compensated Work Therapy/Transitional Residence (CWT/TR) Program
In VA's Compensated Work Therapy/Transitional Residence (CWT/TR)
Program, disadvantaged, at-risk, and homeless veterans live in CWT/TR
community-based supervised group homes while working for pay in VA's
Compensated Work Therapy Program (also known as Veterans Industries).
Veterans in the CWT/TR program work about 33 hours per week, with
approximate earnings of $732 per month, and pay an average of $186 per
month toward maintenance and up-keep of the residence. The average
length of stay is about 174 days. VA contracts with private industry
and the public sector for work done by these veterans, who learn new
job skills, relearn successful work habits, and regain a sense of self-
esteem and self-worth. We are pleased to see the additional funding
provided for in the FY2009 proposed budget.
Mental Health Programs
Virtually every community-based organization that provides
assistance to veterans in crisis depends on the VA for access to
comprehensive health services, and without exception their clients
receive mental health screenings, counseling and necessary treatment as
a matter of course. These services are well documented, and case
managers report this information to the VA as prescribed in their grant
reports. Followup services--counseling, substance abuse treatments,
outpatient therapies, medication histories and family support
initiatives--are also monitored closely and reported in client case
files.
Despite significant challenges and budgetary strains, the VA has
quadrupled the capacity of community-based service providers to serve
veterans in crisis since 2002, a noteworthy and commendable expansion
that includes, at its very core, access to mental health services and
suicide prevention. The development of the VA Mental Health Strategic
Plan from 2003 through November 2004, and its implementation over the
last 3 years with additional funding this Committee fought for, has
increased the number of clinical psychologists and other mental health
professionals at VA medical centers, community-based outpatient clinics
(CBOCs) and VA Readjustment Counseling Centers (Vet Centers). We
believe the VA budget proposal would facilitate further implementation
of the Mental Health Strategic Plan.
We strongly recommend, however, that more attention be directed to
simplifying and expanding access to community mental health clinics for
OIF/OEF veterans in communities not well served by VA facilities.
Current regulations allow a veteran to apply for authorization to
access services at non-VA facilities, but the process is often
frustrating and problematic, particularly for a veteran in crisis.
Protocols should be developed to allow the VA and community clinics to
process a veteran's request for assistance directly and immediately
without requiring the patient to first apply at a VA medical facility.
In the interest of maximizing the immediate benefit of mental health
supports and minimizing the risk of harmful and even suicidal responses
by a veteran to debilitating pressures--perceived or real--this
initiative should be universal and well publicized.
Conclusion
The National Coalition for Homeless Veterans thanks this Committee
for its service to it's veterans in crisis. It has been a long and
difficult campaign, but hundreds of thousands of lives have been
restored and thousands of lives have been saved. We are honored to work
alongside the Congress, the Administration, our Federal partners, and
the service provider network that has transformed policy into hope and
redemption for these deserving men and women. What we have learned in
the last 20 years is the greatest promise we can offer the new
generation of combat veterans coming home from and--we are prepared to
honor your service, help heal your wounds, and ensure you enjoy the
blessings of the freedom you have preserved.
Prepared Statement of Rick Jones
Legislative Director, National Association for Uniformed Services
Chairman Filner, Ranking Member Buyer, and Members of the
Committee:
On behalf of the National Association for Uniformed Services
(NAUS), I am pleased to present testimony to you concerning the
Department of Veterans Affairs (VA) budget request for fiscal year
2009.
First we would like to thank you, Mr. Chairman, and the Members of
this Committee for your hard work in adding substantial funding to the
FY 2008 VA Budget including a $3.7 billion discretionary amount for the
President, who requested those funds for the VA in January. This
funding was sorely needed to take care of not only the troops returning
from combat overseas, but also for those who have been in the VA
healthcare system for many years.
The National Association for Uniformed Services celebrates its 40th
year in representing all ranks, branches and components of uniformed
services personnel, their spouses and survivors. NAUS membership
includes all personnel of the active, retired, Reserve and National
Guard, disabled veterans, veterans community and
their families. We support our troops, remember our veterans and honor t
heir service.
As you approach issues this year, NAUS highly commends the
recommendations of the Veterans' Disability Benefits Commission (VDBC)
and the President's Commission on Care for America's Returning Wounded
Warriors (the so-called Dole/Shalala Commission). The VDBC focused on
all veterans, while the scope of the Dole/Shalala Commission
concentrated on combat-injured troops. NAUS is pleased that its
President, retired Army Major General Bill Matz, actively served on the
Veterans' Disability Benefits Commission.
The final report of the Veterans' Disability Benefits Commission
has received glowing praise from most veterans service organizations,
and we highly endorse those recommendations. We firmly believe that the
recommendations of the Veterans Disability Benefits Commission should
be used by the Committee as a road map to improvements in the Nation's
recognition of the service given by our honored veterans.
The National Association for Uniformed Services strongly urges the
Committee to give close study to the recommendations from the Veterans'
Disability Benefits and, where appropriate, merge them with those of
the Dole/Shalala Commission.
We also urge you to work with your colleagues on the Senate
Veterans' Affairs Committee to establish an Executive Oversight
Committee, as recommended by the VDBC, to track and ensure that there
is sufficient and substantial followup and implementation of the
recommendations made by both Commissions.
Funding for the Department of Veterans Affairs (VA) Healthcare
The National Association for Uniformed Services firmly believes
that the veterans healthcare system is an irreplaceable national
investment, critical to the Nation and its veterans. The provision of
quality, timely care is considered one of the most important benefits
afforded veterans. And our citizens have benefited from the advances
made in medical care through VA research and through VA innovations as
well, such as the electronic medical record.
The National Association for Uniformed Services endorses The
Independent Budget recommendation for a medical care budget of $42.8
billion, an increase of $3.7 billion more than this year's operating
budget and approximately $1.6 billion more than the Administration's
request.
We ask that Members of the Committee give the same effort in
fighting for our veterans that our veterans did in fighting for us. It
is the right thing to do for the men and women who have given so much
in service to our country.
In this regard, Mr. Chairman, the National Association for
Uniformed Services appreciates your work in the bipartisan push to
better fund veterans healthcare and benefits in the current fiscal
year. Rejecting the fees and new charges for veterans and spending more
on care for those returning from the battles in Iraq and Afghanistan is
warmly welcomed. It will help veterans receive the kind of care they
deserve for the sacrifices they made.
Never again should a situation occur in the VA health system as
happened at James A. Haley VA Medical Center in Tampa and Bay Pines VA
Medical Center in St. Petersburg last year.
The National Association for Uniformed Services is informed that
the Haley Medical Center was on ``divert'' status for critical patients
27 percent of the time between Jan. 1, 2006, and Oct. 1, 2007, or the
equivalent of about 170 days. VA figures reviewed by the St. Petersburg
Times showed the hospital had diverted all patients, regardless of
condition, 16 percent of the time over this period.
Since 2000, Bay Pines Medical Center diverted patients far more
frequently than any other hospital in Pinellas County. In 2006, records
show it diverted veterans during 1,150 hours about 48 days, or 13
percent of the time.
VA medical center officials stated they were looking after the
welfare of their pa-
tients by diverting them to facilities that had the space and facilities
to care for them.
The National Association for Uniformed Services believes that no VA
medical facility should have to refuse to admit patients due to lack of
resources. We understand that personnel issues and lack of qualified
doctors and nurses could influence admissions, but these are conditions
that should only occur very seldom and for only very short periods of
time. Our veterans deserve to know that the medical center and related
facilities nearest to them will be open, staffed and ready when needed.
NAUS strongly supports lifting the ban on veterans classified as
Priority 8
The National Association for Uniformed Services strongly supports
lifting the ban on veterans classified as Priority 8. Continuation of
denial of access to VA healthcare for these veterans, only devalues the
service of those who seek care. Restoration of Priority 8 access could
be started by enrolling those veterans who can identify private or
public healthcare insurance. This would also allow the VA to identify
sources and bill for reimbursement for care received by these veterans.
Current policy enrolls all veterans returning from Iraq and
Afghanistan at Priority 6 level initially, for a period of up to 5
years after they return from combat. If they request treatment, they
are assessed and given any appropriate disability levels. However, once
enrolled in the VA healthcare system they are not disenrolled and may
only qualify for a Priority 7 or 8 level once their illness or injury
is treated. We don't disagree with this decision but question why
veterans from prior conflicts or periods of service before the OEF/OIF
period are not afforded the same consideration.
Veterans of WWII, Korean War, Vietnam War and other periods, many
of whom are older and infirm, are not being afforded similar
opportunity for timely access to the VA healthcare system. They deserve
equal consideration.
NAUS strongly opposes user fees
One legislative proposal contained in the VA budget request would
establish a series of enrollment fees based on the income of certain
veterans classified as Priority 7 and Priority 8 veterans. The VA
budget request also proposes to increase co-pays for medications for
those same Priority 7 and Priority 8 veterans to $15 from $8 for a 30-
day supply. The National Association for Uniformed Services believes
that to charge any veteran enrolled in the VA healthcare system more
than a fair amount is not what we, as a Nation, should do. This
diminishes the service these men and women gave to the country.
Disability Claims Backlog
For many years the backlog of claims for benefits has grown larger
despite the best efforts of the Veterans Benefits Administration (VBA).
An increase in the numbers of claims by veterans of earlier conflicts
asking for increases in compensation as their disabilities worsen and
the initial number claims from veterans of the OEF/OIF conflicts are a
major factor in the growth of the backlog.
A decision several years ago to divert part of the VBA budget
earmarked for computer hardware and software upgrades to hire more full
time employees was only partly successful. In the long run, it possibly
hurt processing time more by not replacing older computers with newer
versions designed to handle the volume of claims being received.
Funding in the currently operating fiscal year 2008 VA
appropriation provides VBA the resources necessary to hire an
additional 3,100 full-time claims processors by the end of the current
fiscal year. There remains, however, an enormous backlog of claims yet
to be attended. At the close of January, VBA had more than 650,000
compensation and pension claims pending decision. More than 26 percent
of those claims have been pending in the VBA system for more than 180
days.
At the recent briefing on the 2009 VA Budget, VA Under Secretary
for Benefits, Adm. Daniel Cooper, expressed confidence that recent and
continuing hiring and training efforts will allow the VBA to
significantly reduce the workload and go a long way in their efforts to
cut the average processing time for claims to 145 days for FY 2009. We
hope that the Under Secretary is correct in his estimates.
The monetary benefits are essential to the lives of veterans and
their families. Decisions which sometimes take years to resolve, have
resulted in financial hardships for many including loss of homes and
declarations of bankruptcy. We must speed up the decision process so
not one more veteran has to suffer for lack of funds they deserve.
Restructuring the Current Disability System
The Veterans' Disability Benefits Commission and the Presidents
Commission on Care of Returning Wounded Warriors both recommended that
the disability and compensation systems for DoD and VA should be
restructured.
Under the proposed change, DoD would maintain the authority to
determine fitness to serve. For those found unfit for duty, VA would
then determine the extent of disability and initiate the disability
compensation and benefits programs, eliminating the needless
redundancy.
This would be a more streamlined system that better supports the
needs of those transitioning between active duty and veteran status. It
would reduce the current complexities of processing claims and help
veterans seeking disability compensation gain their awards in a more
timely fashion. Since it is a principal mission of the Department, VA
is in the best position to simplify the disability determination and
compensation process.
MGIB Improvements
When the original GI Bill of Rights was passed at the close of
World War II, it expressed our Nation's gratitude for the ``Greatest
Generation's'' fight against tyranny, and it formed the foundation of
the prosperity that flourished following the war's end.
Our military and its missions have changed a great deal since then
and the current Montgomery GI Bill, as supportive as it is, needs to be
improved to reflect the tremendous contributions of our servicemembers.
The National Association for Uniformed Services believes the SR-
MGIB program should be removed from the darkness of DoD management,
where it has been neglected, to the light of VA jurisdiction, where the
general program has been given the serious attention it deserves.
The MGIB serves well the all-volunteer force by improving the way
servicemen are recruited and retained. By making these much-needed
improvements, we can help the program continue to meet its intended
purpose for years to come.
``Seamless Transition'' Between the DoD and VA
Efforts in 2007 have seen significant progress in the major
stumbling block of electronically transferring DoD medical records to
the VA. We urge both sides to continue to work together and continue
this excellent progress. Soon we may be able to take the term
``seamless transition'' out of our vocabulary, at least as it relates
to healthcare.
Another part of this transition was recognized by both the
Veterans' Disability Benefits Commission and the Dole/Shalala
Commission when they both recommended that the DoD, specifically each
service, make the determinations for fitness for service and that the
VA be the sole determining agency for the percentage of disability.
A test program has been in operation in the Washington, D.C., area
since November 2007. Although no official reports have been made in
regards to how the test is progressing, several anecdotal reports from
various servicemembers indicate they are pleased with the results. The
National Association for Uniformed Services believes that an expansion
of this program to the entire DoD and VA should be made a high
priority.
Prescription Drug Assistance
Mr. Chairman, we are disappointed that little consideration has
been given to those veterans who have been prohibited from enrollment
in VA's healthcare system under a decision made by the Secretary on
Jan. 17, 2003.
The National Association for Uniformed Services urges the Committee
to review this policy and provide a measure of relief to allow
Medicare-eligible veterans to gain access to VA's prescription drug
program.
As a result of the VA decision to restrict new enrollments, a great
number of veterans, including Medicare-eligible veterans, are denied
access to VA. The National Association for Uniformed Services
recognizes that VA fills and distributes more than 100 million
prescriptions annually to 5 million veteran-patients. As a high-volume
purchaser of prescriptions, VA is able to secure a significant discount
on medication purchases.
Enrolled veterans can obtain prescriptions, paying $8.00 for each
30-day supply. However, veterans not enrolled for care before Jan. 2003
are denied an earned benefit that similarly situated enrolled veterans
are able to use.
NAUS, again, asks the Committee to consider legislation that would
allow Medicare-eligible veterans to gain a measure of relief and get a
break on prescription drug pricing.
We recommend the Committee authorize Medicare-eligible veterans,
currently banned from the system and paying retail prices or using the
newly established Part D program, access to the same discount provided
VA in their purchase of prescriptions.
This issue is a win-win situation. Providing the discount would not
cost the government a cent. Medicare-eligible patients would pay the
same price VA pays. And these veterans would see value returned in the
benefit each earned through military service.
Medical and Prosthetic Research
At the recent VA budget roll-out, Veterans Service Organizations
questioned why the medical research budget recommended reducing funding
levels below those of fiscal year 2007. The response focused on the
fact that 2008 increases in VA research resulted from supplemental
funding, not regular funding. It was also stated that recommendation,
despite being lower than previous levels, was sufficient to cover VA
research needs.
The National Association for Uniformed Services finds it
incredulous that supplemental funding increases of $2 million in 2007
and $54 million for 2008 have answered the research matters at VA. With
little known about traumatic brain injury, PTSD and various other
combat-related conditions, reductions in research is not a wise
decision. This reduction is especially ill-advised as our troops remain
in combat, and will probably do so for the foreseeable future, and more
of our brave servicemen and women will likely be affected by TBI and
PTSD.
One need only to visit Ward 57 at Walter Reed Hospital or the VA
prosthetics ward at the Washington VA Medical Center to see the result
of cutting-edge research and development in prosthetics. The VA has
long led the Nation in prosthetics development. The National
Association for Uniformed Services urges the Committee to increase the
budget for medical and prosthetic research.
Medicare Subvention
The National Association for Uniformed Services supports
legislation to authorize Medicare reimbursement for healthcare services
provided to Medicare eligible veterans in VA facilities. Medicare
subvention will benefit veterans, taxpayers and VA.
Medicare subvention is a ``Win-Win'' situation for all. VA would
receive additional, non-appropriated funding. Medicare eligible
veterans would receive world-class medical treatment in a system that
our government has provided for their care. And taxpayers would see the
costs of Medicare-provided care reduced, because medical services can
be provided by the VA at lower costs than in the private sector.
In addition, direct billing between VA and the Centers for Medicare
and Medicaid Services (CMS) would reduce opportunities for fraud, waste
and abuse of the Medicare system.
We urge Members of the Committee to consider legislation to enable
Medicare subvention.
Construction
The budget request for 2009 for all Construction, both major and
minor projects, has been reduced by $855 million. We question the
wisdom of reductions in this account.
In 2004 the VA completed a long study called Capital Asset
Realignment for Enhanced Services (CARES). In it the VA laid out a
well-researched plan to close some assets, build new ones and move some
others. The plan stated good reasons for doing this. One of which is
that the many major building assets are outdated and cost too much to
maintain.
With good progress currently being made in the building and
acquisition of new facilities, now is not the time for VA to reduce
funding for these purposes. We urge Members of the Committee to re-
examine these cuts and if warranted, which we believe will be the case,
restore the funding to a sufficient level necessary to upgrade VA
facilities and assets.
VA Nursing Home Construction, Grants for State Extended Care Facilities
The National Association for Uniformed Services urges Members of
the Committee to recognize the growing long-term care needs of
America's veterans.
VA is a nationally recognized leader in providing quality nursing
home care. One of the settings for nursing home expenditures is in
State veterans' nursing homes. As America's aging veterans population
grows older, affordable State nursing homes remain an attractive
pathway for veterans' nursing care close to home.
The National Association for Uniformed Services strongly supports
additional funding for the State veterans' nursing home program. It is
important that we do so because despite projections of decline in the
overall veterans population, from 24.3 million to 20 million over the
present decade, it is projected simultaneously that the number of those
aged 75 and older will increase from 4 million to 4.5 million and the
number of those over 85 will more than double, from about 640,000
currently to nearly 1.3 million in 2012.
VA reports that a number of State nursing home facilities, already
planned and approved for construction, are hung up because current year
funding falls short of needs. In the current year, the Priority 1
backlog stands at 92 validated construction projects, submitted by 23
States. In addition, it is our understanding that funding for nursing
home construction in smaller States, like Utah, fall behind the
schedule of funding for larger States due to VA decision methodology.
With VA paying about one-third the cost of care in State veterans'
nursing homes, the shortfall of funding in the State program needs to
be addressed. To continue reductions to this program is the wrong way
to go in planning for the care needs of an aging veterans population.
As one of our members said, ``The Nation's old warriors are getting
a double whammy. The Congress and Administration team up to speak for
veterans' nursing homes then refuse to ``walk the talk'' by withholding
the funding required to make nursing homes happen, especially in States
smaller than New York. Conclusion: they speak with forked tongue.''
The Administration request for $85 million will fund fewer than 25
of the 92 projects ready for construction. VA is unable to support the
proposed new State veterans homes without a NAUS-endorsed increase of
$115 million above the Administration request.
Merchant Mariner Belated Thank You
On behalf of the nationwide membership of the National Association
for Uniformed Services (NAUS), we thank Members of the Committee for
its favorable actions on H.R. 23, ``The Belated Thank You to the
Merchant Mariners of World War II Act.''
NAUS commends your strength of leadership in recognition of heroic
service put forth during World War II by the thousands of young men who
volunteered for service in the United States Merchant Marine. These
forgotten heroes have struggled for more than six decades for
acceptance among their military brethren and the public. And it is
unthinkable that these brave men should be given a cold shoulder by the
Nation they proudly served.
Mr. Chairman, the National Association for Uniformed Services
believes that it is now time for the United States to recognize
properly these individuals for their exceptional contribution and
strength of effort. They helped preserve the freedoms we enjoy today.
On behalf of a grateful Nation, we urge you to extend these
benefits to those once young men who went to sea as crewmembers of the
Merchant Marine during World War II. Your action in taking up this bill
and ensuring its passage by the entire House is much appreciated by
NAUS and the surviving Merchant Mariners of that era.
There are not many of them left. They have aged with their country.
But age does not disguise the heroic contribution those now almost-
ancient mariners gave to help secure the American victory in World War
II. They certainly deserve recognition and a very belated ``thank you''
from a grateful Nation. We now ask your colleagues in the Senate take
action soon and produce a similar outcome as this Committee initiated.
Appreciation for Opportunity to Testify
As a staunch advocate for veterans, the National Association for
Uniformed Services recognizes that these brave men and women did not
fail us in their service to country. They did all our country asked and
more. Our responsibility is clear. We must uphold our promises and
provide the benefits they earned through honorable military service.
Mr. Chairman, you and your Committee Members are making progress.
We thank you for your efforts and look forward to working with you to
ensure that we continue to protect, strengthen, and improve veterans
benefits and services.
Again, the National Association for Uniformed Services deeply
appreciates the opportunity to review the previous actions of Congress
and look ahead to the upcoming year.
Statement of Friends of VA Medical Care and Health Research
President's FY 2009 Budget Proposal for the VA Medical and Prosthetic Research Program
----------------------------------------------------------------------------------------------------------------
FY 2009 President's FY 2009 FOVA Recommendation
FY 2008 Appropriation Proposal
----------------------------------------------------------------------------------------------------------------
$480 $442 $555
----------------------------------------------------------------------------------------------------------------
On behalf of the Friends of VA Medical Care and Health Research
(FOVA)--the diverse coalition representing more than 80 national
academic, medical, and scientific societies; voluntary health and
patient advocacy groups; and veteran-focused organizations--thank you
for your continued support of the Department of Veterans Affairs (VA)
Medical and Prosthetic Research Program. We are deeply concerned about
the President's proposed fiscal year (FY) 2009 budget for the VA
research program. A time of war is not the time to cut research on the
grievous injuries being suffered by veterans of the Afghanistan and
Iraq wars.
FOVA Recommendations: For FY 2009, FOVA recommends an appropriation
of $555 million for VA medical and prosthetics research and an
additional $45 million for necessary research facilities upgrades
appropriated via the VA minor construction account.
Prior Year Support: FOVA thanks the Committee for its strong
support of VA research as evidenced by your FY 2008 views and estimates
with regard to the VA Medical and Prosthetic Research Program. The
Committee's recommendation--$480 million--was a $69 million increase
over the previous fiscal year and the President's FY 2008 proposal.
Your support for the program undoubtedly encouraged both chambers to
adopt your recommendation as the program's final appropriation. FOVA
encourages you to develop a views and estimates statement for FY 2009
that reflects this same commitment to medical research for the benefit
of veterans, and ultimately, all Americans.
VA Research Improves Veterans' Lives: The VA Medical and Prosthetic
Research Program is one of the Nation's premier research endeavors,
attracting high-caliber clinicians to deliver care and conduct research
in VA healthcare facilities. The VA research program is patient-
oriented and focused entirely on prevention, diagnosis, and treatment
of conditions prevalent in the veteran population. Recent successes to
which VA has contributed include the implantable cardiac pacemaker, a
new vaccine for shingles, and state-of-the-art prosthetics, including a
new bionic ankle.
President's Budget Request Falls Short: Considering the proven
success of the VA research program, FOVA is disappointed with the
President's proposal of $442 million for VA research in FY 2009. The
proposal fails to maintain funding at the level appropriated in FY
2008. If enacted, the proposed $38 million (8%) cut will lead to
significant programmatic reductions and will impede research advances
in diseases and injuries that impact the veteran population. According
to the President's proposal, VA will have to cut funding for research
in central nervous system injury by 20%; acute and traumatic injury,
military occupations and environmental exposure, and substance abuse by
18%; and mental illness by 15%. The cuts are counter to the Committee's
report language calling for ``additional research in the areas of
mental health--especially the causes, prevention, mitigation, and
treatment of post traumatic stress disorder (PTSD) . . . the full
spectrum of traumatic brain injury; [and] substance abuse.'' The
President's budget request assumes the cut in the VA R&D account will
be made up by large increases in Federal funding from other agencies,
nonprofits, and private industry which we are skeptical will
materialize.
Research Advances Require Sustained Investment: While FOVA
appreciates the significant increase in funding approved last year, a
one-time investment in research will not lead to the medical advances
required to improve the lives of the Nation's veterans. VA research
grants are awarded on a 3- to 5-year cycle; funding must be maintained
over the grant cycle to sustain the investigator's research. Cuts in
funding require VA to cut award levels for ongoing projects, thus
diminishing productivity and output. In addition, funding fluctuation
may limit the number of investigators willing to enter--and remain in--
the VA system. The VA research program offers a dedicated funding
source to attract and retain high-quality physicians and clinical
investigators to the VA healthcare system, who in turn provide first-
class healthcare to our Nation's veterans. FOVA encourages the
Committee to consider the long-term needs of veterans and VA
investigators when promoting future funding allocations for the
program. The coalition encourages Congress to support planned growth
for the VA research budget over the course of the next 3 years to
continue the upward trajectory of the program in an orderly fashion.
Thank you for considering our views.
Statement of Hon. Jeff Miller
a Representative in Congress from the State of Florida
Thank you, Mr. Chairman, for holding this hearing to discuss the
fiscal year 2009 funding for the Department of Veterans Affairs.
I am committed to our responsibility to ensure that the budget we
adopt will continue to meet both the complex needs of our new
generation of younger veterans as well as maintain and improve the
quality of services for our older veterans.
I would first like to congratulate Secretary Peake for his recent
confirmation as VA Secretary and thank him for his appearance before us
today. You have an important task before you, and the Members of this
Committee look forward to working with you in responding to the
emergent challenges in taking care of our veterans.
I also appreciate the Veterans Service Organization representatives
for participating in our hearing today. Your outlook on funding
recommendations for veterans programs and input into the budget is of
great value to me in this process.
It is satisfying to see that after this Committee uncovered
weaknesses in the process VA used to develop its healthcare budget in
2005, the budget request for subsequent fiscal years has become more
transparent. The Department proposes nearly $39 billion for VA
healthcare--the largest amount ever requested by any Administration.
However, I would be remiss in not expressing my concern about the
inclusion of legislative proposals to establish enrollment fees and
increases in pharmacy co-payments for certain veterans without service-
connected conditions similar to requests that Congress has rejected
year after year.
Having chaired the Subcommittee on Disabilities and Memorial
Affairs in the past, I am encouraged that the budget includes planning
to reduce compensation processing time and improve accuracy.
In the State of Florida, the VA patient workload is among the
highest in the Nation and the demand for VA healthcare continues to
grow, especially in Okaloosa County, the center of my Congressional
District.
When they released their report several years ago, the Capital
Asset Realignment for Enhanced Services (CARES) Commission identified
this Florida Panhandle region as underserved for inpatient care. In
fact, it is the only market area in the VISN, VISN 16, without a
medical center.
The absence of a VA inpatient facility continues to be one of the
biggest concerns of veterans who live in this area. Currently, many of
these veterans have to drive to Mississippi to receive inpatient care.
Bringing a full service VA hospital to the first district is
something I have fought for since I first came to Washington and will
continue to do. I look forward to working with the Department in
support of VA's overall capital construction program to address the
issue of providing timely access to inpatient healthcare for veterans
living in and around Northwest Florida.
Collectively, we share the same goal of providing exceptional
service to those who have served in our Armed Forces and sacrificed so
much for our freedom.
I hope that this hearing will point the way toward close
cooperation among all of us as advocates of our Nation's veterans to
respond to their constantly evolving needs and those of their families.
Statement of Hon. Harry E. Mitchell
a Representative in Congress from the State of Arizona
Thank you, Mr. Chairman.
I appreciate you holding a hearing to discuss the President's
Budget Proposal for FY-09.
Since this Congress convened last January we have made veterans'
affairs a top priority. Unfortunately, this budget undermines all of
our hard work.
Last year, we passed a VA appropriations bill which made the
single-largest investment in veterans' healthcare in the 77-year
history of the agency.
We passed the Joshua Omvig Suicide Prevention Act.
And we passed important Wounded Warrior Legislation, which would
not have been possible without your leadership and the work of this
Committee.
These are all important first steps . . . but years of neglect and
lack of oversight at the VA has left much more to be done.
A year ago The Washington Post broke their investigative story
about the poor quality of care at Walter Reed Army Medical Center. As
Chairman of the Oversight and Investigations Subcommittee, I was
especially upset and appalled.
Our Nation's veterans have served honorably to protect us and our
country. We have an obligation to treat them the dignity and respect
they have earned.
The first line of defense against waste, fraud, and abuse is the
independent and nonpartisan Office of Inspector General. The IG is one
of the best ways of ensuring accountability at the VA during a time of
war.
Unfortunately, the President proposes we reduce the IG's budget to
$77 million for FY 2009, a 5 percent decrease from last year. It is
absolutely irresponsible to make deep cuts to the VA's watchdog when
hundreds of thousands of veterans need the VA to make improvements.
The Oversight and Investigations Subcommittee will hear from VA
officials next week to find out how we can afford this cut at a time
when we need serious accountability.
I am also stunned by the President's irresponsible proposal to
slash the Medical and Prosthetic Research budget to $442 million for FY
2009, an 8 percent cut, and the proposed reduction in veterans'
rehabilitation research by more than 7 percent.
I simply can't believe the President wants to deny our war-wounded
veterans the option of having cutting-edge prosthetics.
Our wounded warriors have unique injuries and require unique
prosthetics. It is our responsibility to make sure they have the tools
they need to lead healthy and productive lives following their
injuries.
Last year, we were able to look past the President's irresponsible
VA proposals and win strong bipartisan support for appropriate funding
levels. I know we can do the same this year.
I am looking forward to hearing from our witnesses today, and I
yield back.
MATERIAL SUBMITTED FOR THE RECORD
Committee on Veterans' Affairs
Washington, DC.
March 7, 2008
Honorable James B. Peake, M.D.
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Mr. Secretary:
In reference to our Full Committee hearing on ``The Department of
Veterans Affairs Budget Request for Fiscal Year 2009'' on February 7,
2008, I would appreciate it if you could answer the enclosed hearing
questions by the close of business on April 18, 2008.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
__________
Questions for the Record
The Honorable Bob Filner, Chairman
House Veterans' Affairs Committee
February 7, 2008
The Department of Veterans Affairs Budget Request for Fiscal Year 2009
Question 1(a): The VA research program has proven to be incredibly
successful, even with its modest budget in comparison to other research
entities. Evidence of VA research success includes the discovery of a
shingles vaccine in 2005, exemplary discoveries in prosthetics, and the
implementation of a clinical trial of psychotherapy to treat post
traumatic stress disorder. However, VA researchers face the fact that
the amount of funding they can receive for a grant award is capped at
$125,000 per year for a period of 3 to 4 years. In comparison, National
Institutes of Health researchers receive on average up to $360,000 per
year for a period of 5 years. Even with differences in salary support
included in these numbers, the discrepancy between the grant
allocations is significant. Can you give the Committee your reasoning
to hold the research cap at $125,000 year-to-year, despite the obvious
inflationary factors of the cost of labor, supplies, equipment,
reagents, drugs, procedures, etc.
Response: The Department has maintained the pre-clinical research
funding cap at $125,000 per year in order to maintain the diversity in
breadth of the investigator base. Where appropriate, we will increase
funding individual research projects with the resources provided in the
President's budget submission.
In addition, a large number of projects have received budget
supplements of up to $25,000 with the appropriations provided in fiscal
year (FY) 2007 and FY 2008.
Question 1(b): Considering VA researchers' productivity in spite of
their limited resources, do you believe VA researchers would be more
productive if the VA research funding cap was increased?
Response: The Department of Veterans Affairs (VA) researchers use
all funds provided in an extremely effective manner. Where appropriate,
the Department is able to increase funding for individual research
projects with the resources provided in the President's budget
submission and those increases will result in continued high
productivity.
Question 2(a): VA has implemented the Capital Asset Realignment for
Enhanced Services (CARES) program to prepare the Department for meeting
the healthcare needs of veterans in modern healthcare facilities. CARES
documented a $300-400 million need for construction and upgrading VA
research infrastructure, particularly its research laboratories. Yet we
understand that VA expects your Research Infrastructure Evaluation and
Improvement Project, directed at reviewing the overall function and
performance capabilities of research space and infrastructure, to take
another 3 years to complete. Can you provide us with additional
information on the research facility needs of the program and a
preliminary estimate for research infrastructure costs?
Response: As part of VA's research infrastructure evaluation and
improvement project, a detailed questionnaire regarding current
research space allocation and condition was disseminated to all field
sites to gather preliminary information. Preliminary results showed a
need for research infrastructure corrections across the system. To
better document and prioritize issues identified in the preliminary
assessment, a comprehensive evaluation instrument designed to ensure a
thorough and consistent systemwide review of research space was
developed and tested at three pilot sites.
In 2007, VA selected a contractor to complete the research facility
site visit infrastructure reviews. Since September 2007, 15 site visits
have been conducted at locations across the country. In a 3-year span,
approximately 70 site visits will be completed. Because the research
infrastructure evaluation and improvement project is still underway, a
cost estimate is not yet available.
Question 2(b): During the next 3 years as the Research
Infrastructure Evaluation and Improvement Project proceeds, what are
your plans to improve research space and facilities?
Response: Over the next 3 years, VA plans to thoroughly assess a
large number of sites to identify any deficiencies in research
infrastructure and create an amelioration plan and prioritization list,
accordingly. An added benefit of the site visit infrastructure reviews
is the opportunity to provide a de-brief to facility management,
highlighting deficiencies and needs at each location, encouraging some
more timely corrective actions.
Question 2(c): What research infrastructure projects have the
Research Infrastructure Evaluation and Improvement Project identified
to date, and what are the prospective costs of those projects?
Response: Because the research infrastructure evaluation and
improvement project is still underway, a list of research facility
projects and costs is not yet available.
Question 3(a): Your budget says you intend to cut some programs
that this Committee believes are very high VA research priorities,
including studies in traumatic brain injury, polytrauma, mental health
(with emphasis on PTSD), burns, amputations and eye injuries from Iraq
and Afghanistan. As indicated in your budget request, how were these
particular research studies targeted for reduction, specifically
studies of central nervous system injury to be reduced by 20%; studies
of acute and traumatic injury, military occupations and environmental
exposure and substance abuse, reduced by 18%; and studies in mental
illness, reduced by 15%?
Response: VA's strong commitment to research on mental illnesses,
including post traumatic stress disorder (PTSD), and substance abuse,
and injuries to the brain, spinal cord, and extremities has been
reflected in constant growth in the number of projects and funding over
the last few years. As a result of the supplemental appropriation in FY
2007 and the emergency appropriation in FY 2008, there have been
considerable investments in expensive equipment such as high-resolution
magnetic resonance imagers that will be used to enhance VA research in
these areas. Over the next few years these investments will pay off in
better understanding and treatments of these disorders, but the very
large increases were ``one-time'' expenses that have effectively met
the immediate needs for enhancing the strong ongoing research programs.
Question 3(b): Is your decision to cut these projects consistent
with your public statements to highlight the needs of OIF/OEF veterans,
in both your healthcare and research programs? How so?
Response: Healthcare Programs. VA uses an actuarial model to
forecast patient demand and associated resources needs for healthcare.
Actuarial modeling is the most rational way to project the resource
needs of a healthcare system like the Veterans Health Administration
(VHA). The estimates in the FY 2009 President's submission represent
the best possible estimates based on the information available at that
time. VA estimates it will require $1 billion in FY 2008 to treat
293,345 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF)
unique patients and nearly $1.3 billion in FY 2009 to treat 333,275
OEF/OIF unique patients. Based on our experience in FY 2007 and for FY
2008 to date the 14-percent increase (39,930) in workload and 20-
percent increase ($216 million) in funding appear realistic.
Research Programs. The FY 2009 budget request for medical and
prosthetic research includes $252 million for research directed at the
full range of health issues of OEF/OIF veterans, including traumatic
brain injury (TBI) and other neurotrauma, PTSD and other post-
deployment mental health, prosthetics and amputation healthcare,
polytrauma, and other health issues. In addition, the quality and
effectiveness of the investigators carrying out this research is
reflected by their success in drawing funding for veterans research
from other Federal agencies and from the private sector. For example,
these non-VA sources contributed on the order of 100 million dollars
for mental health and substance abuse research in FY 2007. Due in part
to VA capital investment and vigorous VA efforts to develop Federal and
private partnerships to develop new treatments for PTSD, we expect non-
VA funding to grow substantially in the next few years.
Question 4: In recent years, the government has invested a lot more
in Federal research, especially biomedical research at NIH, NSF, CDC
and also at DoD. But VA's research program investments have lagged and
shown only very modest growth over the past 10 years. This year, the
Administration would actually reduce the program by $38 million over
the FY 2008 funded level, and would hope that NIH and other funders
would step up and fill the void. VA touts its research and researchers
as world-leading. Normally, organizations, whether in the private or
public sectors, are rewarded when they do well. Given that the VA
research program is remarkably productive and necessary to both current
and future veterans, how can you justify cutting your investment in VA
research and allowing your research facilities and laboratories to
continue deteriorating?
Response: VA remains committed to increasing the impact of its
research program. We have carefully prioritized our research projects
to ensure they continue to address the needs of both current and future
veterans. The FY 2009 budget request includes $252 million for research
directed at the full range of health issues of OEF/OIF veterans,
including TBI and other neurotrauma, PTSD and other post-deployment
mental health, prosthetics and amputation healthcare, polytrauma, and
other health issues. Additional research funding priorities covered by
the FY 2009 budget request include aging and geriatrics, chronic
diseases and health promotion, personalized medicine, women's health,
and long-term care. VA researchers also continue to successfully
compete for and receive funding from other Federal and non-Federal
research sponsors that provide additional resources for VA's research
program.
Question 5(a): The VA's FY 2009 budget submission includes
proposals that would institute a tiered annual enrollment fee, increase
pharmaceutical co-payments, and eliminate the VA's current practice of
offsetting third-party billings of first-party debt. The VA's budget
estimates that these proposals would provide receipts of $379 million
in FY 2009, $464 million in FY 2010, and $2.3 billion over 5 years and
$5.2 billion over 10 years. Please provide the Committee with the
estimated number of enrollees and unique patients, by year, for the
period of FY 2009 to FY 2019 that VA estimates will choose not to
enroll and choose not to seek VA healthcare.
Response: The tiered enrollment fee for Priority 7 and 8 enrollees
would be $250 for veterans with family incomes between $50,000 and
$74,999; $500 for veterans with family incomes between $75,000 and
$99,999; and $750 for veterans with family incomes equal to or greater
than $100,000 beginning in FY 2010.
Approximately 1 percent of Priority 7 enrollees have incomes
greater than $50,000 and VA estimates that few, if any, will be
assessed the enrollment fee. VA estimates approximately one-half of the
estimated 1.7 million Priority 8 veterans will not be subject to the
tiered enrollment fee (income less than $50,000). Of the 852,000
Priority 8 veterans assessed the tiered enrollment fee; VA estimates
that 440,000 will choose not to pay the enrollment fee.
Priority 8 enrollees who do not currently use the VA healthcare
system (46 percent did not use VA in 2007) and low users of VA
healthcare services are expected to choose not to pay the enrollment
fee. This information is based on the results of the 2007 VHA survey of
enrollees, which found that 92 percent of Priority 8 enrollees have
some type of public or private healthcare coverage other than VA.
However, Priority 8 enrollees who are not insured are likely to pay the
enrollment fee and remain in the VA healthcare system.
As shown in the table below, VA estimates approximately 444,000
enrollees, or 144,000 patients, would choose not to pay the annual
enrollment fee in 2010.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Impact of Tiered Annual Enrollment Fee and Increased Pharmacy Co-pay, FY 2009-18
---------------------------------------------------------------------------------------------------------------------------------------------------------
FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016 FY2017 FY2018
--------------------------------------------------------------------------------------------------------------------------------------------------------
Unique Enrollees 0 444,085 437,635 452,752 446,032 439,050 432,281 425,914 420,499 414,589
--------------------------------------------------------------------------------------------------------------------------------------------------------
Unique Patients 0 143,808 141,431 146,422 143,605 140,910 138,411 136,112 134,086 131,845
--------------------------------------------------------------------------------------------------------------------------------------------------------
Question 5(b): Since healthcare dollars are ``discretionary,'' by
what mechanism would these receipts be considered ``mandatory'' and
what is the policy rationale for deeming these receipts mandatory
spending?
Response: The Administration made a policy decision that classified
these veterans' fees as mandatory receipts in order to ensure that the
appropriation funding for veterans healthcare was not adversely
impacted should Congress not enact the fees. If the fees were proposed
as discretionary, then the scoring rules of development of the
President's budget would have required direct appropriation offset in
the amount of the anticipated collections. To avoid this potential of
veteran healthcare funding shortfall in the President's budget request,
the fees were proposed as mandatory fees with deposit to the Treasury.
Question 6: The VA's FY 2009 budget request provides nearly $8
million in response to the Dole/Shalala report. With the recent
enactment of Wounded Warrior provisions in the National Defense
Authorization Act, what additional resources will you need in FY 2009,
above and beyond the $8 million you have slated for meeting the
recommendations of the Dole/Shalala report, to comply with the
appropriate provisions of this law?
Response: VA and the Department of Defense (DoD) are working
together to implement the provisions of Dole-Shalala Commission and the
most recently passed National Defense Authorization Act (NDAA). VA has
awarded a $3.2 million contract to Economic Systems, Inc. of Falls
Church, Virginia to perform a 6-month study to develop options for a
new quality of life benefit and a new long-term transition benefit for
participants in VA's vocational rehabilitation & employment program
(Chapter 31). The findings from this study are intended to inform the
Department's decisionmaking process regarding key components of
recommendation two of the Dole-Shalala Commission to completely
restructure the disability and compensation systems. Until all
implementation plans are complete we will not be able to fully estimate
costs.
Question 7: Your FY 2009 budget submission estimates a total
increase of 90,000 unique patients, which includes an estimated
increase of OEF/OIF veterans of 40,000. This increase includes an
estimated increase of 2,621 Priorities 7 and 8 veterans. In light of
your historical experience in estimating workload increases from year-
to-year, how confident are you that your estimated overall increase of
1.6 percent is accurate? How confident are you that you will only see
an additional .2-percent increase in Priority 7 and 8 veterans?
Response: The annual patient projections that are generated by the
VA enrollee healthcare projection model are a function of the projected
enrolled population and the mix and intensity of workload for those
enrollees as projected by the model. The patient projections are then
adjusted to account for those veterans who seek only non-modeled
services such as vet centers.
The following chart presents the accuracy of the model supporting
the 2004 through 2007 VA healthcare budgets. The projections were
adjusted to reflect policies that were not implemented, such as
enrollment fees and pharmacy co-payment increases.
The differences between the projections and what actually happened
have become closer over the years. A significant reason is that
initially there was limited enrollment trend data in the years just
after eligibility reform available to inform the model. For example,
when the model that supported the 2004 budget was developed, VHA only
had actual enrollment data from 1999 to 2001 to inform the analysis,
and the data showed significant variability.
In addition, components of the model methodology and data sources
are continually updated. For example, the model supporting the 2004
budget relied on projections for the veteran population (VetPop) that
were based on the 1990 Census. VetPop has since been updated with data
from the 2000 Census, and the updated VetPop has been incorporated into
later models.
The 2007 enrollment projections and actuals reflect an improved
methodology for identifying enrollee deaths. This reduced both the
projected and actual number of enrollees for 2007 as compared to
earlier years.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Accuracy of Actuarial Model Projections
---------------------------------------------------------------------------------------------------------------------------------------------------------
VETERAN ENROLLEES VETERAN PATIENTS \1\
-------------------------------------------------------------------------------------
Fiscal Year Actuarial Percent Actuarial EFY Actuals Percent
Projections \2\ FY Actuals Difference Projections \2\ Difference
--------------------------------------------------------------------------------------------------------------------------------------------------------
2004 7,130,921 7,419,851 -3.9% 4,796,105 4,622,155 3.8%
--------------------------------------------------------------------------------------------------------------------------------------------------------
2005 7,860,389 7,655,562 2.7% 4,835,534 4,768,304 1.4%
--------------------------------------------------------------------------------------------------------------------------------------------------------
2006 7,941,971 7,872,438 0.9% 4,885,820 4,845,062 0.8%
--------------------------------------------------------------------------------------------------------------------------------------------------------
2007 \3\ 7,618,345 7,833,446 -2.7% 4,834,305 4,872,030 -0.8%
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Includes veteran patients who used services projected by the model. Does not include veteran patients who only used dental, readjustment counseling,
LTC, or foreign medical program services.
\2\ Adjusted to reflect policies not implemented, such as enrollment fees and rx co-payment increases.
\3\ The FY 2007 enrollment projections and actuals reflect an enhanced methodology to identify enrollee deaths, which reduced both the projected and
actual enrollment numbers.
VA believes the 0.2 percent estimated increase in Priority 7 and 8
veteran patients is a reasonable estimate. Approximately 75 percent of
the Priority 7 and 8 patient populations are in Priority 8. The
Priority 7 patient population is growing slowly because of the
relatively small size of the non-enrolled Priority 7 veteran
population. In addition, the Priority 8 population is reduced each year
because of mortality; therefore the actual growth in the combined
Priority 7 and 8 populations over time is slowing.
Question 8: The VA's FY 2009 budget proposes spending $3.9 billion
on mental health, a $319 million increase over FY 2008. This increase
includes a 44-percent increase in spending for the Mental Health
Initiative, a 12-percent increase in VA Domiciliary care, and 4-percent
increases for Inpatient Hospital care, Psychiatric Residential
Rehabilitation treatment, and Outpatient care. Do you feel confident
the increases in areas other than your Mental Health Initiative are
sufficient to meet the ever-growing demand on mental healthcare
services faced by the VA?
Response: The proposed $319 million increase in mental health
spending represents the sum of a $161 million increase in the Mental
Health Initiative and a $158 million increase in mental health spending
through the veterans equitable resource allocation (VERA), all in
medical care funding. Together the funding will be adequate both to
address the needs of returning veterans and to enhance services for
veterans of all eras.
To put the projected increases in funding in perspective, we
calculate that it is sufficient to support the recruitment and hiring
of over 3,200 new mental health staff members. This is an extraordinary
number of new positions for any health system, especially in light of
VA's already filling of more than 3,800 new mental health staff
positions over the past 2\1/2\ years.
Question 9: The VA has requested a 44-percent increase in funding
for the Mental Health Initiative. In November 2006, the GAO reported
that VA failed to fully allocate the resources that had been pledged
for the Mental Health Initiative in FY 2005 and FY 2006. Have the
resources provided in the past for this initiative been fully
allocated? In your opinion, what innovative care and treatment
capabilities have been developed through the Mental Health Initiative
that would not have been realized through simply providing increases in
other mental health programs?
Response: Funding allocated for the Mental Health Initiative is
projected to increase from $370 million in 2008 to $531 million in
2009, an increase of $161 million or 43.5 percent. As noted in the
question, the Government Accountability Office (GAO) raised concerns
about under-execution of these funds in FY 2006. However, in FY 2007,
$306 million was allocated for the Mental Health Initiative and $325
million was actually spent, an excess of over 6 percent and a measure
of VA's commitment to provide access to high quality mental health
services.
The Mental Health Initiative has supported the implementation of
the VHA Comprehensive Mental Health Strategic Plan. In this, it has
supported major enhancements for mental health services. Specific
initiatives have included:
Enhancing access through major increases in staffing.
Increases mental health services available in community-
based outpatient clinics (CBOC).
Developing services for patients with serious mental
illness in rural areas.
Expanding program for homeless veterans.
Promoting the integration of mental health with primary
care.
Increasing mental health services for older adults across
care settings.
Transforming specialty mental health services to
emphasize rehabilitation and recovery.
Establishing mental health services to address the
specific needs of returning veterans.
Implementing a comprehensive strategy for suicide
prevention.
Question 10: In December, this Committee held a hearing on
``Stopping Suicides: Mental Health Challenges within the U.S.
Department of Veterans Affairs.'' In light of the alarming increase in
the suicide rate among veterans, is the VA doing anything differently
today regarding this issue than you were doing 6 months ago? How do you
think the VA can better address this painful issue--does it include
more resources, more data collection, novel approaches to providing
care and services?
Response: VA's information on suicide rates depends upon gathering
information on veterans' causes of death from medical examiners in
communities throughout America as processed by the States and the
Federal Center for Disease Control and Prevention (CDC). This is a
rigorous process that takes time. The data that are available from CDC
goes through the end of 2005.
Studies on returning veterans have demonstrated that the rates of
suicide among those who served in OEF/OIF is not significantly greater
than those for age, sex, and race matched individuals from the general
U.S. population. Studies on veterans who received care from VHA
demonstrated rates of suicide that are somewhat higher than those for
age and sex matched individuals from the community. However, there has
been no significant increase in rates between 2001 and 2005. Moreover,
the observed elevation in rates can be probably best attributed to
greater mental and physical illness as well as disability in the VA
population.
VA is rapidly implementing its program for suicide prevention by
enhancing mental health services and by supplementing its mental health
programs with initiatives that target suicide more directly. It was
approximately 1 year ago that VA began to hire suicide prevention
coordinators in each of its medical centers, and somewhat over 6 months
ago that it partnered with the Substance Abuse and Mental Health
Services Administration to develop hotline services specifically for
veterans. Both of these programs have continued to grow over the past 6
months. One recent advance has been the implementation of a program in
which the suicide prevention coordinators have been identifying
veterans who survive suicide attempts and others at high risk so their
monitoring and care can be enhanced. VA's suicide prevention programs
continue to advance. Some enhancements will be based on established
evidence, while others will require new research and intervention
development.
One of the most important strategies for suicide prevention must be
de- stigmatizing mental illness and promoting its treatment. This can
be best accom-
plished by delivering the message that access to high quality mental
health services is available to veterans through the VA, and that the
treatments provided are effective.
Question 11: On July 31, 2007, the VA submitted a ``White Paper on
the VA Disability Claims Processing Workforce.'' The report listed a
total of 3,100 new hires funded through the FY 2007 appropriation
(400), the FY 2007 supplemental (800), and the FY 2008 House
Appropriations recommended level (1,900). The VA projected an end-of-
year staffing level for Compensation and Pension of 9,068 FTE (direct)
and 10,998 FTE (direct) for FY 2008. The VA's FY 2009 budget submission
provides a 2007 level of 8,353 FTE (direct) and estimates an FY 2008
level of 10,304 FTE. The VA's estimate for FY 2009 is 10,998, the same
level the VA projected in July for the end of FY 2008. The VA's budget
request for FY 2009 estimates an additional 694 direct FTE (for a total
of 10,998) over the FY 2008 current level (10,304). Why is the VA now
estimating the same FTE levels for FY 2009 as you projected, back in
July, for the end of FY 2008?
Response: The table below illustrates the Veterans Benefits
Administration's (VBA) 2008 and 2009 budget for compensation and
pension (C&P) direct personnel as of September 30 of each year. The
onboard full time employees (FTE) are the actual staffing levels.
Cumulative FTE levels translate the onboard FTE's annual employment
period into its equivalent fraction of the year, which explains why the
cumulative and onboard FTE levels differ when FTE are employed for less
than a full year. VBA will continue to hire throughout the fiscal year
to meet the 2008 end-of-year goal of 10,998 onboard direct C&P FTE.
------------------------------------------------------------------------
FY 2008 FY 2009
------------------------------------------------------------------------
On-Board FTE 10,998 10,998
------------------------------------------------------------------------
Cumulative FTE 10,304 10,998
------------------------------------------------------------------------
Question 12: If Congress has already provided the resources to
bring this staffing level up to the level you now project for FY 2009,
haven't we already paid for this increased level, and shouldn't the
resources you propose in FY 2009 to reach this level result in a
greater number of claims processors by the end of FY 2009?
Response: FY 2008 VBA funding supports 14,857 FTE. Inasmuch as one
FTE equals one employee for a full year and we are in an upward hiring
trend, we will end the year with 15,570 employees onboard. About 1,900
of those will be onboard less than a full year and therefore will not
equate to a full FTE for FY 2008. In FY 2009, VBA plans to maintain the
onboard FTE at a constant level of 15,570 throughout the year and
anticipates the 2009 cumulative FTE will equal the onboard FTE, since
no additional hires are projected for FY 2009.
Question 13: How much, overall, do you estimate that it would
require over the next 5 years in Major Construction funding for the VA
to fully meet the CARES recommendations?
Response: The Department estimates that it will, at a minimum,
require maintaining a funding stream consistent with what has been
recently authorized and appropriated (over the past 5 years) to
continue effectively implementing the major medical facility
construction requirements needed to provide improved and efficient
healthcare delivery services to veterans. All future capital needs are
evaluated, along with other VA needs on annual basis, and all funding
decisions are reflected in the President's budget submission.
As reflected in the FY 2009 VA budget submission there are
currently 40 ongoing VA major medical facility projects. Including the
President's 2009 budget request, VA will have received more than $5.5
billion to date in major and minor construction for projects and other
related to CARES since FY 2004. As also shown in the budget submission,
the future funding needs for these existing ongoing projects is
currently $2.3 billon. Along with the existing projects, a number of
potential major medical facility projects are also listed in the VA
budget submission. The list of potential projects are updated each year
as part of the annual VA capital investment process, and projects may
be added or deleted from this list.
Question 14(a): The VA's FY 2009 budget requests $83 million for
facility activations. The VA states that this level will enable the VA
to open 51 CBOCs. Last year, VA requested $21 million and currently
plans on opening 64 CBOCs. In light of the estimate of opening fewer
CBOCs in 2009, is the VA requesting fewer resources for activations in
FY 2009 than it is spending in FY 2008?
Response: The $83 million for facility activations is for the non-
recurring startup costs related to major construction projects, not to
open new CBOCs. The only increased funding requested for new CBOCs is
for the estimated new workload that will be created which is estimated
at approximately $300,000 per CBOCs in the first year and approximately
$35,000 in the second year. This equates to $19,008,000 in FY 2008 (64
new CBOCs x $297,000 = $19,008,000). The estimate for FY 2009 is also
$19,008,000 (which is divided $9,504,000 in medical services and
$9,504,000 in medical facilities).
The FY 2009 computation is as follows:
------------------------------------------------------------------------------------------------------------------------------------------------
51 new CBOCs $300,000 = $15,300,000
------------------------------------------------------------------------
64 CBOCs year 2 $35,000 = $2,240,000
------------------------------------------------------------------------
Estimate for other one-time costs and inflation $1,468,000
------------------------------------------------------------------------
Total $19,008,000
------------------------------------------------------------------------
Question 14(b): Please provide details on which facilities the VA
plans on activating in 2008 and which facilities it plans on activating
in 2009?
Response: There are 64 CBOCs planned for activation in 2008. CBOC
activation sites for 2009 has not been decided, we are reviewing the
2009 recommendations.
2008 CBOC Activations
----------------------------------------------------------------------------------------------------------------
VISN CBOC VISN CBOC VISN CBOC
----------------------------------------------------------------------------------------------------------------
4 Dover 9 Berea 16 Stillwater
----------------------------------------------------------------------------------------------------------------
4 Monongalia 9 Grayson County 16 Branson
----------------------------------------------------------------------------------------------------------------
5 Andrews AFB 9 Hamblen 16 Eglin AFB
----------------------------------------------------------------------------------------------------------------
6 Charlottesville 9 Hawkins 16 Pine Bluff
----------------------------------------------------------------------------------------------------------------
6 Hickory 9 Hazard 18 Miami/Globe
----------------------------------------------------------------------------------------------------------------
6 Hamlet 9 Madison 18 SE Tucson Urban
----------------------------------------------------------------------------------------------------------------
6 Franklin 9 Bolivar 18 Thunderbird
----------------------------------------------------------------------------------------------------------------
6 Lynch 9rg Carroll County 19 Cut Bank
----------------------------------------------------------------------------------------------------------------
9 Dyer County 19 Lewistown
----------------------------------------------------------------------------------------------------------------
7 Aiken 9 Harriman (Roane County) 19 West Valley
----------------------------------------------------------------------------------------------------------------
7 Childersburg 9 Hopkinsville 20 North Idaho
(Christian County)
----------------------------------------------------------------------------------------------------------------
7 Spartanburg 9 Jellico (Campbell County) 20 NW Washington
----------------------------------------------------------------------------------------------------------------
7 Stockbridge 9 McMinnville 20 West Metro Portland
(Warren County)
----------------------------------------------------------------------------------------------------------------
9 Philips County 20 South Puget Sound
----------------------------------------------------------------------------------------------------------------
8 Camden 9 Pigeon Forge Clinic 22 Orange County
----------------------------------------------------------------------------------------------------------------
8 Jackson 9 Scott County 23 Bellevue
----------------------------------------------------------------------------------------------------------------
8 Putnam 23 Carroll
----------------------------------------------------------------------------------------------------------------
10 Parma 23 Cedar Rapids
----------------------------------------------------------------------------------------------------------------
15 Daviess 23 Holdrege
----------------------------------------------------------------------------------------------------------------
15 Hutchinson 11 Alpena County 23 Marshalltown
----------------------------------------------------------------------------------------------------------------
15 Jefferson City 11 Charleston 23 Shenandoah
----------------------------------------------------------------------------------------------------------------
15 Knox 11 Clare County 23 Wagner
----------------------------------------------------------------------------------------------------------------
15 Graves Co KY 11 Elkhart County 23 Watertown
----------------------------------------------------------------------------------------------------------------
Question 14(c): Please provide the Committee with the average cost
to activate a CBOC and the costs that the VA estimates for activations
for a major medical facility.
Response: In FY 2007, the average cost to activate a CBOC,
including the cost of staff, was $4.4 million. These costs including
the cost to activate are included in the budget requests of each of the
three separate appropriations but there is no separate identification
of either the operating or activation costs of CBOCs.
The FY 2009 included $83 million for facility activations which was
for the non-recurring startup costs related to major construction
projects. This is based on an estimated 10 percent of the project cost
for non-recurring activation costs which are requested in the year
these startup costs must be obligated.
Question 15: The VA's budget request for Medical Facilities
estimates $9.5 million in obligations for CBOCs. Please provide the
Committee with the average cost for a CBOC. Also, please provide a list
of obligations for CBOCs and the number of CBOCs (consistent with the
data found on pages 1d-4 and 1D-6 of the FY 2009 submission) over the
last 5 years and any estimates regarding obligations planned for CBOCs
from FY 2009 to FY 2013.
Response: The $9.5 million in the medical facilities appropriation
for CBOCs in FY 2009 is computed as shown below. There is also $9.5
million in the medical services appropriation. The only increased
funding requested for new CBOCs is for the estimated new workload that
will be created which is estimated at approximately $300,000 per CBOCs
in the first year and approximately $35,000 in the second year. This
equates to $19,008,000 in FY 2008 (64 new CBOCs $297,000 =
$19,008,000). The estimate for FY 2009 is also $19,008,000 (which is
divided $9,504,000 in medical services and $9,504,000 in medical
facilities).
The FY 2009 computation is as follows:
------------------------------------------------------------------------------------------------------------------------------------------------
51 new CBOCs $300,000 = $15,300,000
------------------------------------------------------------------------
64 CBOCs year 2 $35,000 = $2,240,000
------------------------------------------------------------------------
Estimate for other one-time costs and inflation $1,468,000
------------------------------------------------------------------------
Total $19,008,000
------------------------------------------------------------------------
Below are the total annual decision support system (DSS) costs for
CBOCs and the average per CBOC: For example in FY 2007, if one divides
the total cost by the average cost, the number of CBOCs is 663 which is
less than the 731 reported in the budget. The reason for this is that
some CBOC are in multiple locations under one contract but are only
counted once for cost purposes and are counted as multiple CBOCs for
facility count purposes. Two examples of this are: Veterans Integrated
Service Network (VISN) 9 St. Charles has 10 CBOC locations under a
single station number for cost purposes and VISN 6 Danville has nine
CBOC locations but only a single station number for cost purposes.
There are a total of 28 locations that are counted once for cost
purposes, but actually have multiple CBOCs ranging from 2 to 10.
------------------------------------------------------------------------
Total Cost (SB) Average Cost ($M)
------------------------------------------------------------------------
FY 2003 $2.086 $3.311
------------------------------------------------------------------------
FY 2004 $2.352 $3.647
------------------------------------------------------------------------
FY 2005 $2.541 $3.885
------------------------------------------------------------------------
FY 2006 $2.713 $4.181
------------------------------------------------------------------------
FY 2007 $2.935 $4.426
------------------------------------------------------------------------
Estimates
------------------------------------------------------------------------
FY 2008 $3.182 $4.426
------------------------------------------------------------------------
FY 2009 $3.421 $4.501
------------------------------------------------------------------------
Estimates for FY 2010 and beyond will not be available until the
submission of the FY 2010 President's Budget.
Question 16: VA Office of Rural Health--$1 million and 1 FTE: is
this sufficient? Studies indicate that over 40 percent of veterans
returning from OEF/OIF come from rural communities. Rural communities
have supplied a disproportionate share of veterans due to large
contingents of National Guard and Reserve servicemembers. Over a year
ago, Congress mandated the creation of the Office of Rural Health. Your
FY 2009 budget requests $1 million and 1 FTE for 2009. Given the scope
of the office--to conduct studies and develop policies and programs to
meet the health needs of the rural veteran population, a population
already presenting challenges in the provision of healthcare--do you
believe that one FTE is sufficient to carry out the responsibilities of
this office?
Response: The Office of Rural Health (ORH) is currently staffed
with a director and a health systems specialist which meets our current
demands. We will increase staff as needed. To complement current ORH
staff, ORH leverages expertise from a range of other VHA offices, VISN
rural health consultants in the field, and is directly supported by the
Assistant Deputy Under Secretary for Health for Policy and Planning,
which provides the staff resources of the Office of Strategic Planning
and Analysis as well as the Office of Enrollment & Forecasting. ORH
also uses contracts which allow ORH to leverage rural health expertise
with rural health leaders, academic institutions, and rural health
organizations outside VA to assist with operational and strategic
planning, coordination of research initiatives, and the development of
pilot programs.
Question 17(a): The VA's FY 2009 budget request for long-term care
estimates an Average Daily Census (ADC) level of 11,000 for nursing
home care. The Veterans Millennium Health Care and Benefits Act (P.L.
106-117), which was enacted in 1999, requires the VA to maintain an ADC
of 13,391. With the veterans' population demographically growing older,
there would seem to be a concomitant increase in demand for nursing
home care. Does the VA plan to submit a budget request for long-term
care that meets these statutory obligations for nursing home care?
Response: VA's philosophy is to provide long-term care services in
the least restrictive environment that is safe for the veteran. The
increasing availability of home and community-based non-institutional
extended care services both in VA and in the private sector during the
decade since the Millennium Act was developed has resulted in stable or
falling nursing home occupancy in both sectors even as the population
has aged. VA will continue to meet the statutory requirement to provide
nursing home care for all veterans with a service-connected disability
rating of 70 percent or more who need such care and seek it from VA.
There are no current plans to seek additional funding for nursing home
care beyond that required to maintain current capacity.
Question 17(b): How much more long-term care funding would be
required to meet the VA's statutory mandate to maintain an ADC of
13,391.
Response: Based on VA's FY 2009 budget request, an additional $664
million would be needed to maintain an average daily census (ADC) of
13,391 in VA nursing home care units.
Question 18: According to the ``Priority List of Pending State Home
Construction Grant Applications'' for FY 2008, VA is facing a backlog
of $553 million in Priority 1 projects. Priority 1 projects are those
projects that already have State funding to start construction. In
light of this increasing backlog, how can the Administration justify a
proposed cut in this account of $80 million?
Response: VA anticipates that the FY 2009 funding request will be
sufficient to fund all Priority Group 1, Subpriority 1 (Remedies for
Life/Safety) projects for State veteran homes.
Question 19(a): Your report to the Committee, dated February 26,
2008, states that VA believes 2013 would be the first year it would be
able to allow enrollment of new Priority 8 veterans. If the enrollment
ban were lifted, allowing the enrollment of new Priority 8 veterans, on
October 1, 2008, how many additional resources, overall and by specific
appropriation account, would the VA estimate would be needed to handle
the increased demand and workload?
Response: VA's strategic analysis identified significant challenges
with regard to building the capacity, both in terms of infrastructure
and staffing, required to re-open enrollment for Priority 8 veterans in
the near term without severely disrupting VA's ability to provide
timely, high quality care to eligible veterans. This analysis
demonstrated that 2013 would be the soonest that VA would be able to
put in place the needed infrastructure to accommodate increases in
demand. The report also noted meeting staffing requirements within this
timeframe would remain a challenge due to nationwide healthcare
workforce shortages. VA estimates that the treatment cost in 2013 for
this policy change is $3.1 billion excluding any additional capital
requirements.
Under current enrollment policy, VA's projected demand for
healthcare services is expected to increase over the next several
years. While enrollment growth has slowed since the suspension of
enrollment in Priority 8, the volume of healthcare services required by
enrollees continues to grow due to the aging of the enrolled
population. VA will need to continue to build capacity in the coming
years to meet this increased need for healthcare services from eligible
veterans. Providing healthcare services to these new Priority 8
enrollees would require that VA develop additional capacity beyond the
growth needed under the current enrollment policy. For example, VA will
need to grow ambulatory services 15 percent by 2013 under the current
enrollment policy and by a total of 24 percent under full enrollment
(including Priority 8 veterans). Further, the growth in demand for VA
healthcare services varies significantly across the VA healthcare
system. For example, to meet the combined increase in demand for
services under both current enrollment policy and full enrollment in
2013, some areas will have to grow ambulatory services by as much as 45
percent. Without first building the needed infrastructure and staff
capacity, VA would be unable to accommodate the large increase in
workload without compromising quality and timeliness of care.
Question 19(b): If the level to qualify as a Priority 7 veteran was
increased to 150 percent of the Geographic Means Test beginning on
October 1, 2008, how many additional veterans does the VA estimate
would be allowed to enroll for VA medical care with such a change and
what additional resources would be required to meet this increased
demand, overall and by appropriation account, for FY 2009.
Response: VA is conducting an analysis to assess the impact on
enrollment and utilization by increasing the income thresholds of the
geographic means test thresholds which vary by county and number of
dependents. VA will provide the results of this analysis to the
Committee when the analysis is completed.
__________
The Honorable John J. Hall, Chairman
Subcommittee on Disability Assistance and Memorial Affairs
House Veterans' Affairs Committee
Question 1: In your testimony, you said the President's Budget
Request would allow for improvement in the timeliness and accuracy of
claims processing. This has been VA Strategic Plan Goal Number One
since at least 2003, but the backlog has only gone up since that time.
Can you provide some clear, concise and measurable objectives for 2009
that will realistically result in improvements that Congress can track?
Response: VBA continues its efforts to reduce the pending claim
inventory and improve claims processing timeliness. Disability
compensation and pension claims receipts requiring a rating decision
are projected to increase to 854,904 in 2008 and 872,002 in 2009. VBA
has set aggressive performance targets to successfully address this
significant increase in claims. Measurable performance objectives
established for FY 2009 include 145 days, on average, to process
compensation and pension rating claims, an accuracy rate of 92 percent
for rating related claims, and an end-of-year inventory of
approximately 300,000.
Question 2: You have listed as a major goal for 2009 to reduce the
timeliness of processing a claim from 183 days to 145 days. At one
point, the goal was 125 days. I recently convened a hearing in which a
private employment plan reminded me that they are obligated under the
ERISA law to process claims in 45 days and can do it in 3 days. How is
it fair to veterans that you do not have the same goals as the private
sector?
Response: There is no private sector model of claims processing
(private insurance, Federal Employees' Compensation Act, etc.) that has
a benefits system as complex as VA's. The following requirements set VA
apart from other entities that process claims:
VA is required to establish that the claimed disability
was incurred in, aggravated by, or otherwise determined to be a result
of military service, often many years after discharge from service.
Under the Veterans' Claims Assistance Act (VCAA), VA has
the duty to assist the claimant in gathering evidence needed to support
their claim. Specific notification requirements must be followed.
VA must determine the veteran's ability to earn income at
a level equal to a non-disabled veteran.
VA must determine the amount of compensation to award
based on a combined disability rating evaluation, as well as process
any ancillary benefits to which the veteran may be entitled.
Rightly, the laws governing VA are designed to benefit veterans.
However, as a result, the system under which claims are adjudicated
imposes legal requirements that create inherent delays in claims
processing.
Recently, the CNA Corporation appeared before the Veterans'
Disability Benefits Commission. CNA compared the VA disability
compensation program to similar Federal disability programs and
explored lessons learned from other programs. Some of the areas
considered were claims processing, performance measurement, quality,
training, staffing, costs, and processing sites. CNA concluded that,
except for timeliness, VA does not appear to be under-performing in
comparison with other disability programs and that recent training
improvements and hiring initiatives seem promising for improving VA
timeliness in the long term.
Question 3: Your projection for the volume of claims receipts is
projected to reach 872,000 in 2009, which is an increase in the
backlog. Isn't that counterproductive to everything you are talking
about doing to improve C&P services?
Response: The disability claims workload from returning war
veterans and veterans from earlier periods has continuously increased
since 2000. VBA's annual rating claims receipts grew 45 percent from
2000 to 2007. In 2008 and 2009, we anticipate receipts will increase to
854,904 and 872,002 respectively. However, as rating receipts increase,
VBA's national production level is also expected to increase to 878,205
in 2008 and 942,706 in 2009. The increase in staffing across the Nation
has prepared VBA for this projected increase in workload. With a
workforce that is sufficiently large and correctly balanced, VBA can
process rating claims in a timely and efficient manner. We project that
our pending rating inventory will decrease in 2008 and 2009 with a
projected end-of-year inventory of approximately 300,000 in 2009.
Question 4: Neither in the budget proposal, nor in your testimony
do I see how you are going to deal with the nature of the complexity of
claims by using more modern tools. I recently held a hearing on using
Artificial Intelligence to automate the claims processes and we heard
from several very credible experts on its use in the private sector and
its potential for VA, but I don't see it as a priority in the budget.
Online Access and Virtual VA do not change the fact that the Regional
Offices still print a paper record and manually rate claims. Where in
the Budget, do you include a request for an automated decision support
system?
Response: VBA, in collaboration with the Office of Information and
Technology (OIT), is developing the paperless delivery of veterans
benefits initiative. This initiative will employ a variety of enhanced
technologies to support end-to-end claims processing. In addition to
imaging and computable data, we will also incorporate enhanced
electronic workflow capabilities, enterprise content and correspondence
management services, and integration with our modernized payment
system, VETSNET. Similarly, we are also exploring the utility of
business-rules-engine software to both manage workflow and potentially
to support improved decisionmaking by claims processing personnel.
To fully develop this initiative, funded through $20 million
appropriated in the FY 07 supplemental, VBA will engage the services of
a lead systems integrator (LSI). The LSI will work closely with VA to
fully document our business and systems requirements for an end-to-end
claims process supported by technology. While this process will be
enhanced by the advanced technologies this is fundamentally a business
transformation effort. Business process modeling and resulting
improvements will be a key feature in this effort, building upon the
claims processing study recently completed by IBM Global Business
Systems.
In addition, the FY 2009 budget request calls for $17 million for
expansion of our existing imaging and electronic file repository,
Virtual VA. This funding will ensure that we are able to make
demonstrable progress in our current efforts to enhance claims
processing through technology as we develop the longer term plan. This
longer-term plan will move us toward a more automated decision-support
system built upon a claims process that is less reliant on paper
records.
Question 5: I see that C&P programs are requesting an additional
$14 million or a 17 percent increase over last year. Does that include
the $20 million supplemental funds VBA got last year?
Response: We assume that this question refers to the compensation
(only) medical exam pilot program, page 2A-2 of the 2009 Budget
Submission. The funding for contract exams in the benefits budget
supports the 10 pilot sites in Atlanta, Boston, Houston, Los Angeles,
Muskogee, Roanoke, Salt Lake City, San Diego, Seattle, and Winston-
Salem. The $20 million in supplemental funds VBA received last year for
contract exams is included in the general operating expenses (GOE) C&P
request. The six sites funded by the GOE appropriation are Cleveland,
Indianapolis, St. Louis, Des Moines, Lincoln, and Waco.
Question 6: You mentioned in your testimony that you are enacting
some of the Dole/Shalala Commission recommendations, but those are
somewhat limited. You did not mention the 113 recommendations from the
Veterans' Disability Benefits Commission, which was a much more in
depth study since it ran for over 2 years and not just 4 months. What
is your plan to deal with those recommendations; especially with the
issues they raised surrounding the VA Schedule for Rating Disabilities,
Quality of Life payments and presumption?
Response: VA is in the process of evaluating all of the
recommendations from the Veterans' Disability Benefits Commission and
the Dole-Shalala Commission. The 113 recommendations made by the
Veterans' Disability Benefits Commission fall into categories based on
what organization has been assigned action: VA, DoD, Congress, some
combination, or no action required. There are 36 assigned to VA alone,
and they are being worked by the organization under which the activity
or responsibility falls. In response to the recommendations made by
both of these commissions, a contract was awarded in February 2008 to
study long-term transition payments, quality-of-life payments, and
earnings-loss payments. The final draft report is expected on July 28,
2008. The contract completion date is August 11, 2008. Any decisions on
changes to the rating schedule, including consideration of quality-of-
life issues, must await the outcome of the study. The Department is
tracking progress on all of the recommendations on which we share
responsibility. VA organizations are updating the status of each
recommendation to reflect ongoing and completed actions.
Question 7: What about the Global War on Terror Heroes Task Force
your predecessor chaired? What are you going to do with those
recommendations?
Response: In April 2007, Secretary Nicholson submitted the task
force on Returning Global War on Terror (GWOT) Heroes report to the
President. The report contained 25 recommendations--which included 100
action items with implementation dates--to improve the delivery of
Federal services to returning servicemembers. The 90 actions items with
target dates on or before March 1, 2008, are completed or commenced as
required.
The task force recommendations have resulted in the enhanced
delivery of VA services to veterans, and VA continues to seek ways to
improve. Senior leaders within VA are accountable for ensuring the
remaining GWOT task force implementation actions in the areas of
information technology enhancements and VA/DoD data exchange are
implemented in a timely manner.
Question 8: A single DoD/VA disability evaluation process has been
advocated by most of the recent Commissions and Task Forces and
certainly seems to have support among the veterans' community. I
understand the pilot is underway, but should conclude shortly. What are
your views on taking such a step with DoD and what would be the next
phase toward implementation of a single exam process?
Response: VA initiated a pilot of the single disability examination
system (DES) with DoD on November 29, 2007. VA has been actively
participating in regular reviews with DoD to evaluate the ongoing
progress and effectiveness of the National Capital Region (NCR) DES
pilot program. VA believes that data from the current workload must be
analyzed and concerns addressed prior to any consideration of expanding
the pilot.
Question 9: At a previous hearing, VA staff were unable to tell me
what happened to the Office of Seamless Transition, which has now
become a VHA/DoD Outreach Coordination Office--how has VBA been dropped
from the process? How are newly disabled veterans who seem to have a
difficult enough time in getting claims processed supposed to navigate
the system without this level of support? Why was Congress not informed
about such a major realignment and our input not included?
Response: In January 2005, the Under Secretary for Health (USH)
established the Office of Seamless Transition (OST) to assist
servicemembers in their transition from DoD to VA. In addition to VHA
employees, OST was supported by VBA, which provided staff to help with
benefits issues. Two active duty Marine Corps officers and one Army
officer were also detailed to the office. The mission of OST was to
ensure that every severely injured or ill servicemember returning from
combat received priority consideration and world-class service within
VA.
In the late summer of 2007, VHA reorganized the OST into three
components: the OEF/OIF Program Office; the Care Management and Social
Work Service; and the Office of OEF/OIF Outreach, recognizing that
separate focuses had evolved with respect to efforts on behalf of our
Nations' returning servicemembers. The USH created the OEF/OIF Program
Office as a direct report. On an ongoing basis, the executive director
of the office collaborates with DoD on policy and course direction
related to transition of healthcare services for servicemembers as they
move between DoD and VHA. The office also works with other offices in
VA and VBA to specify remedies for barriers and challenges as they are
identified. In response to public law, such as components of the NDAA
that require VHA actions, the office facilitates the development of
action plans that assure the intent of such issuances are met fully and
timely, including any that require joint action with other VA or DoD
offices.
In response to a need for higher-level clinical case management,
VHA created the Care Management and Social Work Service within the
Office of Patient Care Services (PCS) in October 2007. The new
service's placement under PCS takes advantage of the synergistic
alignment with the polytrauma and rehabilitation and mental health
chief consultant offices, and other clinical specialties, which are
deemed critical for internal coordination of veterans' care. The
office's mission is to coordinate patients' healthcare and provide
family support. This office has staff detailed from VBA for support on
benefit issues, and from active duty military officers. The office
works closely with OEF/OIF program directors and case managers at VA
medical centers, VBA offices, and DoD discharge staff to ensure a
smooth transition to VA services at locations nearest to the veteran's
residence after their military discharge. This coordination allows
enhanced identification of these veterans at their local VA facilities
for continuity of medical care and processing of benefits claims.
The third component of focus is the Office of OEF/OIF Outreach,
which provides a national focus on VHA's systematic efforts to identify
new veterans and to provide information on services available to them.
The office's military liaison coordinator assures that VHA participates
in National Guard and Reserve's post deployment health reassessment
(PDHRA) activities and assists in coordinating the pre- and post-
deployment briefing. This office also receives lists from DoD of
servicemembers who are in the physical evaluation board process, and
sends this information to the local VHA office where the servicemember
resides. The local VHA office sends a letter from the Secretary with
information about VA. For those leaving active duty due to service
connected medical problems, the outreach effort is intensified to
ensure a full understanding of the VA compensation process and
vocational rehabilitation and employment programs. VA briefings on
healthcare services and benefits are conducted at townhall meetings and
include VHA and VBA staff who assist and present to family readiness
groups and to unit drill activities near the home of returning National
Guard/Reservists. Current efforts are underway to reach out using a
call center to those who are separated from the military and have not
used VA healthcare to encourage them to consider VA as an option as
they need services.
Question 10: I have heard that there has been some confusion over
the clothing allowance. It used to be adjudicated and paid by VBA. Now
VHA has oversight and the veteran must go to a VAMC to apply.
Response: Although VHA has assumed responsibility for the clothing
allowance program, the process for application does not require the
veteran to report to the VA medical center (VAMC) to apply. The veteran
can fill out the form (VAF-8679) and mail it to the local VAMC
prosthetics department. If he does not have a form, he can call and one
will be mailed to him. VHA is also in the process of placing this form
on the Web site to be downloadable and fillable. The only time a
veteran may be asked to come to a VAMC is to determine if he meets the
qualifications for a clothing allowance and this generally applies only
to those non-static veterans whose medical condition is subject to
change.
Question 11: Is this not adding another step to the process?
Response: No additional steps have been added to the process, as a
matter of fact, there has been elimination of the steps when the
application had to be sent from VBA to VHA for determination of non-
static allowances. Now the determination is made and the processing of
payment made at the same time.
Question 12: Additionally, if VBA does not inform the veteran, and
I have seen decision letters that no longer inform amputees and other
eligible veterans about the benefit, how do they know it even exists?
Response: With all new awards of service connection, VA Form 21-
8764, Disability Compensation Award Attachment is included with the
decision letter. The attachment includes an explanation of the clothing
allowance benefit. It also instructs veterans to contact the
prosthetics department at the nearest VHA facility to apply for the
benefit. This information is also provided in VA's annual publication,
Federal Benefits for Veterans and Dependents, which is available at
many VA facilities and also electronically on VA's Web site.
Question 13: Furthermore, some of the OIF/OEF amputees are getting
their prosthesis through TRICARE contracts and are not using VAMCs, so
how are they going to get their clothing allowance?
Response: The veteran only needs to complete the application (VAF
8679) and send it to the local VA prosthetics department, who will
review his rating and if service connected for the condition, the staff
will establish the veteran as ``static'' and no further action will be
required.
Question 14: I am very concerned, as I am sure we all are, about
the caregivers of the severely injured servicemembers and I appreciate
the pilot programs underway to assist them. But my concern is with
providing them with other resources and would like to hear your opinion
on creating a caregiver allowance and extending CHAMPA eligibility to
them, even if they are not the veteran's dependent.
Response: VA will study this option. VA has come to appreciate the
importance of support to family caregivers whose severely injured loved
ones transition into VA healthcare.
Question 15: What is the current status of the Vets Center in
Middletown, NY?
Response: The lease for the Middletown Vet Center (726 East Main
Street, Suite 201, Middletown, NY 10940) was signed on September 28,
2007. The property is currently being built-out and the projected move-
in date is April 14, 2008. The team leader, two counselors and the
office manager positions have been filled and staff are providing
services in temporary space donated at the Orange County Veterans'
Service Office, Port Jervis, Monticello and Newburg CBOCs. The first
client was provided service on December 27, 2007.
Question 16: Regarding the CARES process at the Hudson Valley VA
System I believe the VA must do what is best for our veterans, not what
is most beneficial for the VA bureaucracy. What is the status of the
Enhanced Use Lease process for these hospitals and what principles do
you believe should guide the VA in this decision?
Response: VA's guiding principles when using the enhanced use
leasing program are to produce developments that provide direct
benefits to veterans with much needed healthcare and services that VA
does not offer, not a benefit of VA's bureaucracy. Examples are
assisted living facilities, transactional and permanent housing for
homeless veterans, continuous care retirement communities, low income
senior housing and other in-kind considerations. These types of
services are put in place with veterans' preference and priority
placement as well as the conveyance of the property value as a discount
to the veteran's costs when occupying the facilities.
At Montrose VA expects to facilitate the provision of those types
of services and healthcare with a developer/lessee that will be
selected through a full and open competition. The enhanced use leasing
process will formally begin in the summer of 2008 at a public hearing
to present VA's concepts to the community and stakeholders to receive
input and comments. The process is expected to have 2 phases. The first
phase will be immediate for the land and buildings currently available
due to underutilization and vacancy. The second phase will be the
remaining land and buildings that will be available after the VA's
capital plan for Montrose and Castle Point is completed.
Question 17(a): What stage is the performance bonus review process
in?
Response: The Department concluded its 2007 Senior Executive
Service (SES) performance review process on December 7, 2007.
Question 17(b): What do you think of the level of bonuses that were
paid out last year to Senior Executive Service officials at the VA?
Response: In January 2008, I reviewed the changes made to the VA
SES performance review process including the level of bonuses that were
paid out last year. I believe the distribution and level of bonuses
paid to our SES officials was based on VA's overall performance as a
Department and the individual performance of each executive who
received a bonus.
Question 17(c): Do you intend to take a more active oversight role
in the process than your predecessor?
Response: While serving as Acting Secretary, Deputy Secretary
Gordon H. Mansfield modified various components of VA's SES performance
review process. Deputy Secretary Mansfield's modifications resulted in
more accountability on the part of every SES member and enhanced the
credibility and integrity of VA's SES performance management system.
These modifications also promote a Department-wide service delivery to
our Nation's veterans and their families. I fully support the
modifications he made and will continue the active oversight
implemented by Deputy Secretary Mansfield.
Question 18: In 2004, Congress enacted the Veterans Health Programs
Improvement Act of 2004 (P.L. 108-422). Section 201 of the Act
authorizes VA to make subsidy payments to the States to assist State
veterans homes in recruiting and retaining nursing personnel to reduce
nursing shortages. I understand VA personnel have been developing
regulations to carry out the intent of Congress, but those regulations
have not been published, now nearly 4 years after passage. As required
by Section 201(b) of the Act, ``[t]he Secretary shall establish such
interim procedures as necessary so as to ensure that payments are made
to eligible States under that section commencing not later than June 1,
2005, notwithstanding that regulations under subsection (j) of that
section may not have become final.'' What are the causes for the long
delay in promulgating these regulations, and what are the Department's
plans to implement these provisions of law?
Response: It was necessary for VA to define the scope of coverage
for different categories of nurses and analyze the extent of nursing
shortages and the efficacy of different recruitment and retention
incentives. Consultation with State Veterans Home stakeholders was
undertaken to be sure the final regulation would be compatible with
their needs. The proposed regulation was published in the Federal
Register on April 11, 2008, and is currently outstanding for a 60-day
public comment period from the date of publication.
Question 19: When can State veterans homes expect to see these
regulations published?
Response: The proposed regulation was published in the Federal
Register on April 11, 2008, and is outstanding for a 60-day public
comment period from the date of publication. Following that period, VA
will respond to any public comments received and publish the regulation
as quickly as possible thereafter.
Question 20: In Section 211 of the Veterans Benefits, Health Care,
and Information Technology Act of 2006 (Public Law 109-461), the
Department is authorized and required to provide severely disabled
service-connected veterans (70% disabled or greater) with equitable
access to State veterans homes, by reimbursing homes the full cost of
care for these veterans, as well as for any veteran whose primary need
for nursing home care is due to a service-connected disability. That
Act also requires VA to furnish prescription medications to veterans in
State homes to treat their service-connected disabilities, and
medication for any disabilities of veterans who have service-connected
disabilities rated at 50 percent or more disabling. The Department has
not implemented this law, whose effective date was March 22, 2005.
Currently, the VA is contracting with private sector nursing homes to
deliver care to these veterans. A GAO report on VA Long Term Care
(March 2006) found that the State veterans home program can provide
higher quality of care to veterans at a much lower cost for services.
What is the Department's plan to implement these measures, and what are
the assumed costs or savings that would result from implementation?
Response: VA must establish a new regulation in order to implement
these measures. The regulation has been drafted and was placed in the
concurrence process on February 14, 2008. After departmental
concurrence is received, it will be reviewed by the OMB, published as a
proposed rule in the Federal Register for a 60-day mandatory public
comment period, revised if necessary in response to public comments,
and then published as a regulation in the Federal Register.
Question 21: When can State veterans homes expect to see these
authorities implemented?
Response: VA will proceed to implement these measures as quickly as
possible thereafter.
Question 22: In 2006, this Committee received testimony from the
President of the National Association of State Veterans Homes as
follows: ``States have presented over $400 million in projects that are
presently pending before VA. Also, a February 2006 VA survey of States
documented that $161 million will be required in life-safety projects
alone over the next few years. We believe that the total backlog of all
conceivable State construction projects, including increased capacity
to meet rising demand in California, Texas, Florida and other States,
could easily top $1 billion.'' Last year, Congress provided $165
million in funding for construction grants for State extended care
facilities. This year, the Administration's budget submission requested
only $85 million for this program. What is the current dollar total of
backlogged requests for new construction or renovation under this
program from State homes? Of this amount how much is requested by State
homes for construction of vital life and safety repairs and upgrades
and how many new bed-producing projects, with their costs, are pending
in VA's construction backlog?
Response: There are 178 initial applications included in the FY
2008 State home construction grant program, with an estimated cost to
VA of $971,624,000. Of these, 39 applications are for life and safety
repairs ($97,198,000), 97 are for renovations of existing State
veterans homes ($245,917,000) and 42 are new bed-producing projects
($628,509,000). Only 92 of the 178 initial applications have certified
the commitment of State matching funds required to make them eligible
for a VA grant. These 92 applications have an estimated cost to VA of
$535,467,000, including $80,353,000 for 19 life safety projects,
$78,949,000 for 53 renovation projects, and $376,165,000 for 20 new
bed-producing projects.
Question 23: Based on the Department's contacts with the States,
please estimate the number of construction project requests you expect
to receive this year, with their estimated costs.
Response: The States do not consistently inform VA of its plans. VA
will not know the cost or priority of new grant applications for
certain until after August 15, 2008, which is the deadline for
submission of applications to be considered for inclusion in the FY
2009 priority list.
Question 24: What criteria did the Department use to determine a
funding level of $85 million for the State extended care grant program
for Fiscal Year 2009?
Response: VA anticipates that the FY 2009 funding request will be
sufficient to fund all Priority Group 1; Subpriority 1 projects
(Remedies for Life/Safety).
Question 25: Congress is in receipt of numerous reports that VHA,
NCA and VBA are contracting out Federal functions to contractor
performance without conducting cost comparisons, which is clear
violation of the OMB A-76 Circular, governmentwide competition rules
that apply to the VA, as well as FY 2008 VA appropriations language
that makes even clearer that the VA must comply with these
competitions. VA acknowledges that 80% of the blue collar jobs
contracted out is held by veterans including disabled veterans. Will
you commit to ensure that your Department follows the circular and the
law, in order to ensure that VA is in compliance with the law and that
the interests of the taxpayer and veterans seeking Federal employment
are well served?
Response: VA is committed to following the Circular and the law. In
addition to OMB A-76 Circular, VA must also comply with title 38,
section 8110 which states ``Notwithstanding any other provision of this
title or of any other law, funds appropriated for the Department under
the appropriation accounts for medical care, medical and prosthetic
research, and medical administration and miscellaneous operating
expenses may not be used for, and no employee compensated from such
funds may carry out any activity in connection with, the conduct of any
study comparing the cost of the provision by private contractors with
the cost of the provision by the Department of commercial or industrial
products and services for the Veterans Health Administration unless
such funds have been specifically appropriated for the purpose.''
Federal positions are not being directly converted to contractor
performance in contravention of the Circular or the law. VHA ensures
that it complies with OMB A-76 Circular, Performance of Commercial
Activities, title 38, section 8110 and other applicable laws. VA
submits the Annual Section 305 report required by Public Law 100-262,
Veterans' Health Care Eligibility Reform Act of 1996. All VHA
contracting activities are required to provide an annual certification
and, to report all FTE that are converted to contract performance
during the given fiscal year.
Question 26: You stated at the hearing that a significant share of
the IG's work was done through contractors. Please provide the
Committee with an inventory of the number of contractors used by the IG
over the last 5 years, the functions they performed, the dollar amount
and share of the IG budget that was used to pay contractors, and when
and how contractor performance has been evaluated, to determine if it
is cost effectiveness to continue to contract out this work.
Response: Over the last 5 years, the Office of Inspector General
(OIG) contracted for work related to the annual audits of VA's
consolidated financial statements (CFS) and the Federal Information
Security Management Act (FISMA) as shown in the table below. Although
the majority of the CFS work was performed by contractors, until FY
2007, most of the FISMA work was performed by OIG personnel.
Before FY 2005, OIG provided narrative comments but no rating for
contractor performance. For FY 2005 through FY 2007 OIG evaluated the
contractor's interim performance for the following areas as required by
the Office of Acquisition and Logistics, Acquisition Operations
Service:
Contractor's compliance with initial performance
schedule.
Effectiveness of contractor's schedule tracking system.
Contractor's ability to adapt to customer initiated
schedule changes.
Contractor's ability to plan, develop, track and preserve
project management documentation.
Effectiveness of the contractor's use of teaming.
Ability of contractor to work with the customer.
OIG will provide a final rating of (1) highly effective, (2)
effective, (3) marginally effective, or (4) ineffective at the end of
the contract performance period.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Share of OIG
Contract Budget
Fiscal Year Contractor Amount (percent- Purpose of Contract
rounded)
--------------------------------------------------------------------------------------------------------------------------------------------------------
2007 Deloitte & Touche LLP$3,705,493 5 percent Annual CFS audit
--------------------------------------------------------------------------------------------------------------------------------------------------------
2007 Deloitte & Touche LLP 1,013,550 1 percent Annual FISMA audit
--------------------------------------------------------------------------------------------------------------------------------------------------------
2006 Deloitte & Touche LLP$3,611,915 5 percent Annual CFS audit
--------------------------------------------------------------------------------------------------------------------------------------------------------
2006 Internet Security Systems, Inc. 25,000 .04 percent Penetration testing for
FISMA audit
--------------------------------------------------------------------------------------------------------------------------------------------------------
2005* Deloitte & Touche LLP 3,496,204 5 percent Annual CFS audit
--------------------------------------------------------------------------------------------------------------------------------------------------------
2005 Internet Security Systems, Inc. 25,000 .04 percent Penetration testing for
annual FISMA audit
--------------------------------------------------------------------------------------------------------------------------------------------------------
2004 Deloitte & Touche LLP 4,302,739 7 percent Annual CFS audit
--------------------------------------------------------------------------------------------------------------------------------------------------------
2003 Deloitte & Touche LLP 4,190,734 7 percent Annual CFS audit
--------------------------------------------------------------------------------------------------------------------------------------------------------
* The OIG awarded a new contract in FY 2005 for the annual CFS audit through competition, which resulted in a lower price.
Question 27: P.L. 108-445 requires the Department to report to
Congress annually for 5 years after implementation of the physicians'
pay bill to determine if the law is helping with recruitment and
retention of physicians. The reports during the first 2 years must also
address how many VA medical dollars are still being spent on contract
care rather than in-house medical staff. Congress has still not
received a single report even though the law took effect over 2 years
ago. When is the Department going to comply with these reporting
requirements?
Response: The annual report on physicians pay was provided to the
Chairman and Ranking Members of the Senate and House Committees on
Veterans' Affairs and the House Subcommittee on Health on November 16,
2007.
Question 28: P.L. 108-445 also encouraged the VA to offer its RNs
alternative work schedules that are regularly available to nurses in
the private sector. How many facilities have offered AWS since the law
took effect over 2 years ago, and how many nurses per facility are
working AWS?
Response: VA implemented two alternate schedules authorized by
Public Law 108-445. The 36/40 work schedule that authorizes nurses to
work three regularly scheduled 12-hour shifts within an administrative
work week and be paid for a full 40-hour work week, and the 9 month/3
month work schedule that authorizes nurses to work full-time for 9
months with 3 months off-duty within a fiscal year and be paid at 75
percent of the full time rate.
The law gives the direction for establishing the two work
schedules; however no facility is mandated to use them. Individual
facilities may choose to offer the alternative work schedule (AWS) if
they believe these schedules would benefit its posture of retaining
well qualified staff as an employer of choice.
Currently there is no mechanism to centrally track the complete use
of the AWS per facility and by individual because of limitations in the
personnel and accounting integrated data (PAID) and enhanced time and
attendance (ETA) systems. For example, nurses who are authorized to
work the 36/40 AWS (36/40 AWS) whose tour of duty cross administrative
work weeks presents timekeeping challenges in the ETA system. The
Office of Human Resources Management, Work Life and Benefits Service is
currently researching and considering solutions that can be quickly
implemented to resolve these problems.
__________
The Honorable Joe Donnelly
House Veterans' Affairs Committee
Question 1: VA has said that the budget would provide sufficient
resources to virtually eliminate the time a patient has to spend
waiting for an appointment to see a doctor by the end of 2009. While
that is an admirable goal, is it realistic, and what are some of the
steps you plan to take to ensure that will happen?
Response: The access list in March of 2008 was 28,724, a reduction
of 126,977 since March 2007. (The access list is defined as all
patients on the electronic wait list or those with an appointment but
waiting more than 30 days beyond their desired date). VA is working
diligently to ensure that patients do not have lengthy waits for clinic
appointments and we expect to have the access list down to 25,000 by
the end of FY 2008 and virtually eliminated by September 2009.
Question 2: VA has said that the budget would provide sufficient
funds to reduce the disability claims backlog by 24 percent (to
298,000) by the end of 2009. Is this realistic, and what are some of
the steps you plan to take to ensure that will happen? Also, can we go
further to reduce the backlog and wait time even more, and if so, is
this an issue of funding, or whether we can fundamentally change how
the system works?
Response: VA has embarked on an extensive hiring and training
initiative to reduce the pending inventory. The goal of reducing the
claims inventory to 298,000 by the end of 2009 is realistic if claims
receipts do not exceed projections.
Court cases and legislative changes can result in an unforeseen
increase in claims. Current law also imposes requirements that create
inherent delays in the claims process.
Question 3: Do you believe there is adequate funding in this budget
for mental health, ensuring returning veterans are better screened for
potential problems, and providing care for those in need? How will
increased funds be used to accomplish this goal?
Response: VA's proposed budget for FY 2009 includes $3.9 billion to
continue to improve access to mental health services across the
country. This is an increase of $319 million, or 9 percent, above the
2008 level. These funds will help VA continue to deliver exceptional,
accessible mental healthcare. Our strategy for improving access
includes increasing mental healthcare staff, over 3,800 new mental
health professional and support staff have been hired since FY 2005,
resulting in a total of almost 17,000 mental health staff in the VA
system. In addition to growth in staff, the enhancement funding
supports new care models, such as integration of mental health services
into primary care sites and training of mental health staff to provide
psychotherapies with particularly strong evidence bases, as research
has become available to identify such treatment models. We have
expanded our tele-mental health program, which allows us to reach about
20,000 additional patients with mental health conditions each year.
The budget also include funds for the Mental Health Initiative,
which focuses on enhancing access to all mental health programs,
including those for OEF/OIF veterans, increasing recovery oriented
services, integrating care between mental health and primary care, and
promoting a national model for suicide risk identification and
prevention.
----------------------------------------------------------------------------------------------------------------
Dollars in Thousands 2007 Actual 2008 Estimate 2009 Estimate
----------------------------------------------------------------------------------------------------------------
Mental Health Initiative $352,835 $370,029 $531,283
----------------------------------------------------------------------------------------------------------------
As part of its efforts to increase access to mental health services
in the most appropriate setting, a portion of Mental Health Initiative
funding is directed toward increased staffing for outpatient mental
health programs in 2008 and 2009. In addition, VA is planning to
increase the number of intensive outpatient substance abuse programs.
This effort reflects the continued transition from inpatient care to
more effective intensive outpatient care for treating substance abuse
problems.
----------------------------------------------------------------------------------------------------------------
Dollars in Thousands 2007 Actual 2008 Estimate 2009 Estimate
----------------------------------------------------------------------------------------------------------------
Outpatient $1,421,340 $1,523,990 $1,584,424
----------------------------------------------------------------------------------------------------------------
Mental Heath Initiative funds are being used to increase funding
for suicide prevention.
----------------------------------------------------------------------------------------------------------------
Dollars in Thousands 2007 Actual Estimate 2008 Estimate 2009
----------------------------------------------------------------------------------------------------------------
Suicide Prevention $8,635 $15,472 $15,509
----------------------------------------------------------------------------------------------------------------
These funds have been used to establish a National Suicide
Prevention Center of Excellence in Canandaigua, New York, which has
established a national suicide hotline and a comprehensive public
health education approach within VHA to increase awareness of the issue
of suicide, emphasizing that suicide prevention is the responsibility
of all VA employees. In addition, VHA has funded suicide prevention
coordinators at each medical center to provide local awareness on
preventing suicide among veterans as well as recognizing veterans at
high risk for suicide, and providing appropriate care. Ongoing funds
will expand the Center, provide additional training opportunities, and
support and expand the roles of the facility-based suicide prevention
coordinators.
Increased funding levels reflect the VA OEF/OIF enrollees' unique
healthcare usage patterns, particularly for mental health services. For
example OEF/OIF enrollees are expected to need more than eight times
the number of post traumatic stress disorder (PTSD) residential
rehabilitation days than non-OEF/OIF enrollees. OEF/OIF enrollees also
have an increased need for inpatient acute psychiatric care and
outpatient psychiatric and substance abuse treatment.
Question 4: When will VA lift the ban on enrolling Priority 8 vets?
What is your estimate for the amount of additional resources needed in
order to allow you to lift this enrollment ban?
Response: VA estimates it would require a budgetary increase of
$3.1 billion, not including additional infrastructure costs, to provide
healthcare services to an additional 1.4 million Priority 8 enrollees
and approximately 750,000 patients in 2013, the first year VA believes
it could put in place the necessary infrastructure to accommodate the
increase in workload associated with reopening enrollment Priority 8
veterans.
To understand the full magnitude of the cost of re-opening
enrollment such an endeavor must be viewed within a long-term strategic
framework, namely the estimated 5-year cost of $16.9 billion and the
10-year cost of $39.2 billion. These estimates represent the costs of
providing healthcare services to these new Priority 8 enrollees but do
not include the capital costs needed to build the associated
infrastructure. Further, VA's strategic analysis identified significant
challenges with regard to building the capacity, both in terms of
infrastructure and staffing, required to re-open enrollment for
Priority 8 veterans in the near term without severely disrupting VA's
ability to provide timely, quality care to eligible veterans.
Under current enrollment policy, VA's projected demand for
healthcare services is expected to increase over the next several
years. While enrollment growth has slowed since the suspension of
enrollment in Priority 8, the volume of healthcare services required by
enrollees continues to grow due to the aging of the enrolled
population. VA will need to continue to build capacity in the coming
years to meet this increased need for healthcare services from
currently eligible veterans. Providing healthcare services to these new
Priority 8 enrollees would require that VA develop additional capacity
beyond the growth needed under the current enrollment policy. For
example, VA will need to grow ambulatory services 15 percent by 2013
under the current enrollment policy and by a total of 24 percent under
full enrollment (including Priority 8 veterans). Further, the growth in
demand for VA healthcare services varies significantly across the VA
healthcare system. For example, to meet the combined increase in demand
for services under both current enrollment policy and full enrollment
in 2013, some areas will have to grow ambulatory services by as much as
45 percent. Without first building the needed infrastructure and staff
capacity, VA would be unable to accommodate the large increase in
workload without compromising quality and timeliness of care.
Question 5: We know you are doing your best to ensure that OIF and
OEF veterans receive the necessary medical care. What are you doing
about ensuring the VA's ability to provide care for all veterans, in
both urban and rural areas, in our clinics and hospitals around the
country?
Response: VA monitors its ability to provide care through a series
of internal and external measures with special emphasis on quality and
access. VA has improved access to care for veterans in both urban and
rural areas through a variety of mechanisms to include additional
outpatient access points, technology, sharing agreements and purchased
care.
CBOCs enhance access to all veterans. VA has opened over 570 new
CBOCs since 1995. With regard to veterans residing in rural areas, VA
operates or contracts for care at 100 outpatient clinics located in
areas considered rural or highly rural. CBOCs offer veterans a full
array of primary care, mental healthcare, and in some instances
specialty care services in communities where they live and work.
VA uses the latest advances in information technology with the use
of telehealth technology. Telehealth involves the use of electronic
information and communications technologies to provide and support
healthcare when distance separates the participants. These new
information technologies help support care delivery in the home,
allowing veteran patients to enjoy better health and to continue living
independently. Telehealth also serves to increase access to specialty
care for conditions such as cardiac disease, mental health, diabetes,
post-surgical followup and rheumatology. VA is designating lead
clinicians to formalize these projects into models of care that can be
implemented nationally to increase access to specialty care for
veterans in rural areas. This will begin with mental health, surgery,
rheumatology and endocrinology. Telehealth models have been developed
to link VAMCs and CBOCs. These models encompass the clinical,
technology and management processes involved in providing services to
remote CBOCs.
Telehealth technology has the potential to extend the reach of
other established programs such as home-based primary care, mental
health intensive case management and primary and ambulatory care into
rural and urban areas. Extending these services outside current
geographical boundaries and into rural areas reduces unnecessary
hospital admission and alleviates patient travel burden.
VA is involved in many sharing agreements to maximize resources.
Sharing of healthcare resources results in enhanced healthcare benefits
for veterans; reduced costs and minimized duplication of resources and
services.
VA provides care through the fee basis program to enhance access to
care outside of VA facilities. In FY 2007, VA purchased over $2 billion
in care for our Nation's veterans. VA has implemented a demonstration
project (Project HERO) intended to assess VA's ability to leverage
contracts on a large scale for these needed services. This project,
implemented in four VISNs, requires vendors to meet these internal VA
access standards, provide facilities alternatives to care when internal
resources are not available, and improve sharing of clinical
documentation associated with these external services.
VA established the Office of Rural Health to meet the unique needs
of veterans residing in rural areas. This office collaborates with
other program offices to assess multiple care delivery models to ensure
veterans in rural and remote locations have available services. This
includes tools such as mobile healthcare vans, expanded use of
telehealth tools and additional care coordination with home health
providers.
These multiple options allow VA to be effective and efficient in
providing care for all veterans, in both urban and rural areas.
Committee on Veterans' Affairs
Washington, DC.
February 27, 2008
Honorable James B. Peake, M.D.
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Secretary Peake,
In reference to the full Committee hearing on the Department of
Veterans Affairs Budget Request for Fiscal Year 2009, held on February
7, 2008, I would appreciate a response to the questions listed below.
Please respond to these questions no later than March 27, 2008.
1. With respect to the mileage deductibles for travel
reimbursements, are these deductibles being collected from veterans who
are traveling long distances to VA medical facilities, and if not,
could you please provide documentation on when this practice stopped?
2. What is VA doing to increase the number of doctors, nurses,
mental health professionals and other specialty practitioners in order
to provide better access to care to our veterans?
3. Regarding the VA medical center in San Juan, Puerto Rico, why
has the VA proposed large expenditures for the existing facility in San
Juan, when there is a proposal to replace that facility?
4. When a security breach occurs with a physician's personal
computer which has received a waiver from the Secretary, who will
ultimately be held responsible for the costs of the breach?
It would be appreciated if you could provide your answers
consecutively on letter size paper, single-spaced. Please restate the
question in its entirety before providing the answer.
Thank you for your cooperation in this matter.
Sincerely,
Steve Buyer
Ranking Republican Member
__________
Questions for the Record
The Honorable Steve Buyer, Ranking Republican Member
House Committee on Veterans' Affairs
February 7, 2008
Department of Veterans Affairs Budget Request for Fiscal Year 2009
Question 1: With respect to the mileage deductibles for travel
reimbursements, are these deductibles being collected from veterans who
are traveling long distances to VA medical facilities, and if not,
could you please provide documentation on when this practice stopped?
Response: Currently, the Department of Veterans Affairs (VA) does
collect deductibles from most veterans' travel reimbursements,
including those who travel long distances. However, 38 U.S.C. 111
allows VA to waive the deductibles in cases of ``severe financial
hardship,'' which VA defines in regulations. Under the current
regulation, 38 C.F.R. 17.144, VA may limit findings of severe hardship
for situations including loss of employment, sudden illness or a
disability that causes a veteran's income to fall below the maximum
pension level, currently $13,092.
We are amending the regulation to reflect the new $0.285 (28.5
cents) mileage payment and the new deductible of $7.77 for each one-way
trip.
Question 2: What is VA doing to increase the number of doctors,
nurses, mental health professionals and other specialty practitioners
in order to provide better access to care to our veterans?
Response: With involvement from the VA Healthcare Retention and
Recruitment Office (HRRO), the Office of Management Support, the Office
of Mental Health Services, the Office of Nursing, and the Office of
Patient Care Services, VA has developed comprehensive recruitment
initiatives to attract and retain healthcare professionals to the
Veterans Health Administration (VHA).
Consolidated data from the 2008-2012 Veterans Integrated Service
Network (VISN) Workforce Succession Strategic Plans identified 10
occupations as national priorities for recruitment and retention. The
programs offered through HRRO provide assistance to 8 of these top 10
occupations: registered nurses, physicians, pharmacists, practical
nurses (LPN/LVN), diagnostic radiology technologists, medical
technologists, physical therapists, and medical records technicians.
The Employee Incentive Scholarship program (EISP) impacts the
recruitment and retention of health professionals required throughout
the agency. Over 92 percent of the scholarships went to employees; 187
scholarships were awarded to pharmacists for advanced degrees.
The Education Debt Reduction program (EDRP) provides up to $48,000
of education loan repayment for qualified student debt. It is used as
both a recruitment tool by being offered in vacancy announcements of
hard-to-recruit/retain occupations, and as a retention tool by
spreading out loan payment reimbursements yearly over a maximum of 5
years.
VA has taken several actions at multiple levels to promote the
recruitment and retention of qualified mental health professionals in
VHA. The VA HRRO, the Office of Management Support, and the Office of
Mental Health Services have developed a comprehensive mental health
enhancement recruitment initiative that includes several new
recruitment resources, including employee incentive referral initiative
and recruitment brochure development, on targeted and general
advertising.
Furthermore, VHA closely tracks the hiring status of newly awarded
mental health enhancement positions and backfill positions designed to
support the implementation of the Mental Health Strategic Plan. The
hiring status of these new positions is tracked on a monthly basis
through an online reporting system. These data are reviewed monthly by
program staff and VHA leadership. In addition, the recently implemented
mental health staffing performance monitor tracks the hiring status of
newly awarded mental health positions and backfill positions against
pre-set targets.
Rates of hiring have increased significantly, following the
implementation of the new mental health recruitment resources. Since
fiscal year (FY) 2005, when VA began implementing its Mental Health
Strategic Plan, 3,827 (out of 4,326) newly awarded mental health
enhancement positions have been hired (figures are as of the end of
January 2007). The vast majority (3,355) of these newly hired staff are
mental health professionals. The remaining (472) positions include
support staff essential for cost-effective provision of services.
Question 3: Regarding the VA medical center in San Juan, Puerto
Rico, why has the VA proposed large expenditures for the existing
facility in San Juan, when there is a proposal to replace that
facility?
Response: There is currently a plan in place to upgrade facilities
in San Juan through a combination of a significant amount of new
construction and renovation. The Congress has funded, and construction
is already underway for the construction of a new bed tower of 225,000
gross square feet (GSF) that will contain 314 inpatient hospital beds.
This will relocate all of the nursing units out of the existing tower
and into this modern, seismically safe new building.
In addition, in FY 2008, funding was provided in the appropriation
for the construction of a new administrative building of approximately
100,000 square feet to enable administrative space to vacate the
hospital to permit needed expansion of some clinical programs. The
request in FY 2009 will fund the construction of new clinical space
(120,000 GSF) on top of the ambulatory care center.
When the administration building and the new clinical space are
completed, the existing bed tower will be demolished and the lower
floors of the existing hospital will be remodeled (222,000 GSF). The
opportunity to make these improvements will be much less costly than
constructing a replacement hospital and will provide the modern
facilities needed to serve veterans.
Question 4: When a security breach occurs with a physician's
personal computer which has received a waiver from the Secretary, who
will ultimately be held responsible for the costs of the breach?
Response: In cases where we grant a waiver to a physician for the
use of a personal laptop, VA accepts the risk that the laptop could be
compromised. Therefore, it is VA's responsibility to pay for the costs
of a resulting data breach, such as credit monitoring services.
From lessons learned as a result of the major data breach
experienced in 2006 and the 2007 data breach at one of its research
centers, VA is aggressively addressing information/data security. A top
priority of the Secretary of Veterans Affairs is for the Department to
set the Gold Standard for Data Security. In order to achieve this
priority, VA is implementing systemwide strategies that promote data
security awareness among employees as well as a change in the culture
and capability in all facilities and remote locations. [OMB comment:
Statement from Vol. 2, p. 4-A-5 of 2009 budget submission.]
It is the intent of the VA Chief Information Officer to continue to
reduce the use of other equipment where we can, especially when there
is a demonstrated need to work remotely. VA plans to use government
furnished equipment (GFE) in cases where staff need to work while on
travel or from home.
While it would be very difficult to completely eliminate the use of
other equipment, in order to reduce the associated risk, VA is
implementing a new remote access solution called remote enterprise
security compliance update environment (RESCUE). This will ensure that
VA data are not remotely downloaded to an unencrypted laptop or
desktop. RESCUE will be able to determine if a user is accessing the VA
network through GFE or other equipment. If the user is signing on
through a piece of other equipment, the access will be limited to a Web
browser, and data cannot be saved locally or printed. The user will be
able to continue to work in a restricted area.
Committee on Veterans' Affairs
Washington, DC.
March 7, 2008
Carl Blake
National Legislative Director
Paralyzed Veterans of America
801 18th Street, NW
Washington, DC 20006
Dear Carl:
In reference to our Full Committee hearing on ``The Department of
Veterans Affairs Budget Request for Fiscal Year 2009'' on February 7,
2008, I would appreciate it if you could answer the enclosed hearing
questions by the close of business on April 18, 2008.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
__________
The Independent Budget
Washington, DC.
April 3, 2008
Honorable Bob Filner
Chairman
House Committee on Veterans' Affairs
335 Cannon House Office Building
Washington, DC 20515
Dear Chairman Filner:
On behalf of The Independent Budget, we would like to thank you for
the opportunity to present our views on the FY 2009 budget for the
Department of Veterans Affairs (VA). Only through cooperation between
the veterans' service organizations and the members of the Committee
can we hope to attain an adequate level of funding to provide timely
and quality healthcare and benefits services.
We have included with our letter a response to each of the
questions that you presented following the hearing on February 7, 2008.
Thank you very much.
Sincerely,
Joseph A. Violante
Raymond C. Kelley
National Legislative Director
National Legislative Director
Disabled American Veterans
AMVETS
Dennis Cullinan
Carl Blake
National Legislative Director
National Legislative Director
Veterans of Foreign Wars of the United States
Paralyzed Veterans of America
__________
In the past, The Independent Budget has not included amounts
attributable to Medical Care Collections in your budget estimates. This
year, you have included collections in your baseline for FY 2008 and
these amounts are included in your FY 2009 Medical Services estimate.
In your testimony you again state this year that ``medical care
collections should be a supplement to, not a substitute for, real
dollars.'' VA's collections estimates over the last few years have been
reasonably accurate.
Question 1: Why does The Independent Budget believe that
collections are not ``real dollars''?
Response: The aforementioned quote does not imply that we do not
believe that medical care collections are ``real dollars.'' It is
simply meant to reflect our belief that funding for Department of
Veterans Affairs (VA) healthcare programs should be provided in full
with federally appropriated dollars. Our budget recommendations this
year better reflect this policy position that we have long supported.
The Administration, year-after-year, chooses to include medical care
collections as part of its overall funding authority for Medical
Services. In the past, the VA did a very poor job of meeting
collections estimates that it formulated its operating budget on. We
will not deny that in recent years, the VA has done a much better job
of meeting its collections estimates. However, we remain concerned
about a process that is grounded in so much uncertainty, especially in
light of the fact that shortages between what the VA estimated it would
collect and what it actually collected have never been funded.
As such, we believe that the cost of medical care services should
be provided for entirely through direct appropriations. In order for
The Independent Budget recommendation to best reflect what we believe
the total funding needs of the VA healthcare system for FY 2009 to be,
we had to use the maximum appropriation amount included in P.L. 110-161
for VA medical care and add the projected medical care collections to
that amount to formulate a real baseline.
Despite this fact, we realize that political considerations will
not allow for the policy for which The Independent Budget for FY 2009
advocates as it relates to medical care collections. With this in mind,
we cannot openly oppose a funding level that approaches our bottom line
recommendation for funding, even if collections are considered as a
component.
Question 2: How would The Independent Budget recommend that this
$2.5 billion in estimated collections, roughly 6 percent of the medical
care appropriations request, be utilized?
Response: We believe that this money could be reinvested in various
programs that are part of the Veterans Health Administration (VHA) or
the entire VA. First and foremost, we believe that a large portion of
the money collected can be devoted to capital investment projects. The
VA has not adequately addressed the long list of projects identified by
the Capital Asset Realignment for Enhanced Service (CARES) process.
Moreover, as explained in the Construction section of The Independent
Budget, the VA should be reinvesting 5 to 7 percent in its capital
infrastructure each year. However, the VA currently only reinvests
about 2 percent.
We also remain concerned that the VA falls well below the
requirement for long-term care capacity (defined as average daily
census) as mandated by P.L. 106-117, the ``Millennium Health Care
Act.'' A portion of the money achieved through medical care collections
could be used to correct this deficiency. Additionally, the VA could
invest this money in State Extended Care facilities which support the
VA long-term care program.
We also believe this money could be used to properly staff the
Office of Rural Health so that it can better fulfill its mission. The
Independent Budget believes that this new office has not lived up to
the expectations placed on it. However, the VA has not set this office
up for success. It is telling that the VA plans on devoting only $1
million and one new full-time employee (FTE) to this office in FY 2009.
This will bring the Office of Rural Health up to three FTE. This is
wholly unacceptable, particularly given the fact that rural healthcare
access might be the single biggest healthcare issue facing the VHA.
Finally, we would suggest some of the resources generated through
medical care collections could be used to make the VA more competitive
in the market for hiring critical staff. The VA is at a significant
competitive disadvantage when trying to hire certain healthcare
professionals. This is particularly true of nurses, rehabilitation
specialists, and specialized care doctors.
Question 3: Since collections are reimbursements or payments for
medical services rendered, shouldn't this money be utilized to offset
the cost of providing healthcare?
Response: Historically, the purpose of collections has not had a
direct bearing on the utilization of such funds throughout the
evolution of what is now the Medical Care Collections Fund (MCCF). When
the VA collection authority was initially established in 1986 to seek
reimbursement from third-party health insurers, collections were meant
to be utilized as a deficit reduction tool. It then evolved into a tool
to offset VA's healthcare budget in 1997, and expanded to become a
medical care utilization tool in 1999 by allowing VA to increase cost-
sharing on veterans. In doing so however, such funds were supposed to
be used to reduce medical care waiting times and to reduce the burden
of cost sharing on veterans for medications and prosthetics. In 2003,
MCCF was created to consolidate revenue accounts, thus increasing the
total amount of collections available to further offset VA's healthcare
budget.
While the purpose and utilization of collections has evolved, as
mentioned previously, we continue to hold the belief that collections
supplement the cost of providing healthcare. Veterans' healthcare
should not be dependent upon an uncertain funding mechanism like
medical care collections. However, as we also discussed, we realize
that political considerations will not allow for the policy by which
The Independent Budget for FY 2009 believes funding for VA healthcare
services should be provided. In the meantime, we cannot openly oppose
the use of collections to provide for medical care services so long as
the total of appropriated dollars and actual collected dollars meets
the funding levels that we believe are necessary to operate the VA
healthcare system.
Committee on Veterans' Affairs
Washington, DC.
March 7, 2008
Kerry Baker
Associate National Legislative Director
Disabled American Veterans
807 Maine Avenue, SW
Washington, DC 20024
Dear Kerry:
In reference to our Full Committee hearing on ``The Department of
Veterans Affairs Budget Request for Fiscal Year 2009'' on February 7,
2008, I would appreciate it if you could answer the enclosed hearing
questions by the close of business on April 18, 2008.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
__________
The Independent Budget
Washington, DC.
April 12, 2008
Honorable Bob Filner
Chairman
House Committee on Veterans' Affairs
335 Cannon House Office Building
Washington, DC 20515
Dear Chairman Filner:
On behalf of The Independent Budget, I would like to thank you for
the opportunity to present our views on the FY 2009 budget for the
Department of Veterans Affairs (VA). Only through cooperation between
the veterans service organizations and the Members of the Committee can
we hope to attain an adequate level of funding to provide timely
quality healthcare and benefits services.
I have included with this letter a response to the questions that
you presented following the hearing on February 7, 2008. Thank you very
much.
Sincerely,
Kerry Baker
Associate National Legislative Director
Disabled American Veterans
__________
Claims Processors
The Independent Budget (IB) recommends an increase of $381 million
for the General Operating Expenses account, which provides funding for
the Veterans Benefits Administration. This recommendation is $286
million over the Administration's request. Your testimony states that
``Congress should authorize 12,184 FTE for FY 2009.'' The VA estimates
a total FTE number for Disability Compensation, Pension and Burial of
12,120 for FY 2009, a difference of 64 FTE below your recommended
level.
Question: Providing these additional FTE would cost approximately
$5 million. If we provide this additional increase of $5 million to
meet your FTE target, do you still believe that we should provide the
remaining $281 million of your requested increase or will you provide
the Committee with an updated GOE recommendation?
Response: As an overall concept, it is important to note that we do
not believe that the increase in VBA funding in the Administration's FY
2009 budget submission is enough to meet basic inflation and the
annualized pay raise (2.9 percent). Our assumption for general
inflation applied to VBA accounts is approximately 3.2 percent. In
order for the VBA recommendation to cover the annualized pay raise and
this projected inflation rate alone, it would take approximately $80
million; however, the Administration request is only $44 million over
FY 2008 funding appropriated levels.
The VA also assumed a lower starting level for FTE for Comp & Pen
for 2008. We cannot explain this discrepancy.
As for the budget itself, the VA requests 703 additional FTE for
Comp & Pen at a cost of $48.7 million. We recommend an increase of 825
FTE for Comp & Pen at a cost of $78.3 million. The VA assumes the
lowest possible cost for all new FTE. VA assumed a lower average cost
per FTE for 2009 than they did in FY 2008 and FY 2007, for which we
believe to be unrealistic. We do not assume that the VA will only hire
new claims adjudicators at the lowest possible salary.
The largest single difference in our budget recommendation is
reflected in the ``Summary of Discretionary Appropriation Highlights.''
The VA assumes net reductions due to reimbursements and unobligated
balances for Compensation & Pension (C&P) that are $145 million more
than we project in our budget recommendations. The two items listed
above make up the vast majority of the difference in our C&P
recommendations and by extension our VBA recommendations.
We recommend 160 additional FTE for education at a cost of $14.3
million. The VA only anticipates an increase of 20 FTE at a cost of
$4.3 million. The IB recommends an increase of 115 FTE for Vocational
Rehabilitation and Employment (VR&E), at a cost of $12.5 million. The
VA actually projects a decrease in FTE for VR&E in FY 2009. These two
FTE elements account for approximately $23 million more in the IB
recommendations than the Administration recommends.
The VA projects essentially no increase in obligations for
Insurance. Given that its current FY 2008 estimate starts out $5
million less than our recommendation, we end up with a difference of
approximately $10 million for FY 2009.
The sum of the differences listed above totals approximately $244
million. Other minor differences can be attributed to our assumed pay
increase of approximately 3.0 percent. Likewise, we attribute other
differences in our budget recommendation to not having the exact
information available for VA's baseline amounts for FY 2008 when we
begin developing our recommendations.
Based on the above, we continue to recommend the respective
increase called for in The Independent Budget.